Nursing culture of an operating theater in Italy

The role of organizational and professional cultures in medication safety: a scoping review of the literature

PURPOSE

This scoping review explores what is known about the role of organizational and professional cultures in medication safety. The aim is to increase our understanding of 'cultures' within medication safety and provide an evidence base to shape governance arrangements.

DATA SOURCES

Databases searched are ASSIA, CINAHL, EMBASE, HMIC, IPA, MEDLINE, PsycINFO and SCOPUS.

STUDY SELECTION

Inclusion criteria were original research and grey literature articles written in English and reporting the role of culture in medication safety on either organizational or professional levels, with a focus on nursing, medical and pharmacy professions. Articles were excluded if they did not conceptualize what was meant by 'culture' or its impact was not discussed.

DATA EXTRACTION

Data were extracted for the following characteristics: author(s), title, location, methods, medication safety focus, professional group and role of culture in medication safety.

RESULTS OF DATA SYNTHESIS

A total of 1272 citations were reviewed, of which, 42 full-text articles were included in the synthesis. Four key themes were identified which influenced medication safety: professional identity, fear of litigation and punishment, hierarchy and pressure to conform to established culture. At times, the term 'culture' was used in a non-specific and arbitrary way, for example, as a metaphor for improving medication safety, but with little focus on what this meant in practice.

CONCLUSIONS

Organizational and professional cultures influence aspects of medication safety. Understanding the role these cultures play can help shape both local governance arrangements and the development of interventions which take into account the impact of these aspects of culture.

The relationship between the survey-guided assessment of culture within specific nursing work groups and readiness for change

Change within health-care systems is constant as it relates to the external and internal demands that require continual adaptation by providers. This chapter provides a summary of the history and research contributions related to the study of culture and change through the lens of the nursing profession. The review focuses upon nursing research publications and the knowledge gained, ranging from the earliest to current studies. There has been a substantial increase in research interest regarding the relationship between nursing culture and ability to change; however, there is a considerable gap that remains in understanding subgroups such as individual nursing units or departments, consistent use of tools to measure culture, and interventions that have made a difference over time. From a practical perspective, this discussion provides insight into the importance of recognizing the importance of assessing culture and integrating cultural feedback into operational improvement plans.

Swedish and Chinese nurses' conceptions of ethical problems: a comparative study

AIM

To investigate Swedish and Chinese nurses' conceptions of ethical problems and workplace stress and ascertain whether there are differences between the nurses in the two countries and between types of clinics.

BACKGROUND

Nursing can be regarded as an ethical practice and ethical problems are one type of problems nurses have to deal with.

DESIGN

The research design was comparative and quantitative.

METHODS

A questionnaire was used. The study was carried out at one hospital in China and two hospitals in Sweden. One hundred and thirty-six Chinese nurses and 137 Swedish nurses participated.

RESULTS

There was a statistical difference between nurses working in the different countries regarding commonest stated ethical problem. The Swedish nurses indicated a greater number of ethical problems than the Chinese nurses. The latter felt irritated, dissatisfied or sad at work or after work more often than the Swedish nurses. Forty-one per cent of the nurses in both countries thought there was a modest or rather big difference between the current and the desired quality of nursing.

CONCLUSIONS

The findings were partially the same in the two countries and this underlines the importance of looking at ethical problems from an organisational perspective.

RELEVANCE TO CLINICAL PRACTICE

The findings also show the need for a reduction of nurses' workload as well as the importance of assuring that nurses have the knowledge they need to carry out their work. The communication between nurses and other members of the health-care team, patients and relatives also needs to be improved.

Ethical challenges in pain management post-surgery

This qualitative study describes ethical challenges faced by Iranian nurses in the process of pain management in surgical units. To address this issue, semistructured interviews were conducted with 26 nurses working in surgery units in three large university hospitals in Tehran. An analysis of the transcripts revealed three main categories: institutional limitations; nurses' proximity to and involvement with pain and suffering; and nurses' fallibility. Specific themes identified within the categories were: insufficient resources, medical hierarchy; difficulties with believing patients' complaints regarding pain and suffering; and experiencing the consequences of poor judgments. Our findings lead us to conclude that, as nurses are much closer to patients' pain and suffering than other health professionals, being aware of their ethical problems, and being able to reflect on them and discuss and learn from them, will reduce the burden of the ethical challenges faced. The findings will help nurses in other countries to devise suitable ways to reduce the ethical burdens they bear in their daily practice.

The value of nursing: a literature review

This article is part of a wider study entitled Value of Nursing, and contains the literature search from electronic databases. Key words for the search included 'values of nursing', 'values in nursing', 'organisational values' and 'professional identity'. Thirty-two primary reports published in English between 2000 and 2006 were identified. The findings highlight the importance of understanding values and their relevance in nursing and how values are constructed. The value of nursing is seen to be influenced by cultural change, globalization, and advancement in technology and medicine. These factors are crucial in providing a more structured and measured view of what nursing is, which will result in greater job satisfaction among nurses, better nurse retention and enhanced patient care within a supportive and harmonious organization. The findings of this review have implications for policy makers in recruitment and retention in determining the global value of nursing.

Operating Theater Culture

Health service delivery in the operating theater is vulnerable to shortages because of the unique environment, postregistration training requirements, and the occupational subculture that characterizes social relations. The aim of this mini-ethnography is to explore characteristics of organizational culture of the operating theater and how this culture is communicated and sustained. The field setting is an eight-theater department in a major hospital in Queensland, Australia. Informants include nurses, orderlies, trainee and consultant surgeons, and anesthetists. Three themes related to primacy of knowledge and competence, social order, and situational control are important cultural indicators in this highly specialized milieu. The level to which members are able to assimilate and meet role expectations depends on the amount of knowledge and experience they possess. A lack of acceptance has the potential to affect members' willingness to continue working in the operating theater, and consequently, may contribute to existing nursing shortages in this specialty.

The experiences of nurses who participate in awake craniotomy procedures

In awake craniotomy is a unique neurosurgical procedure in which the patient is conscious during part of the procedure. Little has been documented about how instrument nurses (ie, scrub persons) react to this complex procedure and to the tasks of caring for a conscious patient. A phenomenological investigation was conducted to document the experiences of nine instrument nurses. The nurses were challenged by having to manage the conscious presence of the patient, they placed great importance on controlling the surgical situation, and they reported that participating in this procedure had a compelling emotional effect on them.

Mapping the organizational culture research in nursing: a literature review

AIM

This paper reports a critical review of nursing organizational culture research studies with the objectives of: (1) reviewing theoretical and methodological characteristics of the studies and (2) drawing inferences specific to the state of knowledge in this field.

BACKGROUND

Organizational culture is regarded as significant in influencing research use in clinical practice yet it is not understood how culture shapes practitioners' behaviours. Only one review of this empirical literature in nursing has been completed.

METHOD

Using selected computerized databases, published nursing research studies in English that examine organizational culture were accessed. Organizational culture studies were categorized using Hatch's three perspectives on organizational culture: (1) modern, (2) symbolic-interpretive and (3) postmodern. The review was conducted in 2005.

RESULTS

Twenty-nine studies were in the final data set. Results pointed to variations in cultural definitions and incorporation of organizational sciences theory. In classifying the studies, modern perspectives dominated (n = 22), symbolic-interpretive approaches were an emerging group (n = 6) and one study was unclassifiable. Our results expand current cultural instrument reviews by pinpointing tools that have been previously overlooked and by identifying ongoing theoretical and methodological challenges for researchers.

CONCLUSION

An exclusive reliance on modernistic approaches in organizational culture research cannot yield a complete understanding of the phenomenon. Rather, the field could benefit from a variety of cultural approaches. In a similar vein, researchers need to be mindful of the terminology and the unit of analysis they use in their research, as these are the two largest research challenges.

Nursing is different than medicine: ethical difficulties in the process of care in surgical units

AIM

This paper describes a study of the kinds of ethical difficulties nurses face in the process of care in surgical units.

BACKGROUND

Nurses face ethically difficult situations in trying to find the most appropriate actions to take for patients. Differences of opinion with doctors about the treatment and care of patients and conflicts between nurses' value systems and those in the organization where they are employed are described as sources of ethical difficulty. Nurses experience moral distress when institutional constraints restrict them from carrying out appropriate moral actions.

METHODS

Ten female nurses working in surgical units at one university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and doctors about being in ethically difficult situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. The study was conducted during 2004.

FINDINGS

The main ethically difficult care situations described by the nurses concerned being open and honest, trusting patients' complaints, and creating limits to their involvement. Differences in opinion with doctors about the treatments, the absence of doctors in the unit and limited interest in holistic treatment and care resulted in nurses not receiving the medical orders they needed. A heavy workload, lack of time and staffing problems resulted in difficult ethical prioritizations and reduced standards of care. Shared rooms and beds in the corridors made it difficult to preserve patients' rights to privacy and confidentiality.

CONCLUSION

Interventions and investments are needed to improve the work environment of nurses, especially modifying the job constraints of the work environment. The moral responsibility for upholding the quality of care in surgical services and hospital performance should be more equally distributed between nurses, doctors and hospital managers. Discussions and collaboration between and within healthcare disciplines and managers should be initiated to establish shared moral understanding of the standards of care in hospitals.