Clinical Nursing Experience Research Articles

Turnover intention of graduate nurses in South Korea

The purpose of this study was to identify the turnover intention of graduate nurses in South Korea and to explore the correlates of turnover intention. A descriptive, correlational design was used. The participants comprised 225 female nurses who were working at 13 general hospitals and who had accumulated <12 months of clinical nursing experience since their graduation. The data were collected through a structured questionnaire that was conducted from 5-31 August 2009. The mean score for turnover intention was 7.51. Turnover intention was found to be related to the number of beds in the hospital, workplace, and duration of job orientation (theory and practice), instruction by a preceptor, job stress, clinical competence, self-efficacy, and the practice environment. In the multivariate approach, the practice environment, job stress, and the workplace were found to be significantly related to turnover intention and accounted for 36% of the said intention in the studied graduate nurses. The results support that the characteristics of magnet hospitals that improve the practice environment could play a critical role in retaining nurses in hospitals. Managerial interventions that enhance the practice environment, reduce job stress, and place graduate nurses in nursing units with a single specialty could benefit the hospitals employing such nurses. Further research to explore the effects of managerial strategies on graduate nurses' turnover intention is warranted.

Registered nurse leadership style and confidence in delegation

Leadership and confidence in delegation are two important explanatory constructs of nursing practice. The relationship between these constructs, however, is not clearly understood. To be successful in their roles as leaders, regardless of their experience, registered nurses (RNs) need to understand how to best delegate. The present study explored and described the relationship between RN leadership styles, demographic variables and confidence in delegation in a community teaching hospital. Utilizing a cross-sectional survey design, RNs employed in one acute care hospital completed questionnaires that measured leadership style [Path-Goal Leadership Questionnaire (PGLQ)] and confidence in delegating patient care tasks [Confidence and Intent to Delegate Scale (CIDS)]. Contrary to expectations, the data did not confirm a relationship between confidence in delegating tasks to unlicensed assistive personnel (UAPs) and leadership style. Nurses who were diploma or associate degree prepared were initially less confident in delegating tasks to UAPs as compared with RNs holding a bachelor's degree or higher. Further, after 5 years of clinical nursing experience, nurses with less educational experience reported more confidence in delegating tasks as compared with RNs with more educational experience. The lack of a relationship between leadership style and confidence in delegating patient care tasks were discussed in terms of the PGLQ classification criteria and hospital unit differences. As suggested by the significant two-way interaction between educational preparation and clinical nursing experience, changes in the nurse's confidence in delegating patient care tasks to UAPs was a dynamic changing variable that resulted from the interplay between amount of educational preparation and years of clinical nursing experience in this population of nurses. Clearly, generalizability of these findings to nurses outside the US is questionable, thus nurse managers must be familiar with the Nurse Practice Act in their country in order to ensure proper delegation of tasks to appropriate assistive personnel. It is imperative that nurse managers provide nurses with the educational opportunities necessary to develop delegation and supervision strategies to adapt to the changing RN role while adhering to differences in scope of practice. Globally, RNs are caring for increasing numbers of acutely ill patients with scarce resources ensuring an adequately trained RN/UAP team can help support optimal patient care.

Clinical nursing experience of prevention of neonatal jaundice complicated with bilirubin encephalopathy

目的 总结预防新生儿黄疸并发胆红素脑病的临床观察护理经验.方法 通过观察2008年至2010年我院收治的67例新生儿黄疸患儿,分析新生儿黄疸的发生原因,采取相应的治疗护理措施来预防并发胆红素脑病.结果 新生儿生理性黄疸占71.64%,病理性黄疸占28.36%.经护理治疗后45例新生儿黄疸患儿在1周内,肉眼观察皮肤黄疸消退,血清胆红素下降,平均降至(42.1±20)μmol/L以下;22例新生儿黄疸患儿2.5周内均痊愈;未发生新生儿黄疸并发胆红素脑病的情况.67例患儿住院时间5～14 d,平均住院(6.7±1.0)d.结论 加强新生儿黄疸的观察及护理,有助于尽快找出原因及时治疗,防止胆红素脑病的发生。

Retired RNs: Perceptions of Volunteering

A qualitative study was done to explore the perceptions of volunteering among retired registered nurses (RNs) in Kansas. Participants were volunteers in formal nursing roles or were using their nursing knowledge and experience in non-nursing roles, such as church work. Regardless of the type of volunteer position, retired RNs reported that they use what they have learned as nurses when they volunteer. Volunteering benefits include enhanced self-worth, intellectual stimulation, reduced social isolation, and opportunities to help others. Increased paperwork, new technology, difficulty finding nursing-specific volunteer opportunities, resistance from health care organizations, and a lack of respect for what these nurses know are challenges and barriers to volunteering. Retired RNs have accumulated years of clinical nursing experience and can be helpful to employed nurses. Health care organizations should launch targeted efforts to recruit and utilize retired RN volunteers. Health care professionals who care for older adults should recommend volunteering as a healthful endeavor.

Barriers And Facilitators Relating To Thai Clinical Nurses Use Of Qualitative Software Tools: Informing Hospital Policy

Background This paper discusses the research approaches and experiences of Thai clinical nurses from a purposefully selected group of Thai private hospitals in Bangkok. A public search for research conducted by Thai clinical nurses revealed that little is written about their experiences or their engagement and testing of qualitative software tools related to clinically identified problems or issues.MethodsThe paper utilises a qualitative approach employing a focus group drawn from 4 Thai private hospitals creating a concentrated facet of context and flexibility. This paper addresses issues relating to the conduct of qualitative research by clinical nurses in a small number of private hospitals in Bangkok. Results The developed research questions were mapped to the generated 8 major themes, and supported by 21 sub-themes. The qualitative outcomes presented, highlight the various experiences, perspectives, opportunities and challenges that Thai clinical nurses face. The outcomes indicate that there are 8 barriers and 13 facilitators and that these together illustrate the diversity of research practice opinion of Thai clinical nurses, and underpins the managerial task to reduce the barriers impact and enhance the facilitating factors for Thai clinical nurses.ConclusionsThe impact of this research suggests that hospital management have to address the need to build a more equitable resource base to streamline the available research provision. This would provide greater support for clinical nurses using qualitative methods that lead to clinical research outcomes when engaging in evidence-based qualitative research.

Guideline adherence to chemotherapy administration safety standards: a survey on nurses in a single institute

ObjectiveLittle is known about the guideline adherence of nurses to chemotherapy administration guidelines. We determined the guideline adherence of nurses to the Chemotherapy Administration Safety Standards and the relationship between demographic characteristics and guideline adherence.MethodsSurvey sheets containing two questions on demographic characteristics and 16 questions on the guideline adherence of nurses regarding chemotherapy administration were distributed to all in-patient departments in our hospital in which chemotherapy was performed. All clinical nurses in the department were recommended to respond.ResultsOf 202 nurses, 123 responses were collected (61% response rate). The guideline adherence rate was >70% for 15 of 16 questions, but 55% of respondents indicated that there was no competency monitoring for nurses. Nurses with >7 years of clinical nursing experience felt more competent in performing cardiopulmonary resuscitation (CPR) than nurses with <7 years of clinical nursing experience (p=0.032).ConclusionThe guideline adherence rate of nurses with respect to chemotherapy administration was high, with the exception of the absence of a competency monitoring for nurses. A significant number of nurses with <7 years of clinical nursing experience felt incompetent in performing CPR.

Using a Wellness Program in Public Housing for Community Nursing Clinical Experiences

A group of senior baccalaureate nursing students have been working with elderly and disabled residents in public housing as part of a Wellness Program for more than 5 years. This placement is an alternative to traditional Visiting Nurse Association placements, and encourages students to expand outreach and develop interventions for vulnerable populations while fulfilling nursing educational objectives.

The ethics of simulated nursing clinical experiences

Simulation has the capacity to alleviate many of the problems facing associate degree nursing education today. As the use of simulation increases, nurse educators must examine the ethical aspects of simulated clinical experience. The purpose of this article was to explore the ethical issues surrounding simulation in associate degree nursing education. Current literature supports simulation as an adjunct to traditional teaching methods. Ethical theories and principles are explored as they apply to simulation.

Interruptions and Multitasking in Nursing Care

The environment surrounding registered nurses (RNs) has been described as fast-paced and unpredictable, and nurses' cognitive load as exceptionally heavy. Studies of interruptions and multitasking in health care are limited, and most have focused on physicians. The extent and type of interruptions and multitasking of nurses, as well as patient errors, were studied using a natural-setting observational field design. The study was conducted in seven patient care units in two Midwestern hospitals--an academic medical center and a community-based teaching hospital. A total of 35 nurses were observed for four-hour periods of time by experienced clinical nurses, who underwent training until they reached an interrater reliability of 0.90. In the 36 RN observations (total, 136 hours) 3,441 events were captured. There were a total of 1,354 interruptions, 46 hours of multitasking, and 200 errors. Nurses were interrupted 10 times per hour, or 1 interruption per 6 minutes. However, RNs in one of the hospitals had significantly more interruptions--1 interruption every 4 1/2 minutes in Hospital 1 (versus 1 every 13.3 minutes in Hospital 2). Nurses were observed to be multitasking 34% of the time (range, 23%- 41%). Overall, the error rate was 1.5 per hour (1.02 per hour in Hospital 1 and 1.89 per hour in Hospital 2). Although there was no significant relationship between interruptions, multitasking, and patient errors, the results of this study show that nurses' work environment is complex and error prone. RNs observed in both hospitals and on all patient care units experienced a high level of discontinuity in the execution of their work. Although nurses manage interruptions and multitasking well, the potential for errors is present, and strategies to decrease interruptions are needed.

Spiritual Job Satisfaction in an Iranian Nursing Context

This article reports the results of a qualitative study that used a deep interview method. The aim was to gather lived experiences of clinical nurses employed at government-funded medical centres regarding the non-materialistic and spiritual aspects of the profession that have had an important impact on their job satisfaction. On analysing the participants' concepts of spiritual satisfaction, the following themes were extracted: spiritually pleasant feelings, patients as celestial gifts, spiritual commitment, spiritual penchant, spiritual rewards, and spiritual dilemmas. Content analysis of the data indicated that nurses who viewed these dimensions of job satisfaction as a significant factor considered nursing as an opportunity to worship God while providing care for patients, and regarded their aim as achieving patients' contentment by providing nursing care compatible with scientific care methods.

Parental presence during resuscitation in the PICU: the parents’ experience

To provide in-depth understanding of the meaning for parents who were present or absent during a resuscitation attempt on their child in the PICU. Family presence during resuscitation remains a topic of debate with both benefits and disadvantages identified, yet few studies have asked parents of children in PICU to describe their experiences of being present or absent during this resuscitation and what this means to their understanding and coping. Additionally, minimal research has investigated parental presence during a successful resuscitation. A qualitative design was used based upon van Manen's interpretative phenomenological approach. Fourteen parents of critically ill children from one paediatric intensive care unit in Australia, who had either survived or died following a resuscitation attempt were interviewed. Four main themes were identified: (1) being only for a child; (2) making sense of a living nightmare; (3) maintaining hope in the face of reality; (4) living in a relationship with staff. The findings underpin the inherent need for parents to choose to be present during resuscitation to make sense of the situation. Memories of the resuscitation were not long-lasting and distress was for the potential death of a child, rather than the resuscitation scene. Parents who did not witness their child's resuscitation were more distressed than those who did. Having the opportunity to make the decision to stay or leave was important for parents. Support during the resuscitation was best provided by experienced clinical nurses. Recognition of the parents' compelling need to stay will improve nurses' understanding of how witnessing this event may assist family coping and functioning. Ways in which parents may be better supported in making the decision to stay or leave during resuscitation are identified.

Developing evidence‐based practice: experiences of senior and junior clinical nurses

This paper is a report of a study to compare factors influencing the development of evidence-based practice identified by junior and senior nurses. Assessing factors influencing the achievement of evidence-based practice is complex. Consideration needs to be given to a range of factors including different types of evidence, the skills nurses require to achieve evidence-based practice together with barriers and facilitators. To date, little is known about the relative skills of junior and senior clinical nurses in relation to evidence-based practice. A cross-sectional survey was undertaken at two hospitals in England, using the Developing Evidence-Based Practice Questionnaire administered to Registered Nurses (n = 1411). A useable sample of 598 (response rate 42%) was achieved. Data were collected in 2003, with comparisons undertaken between junior and senior nurses. Nurses relied heavily on personal experience and communication with colleagues rather than formal sources of knowledge. All respondents demonstrated confidence in accessing and using evidence for practice. Senior nurses were more confident in accessing all sources of evidence including published sources and the Internet, and felt able to initiate change. Junior nurses perceived more barriers in implementing change, and were less confident in accessing organizational evidence. Junior nurses perceived lack of time and resources as major barriers, whereas senior nurses felt empowered to overcome these constraints. Senior nurses are developing skills in evidence-based practice. However, the nursing culture seems to disempower junior nurses so that they are unable to develop autonomy in implementing evidence-based practice.

The Omaha System and Quality Measurement in Academic Nurse-Managed Centers: Ten Steps for Implementation

Measuring and describing client problems, nursing interventions, and outcomes is a challenge in nursing care. This study reviews the literature about the use of the Omaha System and describes the steps used to introduce and implement the Omaha System as a documentation and outcome measurement system in academic nurse-managed centers. The goal of the article is to provide a guide for nurse educators to develop and implement a quality measurement system that can be used in clinical settings by undergraduate students. The Omaha System is a strategy to introduce and incorporate evidence-based practice in the undergraduate nursing clinical experience.

The Good Clinical Nursing Educator and the Baccalaureate Nursing Clinical Experience: Attributes and Praxis

Clinical education accounts for a significant portion of baccalaureate nursing (BSN) education. This study examined recent BSN program graduates' views about clinical nursing educator attributes that enhance the ability of the graduates to provide safe, effective patient care. In this descriptive study, 6 participants were interviewed using grounded theory techniques. The study framework blended the elements of cognitive field theory, the humanistic philosophy of teaching and learning, the gestalt theory of learning, and Hergenhahn's behavioral change model. Participants identified three attributes of a good clinical nursing educator: knowledge, interpersonal presentation, and teaching strategies. Analysis revealed that educator attributes and phases of the clinical experience process together form the foundation for clinical experience praxis. Educators can improve the clinical education experience by developing teaching strategies and evaluation tools that build on the positive attributes and phases of the clinical experience identified in this study.

Developing a qualitative approach to 360-degree feedback to aid understanding and development of clinical expertise

This paper presents one aspect of a 5-year multicentre action research study to develop an accreditation process for clinical nursing expertise. Part of the process consisted of the exploration, critique and refinement of qualitative 360-degree feedback as a tool for peer review. Three hundred and sixty-degree feedback is widely used as a personal and professional development strategy. This part of the overall study challenged assumptions about the necessity for anonymity and structured questionnaires to collect data. The study involved 32 experienced clinical nurses drawn from a range of clinical settings supported by 'critical companions' (colleagues from clinical practice, education, management and research, recruited to provide supervision and support). Study participants, facilitated by the project team (the authors), engaged in critiquing and refining 360-degree feedback as a process to help them examine and develop their practice. On the basis of our findings this approach to gathering 360-degree feedback facilitates the collection of evidence that aids professional development. There are indications that it may also contribute to improved working relationships.

Tomorrow's Psychiatric Nurses: Where Are We Today in Providing Students' Clinical Experiences?

BACKGROUND: The increased enrollment of students, scarcity of faculty, and reduction in psychiatric beds challenge traditional ways of providing clinical psychiatric nursing experience to undergraduates. OBJECTIVE: The purpose of the study was to describe the current clinical psychiatric nursing experiences of undergraduates throughout the country. STUDY DESIGN: An online survey was dispersed to undergraduate nurse educators to describe clinical experiences in psychiatric mental health nursing. The survey included demographic questions, questions about students' clinical experiences, and open-ended questions regarding choices of and obstacles to a successful clinical experience. RESULTS: The 160 respondents reported concerns such as availability and quality of clinical sites, poor nursing role models, number of clinical hours, and lack of valuing their expertise. The results raise questions about the minimum number of hours needed to achieve competencies in psychiatric nursing, what simulations or laboratory experiences are essential, and what types of clinical settings provide needed experience. J Am Psychiatr Nurses Assoc, 2007; 13(1), 53-60.

Evaluation of a clinical performance assessment tool (CPAT) within a critical care context

Internationally, the assessment of nursing clinical performance has remained a challenge at undergraduate and postgraduate level. The clinical performance assessment tool (CPAT) was developed to measure paediatric intensive care (PIC) and adult critical care (ACC) postgraduate nursing students' developing clinical performance. The CPAT was based upon the Australian Competency Standards for Specialist Critical Care Nurses 1, which are recognised as the professional standards for specialist level critical care nurses in Australia. A two phase descriptive correlational study was undertaken to examine the applicability, validity and reliability of the CPAT. Data collection included experienced clinical nurses' validation of the CPAT (Phase 1), the students' and assessors' documentation using the CPAT and individual semi-structured interviews (Phase 2). The revised CPAT, incorporating the second edition of the competency standards 2, was further evaluated (Phase 3) by reviewing how the document had been used and surveying students and assessors. The findings supported the format and approach based on the ACCCN competency standards. The CPAT facilitated assessors to assist students to develop their clinical performance. However, substantial refinement and modification of the CPAT was required to make it useful as a clinical assessment tool. The significance of this was supported by the subsequent research examining the construct validity of the competency standards. However, the link with the ACCCN competencies remains evident, and this indirectly further supports the utility of having nationally agreed standards for professional practice within specialty areas.

Opening our hearts and minds: The meaning of international clinical nursing electives in the personal and professional lives of nurses

Although international opportunities are the hallmark of nursing education at a large private university, the meaning of participating in such clinical nursing electives has not been described. The purpose of this phenomenological study of nurses was to examine the personal and professional meaning of participating in international clinical nursing electives during their undergraduate nursing studies. Audiotaped interviews were conducted with 20 former nursing students who had had this opportunity. "Opening our hearts and minds" was described by the study's participants, with the following themes: increasing understanding of other cultures and peoples, increasing understanding of global sociopolitical and health issues, increasing the commitment to make a difference, experiencing personal and professional growth, contributing to professional development in the host country, making interpersonal connexions, and developing cultural competence. This study makes an important contribution to the documentation of the meaning of participating in international nursing clinical experiences. Data are being used for long-term curricular planning in the development and refinement of future international clinical nursing electives and to provide outcomes data for professional accreditation. There are broader implications for the movement beyond individual cultural competence to increasing global consciousness and the improvement of global health care.

A Mental Health Nursing Clinical Experience With Hospice Patients

The author describes a clinical experience with hospice patients developed for an 8-week mental health nursing course. The experience focused on the promotion of mental health in the patient and the therapeutic use of self with students. Students were assigned a hospice patient each of whom they visited once a week. Students kept a journal and met for a weekly support group meeting with their instructor. The experience was evaluated positively by students who thought it improved their use of therapeutic communication, empathy, and gained insight into death and dying.

Effects of ward rotation on subsequent transition processes of Japanese clinical nurses

The purpose of this study was to examine the experience of Japanese clinical nurses undertaking a ward rotation in a general hospital, and its effects on subsequent processes relating to: (i) perception of ward rotation; (ii) reactions to the ward transition process; and (iii) outcomes of ward rotation. In-depth interviews were conducted with 21 Japanese clinical nurses who had an average of 8.8 years (SD = 5.50) clinical experience. Findings indicated that participants experienced role overload, role incongruity and/or role underload, role overqualification, or role ambiguity in the new environment. These role stresses created critical emotional distress during the transition process. The high desire for career development facilitated the transition process, while lack of preparation inhibited the transition process. To facilitate smooth transition, well-prepared and structured supports based on reliable interpersonal relationships are necessary. The findings offer significant cues for effective ward rotation programs. The implication for nursing administrators is that appropriate ward rotations enhance confidence and promote effective role development in the new clinical setting.