Burdensome situations in everyday nursing: an explorative qualitative action research on a medical ward

Support workers' experiences of work stress in long-term care settings: a qualitative study

Background: Support-workers’ performance and well-being are challenged by increasingly high workloads and poor working conditions, leading to high levels of occupational stress.

Aims: To explore the experiences of work stress for support-workers in New Zealand residential facilities.

Design: An Interpretive Descriptive study.

Methods: Data from ten (n = 10) support-workers were collected between December 2013 and June 2014, using semi-structured in-depth face-to-face interviews. Thematic analysis was used to identify key themes that captured participant reports of their experiences.

Results: Work stress was conceptualized by participants as being an everyday experience of having too much to deal with and feeling under constant pressure. It appeared to be a complex and fluid experience representing an inherent, dynamic tension between reasons to be a caregiver and the burden of caregiving. Participants highlighted a range of influencing factors (including lack of recognition, person and work context, and coping strategies), which may account for that fluidity.

Conclusion: The findings extend current knowledge about support-workers’ work stress by identifying the challenges relating to the lack of recognition of their role and expertize, the unintended consequences of person-centered care and the challenges faced by migrant support-workers.

Oral Health Care Guidelines, Training, and Resources among Stroke Care Providers

During a stroke, the mouth tends to become an unhealthy place and may give rise to various life-threatening conditions. To this end, there have been repeated calls to incorporate oral hygiene guidelines and practices for hospitalized stroke patients to prevent aspiration pneumonia and improve patients' oral health. The objective of the study was to determine health care providers' practices of oral health care among patients hospitalized after an occurrence of stroke and to determine health care providers' background and work environment effect on these practices. A cross-sectional study was conducted among stroke care providers in 13 public hospitals in Malaysia. The questionnaires distributed were self-administered, where nursing staff provided details of their oral health care practices for stroke patients. Information on the background of health care providers and work environment was also collected. Overall, a total of 780 responses from the registered nurses were obtained. Almost half of the respondents (48.1%) reported that they recommended toothbrushing twice or more per day to stroke patients. Two-thirds (64.7%) reported that they performed daily mouthwashing on their patient, while less than half (38.8%) reported daily oral hygiene assistance. Result of the analysis revealed that oral hygiene practices were significantly associated with having working wards ( P < 0.05), level of qualification ( P < 0.05), having oral health care guidelines ( P < 0.001), specific resources ( P < 0.05), and attending previous training in oral care ( P < 0.001). Provision of oral hygiene practices for hospitalized stroke patients is important. A lack of oral health care guidelines, support from dental professionals, specific resources, training, and assistance in daily oral care for patients is evident and detrimental to oral hygiene practices. The current findings have significant implications for new initiatives to support health care providers, particularly the registered nurses performing oral health care for hospitalized stroke patients. Knowledge Transfer Statement: This study may provide a basis of information for improving the delivery of oral health care to stroke patients. Enhancement in the training and improvement in the existing guidelines and resources is pivotal for the provision of better oral health care for the potential benefits to these patients, including their improved quality of life and disease prevention.

Implementing action research in hospital settings: a systematic review

Purpose

– Health care organizations and hospitals in particular are highly resistant to change. The reasons for this are rooted in professional role behaviors, hierarchical structures and the influence of hidden curricula that inform organizational culture. Action research (AR) has been identified as a promising bottom-up approach that has the potential to address the significant barriers to change. However, to date no systematic review of the field in health care exists. The paper aims to discuss these issues.

Design/methodology/approach

– A systematic review of the literature was conducted. Studies were reviewed with regard to the four stages of AR; problem identification, planning, implementation and evaluation.

Findings

– Only 19 studies were identified that fit the inclusion criteria. Results revealed significant heterogeneity with regard to theoretical background, methodology employed and evaluation methods used.

Research limitations/implications

– Only studies published and written in the English language were included.

Practical implications

– The field of AR interventions would benefit from a theoretical framework that has the ability to guide the methodology and evaluation processes.

Originality/value

– This is the first systematic review of AR in hospitals.

Structurational divergence theory as explanation for troublesome outcomes in nursing communication

Structurational divergence (SD) theory captures negative communication cycles resulting from interpenetration of incompatible meaning structures. It is estimated that 12-15% of practicing nurses suffer from a problematic level of SD. With a sample of 713 nurses (57 departments) in a large hospital, this study tests a model positing SD as a root explanation of nursing job satisfaction and turnover. A number of variables long presumed to be explanations for job satisfaction and turnover were hypothesized as mediators between SD and those outcomes. Path analysis showed support for burnout, role conflict, bullying, and organizational identification as useful mediators, explaining 68% of the variance in job satisfaction, and 45% in intentions to leave. The study also explores relationships between SD and hospital quality indicators. SD is a concern because it powerfully explains a number of poor outcomes and provides an underlying explanation for a number of factors that predict job satisfaction and turnover.

Working through grief and loss: oncology nurses' perspectives on professional bereavement

PURPOSE/OBJECTIVES

To determine facilitators and barriers to managing patient loss from the combined perspectives of oncology nurses and to extract essential components of a supportive intervention.

RESEARCH APPROACH

Qualitative, descriptive.

SETTING

The comprehensive National Cancer Institute-designated cancer center of a mid-Atlantic university teaching hospital.

PARTICIPANTS

34 nurses from inpatient and outpatient adult and pediatric oncology units.

METHODOLOGIC APPROACH

Focus groups were held with oncology staff nurses to identify challenges regarding work-related bereavement, current support for managing grief and loss, and how to support interpersonal functioning and resiliency.

MAIN RESEARCH VARIABLES

Work-related bereavement, bereavement support, and interventions and management strategies for bereavement and loss.

FINDINGS

Two primary themes emerged: dimensions of work-related loss and working through bereavement. Participants also provided many concrete suggestions for the creation of a supportive self-care environment.

CONCLUSIONS

Support issues were numerous, multilevel, and varied. However, addressing those concerns can improve job satisfaction and decrease compassion fatigue. The findings lay the foundation for appropriate interventions to assist nurses in managing those situations.

INTERPRETATION

Administrators, managers, and individuals interested in furthering the multifaceted goals of oncology care, including nurses themselves, are challenged to create and maintain mutually supportive environments for providing optimal care to patients and families.

Nurses at the nexus: a case study in structurational divergence

Hospital-based nurses are institutionally positioned at a nexus where numerous social structures interpenetrate, compelling the individual to simultaneously fulfill obligations from multiple rules systems. When these rules systems are incompatible, the individual's position is untenable. This article describes the phenomenon of structurational divergence (SD) identified in our previous research, wherein the intersection of incompatible rules systems manifests as unresolved conflict that sets off a negative spiral of communication. To explore and illustrate SD in the nursing role, we present herein a case study of a geriatric care unit where the phenomenon is clearly visible. Using qualitative interviews and observation, we first look simply to identify the negative spiral that is the hallmark of SD. Once the instances of the negative spiral are identified, we explore the issues surrounding them to discover the underlying structurational incompatibilities, using sets of incompatible rules identified in previous research as a guide. Finally, we address the extent to which the SD in this case is particular to this situation or might be linked to nurses' unique institutional positioning, and we discuss our future research agenda.