Background. Implementing simulation requires a substantial commitment of human and financial resources. Despite this, little is known about the strategies used by academic nursing leaders to facilitate the implementation of a simulation program in nursing curricula. Methods. A constructivist grounded theory study was conducted within 13 nursing programs in Ontario, Canada. Perspectives of key stakeholders (n = 27) including nursing administrators (n = 6), simulation leaders (n = 9), and nursing faculty (n = 12) were analyzed using the constant comparison method. Results. Nursing leaders, specifically nursing administrators and simulation leaders who successfully led the adoption and incorporation of simulation into nursing curricula, worked together and utilized negotiating, navigating, and networking strategies that impacted the adoption and incorporation of simulation into nursing curricula. Conclusions. Strategies that were found to be useful when planning and executing the adoption and incorporation of an innovation, specifically simulation, into nursing curricula provide practical approaches that may be helpful to nurse leaders when embarking upon an organizational change.
Participant observation elicits unique observation data from both an insider's and an outsider's perspectives. Despite the growing tendency to adopt participant observation strategies in health care research regarding health-related beliefs and types of behavior, the use of participant observation in current research is mostly limited to structured clinical settings rather than community settings. In this paper, we describe how we use participant observation in a community health research study with Chinese-born immigrant women. We document discrepancies between these women's beliefs and types of behavior regarding health and health promotion. We further discuss the ethnical, time, and setting challenges in community health research using participant observation. Possible solutions are also discussed.
The incidence of diabetes mellitus is on the rise around the world. Middle Eastern countries will be facing a vast increase in the number of diabetes mellitus cases by 2030. Diagnosis of a chronic disease such as diabetes mellitus can be a shocking and life-altering event. Conversely, a diagnosis of a chronic illness can also offer the patient opportunities to change unhealthy behaviors such as poor diet, smoking, and lack of exercise, making them healthier than before their diagnosis. This is referred to as "benefit finding". This study reveals the many benefit findings of Iranian patients who have been diagnosed with diabetes mellitus and illustrates how benefit finding can be an integral part of long-term patient care.
Aims. This study examines mood and cardiovascular variables related to job stress and burnout in hospital personnel. Main Methods. 400 nurses and physicians from a children's hospital in China were recruited. Participants completed job stress, burnout, and mood state questionnaires. Cardiovascular variables such as body mass index (BMI), triglyceride (TG), and high density lipoprotein (HDL) were measured. Key Findings. Job stress and burnout were significantly associated with mood state. Statistically significant correlations were found between triglyceride levels and job stress scores (r = 0.175, P < 0.01), BMI and job stress scores (r = 0.121, P < 0.05), and HDL levels and job stress scores (r = -0.117, P < 0.05). Significance. Mood state changes may be related to job stress and job burnout, in turn, associated with triglycerides and HDL levels. Public health implications and interventions are discussed.
Clinical studies constitute 50% of the bachelor program in nursing education in Norway, and the quality of these studies may be decisive for the students' opportunities to learn and develop their professional competences. The aim of this study was to explore what bachelor students' in nursing perceived to be important for having good learning experiences in clinical studies. Data was collected in a focus group interview with eight nursing students who were in the last year of the educational program. The interview was transcribed verbatim, and qualitative content analysis was used for exploring and interpreting the content of the interview text. One main theme emerged from the analysis: "being in a vulnerable and exposed position characterized by conflicting needs." Four categories were found: "aspects related to the clinical setting", "aspects related to the nurse supervisor," "aspects related to the student," and "aspects related to the student-supervisor relationship". The findings revealed that the students' learning experiences and motivation were related to individual, relational, and organizational aspects. The students highlighted their own as well as their supervisors' attitudes and competences and the importance of positive relationships. In addition, feeling welcomed, included, and valued in the ward improved their motivation, self-confidence, and self-respect.
Objective. Medication errors are the most common types of medical errors which considerably endanger the patient safety. This survey aimed to study the factors influencing not reporting on medication errors from the nurses' viewpoints in Abbasi Hospital of Miandoab, Iran. Methods. This was a cross-sectional, descriptive and analytical study conducted in 2012 in which all nurses (n = 100) working in different inpatient units were studied using a consensus method. Required data were collected using a questionnaire. Collected data were analyzed through some statistical tests including Independent t-test, ANOVA, and chi-square. Results. According to the results, the most important reasons for not reporting on medication errors were related to the managerial factors (3.56 ± 0.996), factors related to the process of reporting (3.32 ± 0.797), and fear of the consequences of reporting (3.01 ± 1.039), respectively. Also, there was a significant relationship between employment status and fear of the Consequences of reporting on medication errors (P < 0.008). Conclusion. This study results showed that managerial factors had the greatest role in the refusal of reporting on medication errors. Therefore, for example, establishing a mechanism to improve quality rather than focus only on finding the culprits and blaming them can result in improving the patient safety.
Objectives. To evaluate the feasibility of implementing a statewide children with special health care needs (CSHCN) program evaluation, case management, and surveillance system using a standardized instrument and protocol that operationalized the United States Health and Human Services CSHCN National Performance Measures. Methods. Public health nurses in local public health agencies in Washington State jointly developed and implemented the standardized system. The instrument was the Omaha System. Descriptive statistics were used for the analysis of standardized data. Results. From the sample of CSHCN visit reports (n = 127), 314 problems and 853 interventions were documented. The most common problem identified was growth and development followed by health care supervision, communication with community resources, caretaking/parenting, income, neglect, and abuse. The most common intervention category was surveillance (60%), followed by case management (24%) and teaching, guidance, and counseling (16%). On average, there were 2.7 interventions per problem and 6.7 interventions per visit. Conclusions. This study demonstrates the feasibility of an approach for statewide CSHCN program evaluation, case management, and surveillance system. Knowledge, behavior, and status ratings suggest that there are critical unmet needs in the Washington State CSHCN population for six major problems.
High frequency ultrasound imaging has been reported as a potential method of identifying the suspected tissue damage in patients "at risk" of pressure ulceration. The aim of this study was to explore whether ultrasound images supported the clinical skin assessment in an inpatient population through identification of subcutaneous tissue damage. Skin on the heels and/or sacral coccygeal area of fifty vascular surgery inpatients was assessed clinically by tissue viability nurses and with ultrasound pre operatively and at least every other day until discharge. Images were compared to routine clinical skin assessment outcomes. Qualitative classification of ultrasound images did not match outcomes yielded through the clinical skin assessment. Images corresponding to 16 participants were classified as subgroup 3 damage at the heels (equivalent to grade 2 pressure ulceration); clinical skin assessment rated no heels as greater than grade 1a (blanching erythema). Conversely, all images captured of the sacral coccygeal area were classified as normal; the clinical skin assessment rated two participants as grade 1b (non-blanching erythema). Ultrasound imaging is a potentially useful adjunct to the clinical skin assessment in providing information about the underlying tissue. However, further longitudinal clinical assessment is required to characterise images against actual and "staged" pressure ulceration.
The purpose of this study was to explore nurse managers' perceptions related to their leadership styles, knowledge, and their skills in these areas in health centre wards in Finland. The data were collected from nurse managers (n = 252) in health centre hospitals in Finland using a structured questionnaire (response rate 63%). Six leadership styles-visionary, coaching, affiliate, democratic, commanding, and isolating-were reflected on. Almost all respondents in every age group considered four leadership styles-visionary, coaching, affiliate, and democratic-to be very important or important. Nurse managers estimated their knowledge and skills in leadership styles to be essentially fairly sufficient or sufficient. Nurse managers' abilities to reflect, understand, and, if necessary, change their leadership style influence the work unit's success and employees' job satisfaction. Nurse managers, especially new nurse managers, need more theoretic, evidence-based education to cope with these expectations and to develop their professional abilities. Together with universities, health care organizations should start planning nurse manager education programmes that focus on strategic issues, leadership, job satisfaction, challenging situations in leadership, change management, work unit management (e.g., economy, efficiency, and resources), and how the nurse managers consider their own wellbeing.
The study examined various methods of peer learning and their effectiveness in undergraduate nursing education. Using a specifically developed search strategy, healthcare databases were systematically searched for peer-reviewed articles, with studies involving peer learning and students in undergraduate general nursing courses (in both clinical and theoretical settings) being included. The studies were published in English between 2001 and 2010. Both study selection and quality analysis were undertaken independently by two researchers using published guidelines and data was thematically analyzed to answer the research questions. Eighteen studies comprising various research methods were included. The variety of terms used for peer learning and variations between study designs and assessment measures affected the reliability of the study. The outcome measures showing improvement in either an objective effect or subjective assessment were considered a positive result with sixteen studies demonstrating positive aspects to peer learning including increased confidence, competence, and a decrease in anxiety. We conclude that peer learning is a rapidly developing aspect of nursing education which has been shown to develop students' skills in communication, critical thinking, and self-confidence. Peer learning was shown to be as effective as the conventional classroom lecture method in teaching undergraduate nursing students.
Introduction and Objectives. Nurses, as behavioral models, play a key role in health promotion, and their attitudes towards health promotion highly influence their health and performance. The aim of this study is to explore nursing students' perception of studies in nursing discipline as a situational influence on health promotion. Materials and Methods. This study was conducted using directed content analysis, by means of 20 deep semistructured interviews with nursing students. The participants were selected on purposive sampling. Data was analyzed by the qualitative content analysis method. All interviews were recorded, transcribed, and reviewed, and all codes were extracted and summarized. The codes were subcategorized on the basis of centralization and were categorized after review of subcategories, and finally, a theme was determined. Findings. The theme of nursing discipline's situational influence on nursing students' health promotion was revealed. This theme consisted of "choosing the field," "unfavorable environmental factors," "negative impacts of studies in nursing discipline on health," "positive effects of studies in nursing discipline on health", "needs," "attractiveness (aesthetics)," and "coping with negative situational influences in nursing discipline." Conclusion. The perception of studies in nursing discipline as a health-promoting behavior is under influence of social environment. Considering the importance of the students' positive perception of the existing situation, it is essential to pay attention to their attitudes and perceptions so that they can provide better services to patients.
Reduction of high-risk neonates' exposure to aversive light stimulation is an important component of developmentally supportive care. In neonatal intensive care unit (NICU), usually light is reduced by reducing the room's light level or by using incubator covers. Many types of incubator covers are in use, including homemade and commercial covers. A comparative study was used to determine the light reducing capabilities of 19 homemade incubator covers, 2 commercial covers, and 1 receiving blanket. The covers were tested by covering and uncovering an incubator and an oxygen hood in the NICU during daytime and nighttime lightings. The light reducing capabilities value was determined for each cover using an Extech light dosimeter when the cover was placed over and removed from an oxyhood, and an incubator. The study showed that the light reducing capability of the commercial covers was 91.2%, the homemade covers capability was 72.1%, and the receiving blankets capability was 55.1%. A significant difference between the commercial and homemade covers was found (F = 452.50, P < 0.00). Commercial incubator covers are the most effective covers to achieve light reduction; homemade covers can be effective if made large enough so that they completely cover all sides of the incubator.
Effects of domestic violence are reflected in victims' physical, psychological, and sexual health as well as in victims' subjective evaluations of health or subjective well-being. The principal aim of this study was to study the extent to which the consequences of domestic violence are reflected in patients' subjectively evaluated well-being, life management, and sense of security in an emergency department, a maternity department, and a reception unit of a psychiatric hospital. A questionnaire on the effects of domestic violence was administered to 530 patients. 61 patients reported either current or previous domestic violence that affected their current well-being and life management. Domestic violence was reported to have an effect on subjective well-being and sense of security: the more recent or frequent the experience of violence was, the greater was considered its impact on well-being and sense of security. Routine inquiry can uncover hidden cases of abuse and hence would be of great benefit in the healthcare context. Early identification of abuse victims can prevent further harm caused by violence.
A society that values mental health and helps people live enjoyable and meaningful lives is a clear aspiration echoed throughout our Canadian health care system. The Mental Health Commission of Canada has put forth a framework for a mental health strategy with goals that reflect the virtue of optimal mental health for all Canadians (Mental Health Commission Canada, 2009). Canadian nurses, the largest group of health care workers, have a vital role in achieving these goals. In Canada, two-thirds of those who experience mental health problems do not receive mental health services (Statistics Canada, 2003). Through a gendered, critical, and sociological perspective the goal of this paper is to further understand how the past has shaped the present state of psychiatric mental health nursing (PMHN). This integrative literature review offers a depiction of Canadian PMHN in light of the intersections of history, gender, education, and quality of nursing work life. Fourteen articles were selected, which provide a partial reflection of contemporary Canadian PMHN. Findings include the association between gender and professional status, inconsistencies in psychiatric nursing education, and the limitations for Canadian nurse practitioners to advance the role of the psychiatric mental health nurse practitioner.
This descriptive qualitative study examined the patient, provider, and institutional factors contributing to nonattendance for hepatitis C (HCV) care throughout the disease course. Eighty-four patients and health and social care providers were interviewed. Thematic analysis of the data yielded 6 interrelated nonattendance themes: self-protection, determining the benefits, competing priorities, knowledge gaps, access to services, and restrictive policies. Factors within the themes varied with the disease course, type of provider/service, and patient context. Nonattendance could span months to years and most frequently began at diagnosis where providers either advised that followup was not necessary or did not recommend any followup. The way services were organized (low barrier access) and delivered (nonjudgmental approach) and higher HCV knowledge levels of patients and providers encouraged attendance. This is the first study to explore the reasons for nonattendance for HCV care throughout the disease course and validate them from multiple perspectives. There are missed opportunities for providers to encourage attendance throughout the disease course beginning at diagnosis. Interventions required include development of integrated health and social service delivery models; mechanisms to improve knowledge dissemination of the disease, its management, and treatment; and implementation of standardized followup protocols for liver disease monitoring in primary care.
The ethnic proportions of the population in the United States are rapidly changing, with the nation's minority population at approximately 101 million. This is also true for the West Texas region, where locally in a city with 183,000 residents, 43 different languages are spoken suggesting that cultural education needs to be included in nursing program curricula. Therefore, a study was conducted during a period of curriculum revision to determine if the current nursing curriculum at a public university offers enough education and experience for graduating nurses to care for such a diverse population by comparing their perceptions of cultural competence with beginning sophomore nursing students' perceptions. Participants were asked to complete the Cultural Competence Assessment (CCA) tool in order to evaluate perceptions of cultural competence. Upon analysis of the data, perceptions of cultural competence among graduating nursing students were significantly higher (P = .002) than the perceptions of cultural competence among beginning nursing students. These results support that nursing students perceive that they have become culturally competent during their nursing education, leading to implications of the need for continued education relating to this concept, beginning with the first course and continuing throughout the nursing curriculum.
In a time of global nursing shortages an alarming number of young registered nurses have expressed a willingness to leave the profession. In this qualitative case study we investigate in depth why young nurses leave nursing profession and reeducate themselves for a new career. The study is based on longitudinal interviews of three young registered nurses in Finland. These nurses were first interviewed between December 2006 and May 2007, when they were 29-32 years old and having an intention to leave the profession. The second interview took place four years later, from January 2011 to March 2011 when all of them had made the transition to a new career. Data were analyzed in two stages. In the first stage, comprehensive career story narratives were formed on the basis of the interviews. In the second stage, emerging themes in these stories were compared, contrasted, and interpreted in the context of the overall career histories. Nursing as a second career choice and demanding work content as well as poor practice environment and the inability to identify with the stereotypical images of nurses were main themes that emerged from these career stories. The results of this interpretative qualitative study reflect a shift toward insights into understanding professional turnover as a complex and long-lasting process.
Translating guidelines into nursing practice remains a considerable challenge. Until now, little attention has been paid to which interventions are used in practice to implement guidelines on changing clinical nursing practice. This cross-sectional study determined the current ranges and rates of implementation-related interventions in Austria, Germany, and The Netherlands and explored possible differences between these countries. An online questionnaire based on the conceptual framework of implementation interventions (professional, organizational, financial, and regulatory) from the Cochrane Effective Practice and Organization of Care (EPOC) data collection checklist was used to gather data from nursing homes and hospitals. Provision of written materials is the most frequently used professional implementation intervention (85%), whereas changes in the patient record system rank foremost among organisational interventions (78%). Financial incentives for nurses are rarely used. More interventions were used in Austria and Germany than in The Netherlands (20.3/20.2/17.3). Professional interventions are used more frequently in Germany and financial interventions more frequently in The Netherlands. Implementation efforts focus mainly on professional and organisational interventions. Nurse managers and other responsible personnel should direct their focus to a broader array of implementation interventions using the four different categories of EPOC's conceptual framework.