Nursing and the primacy of technological progress

Nurse anesthetists' reflections and strategies when supervising master's students

OBJECTIVE

The objective was to describe registered nurse anesthetists' reflections and strategies in relation to supervision of specialist nursing students in anesthetic care.

BACKGROUND

In anesthesiology care, registered nurse anesthetists work with advanced care in a high-technology environment. The complexity of working with production requirements, time pressure and patient safety creates great challenges. Registered nurse anesthetists have a unique position and are responsible for the patient's life during surgery. At the same time, they must supervise students without risking patient safety. Little research to date has focused on the clinical supervisory role in this context.

DESIGN

A qualitative design was used.

METHODS

The data were collected in 2018 from qualitative interviews with a purposive sample of twelve student registered nurse anesthetists from a large hospital in Sweden. The data were analyzed using content analysis.

RESULTS

The results demonstrated that the dual role of registered nurse anesthetist and supervisor was experienced as satisfying, important and promoting development, although it also involved several challenges. Creating opportunities for supervision and learning in perioperative care improved supervisors' prerequisites for supporting students and helping them develop. Being a supervisor was also rewarding, and given the interplay with students, supervision was viewed as a process of mutual growth.

CONCLUSION

By focusing on students and their learning, we can help produce well-qualified registered nurse anesthetists who have positive experiences of the workplace and who want to stay in their profession.

Swedish Operating Room Nurses and Nurse Anesthetists' Perceptions of Competence and Self-Efficacy

PURPOSE

To compare perceived competence and self-efficacy (SE) among Swedish operating room (OR) nurses and registered nurse anesthetists (RNAs), and to evaluate the relationship between SE and competence, gender, age, and years of experience.

DESIGN

Comparative cross-sectional survey.

METHODS

Two validated questionnaires, Perceived Perioperative Competence Scale-Revised and General Self-Efficacy Scale, were sent to members of the Swedish Association of Health Professionals (n = 2,902).

FINDINGS

The response rate was 39% (n = 1,033). OR nurses showed significantly higher scores on Perceived Perioperative Competence Scale-Revised subscale foundational knowledge and leadership as well as General Self-Efficacy Scale scores compared with RNAs. The RNA group showed significantly higher empathy scores compared with OR nurses. Among the OR nurses professional development made the strongest contribution to SE and proficiency among the RNAs.

CONCLUSIONS

These results suggest that there are differences in perceived competence and SE between OR nurses and RNAs. Gender may be an independent factor affecting SE.

Perioperative nursing in public university hospitals: an ethnography

BACKGROUND

In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly specialized operating rooms in public university hospitals?

METHODS

An ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark.

RESULTS

Patients were addressed as either human beings or objects. Likewise, the participants' technical skills were observed and described as either technical flair or a lack of technical skills/technophobia. The different ways in which the technical skills were handled and the different ways in which the patients were viewed contributed to the development of three levels of interaction between technology and nursing care: the interaction, declining interaction, and failing interaction levels.

CONCLUSION

Nursing practice at the interaction level is characterized by flexibility and excellence, while practice at the declining interaction level is characterized by inflexibility and rigidity. Nursing practice at the failing interaction level is characterized by staff members working in isolation with limited collaboration with other staff members in operating rooms. Considering that the declining and failing interaction levels are characterized by inflexibility, rigidity, and isolation in nursing practice, nurses at these two levels must develop and improve their qualifications to reach a level of flexible, excellent interaction. Nurse leaders must therefore refocus their skills on proficiency in perioperative nursing.

A cyborg ontology in health care: traversing into the liminal space between technology and person-centred practice

Person-centred practice indubitably seems to be the antithesis of technology. The ostensible polarity of technology and person-centred practice is an easy road to travel down and in their various forms has been probably travelled for decades if not centuries. By forging ahead or enduring these dualisms, we continue to approach and recede, but never encounter the elusive and the liminal space between technology and person-centred practice. Inspired by Haraway's work, we argue that healthcare practitioners who critically consider their cyborg ontology may begin the process to initiate and complicate the liminal and sought after space between technology and person-centred practice. In this paper, we draw upon Haraway's idea that we are all materially and ontologically cyborgs. Cyborgs, the hybridity of machine and human, are part of our social reality and embedded in our everyday existence. By considering our cyborg ontology, we suggest that person-centred practice can be actualized in the contextualized, embodied and relational spaces of technology. It is not a question of espousing technology or person-centred practice. Such dualisms have been historically produced and reproduced over many decades and prevented us from recognizing our own cyborg ontology. Rather, it is salient that we take notice of our own cyborg ontology and how technological, habitual ways of being may prevent (and facilitate) us to recognize the embodied and contextualized experiences of patients. A disruption and engagement with the habitual can ensure we are not governed by technology in our logics and practices of care and can move us to a conscious and critical integration of person-centred practice in the technologized care environments. By acknowledging ourselves as cyborgs, we can recapture and preserve our humanness as caregivers, as well as thrive as we proceed in our technological way of being.

[The meaning of standardized language NANDA-NIC-NOC intensive care nurses in Madrid: a phenomenological approach]

Nursing standardized language is a tool that makes it possible to integrate a theoretical framework of problem identification, interventions and outcomes in care. Its use in the difference care settings is varied. In the case of intensive care units, it is necessary to study the implications that integration of this language would have in nursing area.

OBJECTIVE

To describe the meaning of standardized NANDA-NIC-NOC language for the nurses working in Intensive Care Units in Madrid.

METHOD

A phenomenological qualitative study was conducted.

INCLUSION CRITERIA

ICU in Madrid of nurses with one year or more experience at the time of the study who were working in the ICU.

SAMPLE

Purposive and Snowball sampling technique.

DATA COLLECTION

Unstructured interviews, personal documents (letters, diaries). Interviews were recorded and transcribed verbatim for later analysis.

ANALYSIS

Giorgi proposal. Identifying meaning units, groups of common senses and themes.

RESULTS

Three themes made up the meaning of standardized language in intensive care nursing. "Living integrating 2 sides of the same coin", "living a conceptual imposition", and "living a development opportunity and professional autonomy".

CONCLUSIONS

There is a gap in the theory of language and its clinical application. Nurses report feeling imposition of a specific conceptual language. This creates the construction of a hierarchy between nurses based on the use of NANDA-NIC-NOC. Even so, the standardized language is experienced as a professional development opportunity.

A critical discourse analysis of provision of end-of-life care in key UK critical care documents

This article highlights certain practical and professional difficulties in providing end-of-life (EOL) care for patients in critical care units and explores discourses arising from guidelines for critical care services.

BACKGROUND

A significant number of patients die in critical care after decisions to withdraw or withhold treatment. Guidelines for provision of critical care suggest, wherever possible, moving patients out of critical care at the EOL. This may not necessarily be conducive to a 'good death' for patients or their loved ones. There is a moral responsibility for both nurses and doctors to ensure that decision-making around EOL issues is sensitively implemented, that decisions about care includes families, patients when able, nurses and doctors, and that good EOL care is provided.

METHODS

A critical discourse analysis (CDA) of four key UK critical care documents published since 1996.

FINDINGS AND RECOMMENDATIONS

The key documents give little clear guidance about how to provide EOL care in critical care. Discourses include the power dynamic in critical care between professions, families and patients, and how this impacts on provision of EOL care. Difficulties encountered include dilemmas at discharge and paternalism in decision-making. The technological environment can act as a barrier to good EOL care, and critical care nurses are at risk of assuming the dominant medical model of care. Nurses, however, are in a prime position to ensure that decision-making is an inclusive process, patient needs are paramount, the practical aspects of withdrawal lead to a smooth transition in goals of care and that comfort measures are implemented.

Nursing in a technological environment: Nursing care in the operating room

Operating room nurses continue to draw criticism regarding the appropriateness of a nursing presence in the operating room. The technological focus of the theatre and the ways in which nurses in the theatre have shaped and reshaped their practice in response to technological change have caused people within and outside the nursing profession to question whether operating room nursing is a technological rather than nursing undertaking. This paper reports findings from an ethnographic study that was conducted in an Australian operating department. The study examined the contribution of nurses to the work of the operating room through intensive observation and ethnographic interviews. This paper uses selected findings from the study to explore the ways in which nurses in theatre interpret their role in terms of caring in a technological environment.

Technology and humane nursing care: (ir)reconcilable or invented difference?

AIM(S) OF THE PAPER: This paper questions the validity of a boundary presumed to exist between technology and humane care. It argues the need for reconciliation of presumed tension(s) between technology and person focused care and the need to reconsider our ways of understanding the relations between technology and nursing.

BACKGROUND/RATIONALE

Recent scholarship in the social sciences related to reproductive and imaging technologies and emergency resuscitation are examined and arguments are presented that question the appropriateness of a humanist view that emphasizes technology on the nonhuman and nonnatural side of a human/nonhuman, nature/artifice divide. It is argued that what determines experiences such as dehumanization is not technology per se but how individual technologies are used and operate in specific user contexts, the meanings that are attributed to them, how individuals or cultural groups define what is human, and the organizational, human, political and economic technological system (technique) that creates rationale and efficient order within nursing, health care and society.

CONCLUSION

The paper concludes by asking whether the commonplace appeal to resolve tensions between humane care and technology has erroneously highlighted technology as the reason for impersonal care, and encourages re-examination of the relationship(s) between technology, humane care and nursing practice.