Declarations by registered nurses from the 1980s: an aid to the understanding of nursing today

This study is part of a more extensive project that aims to rescue significant aspects related to the evolution of nursing care from 1950s until 1990s. This study was developed using the technique of oral declaration by active and retired registered nurses, in the context of a school-hospital from the interior of the S?o Paulo State. The present study particularizes the outcomes regarding to 1980s. As result becomes evident the undertaken effort by nurses in the struggle for profession's recognition and prestige; intense and deep transformations related to nurse's new roles as leadership of the nursing staff and members of the medical team.     

Negotiating the role of the practice nurse in general practice

The debate about the role of the practice nurse is not only about practice nursing per se, but raises broader issues about the organization of primary health care. Two related issues emerge as significant: the role of the practice nurse in providing primary health care; and the effective use of the practice nurse resource in the 'new' National Health Service. This paper, by drawing on material from a qualitative study, specifically examines the type of work performed by practice nurses and the factors that influence this. The responses of practice nurses, general practitioners, Family Health Service Authority (FHSA) advisers, community nurse purchasers and managers of community nursing provider units suggest that a consensus on the future development of practice nursing is unlikely. The different stakeholders emphasized different issues, reflecting their own priorities and backgrounds. Practice nurses' accounts of the future, for example, focused on professional issues. General practitioners stressed the importance of role development which met their General Medical Service responsibilities. Purchasing agencies, provider units and FHSAs adopted a wider perspective and were more concerned to develop an effective and integrated primary health care service. The tensions generated by their different interests and perspectives, and the subsequent organizational and policy initiatives that emerge, will provide the context in which the role of practice nurses will be negotiated.     

Decision-making models of Finnish nurses and public health nurses

This study described nursing decision-making models and variables related to these models. For this purpose a 56-item Likert-type questionnaire was constructed according to the Dreyfus model of skill acquisition as applied to nursing by Benner and information processing theory. The target group consisted of 100 registered nurses working in inpatient clinics and 100 public health nurses working in preventive health care. The decision-making variables explored were nurses' experience, education and knowledge as well as the nature of the nursing task and context. The results revealed four different types of decision-making: (a) unquestioning/questioning decision-making, (b) creative-diversive decision-making, (c) patient/nurse-oriented decision-making, and (d) rule- and situation-based decision-making. The most important factors related to decision-making were experience and the nature of the nursing task and context.     

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.     

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.     

Williams-Richardson vaginopexy. An abdominal suspension operation in prolapse and extensive vaginal descent

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is used by boards of nursing in licensure decision making and must be job related and reflect current entry-level nursing practice. This article describes the rigorous process used to develop the licensure examination for registered nurses.     

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.     

Differentiated levels of nursing work force demand

In addition to reviewing the literature about the extent to which basic nursing education is related to actual nursing practice, this article investigates the extent to which the relationship between nursing practice, education, and experience varies across specific health care settings. The literature presented no consistent or systematic association between type and amount of previous nursing experience and current nursing practice. However, the literature generally provided evidence of a consistent and systematic association between baccalaureate preparation and level of registered nurse (RN) practice. The review of practice and organizational differences across the hospital, nursing home, and ambulatory care sectors suggests that baccalaureate-prepared RNs in hospitals may have a more strongly differentiated role relative to those in nursing homes and ambulatory settings. If baccalaureate-prepared nurses continue to be perceived as capable of more complex and independent practice, and if employers believe that they can increase revenues by increasing the quality of nursing care or can save money by shifting to RNs some responsibilities now held by more costly personnel (such as physicians), then demand for baccalaureate-prepared nurses may increase.     

Emergency nurses investigate their patients' needs

This article reports on a study in which clinical nurses contributed actively to the scientific investigation of the nursing needs of their patients. The study revealed valuable information relating to both the psycho-social needs caused by the accident and the integration of nurses in clinical nursing research.     

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.     

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.     

Disruptive behavior of elderly residents and the use of nursing methods

This study is the first part of a larger research project concerned with disruptive behaviour and the use of physical restraints on elderly nursing home residents. This paper is focused on the types and prevalence of disruptive behaviour among elderly residents, nurses' experiences and the types of nursing interventions employed. Data was collected from nurses of varying qualifications (n = 173) in seven Swiss nursing homes by using a questionnaire. The most frequent behavioural problems reported by nurses were mobility, incontinence, getting dressed, verbal communication, passivity, withdrawal and continual requests. Nurses found physical aggression, continual shouting and verbal abuse the most difficult to manage with. The results also indicated that experiences varied between nurses. In particular, nursing staff always considered disruptive behaviour more disruptive against other residents rather then against themselves. The most frequently used interventions against disruptive behaviour were considering residents' wants and needs, getting close, adjustment to residents' background and organisation of activities. Physical and chemical restraints were also used.     

"Codependency". A disease or the root of nursing excellence?

A hermeneutic phenomenological study was conducted to explore how eight professionally competent nurses experienced and evaluated the relation between their childhood adaptation to dysfunctional families and their nursing careers. From the participants' discussion of this topic, the following themes emerged: escaping difficulties by becoming a nurse, coping roles guide nursing career, sensitivity to the untold, transforming dysfunctional responses, and wounded healers. The study did not support the view that children of alcoholics seek careers in nursing to meet their codependent needs for self-esteem, control, or belonging. Instead, its findings indicate that some children of alcoholics become competent nurses by finding positive application for the coping skills they learn in their families. This indicates that, when working with individuals from dysfunctional families, nurses could support them to create new avenues for their coping skills instead of trying to "exterminate" them because of their "codependent" nature.     

The 1997 Schering Lecture. Quality of life in oncology: nurses' perceptions, values and behaviours

Quality of life is an important dimension of cancer care. Yet, within our current environment of fiscal restraint, restructuring and cancer care system reform, pressures exist which may make it difficult to provide care which attends to issues of quality of life. Oncology nurses are key providers of cancer care and their perspectives on quality of life for cancer patients are very important. In addition, much of the satisfaction oncology nurses experience in their practice emerges from matters related to attending to quality of life issues. Are oncology nurses currently able to incorporate quality of life issues into their daily care of patients? How are they doing so? The purpose of this qualitative study is to identify major themes and dimensions of nurses' perceptions and values related to quality of life and create a profile of the oncology nurse's role in integrating quality of life in nursing practice. A total of 25 oncology nurses in regional cancer centres across Ontario were interviewed. Each semistructured interview was taperecorded and transcribed. Analysis was completed to identify the major themes and dimensions. This presentation will report the findings from the study and will focus on understanding the existing values oncology nurses hold surrounding quality of life, how quality of life is conceptualized, and the patterns of practice and decision-making regarding quality of life.     

Communication and socialisation (1): An exploratory study and explanation for nurse-patient communication in an ITU

This exploratory study was designed to determine the state of communication between conscious, intubated and orientated patients, and nurses in an intensive therapy unit (ITU) and the factors that influence this communication. The aim was to determine whether nurses are able to identify the needs and problems of their patients. This was done by examining characteristics of nurse-patient interactions through participant observation, and exploring nurses' attitudes and knowledge of communication and the nursing process. Dissatisfaction with the nursing process and continual difficulty in communicating with conscious intubated patients by ITU colleagues was the stimulus to investigate the state of nurse-patient communication in the unit where the researcher works. In this paper critical evaluation of previous studies of nurse-patient communication in ITUs is followed by presentation of results of the observations and interviews in this study. The discussion that follows focuses on the socialisation of nurses in 'becoming' ITU nurses related to Bradby's (1990) interpretation of status passage, and the effect that this has on the way in which they communicate.     

Introducing primary nursing: nurses' opinions

This article reports on one aspect of a research project carried out to monitor and evaluate the introduction of primary nursing on four demonstration wards in one health authority. Nursing staff working on the wards were interviewed to identify how the changes were affecting them and their work. Stress questionnaires were also completed by a sample of nurses on the wards. Responsibility and communication--key concepts emerging from the data--are discussed and related to the literature on primary nursing.     

Introduction of wireless, pen-based computing among visiting nurses in the inner city: a qualitative study

The purpose of this qualitative study is to understand how a sample of visiting nurses experienced the practice of home health nursing in the inner city and how they perceived the anticipated introduction of wireless, pen-based computing into their practice. Focus groups were held with visiting nurses 1 week before the introduction of the wireless, pen-based computers. The data were analyzed using Strauss and Corbin's (1990) method for concept development. The following central concepts emerged from the focus groups with visiting nurses: "Missing contact in the field," "Consumption of time writing on forms," "Using the computer to help with the practice of home health nursing," and "Home nursing is a lifeline." These concepts, based on the commentaries by visiting nurses, help one to understand the problems encountered by visiting nurses in the delivery of home health care, identify ways to incorporate evolving technologies to enhance nursing practice, and consider approaches to computer skill acquisition.     

Power or the lack of it in nursing care

Power is required to obtain professional goals. The aim of this study is to clarify the significance of power and the lack of it in the opinions of nurses and in prevailing nursing practice. The power of the nurse was measured by the nurse's own assessment of her/his capability to improve the quality of nursing care. The data were collected from all the registered nurses (n = 179) of five hospitals. The response was 70%. The powerful nurses had more knowledge, were better motivated, implemented policies more often, acted consciously towards nursing goals and collaborated better than the powerless nurses. The results demonstrated that nurses who had enough power possessed both wider and deeper cognitive and moral dimensions and had better skills in human interaction than did the powerless nurses.