Enrolled Nurses Research Articles

Facilitators, Barriers, and Solutions in Pain Management for Older Adults with Dementia

BackgroundAlthough qualitative studies have been conducted to identify barriers and facilitators that influence the pain management of older adults with dementia, as far as we know, only a very recent study (Andrews et al., 2019) has used participatory action research (PAR) as a methodology for studying pain management. It allows nurses to examine and improve their practice based on their realities and within their context. AimTo reflect on nursing practice and identify facilitators and barriers in the management of pain in older adults with dementia and to propose actions for improvement. DesignWe used qualitative participatory action research. Participants/SettingsTen nurses from the geriatric acute care unit of a university hospital in Spain were recruited through convenience sampling. MethodsData were generated through a written questionnaire and three focus groups. ResultsOne of the main facilitators the participants identified was professional experience. The main barriers they identified were lack of knowledge and skills and lack of time. The participants proposed two main improvements: (1) a training program consisting of three courses (pain evaluation and management, dementia and pain, and pharmacology) and (2) the creation of a specific register for nurses to record patients’ pain. ConclusionsInvolving nurses directly in research on their practices can result in precise proposals for improvements based on their needs and oriented toward improving the quality of care. Moreover, our results confirm previous findings in other countries.

‘That splendid body of women’: nursing, professional registration, and suffragette militancy

ABSTRACT In the decades before World War One, a group of women fought for their right to control their own futures, claiming that their governance was in the hands of men whose interests lay in keeping women subservient. Initially articulated by an educated, middle-class few, the women's demands were embraced by widening numbers of both women and men. They saw their hopes dashed on several occasions by political manoeuvring, and only after WWI did their demands begin to be met. This is not an account of the women’s suffrage movement, but rather of the fight for the registration of trained nurses. Both movements claimed the right of women to be actors in their public lives and both faced public condemnation for transgressing social boundaries. The two movements interacted, with nurses connecting their struggle to the wider call for women's rights, and with the suffrage movement foregrounding nurses as disenfranchised women professionals.

An almost ignored Florence Nightingale battle: the opposition to the creation of the state professional register of nurses

This contribution intends to draw attention to some little-known facts in the history of nursing regarding Florence Nightingale, whose 200th anniversary is celebrated. This is her battle against the establishment of the register of qualified nurses (what is now the Order of Nurses). Her reasons were well argued and ranged from the still insufficient education, to the strong medical interference in the Campaign in favour of the register, to the risk that the still poorly defined scientific and social solidity of the profession would have made it ancillary to medicine, up to the concrete impracticability of keeping a register always updated to exclude any subjects who were no longer suitable. In addition to information on the patroness of the Campaign for the registration of nurses Ethel Bedford Gordon Fenwick, one of the founders of the International Council of Nurses (ICN), the links with women's associations of the early twentieth century and the current Italian National Association of Nurses (Consociazione nazionale delle Associazioni infermieri, CNAI) emerge. Furthermore, little known information on the origins of professional regulation of nurses, particularly in the United Kingdom and Italy is reported. In the concluding part, several questions are asked that stimulate reflections on the Italian professional situation and, in particular, on the fundamentals of nursing care, on nursing education and training necessary for professional, specialist and advanced qualification, and the consequent career development.

Accelerated programmes in children's nursing to tackle the workforce gap in the United Kingdom: A cost-consequences analysis

BackgroundWith alarming vacancy rates and dipping availability of European nurses, remedies for the shortage of nurses in the UK are urged. To accelerate the registration of new children's nurses, a health education funder commissioned two education programmes within its region. The first is a 1-year programme designed for UK-registered nurses in adult or mental health. The second is a 2-year programme for individuals, not registered as nurses, who are child or social care graduates with experience of working with children and young people. ObjectivesTo evaluate the economic effectiveness of two accelerated children's nursing education programmes. DesignEconomic evaluation. SettingsTwo accelerated children's nursing education programmes in two sites in England. ParticipantsNursing students enrolled in both programmes (N = 20). MethodsWe adopt a cost-consequences analysis to analyse the programmes' costs and outcomes. ResultsAll graduates were heading for posts within the region where they studied, a favourable outcome for the funder. However, the first programme would deplete the workforce in other nursing fields, whereas the second, by quickening the graduates' career progression, would not dent the long-term shortage in entry roles. Given our small sample size, these impacts may differ if the programmes have wider implementation. ConclusionsOur evaluation measures the effectiveness of two novel accelerated education programmes in tackling the nurses' shortage. Concurrently, it contributes to developing a standardised approach for future economic evaluations in nursing education.

Male nurse: A concept analysis.

Use of the term male nurse is common in nursing wherever the practice setting may be, but no formal analysis has been done to illuminate the meaning of the concept. The term male nurse is often problematic to those referred to, as the label carries stereotypes that further marginalize this extreme minority in the nursing profession. The Nurse Registration Act of 1919 (UK) banned men from nursing de jure, whilst Nightingale's reform of nursing education established the same de facto years before. This potent mix of tradition and law served as the basis for sex-segregation and feminization of nursing. Fast forward to today-in the centennial of the Nurse Registration Act-women still dominate nursing, and attempts to recruit and retain men into the profession remains to be a very challenging task. Walker and Avant's methodology was utilized in this concept analysis. Seven defining attributes of themale nurse were identified: perceived as a male, credentialed as a nurse, increased visibility, nonconformist as to career choice, cautious caregivers, stereotyped/stigmatized, and increased role strain. Antecedents, consequences, and illustrative cases were also discussed. Gender-based labels such as male nurse are injurious to nursing, as it preserves sex-segregation as well as stereotypes that affect both men and women in the profession. This concept analysis corroborates the need to degender nursing and caring, which is a recurrent theme in nursing literature. Ultimately, degendering nursing should translate to measures to increase the proportion of men in the nursing workforce. A gender-balanced workforce, coupled with degendered notions of caring will strengthen the nursing profession and optimize our ability to serve our clientele.

The Nurses Climate Challenge: A National Campaign to Engage 5,000 Health Professionals Around Climate Change.

Climate change poses significant threats to human health and worsens existing inequities. The health sector is a significant contributor to climate change, making up approximately 10% of U.S. greenhouse gas emissions. Yet most nurses do not learn about the health dangers of climate change in their education or in practice, and therefore are ill-equipped to lead action on climate change. When educated about climate change, nurses can effectively lead climate adaptation and mitigation strategies aimed at creating healthier populations. As the most trusted professionals and making up 40% of the health-care workforce, nurses have the potential to impact behavior change and launch a movement around climate solutions. Health Care Without Harm and the Alliance of Nurses for Healthy Environments partnered on the "Nurses Climate Challenge" with the aim of nurses educating 5,000 health professionals on climate and health. In the Nurses Climate Challenge, nurses register as Nurse Climate Champions and gain access to online resources to plan and host educational sessions about climate change. After educating, Nurse Climate Champions return to the online platform to track their progress. Within 10 months, over 540 Nurse Climate Champions from 6 continents, 16 countries, and 42 U.S. states registered for access to the resources. To date, the champions have educated over 5,250 colleagues and students about climate and health. Based on early metrics, this model of education and engagement around climate action may be applicable for other disciplines in health care and beyond.

Acting in the Public Interest: Learnings and Commentary on the Occupational Licensure Literature

There is increased interest in reforming the way occupations are licensed. However, most of the current dialogue focuses on the rapid growth in the number of people who need a license to pursue their chosen occupation. Consequently, significant questions are being raised as to the appropriateness of such requirements for groups that do not appear to present any tangible threat to public safety. Recent research has demonstrated that health professions have failed to articulate the need and value for licensure and how health regulators are addressing the many concerns being raised by the current debate. This study identifies dimensions or aspects of nurse licensure congruent with acting in the public interest and starts to curate (ie, to select, organize, and present) evidence related to each dimension, thereby identifying the current impact and highlighting opportunities for further research. This study utilizes a mixed-methods approach that combines documentary analysis, focus group discussion, and related literature associated with the various dimensions of acting in the public interest to highlight how nurse licensure addresses the current drivers for regulatory reform. A total of 99 documentary sources (ie, papers, articles, reports, and opinion editorials) were uploaded to NVivo 11 Plus for analysis. The analysis generated four overarching themes: (a) licensure reform, (b) impact of occupational associations, (c) occupational licensure issues, and (d) contemporary issues. Associated with these themes, 22 subthemes were also identified. The findings demonstrate there is clear evidence to support the fact that nurse regulators are acting in the public interest. However, further research is needed to provide definitive evidence to inform best practices in regulation and to offer direction for improved nurse regulatory reform. Furthermore, it is suggested that nurse regulators create and effectively maintain a global community capable of learning from one another and driving continuous improvement to better serve the public.

An Exploration of Pain Documentation for People Living with Dementia in Aged Care Services

BackgroundPain in people with dementia is a common occurrence. Providing evidence-based pain management for people with dementia in residential aged care services is imperative to providing quality care. However, it remains unclear from current research how various aged care staff (Registered Nurses (RNs), Enrolled Nurses (ENs), Personal Care Assistants (PCAs)) engage at specific points of the pain management pathway. With structural changes to the residential aged care workforce over the past two decades, understanding the relative contributions of these aged care staff to pain management practices is crucial for future practice development. AimTo investigate the quality and completeness of pain documentation for people living with dementia, and assess the extent to aged care staff are engaged in documentation processes. DesignA three-month retrospective documentation audit. Setting and ParticipantsThe audit was conducted on the files of 114 residents with moderate to very severe dementia, across four Australian residential aged care facilities. MethodsData was collected on each resident’s pain profile (n=114). One hundred and sixty-nine (169) pain episodes were audited for quality and completeness of pain documentation and the extent to which aged care staff (RNs/ENs and PCAs) were engaged in the documentation of pain management. ResultsTwenty-nine percent of pain episodes had no documentation about how resident pain was identified and only 22% of the episodes contained an evidence-based (E-B) assessment. At least one intervention was documented for 89% of the pain episodes, the majority (68%) being non-pharmacological. Only 8% of pain episodes had an E-B evaluation reported. Thirteen percent (13%) of episodes contained information across all four pain management domains (Identification/ problems, assessment, intervention and evaluation). Documentation by PCAs was evident at all points in the pain management pathway. PCAs were responsible for considerately more episodes of assessment (50% vs 18%) compared to nursing staff. Conclusion and Clinical ImplicationsDespite the high prevalence of pain in people with dementia in aged care settings, current pain management documentation does not reflect best practice standards. Future capacity building initiatives must engage PCAs, as key stakeholders in pain management, with support and clinical leadership of nursing staff.

Sociology in UK nurse education curricula: A review of the literature from 1919 to 2019

Student nurses are required to learn about sociology during pre-registration nurse education within the United Kingdom. This literature review explores the key developments which led to the introduction and gradually increasing presence of sociological theory and concepts within nurse education. Historically, there was an early desire to increase nurses’ social awareness as nurse education was further professionalised following the passing of the Nurses Registration Act, 1919. It was not until the radical changes of the 1970s that these early ambitions were realised, culminating in sociology becoming part of the nurse education curriculum in 1977. The landscape changed as nurse education moved into universities and, more recently, as nursing became an all graduate profession. The increasing presence of sociology has been accompanied by an impassioned debate regarding its relevance to nursing and the extent to which it should feature within curricula. These issues have parallels with the education of other professional groups, and it is incumbent upon educators to draw upon the experiences of the past to think deeply about how sociology can be meaningfully embedded within future curricula.

Integrating preparation for care trajectory management into nurse education: Competencies and pedagogical strategies.

Nurses make an important contribution to the organisation and coordination of patient care but receive little formal educational preparation for this work. This paper builds on Allen's care trajectory management framework to specify evidence-based and theoretically informed competencies for this component of the nursing role and proposes how these might be incorporated into nursing curricula. This is necessary so that at the point of registration nurses have the expertise to realise their potential as both providers and organisers of patient care and are better able to articulate and develop this aspect of nursing practice.

Quality improvement: A practical nursing program's admission test

IntroductionAcademic institutions are under pressure to maintain a nearly flawless retention rate, while graduating successful students. The use of standardized admission tests to provide data driven decisions regarding applicant selection is common. The varying reliability and validity of current standardized tests inspired a large Canadian academic institution to use a faculty developed admission test for admission to its practical nursing (PN) program. MethodsThe target population for this project was a purposive, convenience sample of graduated PN students from a large publically funded polytechnic institution in southern Ontario, Canada, who had completed the Canadian Practical Nurse Registration Examination (CPNRE) within 2014–2016 (n = 293). Data was obtained retrospectively, and included program entry grade-point average (GPA) and CPNRE result, as well as chemistry, English, biology, and math admission test scores. ResultsThe predictors of chemistry, English, math admission test scores, and program entry GPA did not have an effect beyond the effects of the model's predictors. In this model, the R2 suggests that 9% of the variance can be explained, and 91% not explained. In consideration of all independent variables, findings indicate that mean biology admission test scores (M =74.96) are a predictor of student CPNRE success. Additionally, students who pass the CPNRE have a higher program GPA. ConclusionsAcademic factors including program entry GPA, English, math, biology and chemistry admission scores are a fragment of the characteristics to be considered when determining the predictability of success in PN students. Therefore, it is imperative that program admission processes identify and measure nonacademic program entry criteria, as academic criterion have limited predictability. Furthermore, in isolation, academic admission criteria could be used to identify at-risk-students for appropriate remediation/counselling or as a placement test.

Predicting international students' clinical and academic grades using two language tests (IELTS and C-test): A correlational research study

Academic English tests are used to ascertain if international English as a Second Language nursing students have sufficient language skills to commence their nursing degrees, and later, if they have sufficient English for nursing registration. However, an academic English test may not be appropriate for clinical contexts. This study examines the relationship between two types of English test and the performance of forty-nine undergraduate international nursing students in both their first year of theory-centred academic topics and practice-centred clinical topics. An academic English test, called the International English Language Testing System (IELTS), and a general English proficiency/processing speed test using a variation of the cloze-test (C-test) format were administered at the commencement of the students' course of study. At the end of one year, grade percentages were collected. It was found that both the IELTS test and the C-test were significantly correlated to both types of topic, albeit with different patterns. The two English tests were also tested for similarities in the constructs they measured, with a significant overlap found. The implications are to rethink the way English tests are applied to entry in university degrees involving a clinical component and, by extension, to direct universities to rethink how nursing students are supported during their degree. The question is also raised about the practice of using academic English tests for professional nursing registration purposes. The benefits of the two testing approaches are also considered, particularly the large differences in monetary outlay and time found between the two tests, given their performance in explaining the variance in grade outcomes.

Knowledge and use of sterile water injections amongst midwives in the United Kingdom: A cross-sectional study

BackgroundThe use of sterile water injections (SWI) for the relief of pain in labour is popular amongst midwives in countries such as Sweden and Australia. Anecdotal reports suggest the procedure is used less commonly in the United Kingdom (UK) and that a number of barriers to introducing the practice may exist. ObjectiveThe objective of this study was to explore the awareness and use of SWI amongst midwives in the UK. DesignA cross-sectional study using an internet-based questionnaire. ParticipantsMidwives with Nursing and Midwifery Council Registration and currently practicing. SettingThe questionnaire was distributed via the Royal College of Midwives Facebook page and Twitter account. Invitations to participate were also sent to Heads of Midwifery to distribute to staff. FindingsThree hundred and ninety-eight midwives completed the survey. Eighty-two percent of midwives did not use SWI in practice although 69% would consider learning the procedure. There was considerable variation in techniques amongst midwives that did provide SWI. The lack of available practice guidelines and the advice from the National Institute for Health and Care Excellence to not use SWI were cited as the main barriers. Key conclusionsSWI use is uncommon in the UK although midwives are interested in incorporating the procedure into practice. Implications for practiceNational guidance on SWI and the lack of information and training is restricting the use of the procedure in practice, despite SWI being widely used in other countries and being effective in the treatment of pain in labour.

A novel solution to the nursing workforce crisis: recruitment of overseas nurses living locally.

Aneurin Bevan University Health Board has recruited nurses from overseas from within and outside the European economic area. This article describes an innovative recruitment initiative that has focused on nurses who trained overseas and are living and working in the local community, but cannot work in a registered nurse role without financial and practical support. It provides an overview of the robust selection processes used, which are in line with the Nursing and Midwifery Council registration requirements, and the stepwise employment offer made to successful applicants.

Scope of practice and workforce issues confronting Australian Enrolled Nurses: A qualitative analysis

BackgroundEnrolled Nurses constitute an important part of the Australian health care system. Recently, improvements to education and medication endorsement have initiated expansion to EN scope of practice. AimThis paper reports on a study conducted to inform development of revised Nursing and Midwifery Board (NMBA) of Australia Enrolled Nurse practice standards that explored with ENs their scope of practice. DesignA qualitative design using focus groups and individual interviews with ENs across Australia. Data were analysed using thematic analysis. FindingsENs work in diverse practice contexts with differing scope of practice. Confusion existed regarding EN scope of practice as a result of many different types of ENs in practice. Care of unstable patients was seen to be outside the EN scope of practice. They were also often required to supervise the work of nursing assistants and new registered nurses. Lack of career pathway was seen as a limitation to ENs. ConclusionsEN education and scope of practice has evolved significantly, particularly in many practice settings, since the existing standards were developed. Further work is needed to address issues related to EN supervision of new RNs and AINs (Assistants in Nursing), and clarity of EN supervision in specialist clinical areas.

Understanding the enrolled nurse to registered nurse journey through a model adapted from Schlossberg's transition theory

BackgroundSubstantial numbers of Enrolled Nurses (ENs) enrol in higher education programs to undergo the transition to Registered Nurse (RN) with the experience described as containing numerous challenges. ObjectivesThis paper reports on a synthesis of the literature that explores the experiences of ENs undertaking a program of study to convert to RN. Consequently, a model is developed to identify educational interventions and resources to enable a successful transition for these students. DesignA narrative review was completed with thematic synthesis of the literature guided by Schlossberg's Transition Theory, and Thomas and Harden's framework for systematic analysis of qualitative studies. Data sourcesCINAHL, Scopus, ProQuest Central and Health Collection were searched. Review methodsThe databases were searched for English language journal articles, theses and grey literature published from 1987 to 2016 from Australia, New Zealand, the United Kingdom, Canada and the USA. The key search words included truncations of: “enrolled nurse”, ‘licensed practical nurse’, “transition”, “conversion” and “experience”. This resulted in the identification of 33 related articles for review. ResultsThemes and sub-themes developed from the literature synthesis were integrated into an ‘EN to RN Transition model.’ The four stages of the model reflect the experiences of the ENs as they overcame the various challenges they encountered during their transition to RN. The model was used to develop recommendations that may improve their transition experience and decrease attrition. ConclusionThis paper reports on a synthesis of the literature, and presents a four stage model, that reflects the experiences of ENs in their transition to RN. Recognising the elements within each stage can assist educators develop strategies and provide educational resources to enhance the EN journey.

Experiences of registered nurses from a refugee background: A scoping review.

This scoping review presents an exploration of international literature on the factors that impact refugees' personal and professional experiences during their journey to being registered nurses in a new host country. Governments of host countries receiving refugees seek to develop strategies that facilitate the successful resettlement, employment and enculturation of refugees that arrive as skilled professionals. There is a scarcity of studies focussing on issues faced by refugees that are RNs or those pursuing nursing registration and employment in a new host country. This study is relevant for resettlement services, nursing registration authorities and education providers and informs the international nursing workforce. Scoping review. Databases such as MEDLINE, EMBASE, Cochrane Library, CINAHL; Google Scholar; PubMed; Scopus and Web of Science were searched for qualitative studies published up to and including 2017. Articles that did not specify explicitly the participants as registered nurses and/or refugees were excluded. All eligible articles were analysed for collective findings, and impact factors were extracted, synthesised and illustrated diagrammatically. This review explored six eligible articles and six impact factors were identified. The challenging impacts were as follows: loss of control; shock in a new environment and bleak employment prospects. Equally three impact factors: reconciling new reality; establishing a new identity and hope for the future, facilitate positive experiences for nurses in their successful transition into society and the nursing workplace. This scoping review reports the small number of international studies on the experiences of refugees seeking to become registered and employed as registered nurses. The six impact factors identified influence the lives of the nurse participants socio-economically in and out of the workplace. Policymakers, managers and educators providing resettlement, registration and employment services could develop strategies that enhance integration and transition experiences of refugees aspiring to be registered nurses.

Essere infermiere in dialisi tra tecnologia e relazione con la persona straniera: l'operatore sanitario

La carenza infermieristica è ormai un problema mondiale, le cui cause sono fortemente correlate tra loro e riconducibili a quattro fattori: • L'invecchiamento della popolazione infermieristica • La riduzione delle iscrizioni ai corsi universitari • Il mutamento delle condizioni lavorative • L'immagine scadente della professione infermieristica. La migrazione infermieristica è motivata dalla ricerca di sviluppo professionale, di una migliore qualità della vita e di sicurezza personale. Vi sono Paesi donatori e Paesi riceventi. Anche in Italia il fenomeno è da anni presente. Nel 2007–2010 vi è stato il boom dell'ingresso in Italia di infermieri stranieri superiore al 25%. Nel 2010 erano iscritti all'albo IPASVI 375 185 infermieri, 77% donne e 10% erano stranieri. Ogni Azienda Sanitaria ha attuato la propria strategia di risoluzione. Presso l'ASLTO2 di Torino, dapprima sono state indette gare per “Cooperative infermieristiche”, poi per “Agenzie Interinali” e attualmente sono presenti i professionisti degli “Studi Associati”. Presso la dialisi del S.G. Bosco di Torino l'esperienza è ormai decennale, strutturata e consolidata. Dal 2001 si sono alternati 30 infermieri stranieri provenienti da sei Paesi diversi, il maggiore è ancora la Romania. Il piano didattico di inserimento del neo infermiere straniero, segue quello usato presso la Struttura complessa per tutti i neo assunti e questo permette una qualità omogenea dell'assistenza e un buon livello di “integrazione” percepito dai lavoratori stranieri. (nursing)

Nurses knowledge and attitudes to individuals who self-harm: A quantitative exploration

Objective: Self-injury can be described as the deliberate destruction of the body without the intent to die, and is a distinct clinical presentation needing to be assessed separately from suicide and para-suicide. Nurses attitude to self-injury is a largely unexplored area particularly within Australia. The aim of this paper is to explore Australian general and mental health nurses’ attitudes towards self-injury taking into account their preparation as registered nurses (RNs) or enrolled nurses (ENs) and length of experience.Methods: This was a mixed methods exploratory design study. Phase one used a combination of two established surveys, the Self-Harm Antipathy Scale (SHAS) and the Attitudes Towards Deliberate Self-Harm Questionnaire (ATDSHQ). Nurses who were either RNs or ENs, mental health educated (MHE) or not, working in the area of mental health or emergency departments (ED) were recruited through a number of professional nursing organisations. A total of 172 nurses completed the phase one online questionnaire. The results of this survey are reported in this paper.Results: The key findings indicated a significant relationship between years of mental health nursing experience and mental health nursing qualification. A significant difference was noted in the knowledge level of self-injury between the mental health nurses who had a greater knowledge compared to those who were not mental health educated. Lastly, the attitudes of nurses to self-injury were generally found to be positive.Conclusions: These results extend much of what is in the literature on knowledge, attitudes and beliefs of nurses to non-suicidal self-injury (NSSI) and place these results in an Australian context. Further research to assess the effectiveness of increased education and community engagement should be undertaken.

Effects of Impact-Absorbing Flooring in Residential Care from the Perspectives of Enrolled Nurses

ABSTRACTFalls are a daily occurrence in nursing homes and few interventions for reducing fall-related injuries have proven to be effective. Impact absorbing flooring (IAF) in residential care has shown promising results in reducing fall-injuries and in the process of developing and implementing IAF all aspects are valuable to explore. Therefore, the aim of this qualitative study is to describe the enrolled nurses (ENs) experiences of IAF. We carried out focus group interviews with ENs and used content analysis to process the data. The ENs experienced both negative and positive aspects with the IAF. Importantly, the ENs perceived the IAF as effective in preventing fall-injuries. They also appreciated the improvements in acoustics. Negative aspects were that the flooring initially was challenging to walk on and that it made it harder to maneuver heavy equipment. A significant and transferable finding in this study was the importance of the ENs' perceived difficulty in preventing fall-injuries amongst elderly people living in nursing homes. This seemed to be a driving force to accept the intervention. Although IAF affects the working conditions in a nursing home, ENs are willing to accept these issues given the perceived effectiveness of the intervention.