The influence of high technology care on patients, their relatives and nurses

Sensing space and making place: the hospital and therapeutic landscapes in two cancer narratives

This article explores the role of senses in the construction and experience of place, focusing on patients' experiences of hospital care. It compares two cancer narratives for their insights into the heterogeneous ways that hospital environments are made into therapeutic landscapes, arguing that they are a product of dynamic processes rather than something that is simply built. The article draws on a relational model of space and place, alongside literary analysis, to explore the making of un/healthy environments in embodied, affective and sensory terms. It indicates that sensory experiences in hospitals are made (un)therapeutic in relation to illness and recovery, as well as a range of social and human/non-human relations. These conclusions warn against making broad claims about 'good' or 'bad' hospital sensescapes, or against treating the hospital as a homogeneous space. They also offer new opportunities for medical geography and the medical humanities, by showing how illness and recovery are part of the relational making of space and place.

Nurses’ roles in discharge decision making in an adult high dependency unit

An ethnographic approach was used to investigate the roles which nurses take in the discharge decision making process in an adult High Dependency Unit (HDU). Participant observation and unstructured interviews were the data collection methods used. Four themes were identified. The first theme encompassed the relationship of nurses with medical staff. Tension was felt between nursing and medical staff, although this was not demonstrated in direct communication between the two professions. Nurses took a submissive role in order to avoid conflict, but this also enabled them to manipulate doctors. Another theme was the unique value of the nurse which was defined as the 'holistic' view which nurses took towards patients which was different to that taken by other health care professionals. Nurses undertook an important administrative role. They had substantial responsibility for bed management and became more proactive in decision-making when there was pressure on HDU beds. Issues associated with decision making were highlighted, as although nurses wanted to contribute to discharge decision making, they were often uncomfortable with this role. There is scope for further investigation into the working relationship of nurses and medical staff, how administrative roles of nurses influence their ability to provide patient care and whether the opinions expressed with regard to decision making are widespread within the nursing community.

Use of technological equipment in critical care units: nurses' perceptions in Greece

AIMS AND OBJECTIVES

The aim of this study was to determine the perceptions of nurses who work in critical care units about positive and negative effects related to the use of technological equipment and identify relationships between these perceptions and demographic characteristics of participants.

BACKGROUND

Previous researchers have investigated the perceptions of nursing personnel about the effects of technology on clinical practice. However, most of them focus on specific negative effects. Positive and negative effects have never been studied as a whole.

DESIGN

Critical care nurses were surveyed to elicit their perceptions regarding the use of technological equipment. The instrument comprised a 14-item questionnaire and a series of demographic characteristics. A five-point Likert scale was used for each of these 14 questions.

METHODS

The questionnaire was administered to 122 nurses working at the four critical care units of a major academic hospital in Patras, Greece, from 1/10/2003 to 31/12/2003. The completion of the questionnaires was achieved by means of a personal interview.

RESULTS

A total of 118 questionnaires were completed. The majority of nurses recognized the positive effects of equipment regarding patient care and clinical practice. At the same time, they agreed that use of equipment possibly leads to increased risk due to human errors or mechanical faults, increased stress and restricted autonomy of nursing personnel.

CONCLUSIONS

The use of machines does not add to nursing prestige and this may be related to decreased autonomy. Human errors, mechanical faults and increased stress do not seem to come as a result of time constriction but rather of inadequate education. Undergraduate and continuing education should respond efficiently to the needs of contemporary critical care.

RELEVANCE TO CLINICAL PRACTICE

Recognition of positive and negative effects of machines through the investigation of perceptions of nurses is the first step before looking for ways of maximizing advantages and facing disadvantages of equipment use.

A transition from nurse to touch therapist--a study of preparation before giving tactile touch in an intensive care unit

Tactile touch is a complementary therapy that is rarely undertaken in intensive care units (ICUs) in Sweden. This study was a part of a larger project that examines whether tactile touch can relieve the suffering of patients in the ICU. The aim of this study was to describe nurses' lived experience of preparation before giving tactile touch in an ICU. Four assistant nurses and one registered nurse, each with diplomas in tactile touch working at three different ICUs in Sweden, participated in the study. A phenomenological approach was chosen to achieve experience-based and person-centred descriptions. Data were collected through interviews and analysed following Giorgi's method. The main finding was that before providing tactile touch, the nurses needed to add the new role as touch therapists, to their professional one. The essential aspect being the transition from nurse to touch therapist. Findings included a general structure, with four constituents; a sense of inner balance, an unconditional respect for the patients' integrity, a relationship with the patient characterised by reciprocal trust, and a supportive environment. Furthermore, the study underlines the difficulties to integrate a complementary caring act, such as tactile touch, in a highly technological environment.

Perceptions and experiences of primary nursing in an ICU: a combined methods approach

With the introduction of the Patient's Charter, greater emphasis has been placed on 'named nursing' (Department of Health 1991). While there is much literature extolling the benefits of this method of delivering care to patients (Reed 1988; Manley 1989; Macguire 1991); there is a dearth of empirical studies exploring primary nursing in an adult intensive care unit (ICU). In addition, little is known about how nurses feel about being a 'primary nurse'. The aim of this study was to determine qualified nurses' perceptions and experiences of the effect of primary nursing on patient care in an intensive care environment (ICU) and to explore nurses' experiences of being a primary nurse. This study was carried out in an ICU in Northern Ireland. Primary team nursing was the system of organizing care within this unit. This system consisted of teams of 'primary' and 'associate' nurses. A total of 65 qualified nurses were surveyed. Sixteen nurses took part in focus group interviews. A combined methods approach comprising a questionnaire and focus group interviews was employed for the study. Part one of the questionnaire provided data on professional and demographic details. Part two facilitated nurses to elaborate on their feelings and perceptions of the concept of primary nursing. The focus groups facilitated in-depth exploration of the respondents' personal feelings and experiences about their role as a primary nurse. The data obtained from the two-part questionnaire were analysed using descriptive statistic and content analysis. The data obtained from the focus groups were analysed using content analysis and the development of emerging themes. Analysis of the data revealed that the nurses' views were similar to those highlighted in the existing literature. Nurses perceived primary nursing to relate to the responsibility for the care of one patient, from admission to discharge with the primary nurse assessing, planning, implementing and evaluating care and the associate nurse assisting in the delivery of this care. Thus, continuity of care was seen as the major advantage of primary nursing. The findings, however, suggested that further teaching on the concept of primary nursing was required. In addition, many of the nurses admitted they experienced considerable stress, particularly in relation to their close proximity over a long period of time, with patients and their relatives. This is an important finding and highlights the need for primary nurses in ICU to have the opportunity (in some instances), to be relieved of their responsibility for a named patient, thereby reducing some of the potential for stress. It is acknowledged that the findings of this study may not be generalized beyond the identified sample. Further empirical studies exploring nurses' perceptions and experiences of primary nursing in an ICU are therefore needed.

Reflections on technology: increasing the science but diminishing the art of nursing?

Technology has had a huge impact on the delivery of health care over the last 10-20 years and although this has been, in general, in the Intensive Care (ICU) environment, the Accident and Emergency (A & E) department has not been immune from technical developments and innovations, a trend that looks destined to continue. The impact of technological developments has given rise to much nursing literature relating to the effects technology has had in 'dehumanizing' the patients in their care, as critical care nurses in all fields endeavour to balance the need for technical competence with the traditional and still important traditional arts of nursing. This paper explores some of the definitions and terminology surrounding technology, nursing, art and science in an attempt to illustrate that technical proficiency, scientific knowledge and nursing artistry can be combined by skilled nurses to achieve a balance of care which preserves the humanity and dignity of patients and their relatives in a critical care environment.

The role of advocacy in critical care nursing: a caring response to another

With the aim of clarifying critical care nursing, six critical care nurses, working in a Swedish intensive care unit (ICU) were each asked to narrate a care situation with which they had been satisfied or dissatisfied. The stories were tape-recorded and analysed using a phenomenological-hermeneutic approach inspired by the philosophy of Ricoeur. The themes uncovered in the analysis describe the nurse's role of advocacy as: to build a caring relationship, to carry out a commitment, to empower, to make room for and interconnect, to be a risk-taker, to be a moral agent and to create a trusting atmosphere conducive to recovery. The meaning of the role of advocacy lies in a moral and existential response to another human being, an expression of caring. Advocacy rests on the patient-nurse relationship and occurs as an outspoken demand of another human being whose autonomy is threatened. The results are discussed from the ethical perspectives of Lögstrup, Watson's concept of care, and existential advocacy as expressed by Gadow.

A critical review of the belief that technology is a neutral object and nurses are its master

This paper discusses technology in relation to nursing practice. The purpose of the paper is to introduce to nursing literature a critique of an important and common assumption concerning the relationship between nurses and technology. The discussion centres on the belief that technology is a neutral influence upon the practice of nursing. Technology is argued to be more pervasive an influence upon the politics of practice, the values of individuals, nursing practice and decision making, than many nurses identify. Therefore adequate understanding of the relationship between technology and nursing practice must address the need to be more critical of the belief that technology is a neutral object, and originates from being cognisant of arguments which both support and oppose the assertion.

Nursing perspectives for intensive care

Within health care, market forces increasingly determine what services have economic value. For nursing to survive this economic onslaught, nurses must clarify their values and roles. While nurses working in intensive care develop useful technical skills and normally work within a constructive multi-disciplinary team framework, they have a potentially unique contribution to care, focusing on the patient as a whole person rather than intervening to solve a problem. The need for both physiological and psychological care creates a need for holistic values, best achieved through humanistic perspectives. Humanistic nursing places patients as people at the centre of nursing care, as illustrated by the limitations of reality orientation compared with the potentials of validation therapy. Intensive care nurses asserting and developing such patient-centred roles offer a valuable way forward for nursing to develop into the 21st century.

Alleviating anxiety in nursing patients' significant others

This paper describes an investigation of factors that help to alleviate anxiety in nursing patients' significant others, based on the assumption that anxiety flows from the feeling of insecurity and accordingly that anxiety can be alleviated by strengthening the sense of security. The focus of the study is on factors that affect experiences of security in the significant others of critically ill patients. In addition, the paper addresses the questions of how the age and gender of the significant other, the duration of intensive care, and the patient's named nurse influence the assessments by significant others of the quality of the nursing care provided. Fourteen significant others of critically ill patients took part. The data were collected in focused interviews. For qualitative analysis the raw data were analysed into four main themes: nurse characteristics, interaction, professional competence, and confidence in nursing care and in the nursing staff. In the quantitative analysis the concern was with how these themes and their subcategories were emphasised by participants and on different variables. Frequencies were used. According to the results, significant others considered it important to have close contact with the nursing staff. Each patient's named nurse had an important role to play in improving the quality of nursing care. In general, respondents appeared to consider that factors which had to do with attitudes, which could be subjectively evaluated and which were not objectively discernible, were the most important determinants of safe, quality nursing care.

Technology and nursing: an anatomy of definition

This paper discusses technology in relation to nursing practice development in order to demonstrate the need to apprehend nursing within the context of technological advancement. Issues pertinent to formulating an understanding of technology are reviewed and four common approaches to the definition of technology within the domain of nursing are critiqued. The purpose of the paper is to analyse issues relevant to defining technology, and to make obvious the limitations of current nursing literature.

Introducing a change of nursing model in a general intensive therapy unit

This paper focuses on the management of change in the context of health care and looks specifically at methods of introducing a new model of nursing into a general Intensive Therapy Unit (ITU). Rationale for change is discussed, change theory is appraised and a strategy for implementation, management and evaluation of change is provided.