Doctor-nurse Relationship Research Articles

The Problem of Nursing Care in Commune I of the District of Bamako

Nursing is an integral part of the health care system, providing support for people who are ill or in good health. It helps to provide comprehensive care for all users of care facilities. The overall aim is to help improve nursing practice in health care institutions. Methodology: we carried out a qualitative, quantitative and explanatory study using a field study in private and one public facilities involving 17 doctors and 25 nurses based on non-random sampling from 1er July to 31 August 2022 after obtaining informed consent. Results: The study revealed that 76% of nurses were unaware of the existence of their establishment's internal regulations and 60% were unaware of the description of their tasks in the department. Similarly, 25% of these nurses concluded that there was no reception procedure in their department. 72% of nurses stated that they did not have an identifier for their facility. While we found that only 4% of the nurses in our study had correctly defined the basis of nursing practice and the components of a nursing care plan, none of the nurses used a care plan in their department. As regards the doctor-nurse relationship within the care team, 29% of doctors treated nurses as subordinates. In conclusion, the problem of nursing care in Commune I is very real, and only strong administrative policies can improve it.

IJCM_428A : Nurses’ Perception of Inter-Professional Cooperation in Hospital

Background: Inter-professional cooperation between doctors and nurses is essential for efficient healthcare delivery. However, hierarchical structures and power imbalances often characterize their relationship. This study aims to assess nurses’ perceptions of their working relationships with doctors in hospital settings, considering factors such as communication, respect, and teamwork. Methodology: A cross-sectional study was conducted in three hospitals. A sample of 200 nursing staff participated, using a semi-structured questionnaire. Data analysis was performed using SPSS, focusing on factors influencing nurse-doctor relationships, including work experience, education level, and perceived conflicts. Results: The majority of nurses were relatively new to their profession (34.0%). Most worked in medical/surgical units (54.0%) and held diplomas (82.5%). The majority (87.5%) believed that doctors understood their responsibilities and respected their judgment. Many felt comfortable asking for advice from doctors (90.5%) and those who preferred consulting nurses first were 81.0%. While conflicts and harassment existed, most nurses (59.0%) reported never experiencing unprofessional dialogue. Majority of nurses (63.5%) don’t have knowledge regarding any specific policy dealing with disagreements. Staff shortages (72.0%) and dictation by doctors (48.0%) were common reasons for strained relationships. Conclusion: Overall, nurses expressed satisfaction with their relationships with doctors, with a majority considering them friendly. Factors such as interpersonal skills, mutual respect, and social interaction outside the hospital influenced these relationships. Hospital administrations should focus on fostering better communication, respect, and teamwork to improve inter-professional cooperation.

Organizational characteristics of nursing practice environments related to registered nurses’ professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study

BackgroundNurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one’s work and have a sense of control – the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses’ perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction.MethodsA cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction.ResultsPrincipal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse–doctor relationships, organization’s quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization’s quality standards, nurse management and leadership, and collegial nurse–doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization’s quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction.ConclusionNurses’ professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses’ job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.

中国护士处方权立法的问题检视与路径优化: 基于《深圳经济特区医疗条例》第65条的分析

The “Shenzhen Special Economic Zone Medical Regulations” has taken the lead in implementing the “nurses’ prescription right” in China, but there are still many regulatory restrictions and problems in the full implementation of nurses’ prescription right in China. The rights and responsibilities of the new doctor-nurse relationship after the prescription right are unclear, and the relevant management institutions and supervision mechanisms are not perfect after the implementation of the nurses’ prescription right legislation. This paper believes that in order to improve the legislation of nurses’ prescription right in the future, it is necessary to reasonably determine the access standards for nurses’ prescription right, clarify the doctor's supervision responsibility for nurses’ prescription right, and improve the supporting guarantee and management mechanism for nurses’ prescription right.

Work success and the physician-nurse professional relationship in emergency departments

Background. Considering the importance of physician-nurse relationship in emergency departments and its role in improving the quality of services, patient satisfaction, job success and staff satisfaction, this study was conducted to investigate nurses' attitude about the professional doctor-nurse relationship and career success of the nurses in emergency departments. Methods. This study is a descriptive study in which 197 nurses working in the emergency departments of hospitals affiliated to Tabriz University of Medical Sciences participated. Data collection tools included demographic characteristic; physician-nurse professional communication questionnaire and nurses' career success questionnaire. The collected data were analyzed using descriptive and inferential statistical tests with SPSS ver.21 statistical software. Results. The findings showed that the mean (SD) of the professional physician-nurse relationship from the perspective of participating nurses was 3.07 (0.54). Cooperating dimension with the mean score of 3.34 (0.79) had the highest score and imposing opinions and tasks dimension with the mean score of 2.62 (0.85) had the lowest score. Also, the mean (SD) score of nurses’ career success was 4.21 (0.40) with the highest mean in the dimension of system assistant 4.33 (0.55) and the lowest mean in the effective dimension 4.08 (0.41). Conclusion. Considering the importance of the professional physician-nurse relationship, it is necessary to pay more attention to the effective factors in its promotion by implementing interventions such as professional communication skills training and effective interaction in strengthening the professional relationship of the treatment team. Practical Implications. The results of this study can be used to improve professional communication between health care team members and their work success. As a result, in addition to increasing job satisfaction and improving the psychological condition of personnel, the safety of patients will also be increased and the amount of injuries caused by communication defects will be decreased.

Humanizing the Physician-Patient Relationship

Humanizing the Physician-Patient Relationship

Nursing ethics for prevention and control of major infectious disease outbreaks: Chinese expert consensus

BackgroundMajor infectious disease has become a serious threat to people’s health worldwide. As the world’s largest healthcare workforce and the core forces fighting against the epidemic, nurses are on the frontline of this battle. A number of ethical issues have given rise to numerous concerns that have largely affected nurses in different ways as they respond to the epidemic. In addition, excessive expectations from people can exert undue pressure, which can easily lead to burnout in nurses. MethodsIn this consensus, the expert panel method was used to develop and reach a consensus. The members involved in the formation of the consensus included an expert discussion panel and a consensus writing expert group, a methodologist, and four secretaries. After 16 rounds of online expert consultation and two rounds of expert panel meetings, the writing team analyzed and reviewed the 78 amendments suggested by the experts to develop a consensus on nursing ethics for prevention and control of major infectious disease outbreaks based on the ethical vision of life care. ResultsThis expert consensus focuses on five essential domains: the responsibilities and rights of nurses, the nurse-patient relationship, the doctor-nurse relationship, and the relationship between society and nurses throughout the epidemic. ConclusionsWe hope this consensus can help nurses better understand and respond to the ethical issues and challenges in public health emergencies, and raise reasonable public expectations of the roles and responsibilities of nurses in these situations.

Primary healthcare personnel challenges and barriers on the management of patients with multimorbidity in Albania.

The number of people living with chronic conditions is increasing worldwide with most of these people receiving the needed healthcare services in primary healthcare (PHC) settings. The objective of this study was to explore the main challenges and barriers that PHC providers confront while treating multimorbid patients. This is a qualitative study utilising semi-structured individual in-depth interviews. The study took place in Vlora City, which is the biggest city located in south Albania. Τhe two biggest PHC centres of the city were enrolled. Purposive sampling method was used to recruit PHC practitioners. Main criteria of participation in the study were being fully employed at the enrolled primary care centres, having worked for at least 1year and to deal with multimorbid patients in daily practice. Data collection took place from September 2019 to January 2020. In total, 36 semi-structured interviews took place with 23 (63.9%) nurses and 12 (33.3%) physicians (general practitioners/family doctors). Communication problems and disputes, lack of materials/equipment and the inappropriate infrastructure, miscommunication and problems in doctor-nurse relationships, coordination problems, lack of protocols and problems in the referral system were reported as the main challenges and barriers that the PHC personnel confront. The findings of this study are critical in understanding challenges that PHC personnel face when dealing with multimorbid patients in PHC settings. The emerged knowledge contributes significantly in a better understanding of the actual situation and to inform health policy makers on how to deal with the existing problems.

Perceived interpersonal and institutional challenges to patient advocacy in clinical nursing practice: a qualitative study from Ghana / Interpersonelle und institutionelle Herausforderungen für die Rolle als Patientenfürsprecher/-in aus Sicht der Pflege: eine qualitative Studie aus Ghana

Abstract Background Nurses often speak on patients’ behalf and safeguard their safety through their advocacy role. However, some challenges like the negative attitude of team members and lack of institutional support often hamper this role. These challenges have not been well studied in the Ghanaian context. Aim This study explores the perceived environmental challenges to patient advocacy among nurses in Ghana. Setting The study was conducted at a regional hospital in Ghana. Participants Participants were nurses or midwives working in the hospital. Methods A qualitative exploratory descriptive design was employed in the study of 15 purposively sampled participants. Participants were interviewed individually and data were analysed using content analysis. Findings The study revealed interpersonal challenges and institutional challenges to patient advocacy, such as hierarchical nurse–doctor relationships and ineffective multidisciplinary team, time constraints and lack of institutional support. Nurses often failed to advocate because they did not want to risk conflict with doctors. Limited interprofessional interaction, suspicion and resentment in the multidisciplinary team negatively affected nurses’ role as patient advocates. Inadequate curricular support for patient advocacy and lack of support for training programmes or to undertake further studies were the additional challenges. Conclusion Patient advocacy could be a stressful role for nurses; thus, efforts to strengthen teamwork and increase nurse involvement in hospital decision-making are required. Implications for nursing and health policy The findings could influence hospital management policies to enhance stronger interprofessional collaboration, increase opportunities for professional advancement for nurses and nurses’ inclusion in decision-making.

Evaluation of health working environment by ICU nurses based on empowerment management model: a cross-sectional research

Objective To investigate the current status of ICU nurses′ evaluation of clinical health work environment and its influence factor under the foundation of empowerment management model. Methods This study included 162 ICU nurses from Renmin Hospital of Wuhan University. The Chinese version of the Essentials of Magnetism II was used to evaluate the healthy working environment and another two 0–10 single-item scales was used to evaluate job satisfaction and quality of care. Results The total score of nurses on the healthy working environment was (183.75±1.56), and score of each dimensions were included medical relationship(2.83±0.43), support for training(2.88±0.05), autonomy of nursing work (2.98±0.03), nursing practical control(2.93±0.03), adequate nursing staff(2.83±0.33), colleagues′ clinical competence(3.37±0.04), nursing manager support(3.50±0.04), cultural values(3.48±0.04), the satisfaction of nursing work(8.12±0.14) and the quality of care evaluation(8.66±0.12) were higher. There were significant statistical difference in the evaluation of nurses′ healthy working environment on age, working years, education and level of authorization. The degree showed low level negative correlation degree and healthy working environment (r=-0.299, P=0.000), the level of authorization showed low level correlation degree and healthy working environment (r=0.236, P=0.003). The independent variable could explain 97.9% of the variation of the dependent variable, among which nursing manager support and cultural values and adequate nursing staff had a high explanatory power for the evaluation of healthy working environment. Conclusions ICU nurses have a higher evaluation of the healthy working environment. Nursing managers should be concerned about more support to different levels of nurses, pay attention to the needs of training, promote the harmonious development of doctor-nurse relationship, improve healthy working environment focuses on the process of nursing manager support and cultural values and adequate nursing staff,so to create a magnetic professional environment that will satisfy the nurses are helpful to improve the quality of care. Key words: Intensive care units; Empowerment management; Health working environment; Nursing management

Analysis of interviews to uncover the effects of nurse prescribing on the doctor-nurse relationship

Objective: The introduction of nurse prescribing has had a profound effect on how patients obtain a prescription. Yet very little has been researched about the effects of nurse prescribing on the professional relationship between nurses and doctors since its introduction. It was this lack of enquiry that led to this research study to see if this relationship has changed since the introduction of the nurse prescriber. Design methods: A purposeful sample approach was chosen, interviews were undertaken using a semi-structured method and interpretative phenomenological analysis was used to analyse the data. Setting: A large teaching hospital in the north west of England. Subjects: Four nurse prescribers and four doctors working in orthopaedics, breast surgery or urology looking after adult elective surgery patients. Main outcomes: What emerged from this study is a complex pattern of readjustment within this relationship. The power once enjoyed by the medical profession is now challenged by the introduction of the nurse prescriber. A number of themes emerged around the topics of prescribing, relationship, educational and communication. Each help to focus how this change manifests itself in the relationship and how it needs to evolve if the maximum benefit from nurse prescribing is to be achieved. Conclusions: What has emerged from this research is how complex the relationship between the nurse prescriber and doctor really is. The power to prescribe medication that was once the sole preserve of the medical profession is now shared with the nurse prescriber. But this shared authority remains unequal; the medical profession remains at least unwilling to give up its position of control just yet, but the dialogue has begun.

The Effect of PDCA Cycle Management Method on the Promotion of Nursing Quality Management in the Operating Room

The quality management of operating room nursing improves the overall level of nursing quality and thus plays a vital role in operation. Here investigations were conducted to detect whether PDCA cycle (Plan, Do, Check and Act) can improve the nursing quality management and the doctors' cooperation satisfaction level towards nurses of the operating room. PDCA cycle management method was implemented in the nursing quality management of the operating room. From June 2015 to June 2016, the influence of the PDCA cycle management method on nursing documents writing, theory knowledge level, skill operation level and surgeon satisfaction in the operating room was investigated by observation. Compared with the average level before implementation of PDCA cycle, the qualification rate of the surgery patient care records, patient transfer lists and tripartite checklists were significantly increased. The pass rate of the nursing theory and nursing skill operation examination of nurses was also increased compared with before. Furthermore, surgeon satisfaction was also increased compared with the average level before implementation of PDCA cycle and the differences had statistical significance (P<0.05). Therefore, PDCA cycle management method implemented in the nursing quality management of the operating room effectively improve the quality of the nursing care, doctor-nurse relationship and therefore should be considered for popularization.

Is it time to re-examine the doctor-nurse relationship since the introduction of the independent nurse prescriber?

Objective: The aim of this paper is to stimulate a debate and discussion into how the nurse‑doctor relationship needs to change. Setting: The National Health Service, United Kingdom. Primary argument: The nurse‑doctor relationship needs to be re‑evaluated in light of the expanding role of nurses into areas that traditionally had been considered a doctor’s role. While the medical profession has been willing to relinquish some control to nurses in areas such as wound or incontinence care because these aspects do not threaten their authority, position or power. The issue of non‑medical prescribing remains for some in the medical profession a topic of concern. Despite non‑medical prescribing being discussed widely in the literature, very little has been mentioned about how the introduction of the nurse prescriber has impacted the professional relationship between the nurse and the doctor. Conclusion: The blurring of the roles between nurses and doctors requires a re‑evaluation of this relationship. As nurses take on more responsibility such as prescribing medication the old traditional view of this relationship is no‑longer viable, if we are to maximise patient health care in the 21st century.

Investigation and analysis on the current situation of job burnout of nurse in Tianjin

Objective To understand the current situation of job burnout of nurse in Tianjin and analyze the related influencing factors. Methods Convenience sampling survey method was used, and authoritative instrument that can evaluate job burnout was applied to have job burnout questionnaire(Maslach Burnout Inventory, MBI, Alpha between 0.73 to 0.86) for 548 nurses of 55 secondary and tertiary hospitals in Tianjin. This questionnaire contained 22 entries, and 3 dimensions which were emotional exhaustion(EE), depersonalization (DP)and reduced personnel accomplishment(PA). Likert 7-grade score was used(0~6 points), where the scores of emotional exhaustion and depersonalization were high, and burnout degree was more serious. When the score of personnel accomplishment was lower, burnout degree was more serious. The score of job burnout of nurses in Tianjin was compared with the evaluation norm for 1 104 American medical workers by Maslach(M's norm) et al. Meanwhile, the result was compared with the investigation and research data of 1 285 large samples in Hangzhou. SPSS 17.0 software was used to make box-type graphs, t-test and χ2 check analysis, etc(P<0.05). Results The research objects were prior to the nurses of tertiary hospitals in Tianjin(67.52%). The nurses of internal medicine and surgical department were in the majority(77.19%), and the education background was prior to junior college(50.18%). The proportion of bachelor degree or above was 34.85%. The proportions of nurse practitioners and nurses were 40.15% and 30.11%. The object of investigation was prior to nurses who worked equal or shorter than 5 years, which was 65.33%. Compared with American Maslach norm, with regard to the investigation result between the nurses of Tianjin in the aspect of EE and American medical workers, the difference had no statistical significance(P>0.05). However, DP and PA values were inferior to American medical workers(P<0.05), which indicated that the depersonalization degree of nurses in this city was inferior to American medical workers, but the sense of personal achievement was inferior to it of American medical workers. Compared with the investigation data of 1 285 samples in Hangzhou, in the aspects of EE, DP and PA, the difference of comparison between the nurses of this city and Hangzhou had statistical significance, of which EE and DP degrees were inferior to it in Hangzhou, but PA was superior to it in Hangzhou(P<0.05). The detection rate of job burnout of nurses and the large sample data comparison of Hangzhou showed that the overall detection rate of job burnout in this city was 63.14%, which was inferior to the investigation result of Hangzhou in 2013(70.44%). Compared based on mild, middle and serious job burnout classification, the job burnout degree of nurses in this city was inferior to it in Hangzhou, and the difference had statistical significance. Conclusions The depersonalization degree of nurses in this city is lower than it of American medical workers, but the sense of personal achievement is inferior to it of American medical workers. It may be because of the cultural difference between the east and the west. The sense of achievement for the nurses of this city is lower, which may be because that the social position Chinese nurses perceive is low, social benefits are lower, the opportunity to have further education and promotion is few, the personal value of nurses can't be recognized.The job burnout degree of nurses in this city is lower than it of Hangzhou, which may be because of the impact of North-South regional difference and humanity difference.Nurse-patient relationship, development of nursing specialty and job itself, including teamwork, doctor-nurse relationship, internal management system, job autonomy, career development and the working environment of nursing specialty are the major influence factors which may cause job burnout to nurses. Key words: Nurses; Job burnout; Survey

Negotiated reorienting: A grounded theory of nurses’ end-of-life decision-making in the intensive care unit

BackgroundIntensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses’ end-of-life (EoL) decision-making practice across cultures. ObjectivesTo understand nurses’ EoL decision-making practices in ICUs in different cultural contexts. DesignWe collected and analysed qualitative data using Grounded Theory. SettingsInterviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine. ParticipantsSemi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine). They were purposefully and theoretically selected to include nurses having a variety of characteristics and experiences concerning end-of-life (EoL) decision-making. MethodsThe study used grounded theory to inform data collection and analysis. Interviews were facilitated by using key questions. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EoL decision-making practices in the ICU. Ethical approval was granted in each of the participating countries and voluntary informed consent obtained from each participant. ResultsThe core category that emerged was ‘negotiated reorienting’. Whilst nurses do not make the ‘ultimate’ EoL decisions, they engage in two core practices: consensus seeking (involving coaxing, information cuing and voice enabling); and emotional holding (creating time-space and comfort giving). ConclusionsThere was consensus regarding the core concept and core practices employed by nurses in the ICUs in the five countries. However, there were some discernible differences regarding the power dynamics in nurse–doctor relationships, particularly in relation to the cultural perspectives on death and dying and in the development of palliative care. The research suggests the need for culturally sensitive ethics education and bereavement support in different cultural contexts.

Impact of DISC Behavioral Styles on Job Satisfaction and Clinical Competencies among Newly Hired Nurses

Purpose: In this study, behavioral styles of Dominance, Influence, Steadiness, and Conscientiousness (DISC) were examined and differences in job satisfaction and clinical competence among newly hired nurses were explored. Methods: For this explanatory correlational research, 176 newly hired clinical nurses were recruited from three university hospitals and one general hospital located in Seoul and Gyeonggi province. Data were collected in August, 2013 though self-report questionnaires. Results: The distribution of behavioral styles was 11.4%, 42%, 29% and 17.6% for Dominance, Influence, Steadiness, and Conscientiousness respectively. DISC behavioral styles were associated with sub-areas of job satisfaction such as professional position and doctor-nurse relationship. DISC behavioral styles were significantly associated with the total score for clinical competence and sub-areas of data collection, basic nursing skills, critical thinking, education and leadership, and attitudes toward professional development and practical skills. Multiple linear regression analysis showed that DISC behavioral styles predicted clinical competence (Adj. R2=.14, F=9.42, p<.001). Conclusion: A focus on cultivating influential and steady behavioral styles among newly hired nurses can be helpful in improving job satisfaction and clinical competence. There is a need to improve interpersonal relationships through a deeper understanding of each person’s behavioral style based on the analysis of DISC behavioral styles.

Nurse-perceived patient adverse events and nursing practice environment.

Objectives:To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level.Methods:In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed.Results:At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, ‘physician- nurse relationship’ correlated with medication errors while ‘education for improving quality of care’ affected patient falls.Conclusions:The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.

Influence of the nursing practice environment on job satisfaction and turnover intention.

Objectives:To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. Methods:Among the 11 731 nurses who participated in the Korea Health and Medical Workers’ Union’s educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. Results:Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses’ job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses’ turnover intention. Conclusions:Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses’ job satisfaction. However, the nursing practice environment was not related to nurses’ turnover intention.

Greek Mental Health Nurses’ Practices and Attitudes in the Management of Acute Cases

The aim of this study was to identify nurses’ interventions, views, and attitudes concerning critical incidents. Using semi-structured interviews, a descriptive study was conducted among mental health nurses working in three major psychiatric hospitals. Analysis of nurses’ audio-recorded data indicated that they had used a number of different interventions under six main categories: counseling, performing security practices, monitoring thinking disturbances, contacting the psychiatrist on-call, contacting the chief nurse on-call, and administering medication. The need for specialized training was noticed and problems like accountability, nurse-patient interactions, and nurse-doctor relationships were considered crucial by the mental health nurses.

Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: qualitative evidence synthesis

Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: qualitative evidence synthesis