This article explores the care British nurses provided to victims of typhus during the Second World War.Background
Typhus is associated with poverty and overcrowding. During wars in the pre-antibiotic era, civilians were particularly susceptible to epidemics, which military governments feared would spread to their troops.Design
This discussion paper draws on archival data from three typhus epidemics in the Second World War to examine the expert work of British nurses in caring for victims during these potential public health disasters.Data Sources
The published sources for the paper include material from nursing and medical journals published between 1940–1947. Archival sources come from the National Archives in Kew, the Wellcome Library and the Army Medical Services Museum, between 1943–1945. Of particular interest is the correspondence with Dame Katharine Jones from nurses on active service overseas.Implications for Nursing
Whilst epidemics of typhus are now rare, nurses in the present day may be required to care for the public in environments of extreme poverty and overcrowding, where life-threatening infectious diseases are prevalent. This article has demonstrated that it is possible for expert and compassionate nursing to alleviate suffering and prevent death, even when medical technologies are unavailable.Conclusion
Expert and compassionate care, adequate nutrition and hydration and attention to hygiene needs are crucial when there are limited pharmacological treatments and medical technologies available to treat infectious diseases. The appreciation of this could have implications for nurses working in current global conflicts.
To analyse the influence of serving method on compliance and consumption of nutritional supplement drinks in older adults with cognitive impairment.Background
Oral nutritional supplement drinks have positive benefits on increasing nutritional status in undernourished older people leading to weight gain. However, consumption of these drinks is low and therefore limits their effectiveness.Design
This study was a non-blind randomized control trial where participants either consumed nutritional supplement drinks in a glass/beaker or consumed them through a straw inserted directly into the container.Method
Participants with long-standing cognitive impairment were recruited from nursing homes (n = 31) and hospitals (n = 14). Participants were randomized to serving method. Nursing and care staff were instructed to give the supplement drinks three times per day on alternate days over a week by the allocated serving method. The researcher weighed the amount of supplement drink remaining after consumption. Data were collected over 12 months in 2011–2012.Results
Forty-five people participated in this study, mean age 86·7 (sd 7·5) years. After randomization, there was no significant difference between the baseline characteristics of the two groups. Participants randomized to consume nutritional drinks from a glass/beaker drank statistically significantly more than those who consumed them via a straw inserted directly into the container. However, supplements allocated to be given in a glass/beaker were more frequently omitted.Conclusion
Nutritional supplement drinks should be given to people with dementia who are able to feed themselves in a glass or a beaker if staffing resources allow (NIHR CSP ref 31101).
To explicate nurses' role and the underlying processes involved in advocating for safe practice in hospitals.Background
Nurses' role as patient advocates in safeguarding patients' interests and well-being is constantly upheld. As previous studies have fallen short in delineating the processes of how and in what conditions the patient advocate role is operationalized, this study was conducted to fill the evidence gap through examining nurses' advocacy role and practices in real clinical contexts.Design
A field study approach that involved multiple methods of data collection was adopted.Methods
This study was conducted from February 2010–March 2011 in four medical units in two public hospitals in Hong Kong. Empirical data were generated from weekly field observations, review of relevant documents and individual semi-structured interviews with 28 nurses and were then analysed through a comparative analysis process.Results
Nurses play an integral role in ensuring safe practice in hospitals through mitigating risk arising from sudden changes in patients' health conditions and the hospitalization process and correcting near-misses for co-workers to prevent harm. The modelling of expert nurses and team-based learning emerged as essential factors facilitating the development of nurses' advocacy role and practices. The state of ‘limited advocacy’, as characterized by the adoption of disempowering and coercive measures to ensure patient safety, clearly indicates a need to re-examine the concept of advocacy in contemporary health care.Conclusion
The findings contribute to a more complete understanding of nurses' advocacy role and practices, which have a significant bearing on patient safety.
To investigate the associations among the ethical climate, professional practice environment and individualized nursing care in care settings for older people.Background
The quality of care provision is affected by organizational environments, such as ethical climate and professional practice environment. Although, the association between professional practice environment and individualized nursing care has been pointed out, we know that little is known about how ethical climate is associated with the level of individualized nursing care delivery.Design
A cross-sectional explorative and correlational survey design.Methods
The study was conducted in 62 units in the vicinity of a Finnish city using a sample of nurses (N = 874, response rate 58%) who worked clinically with older people in different care settings in 2012. Survey data were collected using the Hospital Ethical Climate Survey, Revised Professional Practice Environment scale and Individualised Care Scale-B. Data were analysed statistically using descriptive statistics, correlation coefficients (Pearson) and multiple stepwise regression analyses.Results
Statistically significant correlations were found among the variables, ethical climate and individualized care and between individualized care and all professional practice environment sub-scales. Multiple stepwise regression showed associations among individualized care, ethical climate and internal work motivation, control over practice and leadership and autonomy.Conclusions
The study provided better understanding of the complex concept of individualized care by taking into consideration the ethical climate and the practice environment and their associations. To increase individualization in care provision, efforts need to be directed towards organizational aspects requiring the support of nursing leaders.
To report a trial protocol to determine if a therapeutic play intervention leads to significant reduction in perioperative anxiety, negative emotional manifestations and postoperative pain of children undergoing inpatient elective surgery and in their parents' perioperative anxiety.Background
Children undergoing surgery often experience anxiety, exhibit negative emotional manifestations pre-operatively and postoperative pain. Previous studies report that therapeutic play intervention has positive effects on anxiety reduction, while few studies have examined the effects of such intervention on children undergoing major elective surgery.Design
Randomized controlled trial with repeated measures is proposed.Methods
This study will recruit 106 pairs of 6–14-year-old children undergoing elective surgery in a Singaporean public hospital and their parents (protocol approved in October 2011). Eligible participants will be randomly allocated to either a control group (receiving routine care) or an experimental group (receiving 1-hour therapeutic play intervention plus routine care). Outcome measures include children's anxiety, emotional manifestation and postoperative pain, their parents' anxiety and process evaluation. Data will be collected at baseline (3–7 days before the operation), on the day of surgery and around 24 hours after the surgery.Discussion
This study will identify a clinically useful and potentially effective approach to prepare children for surgery by reducing anxiety of both children and their parents during the perioperative period. The reduction of anxiety may lead to reduction of postoperative pain, which will eventually improve the physical and psychological well-being of children. This study was funded by the National Medical Research Council in Singapore.
To examine the practical applicability of the ‘hard’ and ‘soft’ constraints associated with the ‘nurse rostering problem’ as defined in operations management research literature and thereby investigate the objectivity of the rostering process.Background
In practice, rostering nursing staff is often unrecognized, unrewarded and undervalued; yet, despite four decades of research, operations management has little to offer in terms of faster, safer, fairer or more effective rosters. This paper contrasts the theoretical perceptions of roster ‘constraints’ with the subjective, often political, rules governing practical rosters.Design
Using both qualitative and quantitative data, this inductive study compares the practical process of rostering with that theorized in the nurse rostering problem.Methods
This research spanned 4 years examining the rosters from 28 wards in 14 hospitals. Interviews with senior nursing staff regarding staff levels and with ward managers regarding rules defining the roster were complemented by analysis of actual roster data to establish the number and type of unfilled shifts and rule breakages. Interviews were analysed using thematic content analysis and roster data were evaluated using the HealthRoster™ e-rostering system.Findings
Often the rules governing how nursing staff are scheduled are undocumented, tacit and informal. Furthermore, the roster process can be highly politicized, leading to forms of ‘information anarchy’ or ‘information feudalism’ on the ward.Conclusions
Hospital managers must understand that roster design has a major impact on ward performance and must develop clear roster policies that define staff levels, skill mix, shift patterns and the rules used in preparing the roster.
A tool to assist in optimal allocation of available nursing resources is of paramount importance.Aims
The goals of this study were as follows: (1) to determine whether the standard time values of the Belgian Nursing Minimum Dataset are a valid basis for the development of a Workload Indicator for Nursing; (2) to quantify the impact of factors that most influence nursing workload; and (3) to examine the cross-impact of items of the Belgian Nursing Minimum Dataset.Design
This research project is a prospective observational study with exploratory aspects.Methods
The data for this prospective study were collected during September 2010 from a convenience sample of 23 nursing units in four hospitals in Belgium. The data collection included three parts: (1) the registration of the items of the Belgian Nursing Minimum Dataset; (2) the amount of time committed to direct patient care; and (3) analysis of variables, which influence the nursing workload at patient and unit level.Results
The correlation coefficients for the sum of Direct and Indirect Patient Care and the Workload Indicator for Nursing-score of the surgical, internal medicine and intensive care units were 0·85, 0·88 and 0·89 respectively. Significant differences in standard time utilization for nursing activities at the patient level are directly related to the level of mobility assistance required. Units needing significantly more time for Direct and Indirect Patient Care than predicted by the Workload Indicator for Nursing-score had a higher mean number of complex nursing activities per patient.Conclusions
The high correlation coefficients between the total time utilized for direct patient care and the WiN-score indicate that the standard time values of the Belgian Nursing Minimum Dataset are valid.
To discuss the Foucauldian concept of genealogy as a framework for understanding and transforming nurses' professional identity.Background
The professional identity of nurses has primarily been defined by personal and interpersonal attributes and by the intradisciplinary dimensions of nursing, leading to its conceptualization as a universal, monolithic phenomenon. The Foucauldian genealogical perspective offers a critical lens to examine what constitutes this professional identity; Spanish nursing offers a historical case study of an active effort to impose an identity that fits the monolithic ideal.Data sources
Five of the 33 professional conduct manuals for nurses' training published from 1956–1976 during the Franco dictatorship in Spain and six interviews with nursing instructors or students at the time were analysed using a theoretical framework drawn from Foucault's writing.Discussion
Foucault's genealogical framework considers practices of normalization and resistance as a means of understanding knowledge continuities and discontinuities, clarifying practices that constitute nurses' professional identity in a particular way in specific contexts and analysing the implications of this theoretical frame.Implications for nursing
The genealogy concept offers valuable tools to determine how professional identities are constituted, questions assumptions about the profession and its professionals and envisions alternative approaches. This theoretical approach helps both scholars and practitioners understand, question and transform their practices as needed.Conclusion
The genealogical approach prioritizes analysis of the phenomenon over its description and challenges many unknown, forgotten, excluded and/or unquestioned aspects of identity from a position of diversity and complexity.
To investigate whether overlapping blood pressure and heart rate graphs improve chart-users' ability to recognize derangements in these vital signs on hospital observation charts.Background
Many health professionals prefer blood pressure and heart rate graphs to overlap. One justification is the use of a visual cue called the ‘Seagull Sign’ to detect physiological abnormalities.Design
A 3 × 2 × 2 mixed-design experiment, with three independent variables: participant group, graph format (separate vs. overlapping) and alerting system (integrated colour-based track-and-trigger system present vs. absent).Methods
Over 64 experimental trials, ‘Seagull-trained’ nurses and novices randomly assigned to receive ‘Seagull training’ or remain untrained, viewed sequences of blood pressure and heart rate observations recorded on four different chart design extracts. The designs represented a crossing of the graph format and alerting system variables. For each design, eight cases contained normal data and eight contained an abnormal systolic blood pressure or heart rate observation (half of which yielded a Seagull Sign on overlapping plots). Participants (tested between January–May 2011) judged whether observations were physiologically normal or abnormal.Results
Across all cases, participants from all groups responded faster and made fewer errors when blood pressure and heart rate observations were graphed separately, especially when a track-and-trigger system was present. Even for ‘Seagull-trained’ participants viewing ‘Seagull Sign available’ cases, no advantage of overlapping graphs was found.Conclusions
These findings suggest that overlapping graphs do not yield the performance advantage that many health professionals assume, either for novices or experienced nurses, even when the Seagull Sign is used.
To report the impact of transformational leadership on two dimensions of nurses' safety performance (i.e. safety compliance and safety participation) and to study the mediating role of knowledge-related job characteristics in this relationship.Background
Safety performance refers to the behaviours that employees exhibit to adhere to safety guidelines and to promote health and safety at their workplace. Nurses' safety performance is a major challenge for healthcare settings, urging the need to identify the key determinants and psychological mechanisms that influence it.Design
A cross-sectional survey study.Methods
The study was carried out in September 2010 in a large Belgian hospital. We used self-administered questionnaires; 152 nurses participated. The hypotheses were tested using hierarchical regression analyses.Results/Findings
In line with our first hypothesis, the results show that transformational leadership exerted a significant positive impact on both dimensions of nurses' safety performance. This positive relation was mediated by knowledge-related job characteristics, supporting our second hypothesis.Conclusion
Head nurses' transformational leadership can enhance nurses' compliance with and participation in safety. Furthermore, transformational head nurses are able to influence the perception that their nurses have about the kind and amount of knowledge in their job, which can also lead to increases in both dimensions of nurses' safety performance. This study therefore demonstrates the key impact that transformational head nurses have, both directly and indirectly, on the safety performance of their nurses.
The aim of this study was to predict South Florida family caregivers' need for and use of informal help or formal services, specifically, to explore the predictive power of variables suggested by the Caregiver Identity Theory and the literature and develop and test a structural model.Background
In the USA, most of the care to older adults is given by family members. Caregivers make economic and social sacrifices that endanger their health. They feel burdened, if they receive no assistance with their tasks; however, services available are not sufficiently used.Design
This cross-sectional correlational study was a survey of family caregivers in their home, using standardized and/or pre-tested scales and a cognitive status test of their patients.Methods
A random sample of 613 multiethnic caregivers of frail elders were recruited in home care and community agencies. The interviews were held between 2006–2009. Analyses involved correlation and regression analyses and structural equation modelling. Outcome measures were need and use of family help and formal services.Results/Findings
The model yielded excellent fit indices replicated on three random samples of 370. The patients' functional limitations yielded the strongest predictive coefficients followed by caregiver stress. Cultural indicators played a minor role.Conclusion
The lack of a link between resource need and use suggested access barriers. Important for policy makers and service providers are the delivery of high-quality services and the use of a personal and individualized approach with all ethnicities. Quality service includes understanding the caregiving situations and requires a trusting relationship with family caregivers.
To identify predictors of relational coordination among professionals delivering care to older patients.Background
Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood.Design
This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands.Methods
This study was performed in spring 2010 among team members delivering care to older hospitalized patients (192 respondents; 44% response rate) in one hospital. Relational coordination was measured by the Relational Coordination survey; team climate by the Team Climate Inventory and questions were asked about participation in multidisciplinary team meetings and disciplines represented in these meetings. To account for the hierarchical structure, a multilevel analysis was performed.Results
Correlation analysis revealed a positive relationship among being female, being a nurse and relational coordination; medical specialists showed a negative relationship. The number of disciplines represented during multidisciplinary team meetings and team climate were positively related with relational coordination. The multilevel analysis showed a positive relationship between the number of disciplines represented during multidisciplinary team meetings and team climate with relational coordination.Conclusions
The enhancement of team climate and attendance of diverse professionals during multidisciplinary team meetings are expected to improve relational coordination. Furthermore, this study underscores the importance of enhancing relational coordination between medical specialists and other professionals.