Professional Nursing Practice Research Articles

Portuguese nursing: history of the life and activism of Maria Augusta Sousa.

To analyze the history of the life and activism of Portuguese nurse Maria Augusta Sousa. Sousa's life story was obtained by means of semi-structured interview swith Sousa as the oral source of data. NVivo qualitative research software was used for data analysis. Content analysis focused on thematic analysis based on the theoretical and philosophical ideas of Michel Foucault, in particular, power and techniques of the self. Alienation and political participation were revealed as pertinent issues. In techniques of production of activist subjects, the following were highlighted: the importance of the review of formal education; actions of involvement with the world, society and the profession; and finally, techniques of the self, techniques of constitution of activist subjects, professional identity and way of being. The constitution of the nurse Maria Augusta Sousa as an activist came about through questioning of how to be, education in the context of her family, and political engagement in Catholic Youth. This impacted her trajectory of contributions to Portuguese nursing, as expressed in the following achievements: the integration of nursing training into higher education; the creation of the Regulation of Nurses Professional Practice; and implementation of the Order of Nurses. Analisar a história de vida e militância da enfermeira Maria Augusta Sousa. História de vida, tendo como fonte oral a entrevista semiestruturada. Na análise de dados utilizou-se do software de pesquisa qualitativa Nvivo, e a análise de conteúdo com foco na análise temática e com base teórico-filosófica de Michel Foucault, em especial, o poder e as técnicas de si. Evidenciaram-se a alienação e a participação política comoquestões pertinentes. Nas técnicas de produção de sujeitos militantes destacam-se a importânciada revisão da educação formal, dos atos de implicação com o mundo, a sociedade e a profissão, e por fim, as técnicas de si, técnicas de constituição de sujeitos militantes, a identidade profissional e o modo de ser. A constituição da enfermeira Maria Augusta Sousa como militante acontece por questões do modo de ser, da educação familiar e do seu engajamento político na Juventude Católica, que repercutiu em uma trajetória de contribuição para enfermagem portuguesa, expressa nas seguintes conquistas: a integração do Ensino de Enfermagem no Ensino Superior, a criação do Regulamento do Exercício Profissional de Enfermagem e a implantação da Ordem dos Enfermeiros.

Skin care in nursing: A critical discussion of nursing practice and research

Skin (self-)care is part of human life from birth until death. Today many different skin care practices, preferences, traditions and routines exist in parallel. In addition, preventive and therapeutic skin care is delivered in nursing and healthcare by formal and informal caregivers. The aim of this contribution is a critical discussion about skin care in the context of professional nursing practice. An explicit skin assessment using accurate diagnostic statements is needed for clinical decision making. Special attention should be paid on high risk skin areas, which may be either too dry or too moist. From a safety perspective the protection and maintenance of skin integrity should have the highest priority. Skin cleansing is the removal of unwanted substances from the skin surface. Despite cleansing efficacy soap, other surfactants and water will inevitably always result in the destruction of the skin barrier. Thousands of products are available to hydrate, moisturize, protect and restore skin properties dependent upon their formulation and the concentration of ingredients. These products intended to left in contact with skin exhibit several actions on and in the skin interfering with skin biology. Unwanted side effects include hyper-hydration and disorganization of lipid bilayers in the stratum corneum, a dysfunctional barrier, increased susceptibility to irritants and allergies, and increases of skin surface pH. Where the skin barrier is impaired appropriate interventions, e.g. apply lipophilic products in sufficient quantity to treat dry skin or protect the skin from exposure to irritants should be provided. A key statement of this contribution is: every skin care activity matters. Every time something is placed on the skin, a functional and structural response is provoked. This response can be either desired or undesired, beneficial or harmful. The choice of all skin care interventions in nursing and healthcare practice must be based on an accurate assessment of the skin and concomitant health conditions and on a clearly defined outcome. A standardized skin care and skin care product language is needed for researchers planning and conducting clinical trials, for reviewers doing systematic reviews and evidence-base summaries, for nurses and other healthcare workers to deliver evidence-based and safe skin care.

Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice.

The purpose of this article is to discuss the need to provide culturally sensitive care to the growing number of diverse health care consumers. A literature review of national standards and research on cultural competency was conducted and specifically focused on the field of nursing. This study supports the theory that cultural competence is learned over time and is a process of inner reflection and awareness. The domains of awareness, skill, and knowledge are essential competencies that must be gained by health care providers and especially for nurses. Although barriers to providing culturally sensitive care exist, gaining a better understanding of cultural competence is essential to developing realistic education and training techniques, which will lead to quality professional nursing practice for increasingly diverse populations.

Health Care Reform, Care Coordination, and Transformational Leadership.

This article is meant to spur debate on the role of the professional nurse in care coordination as well as the role of nursing leaders for defining and leading to a future state. This work highlights the opportunity and benefits associated with transformation of professional nursing practice in response to the mandates of the Affordable Care Act of 2010. An understanding of core concepts and the work of care coordination are used to propose a model of care coordination based on the population health pyramid. This maximizes the roles of nurses across the continuum as transformational leaders in the patient/family and nursing relationship. The author explores the role of the nurse in a transactional versus transformational relationship with patients, leading to actualization of the nurse in care coordination. Focusing on the role of the nurse leader, the challenges and necessary actions for optimization of the professional nurse role are explored, using principles of transformational leadership.

Preparing Student Nurses as Parent-based Adolescent Sexual Health Educators: Results of a Pilot Study.

While health promotion and patient education are central to the scope of practice of professional nurses, they often feel ill-equipped to assume the role of sexual health educator and lack adequate knowledge and skills to effectively engage parents in adolescent sexual and reproductive health efforts. Employing a mixed-methods study consisting of both pre- and post-test survey and exit interviews, a pilot study was conducted to assess the impact of implementing a parent-based adolescent sexual health intervention on baccalaureate nursing student outcomes (N = 31). We found statistically significant improvements in student outcome expectancies of parenting strategies, barriers to sexual health communication, self-efficacy, and sexual health counseling experience. Using thematic content analysis of exit interview content, emerging themes were (1) need for increased sexual and reproductive health (SRH) preparation, (2) wanting greater experience and opportunity for involvement in nursing research, and (3) educational gaps in family-focused community public health. Incorporating adolescent sexual health education into public health nursing clinical training can prepare nurses as parent-based adolescent sexual health educators, a core competency for nurses working with families in communities and across all health care delivery settings.

A theory-based approach to nursing shared governance

BackgroundThe discipline of nursing uses a general definition of shared governance. The discipline's lack of a specified theory with precepts and propositions contributes to persistent barriers in progress toward building evidence-based knowledge through systematic study. PurposeThe purposes of this article were to describe the development and elements of a program theory approach for nursing shared governance implementation and to recommend further testing. MethodFive studies using multiple methods are described using a structured framework. The studies led to the use of Lipsey's method of theory development for program implementation to develop a theory for shared governance for nursing. DiscussionNine competencies were verified to define nursing practice council effectiveness. Other findings reveal that nurse empowerment results from alignment between the competencies of self- directed work teams and the competencies of organizational leaders. Implementation of GEMS theory based nursing shared governance can advance goals at the individual, unit, department, and organization level. ConclusionAdvancing professional nursing practice requires that nursing concepts are systematically studied and then formalized for implementation. This article describes the development of a theoretical foundation for the systematic study and implementation of nursing shared governance.

TOLERANCE AS A PROFESSIONALIZATION FACTOR OF NURSES IN PSYCHIATRY

Nurses in psychiatric service are a special group of nursing professionals. Their individualization is due to the specific needs of their patients who have increased level of aggressiveness, behavioral and communicative deviations and problems in self-service. These patients’ quality factors increase the risks of medical staff intolerance. As mechanisms of intolerance decrease some specific mechanisms of tolerance are developed in professional nursing practices. These include specific corporative standards, religious practices and forms of group action. Staff members can approve, ignore or condemn intolerance towards patients, the regulatory basis for this position at the level of subcultural organizational standards meaning the application of moral sanctions to an offender. Active inclusion of religious affiliations in the life of psychiatric healthcare institutions allows external moral arbitrator to enter professional space influencing both the behavior of professionals and the system of moral standards. Specificity of nursing profession in psychiatry requires additional means of inprofessionalization and professional improvement which are spontaneous practices of mentoring (guidance) in psychiatric hospital. All the mechanisms of tolerance increase hold professional community of nurses in psychiatry together.

Clinical Nurse Specialists Guide Staff Nurses to Promote Practice Accountability Through Peer Review.

The aim of the study was to describe the clinical nurse specialist role in developing and implementing a staff nurse education program to promote practice accountability using peer review principles. Peer review is essential for professional nursing practice demanding a significant culture change. Clinical nurse specialists in a Magnet-designated community hospital were charged with developing a staff nurse peer review education program. Peer review is a recognized mechanism of professional self-regulation to ensure delivery of quality care. The American Nurses Association strongly urges incorporating peer review in professional nursing practice models. Clinical nurse specialists play a critical role in educating staff nurses about practice accountability. Clinical nurse specialists developed an education program guided by the American Nurses Association's principles of peer review. A baseline needs assessment identified potential barriers and learning needs. Content incorporated tools and strategies to build communication skills, collaboration, practice change, and peer accountability. The education program resulted in increased staff nurse knowledge about peer review and application of peer review principles in practice. Clinical nurse specialists played a critical role in helping staff nurses understand peer review and its application to practice. The clinical nurse specialist role will continue to be important in sustaining the application of peer review principles in practice.

Sustainability as an Ethical Principle: Ensuring Its Systematic Place in Professional Nursing Practice.

Alongside the central focus on the persons requiring nursing care in professional nursing practice, the perspective of the sustainability of interventions and the use of materials (for example, nursing aids and hygiene articles) is gaining prominence in nursing decision-making processes. This contribution makes the principle of sustainability concrete and delineates its importance in the context of professional nursing practice and decision-making. It further suggests the development of an ethical policy in order to systematically ensure that sustainability has a place in ethical reflection and decision-making, and describes the elements involved. Finally, a synthesis is made between the importance of the principle of sustainability, suggested ethical policies (system of ethical reflection) as they affect nursing practice and professional reflection, decision-making, and practice.

Recommendations From the International Consortium on Professional Nursing Practice in Long-Term Care Homes

In response to the International Association of Gerontology and Geriatrics' global agenda for clinical research and quality of care in long-term care homes (LTCHs), the International Consortium on Professional Nursing Practice in Long Term Care Homes (the Consortium) was formed to develop nursing leadership capacity and address the concerns regarding the current state of professional nursing practice in LTCHs. At its invitational, 2-day inaugural meeting, the Consortium brought together international nurse experts to explore the potential of registered nurses (RNs) who work as supervisors or charge nurses within the LTCHs and the value of their contribution in nursing homes, consider what RN competencies might be needed, discuss effective educational (curriculum and practice) experiences, health care policy, and human resources planning requirements, and to identify what sustainable nurse leadership strategies and models might enhance the effectiveness of RNs in improving resident, family, and staff outcomes. The Consortium made recommendations about the following priority issues for action: (1) define the competencies of RNs required to care for older adults in LTCHs; (2) create an LTCH environment in which the RN role is differentiated from other team members and RNs can practice to their full scope; and (3) prepare RN leaders to operate effectively in person-centered care LTCH environments. In addition to clear recommendations for practice, the Consortium identified several areas in which further research is needed. The Consortium advocated for a research agenda that emphasizes an international coordination of research efforts to explore similar issues, the pursuit of examining the impact of nursing and organizational models, and the showcasing of excellence in nursing practice in care homes, so that others might learn from what works. Several studies already under way are also described.

Governance of professional nursing practice in a hospital setting: a mixed methods study.

Objective: to elaborate an interpretative model for the governance of professional nursing practice in a hospital setting. Method: a mixed methods study with concurrent triangulation strategy, using data from a cross-sectional study with 106 nurses and a Grounded Theory study with 63 participants. The quantitative data were collected through the Brazilian Nursing Work Index - Revised and underwent descriptive statistical analysis. Qualitative data were obtained from interviews and analyzed through initial, selective and focused coding. Results: based on the results obtained with the Brazilian Nursing Work Index - Revised, it is possible to state that nurses perceived that they had autonomy, control over the environment, good relationships with physicians and organizational support for nursing governance. The governance of the professional nursing practice is based on the management of nursing care and services carried out by the nurses. To perform these tasks, nurses aim to get around the constraints of the organizational support and develop management knowledge and skills. Conclusion: it is important to reorganize the structures and processes of nursing governance, especially the support provided by the organization for the management practices of nurses.

Advancing Interprofessional Collaboration in Nursing Education

The purpose of this qualitative case study was to describe and understand the process of nurse educators teaching interprofessional collaboration to student nurses in a Louisiana pre-licensure baccalaureate-nursing program. Components of the theoretical framework for the study included Ray’s theory of bureaucratic caring, complexity theory, and transformational learning theory. As interprofessional collaboration is gaining momentum in the healthcare environment, nurse educators can be key players in a teachinglearning dynamic that encourages positive patient outcomes and a changing healthcare paradigm. Findings indicated the majority of nurse educators describe their role in preparing students for interprofessional collaborative practice using classroom, clinical and simulation teaching strategies. Clinical environments were most often described as settings in which students gain the most knowledge through actual participation with the interprofessional team. Findings from this study indicate a need for curriculum changes and enhanced faculty development programs on interprofessional collaboration in nursing education. Nurse educators and nursing programs can learn from this case study to develop teaching strategies to promote conducive interprofessional collaborative learning environments aiding students in the preparation for professional nursing practice.

The Concept of Care Complexity: A Qualitative Study.

Background:Hospital organisations based on the level of care intensity have clearly revealed a concept, that of care complexity, which has been widely used for decades in the healthcare field. Despite its wide use, this concept is still poorly defined and it is often confused with and replaced by similar concepts such as care intensity or workload. This study aims to describe the meaning of care complexity as perceived by nurses in their day-to-day experience of hospital clinical care, rehabilitation, home care, and organisation.Design and methodsFifteen interviews were conducted with nurses belonging to clinical-care areas and to heterogeneous organisational areas. The interview was of an unstructured type. The participants were selected using a propositional methodology. Colaizzi’s descriptive phenomenological method was chosen for the analysis of the interviews.Results:The nurses who were interviewed predominantly perceive the definition of care complexity as coinciding with that of workload. Nevertheless, the managerial perspective does not appear to be exclusive, as from the in-depth interviews three fundamental themes emerge that are associated with the concept of care complexity: the patient, the nurse and the organisation.Conclusions:The study highlights that care complexity consists of both quantitative and qualitative aspects that do not refer only to the organisational dimension. The use of the terminology employed today should be reconsidered: it appears to be inappropriate to talk of measurement of care complexity, as this concept also consists of qualitative – thus not entirely quantifiable – aspects referring to the person being cared for. In this sense, reference should instead be made to the evaluation of care complexity, which would also constitute a better and more complete basis for defining the nursing skills required in professional nursing practice.Significance for public healthIn recent years, reference to the concept of complexity has become increasingly frequent in the management of healthcare systems. This interpretation of reality and of knowledge reflects the increasing use of a multi-disciplinary approach, in both clinical and research fields, that re-evaluates the importance of the environment and the preferences of the individual. The influence of the epistemological theory of complexity in healthcare can also be identified in discussions on the role and methods of epidemiology and public health; in breaking the walls between the exact sciences and the humanities; in the appreciation of qualitative methods of research and the Bayesian approach to biostatistics.

Evolving the practitioner-teacher role to enhance practice-academic partnerships: a literature review.

The purpose of this article was to review the development of the practitioner-teacher model and its use in advancing clinical nursing. The practitioner-teacher role, or the unification model, incorporates clinical practice, teaching, consultation and research responsibilities for nurses serving in advanced clinical roles or as nursing faculty as part of professional nursing practice. The practitioner-teacher role facilitates a practice-academic partnership that can serve as a beneficial way to advance clinical nursing care. An exploratory literature review was conducted combined with review of practitioner-teacher and practice-academic exemplars. A descriptive review of the practitioner-teacher model of nursing practice reveals that activities of the role include clinical nursing care, serving as a preceptor for nursing students in a focused area of expertise, consulting on patient care issues, presenting in-services and course lectures, and serving as a member of faculty and nursing division committees. The practitioner-teacher role lends itself to promoting practice-academic partnerships that combine clinical nursing care with professional nursing activities. The model of practice, education, consultation and research of the practitioner-teacher position advances practice-academic partnerships. The practitioner-teacher model serves to optimise the way nursing practice and academic work together to integrate knowledge, scholarship, service and learning and to advance the profession and the discipline of nursing. This article discusses aspects of the unique practice-academic partnership using the practitioner-teacher model, how the role evolved, and how it can improve clinical nursing care globally.

Registered Nurse Care Coordination: Creating a Preferred Future for Older Adults with Multimorbidity

The concept of care coordination is often touted as the preferred way to streamline care for complex patients. Care coordination is even more popular with the mention of it in the Affordable Care Act of 2010 and with new Medicare payment models. The purpose of this article is to define care coordination, briefly describe trends for older adults and care coordination, and explore roles for registered nurses. We describe elder-appropriate models of care coordination useful for older adults with multimorbidity. A brief exemplar provides an example of evidence-based care coordination services provided by a nursing and social work team, a model supported by recent literature. As a result of this discussion, readers will become informed about possibilities for the future of care delivery and the future of professional nursing practice.

Von einer Spiritual-Care-Darstellung für die Seelsorgetheologie lernen

Weiher’s book on spiritual care was written to improve the professional practice of hospital doctors and nurses. Thus it shows howa theologian can make the common field of spiritual care and pastoral care plausible for all, including non-religious and non-Christian readers. It helps to distinguish between the possibilities of general spiritual care practised by medical personnel and that of professional spiritual and pastoral care. Religious spiritual care and nonreligious spiritual care can be valued as varieties of a core human practice.

Nurse Knowledge ExchangePlus: Human-Centered Implementation for Spread and Sustainability

Kaiser Permanente implemented a new model of nursing communication at shift change-in the bedside nursing report known as the Nurse Knowledge Exchange (NKE) in 2004-but noted variations in its spread and sustainability across medical centers five years later. The six core elements of NKEplus were as follows: team rounding in the last hour before shift changes, pre-shift patient assignments that limit the number of departing nurses at shift change, unit support for uninterrupted bedside reporting, standardization for report and safety check formats, and collaboration with patients to update in-room care boards. In January 2011 Kaiser Permanente Southern California (KPSC; Pasadena) began implementing NKEplus in 125 nursing units across 14 hospitals, with the use of human-centered design principles: creating shared understanding of the need for change, minimum specifications, and customization by frontline staff. Champion teams on each nursing unit designed and pilot tested unit-specific versions of NKEplus for four to eight weeks. Implementation occurred in waves and proceeded from medical/surgical units to specialty units. Traditional performance improvement strategies of accountability, measurement, and management were also applied. By the end of 2012, 100% of the 64 medical/surgical units and 47 (77.0%) of the 61 specialty units in KPSC medical centers implemented NKEplus-as had all but 1 of the specialty units by May 2013. The mean KPSC score on the NKEplus nursing behavior bundle improved from 65.9% in 2010 to 71.3% in the first quarter of 2014. The mean KPSC Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score for nurse communication improved from 73.1% in 2010 to 76.4% in the first quarter of 2014 (p < . 001). Human-centered implementation appeared to help spread a new model of nursing handoffs and change the culture of professional nursing practice related to shift change.

Maternal Morbidity and Mortality: Identifying Opportunities to Improve Clinical Outcomes.

A better understanding of why women die during pregnancy, childbirth, or postpartum offers valuable insight into strategies aimed at preventing maternal deaths and arresting the progression in the severity of a complication. The rate of severe maternal morbidity and maternal mortality in the United States has been trending upward in recent years and has garnered national attention with concentration on bolstering reviews of maternal deaths and implementing patient safety initiatives. The obstetric nurse is in a unique position to improve maternal outcomes through the anticipation, recognition, and communication of the early warning signs of impending deterioration in maternal condition. Presented in the context of the conceptual model of Stephen Covey's Circle of Influence, the professional nurse can proactively influence maternal outcomes directly, with actions defined by the scope of professional nursing practice or indirectly through professional interactions with others. Advancing one's education, knowledge, and technical skills broadens the influential capacity.

Primerjava dveh teoretičnih modelov in teorije zdravstvene nege preko konceptov metaparadigme

Uvod: Izbira primernega teoretičnega modela ali teorije zdravstvene nege je osnova za dobro prakso. V Sloveniji uporabljamo teoretični model Virginie Henderson, ki ga v članku primerjamo s teoretičnim modelom Imogene M. King in teorijo zdravstvene nege Hildegard E. Peplau. &#x0D; Metode: Uporabili smo deskriptivno metodo dela s pregledom domače in tuje strokovne ter znanstvene literature. Uporabili smo metodo kritičnega branja javno dostopnih virov, navezujoč se na podatke iz doslej objavljenih knjig, člankov in ostale literature, ki se dotika izbrane teme. Spletno iskanje literature je bilo opravljeno preko vzajemne bibliografsko-kataložne baze podatkov (COBIB.SI) ter tujih podatkovnih baz, kot so Jupsline, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL). Za primerjavo teoretičnih modelov in teorije je bil uporabljen okvir za vrednotenje teoretičnih modelov in teorij po Jacqueline Fawcett. &#x0D; Rezultati: Primerjani teoretična modela in teorija zdravstvene nege opišejo koncepte metaparadigme in odnose med njimi. Koncept zdravstvena nega je najpomembnejši v vseh teoretičnih modelih, cilj vseh pa je zdravje. Vse tri teoretičarke se manj poglabljajo v koncept okolje. &#x0D; Diskusija in zaključek: Na področju uporabe teoretičnih modelov in teorij zdravstvene nege v zadnjih letih je narejenega premalo, medtem ko razvoj zdravstvene nege na drugih področjih hitro napreduje. Medicinske sestre morajo nadaljevati z raziskovanjem in razvojem teoretičnih modelov in teorij.

I am only a nurse: a biographical narrative study of a nurse's self-understanding and its implication for practice.

BackgroundThe personal is a vital part of professional nursing practice. From a psycho-social perspective, nurses produce and reproduce conceptions of the Self through experience. A literature search on nurses’ self-understanding in a psycho-social perspective yields no results. Hence, the aim of this study was to investigate personal and professional experiences that may have formed the self-understanding of a nurse, and how this self-understanding may have influenced her professional practice.MethodsUsing a single case approach, I conducted a Biographical Narrative Interview with a 50-year-old experienced Norwegian nurse. I asked the nurse to tell me the story of her life and how her work has affected her and possibly changed the way she saw herself. The overall aim of the interpretation was to understand the historically situated subjectivity in terms of the nurse’s personal, social and professional constraints and chosen options.ResultsThe nurse’s narrative of her life story made it possible to trace a common theme throughout her experiences, the experience of being “only a nurse”. The nurse experienced a low status, as well as a downgrade in the competence needed to deliver quality care in professional relationships. She felt it difficult to identify with the experience of being on the bottom of the social ladder and to identify with the female, mothering ideal connected to nursing. She desired a better position, and wanted to identify with strong women. In contrast to reality, her self-understanding influenced her relationship with her patients, her professional pride and her further professional development.ConclusionsThis study shows that the professional practice of a nurse was informed by her self-understanding. This study suggests that the individual nurse must be given the opportunity to explore her professional vulnerability based on the assumption that it is both personally and socially constituted. This study indicates that the exploration of a nurse’s self-understanding is one way to contribute to professional development.