Showing papers in "Journal of Research in Nursing in 2011"

Secondary analysis of qualitative data: a valuable method for exploring sensitive issues with an elusive population?

Abstract: This paper demonstrates the process of conducting a secondary analysis of primary qualitative datasets. Whilst there is a well-established tradition of carrying out a secondary analysis of quantitative datasets within social and health research this has not been the case with qualitative datasets. Despite a recent growth in interest in secondary analysis of qualitative data, very little information is available regarding the process as publications tend to focus on the outcomes of analyses. A secondary analysis of 28 transcripts sorted from two primary datasets containing longitudinal and cross-sectional interview data was carried out. The choice of applying a secondary analysis fulfilled the aims of: i) addressing a sensitive area of research, and ii) accessing a research population that was elusive, factors that may be barriers to carrying out research in areas that are considered to be of a sensitive nature, or topic

The sound of ‘silence’: A framework for researching sensitive issues or marginalised perspectives in health

Abstract: This paper arises from the conceptual framework underpinning a research study focusing on black Caribbean men’s sexual decisions and health behaviour. In investigating these issues the notion of ‘screaming silences’ was developed to unite the theoretical and philosophical approaches that underpinned the research, the experiences of the researcher and participants involved. While ‘screaming silences’ was initially applied to a sexual health and ethnicity context it provides a useful basis for a theoretical framework for researching sensitive issues or the health care needs of marginalised populations. ‘Screaming silences’ (or ‘silences’) define areas of research and experience which are little researched, understood or silenced. ‘Silences’ reflect the unsaid or unshared aspects of how beliefs, values and experiences of (or about) some groups affect their health and life chances. They exposed issues which shape, influence and inform both individual and group understandings of health and health behaviour. Th...

Integrating quality and safety science in nursing education and practice

Abstract: Worldwide, health care delivery systems are applying new quality and safety science in response to startling reports of negative patient outcomes. Many health care professionals lack the knowledge,...

Job satisfaction and intentions to leave of new nurses

Abstract: Turnover of newly graduated nurses is of significant concern. There are continuing reports that new graduates struggle during the transition to the work setting. The purpose of this study was to examine the effects of perceived demands, control, social support and self-efficacy on the job satisfaction and intention to leave of new nurses utilising Karasek's Job Demands-Control-Support model. A cross-sectional mailed survey was used to gather data. The sample comprised 232 new nurses working in acute care in Canada. Job demands, social support from both supervisors and coworkers and self-efficacy were significantly related to job dissatisfaction, while demands and support from coworkers were related to intention to leave the job. Identifying factors that contribute to the job satisfaction and intentions to leave of new nurses is a first step in developing interventions to assist nurses who are just beginning their careers.

Existential fulfilment, workload and work engagement among nurses:

Abstract: In contrast to workload, existential fulfilment and work engagement are positive dimensions of personal functioning in organisations. Research on positive dimensions fits into the context of positi...

Issues with e-learning in nursing and health education in the UK: are new technologies being embraced in the teaching and learning environments?

Abstract: In this paper we present aspects of a study that scoped e-learning implementation in nursing and health science disciplines throughout the UK and explored the factors affecting use. Data related to the use of technologies are presented here. While there are many drivers for the use of e-learning, the current scope of engagement in nursing and health science disciplines is unknown and variations in adoption have not been explored. A postal questionnaire sent to a purposive sample of 93 Higher Education Institutions (HEIs) obtained data from 25 universities (response rate of 28%) related to their uptake and development of e-learning. Questionnaire data was analysed using descriptive statistics. From this, nine HEIs were identified, reflecting a range of levels of engagement in e-learning. Data was collected through 35 staff interviews across the sites. Qualitative data from the interviews was transcribed to allow thematic analysis. Though e-learning adoption and use vary across the sector, the predominant learning and teaching engagement is instructivist and managed through a virtual learning environment. There is limited experimentation with e-learning and teaching use, linked to key centres of excellence and the efforts of 'champions'. It is suggested that a more systematic approach to development and funding is required to achieve enhanced use of e-learning. © 2011 The Author(s).

Engaged scholarship and research impact: integrating the doing and using of research in practice

Abstract: Demonstrating impact from research has always been a key consideration in the knowledge production business. However, it can be argued that the models and frameworks available for enabling such impact to be demonstrated are poorly developed. Those that do exist are predominantly derived from a linear uni-dimensional perspective of the knowledge flow from the academy to practice. Little sustained attention has been given to the development of models and ways of working that go beyond traditional approaches to impact monitoring through impact factors and citation indices. Engaged scholarship offers a framework that has as an explicit intention, the creation of connections between researchers/universities and practitioners/health care providers. In this paper a model is offered derived from the theory of ‘engaged scholarship’. The principles of engaged scholarship will be outlined, as well as an articulation of engaged scholarship as an approach to the co-production of knowledge. An example of a practice development and evaluation study will be offered that is consistent with the principles of engaged scholarship. The need for a strategic approach to the development of engaged scholarship will be highlighted, as well as the need for sustained partnerships between the academy and practice.

Nursing home culture, teamwork, and culture change:

Abstract: Aims: Most developed countries are taking steps to move away from institutional models of care for the aged, in an attempt to both improve quality of life for those receiving care and improve the w...

Research and dementia, caring and ethnicity: a review of the literature

Abstract: Despite the need for services which are culturally appropriate there is a dearth of robust research on the impact of ethnic background on dementia and caregiving. A literature search has revealed a relative lack of published research from the UK, with more US studies available. This paper provides a review of the literature on these topics and includes a critique of ethnicity categorisation and commonly held assumptions. It explores the complexities of the concept of ethnicity and examines its significance in relation to understandings of health and illness in general, and dementia in particular. Ethnic background appears to account for differences in experiences of dementia and caregiving, but other compounding variables, including socio-economic factors and education, also need to be taken into account when considering the experiences of specific ethnic communities. The paper concludes that ethnicity is significant in regard to how people experience dementia and caregiving, but also highlights a continuing need for research which explores the impact of ethnic background in a sensitive and sophisticated manner.

Patient safety: a core value of nursing - so why is achieving it so difficult?:

Abstract: Patient safety in the perioperative setting is determined by many interdependent factors including reliable systems, good teamwork, psychological safety, optimal communications and most crucially shared vision and goals. The necessary organizational, environmental and behavioural conditions for quality care are not new and were in fact known to Florence Nightingale as much as 150 years ago. As noted by Nightingale, and something that remains unchanged today, the greatest threat to patient safety are the frailties of the human condition, complacent attitudes and unconscious behaviours. Recognizing that error is normal and somewhat inevitable, given the complexity of modern surgery, is undoubtedly the first step to mitigating error and harm, and the basis from which to tackle variability and sub-optimal conditions to deliver quality improvement.

The consequences of executive turnover

Abstract: The high rate of executive turnover in the healthcare industry is a major issue for health service organisations and their staff both in Australia and internationally. In the course of planning a research project examining nurse turnover at the clinical level within three Australian States/ Territories, the researchers became aware of frequent executive turnover at all levels (State Department of Health, Area Health Service, hospital). Over a period of approximately 2 years there were 41 executives occupying 18 different positions, highlighting the scope of this issue in Australia. Few studies have examined the causes and consequences of this phenomenon in depth. Factorssuch asage, gender,education, lackofcareeradvancement opportunitiesand remuneration have all been identified in the literature as important contributors to executive turnover. High turnoverrates havebeen found to be associated with a numberof negative consequences, including organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care. While the use of ‘acting’ roles may assist in filling executive positions on a temporarybasis, consequences for the rest of the organisation areassociated withtheirextended

Role model clinical instructor as perceived by Jordanian nursing students

Abstract: Nursing is considered to be an applied science. Thus clinical teaching is central to nurse education, where the learning situation often cannot be repeated. The aim of this work was to identify motivating behaviours of role model clinical instructors that enhance student learning, as perceived by Jordanian senior nursing students. Critical incident technique was utilised and analysis of the incidents through Cormack’s technique was applied. A total of 156 student nurses participated in this study and 210 critical incidents related to behaviours of role model clinical instructors were obtained. A total of 10 categories that reflected the behaviours of role model clinical instructors were created. The overall findings indicated that the behaviours of role model clinical instructors identified by Jordanian nursing students as enhancing their learning in the clinical setting were mainly those already identified in the literature as good teaching in nursing practice.

Nurses’ work patterns: perceived organizational support and psychological contracts

Abstract: With unfolding human resource challenges in health care, little is known of the impact of changing work patterns and employment relationships on the organization and the nursing profession. Social Exchange Theory (perceived organizational support (POS) and psychological contracts) was used to gain understanding of the influence of nurse's employment patterns on employment relationships and individual, organizational and professional outcomes. The sample consisted of 650 randomly selected nurses employed in full-time, part-time, and casual positions across healthcare settings in Ontario, Canada. A cross-sectional survey design explored demographics, volition, POS, psychological contract, job satisfaction, career commitment, and job and career withdrawal. Work patterns and employment relationships are complex and cannot be examined in isolation of other variables such as volition and work congruence. Full-time nurses were found to have more of a relational psychological contract than part-time or casual nur...

Working in collaboration with young people and health professionals. A staged approach to the implementation of a randomised controlled trial

Abstract: ASyMS© is an Advanced Symptom Management System utilising mobile phone technology to monitor chemotherapy-related symptoms and promote self-care. It was first developed with an adult cancer population and is now being evaluated with young people through an iterative development process. ASyMS© involves patients recording and sending symptom reports to the hospital and receiving tailored self-care advice. Health professionals are alerted when severe symptoms are reported. Three phases of the ASyMS©-YG (young people) study are complete. Phase 1 involved young people identifying the symptoms to be assessed. Phase 2 involved young people testing the symptom report system, and ascertaining young people's, parents' and professionals' perceptions of ASyMS©-YG. This paper reports on Phase 3, in which the system was developed further in preparation for a randomised controlled trial (RCT). Health professionals devised an alert system based on risk modelling side-effect severity, and young people and professionals developed self-care advice. A pilot study was conducted to test the alert system and study design in readiness for a definitive RCT. The contribution young people and professionals have made to this project is invaluable in evaluating the practical effectiveness of ASyMS©-YG and ensuring the intervention is acceptable and works in everyday practice. © The Author(s) 2010.

What factors affect nursing retention in the acute care setting

Abstract: Moral distress and professional stress affect the lives of acute care nurses everyday. The impact of these stressors may be causing nurses to leave the acute care setting. This paper will outline t...

Self-rating Scale of Self-directed Learning (SRSSDL): preliminary results from the Italian validation process

Abstract: Self-directed learning is considered a key feature in the learning process. Despite the emerging debate regarding continuing education strategies and the effectiveness and pertinence of the learning needs of adult learners, little evidence is available on the measurement of the self-directed learning competence of nurses. The main aim of the study was to evaluate the validity and reliability of the Self-rating Scale of Self-directed Learning (SRSSDL) in an Italian sample of nurses. The forward–backward translation process of the original SRSSDL was adopted. Forty-one nurses were involved in the test–retest reliability. Internal consistency was evaluated in a convenience sample of 334 nurses working in Northeast Italy. The Italian version of the SRSSDL has demonstrated good reliability (Pearson coefficient 0.73) and internal consistency (Cronbach’s alpha coefficient 0.94). The SRSSDL was found to be a valid and reliable instrument in the Italian context. This study has implemented the external validity of the scale by its application to a different population and context in its first validation process.

Does nursing research impact on policy? A case study of health visiting research and UK health policy

Abstract: "The final, definitive version of this article has been published in the Journal of Research in Nursing,16 (2) 2011, © SAGE Publications Ltd, 2011: on SAGE Journals Online: http://online.sagepub.com/"

Knowledge transfer and the integration of research, policy and practice for patient benefit

Abstract: Multiple routes are proposed within the nursing and healthcare literature for implementing traditional and reflexive research evidence into practice. Knowledge transfer is a relatively new field of...

International principles of social impact assessment: lessons for research?:

Abstract: The ability and importance of being able to demonstrate how research has benefited humankind has been a by-product of global assessment exercises and has attracted only marginal interest. However, with the introduction of new indicators for ?what counts? in research, impact has now entered centre-stage. Nursing ought to have little problem with the concept of impact: we should be able to demonstrate the influence of nursing research on culture, health, society, policy (etc.) in a way that might be more difficult for disciplines that are less applied. Whilst the international principles of impact assessment are quite familiar to those working in the third sector and are encouraged by governments across the world, academic disciplines in general ? and possibly nursing in particular ? appear to lag behind in knowledge of these principles. Moreover, on examination, nursing has much that is congruent with the principles, but so far has left these unstated. In this paper we explore potential lessons from the principles of social impact assessment for nursing research. We use illustrative examples from our own area of expertise ? child protection ? but the principles apply across all substantive topics. Social impact assessment is underpinned by four principles that we explore first: the precautionary principle; then the principles of intergenerational equity; multisectoral integration; and subsidiarity. We go on to unpack the seven focus areas of impact assessment to demonstrate how these could be articulated within nursing research. Finally, we offer some pointers as to how nurse researchers might begin to assess and measure the social value of interventions and services through the framework of Social Return on Investment. Impact mapping can make useful delineation between outputs, outcomes and impact and as a framework, social impact assessment has much positive guidance to offer nursing research.

Building capacity and capability in patient safety, innovation and service improvement: an English case study:

Abstract: It is clear that for at least the next decade, funding for many health systems across the world will be challenged by serious uncertainties in country economies.In facing these challenges nurses have to respond positively to innovations in the delivery of care, increases in productivity and the eradication of errors that result in harm to patients.In committing to supporting this necessary change, quality improvement and innovation programmes are now available from national, not-for-profit organisations, such as the Health Foundation (UK) and the Institute for Health Improvement (USA) and the National Health Service Institute for Innovation an Improvement (UK) that specifically address these important issues. Although the targets for these programmes are often health care systems at the macro level, the role of nurses in understanding and delivering innovative practices at a more micro level is vital. Evidence is now available that demonstrates the outputs of such programmes and the impact from making con...

‘You’ve got to keep account of heads all the time’: staff perceptions of caring for people with dementia:

Abstract: Research aim: Little is known regarding the pressures of working within dementia care units, as the majority of literature has focused broadly on long-term care rather than the provision of special...

Graduate nurses’ and midwives’ perceptions of research

Abstract: An increasing amount of quantitative research has shown that nurses face considerable organisational and motivational barriers to conducting research. However, there is comparatively little qualita...

Strategies to engage clinical staff in subject recruitment.

Abstract: Purpose. In many countries, meeting subject recruitment goals is challenging for researchers relying on clinical staff members (CSMs) to identify or recruit subjects. This paper describes research strategies that improved staff engagement in three different studies conducted in US clinical settings.Method. The recruitment strategies described in this paper were identified during the process of consultation among three US researchers recruiting via CSMs. Strategies which successfully engaged CSMs are described.Results. Our approach improved engagement with CSMs in three different US studies. Early engagement strategies included establishing trust, gathering input from CSMs, and using succinct training procedures as well as a study logo. Middle phase strategies included assigning recruitment, publishing a study newsletter, giving the CSMs compensation and appreciation for their participation, and expanding the subject pool. Completion strategies included closing with an appreciation meeting and adding merit...

The impact of nursing innovations in the context of governance and incentives

Abstract: This discursive paper is a structured analysis of four completed national and regional studies carried out in the UK. It sets out retrospectively to explore the impact of key contextual, profession...

Data collectors' field journals as tools for research.

Abstract: With rising numbers of families giving care to elderly loved ones, novel methods and sources of data need to be used to obtain comprehensive information about family caregiving patterns. The purpose of this paper is to present the interviewers' reflective journals as a source of rich data. Data collectors interviewed Hispanic family caregivers as part of a quantitative study of caregiving patterns. The stories derived from the personal journals brought to life three themes: caregiving as responsibility; creativity in giving care; and resistance to delegating tasks. Well-written journals have the potential of enhancing the interpretation of data collected by other means and of raising the quality of interviews and data through introspection and cultural understanding of the caregiving reality.

Marte Meo Counselling: a promising tool to support positive interactions between residents with dementia and nurses in nursing homes:

Abstract: Marte Meo Counselling (MMC) is an educational video-based counselling method developed to improve interactions between persons. This study aimed at investigating whether changes could be identified ...

Guest editorial: Sensitive issues in healthcare research: the protection paradox

Abstract: Most research in nursing is unlikely to cause physical harm. Psychological harm however, such as upsetting people or exposing them to uncomfortable questions, may be more likely. For this reason it is widely acknowledged that the psychological effects of research need to be considered carefully. Our contention here is twofold: first, that such consideration has largely been in relation to research participants and to some extent, researchers. But potential unwitting psychological harm to an invisible group of people has been largely ignored. Second, by exposing research protocols to people who may have closeted negative or skewed attributions to the topic under scrutiny, a new layer of gatekeeping has been introduced. Quite simply, there is a protection paradox at play. Protection of research participants forms the cornerstone of all well-conducted research. The research protection agenda hinges on the fact that allowing a researcher into one’s life implies a loss of power (Iphofen 2005). Thus, nurse researchers have a plethora of international guidance to help them protect research participants (Social Research Association (SRA) 2003; International Council of Nurses (ICN) 2006; World Medical Association 2008; Royal College of Nursing (RCN) 2009). Specifically within the UK, robust research governance procedures provide an additional protective mechanism (Department of Health (DH) 2005). The loss of power to which Iphofen refers is applicable to all research participants. Understandably however, there is significant emphasis on the protection of those who are most vulnerable, such as children and those who lack capacity to consent (SRA 2003; RCN 2009), especially when researchers seek out the views of seldom-heard or marginalized groups (Serrant-Green 2011). Our own research focus, such as many other clinical topics, is concentrated in populations where double or even triple vulnerability exists. This arises from participants’

Planning nurse staffing: are we willing and able?

Abstract: Academic research and public enquiries demonstrate the link between adequate staffing levels and patients' experiences and outcomes. Health care providers have a legal duty to ensure (and demonstrate to care regulators) that staffing levels are safe. Yet evidence of effective workforce planning, locally or nationally, is scarce. A plethora of tools exist to help employers to determine nurse staffing required. Although not perfect, the technical resource is none the less available to support planning, but are we willing to use it? In England the different systems have not been reviewed or tested and there is no consensus about the best approach to use. This paper asserts that decisions about current and future configurations of the nursing workforce are currently taken in a data vacuum. Fundamental aspects of nurse deployment - the proportion of registered nurses, the ratio of patients to nurse - are not systematically captured or recorded, either nationally or locally. We argue that a first step in planning is to establish this baseline. We need data on nursing inputs to relate to the growing body of data on patient outcomes, to enable managers and policy makers to understand the efficacy of current workforce configurations and inform future plans.

The future of nursing workforce research

Abstract: Twenty years and two global nurse shortages ago, nursing workforce research was just emerging as a field. However, workforce participation among nurses and interest in nursing careers had swung widely for many decades before (Friss, 1994). Concerns about working conditions for nurses and difficulties in relations between nurses and other members of the healthcare team had long been recognized but were perhaps accelerated by the second wave of feminism beginning in the 1960s (Sullivan, 2002). Workforce research was arguably a response to the practical problems created by staffing shortages in the mid to late 1980s, when many hospitals went through periods where beds were closed or surgeries were cancelled to cope with staffing shortages. In many communities, nursing school enrollments dropped several years earlier when decreased job availability and declines in the perceived attractiveness of nursing careers led to an inability to cover rebounds in demand and normal attrition. By the late 1990s, when workforce research had already established some roots, developments in healthcare systems worldwide, especially deep cuts and restructuring of healthcare systems, were about to trigger yet another shortage several years down the line. A simplified interpretation of demographic trends (an ‘aging of the population’ story) told us that these earlier shortages were only the beginning of deep imbalances between supply and demand. However, the key ‘game changer’ in postmillennial nurse labor markets has been a global financial crisis that has led to delays in service expansion and restrictions in new hiring. For a variety of reasons, many nurses readying themselves for retirement have put off their plans indefinitely and prospects for new graduates have darkened: many hope this is only a short-term trend. Furthermore, smaller, quieter moves reframing the boundaries among the health professions and between groups of nurses (practical nurses and nurse practitioners are but two examples) are occurring across healthcare systems. Thus, while researchers and professional groups in many countries are retaining predictions of shortages in the long term, the aftershocks of the economic crisis, along with changes (often, but not always, cuts) in healthcare driven by demographic and fiscal realities, may well have reset the future of healthcare employment and prospects for nurses for good. Models of service delivery dominated by professional nurses having exclusive or nearexclusive responsibility for direct care in institutional settings are under fire at the same time as the domination of institution-based over community-based healthcare services appears to be reaching an end. So where next? It is time to reassess the purpose of this field. What makes the nurse workforce special? Is it the broad scale and scope of the services nurses provides? The nature of the work and its physical, emotional and intellectual demands? The historically gendered nature of nursing that has influenced politics within the profession and its interaction with groups and forces outside it? If

Ways of assessing the economic value or impact of research: is it a step too far for nursing research?:

Abstract: To identify lessons that could be applied to nursing research, this paper draws on some reviews of the increasing, although apparently still relatively small, number of studies that attempt to assess economic impacts from health research. One review describes several important steps, including identifying the health and other outcomes from specific bodies of research and then valuing the outcomes. We describe major studies in fields such as cardiovascular research that show how the economic value of health research can be demonstrated. In addition, we examine various nursing studies, including ones showing the benefits (especially economic) from nursing itself (as opposed to from nursing research), and also studies describing economic evaluations of new devices and techniques used by nurses, which have the potential to be used when trying to value the research. Currently, such studies rarely go on and demonstrate how the nursing research has had a wider impact on nursing policies and practice, and hence led to outcomes that could be valued. There is, nevertheless, scope to build on these existing nursing studies. Conducting impact assessments could potentially result in a portfolio of examples of nursing research that have informed policies and practices and led to economic impacts in terms of cost savings, and possibly also in terms of health gains that could be valued