This paper aims to present a theoretical account of professional nursing challenges involved in providing care to patients suffering from chronic obstructive pulmonary disease. The study objectives are patients' and nurses' expectations, goals and approaches to assisted personal body care.
The provision of help with body care may have therapeutic qualities but there is only limited knowledge about the particularities and variations in specific groups of patients and the nurse-patient interactions required to facilitate patient functioning and well-being. For patients with severe chronic obstructive pulmonary disease, breathlessness represents a particular challenge in the performance of body care sessions.
We investigated nurse-patient interactions during assisted personal body care, using grounded theory with a symbolic interaction perspective and a constant comparative method.
Twelve cases of nurse-patient interactions were analysed. Data were based on participant observation, individual interviews with patients and nurses and a standardized questionnaire on patients' breathlessness.
Nurses and patients seemed to put effort into the interaction and wanted to find an appropriate way of conducting the body care session according to the patients' specific needs. Achieving therapeutic clarity in nurse-patient interactions appeared to be an important concern, mainly depending on interactions characterized by: (i) reaching a common understanding of the patient's current conditions and stage of illness trajectory, (ii) negotiating a common scope and structuring body care sessions and (iii) clarifying roles.
It cannot be taken for granted that therapeutic qualities are achieved when nurses provide assistance with body care. If body care should have healing strength, the actual body care activities and the achievement of therapeutic clarity in nurses' interaction with patients' appear to be crucial.
The paper proposes that patients' integrity and comfort in the body care session should be given first priority and raises attention to details that nurses should take into account when assisting severely ill patients.
To examine the psychometric and unit of analysis/strength of culture issues in patient safety culture (PSC) measurement.
Two cross-sectional surveys of health care staff in 10 Canadian health care organizations totaling 11,586 respondents.
A cross-validation study of a measure of PSC using survey data gathered using the Modified Stanford PSC survey (MSI-2005 and MSI-2006); a within-group agreement analysis of MSI-2006 data. Extraction Methods. Exploratory factor analyses (EFA) of the MSI-05 survey data and confirmatory factor analysis (CFA) of the MSI-06 survey data; Rwg coefficients of homogeneity were calculated for 37 units and six organizations in the MSI-06 data set to examine within-group agreement.
The CFA did not yield acceptable levels of fit. EFA and reliability analysis of MSI-06 data suggest two reliable dimensions of PSC: Organization leadership for safety (alpha=0.88) and Unit leadership for safety (alpha=0.81). Within-group agreement analysis shows stronger within-unit agreement than within-organization agreement on assessed PSC dimensions.
The field of PSC measurement has not been able to meet strict requirements for sound measurement using conventional approaches of CFA. Additional work is needed to identify and soundly measure key dimensions of PSC. The field would also benefit from further attention to strength of culture/unit of analysis issues.
When doing secondary data analysis, it is not uncommon to find that a key variable was not measured. Often the researcher has no option but to do without the missing indicator, but when nearly parallel datasets exist, the researcher may have other options. In an earlier article leading up to this special issue, this research team was confronted with the problem that research utilization had been measured in only one of two similar datasets, namely, in the 1996 but not the 1998 Alberta Registered Nurse survey. The 1998 dataset had a larger sample size (6,526 compared to 600 nurse respondents in 1996) and a stronger set of measured variables, but was missing the key variable of interest--research utilization. To overcome this, a regression-based strategy was used to create a research utilization score for each nurse in the 1998 survey by exploiting the availability of several anticipated causes of research utilization in both datasets. Presented here is an alternative and more complicated procedure that might be applied in future investigations. The article presents a methodological understanding of how to use a phantom variable to account for the unmeasured research utilization variable in a two-group structural equation model. This approach could be used to overcome several of the limitations connected to using a regression-based approach to creating a key missing variable when nearly parallel datasets are available.
Comment On: Nurs Res. 2006 May-Jun;55(3):149-6016708039
To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture.
Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control).
A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop.
Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture.
A statistically significant improvement in one of three safety culture measures was shown for the study group (p
Cites: Qual Saf Health Care. 2002 Mar;11(1):40-412078368
Cites: Health Aff (Millwood). 2002 May-Jun;21(3):80-9012026006
Increasingly, nurses are expected to systematically improve their practice according to principles of evidence-based practice (EBP). In 2009, the Norwegian Radium Hospital, inspired by the EBP nursing model at its sister institution, The University of Texas MD Anderson Cancer Center, began transitioning its oncology nurses to an EBP model. Norwegian Radium Hospital nursing leaders selected an EBP expert to design an EBP educational program. The program consisted of a 1-semester, 15-credit-hour postgraduate EBP course followed by a clinical practicum during which selected nurses worked in groups to apply principles of EBP to challenging clinical questions. As of this writing, 60 staff nurses have completed the program. Nurses participating in the EBP program have developed 13 evidence-based clinical guidelines, evidence-based clinical procedures, and patient information documents, 9 of which have been adopted as national standards. Participants have demonstrated increased confidence in providing the best available patient care, deeper reflection about their practice, and a sense of being valued by their nurse and physician colleagues. At the institutional level, the EBP project has resulted in higher confidence that patients are receiving patient-centered care based on the best scientific evidence. The project has also resulted in increased collaboration between nurses and other practitioners within multidisciplinary clinical problem-solving teams. This successful EBP program could serve as a model for other cancer hospitals desiring to move to an EBP patient-care model, not only for nursing practice but also, more broadly, for delivery of cancer care by diverse multidisciplinary teams.
To identify factors which may influence attitudes to spiritual care, test the relevance of these identified influencing factors in a Swedish nursing context, and replicate a part of a previous study by Strang et al. (Journal of Clinical Nursing 2002;11:48-57) dealing with attitudes to spiritual care in a holistic perspective. A questionnaire was handed out to all nursing staff at a Swedish oncology clinic (n=93) excluding the radiation therapy ward. Data were obtained from 68 nurses or nursing auxiliaries.
(i) Literature review of international research reports concerning spiritual care in a nursing context. (ii) Construction of a questionnaire comprising 17 questions with given alternatives based on the previous literature study. (iii) Operationalization of the concept 'attitudes to spiritual care' into some more easily measurable questions through identification in earlier research reports of conceivable indicators of attitudes to spiritual care. (iv) Construction of a suggestion for a definition of the concept 'spiritual care' from the results of Strang et al. (2002) to be used in the questionnaire. (v) Statistical analysis of the data from the questionnaire and a comparison with previous studies.
The replicating part of the study are mainly in accordance with Strang et al. (2002) and lead to the conclusions that holistic care (i) is desirable, (ii) should include spiritual needs of the patients and (iii) is not yet realized in Swedish health care. The identified influencing factors are relevant in a Swedish nursing context. The factors influencing the largest number of indicators of attitudes to spiritual care are 'non-organized religiousness' and 'degree of comfort while providing spiritual care'. Other influencing factors are: 'belief in God', 'belief in life after death', 'organized religiousness', 'profession', and 'the perceived degree of education in spiritual care'.
Knowledge of attitudes towards spiritual care among nursing staff and factors influencing these attitudes will improve the possibilities of meeting the spiritual needs of patients.
The purpose of this study was to identify barriers and facilitators influencing the implementation of an interactive Internet-portal application for patient education in psychiatric hospitals.
The data were collected from nurses by means of a questionnaire with thematic open-ended questions. The data was analysed using qualitative content analysis.
Four main categories were formed to describe barriers and facilitators of portal implementation in psychiatric wards. These categories were organisational resources, nurses' individual characteristics, patient-related factors and portal-related factors. Some major barriers were identified restricting the use of the portal in patient education: lack of computers, lack of time for patients, nurses' negative attitudes towards computer use and lack of education. The main facilitators for portal use were appropriate technological resources, easy Internet access, enough time for portal use, and level of motivation among staff to use computers.
The specific challenge in achieving patient education with the computer in psychiatric care is to ensure technological resources and that the staff are motivated to use computers. At the same time, attention should be paid the relationship between patient and nurse.
It is important to examine the patient-nurse relationship in the education process and also to define the usability of the application from the patients' point of view.
Epicardial pacer wires inserted at the time of cardiac surgery are routinely removed prior to discharge. Traditionally, in most centres in Canada, this task has been carried out by physicians. Delays in discharge, insufficient patient preparation and inadequate monitoring practices post-wire removal have led to a need for a change in practice. The aim of this article is to present the development, implementation and evaluation of a project in which all bedside nurses on a post-operative cardiac surgery unit remove patients' epicardial pacer wires.
Comment In: Can J Cardiovasc Nurs. 2007;17(1):3-417378517
More than half of hospitalized older adults will experience delirium, which--if left untreated--can lead to detrimental outcomes. Despite the prevalence and severity of delirium, nurses recognize less than one third of cases. Because little is known about how nurses manage this problem, a qualitative study was conducted to explore how nurses care for hospitalized older adults at risk for delirium. The data revealed that nurses care for older adults byTaking a Quick Look, Keeping an Eye on Them, and Controlling the Situation. The context in which nurses choose their priorities and interventions was reflected in the themes of the Care Environment and Negative Beliefs and Attitudes about older adults. Nurses are caring for an older population whose care requirements are different than those of younger people and in a context where this challenging work is rarely addressed. To improve care, the older population must be acknowledged, and nurses must possess the knowledge and resources needed to meet this population's unique needs.