Current Issue : January - March Volume : 2014 Issue Number : 1 Articles : 6 Articles
Background: Although there is a sizeable body of evidence regarding the nature of hostile behaviours among\r\nclinicians in the nursing workplace, what is less clear is the nature of the relationship between these behaviours\r\nand patient care. To inform the development of appropriate intervention strategies we examine the level of\r\nevidence detailing the relationships between hostile clinician behaviours and patient care.\r\nMethods: Published qualitative and quantitative studies that examined hostile clinician behaviours and patient care\r\nwere included. Quality assessment, data extraction and analysis were undertaken on all included studies. The search\r\nstrategy was undertaken in July and August 2011 and comprised eight electronic databases (CINAHL, Health\r\nCollection (Informit), Medline (Ovid), Ovid Nursing Full Text, Proquest Health and Medicine, PsycInfo, Pubmed and\r\nCochrane library) as well as hand searching of reference lists.\r\nResults: The search strategy yielded 30 appropriate publications. Employing content analysis four themes were\r\nrefined: physician-nurse relations and patient care, nurse-nurse bullying, intimidation and patient care, reduced nurse\r\nperformance related to exposure to hostile clinician behaviours, and nurses and physicians directly implicating patients\r\nin hostile clinician behaviours.\r\nConclusions: Our results document evidence of various forms of hostile clinician behaviours which implicate\r\nnursing care and patient care. By identifying the place of nurse-nurse hostility in undermining patient care, we\r\nfocus attention upon the limitations of policy and intervention strategies that have to date largely focused upon\r\nthe disruptive behaviour of physicians. We conclude that the paucity of robustly designed studies indicates the\r\nproblem is a comparatively under researched area warranting further examination....
Background: The implementation of unfolding scenario-based case studies in the didactic classroom is associated\r\nwith learner-centered education. The utilization of learner-centered pedagogies, such as case studies, removes the\r\nfocus from the instructor and instead places it on the student. Learner-centered pedagogies are believed to\r\nimprove students� levels of cognition. The purpose of this study was to examine how nurse educators are\r\nimplementing the pedagogies of case studies in their undergraduate didactic courses. The goal was to examine,\r\ndocument, report, and, ultimately, implement the strategies.\r\nMethods: Purposeful sampling was utilized in this qualitative, multisite-designed study. For each of the four\r\nparticipants, three separate site visits were completed. Observations and post-observational interviews took place at\r\neach site visit. Transcribed data from interviews, observations, and course documents were imported into the\r\ncomputer program Nvivo8. Repetitive comparative analysis was utilized to complete the data coding process.\r\nResults: The guiding research question of this study sought to investigate the implementation strategies of case\r\nstudies in didactic nursing courses. The implementation of case studies by the participants reflected two primary\r\npatterns: Formal Implementation (FI) and Informal Implementation (II) of case studies. The FI of case studies was\r\nfurther divided into two subcategories: Formal Implementation of case studies used Inside the Classroom setting\r\n(FIIC) and Formal Implementation of cases studies used Outside of the Classroom (FIOC).\r\nConclusion: Results of this investigation have led to an increased understanding of implementation strategies of\r\nunfolding scenario-based case studies in undergraduate nursing didactic courses. Data collected were rich in the\r\ndescription of specific methodologies for utilization of case studies and may serve as a resource for faculty in\r\ndevelopment of creative strategies to enhance the didactic classroom experience....
Background: Diabetes is a major health issue for individuals and for health services. There is a considerable\r\nliterature on the management of diabetes and also on communication in primary care consultations. However, few\r\nstudies combine these two topics and specifically in relation to nurse communication. This paper describes the\r\nnature of nurse-patient communication in diabetes management.\r\nMethods: Thirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as\r\npart of a larger multi-site study tracking health care interactions between health professionals and patients who\r\nwere newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the\r\n6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography\r\nand interaction analysis.\r\nIn addition to analysis of the recorded consultations and interviews, the number of consultations for each patient\r\nand total time spent with nurses and other health professionals were quantified and compared.\r\nResults: This study showed that initial consultations with nurses often incorporated completion of extensive\r\nchecklists, physical examination, referral to other health professionals and distribution of written material, and were\r\ntypically longer than consultations with other health professionals. The consultations were driven more by the\r\nnurses� clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed\r\nthat protocols and checklists both help and hinder the communication process. This contradictory outcome was\r\nalso evident at a health systems level: although organisational targets may have been met, the patient did not\r\nalways feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed\r\narising from the sheer volume of information exchanged along with a mismatch in expectations.\r\nConclusions: Conscientious nursing work was evident but at times misdirected in terms of optimal use of time.\r\nThe misalignment of patient expectations and clinical protocols highlights a common dilemma in clinical practice\r\nand raises questions about the best ways to balance the needs of individuals with the needs of a health system.\r\nVideo- recording can be a powerful tool for reflection and peer review....
Background: Research evidence supports the positive impact on resident outcomes of nurse practitioners (NPs)\r\nworking in long term care (LTC) homes. There are few studies that report the perceptions of residents and family\r\nmembers about the role of the NP in these settings. The purpose of this study was to explore the perceptions of\r\nresidents and family members regarding the role of the NP in LTC homes.\r\nMethods: The study applied a qualitative descriptive approach. In-depth individual and focus group interviews\r\nwere conducted with 35 residents and family members from four LTC settings that employed a NP. Conventional\r\ncontent analysis was used to identify themes and sub-themes.\r\nResults: Two major themes were identified: NPs were seen as providing resident and family-centred care and as\r\nproviding enhanced quality of care. NPs established caring relationships with residents and families, providing both\r\ninformational and emotional support, as well as facilitating their participation in decision making. Residents and\r\nfamilies perceived the NP as improving availability and timeliness of care and helping to prevent unnecessary\r\nhospitalization.\r\nConclusions: The perceptions of residents and family members of the NP role in LTC are consistent with the\r\nconcepts of person-centred and relationship-centred care. The relationships NPs develop with residents and families\r\nare a central means through which enhanced quality of care occurs. Given the limited use of NPs in LTC settings,\r\nthere is an opportunity for health care policy and decision makers to address service inadequacies through strategic\r\ndeployment of NPs in LTC settings. NPs can use their expert knowledge and skill to assist residents and families to\r\nmake informed choices regarding their health care and maintain a positive care experience....
Background: During the last 25 years, cultural diversity has increased substantially with global migration. In more\r\nrecent years this has become highly evident in the south of Spain with its steadily increasing Moroccan population.\r\nThe accompanying differences in ethnocultural values and traditions between the host and newcomer populations\r\nmay greatly impact healthcare interactions and thus also effective provision of care. This landscape provides for\r\nexcellent exploration of intercultural communication in healthcare settings and elucidation of possible ways to\r\novercome existing barriers to provision of culturally competent care by nurses. This study aimed to ascertain how\r\nnurses perceive their intercultural communication with Moroccan patients and what barriers are evident which may\r\nbe preventing effective communication and care.\r\nMethods: A focused ethnography was conducted with semi-structured interviews of 32 nurses in three public\r\nhospitals in southern Spain. Interviews were audio-recorded and transcribed verbatim before undergoing translation\r\nand back-translation between Spanish and English. Data was managed, classified and ordered with the aid of\r\nAQUAD.6 (GÃ?¼nter L. Huber, TÃ?¼bingen, Germany) qualitative data analysis software.\r\nResults: As an important dimension of cultural competence, findings from the interviews with nurses in this study\r\nwere interpreted within the framework of intercultural communication. Various barriers, for which we have termed\r\nââ?¬Å?boundariesââ?¬Â, seem to exist preventing effective communication between nurses and their patients. The substantial\r\nlanguage barrier seems to negatively affect communication. Relations between the nurses and their Moroccan\r\npatients are also marked by prejudices and social stereotypes which likely compromise the provision of culturally\r\nappropriate care.\r\nConclusions: The language barrier may compromise nursing care delivery and could be readily overcome by\r\nimplementation of professional interpretation within the hospital settings. Moreover, it is essential that the nurses of\r\nsouthern Spain are educated in the provision of culturally appropriate and sensitive care....
Background: Health practitioners play a pivotal role in providing patients with up-to-date evidence and health\r\ninformation. Evidence-based practice and patient-centred care are transforming the delivery of healthcare in the UK.\r\nHealth practitioners are increasingly balancing the need to provide evidence-based information against that of\r\nfacilitating patient choice, which may not always concur with the evidence base. There is limited research exploring\r\nhow health practitioners working in the UK, and particularly those more autonomous practitioners such as health\r\nvisitors and practice nurses working in community practice settings, negotiate this challenge. This research provides\r\na descriptive account of how health visitors and practice nurses negotiate the challenges of communicating health\r\ninformation and research evidence in practice.\r\nMethods: A total of eighteen in-depth telephone interviews were conducted in the UK between September 2008\r\nand May 2009. The participants comprised nine health visitors and nine practice nurses, recruited via adverts on a\r\nnursing website, posters at a practitioner conference and through recommendation. Thematic analysis, with a focus\r\non constant comparative method, was used to analyse the data.\r\nResults: The data were grouped into three main themes: communicating evidence to the critically-minded patient;\r\nconfidence in communicating evidence; and maintaining the integrity of the patient-practitioner relationship. These\r\nfindings highlight some of the daily challenges that health visitors and practice nurses face with regard to the\r\ncomplex and dynamic nature of evidence and the changing attitudes and expectations of patients. The findings\r\nalso highlight the tensions that exist between differing philosophies of evidence-based practice and patient-centred\r\ncare, which can make communicating about evidence a daunting task.\r\nConclusions: If health practitioners are to be effective at communicating research evidence, we suggest that more\r\nresearch and resources need to be focused on contextual factors, such as how research evidence is negotiated,\r\nappraised and communicated within the dynamic patient-practitioner relationship....
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