Showing papers in "Nursing Forum in 2010"

Concept analysis of interdisciplinary collaboration.

Abstract: PURPOSE. The study aims to explore the meaning of interdisciplinary collaboration within the context of health care. ORGANIZING FRAMEWORK. Rodgers' Evolutionary View of Concept Analysis was employed to identify attributes, antecedents, and consequences of interdisciplinary collaboration. METHODS. Utilizing an inductive approach, a systematic review of the literature was undertaken in August 2007 to clarify the current use of interdisciplinary collaboration in health care. FINDINGS. Interdisciplinary collaboration is commonly described using the terms problem-focused process, sharing, and working together. The elements that must be in place before interdisciplinary collaboration can be successful are interprofessional education, role awareness, interpersonal relationship skills, deliberate action, and support. Consequences of interdisciplinary collaboration are beneficial for the patient, the organization, and the healthcare provider. CONCLUSIONS. A comprehensive definition of interdisciplinary collaboration within the context of health care is presented as an outcome of this analysis. It is recommended that further inquiry in this area focus on the development of valid measures to accurately evaluate interdisciplinary collaboration in health care.

Perceptions of Effective and Ineffective Nurse–Physician Communication in Hospitals

Abstract: PROBLEM. Nurse–physician communication affects patient safety. Such communication has been well studied using a variety of survey and observational methods; however, missing from the literature is an investigation of what constitutes effective and ineffective interprofessional communication from the perspective of the professionals involved. The purpose of this study was to explore nurse and physician perceptions of effective and ineffective communication between the two professions. METHODS. Using focus group methodology, we asked nurses and physicians with at least 5 years' acute care hospital experience to reflect on effective and ineffective interprofessional communication and to provide examples. Three focus groups were held with 6 participants each (total sample 18). Sessions were audio recorded and transcribed verbatim. Transcripts were coded into categories of effective and ineffective communication. FINDINGS. The following themes were found. For effective communication: clarity and precision of message that relies on verification, collaborative problem solving, calm and supportive demeanor under stress, maintenance of mutual respect, and authentic understanding of the unique role. For ineffective communication: making someone less than, dependence on electronic systems, and linguistic and cultural barriers. CONCLUSION. These themes may be useful in designing learning activities to promote effective interprofessional communication.

Concept Analysis: Nurse-to-Nurse Lateral Violence

Abstract: PURPOSE. The purpose of this paper is to examine the concept of nurse-to-nurse lateral violence (LV). SOURCE. Published literature-LV among nurses is significant and results in social, psychological, and physical consequences, negative patient and nursing outcomes, and damaged relationships. An extensive review of literature through Health Source, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest health, and Medical Complete was used to determine agreement and disagreement across disciplines and emerging trends. CONCLUSION. This concept analysis demonstrates that nurse-to-nurse LV is nurse-to-nurse aggression with overtly or covertly directing dissatisfaction toward another. Origins include role issues, oppression, strict hierarchy, disenfranchising work practices, low self-esteem, powerlessness perception, anger, and circuits of power. The result of this analysis provides guidance for further conceptual and empirical research as well as for clinical practice. Organizations must learn how to eliminate antecedents and provide nurses with skills and techniques to eradicate LV to improve the nursing work environment, patient care outcomes, and nurse retention. Language: en

Retention Priorities for the Intergenerational Nurse Workforce

Abstract: TOPIC. Retention of senior, Gen-X, and Millennial nurses is influenced by manager interactions and efforts to create a satisfying work experience. PURPOSE. The purpose of this project was a generational assessment of job satisfaction, work environment, and desired characteristics of managers in an effort to improve nurse retention. SAMPLE AND METHODS. Data from staff nurses at 22 southern hospitals collected by online survey included measures of job satisfaction and perceptions of safety, the Nurse Manager Desired Traits survey, and the Nursing Work Index-Revised. FINDINGS. The satisfaction with work environment scores for the whole group (n = 1,773) were high. Subscale scores showed highest satisfaction with nurse/physician relationships; lowest was nurse control of practice. A specific satisfaction question showed the younger nurses were less satisfied than those over age 40. Nurse safety concerns were expressed by 40% of the sample. One third of Millennial nurses plan to leave their job within the next 2 years. Over two thirds plan to be gone within the next 5 years. Especially alarming is the fact that 61% of the nurse group stated they plan to leave their current jobs within 10 years. RECOMMENDATIONS. (a) Create model managers; (b) empower staff nurse councils; (c) stabilize staffing; (d) revamp incentives; and (e) focus on safety.

The medical-surgical nurse perspective of advocate role.

Abstract: Nursing advocacy for patients is viewed as a vital role for the nursing profession; however, there is little empirical research regarding nursing advocacy. PROBLEM. The medical-surgical nursing specialty is the largest specialty in acute care settings, but few advocacy studies have focused exclusively on this specialty population. METHODS. The purpose of this study was to explore the nurse advocacy actions and workplace support for advocacy using written narrative responses to a mailed survey using a medical-surgical nursing sample. FINDINGS. The responses help to illuminate the importance of the advocate role for this nursing specialty and provide preliminary information on the advocacy actions and workplace support as reported by the nurses. CONCLUSIONS. The resulting data provide a basis for examining the workplace environmental support for nursing advocacy, further delineate the actions of the nurse advocate, and clarify how nurse advocates follow patient desires regarding care. In addition, the results can be used in education, improving advocacy skills, and safety initiatives.

"Leaving the comfort of the familiar": fostering workplace cultural awareness through short-term global experiences.

Abstract: PROBLEM. Facilitating the development of student nurses' cultural competence and translating these experiences into the clinical setting. METHODS. Qualitative methods. FINDINGS. A short-term global immersion experience informs student nurses' cultural awareness, education, and future clinical practice. CONCLUSIONS. Participation in a short-term global health experience contributes to students' personal growth and broadens their insight into multicultural care.

Listening: a concept analysis.

Abstract: The concept of listening is acknowledged as an essential component of effective communication by many disciplines. Listening has always been considered a crucial component of nursing care, and its benefits have been documented in nursing literature. Certain characteristics that are essential to listening have been identified in all of the reviewed literature. These defining attributes include empathy, silence, attention to both verbal and nonverbal communication, and the ability to be nonjudgmental and accepting. In addition, listening is a deliberate act that requires a conscious commitment from the listener. Although listening is considered to be an important nursing intervention, it has not received the same consideration as other nursing skills. Very few tools are available to measure the concept of listening, and no tools are available to measure the patients' perception of nurses' listening skills. Research aimed at theory development should incorporate the concept of listening as an integral component of nursing care. Such research may provide a framework for the use of listening as it pertains to nursing practice. Finally, research is necessary for the development and validation of tools that may be used to evaluate the effectiveness of listening from both the nurses' and patients' perspectives.

A Holistic Framework for Nursing Time: Implications for Theory, Practice, and Research

Abstract: Topic Nursing time has relevance for those who produce it, those who receive it and those who must pay for it. Though the term nursing time may be commonly used, a common understanding of the concept within the fields of nursing and healthcare administration is lacking.

Nursing presence in contemporary nursing practice.

Abstract: TOPIC. The concept of nursing presence has been explored within the context of contemporary nursing practice. PURPOSE. The purpose of this study was to enhance the understanding of the concept of presence in nursing and to enlighten nurses on the subject of being with people in ways that values the meaning of the lived experience of patients. SOURCES OF INFORMATION. Professional literature, electronic resources, and nursing textbooks were used. CONCLUSION. This is a literature review that clarifies the concept of presence for nurses. Clarifying this concept will further aid in the development of nursing research and education, and will provide nurses with the ability to apply the act of being present into their professional practice.

Competency education and validation in the United States: what should nurses know?

Abstract: This article provides an overview of the progress in the past decade toward effectively documenting the initial and continuing competence of registered nurses.

An Exploratory Study of Nurses' Presence in Daily Care on an Oncology Unit

Abstract: PURPOSE/OBJECTIVES. Explore the use of presence among nurses on an oncology unit. PARTICIPANTS. Five oncology nurses and 10 assigned patients. METHOD. Descriptive qualitative study using participant observation, individual and group interviews. FINDINGS. Presence was embedded in each nurse's individual manner and approach, in the structure and nature of morning care, and in the nature of the individual patient situation. Nurses' presence varied based on patient cues. There was a similarity and pattern to the ways that nurses were present, suggesting an overall process that included three major phases in which the nurse moved from presence, to partial presence, and then full presence. INTERPRETATION/IMPLICATIONS. Morning care is an opportunity for the emergence of different ways of being present with the patient. Developing patient-nurse trust and responsiveness to patient cues is critical to the emergence of full presence. The nurse needs to be aware of potential stressors, whether personal or organizationally based, that could detract from the energy needed to be present. Nurses can use presence as a way to provide emotional support to patients who are exposed to overwhelming threats to their mind, body, and spiritual integrity.

Intimidation: a concept analysis.

Abstract: PROBLEM. Patient safety is being compromised by intimidating communication and ineffective teamwork among healthcare providers. The Joint Commission Update indicates that ineffective communication has been the leading root cause of the majority of sentinel events since 1996. Furthermore, the organizational implementation of policies and procedures for addressing this dangerous situation is now mandated by The Joint Commission Sentinel Event Alert. However, in order to consistently identify and address this problem, there must be a clear and universal definition of intimidation. METHODS. The purpose of this article is to clarify the definition of intimidation in healthcare settings. Without this clarity, the role of intimidation as a precursor to the occurrence of medical errors will inevitably be obscured. The framework for concept analysis proposed by Walker and Avant is used to explicate the definition, attributes, antecedents, consequences, and cases of intimidation. FINDINGS. Analyzing the extent of the relationship between intimidation and medical errors will provide healthcare organizations and professionals with a foundation for the development of strategies to combat the effects of intimidation on medical errors and patient safety. CONCLUSIONS. The necessity to create a culture of safety in healthcare settings is paramount.

The Gift of Listening: JUST Listening Strategies

Abstract: The purpose of this paper is to examine how the simple act of listening deeply to patients serves as a potentially powerful tool in determining treatment plans, improving patient compliance, decreasing costs, increasing efficacy, and improving patient-practitioner relationships. Nonegoic listening is a transformative practice that can be integrated into clinical training and practice. A growing body of experiential and anecdotal evidence indicates that this is an area ripe for further investigation to enhance nursing interventions and cultural competencies. Given the significant role that advance practice nurses have in directing patient care, integrative listening can be valuable in shaping patient care.

Complex responsive processes: a new lens for leadership in twenty-first-century health care.

Abstract: PROBLEM. Health care is currently in the midst of an age change. Leadership styles and organizational structures that were prevalent in the twentieth century no longer apply in twenty-first-century health care. Leaders of health care must embrace and help others to embrace new ways of being and relating in twenty-first-century organizations. METHODS. This paper introduces a new framework through which leaders can see their organizations differently. Complex responsive processes (CRPs) focus on the interactions between people that take place in the living present as the building block of transformative organizations. This paper also introduces the seven da Vincian principles as a personal tool that twenty-first-century leaders might use to increase their capacity for creativity and to develop their ability to thrive in uncertainty. FINDINGS. The power to shape the preferred future of health care lies within our relationships with others that take place locally and in the living present. CONCLUSIONS. Viewing organizations through the lens of CRPs and developing practices around the seven da Vincian principles provides directions and a starting point for traditional leaders to move away from rationalist, twentieth-century practices toward transformative leadership practices.

The Future of Baccalaureate Degrees for Nurses

Abstract: PROBLEM. Unlike other professional healthcare disciplines, the profession of nursing has multiple levels of entry. Recently, several states have proposed legislation to mandate completion of baccalaureate education after 10 years of nursing licensure. METHODS. This article examines the proposals, statistics, strategies, and other relevant literature on baccalaureate education for nurses and the positive outcomes associated with a more highly educated nursing workforce. FINDINGS. The proposal recognizes the entry level preparation provided by associate degree nurses and is an innovative solution that offers a balance between multiple entry levels into practice and continued educational preparation. CONCLUSIONS. Through a combination of the entry level preparation of associate degree nurses and baccalaureate education, a stronger nursing workforce can be created and patient outcomes and quality of care improved.

Is the DNP the answer to the nursing faculty shortage? Not likely!

Abstract: The DNP is being touted as the answer to the faculty shortage. There is no evidence that DNP graduates are any more willing to embrace the low salaries of nursing faculty than PhD graduates. The idea of the DNP as the answer to the faculty shortage is challenged.

Economic Theory and Nursing Administration Research—Is This a Good Combination?

Abstract: TOPIC. Economic theory is used to describe and explain decision making in the context of scarce resources. PURPOSE. This paper presents two applications of economic theory to the delivery of nursing services in acute care hospitals and evaluates its usefulness in guiding nursing administration research. SOURCES OF INFORMATION. The description of economic theory and the proposed applications for nursing are based on current nursing, healthcare, and economic literature. Evaluation of the potential usefulness of economic theory in guiding nursing administration research is based on the criteria of significance and testability as described by Fawcett and Downs. CONCLUSIONS. While economic theory can be very useful in explaining how decisions about nursing time allocation and nursing care production are made, it will not address the issue of how they should be made. Normative theories and ethical frameworks also must be incorporated in the decision-making process around these issues. Economic theory and nursing administration are a good fit when balanced with the values and goals of nursing.

Immunizing children who fear and resist needles: is it a problem for nurses?

Abstract: This is the pre-peer-reviewed version of the following article: IMMUNIZING CHILDREN WHO FEAR AND RESIST NEEDLES: IS IT A PROBLEM FOR NURSES, which has been published in final form at : http://www3.interscience.wiley.com/journal/123274252/abstract

An appraisal of the factors influencing human sexuality research in nursing.

Abstract: BACKGROUND. Conducting human sexuality research continues to be a challenge for nurse researchers and may seem daunting to nursing students interested in conducting human sexuality research. PURPOSE. The purpose of this paper was to conduct a comprehensive review of the literature to appraise the factors that have influenced human sexuality research for nurse researchers. FINDINGS. Various factors, both intrinsically and extrinsically to the nursing profession, have had an influence on human sexuality studies conducted by nurse researchers. CONCLUSION. A critical appraisal of the findings from the review of the literature provide implications for nurse researchers as well as students of nursing interested in conducting human sexuality research.

Teaching Research to Graduate Nursing Students: A Strategy Using Clinically Based Research Projects

Abstract: This article describes an approach to teaching advanced practice nursing students the research process through the application of the research process to clinical problems. In the course, students propose solutions to clinically based research projects through conceptualizing the problem, identifying an appropriate theoretical framework, conceptualizing the intervention or clinical guidelines, and designing a project that includes the research design, sampling strategies, procedures for implementation of the project, and plans for data collection and analysis. These strategies challenge the advanced practice nursing student to apply research concepts to problems encountered in clinical practice and reinforces the skills needed to critique the literature, to summarize the published findings on a problem, to conceptualize a research study, and to disseminate their findings in oral presentations.

Reasons for nursing telephone counseling from individuals discharged in the early postoperative period after breast surgery.

Abstract: The aim of this study was to determine the rate of and causes of asking for telephone counseling in patients undergoing modified radical mastectomy (MRM) and breast-conserving surgery (BCS), and discharged one night after surgery. METHOD. This is a randomized descriptive study. This study was conducted on surgery service of a university hospital in Istanbul, Turkey, with MRM and BCS patients. This study sample included 174 patients. Inclusion criteria were staying in hospital for one night and being discharged, ability to talk on the phone, and being a candidate for MRM or BCS. Data were collected on a form that was developed by the researcher after consultation with experts, reviewing THE related literature, and clinical observations. The patients were given two mobile telephone (for two of the researchers) and home telephone number (for two of the researchers) that had an answering machine and were encouraged to call or leave a message for health problems they experienced at home. RESULTS. A higher rate of the patients undergoing mastectomy asked for telephone counseling. The rate of the women asking for telephone counseling was very high within the first 6 weeks of discharge. The leading causes of asking for telephone counseling were wound problems, arm exercises, and difficulties in adapting to daily living activities. The women also had a psychological problem: fear of inability to recover. CONCLUSIONS. The study found that home follow-up of patients undergoing mastectomy was particularly important.

Said another way: asking the right questions regarding the effectiveness of simulations.

Abstract: Applying simulations in healthcare practice and education is increasingly accepted, yet a number of recent authors have questioned the effectiveness of these technologies. The contention is that while high-fidelity simulators may contribute to educational gains, their gains compared to low-tech alternatives are often "not significant." That assessment, however, and the evidence it is based on, may be a consequence of asking the wrong questions. Typical studies often compare a measure for "average success" for one group's members versus another's on some criteria, but this can mask important information about the "tails" of the distribution for how trainees are performing. An alternative approach, adapted from quality control, compares error rates for each group in the experiment, in aggregate. The statistical results of evaluations can change if this method is used, as illustrated by a recent study showing that simulation training can significantly reduce the frequency of medication administration errors among student nurses on placement. The paper includes a case study to tangibly demonstrate how the way we frame our evaluation test question can reverse the apparent statistical finding of the significance test.

Combat-related blast-induced neurotrauma: a public health problem?

Abstract: The purpose of this article is to raise nurses' awareness of the significance and potential public health impact of combat-related blast-induced neurotrauma (BINT) in U.S. troops returning from Afghanistan and Iraq. A comprehensive review of the current literature on BINT was completed by the author, based primarily on combat-related blast exposure in the military population. She found that it is necessary to theorize about potential etiologies for mild traumatic brain injury in the military population since the literature suggests that neurological and psychological trauma resulting from military duty may be linked to exposure to blasts. Identification of potential risk factors for BINT in the military population provides direction for scientific inquiry into this emerging phenomenon. Gaps in current knowledge and its health implications for future scientific study in nursing are presented.

Concept Analysis of Risk in Relation to Coronary Heart Disease Among Filipino‐Americans

Abstract: PURPOSE. To analyze the concept of risk in relation to coronary heart disease (CHD) among Filipino-Americans (FAs) and provide a new definition of risk. SOURCE. Published literature. CONCLUSION. This concept analysis provided a new meaning of risk in relation to CHD among FAs and shed light on further understanding of risk. Risk has been laced with negativity in health care, but based on the current literature, risk can be conceptualized in a positive perspective, especially in the area of chronic health disease such as CHD. However, further research is needed in the conceptualization of risk related to CHD for consistency, adequacy, and meaning.

Mock webpage: an innovative assignment for second-degree nursing students.

Abstract: Generating challenging and meaningful academic assignments for nursing students in which the student manages the technology used to deliver information is needed for accelerated second-degree nursing students. Developing those assignments is critical for keeping accelerated second-degree students engaged in the learning process. They are highly motivated, self-directed learners who have been found to have a preference for teaching-learning experiences that incorporate the use of technology. This paper describes the development of a mock webpage assignment to meet the learning needs of accelerated second-degree nursing students.

Fatigue among older people with pain--a neglected problem?

Abstract: The frequency of fatigue among older people (both with and without chronic pain) and its major impact on daily life indicate the urgent need for further research about fatigue, the mechanisms behind it, as well as interventions to alleviate it. Such interventions are necessary to promote health, improve quality of life, and provide opportunities for successful aging.

Musings From Nicaragua: My Second Year and Counting

Abstract: PROBLEM. To create, organize, and implement an international experience for students in a baccalaureate nursing program. METHODS. Returning to Nicaragua after a year, I was confronted with the loss of a friend there who had exhausted treatment options for her breast cancer. Reflecting on this and other realities of healthcare delivery provided a poignant lesson for the author and students in the realities of health care in a developing nation. FINDINGS. International experiences are life changing for students preparing to be nurses and enrich their professors. CONCLUSIONS. International experiences stay with us well beyond the limited time we get to spend in another culture. They have the potential to inspire us to continue to work and serve in the global health community. Our experiences also solidified my commitment to return and to explore more opportunities to both teach and learn from Nicaragua's people with whom we have the privilege to work.