Nurses' everyday activities in hospital care

From Preventing physical infection to managing affective contagion: An initial study of daily nursing practices in the early outbreak of the COVID-19 pandemic in Wuhan

This paper examines the daily practices of caring for COVID-19 patients in Wuhan, China, in early 2020 and the challenges that nurses faced. The paper shows that the affective contagion, especially among patients, introduced unexpected challenges for nurses in caring for COVID-19-infected patients. Nurses had to contend with the challenges of treating both physical and psychological problems in patients simultaneously. As a result, it was necessary for nurses to adapt to the different rhythm of COVID-19 wards to address these challenges and do so through taking on a range of general and specific nursing tasks and playing a diverse range of roles on the wards, from garbage collector to "psychological counselor." Thus, the paper brings attention to the experiences and demands of providing nursing care in an emergency pandemic context, in particular the necessity of responding to both the physical and the psychological needs of patients. These insights could better prepare health services in China and elsewhere in the world for responding effectively to potential future pandemics.

The time, places, and activities of nurses in a psychiatric inpatient context - A time and motion study with a time-geographic perspective

Nurses in psychiatric inpatient care spend less time than desired with patients and investigation of the nature of nursing in this setting is needed. This study explores how nursing activities in psychiatric inpatient wards is distributed over time, and with a time-geographic perspective show how this relates to places. Observations were used to register place, activity, and time. A constructed time-geographic chart mapped the nurses' path which showed that nurses spent little time in places where patients are. There might be constraints that affect nursing. Nurses need to evaluate where time is spent and interventions that facilitate relationships are needed.

Assessing Preferences and Perceived Restorative Qualities of Break Spaces for Nurses in China

OBJECTIVE

This study investigated Chinese nurses' preferences for (a) proximity of break areas, (b) functionality of break areas, (c) amenities, and (d) nature-related environmental features.

BACKGROUND

While nurses in China need support to adequately perform their jobs, little is known about how restorative spaces impact their mental and physical health.

METHODS

Data were collected through interviews (N = 12), survey questionnaires (N = 88), and visual assessments (N = 88) from nurses who worked in inpatient settings in China.

RESULTS

Nurses preferred the break room to be close to nursing stations; to have visual privacy from patients; and to provide space and facilities for drinking, taking naps, dining, and chatting with colleagues. Balconies and windows were shown to have a significant restorative effect. Well-designed break areas were perceived to have positive impacts on nurse perceived levels of well-being and increase nurses' satisfaction levels with their work environment.

CONCLUSION

The study outcomes emphasize the importance of restorative spaces for inpatient nurses and recommend including natural elements in the break rooms.

How do nurses spend their time? A time and motion analysis of nursing activities in an internal medicine unit

Aim

To describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward.

Design

A single‐centre observational descriptive study.

Method

Using a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre‐registered list of 42 activities classified into 13 dimensions.

Results

A total of 507.5 work hours were observed. Less than one third of registered nurses’ work time was spent with patients. They allocated the most time to the dimensions of ‘communication and care coordination’ and ‘care planning’, whereas ‘optimizing the quality and safety of care’, ‘integrating and supervising staff’ and ‘client education’ were allocated the least time.

Conclusion

This study provided a reliable description of nurses’ time use at work. It highlighted suboptimal use of the full scope of nursing practice.

Impact

Both work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses’ skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses’ knowledge.

Approaches to workload in psychiatric and mental health nursing

OBJECTIVE

to investigate approaches to workload in psychiatric and mental health nursing in Brazilian and international production of knowledge Methods: integrative literature review using six databases, covering January 2005 to March 2019. Articles in full in English, Spanish and Portuguese were included.

RESULTS

the sample consisted of 23 original articles classified as quantitative or emotional. The quantitative dimension was addressed in 12 articles and included: assessing patient care needs, identifying activities performed by the team, measuring time spent and developing and validating a measurement instrument. The emotional dimension included 11 articles the focus of which was on identifying stressors in the workplace, psychosocial risks and coping strategies.

CONCLUSION

strategies were found for measuring workload and assessing the impact of stressors on nursing teams.

Scope of nursing practice on a surgery ward: A time-motion study

AIM

To log the activities of registered nurses and nursing assistants on a visceral surgery ward.

BACKGROUND

By prioritizing their activities, nurses fail to exercise their full scope of practice even though this is essential for health care systems to function effectively and efficiently.

METHOD

A descriptive observational time-motion study was conducted over a period of 48 days. The activities of nurses (n = 24) and nursing assistants (n = 9) were logged over the course of their entire work shifts, both in the day and at night.

RESULTS

In all, 499 hr of observation were logged. Tasks that fell under the dimensions of care activities and of communication and care coordination, which cover documentation, non-care activities and delegated medical tasks, were the ones that took up most of the nurse work time. Patient assessment, relational care, therapeutic teaching/coaching, and knowledge updating and utilization were categories that nurses were under-engaged in.

CONCLUSION

The study shows that the scope of nursing practice was not optimal.

IMPLICATION FOR NURSING MANAGEMENT

The results can serve to improve the work environment of carers, optimize the use of human resources and increase the visibility and efficiency of nursing work.

Linking the Saudi Arabian 2030 vision with nursing transformation in Saudi Arabia: Roadmap for nursing policies and strategies

The Saudi government is currently facing multiple challenges in achieving "The Gold Standard" in nursing practice. This is not limited to educational challenges, staffing shortage, paucity of international and national benchmark evidence, absence of clear and defined scope of nursing practice, and lack of appropriate policies and regulations. This study presented a comprehensive plan for developing a policy based on current challenges, recognition of policy goals, assessment of potential options and alternatives, identification of stakeholders, proposition of recommended solutions, and implementation of the framework to transform nursing standards and link these changes with the Saudi Vision 2030. However, amendments are required in the present strategic plan for the better management of the nursing profession. It is doubtful that the current nursing profession status quo is capable of meeting the golden standards for health care. Thus, the transformation of the nursing profession in Saudi Arabia is necessary.

Depicting clinical nurses' priority perspectives leading to unfinished nursing care: A pilot Q methodology study

AIMS

To highlight (a) trends common to all nurses on priorities attributed to interventions, and (b) whether there are profiles of nurses working in the same context who prioritize interventions in a similar way.

BACKGROUND

The underlying prioritization of interventions leading to unfinished nursing care has been minimally investigated.

METHODS

A 2017 pilot Q methodology study. Full-time nurses, with at least 6 months of experience in a surgical unit, were involved. Eleven nurses rated the priority given in daily practice (from -3 as the lowest to +3 as the highest) to 35 Q-sample statements representing nursing care, non-nursing and organisational interventions.

RESULTS

Overall, the intervention receiving the lowest priority was 'Providing patient hygiene', while the highest was 'Answering phone calls'. In the by-person factor analysis (total variance = 60.79%), three profiles of nurses emerged, (a) 'Patient safety-oriented' (variance = 31.66%); (b) 'Nursing task-oriented' (=16.32%); and (c) 'Team process-oriented' (=12.81%).

CONCLUSIONS

Three profiles of nurses emerged in the same setting with significant differences both in the statistical order of priorities and in their practical implications.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding levels of prioritization, which are not only affected by the unit but also by sub-groups of nurses who rank priorities in a similar way, can support nurse managers in their role.

"How do we use the time?" - an observational study measuring the task time distribution of nurses in psychiatric care

Background

The nurse’s primary task in psychiatric care should be to plan for the patient’s care in cooperation with the patient and spend the time needed to build a relationship. Psychiatric care nurses however claim that they lack the necessary time to communicate with patients. To investigate the validity of such claims, this time-motion study aimed at identifying how nurses working at inpatient psychiatric wards distribute their time between a variety of tasks during a working day.

Methods

During the period of December 2015 and February 2016, a total of 129 h and 23 min of structured observations of 12 nurses were carried out at six inpatient wards at one psychiatric clinic in southern Sweden. Time, frequency of tasks and number of interruptions were recorded and analysed using descriptive statistics.

Results

Administering drugs or medications accounted for the largest part of the measured time (17.5%) followed by indirect care (16%). Relatively little time was spent on direct care, the third largest category in the study (15.3%), while an unexpectedly high proportion of time (11.3%) was spent on ward related tasks. Nurses were also interrupted in 75% of all medication administering tasks.

Conclusions

Nurses working in inpatient psychiatric care spend little time in direct contact with the patients and medication administration is interrupted very often. As a result, it is difficult to establish therapeutic relationships with patients. This is an area of concern for both patient safety and nurses’ job satisfaction.

Advancing the status of nursing: reconstructing professional nursing identity through patient safety work

Background

Recent decades have seen increased attention to patient safety in health care. This is often in the form of programmes aiming to change professional behaviours. Health professionals in hospitals have traditionally resented such initiatives because patient safety programmes often take a managerialist form that may be interpreted as a challenge to professional identity. Research, however, has mostly paid attention to the role of physicians. This study aims to highlight how such programmes may affect professional nursing identity.

Methods

We qualitatively investigated the implementation of a patient safety programme in Norway, paying attention to changes in nurses’ practices and values. Based on purposive sampling, two group interviews, four individual interviews and five hours of observational studies were conducted in a hospital department, involving ten nurses and three informants from the hospital management. Interviews were conducted in offices at the hospital, and observations were performed in situ. All the interviews lasted from one to one and a half hours, and were recorded and transcribed ad verbatim. Data was analysed according to ad-hoc meaning generation.

Results

The following analytical categories were developed: reconstructing trust, reconstructing work, reconstructing values and reconstructing professional status. The patient safety programme involved a shift in patient safety-related decisions, from being based on professional judgement to being more system based. Some of the patient safety work that previously had been invisible and tacit became more visible. The patient safety programme involved activities that were more in accordance with the ‘cure’ discourse than traditional ‘care’ work within nursing. As a result, this implied a heightened perceived professional status among the nurses. The safety programme was – contrary to the ‘normal’ resistance against audit systems – well received because of the raised perceived professional status among the nurses.

Conclusions

Reconstructing trust, work, values and status, and even the profession itself, is being reconstructed through the work involved in implementing the procedures from the safety programme. Professional knowledge and identity are being challenged and changed, and what counts as good, professional nursing of high quality is being reconstructed.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4222-y) contains supplementary material, which is available to authorized users.

Voices used by nurses when communicating with patients and relatives in a department of medicine for older people-An ethnographic study

AIMS AND OBJECTIVES

To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden.

BACKGROUND

Communication is an essential tool for nurses when working with older patients and their relatives, but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome.

DESIGN

An ethnographic design informed by the sociocultural perspective was applied.

METHODS

Forty participatory observations were conducted and analysed during the period October 2015-September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken, and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semistructured follow-up interviews were conducted with five nurses.

RESULTS

In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualised, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices, this indicates a shift in the orientation or situation.

CONCLUSION

The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved.

RELEVANCE TO CLINICAL PRACTICE

Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes.

Nurse middle managers contributions to patient-centred care: A 'managerial work' analysis

Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between "organizing work" and "caring work" is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both "hands-on" and "heads-on" caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate "doings" of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work.

Nurses' Time Use in Forensic Psychiatry: Core Interventions Outlined in the Finnish Clinical Practice Guideline on Schizophrenia

Forensic psychiatric nurses are key in implementing the core interventions outlined in the clinical practice guideline on schizophrenia. This study endeavors to ascertain how these were implemented in routine practice in forensic psychiatry by measuring how nurses use their time. Data were collected from registered nurses and practical mental nurses in all forensic psychiatric facilities in Finland using self-report diary forms for 1 week. In total, nurses used 20% of their weekly working hours on core interventions. The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the following core interventions: (a) care planning with physicians, (b) pharmacotherapy, and (c) basic clinical care. Nurses' qualifications, types of facilities and units, working experience, gender, and staffing levels explained the time used on core interventions. In summary, forensic psychiatric inpatients received insufficient appropriate nursing services according to the relevant guideline regarding schizophrenia. Furthermore, managerial recommendations need to restructure nurses' time use to increase the proportion of productive working hours spent with patients.

A grounded theory of humanistic nursing in acute care work environments

Background:

Humanistic nursing practice which is dominated by technological advancement, outcome measurement, reduced resources, and staff shortages is challenging in the present work environment.

Objective:

To examine the main concern in humanistic nursing area and how the way it is solved and resolved by Iranian nurses in acute care setting.

Research design:

Data were collected from interviews and observations in 2009–2011 and analyzed using classic grounded theory. Memos were written during the analysis, and they were sorted once theoretical saturation occurred.

Participants and research context:

In total, 22 nurses, 18 patients, and 12 families from two teaching hospitals in Tehran were selected by purposeful and theoretical sampling.

Ethical considerations:

The research was approved by the Ethics Committee of the university and hospitals.

Results:

The main concern for the nurses is the violation of their rights. They overcome this concern when there is a synergy of situation–education/learning, that is, a positive interaction between education and learning of values and sensitivity of the situation or existence of care promotion elements. They turn to professional values and seeking and meeting others’ needs, resulting in “success and accomplishment” of nurse/nursing manager and patient/family.

Conclusion:

This theory shows that professional values, elements of care promotion, and sensitivity of the situation have a key role in activation of humanistic approach in nursing. Violation of the nurses’ professional rights often leads to a decrease in care, but these factors make the nurses practice in an unsparing response approach. It is necessary to focus on development of professional values and provide essential elements of care promotion as changeable factors for realization of humanistic nursing although there is a context in which the nurses’ rights are violated.

The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

BACKGROUND

Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals.

OBJECTIVE

This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals.

METHODS

During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis.

RESULTS

The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers' recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration.

CONCLUSION

The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care.

Influences on and outcomes of enacted scope of nursing practice: a new model

Enacted scope of practice is a major issue for nursing administrators, given the potentially negative effect on accessibility, continuity, safety and quality of care, job satisfaction, and organizational costs of nurses working at reduced scope. Optimal deployment of nurses to a fuller enacted scope of nursing practice holds much promise for addressing all of these larger challenges. In this sense, new model of the Enacted Scope of Nursing Practice presented in this article provides a number of directions for interventions that could improve health system functioning.

Experiences and Views of the Discharge Planning Process Among Swedish District Nurses and Home Care Organizers

Discharge planning is an important care process, but deficits in planning are common. The aim of this study was to explore district nurses’ (DNs) and home care organizers’ (HCOs) experiences and views of the workflow during the discharge planning process (DPP). Demands, workload, time, collaboration, and engagement, together with knowledge and professional confidence, are factors that influence workflow and outcome of the DPP for DNs and HCOs. Strengths and obstacles at the organization, group, and individual levels affect the workflow during the discharge planning. Knowledge of these strengths and obstacles should help care providers in their practice as well as help management and politicians become more aware of prerequisites needed to achieve a safe and efficient workflow for securing the patient’s discharge.

Non-nursing tasks, nursing tasks left undone and job satisfaction among professional nurses in South African hospitals

AIM

To investigate the relationship between non-nursing tasks (NNTs), nursing tasks left undone (NTLU) and job satisfaction among professional nurses (PNs) in South Africa (SA).

BACKGROUND

This study adds to the international debate about the relationship between non-nursing tasks, nursing tasks left undone and job satisfaction by studying the variables at individual nurse and hospital unit level.

METHOD

A cross-sectional survey design of 1166 PNs in 60 medical and surgical units in 55 private hospitals and seven public hospitals.

RESULTS

Nationally, the three main non-nursing tasks performed were clerical duties (M = 1.81), arranging discharge referrals and transport (M = 1.38) and performing non-nursing care (M = 1.31), while the main nursing tasks left undone were comfort/talk with patients (62.2%), educating patients and family (57.9%) and develop/update nursing care plans/pathways (51.6%). Nursing tasks left undone were only related to three non-nursing tasks, and job satisfaction correlated most highly with nursing tasks left undone.

CONCLUSION

Professional nurses conduct many non-nursing tasks, and leave several important nursing tasks left undone. Nursing tasks left undone cause the greatest degree of job dissatisfaction amongst professional nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Role overlapping and work performed by professional nurses below their skill level should be identified and re-organised; support services should be employed and efficiently used.

Re-conceptualising holism in the contemporary nursing mandate: from individual to organisational relationships

Over the last forty years, nursing's claim to professional expertise has been expressed in terms of its care-giving function. Informed by a distinctive 'holistic' approach, models of nursing identify therapeutic relationships as the cornerstone of practice. While 'knowing the patient' has been central to clinicians' occupational identity, research reveals that nurses not only experience significant material constraints in realising these ideals, their contribution to healthcare extends far beyond direct work with patients. Amidst growing concern about healthcare quality, a body of critical commentary has emerged proposing that the contemporary nursing mandate, with its exclusive focus on care-giving, is no longer serving the interests of the profession or the public. Drawing on an ethnographic study of UK hospital nurses' 'organising work' and insights from practice-based approaches and actor network theory, this paper lays the foundations for a re-conceptualisation of holism within the nursing mandate centred on organisational rather than therapeutic relationships. Nurses can be understood as obligatory passage points in health systems and through myriad processes of 'translational mobilisation' sustain the networks through which care is organised.

Barriers to information exchange during older patients' transfer: nurses' experiences

AIMS AND OBJECTIVES

To describe nurses' experiences of barriers that influence their information exchange during the transfer of older patients between hospital and home care.

BACKGROUND

The successful transfer of an older patient across health organisations requires good communication and coordination between providers. Despite an increased focus on the need for cooperation among providers across healthcare organisations, researchers still report problems in the exchange of information between the hospitals and the healthcare systems in the municipalities.

DESIGN

A qualitative study using focus group methodology.

METHODS

Three focus group interviews using topic guides were conducted and interpreted. The study included registered nurses (n = 14) from hospital and home care. The data were analysed through content analysis.

RESULTS

Three main themes were identified: barriers associated with the nurse, barriers associated with interpersonal processes and barriers associated with the organisation. These themes included several subthemes.

CONCLUSIONS

The findings highlight the challenges that nurses encounter in ensuring a successful information exchange during older patients' transfer through the healthcare system. The barriers negatively influence the nurses' information exchange and may put the patients in a vulnerable and exposed situation. In order for nurses to conduct a successful exchange of information, it is critical that hospital and home care systems facilitate this through adequate resources, clear missions and responsibilities, and understandable policies.

RELEVANCE TO CLINICAL PRACTICE

Recognition of the barriers that affect nurses' exchange of information is important to ensure patient safety and successful transitions. The barriers described here should help both nurses in practice and their leaders to be more attentive to the prerequisites needed to achieve a satisfactory nursing information exchange and enhance informational continuity.

The competence of certified nurse assistants caring for persons with dementia diseases in residential facilities

In Sweden, a majority of elderly persons living in residential facilities have some form of dementia, and caring for them is a demanding and complex task. The formal education level of personnel in residential facilities is low. The aim of this paper is to describe certified nurse assistants' (CNAs) content of competence caring for persons with dementia diseases in residential facilities. Information from 22 diary notes was obtained and 12 CNAs in four residential facilities were interviewed. The diary notes and interviews were transcribed and analysed using conventional content analysis. Three main categories were generated from the diaries: Social and Health Care, Health Care Targeted towards Medicine and, finally, Organization. The same categories were generated from the interviews but with the addition of Knowledge - its use, growth and deficiencies. The results show that competence is mainly based on personal, experienced-based knowledge and 'standard routines'. In general, the nurse assistants' interest in developing knowledge is weak. Furthermore, CNAs lack competence in essential theoretical knowledge about dementia diseases. It is notable that CNAs, caring for people with serious dementia, know little about the reasons for the residents' divergent behaviour. Consequently, knowledge related to dementia and mental diseases must be highlighted. Therefore, formal education focused on these diseases is crucial.