Showing papers in "Journal of Research in Nursing in 2014"

Clinical leadership characteristics confirmed

Abstract: AimsThis paper compares the results of two studies conducted by the same researcher into the attributes and characteristics of clinical leaders.BackgroundThe two studies used an almost identical questionnaire; however, they were conducted 6 years apart, in different counties, with different health care staff (nurses and paramedics), made up of very different gender ratios. The initial study was larger and focused on more than describing clinical leader attributes; however, this was the principle focus of the second study.FindingsThe findings from both studies offer very similar results and describe clear insights into the attributes health professionals seek in clinical leaders. The research findings are remarkably similar given the differences in professional group, gender variations, country differences and time span.ConclusionsLeaders are followed because there is a match between the leaders values and beliefs and their actions. People identify with the leaders values and follow them if they are reflec...

A realist logic model of the links between nurse staffing and the outcomes of nursing

Abstract: Background:There has been a long-standing debate over the definition and nature of the quality of healthcare and factors that influence and enhance quality. Within nursing, the challenge is to iden...

Conflict on the treatment floor: an investigation of interpersonal conflict experienced by nurses

Abstract: Nurse conflict has numerous detrimental outcomes for healthcare organisations, patients and nurses themselves. Although past literature has advanced general understanding of conflict and aggression, much of it is limited in its explanation of negative interactions between nurses themselves. To address this, we used a mixed-method approach to identify and describe characteristics of conflict between nurses using content analysis of qualitative descriptions and associated quantitative ratings from practicing registered nurses over 12 weeks of a weekly work experience survey administered online. We found six reliable themes describing the nature of nurse conflict including such characteristics as feeling unfairly treated, others’ irresponsible behaviours and work disagreement. Conflicts containing perceived unfair treatment as well as negative emotion and rude behaviour between nurses were rated very negatively. Results suggest that a comprehensive workplace conflict prevention strategy should include multip...

Guest editorial: Nursing, the politics of organisation and meanings of care:

Abstract: How should the ‘state of nursing’ be addressed in the light of seeing nurses take strike action, including midwives who have never done so before (Triggle, 2014)? In this editorial I want to suggest how this political action might be understood in the wider context of what has been happening to nursing, arising from disarray and dispute over the meanings of care and as a consequence of government agendas feeding and fuelling struggles and conflict in the ‘organisational politics’ of the NHS. In so doing I pick up on the link made in the Francis reports between a demoralisation of nursing and the preoccupation of the organisation with finance and targets to the detriment of the quality of patient care. My aim, however, is to suggest how any demoralisation also relates, first, to a fundamental downgrading of the status of nurses through changes to the organisational structure and the institutions within which they work, and second, to a devaluation of their work as a consequence of witting and unwitting manipulations in the meanings of care. What is striking is that this demoralisation and downgrading of status has happened over the same three or so decades in which the steering bodies representing nursing promised to raise its profile by ‘professionalising’ the profession. Indeed, far from the reforms in nursing education helping to equalise its standing (to say nothing of pay) with other health professions (doctors were always seen as the paradigm example), nurses continue to be positioned within class and gender social structures as a relatively oppressed group, with little power over either strategy or the distribution of resources. If lip service continues to be paid to nurses’ central contribution to the organisation of health services then the nurse

Reducing interruptions during medication administration: the White Vest study:

Abstract: The well-established Institute of Medicine report entitled To Err is Human: Building a Safer Health System highlighted the importance of preventative errors in medicine, suggesting interruptions are a contributing factor. Patient safety organisations, such as The Joint Commission, acknowledge that interruptions contribute to preventable medical errors. The aim of this research is to examine the most frequently observed interruptions experienced by nurses administering medications and evaluate an intervention designed to reduce those interruptions. The primary intervention consisted of a White Vest worn during administration stating: ‘Please do not interrupt while passing medications’. A quasi-experimental design was employed. Nurses were observed for 2 weeks during routine administration of morning medications. The vest was then introduced and worn during administration for 2 weeks for post-intervention data collection. The hospital unit, date, time, duration, and description of the interruption were reco...

Patients’ experiences of sleep in hospital: a qualitative interview study

Abstract: Many patients experience sleep disturbances and a reduced quality of sleep while hospitalised. Studies have shown that a person with a disease and/or a bodily injury has an increased need for sleep...

Caring after Francis: moral failure in nursing reconsidered:

Abstract: This discussion paper considers recent nursing failures. Drawing on a selection of key literature and ongoing research, it argues that nursing failures are a possibly inevitable consequence of work...

Conflict management styles used by nurses in Jordan

Abstract: Aim:This paper is a report of a study of conflict management styles used by nurses in Jordan.Background:There are five main styles used to deal with conflict. At present research into their utilisa...

Measuring perceptions of shared governance in clinical practice: psychometric testing of the RN-focused Index of Professional Governance (IPNG)

Abstract: Shared governance is considered an innovative management process model that includes shared decision-making between all members of the healthcare workforce and focuses on nurses’ control over their practice and accountability of care. One specific tool that measures shared governance perceptions of nurses is the RN-focused Index of Professional Governance (IPNG). The objective of this study was to assess reliability and add to the validity of the IPNG by further establishing the construct validity and correlating the scale scores to measures of satisfaction obtained from the National Database of Nursing Quality Indicators (or NDNQI) survey. There were 76 respondents representing six units in one hospital. We reported high reliability for each one of the six subscale scores as well as for the total score (Cronbach alphas of 0.94 and higher). Construct validity was supported by the invariance of the scores across age groups along with schooling and experience levels. Concurrent validity was supported by a c...

The impact of the economic crisis and austerity on the nursing and midwifery professions in the Republic of Ireland – ‘boom’, ‘bust’ and retrenchment:

Abstract: The year 2008 marked a profound crisis for Irish public services, with the economy moving from a state of ‘boom’ to ‘bust’. This economic context has significantly impacted on Irish nursing and mid...

Evaluation of leadership practices: how to develop a vision

Abstract: Leadership competencies and more specifically a strategic vision are essential to managing increasingly complex healthcare organisations and change. However, Switzerland, like many other countries, has identified a lack of leadership skills among nurse leaders. Therefore the Royal College of Nursing’s (RCN) Clinical Leadership Programme has been adapted, implemented and evaluated in the Swiss nursing context. The aim of this qualitative study was to evaluate the Leadership Programme’s support for vision development. In-depth interviews with six nurse leaders, who were purposefully selected according to the quantitative results of the overall mixed-methods evaluation project were included. Interviews were audio-recorded and transcribed prior to qualitative content analysis. Findings showed the different approaches used in the process of vision formation. Some used cognitive-analytical techniques and proceeded very methodically and systematically, whereas others described a more intuitive approach. Some als...

Occupational stress and adaptation of immigrant nurses from the Philippines

Abstract: Immigrant nurses face multiple challenges that create vulnerability to stress. The purpose of this study was to explore the stresses and work experiences of Filipino immigrant nurses. Specific aims...

Forging a strong nursing future: insights from the Canadian context

Abstract: Canadian nurses, with their colleagues around the globe, are experiencing waves of change in their practice and work lives, and in expectations of how they will continue to make a difference for he...

Difficulty, despair and hope – an insight into the world of the health professionals treating paediatric pain in sub-Saharan Africa

Abstract: The recognition and treatment of paediatric pain in sub-Saharan Africa brings many challenges and barriers for health professionals to overcome This paper aims to give a unique insight into the wo

It’s not about the hoist: A narrative literature review of manual handling in healthcare:

Abstract: The manual handling of people and objects is integral to the provision of nursing care to patients globally. Despite over 30 years of research intended to guide improvements for nurses’ safety, sub...

Developing awareness and understanding amongst mental health nursing students of the lived experience of dementia with the aid of selected first-person media resources:

Abstract: This study examines the influence that first-person media products (film, television, internet, books and newspapers) have upon promoting empathic understanding of the dementia experience amongst m...

Exploration of the effects of peer teaching of research on students in an undergraduate nursing programme

Abstract: The use of peer teaching has been recognised as a valuable teaching and learning strategy in higher education. It has been used in nursing as an adjunct to lectures and to support learning in clini...

Clinical leadership characteristics confirmed

Abstract: In view of the recent headlines that the newly formed NHS Commissioning Board must encourage nurse leadership (Independent Nurse, 2012), this paper is a welcome opportunity for policy makers, managers and clinical staff in the health services to take a good look at how many of their preconceptions fall short of reality. The work described is not rocket science, it is about finding out what makes a good nurse or paramedic, who really leads when it comes to standards and quality. ‘Quality’, when I use it here, is not merely value for money, it is about compassion, caring, something that so often seems to be overlooked in today’s health care judging by the number of complaints against the NHS (Patients’ Association, 2011). And at a time when, in the UK at least, standards seem to be dropping in tandem with the current funding crisis, it is a foolish manager who dismisses such research as ‘light’ or anecdotal. Certainly the response rates are low – could it be that staff is too disaffected to partake? Does that alter the validity of those who cared enough to see the research through? The importance of this paper is that, despite its simplicity, it distils decades of health care studies in relation to quality care. I bring to mind – though there were and possibly still are those policy makers who would prefer that I did not – the work of Carr-Hill et al. (1992), which looked at skill mix and the effectiveness of nursing care. Studies were largely based on the mistaken premise that a huge demographic blip would reduce the UK’s input of potential qualified nurses. Despite this not being the case, indeed we have UK-trained nurses unable to obtain posts in the NHS as cheaper staffing options have been pursued, and there is an economic drive for policy makers not to change their habits. The work of Carr-Hill et al. (1992), though in many ways exploratory, indicated clearly that care directed by qualified staff met with higher satisfaction and effectiveness, findings further supported by subsequent work such as that by Buchan (2002, 2004). Focusing less directly on skill-mix but still pursuing the issue of quality in health care, Maben and Griffiths (2008) consider leadership and ownership fundamental. The other side of the professional coin is highlighted by Saks (2009) who identifies techniques employed on both sides of the Atlantic which, while masquerading as being for the public good, were more inclined to benefit the professionals involved! A plea for increased numbers of qualified staff may

Knowledge, attitudes, and practices of parents/guardians regarding pediculosis in the Umm el-Jimal district of Jordan

Abstract: The aim of this study is to assess the prevalence of pediculosis capitis in one district in Jordan, and to determine the knowledge, attitudes and practices of parents/guardians regarding head lice. The study was performed in Jordan’s Umm el-Jimal district from February 2010 to May 2010, and involved the surveying of 105 randomly selected households containing a total of 213 children. The households’ parents were interviewed for their knowledge, attitudes and practices regarding pediculosis, and afterward their children’s hair was checked for head lice via a 5-min visual scalp examination. Chi-square testing was used to analyse the data, with statistical significance assumed at p < 0.05. The prevalence rate of pediculosis among the 213 children was found to be 14.6%. Parental knowledge of head lice was found to be very limited; only 35.2% of the parents/guardians correctly answered 10 of the 20 questions (50%), and only 17.1% correctly answered 14 questions (70%). More than 94% of the parents reported feel...

Maternal postadoption depression: theory refinement through qualitative content analysis:

Abstract: Background:Some adoptive parents struggle with depressive symptoms post-placement. Foli’s Mid-Range Theory of Postadoption Depression provided the theoretical context for the analysis.Research Aim:...

Board editorial: The nursing profession and its leaders – hiding in plain sight?

Abstract: This edition of the journal is my last as a Board member. I was delighted when the journal editors and the Board asked me to lead this special edition, making the focus an international reflection on the work of nurses and some of the difficulties they face in the present and near future. The final product is several things. It offers insights into some questions facing the nursing profession in six countries and some European oversight. The questions raised are both interesting and challenging in that while they have echoes for us all, they are also situation specific. There are not, and do not intend to be definitive accounts of a particular nation state, and should not be seen in this light. Separately and together, however, they ask pressing questions of us all. The subject focus of the edition was clearly prompted by a harrowing and very public debate about poor and neglectful health care exposed by the Francis (2013) report, in which nurses were publically criticised for their part in collective and clear failures in Mid Staffordshire, England. The profession’s response and the situational circumstances that allowed it to happen are matters dealt with by several authors in this edition, but I would wish to note with disappointment the ease with which the UK Government, which presides over the health care system in England, has heaped the blame on nurses and other clinicians – it is unconscionable. The circumstances leading to Mid Staffordshire and other wellpublicised cases of patient neglect have as much to do with repeated meddling by Governments in NHS systems and processes as with clinicians and local organisations. It takes courage to own up to this – something clinicians have done at least in part, but which Government and senior health care managers have yet to properly reflect on and admit their part. Their response, as usual, is to punish those most visibly accountable and ignore the significant contribution made by those running a flawed and badly managed system. At the time of writing this editorial, NHS England has announced that this incoherent system must be overhauled and brought together in a more sensible structure that embraces hospital and community care and recognises the equal role of both health and social care. Sadly, while in itself an excellent report (NHS England, 2014a), the system response will likely be on

Consultation workshops with patients and professionals: developing a template of patient-centred professionalism in community nursing:

Abstract: The study aimed to clarify the notion of patient-centred professionalism through consultation with the public, stakeholders and professionals in order to develop a thematic template within nursing. The paper also examines innovative methodology informing eight template themes developed qualitatively. Patient-centred professionalism has had little coverage in nursing literature, whilst ‘patient-centredness’ is supporting patients through holistic care according to needs and expectations. The study took place in Wales, UK, between October 2009 and September 2010. Data collection entailed consultation workshops with newly qualifying nurses (13 participants), community nurses (nine participants), nursing stakeholders (six participants) and the public (six participants). Analysis involved summative and thematic approaches. Result were revealed through template themes, identified in rank order of significance: the patient, nursing ethos, community nurse as a person, knowledge and skills, working relationships, service delivery, training and information and environment. The patient comes first for nurses and was the major theme of the analysis. This almost goes without saying for nurses, whilst for patients this is a surprise, as they see themselves as marginalised. The patient in patient-centred professionalism has multiple identities, many of which contradict one another – recipient and object of care, a force of resistance and a focus of negotiation. In conclusion, a clearer understanding of the concept should play a central role in policy development for optimal care, informing education and training, and methodological strengths could be explored further by other researchers, across a wide range of contexts.

Editorial: Nursing and super-diversity:

Abstract: There now exists in many countries a complex pattern of migration-related ethnic diversification which intersects with socio-economic stratification and a range of other differentiating statuses, to produce societies characterised by highly dynamic processes of sociocultural diversification. How to conceptualise this social stratification without using essentialist categories is a major and ongoing issue for social scientists. However, this ‘superdiversity’ (Phillimore, 2011) also poses important challenges for policy makers and for those delivering health and other social services. Most advanced societies still face considerable challenges in designing and delivering a healthcare system which includes adequate provision for an increasingly complex multi-ethnic population. It is fair to say that while there has been much debate and many policy initiatives on ethnic health inequalities, less well positioned members of migrant and minority ethnic communities in the UK and elsewhere remain more vulnerable to a range of conditions and ethnic inequalities in access to healthcare persist (Bhopal, 2013). In the field of nursing, the influence of a particular understanding of ‘transcultural nursing’ inspired by the work of Madeleine Leininger, has led some commentators to propose a form of culturally sensitive care which often operates with an exaggerated and simplistic notion of ‘cultural difference’, leading to ethnic reductionism and cultural stereotyping which, I have argued elsewhere, is misleading and potentially harmful in its effects (Culley, 2006). To understand complex problems we need more sophisticated ways of theorising how and why social conditions shape health and how a range of social characteristics and diverse understandings of healthcare might influence the negotiation and navigation of healthcare systems (Green et al., 2014). The first paper in this volume demonstrates very clearly the ease with which we can slip into essentialist thinking when grappling with the difficult and often messy world of diversity research. In ‘Researchers Experiences of Focus Group Dynamics in Singapore, Australia and the Netherlands: Troubling Multicultural Assumptions’, Professor Vicki Drury and her co-authors show the need for constant critical reflection on assumptions made and decisions taken during the course of cross-cultural research. This paper is an unusual account of some of the ‘backroom’ issues in research. In particular, it exposes the way in which the authors of three studies initially conceived of some of the processes involved in facilitating and

The struggle for safe staffing levels in the USA: A political economy of evidence-based practice

Abstract: This paper examines the debate over nursing staff to patient ratios through the lens of Marxist political economy, arguing that the owners and controllers of healthcare in the USA have a vested int...

The experience of chronic illness among a group of Irish patients: a qualitative study:

Abstract: AimThis paper reports a study that explored the experience of people living with chronic illness among a group of Irish patients.BackgroundChronic conditions affect the lives of millions of people around the world. Understanding their experience and how they cope with chronic illness can help nurses develop appropriate plans for their patients. To date no study on the experience of chronic illness in Ireland was found.DesignA qualitative descriptive design using focus group interviews was used in this study.MethodTwo focus group interviews with a convenient sample of 19 people with chronic illness were carried out and data collection took place in 2008.Findings/resultsAlthough the participants’ chronic conditions were varied, a number of common themes were evident from their narratives. These were: ‘a sense of loss’, ‘feelings of anger and frustration’, ‘uncertainty and stress’ and ‘adapting to a new life’. Financial loss and the fragmented nature of health care for people with chronic illness were partic...

Jordanian parental needs of critically ill infants in neonatal intensive care units

Abstract: This descriptive correlational study was conducted to identify perceived parental needs of critically ill infants in Neonatal Intensive Care Units (NICUs). Jordanian parents who were visiting their infants admitted in NICU (N = 170) composed the study sample. Participants completed the demographic data sheet and the NICU Family Needs Inventory. Findings showed that parents ranked assurance, information and proximity as the most important needs, while comfort and support were ranked the lowest. The primary concern of parents was to be assured and informed about the progress of their infant. In addition, the results indicated that the mother’s perceived needs for support, information and proximity were significantly more important than the father's. Accordingly, nurses should establish a rapport with family members and provide them with understandable and honest information. Furthermore, the provision of quality, holistic, family-centered nursing care that relies primarily on early and comprehensive needs a...

Spiritual wellbeing of Iranian patients with acute coronary syndromes: a cross-sectional descriptive study:

Abstract: Spiritual wellbeing harmonises several dimensions of human life and is essential for coping with diseases. Acute coronary syndromes (ACS) cause crisis in physical, psychological aspects and spiritu...

Coping with breathlessness among people with COPD: distinct physiological and behavioural indicators

Abstract: Identifying indicators on predominant types of coping with breathlessness may facilitate the possibility for qualified individualised advice on how to live with breathing difficulties. This paper reports the statistical findings on several parameters constituting possible coping-type-specific indicators with the ability to discriminate between four previously identified types of coping with breathlessness. Data were collected from 12 patients with moderate to very severe chronic obstructive pulmonary disease (COPD) in relation to body care during hospital stay and at home. Data consisted of: (a) Bedside forced expiratory volume in 1 s of predicted; (b) scores on the Modified Borg Scale; (c) respiratory rate; (d) peripheral oxygen saturation and (e) use of breaks from activity and break time duration. We found that the following parameters were able to discriminate between the four coping types: COPD severity, intensity of breathlessness, respiratory rate, level of oxygen saturation and the patients’ use o...

Nursing in media-saturated societies: implications for cultural safety in nursing practice in Aotearoa New Zealand

Abstract: This educational piece seeks to apprise nurses and other health professionals of mass media news practices that distort social and health policy development. It focuses on two media discourses evident in White settler societies, primarily Australia, Canada, New Zealand and the United States, drawing out implications of these media practices for those committed to social justice and health equity. The first discourse masks the dominant culture, ensuring it is not readily recognised as a culture, naturalising the dominant values, practices and institutions, and rendering their cultural foundations invisible. The second discourse represents indigenous peoples and minority ethnic groups as ‘raced’ – portrayed in ways that marginalise their culture and disparage them as peoples. Grounded in media research from different societies, the paper focuses on the implications for New Zealand nurses and their ability to practise in a culturally safe manner as an exemplary case. It is imperative that these findings are ...

The significance of cognitive representations of symptoms of acute coronary syndrome and coping responses to the symptoms in predicting prehospital delay in Omani patients

Abstract: The purpose of this study was to examine the significance of cognitive representations of symptoms of acute coronary syndrome (ACS) and coping responses to the symptoms, as elements of a consequent...