Is the humanistic view of the nurse role still alive--in spite of an academic education?

Effect of Training on the Ability of Nurses to Provide Humanistic Care: Systematic Review and Meta-analysis

BACKGROUND

This article describes a systematic review evaluating the effectiveness of training on the humanistic care abilities of nurses.

METHOD

The literature search was conducted in electronic databases to identify studies that evaluated the effect of training on the humanistic care abilities of nurses. Study selection was based on precise eligibility criteria. After the systematic review, a meta-analysis of standardized mean differences (SMDs) between posttraining and pretraining humanistic care scale scores was performed to evaluate the effect of training.

RESULTS

A total of 11 studies were included (624 nurse participants; 97% women; weighted average age = 38.4 years; 95% confidence interval (CI) [31.5, 45.4]). Training schedules varied and ranged from a full-day workshop to brief weekly sessions for up to 2 months. The training framework involved compassion and empathy communication in most of the included studies. Training improved the humanistic care scale scores of the participants (SMD = 1.171; 95% CI [0.626, 1.716]; p < .0001), whereas no significant change was seen in the scores of control subjects (SMD = 0.588; 95% CI [-0.536, 1.713]; p = .305). The effect of training was observable for up to 1 year, although few studies carried out follow-up evaluations.

CONCLUSION

Training has the potential to improve the humanistic care abilities of nurses. [J Contin Educ Nurs. 2023;54(9):430-436.].

The meaning of a "good nurse" in pediatric care: a concept analysis

OBJECTIVE

to analyze the attributes, antecedents and consequences of the concept a "good nurse" in the context of Pediatrics.

METHOD

concept analysis study based on Rodgers' evolutionary method. Theoretical stage consisted of searching for articles in the CINAHL, Embase and Pubmed databases and a practical stage of semi-structured interviews with pediatric nurses. The final analysis unified the two stages by categories of antecedents, attributes and consequences of the concept.

RESULTS

20 articles and 10 interviews were analyzed revealing as antecedents aspects related to education, scientific development and ethical-moral skills and values. Responsibility, compassion, honesty and advocacy stand out as attributes of the "good nurse." The consequences describe implications for children and families, as well as for professionals.

FINAL CONSIDERATION

the analysis of the concept of the "good nurse" allowed us to clarify fundamental aspects for the execution of good practices, establishing parameters for investment in professional development programs.

Development and validation of Nurses' Moral Courage Scale

BACKGROUND

Moral courage is required at all levels of nursing. However, there is a need for development of instruments to measure nurses' moral courage.

OBJECTIVES

The objective of this study is to develop a scale to measure nurses' self-assessed moral courage, to evaluate the scale's psychometric properties, and to briefly describe the current level of nurses' self-assessed moral courage and associated socio-demographic factors.

RESEARCH DESIGN

In this methodological study, non-experimental, cross-sectional exploratory design was applied. The data were collected using Nurses' Moral Courage Scale and analysed statistically.

PARTICIPANTS AND RESEARCH CONTEXT

The data were collected from a convenience sample of 482 nurses from four different clinical fields in a major university hospital in Finland for the final testing of the scale. The pilot comprised a convenience sample of 129 nurses.

ETHICAL CONSIDERATIONS

The study followed good scientific inquiry guidelines. Ethical approval was obtained from the university ethics committee and permission to conduct the study from the participating hospital.

FINDINGS

Psychometric evaluation showed that the 4-sub-scale, 21-item Nurses' Moral Courage Scale demonstrates good reliability and validity at its current state of development showing a good level of internal consistency for a new scale, the internal consistency values ranging from 0.73 to 0.82 for sub-scales and 0.93 for the total scale, thus well exceeding the recommended Cronbach's alpha value of >0.7. Principal component analysis and confirmatory factor analysis supported the theoretical construct of Nurses' Moral Courage Scale. Face validity and expert panel assessments markedly contributed to the relevance of items in establishing content validity.

DISCUSSION AND CONCLUSION

Nurses' Moral Courage Scale provides a new generic instrument intended for measuring nurses' self-assessed moral courage. Recognizing the importance of moral courage as a part of nurses' moral competence and its assessment offers possibilities to develop interventions and educational programs for enhancement of moral courage. Research should focus on further validation measures of Nurses' Moral Courage Scale in international contexts.

Remaining in the nursing profession: The relevance of strong evaluations

BACKGROUND:

Why nurses remain in the profession is a complex question. However, strong values can be grounds for their remaining, meaning nurses evaluate the qualitative worth of different desires and distinguish between senses of what is a good life.

RESEARCH QUESTION:

The overall aim is to explore and argue the relevance of strong evaluations for remaining in the nursing profession.

RESEARCH DESIGN:

This theoretical article based on a hermeneutical approach introduces the concept strong evaluations as described by the Canadian philosopher Charles Taylor and provides examples of nurses' experiences in everyday nursing care drawn from a Norwegian empirical study.

PARTICIPANTS AND RESEARCH CONTEXT:

Data collected in the original study consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses. The research context was the primary and secondary somatic and psychiatric health service, inside as well as outside institutions.

ETHICAL CONSIDERATION:

The article uses data from an original empirical study approved by the Norwegian Social Science Data Services. Information was given and consent obtained from the participants.

FINDINGS:

Remaining in the nursing profession can be understood as revolving around being a strong evaluator. This has been concretized in issues of being aware of different incidents in life and having capacities as a nurse.

DISCUSSION:

Why nurses remain is discussed in relation to how nurses have shaped themselves by reflecting on what is of significance in their life. However, being a strong evaluator cannot be seen as the casual condition for remaining.

CONCLUSION:

Remaining in the nursing profession is obviously not a contingent matter, rather it is a matter concerned with the qualitative worth of different desires and values. Nurses' awareness of a life choice impacts on whether they remain or not. Consequently, nurses may need to articulate and reflect on their priorities for remaining.

Nurses' narratives of moral identity: Making a difference and reciprocal holding

BACKGROUND

Explicating nurses' moral identities is important given the powerful influence moral identity has on the capacity to exercise moral agency.

RESEARCH OBJECTIVES

The purpose of this study was to explore how nurses narrate their moral identity through their understanding of their work. An additional purpose was to understand how these moral identities are held in the social space that nurses occupy.

RESEARCH DESIGN

The Registered Nurse Journal, a bimonthly publication of the Registered Nurses' Association of Ontario, Canada, features a regular column entitled, 'In the End … What Nursing Means to Me …' These short narratives generally include a story of an important moment in the careers of the authors that defined their identities as nurses. All 29 narratives published before June 2015 were analysed using a critical narrative approach, informed by the work of Margaret Urban Walker and Hilde Lindemann, to identify a typology of moral identity. Ethical considerations: Ethics approval was not required because the narratives are publicly available.

FINDINGS

Two narrative types were identified that represent the moral identities of nurses as expressed through their work: (1) making a difference in the lives of individuals and communities and (2) holding the identities of vulnerable individuals.

DISCUSSION

Nurses' moral identities became evident when they could see improvement in the health of patients or communities or when they could maintain the identity of their patients despite the disruptive forces of illness and hospitalization. In reciprocal fashion, the responses of their patients, including expressions of gratitude, served to hold the moral identities of these nurses.

CONCLUSION

Ultimately, the sustainability of nurses' moral identities may be dependent on the recognition of their own needs for professional satisfaction and care in ways that go beyond the kind of acknowledgement that patients can offer.

Moral courage in nursing: A concept analysis

BACKGROUND

Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one's moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing contexts remains ambiguous.

OBJECTIVE

This article is an analysis of the concept of moral courage in nursing.

DESIGN

Rodgers' evolutionary method of concept analysis provided the framework to conduct the analysis.

DATA SOURCES

The literature search was carried out in September 2015 in six databases: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and The Philosopher's Index. The following key words were used: "moral" OR "ethical" AND "courage" OR "strength" AND "nurs*" with no time limit. After applying inclusion and exclusion criteria, 31 studies were included in the final analysis. Ethical considerations: This study was conducted according to good scientific guidelines.

RESULTS

Seven core attributes of moral courage were identified: true presence, moral integrity, responsibility, honesty, advocacy, commitment and perseverance, and personal risk. Antecedents were ethical sensitivity, conscience, and experience. Consequences included personal and professional development and empowerment.

DISCUSSION AND CONCLUSION

This preliminary clarification warrants further exploring through theoretical and philosophical literature, expert opinions, and empirical research to gain validity and reliability for its application in nursing practice.

Nurses' perceptions and experiences of work role transitions: a mixed methods systematic review of the literature

AIM

To understand nurses' perceptions and experiences of work role transitions.

BACKGROUND

Globally an uncertain healthcare landscape exists and when changing work roles nurses experience periods of transition when they may not cope well. A greater understanding of work role transitions may help facilitate workforce retention and successful careers.

DESIGN

Mixed methods systematic review.

DATA SOURCES

Six data bases were searched for peer reviewed primary empirical research, published in English language between January 1990 and December 2014, supplemented by hand and citation searching.

REVIEW METHODS

Evidence for Policy and Practice Information and Co-ordinating Centre methods for systematic reviews principles were followed. Analysis and synthesis of the qualitative and quantitative papers was conducted separately using thematic analysis. A third synthesis combined the narrative findings and a narrative synthesis of results is presented.

RESULTS

Twenty-six papers were included. Across nurses' work role transitions two pathways were found: Novice and Experienced. 'Novice' comprises pre-registration and newly qualified nurses. 'Experienced' comprises, Enrolled/Licensed Practical Nurse to Registered Nurse, experienced to specialist nurse and clinical role changes. Each pathway results in different emphasizes of two themes; 'Striving for a new professional self' includes emotional upheaval and identity while 'Know how' includes competence and boundaries. Novice nurses are more susceptible to the extremes of emotional upheaval while experienced nurses' competence eases aspects of transitions while boundary issues pervade.

CONCLUSION

Informed work and educational environments are required for all groups of nurses. Using existing models of transition can facilitate successful individual transitions and develop the workplace.

A qualitative exploration of perceived key knowledge and skills in end-of-life care in dementia patients among medical, nursing, and pharmacy students

BACKGROUND

The steady increase in the number of people living and dying with dementia, coupled with the recent focus on quality of care, has highlighted the importance of dementia training for health care professionals. This exploratory study aimed to discover which skills health care students felt were important in providing quality end-of-life care to dementia patients.

METHODS

Ninety-four medicine, nursing, and pharmacy students participated in a larger study using open-ended and closed questions to explore attitudes related to caring for dementia patients at the end of life. This study looks at the student responses to an open-ended question regarding the skills and knowledge they believe are needed to provide end-of-life care to dementia patients. Individual responses were reviewed by the researchers, coded into key issues, and tabulated for frequency of occurrences and group differences.

RESULTS

Several common issues emerged: knowledge, patience, empathy, understanding, family involvement, compassion, medication knowledge, respect/patient autonomy, communication, quality of life, and patient education. Significant differences were observed among the participant groups on the following issues: Patience and understanding (pharmacy students mentioned these issues less frequently than medical and nursing students), compassion (medical students mentioned this issue more frequently than pharmacy students), and medication knowledge (pharmacy students mentioned this issue more frequently than medical and nursing students).

CONCLUSIONS

Different health care disciplines (in-training) value different skill sets for the provision of dementia care at the end-of-life. As health care education for dementia patients at the end of life is expanded, it will be important to understand which skills both patients and health care students value.

Nurse to educator? Academic roles and the formation of personal academic identities

This aim of this research was to investigate the academic role of the nurse educator and its contribution to the formation of personal academic identity. Data was gathered using in-depth interviews (n=14) with experienced nurse educators employed within pre-1992 and post-1992 universities. Prolonged analysis, reflection and theorisation of the findings indicated that participants experienced multiple challenges when seeking to assimilate personal academic identity, adopting, and adapting a variety of identities over time. A conceptual model of identity transformation encompassing five stages: pre-entry, reaffirming, surmounting, stabilising and actualising, provides a useful analytical framework to inform and shape the professional development of nurse educators.

Health literacy among consumers in community pharmacy: perceptions of pharmacy staff

BACKGROUND

Low health literacy has important consequences for health status, medication adherence and use of health services. There is little insight from the perspective of pharmacy staff into how they identify the information needs of consumers and particularly the signals and risk factors of limited health literacy that they encounter in their day-to-day communication with consumers.

OBJECTIVE

To investigate factors impacting on consumer health literacy, from the perspective of pharmacy staff.

METHODS

The research comprised semi-structured interviews conducted in a convenience sample of pharmacies in the south-east region of Queensland, Australia. Eleven pharmacists and nine pharmacy assistants agreed to participate. Interviews were audio-recorded and transcribed verbatim. Initial coding of the anonymized transcripts was performed using NVivo(®). Codes were analysed into overarching themes and subthemes, which were then re-named and refined through consensus discussion.

RESULTS

Three overarching themes were identified from the coding process: complexity of the health system, clarity of information, and dialogue among consumers and health-care professionals. Two of the themes were system related, namely the health system and pharmacy labels; the health literacy issues included lack of clarity, complexity and misunderstanding. The third theme was related to communication.

CONCLUSIONS

Complexity of the health system, clarity of information and dialogue among consumers and health-care professionals were identified as factors associated with consumers' health literacy. We call for increased engagement between pharmacy staff and consumers with improved focus on areas of potential confusion, such as medicine labels and navigation of the health system, aiming to minimize negative consequences of limited health literacy and optimize patient health outcomes.

"This is nursing": nursing roles as mediated by precepting nurses during clinical practice

In nursing education, it has been argued that professional socialization is facilitated by clinical experiences where students work together with precepting nurses. However, few studies found have focused on how nurses think and act as preceptors, hence providing a base for professional socialization to occur. Therefore; this study aimed to describe how preceptors mediated nursing as a profession to undergraduate nursing students during clinical practice. This was an ethnographic study guided by symbolic interactionism. A purposeful sampling of 13 precepting nurses was observed during the field work period. In addition, 16 staff nurses, purposively selected, and experienced in precepting, participated in focus group interviews. All text from field notes and interviews were read as a whole and analyzed following the ethnographic approach. Findings illustrated how nursing was mediated as the medical-technical, the administrative, and the caring role. Preceptors aimed for professionalism in their students by teaching the students to reflect on what they can do independently as nurses. Preceptors strived to verbalise their practical knowledge to make theory explicit and contextualize to student nurses. This knowledge can guide implementation of preceptor programmes focusing on the meaning and implications of professionalism.

Factors of importance to the development of pressure ulcers in the care trajectory: perceptions of hospital and community care nurses

AIM

The study aimed at describing contributing factors for the progression or regression of pressure ulcers in the care trajectory as they were understood by nurses working in hospitals or community care.

BACKGROUND

The development of pressure ulcers is considered to be connected with early prevention and awareness among nurses and some studies have indicated that the care trajectory may be a weak point.

DESIGN

The study was carried out with a qualitative design.

METHOD

Fifteen nurses from two Swedish hospitals and 15 nurses from community care were interviewed during 2005. Qualitative content analysis was used to make an understanding of patterns possible.

FINDINGS

Three main categories arose, showing that pressure ulcers were considered to be affected in the care trajectory by factors related to the individual patient, to the healthcare personnel and to the healthcare structure. Hospital and community care nurses mostly had corresponding perceptions of these factors.

CONCLUSION

The study both confirmed previous findings and added new knowledge about factors that may affect pressure ulcer in the trajectory of care. The informants' views of nurses' responsibilities and their attitudes towards the care of pressure ulcers could, along with their views on the organisation of care, increase the understanding of the occurrence of pressure ulcers. The need for development and clarification of the organisation and responsibility of pressure ulcer care in the care trajectory was stressed. Relevance to clinical practice. The study highlighted attitudes and values among registered nurses, as well as to how to preserve their commitment and increase their knowledge concerning prevention of pressure ulcers.

The meaning of autonomy in nursing practice

AIM

To illuminate the meaning of nurses' experiences of autonomy in work situations.

BACKGROUND

Professional autonomy means having the authority to make decisions and the freedom to act in accordance with one's professional knowledge base. An understanding of autonomy is needed to clarify and develop the nursing profession in rapidly changing health care environments and internationally there is a concern about how the core elements of nursing are taken care of when focusing on expansion and extension of specialist nursing roles.

DESIGN

Qualitative study.

METHODS

This paper reports part of a project aimed at exploring the education and work qualifications required by the nursing profession. Eleven Norwegian nurses, each with 2-3 years of work experience since graduation, participated in both in-depth interviews and focus group interviews in 2006. A qualitative hermeneutic approach, inspired by Gadamer's philosophy, guided the research process and the analysis and interpretation of the transcribed interview-texts.

RESULTS

The nurses' descriptions of their experiences of autonomy in work situations emerged as four themes: 'to have a holistic view', 'to know the patient', 'to know that you know' and 'to dare'. To be knowledgeable and confident was found to be the coherent meaning of autonomy in nursing practice.

CONCLUSIONS

Authority of total patient care, the power to make decisions in a relationship with the patient and next of kin and the freedom to make clinical judgements, choices and actions seem to be connected to the meaning of autonomy in nursing practice.

RELEVANCE TO CLINICAL PRACTICE

To gain autonomous practice, nurses must be competent and have the courage to take charge in situations where they are responsible. This study shows the challenges in handling this autonomous practice.

Specialist nurses for older people: implications from UK development sites

AIM

This paper is a report of a study to explore the development of specialist staffing for older people in six case study sites in the United Kingdom.

BACKGROUND

In the United Kingdom there has been some concern about the health care available to older people, leading to the development of a National Service Framework. A key theme of this framework is the development of specialist staff skilled in providing services tailored to the needs of older people.

METHOD

A soft systems methodology was used in 2004-2005 to carry out interviews with key people, including specialist nurses for older people, other service providers, patients and informal carers (n = 132) in six case study sites identified from a national questionnaire. Interviewees were asked to describe their perceptions of the development, its history and its impact.

FINDINGS

The development of specialist nursing services seemed to be shaped by national policy drivers for service development, which may not have been directly linked to the needs of older people. The ideal qualities of a specialist nurse for older people were described by participants as including not only knowledge and skills, but also personal characteristics.

CONCLUSION

While progress has been made in establishing specialist posts, much remains to be explored about the roles of postholders, the qualities needed, and the support and preparation required. While advanced practice is a professional aspiration, a number of questions arise about the development of nursing as a self-directing profession in diverse international settings. Theories of specialist nursing practice also need to address the tensions between universal and local models and to consider theories about nursing older people.