'It's not like the wards'. Experiences of nurses new to critical care: a qualitative study

Self-efficacy as a psychological resource in the management of stress suffered by ICU nurses during the COVID-19 pandemic: A prospective study on emotional exhaustion

BACKGROUND

Intensive care unit (ICU) nurses have experienced a high degree of stress during the COVID-19 pandemic. While the literature on the consequences on emotional symptomatology is abundant, studies on the protective psychosocial variables that have contributed to buffering these consequences are scarcer.

AIM

This study analyses the role of self-efficacy as a protective personality trait in ICU nurses during the COVID-19 pandemic, using a moderated mediation model that begins with the stress and anxiety experienced at the onset of the pandemic and concludes with the emotional exhaustion experienced 6 months later.

STUDY DESIGN

Prospective longitudinal study with two data collection periods during the COVID-19 pandemic: (1) from 5 May to 21 June 2020 and (2) a follow-up 6 months after the state of alarm finalized (January-April 2021). These were both very stressful periods for ICU staff because of the COVID-19 pandemic. This study was conducted with 129 ICU nurses (a non-probabilistic convenience sample in the Spanish health care system). Socio-demographic, occupational and psychosocial variables (i.e. stress, anxiety, self-efficacy and emotional exhaustion) were assessed. Descriptive analyses, Pearson correlations, covariate analyses (i.e. Student's t-test, one-factor ANOVA) and moderated mediation analyses were carried out (SPSS PROCESS macro, model 7). STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) reporting guidelines were followed.

RESULTS

It shows that the higher the self-efficacy score, the lower the effect of stress on anxiety (p < .001); likewise, the moderating role of self-efficacy was equally valid for the whole final model (F = 8.790, p < .001), showing self-efficacy to be a good buffer for emotional exhaustion derived from the stress suffered in the ICU.

CONCLUSIONS

Self-efficacy (i.e. the belief of being able to do certain tasks successfully) is shown to be a highly relevant trait to enhance among ICU nurses during the COVID-19 pandemic, allowing them to manage work stress effectively and thus buffering the development of anxiety in the short term and emotional exhaustion in the long term.

RELEVANCE TO CLINICAL PRACTICE

Our results point to the need to assess and take action on self-efficacy in ICU nurses in highly stressful situations such as the COVID-19 pandemic. As a psychological variable, self-efficacy refers to beliefs and therefore has to be trained by evidence-based psychological techniques, such as cognitive behavioural therapy. In addition, previous literature has pointed out that previous experience or specific training is an influential (although not a determining) factor in self-efficacy, so specialization for ICU nurses could also be considered.

The impact of preceptorship on the newly qualified nurse and preceptors working in a critical care environment: An integrative literature review

BACKGROUND

Preceptorship has been found to be effective in supporting Newly Qualified Nurses (NQNs) during their transition into challenging environments, particularly in addressing issues related to confidence and anxiety. Effective preceptorship is an element of best practice and essential to support NQNs' transition into the critical care setting. However, the impact of preceptorship on NQNs and their preceptors in critical care units is yet to be completely understood.

AIM

To review the impact of preceptorship on NQNs and preceptors working in a critical care environment.

STUDY DESIGN

An integrative literature review of the literature. The review employed Whittemore and Knafl's (2005) five-stage integrative review approach.

METHODS

Three databases (MEDLINE, CINAHL and PsycINFO) were searched for papers published between January 2010 and May 2022. The PRISMA framework was used to guide the search and screening. Thematic analysis was used to extract, organize and analyse the data.

RESULTS

Nine studies were included in this review. Reflective thematic analysis revealed three themes, with four related subthemes. Preceptorship has an impact on the development of the NQNs and preceptors' 'nurturing' relationship. NQNs develop their knowledge, competence and confidence when experiencing supportive preceptorship. Meanwhile, preceptors experience a combination of increased workload and opportunities for learning and professional development as a result of preceptorship.

CONCLUSION

There is evidence of the impact of preceptorship on learning and professional development for both NQNs and preceptors, but this is a complex phenomenon and further research is required to understand this area more fully.

RELEVANCE TO CLINICAL PRACTICE

In nursing practice, it is well-established that Newly Qualified Nurses (NQNs) often face heightened levels of anxiety and a lack of confidence when embarking on their careers, particularly in the demanding and stressful environment of critical care units. This review holds particular significance in the realm of clinical practice as it delves into the pivotal role of preceptorship in nurturing the professional growth and development of NQNs within the challenging domain of critical care. Effective preceptorship, as an essential component of best practice, plays a pivotal role in aiding NQNs' transition into critical care settings.

Headache and Associated Psychological Variables in Intensive Care Unit Nurses during the COVID-19 Pandemic: A Prospective Study

(1) Background: Headaches in health professionals have been studied over the years. This has become even more relevant during the COVID-19 pandemic, due to their link with the use of masks, being female or working in highly complex units. However, their association with different personality traits has not been studied in healthcare workers (HCWs). The aim of this study was to assess the prevalence and evolution of headaches throughout the pandemic in Intensive Care Unit (ICU) nurses and to analyze their association with sociodemographic, occupational and personality variables as well as with other symptoms. (2) Methods: This was an observational, descriptive, longitudinal, prospective study with two periods of data collection (at the end of the containment phase and six months thereafter). A non-probabilistic convenience sampling was performed (n = 131). (3) Results: A high percentage of ICU nurses reported headaches during the first (71%) or second (79.4%) time point; more than half of the sample (58.8%) reported headaches over time (chronic headache). Although a higher prevalence of headaches was observed in women at both assessment points, no significant gender-related relationships were observed for headaches maintained across the two time points. Regarding the symptoms and personality variables, positive relationships were found between headaches and anxiety (p = 0.005), insomnia (p = 0.030) and emotional exhaustion (p = 0.022), and a negative relationship was found between headaches and hardiness (p = 0.031). (4) Conclusions: Our study highlights the importance of assessing occupational, psychological and emotional aspects in order to decrease the prevalence of headaches and thus improve the quality of the work life of nurses in such demanding environments as the ICU.

Newly employed nurses' transition into their new role in the ambulance service- a qualitative study

BACKGROUND

Nurses are essential to ensure safe and high-quality care worldwide. The World Health Organization (WHO) forecasts a shortfall of 5.9 million nurses by the year 2030, and in the ambulance service, the turnover rate ranges between 20% and 30%. With this study, we seek to increase knowledge by exploring the transition of newly employed experienced nurses into their roles in the ambulance service using the Meleis theory of transition. Through understanding transition, support for newly employed nurses can be developed, turnover rates can decrease, and in the long term, patient safety may increase.

DESIGN

The study employed a qualitative approach.

METHODS

Eighteen newly employed experienced nurses were individually interviewed four times during their first six months of employment. Deductive qualitative content analysis was used to analyse the data. The reporting of this research adheres to the COREQ checklist.

RESULTS

The results show that the transition process for newly employed nurses in the ambulance service encompassed all five aspects of Meleis' transition theory: Awareness, Engagement, Change and Difference, Time Span, and Critical Points. The transition period varied among the participants, and it was also observed that not all nurses went through a transition in line with Meleis' theory. Additionally, there were findings that nurses highlighted the impact of the ambulance service culture on their transition.

CONCLUSIONS

The findings provide a more profound insight into how newly employed nurses with previous experience as nurses navigate their roles and transition into a new profession in a new context. An ambulance service where the organisation is aware of the newly employed nurses' transition processes and what the transition entails can develop and promote a supportive and permissive culture within the ambulance service. For newly employed nurses who are adequately supported, health transitions are more likely to occur, which may increase retention and in the long term increase patient safety. The insights gained from the study can empower ambulance organisations to improve their introduction programmes and offer enhanced support for newly employed experienced nurses entering the ambulance service.

Combining clinical practice and education in critical care nursing-A trainee program for registered nurses

AIM

The aim of this study was to describe the experiences of a master's-level critical care nursing program for trainees in postoperative and intensive care units.

DESIGN

An exploratory design with a multidimensional approach was chosen.

METHODS

The study was conducted from 2018 to 2019 at a university hospital in southern Norway in collaboration with a university college of nursing. Data were collected through seven focus group interviews with trainees, preceptors, heads of departments, clinical nurse educators and professors (n = 26). The thematic analysis progressed from description to a deeper understanding, searching for manifest and latent patterns across the data. The COREQ checklist was used for reporting the study.

RESULTS

The analysis resulted in one overarching theme: 'To walk the critical care nursing pathway - balancing competency, time, and challenges to become proficient'. The subthemes were 'expectations, obligations, and workload in unknown environments', 'constantly assessing while being assessed', 'continuous precepting and challenges', 'vulnerability and commitment' and 'thriving in the role, mastering new skills'. The study provides valuable insights into a complex learning environment and the importance of caring aspects for trainees during their critical care nursing education.

CONCLUSION

Precepting, continuous competence assessment and clear learning outcomes are necessary to create a safe environment for the trainees during their development.

IMPLICATIONS FOR THE PROFESSION

The results advocate investing in inexperienced trainees' competency development to become proficient, creating a safe learning environment in a highly complex setting. This may also, as previous studies suggest, increase staff retention.

Sacrifices from relocation to a foreign land: Multifaceted challenges experienced by self-initiated expatriate female nurses during cross-cultural adjustment

The purpose of this exploratory study is to understand the nature and multidimensional challenges of cross-cultural adjustment as experienced by female Malaysian self-initiated expatriates (SIE) working as registered nurses (RNs) in Saudi Arabia. In-depth interviews with twenty-two Malaysian SIE RNs provided rich data on their adjustment experiences. The resulting data were subjected to a qualitative content analysis using Black, Mendenhall, and Oddou's (Black et al., 1991) cross-cultural adjustment (CCA) model. The results show that the nurses faced several challenges. Five themes emerged: learning to speak Arabic, adapting to a confrontational communication style, facing new work practices, dealing with homesickness and loneliness, and adjusting to new gender norms at work and in public. This study contributes to our understanding of expatriate adjustment by providing new interpretations of the cultural challenges faced by female SIEs and the nature of their adjustment process. The results also support the literature on expatriation by highlighting the challenges of cultural adjustment and giving specific information on the conditions and constraints facing female RNs in Saudi Arabia, a subject that has received little critical attention so far.

[Intensive care nurse in 2021, from expertise to recognition]

The profession of intensive care nurse has been in constant evolution since the 1960s. The technical nature of medical equipment and the care of increasingly complex patients require a high level of qualification. The current health crisis has highlighted the difficulties of this profession and the lack of recognition of these carers. They are demanding a specialisation with a diploma course aimed at improving the quality of patient care.

Proceed With Caution: Integrating Newly Graduated Nurses Into an Emergency Department

Virtually, no published research is available on the relationship between employing newly graduated nurses (NGNs) in the emergency department (ED) and the advancing of nursing practice and the optimization of patient care outcomes. Traditionally, nurses hired into these practice areas have required advanced skills in clinical assessment and experience with a variety of situations that were assumed to offer them a framework by which they could recognize and respond to potentially life-threatening changes in a patient's status. This qualitative study explored the issues of integrating NGNs into the ED. Findings clearly established the challenges to integrating NGNs into this practice context. The intersection of variables included a low level of clinical predictability accompanied by high acuity; an increased level of practitioner autonomy combined with high levels of risk when applying decision making to patient outcomes; and the potential for devolution of professional identity in the face of highly intense, morally conflicted, and socially nuanced care situations.

Workforce and Task Sharing of Nurses in the Japanese Intensive Care Unit-Cross-Sectional Postal Survey

This study aimed to estimate the number of nurses who independently care for patients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous extracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. We performed a cross-sectional study using postal questionnaire surveys. The study included 725 Japanese intensive care units (ICUs). Data were analyzed using descriptive statistics. Among the 725 ICUs, we obtained 302 responses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% (IQR: 42.3–77.3). The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7–63.3%) in the ICUs that had experience with VV-ECMO use. With regard to task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always titrated sedative dosage in 44.5% of ICUs. Nurse staffing might be inadequate in all ICUs, especially for the management of patients with severe respiratory failure. The proportion of competent nurses to care for severe respiratory failure in ICUs should be considered when determining the workforce of nurses.

Understanding new nurses' learning experiences in intensive care

OBJECTIVES

Recruitment and retention of nurses in intensive care units (ICU) has been challenging over the last few years. Rising demand is now exacerbated by the ongoing Covid-19 pandemic. Transition to ICU from other clinical areas is stressful resulting in significant nurse retention issues. This study therefore aimed to illuminate and explore new nurses' learning experiences in one large intensive care unit in the United Kingdom.

METHODOLOGY/METHODS

Exploratory qualitative case study utilising two data collection methods: one to one interview with six new ICU nurses and focus groups with six senior/clinical education ICU nurses.

SETTING

A large major trauma centre in London with over ninety ICU beds.

FINDINGS

Findings indicate that ICU is a challenging learning environment for new nurses due to the large number of skills which must be developed in a short period of time. Forming supportive social relationships proved important in helping new ICU nurses learn and adapt to this complex clinical environment. The high-risk culture of ICU makes it harder to learn particularly for internationally educated nurses. Frequently changing shift patterns also impacts learning.

CONCLUSION

Senior ICU nurses should be aware of the issues affecting new nurses and where possible alleviate the stress of working in this challenging environment. They should also consider individual circumstances whilst maintaining high quality education. Social support should be facilitated where possible and new nurses need to be aware of the realities of ICU work.

Experiences of Newly Qualified Nurses in Critical Care: A qualitative systematic review

Recent nursing shortages have been particularly felt in specialist areas, like Critical Care, which require higher staffing quotas; leading to increased recruitment of Newly Qualified Nurses in an area once reserved for the more experienced. This qualitative systematic review aimed to explore the experiences of Newly Qualified Nurses working in Critical Care, as their first job post-registration. A systematic search was undertaken between December 2017 and May 2018, yielding eight studies for inclusion in this review. Eligibility criteria included a qualitative design; Newly Qualified Nurses with less than two years post-registration experience, working in adult Intensive Care Units. Data were extracted and synthesised using the Thematic Synthesis approach. Five main themes emerged from the data: Intensive Care Unit Readiness; An Emotional Spectrum; Developing Relationships; The Journey to Self-Satisfaction and Intensive Care Unit Commitment. Conclusions are that an undergraduate placement in Critical Care should be facilitated where possible, consistent mentorship enhances Newly Qualified Nurse satisfaction, peer support is an important coping mechanism and opportunities for socialisation should be facilitated.

New Graduate Nurse Transition Into the Intensive Care Unit: Qualitative Insights From a Longitudinal Study-Part 1

BACKGROUND AND PURPOSE

Patients admitted to intensive care units (ICUs) are critically ill and suffer from life-threatening sickness of injury. To work in ICU, registered nurses require additional knowledge and skills. While practices regarding the hire of new graduate nurses (NGNs) into settings such as the ICU vary, it is common that NGNs are being hired. However, NGNs in general, are at a higher risk for turnover within the profession as compared to their more experienced colleagues. NGNs in ICU settings may be at higher risk of turnover due to the complexity of the care context. It is of particular importance that the experiences of NGNs in ICU be explored with the intent of identifying what these nurses experience but also to consider how they can be best supported during a period of transition. This manuscript reports the findings from a mixed design study that sought to understand the transition of a cohort of NGNs over a period of 2 years.

METHODS

This study used both a purposive and convenience sample of NGNs. The qualitative component incorporated Thorne's (2016) interpretive description. Face-to-faceinterviews were completed.

RESULTS

Five themes were identified: an emotional transition, a social transition, a transitioning mindset, transitioning through firsts, and transitioning with confidence. Within each theme, there is a distinct difference and elements of transition were evident. Findings demonstrate that the NGNs appeared to be more confident in their skills and in their nursing practice over time. Findings from this study provide important insight into the experiences of NGNs in ICUs.

Challenging encounters as experienced by registered nurses new to the emergency medical service: explored by using the theory of communities of practice

The aim of this study was to explore challenging encounters experienced by registered nurses (RN) during their first year in the emergency medical service by using the social learning theory of communities of practice. During the first year in a new professional practice, a new RN experiences a transition during which the new professional identity is being formed. This is a challenging and demanding period of time. According to the learning theory of communities of practice by Lave and Wenger, individuals' learning and development in a new professional practice occurs through participation in social activity and is influenced by context. This study is based on the qualitative data from semi-structured interviews. Thirty-two RNs working in the Swedish emergency medical service were interviewed via telephone during the spring of 2017. A qualitative content analysis with deductive reasoning of the interviews was used. The analysis process generated the main category; New RNs participation is challenged by unpredictability and uncertainty in practice. The main category was based on three generic categories; Loneliness in an unpredictable context, Uncertainty about the team, and Uncertainty in action. The challenges new RNs encounter during the first year relate to all three dimensions of a community of practice; mutual engagement, joint enterprise and shared repertoire. The encountered challenges also relate to the EMS context. Taking into account all these aspects when designing support models for RN's professional development may be advantageous for creating positive development for RNs new to the EMS and/or similar practices.

Outcomes of a Critical Care Hospital-Based Fellowship for Senior Nursing Students

BACKGROUND

A partnership between four academic sites and one practice site was created to address a gap in baccalaureate nursing education resulting from the lack of pediatric and critical clinical experience. Four schools of nursing (SONs) were invited to recruit senior-level nursing students to participate in a critical care fellowship opportunity during their senior synthesis courses.

METHOD

In a mixed-method evaluation, data were collected through three questionnaires.

RESULTS

The findings indicated that the students increased their knowledge and ability in caring for critical pediatric patients. The difference in clinical hours by the SONs did not reveal significant mean differences across measures of self-efficacy, clinical knowledge, or clinical confidence.

CONCLUSION

The critical care hospital-based fellowship can be used as a partnership between a hospital and SONs to expose prelicensure students to clinical experiences and education related to pediatric critical care to decrease nursing shortages in these specialty areas. [J Nurs Educ. 2018;57(8):469-475.].

Operating Room Nurses' Perceptions of the Clinical Learning Environment: A Survey Study

BACKGROUND

Authors commonly agree that the clinical learning environment significantly affects student learning. Studies of how operating room nurses perceive the clinical learning environment during their specialist studies are sparse.

METHOD

This study aimed to examine newly graduated operating room nurses' perceptions of the clinical learning environment during their specialist education. Fifty newly graduated operating room nurses answered a questionnaire gaging their perceptions of clinical education.

RESULTS

Most participants perceived the clinical learning environment as good and highly associated with the supervisor's ability to supervise, enjoy supervision, and show interest in the participants' degree project. The management at the clinical setting, which was perceived to emphasize the importance of supervision, time allocated especially for supervision, and perceived cooperation between the University and hospital, also had an impact.

CONCLUSION

Social interactions and structures within the operating room affect how the clinical learning environment is perceived. J Contin Educ Nurs. 2018;49(9):416-423.

The experiences of new graduate nurses hired and retained in adult intensive care units

BACKGROUND

It is a common practice that new graduate Registered Nurses are hired into adult intensive care units as initial entry into practise. There exists a practice readiness gap between nursing curricula and actual clinical practise expectations at adult intensive care settings; this has led to negative consequences and subsequent nurse turnover, a concern nationwide. Nonetheless, some new graduate nurses survived their initial transition and continue to practise in adult settings. The purpose of this study was to explore the experiences of nurses who were hired into adult intensive care as a new graduate and survived their transition from novice to competent, starting the third year of practise.

METHODOLOGY

The study used the hermeneutic phenomenology research approach.

FINDINGS

Data analysis revealed the overall meaning of the experience: coming to terms with being comfortable with being uncomfortable. The six themes associated with being comfortable with being uncomfortable were: confidence and uncertainty, gaining experiences and forever learning, intuitive knowing and intuition, difficult and stressful, being courageous and assertive, and the team and support people.

CONCLUSION

New graduate nurses can survive to become competent adult intensive care nurses. This study reveals the need to promote exposure to a variety of clinical situations early, to promote resilience and self-care, and to foster unit teamwork and mentoring to ensure successful transition and overall retention of new nurses hired into in adult intensive care.

Education on invasive mechanical ventilation involving intensive care nurses: a systematic review

BACKGROUND

Intensive care unit nurses are critical for managing mechanical ventilation. Continuing education is essential in building and maintaining nurses' knowledge and skills, potentially improving patient outcomes.

AIMS

The aim of this study was to determine whether continuing education programmes on invasive mechanical ventilation involving intensive care unit nurses are effective in improving patient outcomes.

METHODS

Five electronic databases were searched from 2001 to 2016 using keywords such as mechanical ventilation, nursing and education. Inclusion criteria were invasive mechanical ventilation continuing education programmes that involved nurses and measured patient outcomes. Primary outcomes were intensive care unit mortality and in-hospital mortality. Secondary outcomes included hospital and intensive care unit length of stay, length of intubation, failed weaning trials, re-intubation incidence, ventilation-associated pneumonia rate and lung-protective ventilator strategies. Studies were excluded if they excluded nurses, patients were ventilated for less than 24 h, the education content focused on protocol implementation or oral care exclusively or the outcomes were participant satisfaction. Quality was assessed by two reviewers using an education intervention critical appraisal worksheet and a risk of bias assessment tool. Data were extracted independently by two reviewers and analysed narratively due to heterogeneity.

RESULTS

Twelve studies met the inclusion criteria for full review: 11 pre- and post-intervention observational and 1 quasi-experimental design. Studies reported statistically significant reductions in hospital length of stay, length of intubation, ventilator-associated pneumonia rates, failed weaning trials and improvements in lung-protective ventilation compliance. Non-statistically significant results were reported for in-hospital and intensive care unit mortality, re-intubation and intensive care unit length of stay.

CONCLUSION

Limited evidence of the effectiveness of continuing education programmes on mechanical ventilation involving nurses in improving patient outcomes exists. Comprehensive continuing education is required.

RELEVANCE TO CLINICAL PRACTICE

Well-designed trials are required to confirm that comprehensive continuing education involving intensive care nurses about mechanical ventilation improves patient outcomes.

Transition support for new graduate and novice nurses in critical care settings: An integrative review of the literature

Transition into critical care areas for new graduate nurses may be more difficult than transitioning into other areas due to the specialised knowledge needed. It is unknown which aspects of transition programs best support new graduate nurses improve competence and confidence to transition into critical care nursing specialties. Identifying these aspects would assist to design and implement best practice transition programs for new graduates in critical care areas. Themes identified in the literature include; having a designated resource person, workplace culture, socialisation, knowledge and skill acquisition, orientation, and rotation. Allocation of a quality resource person/s, supportive workplace culture, positive socialisation experiences, knowledge and skill acquisition and structured orientation based on new graduates' learning needs all positively supported increased confidence, competence and transition into nursing practice. Rotations between areas within graduate programs can potentially have both positive and negative impacts on the transition process. Negative impacts of including a rotation component in a transition program should be carefully considered alongside perceived benefits when designing new graduate nurse transition programs.

An exploration of participants' experience of an intensive care nursing transition to specialty practice program

BACKGROUND

Transition to specialty practice programs were developed to support, educate and facilitate recruitment and retention of nurses in specialised areas of practice. The intensive care nursing transition to specialty practice program in this study was implemented in 2000. To date, in Australia there are no published studies which focus on intensive care nursing transition to specialty practice programs.

OBJECTIVES

The study aimed to explore the effects of an intensive care nursing transition to specialty practice program offered in two intensive care units in a single Australian health service.

METHODS

A cross-sectional survey design was used. Quantitative data were collected from nurses who participated in the transition to specialty practice program from 2005 to 2015 using an anonymous online survey. Summary statistics and Chi-square tests were used to analyse the data.

RESULTS

The response rate was 51.8% (n=86). Most of the transition to specialty practice program participants had medical nursing experience (n=35, 40.7%) or surgical nursing experience (n=35, 40.7%) prior to enrolling into the program. More than half (n=46, 53.5%) of the participants had worked in the intensive care units for more than two years post program. The majority of the participants (n=60, 69.8%) undertook post graduate education after the transition to specialty practice program.

CONCLUSION

Significant numbers of experienced nurses undertook transition to specialty practice program into intensive care and majority of the participants reported positive results of the program.

Striving for balance - A qualitative study to explore the experiences of nurses new to the ambulance service in Sweden

New nurses and nurses new to a professional practice go through a transition where they adopt a new professional identity. This has been described as a challenging time where peer support and limited responsibility are considered necessary. Little is known about the experience of nurses being new to the ambulance service where support is limited and the nurse holds full responsibility of patient care. The aim of this study has therefore been to explore nurses' experiences during their first year of employment in the Swedish ambulance service. Data was generated from semi-structured interviews with 13 nurses having less than 12 months of experience of work in the ambulance service. The nurses represented nine different districts in Sweden. Analysis was a latent inductive qualitative content analysis. The analysis resulted in the main category, "Striving for balance during the transition process in the ambulance context". Transition in the ambulance service was experienced as a balance act between emotions, expectations and a strive for professional development. The balance was negatively affected by harsh, condescending attitudes among colleagues and the lack of structured support and feedback. In striving for balance in their new professional practice, the nurses described personal, unsupervised strategies for professional development.

Novice Nurse Practitioner Workforce Transition Into Primary Care

The purpose of this integrative review was to analyze the current state of the science related to the novice nurse practitioner (NP) transition into primary care. A systematic review of the literature was conducted using the databases Pubmed, MEDLINE, Ovid, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) with the terms nurse practitioner, role, and transition to search articles published after 1997. Three major themes emerged from the literature related to the novice NP transition into primary care. These themes were categorized as “experiencing role ambiguity,” “quality of professional and interpersonal relationships,” and “facing intrinsic and extrinsic obstacles.” Strategies to reduce role ambiguity, improve the quality of professional relationships, and mitigate extrinsic obstacles faced by novice NPs may improve their transition into the primary care workforce. Educational institutions, employers, and novice NPs all have a stake in the successful transition from student to primary care practitioner and should be engaged in developing effective NP transition-to-practice programs.

Experiences of Turkish undergraduate nursing students in the intensive care unit

BACKGROUND

Clinical practicum provides many opportunities for nursing students to learn more about their subject and develop essential nursing skills. In contrast, nursing students often have difficulties during their clinical practicum.

AIM

This study aims to describe the clinical experiences of undergraduate nursing students in the intensive care unit.

METHODS

A descriptive qualitative approach was used in this study. The study was performed at a military medical academy between 1 March and 30 April 2008. The study was conducted with 15 fourth-year baccalaureate nursing students. Data were obtained through open-ended and in-depth audio-taped interviews, which lasted approximately 35-45 min.

FINDINGS

Themes emerged from the participants' descriptions of their experiences in the intensive care unit: anxiety, fear of doing harm, emotional connection and empathy, improving self-confidence, perceived responsibility for patients, prioritizing care of patients, preserving dignity, coping with confronting situations, and communication in the intensive care unit.

CONCLUSION

The views and expectations of nursing students regarding intensive care practice are important for the organization of the nursing education environment. The nursing curriculum must be revised and developed according to the needs of students.

Professional integration as a process of professional resocialization: internationally educated health professionals in Canada

This paper examines the process of professional resocialization among internationally educated health care professionals (IEHPs) in Canada. Analyzing data from qualitative interviews with 179 internationally educated physicians, nurses, and midwives and 70 federal, provincial and regional stakeholders involved in integration of IEHPs, we examine (1) which aspects of professional work are modified in transition to a new health care system; (2) which aspects of professional practice are learned by IEHPs in the new health environment, and (3) how IEHPs maintain their professional identity in transition to a new health care system. In doing so, we compare the accounts of IEHPs with the policy stakeholders' positions and analyze the similarities and the differences across three health care professions (medicine, nursing, and midwifery). This enables us to explore the issue of professional resocialization from the analytical intersection of gender, professional dominance, and institutional/organizational lenses.

An interprofessional approach to undergraduate critical care education

Published research suggests that the best outcomes in critical care clinical practice require an interprofessional (IP) collaborative approach to patient care. The Institute of Medicine has called for increased IP education. This article describes the development of an elective undergraduate IP critical care course. The course was developed to educate nursing and respiratory care students on the importance of IP practice, current evidence, and essentials of critical care. Several challenges were met in the development and implementation of the course. Various IP teaching strategies were used, including simulation, clinical observations, and student patient case presentations. An IP course provides a unique learning environment in which fundamental principles of critical care clinical practice and IP practice can be learned in an IP educational environment. There is a critical need to increase IP education and to conduct research related to IP education and its outcomes in preprofessional educational programs.

Nurses' role transition from the clinical ward environment to the critical care environment

AIM

To explore the experiences of nurses moving from the ward environment to the critical care environment.

BACKGROUND

Critical care areas are employing nurses with no critical care experience due to staff shortage. There is a paucity of literature focusing on the experiences of nurses moving from the ward environment to the critical care environment.

METHODOLOGY

A Heideggerian phenomenology research approach was used in this study. In-depth semi structured interviews, supported with an interview guide, were conducted with nine critical care nurses. Data analysis was guided by Van Manen (1990) approach to phenomenological analysis.

RESULTS

Four main themes emerged: The highs and lows, you need support, theory-practice gap, struggling with fear. The participants felt ill prepared and inexperienced to work within the stressful and technical environment of critical care due to insufficient education and support.

CONCLUSION

The study findings indicated that a variety of feelings and emotions are experienced by ward nurses who move into the stressful and technical environment of critical care due to insufficient skills and knowledge. More education and support is required to improve this transition process.

Modernisation as a professionalising strategy: the case of critical care in England

There has been broad agreement about how to characterise the processes of 'modernisation' of the public sector in welfare societies, but rather less consensus on the impact of this modernisation on professionals. This paper takes critical care in England as a case study to explore how professionals in one setting account for the changes associated with modernisation. In contrast to reports from other arenas, critical care professionals were positive about the processes and outcomes of 'modernisation' in general, and there was a surprising lack of nostalgia in their accounts of organisational changes. However, joking comments suggested considerable scepticism about the initiatives explicitly associated with the national organisation that was charged with 'modernising' critical care, the Modernisation Agency. We suggest that the relative optimism of staff is in part explained by historical and political contingencies which meant that critical care, as a relatively new clinical specialty, benefited in tangible ways from modernisation. Further, all staff groups were able to attribute gains, rather than losses, in autonomy and authority to the modernisation of critical care. Their accounts suggest that modernisation can be a professionalising strategy, with responses to change being neither resistant nor compliant, but sceptically strategic.

The process of acquiring practical knowledge by emergency nursing professionals in taiwan: a phenomenological study

INTRODUCTION

The emergency department is the front line in the hospital battlefield. Medical staff are frequently tested with highly complex and fast-changing clinical situations. Nurses must acquire practical knowledge in a fast-changing environment in order to provide the most appropriate form of nursing care. This study explores the process of the development of practical knowledge in emergency nurses.

METHOD

This study uses a phenomenological approach and in-depth interviews and adopts Moustakas data analysis techniques. In 2007, the researcher interviewed 10 professional nurses with at least 3 years of ED experience and collected 13 interview transcripts.

RESULTS

Data analysis identified 4 major themes and 10 sub themes in the process of development of practical knowledge for ED nurses. The 4 major stages in the learning process are (1) matter-of-course apprenticeship, (2) stimulus-response learning, (3) work demand-oriented learning, and (4) self-reflective learning.

DISCUSSION

Upon entering the emergency department, nurses began learning by serving as apprentices to seniors. After this, they experienced the stimulus-response learning phase as they responded to stimuli in the form of pressure to grow and learn. As they gradually drifted away from the protection of seniors, they continued to learn in order to meet work demands, hold on to their jobs, and maintain a proper level of professional competence. A small number of participants entered the final stage of self-reflective learning, in which they examined their life experience by self-reflection and developed a proper nursing attitude and knowledge about holistic patient care.

Quality of practice in an intensive care unit (ICU): a mini-ethnographic case study

BACKGROUND

Nurses' perspectives of maintaining quality practice is important in the context of today's safety and quality agenda. This study provides a snapshot of registered nurses' perspectives on practice quality in one Australian ICU.

METHODS

A mini-ethnographic case study examined how quality is embedded in the culture of ICU nursing. Semi-structured interviews of 10 informants were analysed using Spradley's (Spradley JP. The ethnographic interview. Sydney: Holt, Rinehart and Winston, Inc.;1979) ethnographic guidelines.

FINDINGS

Three major themes influenced nursing quality: maintaining cohesiveness in a complex and stressful environment; rapid, effective and respectful communication; and specialist knowledge gained through experience and formal learning.

CONCLUSION

The nurses reported satisfaction with the quality of their ICU practice, but revealed factors that could diminish quality and contribute to job dissatisfaction. Given current recruitment and retention issues and the link between satisfaction and retention, it is important to consider this these factors in advancing the knowledge base for workforce planning.

From novice to advanced beginner: the critical care internship

Our unit is a 12-bed medical-surgical intensive care unit in a small central Florida community. Finding experienced critical care nurses to fill vacancies is very difficult. We have offered a critical care internship for the past few years to attempt to augment our staff. Without the resources of a unit-based educator or clinical nurse specialist and with a very limited budget, we are committed to improving our internship to provide us with safe, competent critical care nurses who are willing to become members of our team. A literature review was conducted, and recommendations were developed to improve our current internship to better meet the needs of the unit and the beginning critical care nurses.

Lost in translation, or the true text: mental health nursing representations of psychology

One theme of academic discourse and research in mental health nursing is the exploration and application of psychosocial models of nursing practice. Despite this, the influence of disciplinary psychological knowledge on practitioners' talk about nursing practice has not been extensively researched. To address this gap, the authors analyzed talk about psychological work using transcripts of 10 focus groups involving 59 mental health nurses. Nurses identified a psychological domain of practice as central to their work. Given the amount of time spent with clients, nurses are the prime resource for psychological work. Psychological talk was organized into three categories related to the nursing process and organizational context and analyzed through empowerment and critical perspectives on power. Although technical ("formal") and everyday ("informal") discourses were generally well integrated, the authors question the oral basis to this body of knowledge in terms of accountability to service users and as a marker of disempowerment.