This article analyses problem situations in the context of anaesthesia care. It considers what it means for nurse anaesthetists to be in problematic situations in the anaesthesia care of older patients. Benner's interpretive phenomenological approach proved useful for this purpose. Paradigm cases are used to aid the analysis of individual nurses' experiences. Thirty narrated problematic anaesthesia care situations derived from seven interviews were studied. These show that experienced nurse anaesthetists perceive anaesthesia care as problematic and highly demanding when involving older patients. To be in problematic anaesthesia care situations means becoming morally distressed, which arises from the experience or from being prevented from acting according to one's legal and moral duty of care. An important issue that emerged from this study was the need for an ethical forum to discuss and articulate moral issues, so that moral stress of the kind experienced by these nurse anaesthetists can be dealt with and hopefully reduced.
OBJECTIVES: This study was designed to investigate attitudes to and incentive for reporting adverse drug reactions (ADRs) in general and towards nurses as reporters of ADRs in particular in a sample of hospital physicians. METHOD: A questionnaire was sent to 1,201 randomly selected hospital physicians. RESULTS: The main factors for the decision to report an ADR were the severity of the reaction, a reaction to a new drug, and an unusual reaction. The most important factor for refraining from reporting was that the reaction was well known. There were no significant differences between males and females or between age groups in these aspects. A majority were positive or neutral to nurses as reporters. Only 6% stated that their willingness to report ADRs would be affected in a negative way if nurses were involved in the program for reporting. CONCLUSIONS: The results of this survey showed that inclusion of hospital nurses as reporters will not decrease the reporting rate from the physicians.
PURPOSE: To describe the attitudes of female nurses and female resident physicians toward each other in surgery, internal medicine, obstetrics-gynecology, and emergency medicine in one Midwest teaching hospital in the United States. METHOD: Using a qualitative methodology, 51 women were interviewed in 2002: 28 nurses and 23 residents. Questions were asked to determine if and how female nurses and female residents believed gender was a factor in their interprofessional relationships, how each described their relationship with the other, the kind of assistance female nurses provide to female residents, the kind of assistance sought by female residents, and the strengths and challenges of the female nurse-female resident relationship. Data were analyzed using NUD*IST software. RESULTS: Consistent with similar studies conducted in Norway and Australia, the results include the following: For female nurses, occupation is secondary to gender, which is to say that gender is the most important link between female nurses and female residents. For female residents, gender is secondary to occupation/occupational status. CONCLUSIONS: With the number of female residents increasing each year in hospitals, this relationship should be further examined so that dysfunctional communication patterns between the two groups can be challenged.
Despite all efforts, recruitment of healthcare personnel has become increasingly difficult in Greenland as in other remote areas. The aim of this observational study was to describe the extent of health care delivered by nurses in Greenland's healthcare system. Reasons for encounter, diagnostic procedures, treatments and need for a physician's assistance, as well as the nurses' self-perceived competency, were also analysed.
A total of 42 nurses registered all patient encounters for 10 days in late autumn 2006 in 14 out of 16 healthcare districts in Greenland.
Nurses treated 1117 encounters (60%) singlehandedly. The nurses felt competent in what they were doing in 1415 encounters (76%). In 525 encounters (31%), a physician's advice was sought. Either the physician was asked to come or the physician's advice was obtained by telephone. In four cases the nurses did not feel completely competent, but did not seek advice from the physician on call. Feeling competent did not depend on length of experience in Greenland.
In Greenland, nurses independently receive, diagnose and treat a substantial number of primary healthcare patients. The nurses take care of the patients and perform a number of clinical and laboratory procedures with great confidence. There has been speculation that part of the difficulty in recruiting doctors and healthcare personnel in remote areas may be due to uneasiness about professional responsibilities and, to some extent, lack of confidence. At least among the registering nurses in this study, this did not seem to be a problem.
The aim of the study was to acquire a deeper understanding of what it is to be an intensive care nurse in situations related to questions of withholding or withdrawing curative treatment.
Nurses in intensive care units regularly face critically ill patients. Some patients do not benefit from the treatment and die after days or months of apparent pain and suffering. A general trend is that withdrawal of treatment in intensive care units is increasing. Physicians are responsible for decisions concerning medical treatment, but as nurses must carry out physicians' decisions, they are involved in the consequences.
The research design was qualitative, based on interpretative phenomenology. The study was carried out at an adult intensive care unit in Norway. Data were collected by group interviews inspired by focus group methodology. Fourteen female intensive care nurses participated, divided into two groups. Colaizzi's model was used in the process of analysis.
The analysis revealed four main themes which captured the nurses' experiences: loneliness in responsibility, alternation between optimism and pessimism, uncertainty--a constant shadow and professional pride despite little formal influence. The essence of being an intensive care nurse in the care of patients when questions were raised concerning curative treatment or not, was understood as 'being a critical interpreter and a dedicated helper.'
The findings underpin the important role of intensive care nurses in providing care and treatment to patients related to questions of withholding or withdrawing curative treatment.
The findings also show the need for physicians, managers and intensive care nurses themselves to recognize the burdens intensive care nurses carry and to appreciate their knowledge as an important contribution in decision making.
The delivery of cancer care in Ontario is facing unprecedented challenges. Shortages in nursing, as in all professional disciplines, are having an impact on the delivery of cancer care. Oncology nurses have a major role to play in the delivery of optimum cancer care. Oncology nursing, when adequately defined and supported, can benefit the cancer delivery system, patients, and families. A primary nursing model is seen as being key to the delivery of optimum cancer care. Primary nursing as a philosophy facilitates continuity of care, coordination of a patient's care plan, and a meaningful ongoing relationship with the patient and his/her family. Primary nursing, when delivered in the collaboration of a nurse-physician team, allows for medical resources to be used appropriately. Defined roles enable nurses to manage patients within their scope of practice in collaboration with physicians. Enacting other nursing roles, such as nurse practitioners and advanced practice nurses, can also enable the health care system to manage a broader number of patients with more complex needs. This article presents a position paper originally written as the basis for an advocacy and education initiative in Ontario. It is shared in anticipation that the work may be useful to oncology nurses in other jurisdictions in their efforts to advance oncology nursing and improvement of patient care.
An estimated 250,000 Canadians are infected with the hepatitis C virus (HCV). The present study describes a cohort of individuals with HCV referred to community-based, integrated prevention and care projects developed in British Columbia. Treatment outcomes are reported for a subset of individuals undergoing antiviral therapy at four project sites.
Four demonstration projects based on a public health nurse and physician partnership were established in rural and small urban centres in British Columbia. Comprehensive medical assessments determined whether individuals received treatment, or counselling and education. Outcomes of the treatment group were compared with published randomized controlled trials. Client demographics were mapped using geographical information systems applications.
A total of 1795 individuals were referred to the clinics for medical assessment between September 2001 and December 2005. After assessment, 26% were eligible for therapy, while 74% received counselling and education. Wait times decreased annually, with one-half of all referrals assessed within 30 days. Combination antiviral therapy was initiated in 363 clients with interferon plus ribavirin (n=36) or pegylated interferon plus ribavirin (n=327). Treatment outcomes were available for 205 individuals. The overall rate of sustained virological response was 61% (126 of 205 individuals). The number of individuals assessed at each site represented, on average, 20% of the total cumulative reported HCV cases in the catchment areas.
The study findings illustrate how a public health nurse and physician partnership can service a population with complex medical needs while simultaneously increasing local capacity. Treatment outcomes were comparable with published clinical trials.
A deficit situation prompted Hôtel-Dieu Grace Hospital in Windsor, Ontario to examine aspects of the funding process. A review of charts suggested that the documentation in the patient record did not accurately reflect the care given. Improving the documentation could potentially improve hospital revenue. This approach has been successfully used in the U.S., but is not reported to have been implemented widely within the Canadian setting. Coached by an American team, three experienced nurses were trained to work with physicians to explore opportunities to improve their documentation, and to work with the Health Records Technicians to optimize the accuracy of their efforts. Results demonstrate that such an initiative could impact behavioural changes in the hospital setting, and that such changes could impact hospital revenue. Realizing that front-line staff could actively participate in financial recovery was very empowering.