High-quality Nursing Care Research Articles

Harmonising Nursing Education: Theory and Practice

IntroductionNURSES ARE AN INTEGRAL PART OF a country's national development since they constitute the greatest part of any health care delivery system that helps to maintain productive human capital. They provide health care services for families across the life cycle, culminating with the last developmental stage of death. Primary, secondary and tertiary health care services are delivered by nurses who must be scientifically and clinically prepared to address the health needs of the community. The education of an adequate cadre of nurses should be of national importance because inadequate numbers of registered nurses lead to higher morbidity and mortality rates. A recent study concluded that hospitals with high pa tient-to-nurse ratios, surgical patients experience higher risk-adjusted three-day mortality rates and failure-to-rescue rates and that nurses are more likely to experience burnout and job dissatisfaction.1 The minimum standard of 18 nurses per 10,000 population is required to ensure that 80 percent of all childbirths are attended by a professional nurse.2 Belize is below acceptable standards with 15 nurses per 10,000, which should signal to all sectors that educating well-prepared nurses is a matter of high priority for inclusion in national development strategies.Nursing education has a major role to play in the development of graduates who can deliver high-quality nursing care, and in a manner that harmonises theory and practice. However, the gap between theory and practice continues to be a prevailing problem in nursing and midwifery. In addition to having to be adequately prepared for their future professional role, nursing students have to seamlessly fit into the nursing workforce. Despite much discussion and several efforts to implement various integration strategies, newly graduated nurses often confront an array of physical, technical and mental challenges in bridging the academic and clinical divide. Bridging the gap between theory and practice has implications for recruitment of students into the nursing programme, as well as retention of newly educated nurses. Reflectively, it is time for the nursing community and the University of Belize to utilise innovative strategies to expand and meet human resources in health requirements. A unified approach must be pursued to address existing challenges.The purpose of this article is to examine the issues and challenges related to student nurses' professional development, focusing on mechanisms to bridge the gap between theory and practice in general, and specifically in the University of Belize's Professional Nursing Education programme. Academic issues, including recruitment and selection of students, attrition and completion, and retention will be discussed; as well as methods used to facilitate students' acquisition of technical, clinical skills. Practice issues that will be explored include quality of care issues, and bridging mechanisms such as orientation, preceptoring, coaching and mentoring.Theoretical frameworkToday, nurses are confronted by new challenges within the health reform mandate to provide equitable, effective, affordable and quality health care services. The health care environment is constantly changing, and challenges abound to use computerised information systems, deliver evidence-based nursing care, and participate in quality improvement initiatives. There are certain characteristics which define how nurses perceive, comprehend and interpret health simations. Four perspectives are integrated into the curricula for nursing education: (i) the nature of nursing science as a human science; (2) practice aspects of nursing; (3) caring relationships that nurses and patients develop; and (4) a health and wellness perspective.3 A common complaint from nurses in clinical settings and the general public is that nurses seem to lack what is considered the essence of nursing - human caring. Patricia Cook and Janice Cullen propose that today the demonstration of caring is an exception rather than the rule. …

Families and health-care professionals' perspectives and expectations of family-centred care: hidden expectations and unclear roles.

Family-centred care (FCC) is viewed as a pivotal concept in the provision of high-quality nursing care for children and their families, yet implementation continues to be problematic worldwide. This research investigated how FCC was enacted from families and nurses' perspectives. Descriptive qualitative approach using elements of analysis from grounded theory method. Data were collected though individual interviews with 18 children aged 7-16 years, their parents (n = 18) and 18 nurses from two children's hospital and one children's unit in a large general hospital in Ireland. Four key themes were identified: expectations; relying on parents' help; working out roles; and barriers to FCC. Nurses wholeheartedly endorsed FCC because of the benefits for families and their reliance on parents' contribution to the workload. There was minimal evidence of collaboration or negotiation of roles which resulted in parents feeling stressed or abandoned. Nurses cited busy workload, under-staffing and inappropriate documentation as key factors which resulted in over-reliance on parents and hindered their efforts to negotiate and work alongside parents. Families are willing to help in their child's care but they require clear guidance, information and support from nurses. Hidden expectations and unclear roles are stressful for families. Nurses need skills training, adequate resources and managerial support to meet families' needs appropriately, to establish true collaboration and to deliver optimal family-centred care.

Understanding quantitative research: part 1

This article, which is the first in a two-part series, provides an introduction to understanding quantitative research, basic statistics and terminology used in research articles. Critical appraisal of research articles is essential to ensure that nurses remain up to date with evidence-based practice to provide consistent and high-quality nursing care. This article focuses on developing critical appraisal skills and understanding the use and implications of different quantitative approaches to research. Part two of this article will focus on explaining common statistical terms and the presentation of statistical data in quantitative research.

Influence of British army nurses on mental healthcare

Without war and conflict, the mental health treatments that are now considered routine in the NHS and civilian practice would not exist. This article discusses how many mental healthcare initiatives have emerged as a result of the requirement to provide high-quality nursing care for soldiers. Much has been learned since the first formal deployment of army nurses during the Crimean War (1853–56). Reference will be made to how military conflicts have shaped clinical nursing practice within civilian health services in areas including group psychotherapy, assertive outreach, community based care, and crisis intervention. It focuses on the period 1853–1918, and aligns lessons learnt to recent nursing-led initiatives for the care of soldiers and their implications for occupational mental health services.

Interventions for preventing and reducing the use of physical restraints in long‐term geriatric care – a Cochrane review

To evaluate the effectiveness of interventions to prevent and reduce the use of physical restraints in older people requiring long-term nursing care. Physical restraints are commonly used in geriatric long-term care. However, they are associated with adverse outcomes. Therefore, freedom from physical restraints should be the aim of high-quality nursing care. Systematic review of randomised controlled trials. This review followed the methods of the Cochrane Handbook of systematic reviews of interventions. The systematic search (September 2009) covered the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO and LILACS. Six cluster-randomised controlled trials met the inclusion criteria. All studies investigated educational approaches targeting nursing staff. In addition, two studies offered consultation, two guidance and one support and free access to technical aids. Five studies examined nursing home residents and one study residents in group dwelling units. No studies in community settings were included. Overall, the methodological quality of studies was low. Their results were inconsistent. One study with good methodological quality in the nursing home setting documented an increase in physical restraints use in both groups, while the other four studies with lower quality found reduced use of physical restraints in the intervention group. The single study in group dwelling units found no change in physical restraints use in the intervention group but a significant increase in the control group. There is insufficient evidence supporting the effectiveness of educational interventions targeting nursing staff for preventing or reducing the use of physical restraints in geriatric long-term care. Relevance to clinical practice. Our findings indicate that educational programmes targeting nursing staff might not be effective in reducing the use of physical restraints in geriatric long-term care. It remains unclear which components should be included in educational programmes aiming to reduce physical restraints.

Psychiatric Discharge Process

Background. Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Discharge planning is an essential process in psychiatric nursing field, in order to prevent recurrent readmission to psychiatric units. Objective. The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. Methods. A search of electronic databases was conducted. The search process aimed to locate different levels of evidence. Inclusion criteria were studies including outcomes related to prevention of readmission as stability in the community, studies investigating the discharge planning process in acute psychiatric wards, and studies that included factors that impede discharge planning and factors that aid timely discharge. On the other hand, exclusion criteria were studies in which discharge planning was discussed as part of a multi faceted intervention and was not the main focus of the review. Result. Studies met inclusion criteria were mainly literature reviews, consensus statements, and descriptive studies. All of these studies are considered at the lower levels of evidence. Conclusion. This review demonstrated that discharge planning based on general principles (evidence based principles) should be applied during psychiatric discharge planning to make this discharge more effective. Depending on this review, it could be concluded that effective discharge planning includes main three stages; initial discharge meeting, regular discharge meeting(s), and leaving from hospital and discharge day. Each stage of them has requirements should be accomplished be go to the next stage.

Registered nurse retention strategies in nursing homes

As the American population ages and the proportion of individuals over the age of 65 expands, the demand for high-quality nursing home care will increase. However, nursing workforce instability threatens care quality and sustainability in this sector. Despite increasing attention to nursing home staff turnover, far less is known about registered nurse (RN) retention. In this study, the relationships between retention strategies, employee benefits, features of the practice environment, and RN retention were explored. Further, the utility of Herzberg's two-factor theory of motivation as a framework for nursing home retention studies was evaluated. This study was a secondary analysis of the nationally representative 2004 National Nursing Home Survey. The final sample of 1,174 participating nursing homes were either certified by Medicare or Medicaid or licensed by state agencies. We used a weighted multinomial logistic regression using an incremental approach to model the relationships. Although most nursing homes offered some combination of retention programs, the majority of strategies did not have a significant association with the level of RN retention reported by facilities. Director of nursing tenure and other extrinsic factors had the strongest association with RN retention in adjusted analyses. To improve RN retention, organizations may benefit greatly from stabilizing nursing home leadership, especially the director of nursing position. Second, managers of facilities with poor retention may consider adding career ladders for advancement, awarding attendance, and improving employee benefits. As a behavioral outcome of motivation and satisfaction, retention was not explained as expected using Herzberg's two-factor theory.

Determining resource intensity weights in ambulatory chemotherapy related to nursing workload

Ontario cancer programs aim to deliver high-quality nursing care and treatment that is safe for patients and staff. The reality of health care is that financial constraints, inherent in the delivery of care, require that funding mechanisms count not only the cost of drugs, but factors such as pharmacy and nursing human resource costs. While some organizations have developed patient classification systems to measure nursing intensity and workload, these systems apply primarily to inpatient populations, and are fraught with numerous challenges, such as the need for nurses to document to justify the workload required for care. The purpose of this paper is to outline the methodology and engagement of nurses to develop regimen-based resource intensity weights that can be applied to ambulatory chemotherapy suites. The methodology included determination of workload related to nursing time to prepare, teach, counsel and assess patients, as well as time to gather supplies, access lines, monitor, manage adverse reactions, manage symptoms and document care. Resource intensity weights provide better measures of the complexity of care required by cancer patients in ambulatory settings.

Nurses’ research utilization two years after graduation—a national survey of associated individual, organizational, and educational factors

BackgroundNurses’ research utilization (RU) as part of evidence-based practice is strongly emphasized in today’s nursing education and clinical practice. The primary aim of RU is to provide high-quality nursing care to patients. Data on newly graduated nurses’ RU are scarce, but a predominance of low use has been reported in recent studies. Factors associated with nurses’ RU have previously been identified among individual and organizational/contextual factors, but there is a lack of knowledge about how these factors, including educational ones, interact with each other and with RU, particularly in nurses during the first years after graduation. The purpose of this study was therefore to identify factors that predict the probability for low RU among registered nurses two years after graduation.MethodsData were collected as part of the LANE study (Longitudinal Analysis of Nursing Education), a Swedish national survey of nursing students and registered nurses. Data on nurses’ instrumental, conceptual, and persuasive RU were collected two years after graduation (2007, n = 845), together with data on work contextual factors. Data on individual and educational factors were collected in the first year (2002) and last term of education (2004). Guided by an analytic schedule, bivariate analyses, followed by logistic regression modeling, were applied.ResultsOf the variables associated with RU in the bivariate analyses, six were found to be significantly related to low RU in the final logistic regression model: work in the psychiatric setting, role ambiguity, sufficient staffing, low work challenge, being male, and low student activity.ConclusionsA number of factors associated with nurses’ low extent of RU two years postgraduation were found, most of them potentially modifiable. These findings illustrate the multitude of factors related to low RU extent and take their interrelationships into account. This knowledge might serve as useful input in planning future studies aiming to improve nurses’, specifically newly graduated nurses’, RU.

Oral Care for Hospice Patients With Severe Trismus

Oral care is a hallmark of attentive, high-quality nursing care. Oral care improves a patient's sense of well-being, communication, and nutritional status, and lowers the risk for pneumonia. However, for patients with severe trismus, oral care may seem impossible. Trismus is the inability to open the mouth more than 35 mm and often results from medical therapies for head and neck cancers. This article details a simple approach to oral care that was implemented successfully with five hospice patients with severe trismus.

Perspectives on Cancer CarePerspectives on Cancer Care

This inspiring and engaging book offers insights based on the knowledge and experience of a range of expert contributors. It encourages high-quality nursing care by putting patients first and articulating their needs.

Establishment and evaluation of "high-quality nursing practice area" in emergency and outpatient department

Based on JCI standard,conduct nursing practice area activities themed as Warmness,Safe and Painless in the emergency department and outpatient department,deepen the connotation of nursing service.Use PDCA to achieve improvement simultaneously.In all these ways,we improved nursing quality,decreased sentinel event and increased satisfactory rate of the patients,enhance the nursing staff ＇s overall image,promote harmonious relations between nurses and patients. Key words: Outpatient department and emergency; Nursing management; High-quality nursing care

On the Doctor of Nursing Practice (DNP)

Doctoral degrees in nursing fall into two categories. The first is the researchfocused doctorate, the Doctor of Philosophy (PhD) or Doctor of Nursing Science (DNSc or DNS); and the second is the practice doctorate or Doctor of Nursing Practice (DNP). Nurses who graduate from research-focused doctoral programs are or should be prepared to generate new evidence for the profession. Nurses who graduate from the practice-focused doctorate are or should be prepared to be experts in advanced nursing practice and leaders in applying the best evidence to improve nursing practice, whether it be clinical, academic, or administrative. The authors should indicate our bias upfront. We believe that the DNP degree is meant to prepare leaders to improve practice and thus the focus of the degree should be on implementing practice change that improves outcomes for patients, nurses, and/ or students. Thus there should be a strong evidence-based practice (EBP) component in the curriculum, and the capstone in these programs should be on evidence synthesis and/or practice improvement projects (which can also be administrative or educational in nature), not research. The DNP degree has continued to blossom since the American Association of the Colleges of Nursing (AACN) released their Position statement on the Practice Doctorate in Nursing in 2004. There are currently 153 DNP programs in the United States with an additional 160 nursing schools planning similar programs (AACN, 2011). Existing DNP programs follow either a clinical, educational, or administrative track to prepare leaders in each of these areas. All DNP programs are expected to include in their curriculum the seven Essentials of Doctoral Education for Advanced Practice Nurses developed by the AACN (2006). Included in the Essentials is the edict that DNP graduates be able to . . . demonstrate refined assessment skills and base practice on the application of biophysical, psychosocial, behavioral, sociopolitical, cultural, economic, and nursing science as appropriate in their area of specialization (AACN, 2006, p. 16). The DNP degree was conceived as an educational program to prepare graduates to be experts and leaders in evidence-based practice. The DNP clinician is ideally prepared to improve healthcare outcomes by facilitating the translation of current, best evidence into clinical practice. The DNP is proposed by AACN as the terminal degree for advanced practice nurses. DNP graduates may continue to work in the same practice environments with other nurses with different educational levels as well as other health care disciplines. Many organizations are still trying to determine how to utilize the DNP graduate within their practice environments. With pending health care reform, the threat of reduced reimbursement for poor outcomes, and the ongoing shortage of primary care providers, it is crucial for current best evidence to be quickly translated into clinical practice to improve outcomes for the patients and communities we serve. In addition, many healthcare organizations are applying for Magnet status, a recognition program developed by the American Nurses Credentialing Center (ANCC) for high-quality nursing care. Magnet hospitals must demonstrate their contribution to generating knowledge, innovations, and improvements for the professions through the translation and application of existing evidence and by identifying areas where new research is needed (ANCC, 2011). Despite the Institute of Medicine's (2011) challenge for nursing to reconceptualize the role of nurses while developing innovative solutions to care delivery, many barriers to full implementation of evidence-based practice still exist. Nurses continually report lack of time as the most common barrier to applying evidencebased practice approaches to clinical practice (Bertulis, 2008; Brown, Wickline, Ecoff, & Glaser, 2009; Pravikoff, Tanner, & Pierce, 2005). Other barriers that have been reported include the difficulty accessing resources, poor computer skills, poor understanding of statistics and research technique, inadequate preparation to critically appraise research, lack of support from administration and other staff, and a disbelief that evidence-based practice can improve outcomes (Bertulis, 2008; Brown et al. …

Psychometric Analysis of the JSPE Nursing Student Version R: Comparison of Senior BSN Students and Medical Students Attitudes toward Empathy in Patient Care

Background. Empathic communication skills are critical to providing high-quality nursing care to holistically understand the patient's perspective. A survey research design was used to address the research questions discussed in this study. Data consisted of responses from nursing students attending accredited programs in the southeastern United Sates using the Jefferson Scale of Physician Empathy Nursing Student Version R (JSPE-R). Findings. Comparisons of the total scores from JSPE Versions S and R yielded similar means and standard deviations with 115 and 114.57, respectively, and standard deviations of 10 and 10.94, respectively. The results of a one-sample t-test failed to render statistical significance (t = −1.22, P = .224), indicating that the overall attitudes of nursing students and medical students are similar. The 25th, 50th, and 75th percentiles and overall instrument reliability were also comparable. Conclusions. This paper supports the emergence of alternative factor analysis structures as applied to nursing students through statistical progression from exploratory factor analysis to confirmatory structures. Implications for practice explore the utility of empathy instruments in nurse education, such as empathy progression through curriculum. As nursing educators, the utility of development of instruments to measure effectiveness of teaching strategies and pedagogy for empathy enhancement in practice is important.

Global and Cultural Perinatal Nursing Research

High-quality perinatal nursing care should be based on the best evidence including research findings, clinical expertise, and the preferences of women and their families. Principles of perinatal research initiatives are defined, with suggested research priorities designed to close current gaps in the micro and macro environments of perinatal nursing throughout the world. Nearly a decade ago, the following question was asked, "Where is the 'E' (evidence) in maternal child health?" Improving the quality and safety of perinatal nursing care for culturally diverse women globally is the primary goal of nurse researchers leading the future of perinatal healthcare.

Early Career RNs’ Perceptions of Quality Care in the Hospital Setting

The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.

Nursing Home Termination, Nursing Home Closure, and Many Unanswered Questions

Nursing Home Termination, Nursing Home Closure, and Many Unanswered Questions

“Help, I Need Somebody. . .” A Collaborative Approach to Nurses Helping Nurses

In our unit, we have tackled head on the Act With Intention directive put forth by Beth Hammer, president of the American Association of Critical-Care Nurses (AACN). We never want a nurse to leave our unit because no one was available to help with patient care when the help was needed most. We never want a nurse to hesitate to ask a medication-related question because of fear of retaliation. We never want a nurse to leave our unit because he/she felt as if no one was available to help with patient care when he/she needed it most. We never want a nurse to be afraid to ask for help. The reality is that progressive care environments are typically characterized by high volume and high turnover of patients. Time constraints and patients’ rapidly changing conditions, along with the complex nursing care required, can cause frustration and feelings of being overwhelmed among nurses who are striving to provide excellent patient care in a rapidly changing health care environment.“Everyone seems too busy to help.” “Nurses are becoming frustrated and overwhelmed with patient turnover.” “Some nurses are afraid to ask for help.” How do we combat these sorts of comments on our unit?We implemented primary partner nursing (PPN) on our progressive critical care unit in an academic, community Magnet hospital, in an effort to improve communication and collaboration through the formation of nursing partnerships.Our nurses tell us that feeling supported and perceiving that they are able to deliver high-quality nursing care translate into improved patient care and nursing satisfaction. PPN is an initiative of the nursing practice council that establishes a culture of teamwork among all nurses with the common goal of fostering excellence in nursing practice and patient care.Nursing partners collaborate to facilitate patient care, including admissions, discharges, transfers, diagnostic testing, establishing vascular access, initiating and maintaining infusion therapy, wound care, patient education, and managing patients’ rapidly changing conditions. Partnerships, groups of 2 or 3 registered nurses (RNs), are established on the basis of proximity and experience. The partnerships are determined at the beginning of each shift and are shared on the nursing assignment board. New graduate nurses are introduced to PPN during their orientation, where PPN is presented as a support system to guide their developing clinical practice. All nurses rely on PPN as a source of mutual support and consultation to deliver high-quality nursing care. We acknowledge each other publicly by posting thank-you notes on our unit that highlight the contributions that each nurse brings to the partnerships.PPN has facilitated the culture of teamwork on our unit for more than 2 years. Our nurses tell us that the partnerships are effective and “definitely, PPN has improved patient care.” Survey results revealed that 70% of nurses think that PPN also has improved satisfaction among nurses. “Having an RN ask me, ‘How are your patients? Do you need any help?’ makes me feel supported and creates an environment of teamwork.”Through surveys and unit meetings, nurses share exemplars of how PPN has influenced their practice.PPN is here to stay in our unit and we are excited to share our success with other nursing units. Nursing partnerships can be used by any organization to engage nurses to improve communication and collaboration, which supports the AACN Healthy Work Environment Initiative. PPN also supports the American Nurses Credentialing Center’s Forces of Magnetism by enhancing nurses’ quality of care. So go ahead and ask for help; you will improve nursing satisfaction and patient care!The authors would like to thank Nicole Hartman, rn, bsn, Nursing Excellence Specialist, Center for Professional Excellence, LVHN, for all her support.

What Are You Doing to Promote Tobacco Cessation with Your Patients?

The International Nurses Society on Addictions (IntNSA) is dedicated to the advancement of nursing care for the prevention and treatment of addictions for diverse populations across all practice settings through advocacy, collaboration, education, research and policy development. IntNSA’s goal is to help nurses provide comprehensive, high-quality nursing care for addicted patients and their families. IntNSA has something to offer every nurse, regardless of their area of nursing practice. With the prevalence of addiction-related health consequences, we believe that all nurses must maintain a basic level of knowledge and skills in addictions. Vision IntNSA’s strength comes from its members, including clinicians, educators, managers and researchers who practice in a wide variety of settings, including treatment centers, hospitals, schools, private practices, primary care and other community agencies. IntNSA believes that all nurses, regardless of their specialty or practice setting, can play a role in the promotion of healthy lifestyles and the early identification of people at a greater risk for developing problems associated with the abuse of addictive substances.

Valuing Nurses and the Work They Do

All nurses, wherever they work, are involved with providing end-of-life care to their patients. It is important that people receive high-quality nursing care at all times throughout their life, but particularly as they approach the end of their life. Nurses and other practitioners have one opportunity to get the care right for dying people and their families. Nurses working in the care home setting provide care for a large proportion of people in the later years of life. Care home residents often have complex health and social needs that affect their wellbeing and quality of life. An increasing number of people with some degree of cognitive impairment and/or dementia live within care homes. Nurses working in care homes often make a significant difference to the quality of residents’ lives and that of the residents’ families. This article will provide an outline of the Gold Standards Framework in Care Homes (GSFCH) Programme and highlight the important role of nurses in facilitating the Programme within their care homes.