Considering nursing resource as "caring time'

The present constrained economic climate faced by health care agencies underscores the need for nurse administrators to have an in-depth appreciation of how nursing services are being used. The purpose of this investigation was to increase the understanding of nursing as a resource. Using phenomenological research methodology, the investigator purposefully selected six patients and a chain sample of 14 professionals responsible for their care, including nurses, nurse managers and physicians. Data collection methods included in-depth interviews, document reviews, and participant observation. The inductive interpretation depicts the nature of nursing resource to be "caring time'. Caring was understood primarily in terms of time and was experienced by all participants as "spending time'. Caring time was spent through "being with' and "doing to/doing for' the patient. Study participants experienced tension with regard to how best to spend precious "caring time'. Nursing resource was inextricably linked to both quantitative and qualitative expressions of nursing, and "being with' patients was a highly valued, under-allocated, and unintentionally provided component of nursing resource. The researcher concluded that nursing administrators, nurse managers and practitioners all have leadership roles to play in achieving recognition, allocation and promotion of caring time within their agencies.     

Caring

Many nurse scientists consider caring to be the core concept of nursing practice. This article describes the caring process that occurs when a nurse and a client interact in a nursing care situation. This interactional process has five integrating phases: co-presence, experience-sharing, caring acts, caring-perception, and mutual care-receiving. The authors provide a specific example that illustrates this caring process. The difficulties inherent in the caring process relate to one, or a combination of, three factors: the nurse, the client, and/or the circumstances. Nurses must be cognizant of the client's expression of subtle clues that indicate the need for caring. They also need to learn to recognize their own personal signals that might prevent them from engaging in the caring process. For caring, in its full context, can only occur when nurses know how to care for themselves. Nurses face unpredictability and challenges in their practice on a daily basis. In order to promote caring they must learn to promote an environment that nurtures this process. The authors discuss the essential characteristics of a favorable caring environment and present the conditions that can enhance quality nursing. The challenges that caring nurses face are counterbalanced by the value they attribute to this basic human need and the profound human benefits that caring brings.     

CD4(+) T cells tolerized ex vivo to host alloantigen by anti-CD40 ligand (CD40L:CD154) antibody lose their graft-versus-host disease lethality capacity but retain nominal antigen responses

Health care reform in Hong Kong in the 1990s has brought about dramatic change to the nursing discipline. This paper reports an ethnographic study which aimed at exploring the transformation of nursing in a regional hospital in Hong Kong during this period of reform. In the study, the restructuring of nursing work, its associated dynamics and resulting impacts upon the nursing profession were examined. A methodological triangulation approach to data collection encompassing interviews, participant observation and review of documents was used. The findings in this study suggest that the majority of nurses working in the case study hospital continue to be subject to medical dominance and are under management control. The emphasis on cost-effective care has however, fostered qualified nurses to claim more ownership of their professional judgement and autonomy. The health care reform has confirmed the status of two newly established groups of nurses, the nurse specialists and nurse managers. The development of the nursing profession is found to be closely connected to its work development. The preparation of the new generation of nurses, as revealed in this study, needs to emphasize the cognitive dimension of the professional competence. Some nurses need to be further educated in specialist practice and clinical management to maximize the contribution of nursing in health care delivery.     

Inhibition of hepatic inositol 1,4,5-trisphosphate receptor function by ethanol and other short chain alcohols

OBJECTIVE: To formulate the fundamental structure of caring as lived by Critical Care Nurses. DESIGN: Colaizzi's phenomenological research method and Diekelmann's dialogue technique were applied. SETTING: The home of each nurse constituted the setting for the interview. The nurses were employed in critical care units in six large metropolitan hospitals in the Southwest. SAMPLE: The availability sample consisted of 15 female critical care registered nurses. The nurses' mean age was 35 years. The mean number of years in critical care nursing was 4.7. One nurse was Asian, one was Hispanic, and 13 were Caucasian. RESULTS: Caring was composed of affective, cognitive, action, and outcome subprocesses. The caring process originated in the nurse's feelings and knowledge, and moved the nurse to competent actions that contributed to patient, family, and nurse outcomes. CONCLUSIONS: Understanding of the process of caring was strengthened by the findings. The decision process used by nurses would benefit from further examination for the presence of the affective and nurse outcome subprocesses.     

A triangulation approach to the identification of acute sector nurses' training needs for formal nurse practitioner status

The current confusion surrounding the definition and role function of the nurse practitioner (NP) has created a situation in which advanced clinical practice is delivered in a variety of ways and at many levels. Not surprisingly, this has led to difficulties in regulating educational provision for NPs. This study reports a survey of the perceptions of the role definitions and training needs of all nurses working at advanced clinical levels within an acute sector Trust. Although this concept is not a novel one in advanced nursing practice, the procedure adopted differed from previous studies in two fundamental ways: firstly, a unique training needs assessment instrument was used, which because of its validity and opacity, was capable of yielding a highly reliable data-base, comprising a prioritized profile of real training needs as opposed to the standard wish-list typically elicited. Secondly, it did not rely simply on the self-reported needs of the nurse sample, but also included the perceptions of the sample's immediate medical and managerial colleagues. In this way, a triangulation paradigm was adopted. The results indicated that overall, there was high agreement between the nurses and their managers, regarding both the definition of the NP role and the essential training requirements, with somewhat different opinions being offered by the medical staff. When the raw scores were standardized to correct for response bias, the data provided an operational definition of the role of the NP and a prioritized profile of training needs for nurses who wished to train to this level.     

Philosophy of nursing: future directions

At a time when psychiatric nurses in Australia face the changes brought about by the transfer of nursing education to the universities, it is timely to reconsider the knowledge base of the profession, not from the perspective of any one theoretical position, but by reflecting on a fundamental division in the way nursing is thought about. Many nurse theorists argue for a shift away from conceptions of nursing based on medicine and science. The alternative, idealism, brings with it a new set of problems, particularly the tendency to react against the perceived dominance of the medical profession instead of positing a philosophy of nursing that reflects a more considered response. The argument developed here begins by aligning medicine and related conceptions of nursing with materialism. This leads to a consideration of the relevance of philosophical positions on the nature of body and mind, that is then linked to the assumptions of medicine and nurse theorists. Introduction of the concepts of holism and interactionist dualism follows. The implications of these concepts for psychiatric nursing are drawn out by using conceptions of the objective and rational. Finally, it is argued that interactionist dualism enables psychiatric nurses to be sensitive to the experiences of patients while still acknowledging the importance of objective knowledge.     

The apparent desensitization of student nurses during their professional socialization: a cognitive perspective

It is argued that the structures and processes of traditional patterns of pre-registration nurse education in the United Kingdom led to an apparent and relative desensitization of student nurses to human need. The processes underpinning this apparent desensitization were those which promoted both a 'compartmentalization' of concepts for theory and concepts for practice in the cognitions of student nurses and their habituation to examples of poor nursing practice. These processes are described and their nursing pedagogical implications are discussed. It is suggested that unless clinical learning environments are deliberately manipulated to foster the construction and utilization of 'appropriate' action schemata, the considerable opportunities offered by the implementation of Project 2000 to improve both nursing education and nursing practice could be wasted. It is further suggested that this deliberate manipulation should include nurse tutors teaching theory and practice in clinical areas if they are seriously concerned to render nursing care more intelligently responsive to human need.     

Nursing informatics educational needs

A survey was conducted among 497 respondents in a northeastern metropolitan area to determine the informatics educational needs of professional nurses. All subjects were asked to indicate on a four-point scale their current knowledge and their desired knowledge in 23 content areas. The population was subdivided into three subsamples based on job classification. There were differences in the informatics educational needs of nurse educators, nurse managers, and informatics nurses. There was interest in returning to school for a graduate degree or certificate in nursing informatics by a majority of the sample, although 71% of the respondents already possess a higher degree.     

Regulation of rat neuronal voltage-dependent calcium channels by endogenous p21-ras

Clinical teaching behaviour is a critical determinant for quality clinical learning experiences of student nurses. It is believed that a better understanding of the perceptions of clinical teaching behaviours between student nurses and nurse educators will enhance clinical teaching. This study examined the perceptions of effective clinical teaching behaviours of nurse educators by student nurses (n = 81) and nurse educators (n = 10) in a hospital-based 3-year general nurse training programme in Hong Kong. Knox & Mogan's Nursing Clinical Teacher Effectiveness Inventory (NCTEI) (1985) was adopted. The respondents were asked to rate the importance of each discrete behaviour on a seven-point scale. It was found that there was greater agreement in the 10 most important behaviours than the 10 least important behaviours among the four groups: students, junior students, senior students and nurse educators. No statistically significant difference could be identified in the perceptions between the nurse educators and students as well as between the junior and senior students regarding the five behavioural categories. The nature and the student status of the nursing programme was accountable for most of the discrepancies between the findings of this study and those of past studies.     

Role orientation in novice home healthcare nurses

The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.     

Challenges associated with assessment of risk for tuberculosis in a dental school setting

The Ballarat Health Education Forum has the express purpose of identifying and responding to the educational needs of registered nurses (RNs) in western Victoria. Since the senior nurse members of the forum believed that there was a strong need for management education amongst the nurses involved in middle management in the target region, the total nursing population was surveyed to determine if that perception was shared by RNs themselves. Results of the study confirm that educative programs in management are viewed as a high priority for the professional development of nurses but that family and work commitments are dominant factors which hinder participation. It is argued that education for the managerial role into which many nurses are thrust is sporadic and bereft of appropriate content. Background to the issue of management skills and training among RNs is provided and survey methodology and outcomes are described. The paper discusses the implications of survey outcomes and makes recommendations based on findings.     

Microscopical imaging of hydroxyapatite/mica composite and packed hydroxyapatite structure--an atomic force microscopy investigation

A focus on the importance of leisure in the development of student nurses has been neglected in the 1990s. This study considers 444 prospective nurses on conventional, diploma and degree courses in two areas of England. It examines their activities associated with socializing, their social support networks and their use of clubs, sports and hobbies before entering nursing. It is evident that students enter nurse training with a wide variety of leisure experiences. Changing recruitment patterns and the structure of nurse training has an effect on the leisure needs of prospective nurses which must be addressed.     

Informatics nurse specialist: roles in health care organizations

The cost of managing and processing health care information is a significant component of hospital operating budgets, yet health care lags far behind other industries in the effective use of information technology. As nurses are the largest group of users of health care information, improving nurses' information management capability could have a significant impact. Informatics nurse specialists understand the concepts and technology of nursing information management and can provide operational and strategic benefits to nursing organizations. In this article, educational preparation, certification, and roles of informatics nurse specialists are discussed along with functions of health care information technology and nursing informatics.     

Investigations of antisense oligonucleotides targeted against bcl-2 RNAs

The purpose of this article is to describe how nurse instructors understand nursing and the necessary conditions for high quality nursing care. The approach of the study was inductive and based on phenomenology and a sociological field research method, i.e. grounded theory. It emerged that the core of nursing is a process, termed here caring, with three stages. Three types of caring emerged. Understanding the client, the art of nursing, co-operation between the nurse and other health care professionals were found to be necessary conditions for a high quality nursing care and it was also found that it is not possible to separate caring from the society and its history.     

Changes in hospital nursing care due to the Brazilian Unified Health System

Considering changes in the Health System, this survey analyses the view of 31 nurses from a hospital institution linked to the Brazilian Unified Health System (SUS) in order to learn how they face the changes and their actions in 1995. To better understand the content of the interviews, authors use a thematic analysis proposed by BARDIN (1977). This analysis shows that some nurses recognize a different action after the SUS inclusion and others do not. However, when their actions are analysed as a whole, they are mainly directed to be a physician complementary action. The inadequate management by the nurse has contributed for a not entire nursing care. Authors suggest the management improvement of nurses in order to redirect nursing actions.     

The hidden illness of endoscopy patients: mental health disorders, Part I

Because nearly half of all adults experience some mental health disorders in their lifetime, many endoscopy patients must have psychiatric problems along with their gastrointestinal (GI) illnesses. In addition, all patients undergoing an endoscopic procedure experiences some degree of apprehension and worry; anxiety itself is a major factor in most mental illnesses. Endoscopy nurses are very good at establishing rapport quickly with patients and learning about the patient's health history from all the available sources of information. These nurses spend much of their time teaching, listening, reassuring, and caring for people undergoing GI procedure, and these same skills are an important part of the care in mental health disorders. A series of case studies of GI patients in a busy endoscopy department document and summarize the mental health disorder each experienced and the pertinent care given by the GI nurse during an endoscopy or gastric laboratory procedure. Although it is inappropriate for endoscopy nurses to attempt to diagnose major psychiatric disease or provide psychiatric interventions for these patients, their nursing care and reassurance enable the patients to successfully complete their GI procedures.     

The origin and mode of fibroblast migration and proliferation in granulation tissue

The professions of nursing and medicine are committed to interprofessional education, in the belief that through this, patient care and satisfaction will be improved. Most initiatives involving nurses have been at post-qualification level, in primary health care, and concerning interpersonal or information management skills. Much of this collaboration has been with professions allied to medicine or social services. This paper discusses an innovative programme of shared learning in acute care, involving final year medical students and newly qualified staff nurses. The programme, developed in response to the blurring of professional roles between nurses and junior doctors, took place in our interprofessional Clinical Skills Centre. It was based around a developing patient scenario which was pertinent to the participants' area of practice. Each session was led by an experienced nurse lecturer and doctor, supported by specialist contributors. The style of learning was participative, with small interprofessional groups addressing a range of patient management issues. In this way, relevant clinical and communication skills were integrated within the context of holistic patient care. The course was well evaluated by both professional groups of participants and their managers. Subsequent research and curriculum development are leading to the expansion of this successful initiative.     

Chronic intrarenal infusion of low-dose angiotensin II in dogs increases arterial pressure without impairment of renal function

In an effort to be a good manager, it is easy to lose sight of the fact that knowledge workers require a unique approach from their manager. Because nurses are independent and capable individuals that prosper in an environment that recognizes them as knowledge workers, nurse managers often find that traditional management techniques are not sufficient. Trying to manage all of the nurses on a unit as a single group is much like trying to herd cats. It might be less frustrating for the nurse manager to lead gently rather than manage with a firm hand. Warren Bennis suggests that this approach may provide a valuable key to successfully managing in a world of constant change.