Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 7 Articles
Background: There are several studies that have targeted student nurses, but few have clarified the details\npertaining to the specific ethical problems in clinical practice with the viewpoint of the nursing faculty. This study\nwas to investigate the ethical problems in clinical practice reported by student nurses to Japanese nursing faculty\nmembers for the purpose of improving ethics education in clinical practice.\nMethod: The subjects comprised 705 nursing faculty members (we sent three questionnaires to one university)\nwho managed clinical practice education at 235 Japanese nursing universities. We performed a simple tabulation of\nthe four items shown in the study design. 1) the details of student nurse consultations regarding ethics in clinical\npractice (involving the students themselves, nurses, care workers, clinical instructors, and nursing faculty members);\n2) the methods of ethics education in clinical practice; 3) the difficulties experienced by the nursing faculty\nmembers who received the consultations; and 4) the relationship between clinical practice and lectures on ethics.\nFurthermore, the analysis was based on the idea of ethical principles, respect for persons, beneficence, and justice.\nResults: The response rate was 28% (198 questionnaires). The nursing faculty members were consulted for various\nproblems by student nurses. The details of these consultations were characterized by the principles of respect for patient\nby nurses, the principles of benevolence by faculty and clinical instructors, and the principle of justice pertaining to\nevaluations. The results indicate that there is an awareness among the nursing faculty regarding the necessity of some\nsort of ethics education at clinical settings. Moreover, based on the nature of the contents of the consultations regarding\nthe hospital and staff, it was evident that the nursing faculty struggled in providing responses. More than half of subjects\nexhibited an awareness of the relationship between the classroom lectures on ethics and clinical practice.\nConclusion: The results suggest the need for analyzing the ethical viewpoints of student nurses, prior learning, and\ncollaboration with related courses as part of ethics education in clinical practice...
Background: Despite advanced nursing roles having a research competency, participation in research is low. There\nare many barriers to participation in research and few interventions have been developed to address these. This\npaper aims to describe the implementation of an intervention to increase research participation in advanced clinical\nnursing roles and evaluate its effectiveness.\nMethods: The implementation of the intervention was carried out within one hospital site. The evaluation utilised a\nmixed methods design and a implementation science framework. All staff in advanced nursing roles were invited\nto take part, all those who were interested and had a project in mind could volunteer to participate in the\nintervention. The intervention consisted of the development of small research groups working on projects\ndeveloped by the nurse participant/s and supported by an academic and a research fellow. The main evaluation\nwas through focus groups. Output was analysed using thematic analysis. In addition, a survey questionnaire was\ncirculated to all participants to ascertain their self-reported research skills before and after the intervention. The\nresults of the survey were analysed using descriptive statistics. Finally an inventory of research outputs was collated.\nResults: In the first year, twelve new clinical nurse-led research projects were conducted and reported in six peer\nreviewed papers, two non-peer reviewed papers and 20 conference presentations. The main strengths of the\nintervention were its promptness to complete research, to publish and to showcase clinical innovations. Main\nbarriers identified were time, appropriate support from academics and from peers. The majority of participants had\nincreased experience at scientific writing and data analysis. Conclusion: This study shows that an intervention, with minor financial resources; a top down approach; support of a\nhands on research fellow; peer collaboration with academics; strong clinical ownership by the clinical nurse researcher;\nexperiential learning opportunities; focused and with needs based educational sessions, is an intervention that can\nboth increase research outputs and capacity of clinically based nurses. Interventions to further enhance nursing\nresearch and their evaluation are crucial if we are to address the deficit of nurse-led patient-centred research in the\nliterature....
Background: The nursing process is a tool that is recommended for use by all professional nurses working in\nGhana, in order to provide nursing care. However, there is currently a limited use of this tool by nurses in Ghana.\nThe purpose of this research study was to explore the various factors that influence the utilization of this nursing\nprocess.\nMethod: An exploratory descriptive qualitative-research design was employed. Ten participants were involved by\nusing the purposive sampling method. A semi-structured interview guide was used to collect the data from the\nresearch participants; and the data were analysed by using content analysis. One main theme, with five subthemes,\nemerged from the analysis.\nResults: It was found that there are factors, such as nurses not having a better understanding of the nursing process,\nwhilst in school; the absence of the care plan in the ward, as well as the lack of adequate staff, with limited time being\navailable for coping with contributed to the non-usage of the nursing process.\nConclusions: We conclude that the clinical utilization of the Nursing process at the clinical setting is influenced by lack\nof understanding of Nurses on the Nursing process and care plan as well as lack of adequate nurses and time.\nWe recommend that the care-plan form be made officially a part of the admission documents. Furthermore,\nthe nursing administration should put measures in place to provide nurses with the needed resources to\nimplement the nursing process. Additionally, they should ensure that the care-plan forms and other resources\nneeded by the nurses are regularly and adequately provided. Nurses should further see the nursing process\nas a means of providing comprehensive care to their patients and addressing their specific problems. They\nshould therefore make time despite their busy schedules to use it in order to improve quality of care and\nthe image of nursing in Ghana....
Purpose: To evaluate the stress level of second-yearâ��s nursing students during their first oncology clinical experience. Methods: The descriptive study in order to determine the stress levels of second-yearâ��s nursing students. This study was conducted with the students of Uludag University. The study population was consisting of 156 nursing students attending second year class in nursing school. Pagana Clinical Stress Questionnaire (PCSQ) was used. Data in analysis of surveyâ��s results was evaluated mean, Pearson's correlation method, t-test was used in statistical analysis percentage. Results: When a comparison is made between the mean score of clinical stress and socio-economic data of the students involved in the study; any meaningful difference has not been observed between the mean scores of stress and the sex, approaches to nursing profession, previous hospital experiences, health status whether having a chronic disease or not. Only meaningful difference (p>0.05) has been observed with family member status whether working as a health worker or not (p<0.05). The mean score of stress of students in the first clinical practice was found as 70 �± 4.15. This result exhibited that the students experienced stress is the average. Conclusions: It was found that the nursing students had a high level of stress during the first clinical practice and experienced the most stress \"fighting\" dimension from the subscales. So, it was thought that the clinical orientation program must be done before student experience. Because clinical orientation program was effective to reduce the risk....
Background: Multimorbidity is a major issue for primary care. We aimed to explore primary care professionalsââ?¬â?¢\naccounts of managing multimorbidity and its impact on clinical decision making and regional health care delivery.\nMethods: Qualitative interviews with 12 General Practitioners and 4 Primary Care Nurses in New Zealandââ?¬â?¢s Otago\nregion. Thematic analysis was conducted using the constant comparative method.\nResults: Primary care professionals encountered challenges in providing care to patients with multimorbidity with\nrespect to both clinical decision making and health care delivery. Clinical decision making occurred in time-limited\nconsultations where the challenges of complexity and inadequacy of single disease guidelines were managed\nthrough the use of ââ?¬Å?satisficingââ?¬Â (care deemed satisfactory and sufficient for a given patient) and sequential\nconsultations utilising relational continuity of care. The New Zealand primary care co-payment funding model was\nseen as a barrier to the delivery of care as it discourages sequential consultations, a problem only partially\naddressed through the use of the additional capitation based funding stream of Care Plus. Fragmentation of care\nalso occurred within general practice and across the primary/secondary care interface.\nConclusions: These findings highlight specific New Zealand barriers to the delivery of primary care to patients\nliving with multimorbidity. There is a need to develop, implement and nationally evaluate a revised version of\nCare Plus that takes account of these barriers...
Background: Given the increasing complexity of acute care settings, high patient acuity and demanding workloads,\nnew graduate nurses continue to require greater levels of support to manage rising patient clinical care needs. Little is\nknown about how change in new graduate nursesââ?¬â?¢ satisfaction with clinical supervision and the practice environment\nimpacts on their transitioning experience and expectations during first year of practice. This study aimed to examine\nchange in new graduate nursesââ?¬â?¢ perceptions over the 12-month Transitional Support Program, and identify how\norganizational factors and elements of clinical supervision influenced their experiences.\nMethods: Using a convergent mixed methods design, a prospective survey with open-ended questions was\nadministered to new graduate nursesââ?¬â?¢ working in a tertiary level teaching hospital in Sydney, Australia. Nurses were\nsurveyed at baseline (8ââ?¬â??10 weeks) and follow-up (10ââ?¬â??12 months) between May 2012 and August 2013. Two standardised\ninstruments: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS)\nwere used. In addition to socio-demographic data, single ââ?¬â??item measures were used to rate new graduate nursesââ?¬â?¢\nconfidence, clinical capability and support received. Participants were also able to provide open-ended comments\nexplaining their responses. Free-text responses to the open-ended questions were initially reviewed for emergent\nthemes, then coded as either positive or negative aspects of these preliminary themes. Descriptive and inferential\nstatistics were used to analyse the quantitative data and the qualitative data was analysed using conventional content\nanalysis (CCA). The study was approved by the relevant Human Research Ethics Committees.\nResults: Eighty seven new graduate nurses completed the follow-up surveys, representing a 76% response rate. The\nmedian age was 23 years (Range: 20 to 53). No change was seen in new graduate nursesââ?¬â?¢ satisfaction with clinical\nsupervision (mean MCSS-26 scores: 73.2 versus 72.2, p = 0.503), satisfaction with the clinical practice environment (mean\nPES-AUS scores: 112.4 versus 110.7, p = 0.298), overall satisfaction with the transitional support program (mean: 7.6 versus\n7.8, p = 0.337), satisfaction with the number of study days received, orientation days received (mean: 6.4 versus 6.6,\np = 0.541), unit orientation (mean: 4.4 versus 4.8, p = 0.081), confidence levels (mean: 3.6 versus 3.5, p = 0.933) and not\npractising beyond personal clinical capability (mean: 3.9 versus 4.0, p = 0.629).\nNegative responses to the open-ended questions were associated with increasing workload, mismatch in the level of\nsupport against clinical demands and expectations. Emergent themes from qualitative data included i) orientation and\nTransitional Support Program as a foundation for success; and ii) developing clinical competence.Conclusions: While transitional support programs are helpful in supporting new graduate nurses in their first year of\npractice, there are unmet needs for clinical, social and emotional support. Understanding new graduate nursesââ?¬â?¢\nexperiences and their unmet needs during their first year of practice will enable nurse managers, educators and nurses to\nbetter support new graduate nursesââ?¬â?¢ and promote confidence and competence to practice within their scope....
Background: While greater reliance on nurse practitioners in primary healthcare settings can improve service\nefficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both\nregistered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare\nnurse practitioners� integration. This study�s main objective is to examine different structures and mechanisms put\nin place to support the development of primary healthcare nurse practitioner�s practice in different healthcare\nsettings, and develop a practical model for identifying and planning adequate support practices.\nMethods: This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province\nof Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse\npractitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of\nlocation, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based\non the analysis of available documentation in each primary healthcare setting and on semi-structured interviews\nwith key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis\napproaches.\nResults: This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis\ndemonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based,\nmultilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very\ndifferent implementation structures and practices, and different actors were involved at each of the three levels.\nThe results also indicated that nursing departments played a decisive role at all three levels.\nConclusions: Based on these findings, we suggest that support practices should be adapted to each organization�s\nenvironment and experience and be modified as needed throughout the integration process. We also stress the\nimportance of combining this approach with a strong coordination mechanism involving managers who have indepth\nunderstanding of nursing professional roles and scopes of practice. Making primary healthcare nurse\npractitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing\nmanagers could be the key to successful integration....
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