Charting the course of change

? Change and transition are different concepts. ? Transition for practitioners in the workplace is complex. ? Transition within roles needs a positive tripartite arrangement with teacher and clinical manager. ? This paper looks at the findings from a study of 100 enrolled nurses undertaking a part-time conversion programme to RGN, RMN or RSCN. ? Evidence suggests that student perceptions change over time within a 2-year programme. ? This conversion programme is seen as a positive experience by participants and employers.     

A systematic literature review of nurse shortage and the intention to leave

chan z.c.y., tam w.s., lung m.k.y., wong w.y. & chau c.w. (2013) Journal of Nursing Management  21 , 605–613 A systematic literature review of nurse shortage and the intention to leave Aim To present the findings of a literature review regarding nurses’ intention to leave their employment or the profession. Background The nursing shortage is a problem that is being experienced worldwide. It is a problem that, left unresolved, could have a serious impact on the provision of quality health care. Understanding the reasons why nurses leave their employment or the profession is imperative if efforts to increase retention are to be successful. Evaluation Electronic databases were systematically searched to identify English research reports about nurses’ intention to leave their employment or the profession. Key results concerning the issue were extracted and synthesized. Key issues The diversified measurement instruments, samples and levels of intention to leave caused difficulties in the attempt to compare or synthesize findings. The factors influencing nurses’ intention to leave were identified and categorized into organizational and individual factors. Conclusions The reasons that trigger nurses’ intention to leave are complex and are influenced by organizational and individual factors. Further studies should be conducted to investigate how external factors such as job opportunities correlate with nurses’ intention to leave. Implications for nursing management The review provides insight that can be useful in designing and implementing strategies to maintain a sustainable workforce in nursing.     

Occupational changes in nursing: the situation of enrolled nurses

BACKGROUND: The move to one level of qualified nurse in the United Kingdom (UK) is, in part, a consequence of professionalizing strategies. Registered nurses now undertake technical work previously performed by doctors. The role of enrolled nurses, and their career intentions, have not been considered in light of these changes, despite the fact that many still work in the National Health Service. AIM: This paper considers the pursuit of professionalization by nurses, illustrating the argument with findings from an empirical study of conversion to registered nurse by enrolled nurses. METHODS: The paper is based on a secondary analysis of a large data set, originally used to explore ethnic inequalities in nursing. Data from 2968 respondents were analysed to answer a number of research questions relating to the characteristics of different groups of enrolled nurses and predictors of conversion to registered nurse. These included demographic characteristics, markers of career orientation, career progression and job satisfaction. STUDY LIMITATIONS: This study used secondary analysis of data and, therefore, exploration of issues was limited, not least because the data were 10 years old. Also, the design was cross-sectional and respondents' experiences related to different stages of the phenomenon under study and the same group was not studied over time. FINDINGS: Enrolled nurses who had converted to registered nurse were more likely than those who had no intention of converting to: be male, be younger, have been nursing longer, not be working on elderly care wards, have a high career orientation, not have taken a career break, and work full-time. Most of these factors predicted likelihood to convert. Although nurses who converted to registered nurse were more likely to anticipate career progression, they were less likely to be satisfied with their work. CONCLUSION: In attempts to define rewarding nursing work, the importance of ensuring that qualified nurses continue to retain basic nursing care skills should be acknowledged. This may offer an uncomfortable view to those seeking to further the professional status of nursing.     

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Aims and objectives. To systematically review the research regarding communication between nurses and patients with complex communication needs (CCN). The research was reviewed with respect to the following themes: (a) the importance of communication; (b) the barriers to effective communication; (c) the supports needed for effective communication; and (d) recommendations for improving the effectiveness of communication between nurses and patients with CCN. Augmentative and alternative communication (AAC) strategies that can be used by nurses to facilitate more effective communication with patients with CCN are discussed. Background. Effective nurse‐patient communication is critical to efficient care provision. Difficulties in communication between nurses and patients arise when patients are unable to speak. This problem is further complicated because nurses typically receive little or no training in how to use AAC to communicate with patients with CCN. Design. Systematic review. Method. This paper reviewed the published research focusing on the perspectives of nurses, patients with CCN and their caregivers regarding the challenges to effective communication between nurses and patients with CCN. Further, specific strategies (i.e., using AAC) that nurses can use to improve and facilitate communication with patients with CCN are provided. Conclusions. Communication between nurses and patients is critical to providing and receiving quality care. Nurses and patients have reported concern and frustration when communication is not adequate. Using AAC strategies will help nurses and patients better communicate with each other when speech is not an option. Relevance to clinical practice. Communication with all patients is very important to the provision of quality nursing care. Communication cannot always be achieved using the speech modality. Nurses need to have tools and skills that will allow them to communicate with all of their patients whether or not they can speak.     

The lived experiences of newly qualified nurses on clinical placement during the first six months following registration in the Republic of Ireland

Aim. To explore the lived experiences of newly qualified nurses on clinical placement, during the first six months following registration, in the Republic of Ireland. Background. The subject of the experiences of newly qualified nurses is not generally well researched, although anecdotal articles are plentiful. In particular, the lived experiences of newly qualified diploma nurses in the Republic of Ireland are not reflected in the research literature. However, available literature on the subject clearly demonstrates that being a newly qualified staff nurse is particularly stressful and many nurses feel unprepared for the staff nurse role. Design. A phenomenological, Heideggerian, hermeneutic approach was used for this study. Methods. Ten diplomate staff nurses were interviewed and the data were analysed using a thematic analysis framework. Results. Newly qualified nurses in the Republic of Ireland describe their initial experiences of being on the ward as stressful. This stress is primarily related to the multi‐dimensional responsibilities associated with the new role and to managerial/organizational/clinical skills deficits. The allocation of students and dealing with situations that they felt unprepared for added to their anxieties. However, diplomate nurses were willing to acknowledge these limitations and seek help when appropriate. Feeling valued, making a difference and financial reward were cited as being the positive aspects of the new role. Relevance to clinical practice. The preregistration nurse education curriculum needs to be developed further to help alleviate the problems associated with the initial transition to the staff nurse role. In addition, effective supportive systems need to be introduced for newly qualified nurses to help ensure that they are prepared for and supported in their professional role.     

‘A thorny problem for feminism’: an analysis of the subjective work experiences of enrolled nurses

• ? Feminist methodology has been used in this study to investigate the subjective work experiences of 19 enrolled nurses.
• ? Reflexive conversational techniques enabled participants to relate autobiographical narratives examining their experiences of working in a nursing hierarchy.
• ? Two themes are reported: ‘nursing identity’ and ‘exploitation’. Through an analysis of these themes insight has been gained into the manner in which nurses inter-relate.
• ? The study demonstrates how the correlation between rank, status and expertise within the nursing hierarchy may have negative consequences for patient care.

     

Private prayer as a suitable intervention for hospitalised patients: a critical review of the literature

Aim. This critical review seeks to identify if there is evidence that private (personal) prayer is capable of improving wellbeing for adult patients in hospital. Background. The review was conducted in the belief that the spiritual needs of hospitalised patients may be enhanced by encouragement and support to engage in prayer. Design. Systematic review. Method. A systematic approach was used to gather evidence from published studies. In the absence of experimental research involving this type of population, evidence from qualitative and correlational studies was critically reviewed. Results. The findings indicate that private prayer, when measured by frequency, is usually associated with lower levels of depression and anxiety. Most of the studies that show positive associations between prayer and wellbeing were located in areas that have strong Christian traditions and samples reported a relatively high level of religiosity, church attendance and use of prayer. Church attenders, older people, women, those who are poor, less well educated and have chronic health problems appear to make more frequent use of prayer. Prayer appears to be a coping action that mediates between religious faith and wellbeing and can take different forms. Devotional prayers involving an intimate dialogue with a supportive God appear to be associated with improved optimism, wellbeing and function. In contrast, prayers that involve pleas for help may, in the absence of a pre‐existing faith, be associated with increased distress and possibly poorer function. Conclusion. Future research needs to differentiate the effects of different types of prayer. Relevance to clinical practice. Encouragement to engage in prayer should be offered only following assessment of the patient’s faith and likely content and form of prayer to be used. Hospitalised patients who lack faith and whose prayers involve desperate pleas for help are likely to need additional support from competent nursing and chaplaincy staff.     

临床护士对承担生活护理体验的质性研究

目的 了解临床护士承担生活护理的心理体验,为护理管理者制订护士有效落实生活护理的措施提供理论依据.方法 采用质性研究中现象学研究法,以半结构性的深入访谈方式对12名女性护士进行深入访谈,应用类属分析法分析资料.结果 提炼出3个主题:①对病人生活护理由护士承担的看法(护士没时间承担病人全部生活护理,病人生活护理没必要全部由护士来承担);②护士承担生活护理的负性感受(被迫、无奈、价值感丢失、自卑);③护士承担生活护理的正性感受(护患关系拉近了,病人认可).结论 护理管理者应保障护士的人力资源、重视临床护士的感受,引导护士转变观念,做好护士的分层使用,从而为病人提供优质护理服务.