Nurses' knowledge and opinions about the nursing research process in The Netherlands

Nursing research is just gaining ground in The Netherlands, as it is in every European country. Therefore, this study had the purpose of discovering to what extent Dutch nurses in the clinical areas have acquired research-based knowledge since it was introduced into the country, in the 1970s. Questionnaires, which included provision for demographic data, were distributed to 110 nurses, comprising head nurses, recently qualified nurses and final-year student nurses. A 65% response was achieved and the findings revealed that nursing research as a concept was not new to the Dutch nurses. They claimed they had obtained their knowledge through nursing training, reading, conferences and other sources such as mass media. The head nurses were the most knowledgeable followed by the recently qualified nurses and then the student nurses. However, the respondents claimed that their knowledge was superficial. The need to extend nurses' knowledge through support and encouragement in relation to nursing research seminars and conferences is recommended.     

Research in long-term care: what do we know, what can we use?

Urinary incontinence is a significant problem for nurses in long-term care. However, there is sufficient research to show that it is a treatable condition, Risk and associated factors have been identified. Impairments in mobility and cognition play a role in the development of incontinence and must be addressed in any strategy used to prevent incontinence from occurring in dry residents. Nurses must become comfortable in reading research reports and applying the findings to their facility. Using assessment techniques, including a voiding record and determining whether an individual is appropriate for one of the several behavioral techniques, are critical nursing actions. Administrative support including the delegation of authority and provision of resources is necessary as nurses change practice from traditional methods to evidence-based practice.     

Developing a patient education program: overcoming physician resistance

Scientific expertise in the management of diabetes was an important factor in overcoming physician resistance to the education program. Nurses have expertise, and their expertise must be acknowledged for them to be viewed as leaders. Not only are nurses responsible for sharing their expertise with other nurses, it is equally important for them to share their expertise with the physicians, who may appreciate receiving any information that can help them improve their patients' outcomes. The components that are essential for success in pioneering a new program are good listening skills, a willingness to cooperate, self-confidence, scientific knowledge, vigilance, determination, and a clear vision. Patient outcomes will improve when nurses use their scientific knowledge base and leadership skills through patient-centered nursing practice, planned change strategies, and advanced practice nursing.     

Do nurses have the information resources and skills for research utilization?

While access to information resources and the skills to use them do not ensure that nurses will use nursing research in their practice, they are important facilitators. Mailed questionnaires to assess existing information resources, the information management skills of nurses, and what additional resources and training are required were returned by 67 of the 71 vice-presidents or directors of nursing in hospitals in two regions of Ontario. The two regions have similar information resources, nursing staff with research expertise, and opportunities for training in research and information management but there is variation among hospitals. Most vice-presidents agreed that nurses need better information resources and skills to access and evaluate professional literature. The rapidly developing field of information technology, including the Internet, provides potential for sharing resources and expertise. Nursing administrators can minimize barriers and help staff nurses recognize that information management skills enhance professional development and improve patient care.     

Preserving moral integrity: a follow-up study with new graduate nurses

The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow-up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the 'real world' of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho-social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one's moral convictions. Data supported that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.     

Catharsis: an investigation of its meaning and nature

Nurses commonly use catharsis and cathartic techniques as part of their clinical practice to enable clients and themselves to release emotion, to feel better and to facilitate coping. However, the literature does not provide clinical nursing evidence for its use. The main purpose of the investigation is to examine the beliefs about and understanding of catharsis which two groups of nurses hold: one group of nurse teachers and one group of nursing students. One hundred and forty-two respondents completed self-administered questionnaires asking about their understanding of and beliefs about catharsis as being beneficial, social, negative or psychotherapeutic in nature. The possible relationship of their answers to age, sex, philosophical orientation and qualifications was deemed to be important. The results suggest nurses understand that catharsis is related to emotion and has a psychotherapeutic purpose. However, there appear to be gaps in their understanding. Nurses also seem to believe that the release and expression of emotions is more acceptable for women than for men. There is also evidence that the more experienced nurses think differently from less experienced nurses, placing more emphasis on behaviour rather than emotion as they grow older. The problems associated with catharsis are discussed along with the implications for research and practice.     

Stress, seen from outside

This article draws from the vast literature on stress in nursing and discusses the preoccupation that researchers and specialists have with this area. It asks the reader to take a moment to reflect on the types of stressful situations that nurses face on a daily basis. The authors focus on the potential tensions that can ensue following exposure to stress and the resulting psychosomatic, psychological, behavioral and organizational consequences. The authors challenge legislators, governments, administrators, members of the multidisciplinary team and nursing organizations to tackle the issue of stress in nursing and make it a priority. Research conducted during the last 20 years provides overwhelming evidence that nurses work in a high-stress environment. The sources of stress vary and their consequences are significant. However, it is recognized that certain personal factors such as type "A" personality can influence the way nurses deal with stress. Ultimately, the authors conducted their literature review with the aim of proposing anti-stress strategies.     

Impact of clinical information systems on nursing practice. Nurses' perspectives

This article adds to the literature on the impact of computerized clinical information systems by asking nurses important questions about their nursing practices. A research tool was developed from collaborative work with clinicians who have used computers in their daily practice for more than two decades. A statewide study then was conducted on how nurses believed computer technology impacted their practice. This study also examined the different views that computer users and nonusers held. Questions were posed relating to resource consumption, nursing work practices, and professional and patient outcomes. It was found that nurses, whether computer naive or knowledgeable, clearly do not expect the technology to have negative impact on practice. The two groups differed mostly in the strength of their beliefs. One startling outcome, that slow computer response time delayed care, was identified within the computer-user group and direct action was taken as a result.     

The commodification of specialty nurse education

The nexus between tertiary nursing education and employment was strengthened during the 1990s when universities became involved in delivering a plethora of specialty graduate certificates and diplomas which largely replaced hospital-based post-registration courses. These university-based courses can be seen as contributing to the commodification of education as well as the legitimisation of a stratification of nursing knowledge through which biological sciences and experiential knowledge remain privileged. In the development of specialist nurse education courses, it is vital there is an accompanying examination of whose interests are being served by the models adopted. In particular, there is a need to contest the dominance of service needs in shaping nurse education. Rather than continuing to respond with uncritical acceptance of courses that are characteristically highly technical and vocational in nature, nursing needs to explore curriculum models that enable students to choose their course pathways to develop their practice. It is argued that nurse academics are complicit in reproducing power relations which continue to subjugate nurses within medical and economic discourses.     

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.     

Persistence: the key to nursing diagnosis development

Respiratory system evaluation and diagnosis is one basis of physiological assessment. Nurses perform independently and collaboratively in all areas of respiratory nursing, and there is a need to describe what it is they diagnose and how the diagnosis relates to the selected nursing interventions. Nursing diagnosis is an appropriate method to describe patients' responses to illness. Respiratory nurses in all educational, practice, and professional arenas have an opportunity to be involved in research that validates existing respiratory nursing diagnoses and promotes development of specific diagnoses that patients experience.     

A comparison of hospital- and community-based mental health nurses: perceptions of their work environment and psychological health

This study compares hospital- (n = 67) and community-based (n = 55) mental health nurses in relation to their perceptions of the work environment and also their psychological health. Measures include: the General Health Questionnaire, the Maslach Burnout Inventory and the Work Environment Scale. The data, obtained from self-returned questionnaires, show that community nurses rated their work environments higher for the dimensions of Involvement, Supervisor Support, Autonomy, Innovation and Work Pressure. Hospital nurses saw their environments as being higher in (managerial) Control. There were no differences between the groups for the dimensions of Peer Cohesion, Task Orientation, Clarity or (physical) Comfort. Furthermore, there were no overall differences between the two groups in relation to psychological health, although the pattern of factors associated with emotional well-being differed. Finally, analyses of the community data revealed that those nurses with 'flexitime' arrangements evaluated their work environments less positively and showed higher levels of psychological strain than did those working 'fixed-time' schedules. The findings suggest that the hospital and community environments make different demands on nursing staff, and that this should be considered when organizing nursing services if stress is to be avoided.     

The approaches to learning of student nurses in the Republic of Ireland and Northern Ireland

In recent years during a period of change in nurse education, there has been an increased interest in educational theory and nurse educators have examined and questioned the fundamental principles upon which the system of education is constructed. In nurse education it is likely that no single theory of learning can account for all aspects of learning and there are reflections of many learning theories in the nursing curriculum. The literature in the area of student learning is complex and wide ranging and is poorly represented in the nurse education literature. In recognition of a lack of understanding and clarity on learning approaches in nurse education during a period of unprecedented change in Irish and United Kingdom (UK) nurse education, this paper aims to highlight the importance of understanding student nurse learning. A study is described which investigated the approaches to learning of student nurses from the Republic of Ireland, who were receiving a traditional apprenticeship training, and student nurses from Northern Ireland in a Project 2000 programme. On comparative statistical analysis significant differences were identified between the two groups in their approaches to learning. It is concluded that students' constructs of learning in nurse education are primarily dependent on their interpretation of the demands of the task, on assessment, teaching and the learning environment. The study provides nurse educationalists with important evaluative information from the students' perspective. It suggests that the way forward is to identify the significant contextual factors influencing student learning and to incorporate them into the nursing curriculum. Such an approach will serve to focus the system on variability in the quality of learning rather than on stability in human attributes.     

Balanced designs in longitudinal population pharmacokinetic studies

Despite the proliferation of research on primary nursing, most studies have investigated the effects of primary nursing on quality of care, job satisfaction and collegial relationships. Few researchers have attempted to isolate the key dimensions of primary nursing in an observable and measurable form. The purpose of this exploratory study was to devise an audit tool for primary nursing that builds on Mead's research and incorporates views of patients/clients, relatives, nurses and other members of the multidisciplinary team. Preliminary findings suggest that the audit is a useful indicator of the extent to which the crucial elements of primary nursing are present or absent in any clinical setting. Furthermore it suggests that while many wards claim to practise primary nursing there is a considerable variation in the extent to which this is actually carried out.     

Cadmium suppresses delta 9 desaturase activity in rat hepatocytes

This paper challenges contemporary portrayals in the nursing literature of the spaces within which care of patients in hospital settings is conducted. Within the wider discourse of fiscal restraint on health care spending, professional nursing has cast its disciplined eyes on details of the nurse-patient relationship for the ostensible purpose of repairing that which is treated as individual failings of nurses to practice in ways prescribed by nursing theories. Set aside in this approach to the so-called 'problems' of nursing practice has been an examination of the conditions within which nurses come in contact with patients, and a critical recognition that such contacts represent skilled accomplishments of social action. In this paper, these conditions are treated as resources available to both nurses and patients to generate accounts for the nurse's presence as well as the nurse's absence. Examples from an ethnographic study of nursing practice are used to illustrate how the spaces operating between nurses and patients are not empty voids but are social spaces through which particular meanings about nursing care can be conveyed.     

Transcultural nursing practice described by registered nurses and baccalaureate nursing students

Using Leininger's Theory of Culture Care Diversity and Universality as a framework, this research examined transcultural practices of nurses and students. A survey was administered to a convenience sample of registered nurses and senior baccalaureate students with 767 usable questionnaires returned. Neither group expressed confidence in their ability to care for culturally-diverse patients. Registered nurses (RNs) reported assessing cultural factors and modifying practices more frequently than did students. Respondents reported their beliefs about transcultural nursing were influenced by being with people of other cultures, their own personal values, and education. Analysis of the open-ended questions revealed two major themes. First, both nurses and students perceive an overwhelming need for transcultural nursing. Second, nurses and students respond to cultural challenges by modifying their care. Modifications are based on language and communication, pain perception and relief, religious and spiritual dimensions, gender and family roles, and other values. Results suggest that nurses and students are aware of culture, recognize that culture influences the care they provide, and modify their health teaching and nursing care based on culture. The use of a conceptual framework to help make modifications in care was not mentioned.     

Toward successful compliance with JCAHO standard NC.1

Recommendations resulting from a JCAHO survey can be a true blessing as they force nursing departments to assess critically their professional practice and documentation systems. Systematic preparation, begun at least two years prior to the survey, includes Nursing Administration, a Nursing Documentation Task Force and all staff nurses. Educational consultants assigned to each unit bring nurses up-to-date on nursing process and nursing diagnosis. Mock surveys and cross-training in chart review prepare staff nurses for confident participation in the accreditation process.     

Expression of IGFs and their receptors is a potential marker for embryo quality

This paper is based on a one-year ethnographic study that focused on nurse-patient relationships on a ward where therapeutic nursing and professional autonomy were explicit nursing goals. Through participant observation and semi-structured interviews, it was found that nurses, as a team, adopted a highly relaxed form of posture. Their informal and open stance served to emphasize their 'closeness' with patients, supporting nurses' claim of a special role in the healthcare team, and making flesh some of the differences between nursing and medical roles. The interpretation of nurses' bodily practice rested in part on the meanings given to the ward space patients felt the ward to be a private domain in which nurses' informality endorsed their sense of being cared for as if by family, while for medical staff the ward remained a public space in which female nurses tacitly challenged their authority as men through the adoption of a masculine bodily praxis. The paper thus looks at links between the gendered body, the gendered professions of medicine and nursing, and the gendered nature of space. It argues that work on occupational closure has previously privileged the discursive, and suggests that understanding how nurses arbitrate professional boundaries in everyday practice will benefit from consideration of the nurse's body as a point of political resistance.