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Huang Y, Zhang R, Zhao Q, Wang X, Ge L, Zhang S, Yang Q, Zhang C, Zhang X, Chen C. Pathways to Improve Provision of Home and Community-Based Services-A Configurational Approach Based on a Fuzzy-Set Qualitative Comparative Analysis From China. J Appl Gerontol 2024; 43:89-100. [PMID: 38041624 DOI: 10.1177/07334648231197029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Providing home and community-based services (HCBS) is critical for active and healthy aging. However, in China, the positive factors for improving HCBS provision are unclear, limiting its contribution to improving older adults' quality of life and promoting active and healthy aging. Therefore, this study examines the configurations that produce differences in HCBS and identifies multiple pathways for improving them and narrowing regional disparities. Using data from multiple datasets comprising 23 cases, we performed configuration analysis using fuzzy-set qualitative comparative analysis. Four pathways producing high HCBS provision and three pathways producing low HCBS provision were found. Different combinations of the aging population, economic development, institutional support, financial support, and development of multiple stakeholders influence HCBS provision. Thus, measures based on the main factor characteristics should be implemented to improve the HCBS provision level.
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Affiliation(s)
- Yunyun Huang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Rujia Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Qianru Zhao
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyi Wang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Lizheng Ge
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Songjia Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Qingren Yang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | | | - Xiangyang Zhang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
- Institute for County Chronic Disease Health Management Research, Wenzhou Medical University, Taizhou, China
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Jackson D. Missed nursing care, low value activities and cultures of busyness. J Adv Nurs 2023; 79:4428-4430. [PMID: 37162172 DOI: 10.1111/jan.15701] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Debra Jackson
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
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Kasper MS, Santos FLD, Oliveira PSD, Silva JPD, Santos KDS, Araujo PND, Souza GC, Quintão CBDS, Viana AL, Matumoto S, Mishima SM, Fermino TZ, Abrahão AL, Righi LB, Monceau G, Fortuna CM. The Work of Nurses in Primary Health Care: Crossings of the New Public Management. Healthcare (Basel) 2023; 11:healthcare11111562. [PMID: 37297702 DOI: 10.3390/healthcare11111562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
The literature in the field of health management mentions a concept called new public management (NPM), introduced in Brazil and France at the end of the 20th century. The objective of the study was to analyze the repercussions of the work of nurses in primary health care in Brazil and France under the influence of NPM. This is an excerpt of a double-titled thesis, which is a research intervention with nurses from two Brazilian states and five French departments. Data were produced between February 2019 and July 2021. The public policy Health on the Hour acted as an institutional transducer, provoking a reduction in access and producing effects on professional practices. In both countries, NPM amplified the predominance of technical and quantifiable acts, the focus on individual care, and the loss of autonomy. Nurses reported insurmountable situations, using the metaphor "Sophie's choice". The results showed that making dilemmatic decisions has been the daily routine of nurses, which has not resulted in debureaucratization and higher quality of care.
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Affiliation(s)
- Maristel Silva Kasper
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
- Laboratoire École-Mutations-Apprentissages, CY Cergy Paris Université, 92230 Gennevilliers, France
| | - Felipe Lima Dos Santos
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
- Laboratoire École-Mutations-Apprentissages, CY Cergy Paris Université, 92230 Gennevilliers, France
| | - Poliana Silva de Oliveira
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Janaina Pereira da Silva
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Educatives et des Pratiques Sociales, Université Paris-Est-Créteil-Val-de-Marne, 94010 Créteil, France
| | - Karen da Silva Santos
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
- Laboratoire Éducation et Diversité en Espaces Francophones, 87036 Limoges, France
| | - Priscila Norié de Araujo
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Gabriella Carrijo Souza
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Cássia Bianca de Souza Quintão
- Technology and Innovation in Nursing Professional Master Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Angelina Lettiere Viana
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Silvia Matumoto
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Silvana Martins Mishima
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Tauani Zampieri Fermino
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Ana Lucia Abrahão
- Department of Medical-Surgical Nursing, Aurora de Afonso Costa College of Nursing at Fluminense Federal University, Niterói 24020-090, Rio de Janeiro, Brazil
| | - Liane Beatriz Righi
- Department of Collective Health, Health Sciences Center of the Federal University of Santa Maria, Santa Maria 97105-900, Rio Grande do Sul, Brazil
| | - Gilles Monceau
- Laboratoire École-Mutations-Apprentissages, CY Cergy Paris Université, 92230 Gennevilliers, France
| | - Cinira Magali Fortuna
- Public Health Nursing Graduate Program, Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto 14040-902, São Paulo, Brazil
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Dadich A, Rodrigues J, De Bellis A, Hosie A, Symonds T, Prendergas J, Bevan A, Collier A. Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography. DEMENTIA 2023:14713012231168958. [PMID: 37032597 DOI: 10.1177/14713012231168958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Patient safety for people experiencing dementia in acute hospitals is a global priority. Despite national strategies as well as safety and quality guidelines, how safety practices are enacted within the complexities of everyday work are poorly understood and articulated. METHODS Using video reflexive ethnography, this 18-month study was conducted within an inpatient geriatric evaluation and management unit for people experiencing dementia and/or delirium in Australia. Patients, family members, and staff members participated by: allowing researchers to document fieldwork notes and video-record their practices and/or accounts thereof; and/or interpreting video-recordings with researchers to co-analyse and make sense of the data. RESULTS Safe care for people experiencing advanced dementia involved: negotiating risk via leadership, teamwork, and transparency; practice-based learning through situated adaptation; managing personhood versus protocols by doing the 'right' thing; joyful and meaningful work; as well as incorporating patient and family voices to do safety together. CONCLUSION Patient safety for people experiencing dementia requires continuous responsiveness and prioritising in the context of multiple risks by a staff collective with a shared purpose. Ongoing research to better understand how the nuances of patient safety unfold in everyday complex clinical realities in diverse contexts and with key stakeholders is required.
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Affiliation(s)
- Ann Dadich
- School of Business, 6489Western Sydney University, Parramatta, NSW, Australia
| | - Jade Rodrigues
- School of Business, 6489Western Sydney University, Parramatta, NSW, Australia
| | - Anita De Bellis
- College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Annmarie Hosie
- School of Nursing and Midwifery, 3431University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Tamsin Symonds
- 6677Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Justin Prendergas
- 6677Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Alan Bevan
- 1066University of Adelaide, Adelaide, SA, Australia
| | - Aileen Collier
- Research Centre for Palliative Care, Death, and Dying (RePadd), 1065Flinders University, Adelaide, SA, Australia
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Hernández-Corral S, Serván-Mori E, Benítez-Chavira LA, Nigenda G, Zárate-Grajales RA. Missed nursing care in highly specialized hospitals: A Mexican case study. Int J Health Plann Manage 2022; 37:2997-3005. [PMID: 35723665 DOI: 10.1002/hpm.3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/16/2022] [Accepted: 05/03/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To assess the status of missed nursing care and the reasons for its occurrence in a highly specialised public hospital in Mexico. MATERIALS AND METHODS An observational cross-sectional analysis with data collected from January to June 2019 at the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra in Mexico City. We assessed missed care and its causes by conducting the MISSCARE survey among 116 nursing professionals selected from a population of 162 nurses. This work presents the estimated rates of missed care-overall and broken down into its four dimensions-as well as the reasons for its occurrence, namely limited labour resources, inadequate material resources and communication problems among work teams. RESULTS The overall score for missed care was 16% (95% CI: 11.84%-20.15%), with the following rates by dimension: 19.48% for basic care, 14.66% for individual needs, 6.47% for patient education and discharge planning, and 4.31% for continuous patient assessment. The main reason cited for missed care was inadequate material resources, followed by limited labour resources and communication problems among work teams. CONCLUSION Basic care and individual needs interventions were the most frequently omitted services, primarily because of inadequate material resources, limited labour resources and communication problems among work teams. An increase in the frequency of missed care can be expected in light of the high demand for health services, particularly as regards labour and material resources, imposed by the SARS-CoV-2 pandemic.
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Affiliation(s)
| | - Edson Serván-Mori
- Center for Health Systems and Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Luis A Benítez-Chavira
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosa A Zárate-Grajales
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
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Esdaile EK, Rissel C, Baur LA, Wen LM, Gillespie J. Intergovernmental policy opportunities for childhood obesity prevention in Australia: Perspectives from senior officials. PLoS One 2022; 17:e0267701. [PMID: 35482812 PMCID: PMC9049527 DOI: 10.1371/journal.pone.0267701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early childhood (from conception to five years) is a key life stage for interventions to prevent obesity. In the Australian Federation, policy responsibility for obesity prevention sits across all levels of government and several intergovernmental institutions, rendering a complicated policy space. There is a gap in our understanding of the role of intergovernmentalism in developing obesity prevention policy in Australia. Given the complexity of intergovernmental structures and initiatives influencing childhood obesity prevention policy, it is important to understand the perspectives of senior health officials within the bureaucracy of government who through their roles may be able to influence processes or new strategies. METHODS Document analysis relating to obesity prevention in the intergovernmental context provided material support to the study. This analysis informed the interview guides for nine interviews with ten senior health department officials (one interview per jurisdiction). FINDINGS Several opportunities exist to support nutrition and obesity prevention in early childhood including marketing regulation (discretionary choices, breastmilk substitutes, commercial complementary foods and 'toddler milks') and supporting the early childhood education and care sector. This study found a widening structural gap to support national obesity policy in Australia. New public management strategies limit the ability of intergovernmental institutions to support coordination within and between governments to address complex issues such as obesity. Subnational informants perceived a gap in national leadership for obesity prevention, while a Commonwealth informant noted the commitment of the national government to partner with industry under a self-regulation model. In this gap, subnational leaders have pursued nationally consistent action to address obesity, including the development of a national obesity strategy as a bipartisan endeavour across jurisdictions. Public officials calculate the strategic possibilities of pursuing opportunities within state agendas but note the limited chances of structural change in the absence of national leadership and funding.
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Affiliation(s)
- Emma K. Esdaile
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence for the Early Prevention of Obesity in Childhood, Canberra, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence for the Early Prevention of Obesity in Childhood, Canberra, Australia
| | - Louise A. Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence for the Early Prevention of Obesity in Childhood, Canberra, Australia
- Specialty of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence for the Early Prevention of Obesity in Childhood, Canberra, Australia
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - James Gillespie
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia
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7
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Kendrick M, Kendrick KB, Taylor NF, Leggat SG. A qualitative study of hospital clinical staff perceptions of their interactions with healthcare middle managers. J Health Organ Manag 2021; ahead-of-print. [PMID: 34921600 DOI: 10.1108/jhom-06-2021-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment. DESIGN/METHODOLOGY/APPROACH Semi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis. FINDINGS Of 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles. PRACTICAL IMPLICATIONS Strategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care. ORIGINALITY/VALUE This article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.
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Affiliation(s)
- Madeleine Kendrick
- Public Health, La Trobe University - Bundoora Campus, Melbourne, Australia
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9
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Whittam S, Torning N, Patching J. A narrative inquiry approach to understanding senior intensive care nurses' experiences of working with new graduate nurses. J Clin Nurs 2021; 30:3314-3329. [PMID: 34021641 DOI: 10.1111/jocn.15844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To report a qualitative inquiry exploring senior registered nurses' stories of experience working with new graduate nurses in the intensive care unit. BACKGROUND While new graduate nurses' perceptions of transitioning into professional practice in the intensive care unit have been examined, few studies have explored the experiences of the senior registered nurses working alongside them. DESIGN A narrative inquiry methodology informed by Dewey's (1938) theory of experience. METHODS Individual in-depth, unstructured, interactive interviews were conducted with five senior registered nurses. The inquirer co-composed individual narrative accounts with each participant. Narrative inquiry's three commonplaces of temporality, sociality and place formed the lens of analysis. Thematic analysis identified two overarching threads that resonated across the narrative accounts. This inquiry adheres to COREQ checklist reporting. RESULTS The overarching threads 'Reverberations' and 'Caring' depict the experiences of senior registered nurses. 'It's Dangerous', 'Patrolling Like Surf Lifesavers', 'We Carry Them', 'Survival Mode' and 'Enjoyable Moments' are minor threads describing the challenges, while 'I've Been There', 'They Must Ask Questions' and 'Not In My Backyard' reveal their insights. CONCLUSIONS Working with new graduate nurses increased senior registered nurses' patient surveillance and workload, contributing to stress, pressure and feeling overwhelmed. However, senior registered nurses felt an obligation to care for new graduate nurses, who they perceived as still acquiring the skills to autonomously care for critically ill patients. Therefore, senior registered nurses require support themselves. RELEVANCE TO CLINICAL PRACTICE Senior registered nurses perceive workplace constraints as impeding their capacity to provide sufficient support and surveillance to new graduate nurses. The gap between new graduate nurses' clinical capacity and patients' needs underpins senior registered nurses' recommendation that new graduate nurses should not be placed in intensive care units unless additional workforce support is provided, safeguarding their development as well as patient safety.
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Affiliation(s)
- Susan Whittam
- School of Nursing, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Nerilee Torning
- School of Nursing, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Joanna Patching
- School of Nursing, University of Notre Dame Australia, Sydney, NSW, Australia
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Hoff JL, Kuiper M. The governmentality of nursing professionalization in advanced liberal societies. JOURNAL OF PROFESSIONS AND ORGANIZATION 2021. [DOI: 10.1093/jpo/joaa027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
In Western countries, the occupational discipline of nursing is undergoing processes of professionalization. Although professionalization offers an appealing perspective on occupational advancement, it is an ambiguous process, especially in the context of ongoing reforms of advanced liberal states. More specifically, there is a confusing relationship between the professionalization of nursing and the state. This relation is underexamined in theories of nursing professionalization. Instead of seeing the state and professions as two distinct spheres, this article highlights their interconnectedness. It argues that nursing professionalization can be understood as a strategy of advanced liberal governmentality. Through an empirical analysis of the professionalization of Dutch nursing from a Foucauldian perspective, it shows how the appeal to ‘professionalism’ functions as a disciplinary mechanism that produces forms of advanced liberal ‘(bio)power’. This generates academic and practical questions, since nurses—the largest group of healthcare professionals—have distinctive relations with their patients, who regard them as ‘independent’ and ‘caring experts’. Furthermore, it sheds light on the academic debate about the reconfiguration of professionalism by showing how certain ‘professional’ reconfigurations are not only unavoidable but unavoidably (bio)political as well.
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Affiliation(s)
- Jan-Luuk Hoff
- Utrecht University School of Governance, Utrecht University, 3511 ZC Utrecht, the Netherlands
| | - Marlot Kuiper
- Utrecht University School of Governance, Utrecht University, 3511 ZC Utrecht, the Netherlands
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Bosley H, Appleton JV, Henshall C, Jackson D. The influence of perceived accessibility and expertise of healthcare professionals, and service austerity, on mothers' decision-making. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:526-534. [PMID: 32744784 DOI: 10.1111/hsc.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 06/11/2023]
Abstract
Mothers often make key decisions regarding their children's health. They hold core beliefs and attitudes towards healthcare providers, relying on healthcare services to provide support, advice and reassurance. It is crucial that health providers form authentic relationships with families with young children, in order to effectively provide healthcare, support and information as needed. In this paper, we explore mothers' views on the accessibility and expertise of healthcare professionals caring for their child's health. A case study, using a geographic post code as the case boundary was used. Focus groups and semi-structured interviews with mothers of children aged under five years old were conducted. Participants (n = 33) were recruited from local playgroups and six focus groups (19 participants) and 14 individual interviews were conducted. Qualitative data were analysed using thematic analysis. General Practice (including general practitioners [GPs] and practice nurses) was considered to be the preferred option when seeking timely healthcare advice and information. Participant mothers were open to accessing professional advice concerning their child's health, from a range of health professionals and understood the role and potential contribution of various health professionals. However, some factors, influenced mothers' decision-making. These were captured in three themes: maternal perceptions of GPs as accessible experts; practice nurses as approachable and reassuring sources of advice; and difficulty in accessing health visiting services primarily due to service funding cuts. Further investment in primary care services, including expansion of the practice nurse role and an increase in health visiting service provision, may help to provide sufficient support for mothers seeking healthcare advice. In addition, healthcare service strategies, which engage with mothers and ensure nurses are recognised as knowledgeable, accessible, supportive and a suitable alternative to GPs, would be beneficial.
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Affiliation(s)
- Helen Bosley
- Faculty of Health & Life Sciences, Oxford Institute of Nursing, Midwifery & Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
- Nurse Consultant, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jane V Appleton
- Professor of Primary and Community Care, Faculty of Health & Life Sciences, Oxford Institute of Nursing, Midwifery & Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
| | - Catherine Henshall
- Faculty of Health & Life Sciences, Oxford Institute of Nursing, Midwifery & Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
- NIHR Oxford Cognitive Health Clinical Research Facility, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Debra Jackson
- Professor of Nursing, Faculty of Health, University of Technology, Sydney (UTS), Sydney, NSW, Australia
- Professor of Nursing, Oxford Health NHS Foundation Trust, Oxford, UK
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Byrne AL, Harvey C, Baldwin A. Nurse navigators and person-centred care; delivered but not valued? Nurs Inq 2021; 28:e12402. [PMID: 33645885 DOI: 10.1111/nin.12402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022]
Abstract
Positioning the individual at the centre of care (person-centred care [PCC]) is essential to improving outcomes for people living with multiple chronic conditions. However, research also suggests that this is structurally challenging because health systems continue to adopt long-standing, episodic care encounters. One strategy to provide a more cohesive, individualised approach to care is the implementation of the nurse navigator role. Current research shows that although PCC is a focus of navigation, such care may be hindered by the rigid, systematised health services providing siloed specialist care. In this paper, we utilised a case study method to investigate the experiences of a nurse navigator and patient. The nurse navigator and the patient participated in individual interviews, the transcripts of which were analysed using critical discourse analysis. Findings from a larger research project suggest that traditional measures (hospital avoidance, emergency department usage) which work as the service objectives of the nurse navigator service have the potential to stifle the delivery of PCC. The analysis from this case study supports the broader findings and further highlights the need for improved alignment between service objectives and the health and well-being of the individuals utilising the services.
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Affiliation(s)
- Amy-Louise Byrne
- School of Nursing and Midwifery and Social Science, Central Queensland University, Townsville, QLD, Australia
| | - Clare Harvey
- School of Nursing and Midwifery and Social Science, Central Queensland University, Townsville, QLD, Australia
| | - Adele Baldwin
- School of Nursing and Midwifery and Social Science, Central Queensland University, Townsville, QLD, Australia
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13
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Nymark C, Göransson KE, Saboonchi F, Falk AC, von Vogelsang AC. Translation, culture adaption and psychometric testing of the MISSCARE Survey-Swedish version. J Clin Nurs 2020; 29:4645-4652. [PMID: 32956504 PMCID: PMC7756567 DOI: 10.1111/jocn.15505] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/06/2020] [Indexed: 11/30/2022]
Abstract
AIM To translate the MISSCARE Survey into Swedish and establish its validity and reliability by evaluating its psychometric properties. BACKGROUND Missed nursing care is defined as any aspect of required nursing care that is omitted or delayed. The consequence of missed nursing care is a threat to patient safety. The MISSCARE Survey is an American instrument measuring missed nursing care activities (part A) and its reasons (part B). METHODS The translation was accomplished according to World Health Organization guidelines, focusing on a culture adaptation. Acceptability, construct validity, test-retest reliability and internal consistency were analysed. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) was used as reporting checklist. RESULTS The translation and culture adaptation needed several revisions. A total of 126 nurses answered the test and retest which showed acceptability of missing data. The factor analysis revealed a lack of fit to data for the original factorial structure in part B, while further analysis provided results suggesting a modification based on omitting six items. The internal consistency for part B and its subscales showed good results. CONCLUSIONS The MISSCARE Survey-Swedish version is a reliable and valid instrument, with good psychometric properties. RELEVANCE TO CLINICAL PRACTICE More reliable language versions of the instrument enable national and international comparisons that could be valuable for nursing managers and/or directors of nursing who are responsible for quality of care and patient safety in the strategic care planning process.
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Affiliation(s)
- Carolin Nymark
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina E Göransson
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.,Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, The Swedish Red Cross University College, Stockholm, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Charlotte Falk
- Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.,Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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14
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Debout C. Pandémie de Covid-19 et pénurie infirmière en France : un phénomène prévisible. REVUE FRANCOPHONE INTERNATIONALE DE RECHERCHE INFIRMIÈRE 2020. [PMCID: PMC7833931 DOI: 10.1016/j.refiri.2020.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Abstract
There is no agreed minimum standard with regard to what is considered safe, competent nursing care. Limited resources and organizational constraints make it challenging to develop a minimum standard. As part of their everyday practice, nurses have to ration nursing care and prioritize what care to postpone, leave out, and/or omit. In developed countries where public healthcare is tax-funded, a minimum level of healthcare is a patient right; however, what this entails in a given patient’s actual situation is unclear. Thus, both patients and nurses would benefit from the development of a minimum standard of nursing care. Clarity on this matter is also of ethical and legal concern. In this article, we explore the case for developing a minimum standard to ensure safe and competent nursing care services. Any such standard must encompass knowledge of basic principles of clinical nursing and preservation of moral values, as well as managerial issues, such as manpower planning, skill-mix, and time to care. In order for such standards to aid in providing safe and competent nursing care, they should be in compliance with accepted evidence-based nursing knowledge, based on patients’ needs and legal rights to healthcare and on nurses’ codes of ethics. That is, a minimum standard must uphold a satisfactory level of quality in terms of both professionalism and ethics. Rather than being fixed, the minimum standard should be adjusted according to patients’ needs in different settings and may thus be different in different contexts and countries.
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Affiliation(s)
| | - Anne Scott
- 8799National University of Ireland Galway, Ireland
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16
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Kalánková D, Kirwan M, Bartoníčková D, Cubelo F, Žiaková K, Kurucová R. Missed, rationed or unfinished nursing care: A scoping review of patient outcomes. J Nurs Manag 2020; 28:1783-1797. [DOI: 10.1111/jonm.12978] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dominika Kalánková
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
| | - Marcia Kirwan
- School of Nursing and Human Sciences Dublin City University in Dublin Glasnevin, Dublin Ireland
| | - Daniela Bartoníčková
- Department of Nursing 2nd Faculty of Medicine Charles University in Prague Prague Czech Republic
| | - Floro Cubelo
- School of Health and Social Studies Jyväskylä University of Applied Sciences Jyväskylä Finland
| | - Katarína Žiaková
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
| | - Radka Kurucová
- Department of Nursing Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovak Republic
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17
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Byrne AL, Baldwin A, Harvey C. Whose centre is it anyway? Defining person-centred care in nursing: An integrative review. PLoS One 2020; 15:e0229923. [PMID: 32155182 PMCID: PMC7064187 DOI: 10.1371/journal.pone.0229923] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/18/2020] [Indexed: 11/19/2022] Open
Abstract
AIM The aims of this literature review were to better understand the current literature about person-centred care (PCC) and identify a clear definition of the term PCC relevant to nursing practice. METHOD/DATA SOURCES An integrative literature review was undertaken using The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Scopus and Pubmed databases. The limitations were English language, full text articles published between 1998 and 2018 within Australian, New Zealand, Canada, USA, Europe, Ireland and UK were included. The international context off PCC is then specifically related to the Australian context. REVIEW METHODS The review adopted a thematic analysis to categorise and summarise themes with reference to the concept of PCC. The review process also adhered to the Preferred Reporting System for Meta-Analysis (PRISMA) and applied the Critical Appraisal Skills Programme (CASP) tools to ensure the quality of the papers included for deeper analysis. RESULTS While definitions of PCC do exist, there is no universally used definition within the nursing profession. This review has found three core themes which contribute to how PCC is understood and practiced, these are People, Practice and Power. This review uncovered a malalignment between the concept of PCC and the operationalisation of the term; this misalignment was discovered at both the practice level, and at the micro, meso and micro levels of the healthcare service. CONCLUSION The concept of PCC is well known to nurses, yet ill-defined and operationalised into practice. PCC is potentially hindered by its apparent rhetorical nature, and further investigation of how PCC is valued and operationalised through its measurement and reported outcomes is needed. Investigation of the literature found many definitions of PCC, but no one universally accepted and used definition. Subsequently, PCC remains conceptional in nature, leading to disparity between how it is interpreted and operationalised within the healthcare system and within nursing services.
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Affiliation(s)
- Amy-Louise Byrne
- Central Queensland University School of Nursing, Midwifery and Social Science, Townsville, Queensland, Australia
| | - Adele Baldwin
- Central Queensland University School of Nursing, Midwifery and Social Science, Townsville, Queensland, Australia
| | - Clare Harvey
- Central Queensland University School of Nursing, Midwifery and Social Science, Townsville, Queensland, Australia
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18
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Digby R, Bolster D, Hughes L, Perta A, Bucknall TK. Examining subacute nurses' roles in a changing healthcare context. J Clin Nurs 2020; 29:2260-2274. [PMID: 32145040 DOI: 10.1111/jocn.15235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/23/2020] [Accepted: 02/07/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore and describe nurses' role in the rehabilitation and care of patients in one subacute care facility in Melbourne, Australia. BACKGROUND The role of nurses in subacute care and within the rehabilitation team is evolving and remains unclear. DESIGN Mixed methods. METHODS Fourteen nurses from seven rehabilitation and geriatric evaluation and management wards in one subacute facility in Melbourne, Australia, were observed in practice for two hours and then interviewed. Activities were recorded electronically. Interviews were audio-recorded and transcribed. Data were analysed using content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS Three main themes are as follows: (a) Nurses as rehabilitators; (b) Teamwork in rehabilitation; and (c) The changing context of subacute care. Nurses prioritised patient personal and clinical care above other responsibilities. They were largely excluded from team decision-making because clinical responsibilities precluded them from attending team meetings. Unsuitable buildings, increased patient acuity and time constraints were further challenges. CONCLUSIONS Nurses have a multifaceted role in patient rehabilitation that is poorly understood. An evaluation of the nursing role within the interdisciplinary team, skills and processes of care may increase understanding, and improve communication and relationships between disciplines potentially benefiting patients. Role clarity and differentiation in nursing skills are required within the nursing workforce. RELEVANCE TO CLINICAL PRACTICE Nurses have a unique role in both clinical care and rehabilitation of patients, and as part of the interdisciplinary team. Respectful professional relationships need fostering within the interdisciplinary team to achieve optimal patient outcomes. The way that team meetings and decision-making occur in the subacute wards requires adjustment to ensure that the valuable contribution of nurses, both to the interdisciplinary team and to the rehabilitation of patients, is used and acknowledged to improve patient care.
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Affiliation(s)
- Robin Digby
- School of Nursing and Midwifery, Faculty of Health, Deakin University Locked Bag, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | | | | | - Andrew Perta
- Caulfield Hospital, Caulfield, Victoria, Australia
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Faculty of Health, Deakin University Locked Bag, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
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19
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Henderson J, Willis E, Roderick A, Bail K, Brideson G. Why do nurses miss infection control activities? A qualitative study. Collegian 2020. [DOI: 10.1016/j.colegn.2019.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Sönmez B, İspir Ö, Türkmen B, Duygulu S, Yıldırım A. The reliability and validity of the Turkish version of the MISSCARE Survey-Patient. J Nurs Manag 2019; 28:2072-2080. [PMID: 31513721 DOI: 10.1111/jonm.12865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/05/2019] [Accepted: 09/08/2019] [Indexed: 11/28/2022]
Abstract
AIM This methodological study aimed to adapt the MISSCARE Survey-Patient, which evaluates patients' experiences regarding nursing care based on their reports, and to test it for validity and reliability in Turkish. BACKGROUND Identifying the missed care interventions on the basis of nurse and patient reports are important to ensure an objective evaluation and develop solutions to the causes behind the failure to meet care needs. METHODS The study sample consisted of 267 inpatients in the internal and surgery services in a university hospital (n = 267). The Turkish version of the survey was subjected to language and content validity analyses and to confirmatory factor analysis for construct validity. The reliability of the survey was tested through test-retest method and the Cronbach's alpha internal consistency coefficient. RESULTS It was determined that the original construct was preserved in the Turkish version of the MISSCARE Survey-Patient. The findings indicated that the scale was stable and reliable. CONCLUSION The Turkish version of the MISSCARE Survey-Patient was found to be valid and reliable. IMPLICATIONS FOR NURSING MANAGEMENT The survey can be used to determine the frequency and duration of nursing care based on patients' reports and is a valid and reliable instrument for cross-cultural studies.
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Affiliation(s)
- Betül Sönmez
- Department of Nursing Management, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Öznur İspir
- Department of Nursing Management, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Buse Türkmen
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Sergül Duygulu
- Department of Nursing Management, Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Aytolan Yıldırım
- Department of Nursing Management, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
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21
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Gunn V, Muntaner C, Ng E, Villeneuve M, Gea-Sanchez M, Chung H. Gender equality policies, nursing professionalization, and the nursing workforce: A cross-sectional, time-series analysis of 22 countries, 2000-2015. Int J Nurs Stud 2019; 99:103388. [PMID: 31493758 DOI: 10.1016/j.ijnurstu.2019.103388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/18/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Nursing professionalization has substantial benefits for patients, health care systems, and the nursing workforce. Currently, however, there is limited understanding of the macro-level factors, such as policies and other country-level determinants, influencing both the professionalization process and the supply of nursing human resources. OBJECTIVES Given the significance of gender to the development of nursing, a majority-female occupation, the purpose of this analysis was to investigate the relationship between gender regimes and gender equality policies, as macro-level determinants, and nursing professionalization indicators, in this case the regulated nurse and nurse graduate ratios. DESIGN This cross-sectional, time-series analysis covered 16 years, from 2000 to 2015, and included 22 high-income countries, members of the Organisation for Economic Co-operation and Development. We divided countries into three clusters, using the gender policy model developed by Korpi, as proxy for gender regimes. The countries were grouped as follows: (a) Traditional family - Austria, Belgium, France, Germany, Greece, Italy, Netherlands, Portugal, and Spain; (b) Market-oriented - Australia, Canada, Ireland, Japan, New Zealand, South Korea, Switzerland, United Kingdom, and the United States; and (c) Earner-carer - Denmark, Finland, Norway, and Sweden. METHODS We used fixed-effects linear regression models and ran Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction to examine the effect of gender equality policies on nursing professionalization indicators. Given the existence of missing observations, we devised and implemented a multiple imputation strategy, with the help of the Amelia II program. We gathered our data from open access secondary sources. RESULTS Both the regulated nurse and nurse graduate ratios had averages that differed across gender regimes, being the highest in Earner-carer regimes and the lowest in Traditional family ones. In addition, we identified a number of indicators of gender equality policy in education, the labour market, and politics that are predictive of the regulated nurse and nurse graduate ratios. CONCLUSION This study's findings could add to existing upstream advocacy efforts to strengthen nursing and the nursing workforce through healthy public policy. Given that the study consists of an international comparative analysis of nursing, it should be relevant to both national and global nursing communities.
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Affiliation(s)
- Virginia Gunn
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, M5T 1P8, Canada; Dalla Lana School of Public Health, Collaborative Specialization in Global Health, University of Toronto, Ontario, M5T 1P8, Canada.
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, M5T 1P8, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, M5T 1P8, Canada
| | - Edwin Ng
- School of Social Work, Renison University College, University of Waterloo, Ontario, N2L 3G1, Canada
| | - Michael Villeneuve
- Governance and Strategy, Canadian Nurses Association, Ottawa, K2P 1E2, Canada
| | - Montserrat Gea-Sanchez
- GESEC Group, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Catalunya, ES 25003, Spain; GRECS Group, Biomedical Research Institute of Lleida, Lleida, Spain
| | - Haejoo Chung
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, South Korea; School of Health Policy & Management, College of Health Sciences, Korea University, Seongbuk-gu, Seoul, KR 02841, South Korea
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22
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Gunn V, Muntaner C, Ng E, Villeneuve M, Gea‐Sanchez M, Chung H. The influence of welfare state factors on nursing professionalization and nursing human resources: A time‐series cross‐sectional analysis, 2000–2015. J Adv Nurs 2019; 75:2797-2810. [DOI: 10.1111/jan.14155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/30/2019] [Accepted: 07/03/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Virginia Gunn
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto ON Canada
- Collaborative Doctoral Program in Global Health, Dalla Lana School of Public Health University of Toronto Toronto ON Canada
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto ON Canada
- Dalla Lana School of Public Health University of Toronto Toronto ON Canada
| | - Edwin Ng
- School of Social Work Renison University College, University of Waterloo Waterloo ON Canada
| | | | - Montserrat Gea‐Sanchez
- GESEC Group, Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- GRECS Group Biomedical Research Institute of Lleida Lleida Spain
| | - Haejoo Chung
- Department of Public Health Sciences, Graduate School Korea University Seoul South Korea
- School of Health Policy & Management College of Health Sciences, Korea University Seoul South Korea
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23
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Zeleníková R, Gurková E, Jarošová D. Missed nursing care measured by MISSCARE Survey - the first pilot study in the Czech Republic and Slovakia. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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24
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Willis E. Rationed, Missed, or Nursing Care Left Undone: a comment from the Antipodes. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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25
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Cleary‐Holdforth J. Missed Nursing Care: A Symptom of Missing Evidence. Worldviews Evid Based Nurs 2019; 16:88-91. [DOI: 10.1111/wvn.12351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joanne Cleary‐Holdforth
- Faculty of Science and HealthProgramme Chair‐MSc in Integrative Counselling and PsychotherapySchool of Nursing and Human SciencesDublin City University Dublin Ireland
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26
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Strandås M, Wackerhausen S, Bondas T. Gaming the system to care for patients: a focused ethnography in Norwegian public home care. BMC Health Serv Res 2019; 19:121. [PMID: 30764824 PMCID: PMC6376668 DOI: 10.1186/s12913-019-3950-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background With its emphasis on cost-reduction and external management, New Public Management emerged as the dominant healthcare policy in many Western countries. The ability to provide comprehensive and customized patient-care is challenged by the formalized, task-oriented organization of home-care services. The aim of this study is to gain deeper understanding of how nurses and the patients they care for, relate to and deal with the organizational systems they are subjected to in Norwegian home care. Methods The focused ethnographic design is based on Roper and Shapira’s framework. Data collection consisted of participant observation with field notes and semi-structured interviews with ten nurses and eight patients from six home care areas located in two Norwegian municipalities. Results Findings indicate cultural patterns regarding nurses’ somewhat disobedient behaviors and manipulations of the organizational systems that they perceive to be based on economic as opposed to caring values. Rigid organization makes it difficult to deviate from predefined tasks and adapt nursing to patients changing needs, and manipulating the system creates some ability to tailor nursing care. The nurses’ actions are founded on assumptions regarding what aspects of nursing are most important and essential to enhance patients’ health and ensure wellbeing – individualized care, nurse-patient relationships and caring – which they perceive to be devalued by New Public Management organization. Findings show that patients share nurses’ perceptions of what constitute high quality nursing, and they adjust their behavior to ease nurses’ work, and avoid placing demands on nurses. Findings were categorized into three main areas: “Rigid organizational systems complicating nursing care at the expense of caring for patients”, “Having the patient’s health and wellbeing at heart” and “Compensating for a flawed system”. Conclusions Our findings indicate that, in many ways, the organizational system hampers provision of high-quality nursing, and that comprehensive care is provided in spite of - not because of - the system. The observed practices of nurses and patients are interpreted as ways of “gaming the system” for caring purposes, in order to ensure the best possible care for patients.
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Affiliation(s)
- Maria Strandås
- Nord University, Universitetsalleén 11, 8049, Bodø, Norway.
| | | | - Terese Bondas
- Nord University, Universitetsalleén 11, 8049, Bodø, Norway
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27
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Harvey CL, Baret C, Rochefort CM, Meyer A, Ausserhofer D, Ciutene R, Schubert M. Discursive practice - lean thinking, nurses' responsibilities and the cost to care. J Health Organ Manag 2018; 32:762-778. [PMID: 30299224 DOI: 10.1108/jhom-12-2017-0316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to explore the literature regarding work intensification that is being experienced by nurses, to examine the effects this is having on their capacity to complete care. The authors contend that nurses' inability to provide all the care patients require, has negative implications on their professional responsibility. DESIGN/METHODOLOGY/APPROACH The authors used institutional ethnography to review the discourse in the literature. This approach supports inquiry through the review of text in order to uncover activities that remain institutionally accepted but unquestioned and hidden. FINDINGS What the authors found was that the quality and risk management forms an important part of lean thinking, with the organisational culture influencing outcomes; however, the professional cost to nurses has not been fully explored. RESEARCH LIMITATIONS/IMPLICATIONS The text uncovered inconsistency between what organisations accepted as successful cost savings, and what nurses were experiencing in their attempts to achieve the care in the face of reduced time and human resources. Nurses' attempts at completing care were done at the risk of their own professional accountability. PRACTICAL IMPLICATIONS Nurses are working in lean and stressful environments and are struggling to complete care within reduced resource allocations. This leads to care rationing, which negatively impacts on nurses' professional practice, and quality of care provision. ORIGINALITY/VALUE This approach is a departure from the standard qualitative review because the focus is on the textual relationships between what is being advocated by organisations directing cost reduction and what is actioned by the nurses working at the coalface. The discordant standpoints between these two juxtapositions are identified.
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Affiliation(s)
- Clare Lynette Harvey
- School of Nursing, Midwifery and Social Sciences, Central Queensland University , Mackay, Australia
| | - Christophe Baret
- The Institute of Labour Economics and Industrial Sociology (LEST - CNRS), Aix-Marseille University , Aix en Provence, France
| | - Christian M Rochefort
- School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke , Quebec, Canada.,Research Centre, University Hospital Center of Sherbrooke (CHUS) , Sherbrooke, Canada.,Research Centre, Charles-LeMoyne Hospital, Longueuil, Canada
| | - Alannah Meyer
- School of Nursing, Eastern Institute of Technology, Taradale, New Zealand
| | | | - Ruta Ciutene
- Faculty of Social Sciences, Kaunas University of Technology , Kaunas, Lithuania
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Gunn V, Muntaner C, Villeneuve M, Chung H, Gea-Sanchez M. Nursing professionalization and welfare state policies: A critical review of structural factors influencing the development of nursing and the nursing workforce. Nurs Inq 2018; 26:e12263. [PMID: 30175496 DOI: 10.1111/nin.12263] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022]
Abstract
Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in-depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing professionalization. The use of a welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country-level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill-level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings.
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Affiliation(s)
- Virginia Gunn
- Lawrence S. Bloomberg Faculty of Nursing & Global Health Collaborative Specialization, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Michael Villeneuve
- Governance and Strategy, Canadian Nurses Association, Ottawa, Ontario, Canada
| | - Haejoo Chung
- School of Health Policy and Management, College of Health Sciences, Korea University, Seoul, South Korea
| | - Montserrat Gea-Sanchez
- GESEC Group, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,GRECS Group, Biomedical Research Institute of Lleida, Lleida, Spain
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29
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Bagnasco A, Timmins F, Aleo G, Sasso L. Double Jeopardy - Missed care for the vulnerable in community settings. J Clin Nurs 2018; 27:3827-3829. [DOI: 10.1111/jocn.14541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Fiona Timmins
- School of Nursing and Midwifery; Trinity College Dublin; Dublin 2 Ireland
| | - Giuseppe Aleo
- Department of Health Sciences; University of Genoa; Genoa Italy
| | - Loredana Sasso
- Department of Health Sciences; University of Genoa; Genoa Italy
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30
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Brunton M, Cook C. Dis/Integrating cultural difference in practice and communication: A qualitative study of host and migrant Registered Nurse perspectives from New Zealand. Int J Nurs Stud 2018; 83:18-24. [PMID: 29684831 DOI: 10.1016/j.ijnurstu.2018.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several earlier studies have provided evidence of the difficulties nurses have had adapting to foreign workplaces, however few have considered wider perspectives of the workplace communication environment. OBJECTIVE The aim of this study was to examine the viewpoints and experience of both New Zealand qualified nurses and internationally qualified nurses in managing communication within teams and the clinical practice context in an increasingly diverse healthcare workplace in New Zealand. DESIGN Interviews with 53 nurses currently employed in the New Zealand healthcare sector were carried out over a period of 15 weeks to gain insight into their intercultural experiences and how they responded. The transcripts of the interviews were analysed thematically. SETTING The interviews were all held outside working hours in venues and at times nominated by respondents. PARTICIPANTS There were 53 participants (17 New Zealand registered nurses and 36 internationally qualified nurses) in the study. Respondents were nurses working in the health care sector who answered a call for participation in the study from an advertisement in the national nursing journal Kai Tiaki. METHODS A structured interview schedule was developed from the literature. The questions focused on cultural challenges and benefits, sources of learning, value-based differences accompanied by a description of critical incidents that were reflective of those events. RESULTS Qualitative thematic analysis of the data resulted in three primary themes: a polarized workplace (loss and learning); ethnocentrism 'othering' and empathy; and value based conflict. The results were discussed with a focus group of available respondents to verify the findings. CONCLUSION All nurses in this study struggled with a care-rationed work environment, complicated by increasing diversity in both patients and staff. Despite evidence of conflict and misunderstanding, nurses also appeared willing to learn to adapt to enhance their practice. However, this process requires opportunities and resources to facilitate mutual understanding and accommodation to occur. The alternative of maintaining the status-quo will remain costly in terms of retention problems, the extent to which teams collaborate, and the contribution of insider-outsider divisions to sentinel events.
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Affiliation(s)
- Margaret Brunton
- School of Communication, Journalism and Marketing, Massey University, Private Bag 102 904, North Shore Mail Centre, Auckland, 1311, New Zealand.
| | - Catherine Cook
- School of Nursing, Massey University, Private Bag 102 904, North Shore Mail Centre, Auckland, 1311, New Zealand.
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Scott PA, Harvey C, Felzmann H, Suhonen R, Habermann M, Halvorsen K, Christiansen K, Toffoli L, Papastavrou E. Resource allocation and rationing in nursing care: A discussion paper. Nurs Ethics 2018; 26:1528-1539. [PMID: 29607703 PMCID: PMC6681425 DOI: 10.1177/0969733018759831] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues - missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care left undone - suggesting that nurses, in certain contexts, are actively engaged in rationing care - in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care - despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource.
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Affiliation(s)
| | | | | | - Riitta Suhonen
- University of Turku, Turku University Hospital and City of Turku Welfare Division, Finland
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