Parenteral nutrition in home-based palliative care: Swedish district nurses experiences

Ward-level nurse turnover and related workplace factors in long-term care hospitals: A cross-sectional survey

AIM

To explore the association between the ward-level nurse turnover rate and the ward's organisational, patient and nurse characteristics in long-term care (LTC) hospitals.

BACKGROUND

Nurse turnover adversely impacts not only LTC hospitals through higher recruitment and replacement costs but also resident health outcomes.

METHODS

This study employed a cross-sectional design with secondary analyses. Participants were 199 ward managers and 2,508 nurses in LTC hospitals across Japan. Data were collected between September and November 2015.

RESULTS

The wards with higher nurse turnover were significantly associated with a non-12-hr work shift, higher rate of patients with intravenous hyperalimentation (IVH), lower average of nurse emotional exhaustion, lower average of nurse-perceived quality of the care process and lower rate of employment stability as the reason for choosing the workplace.

CONCLUSIONS

Actual ward-level nurse turnover can be influenced by factors related to the organisation (e.g. shift style and employment stability), patient (e.g. patients with IVH) and nurse attributions (e.g. burnout, perceived care quality).

IMPLICATIONS FOR NURSING MANAGEMENT

To minimize nurse turnover in LTC hospitals, multifactorial ward-level interventions would be possible, such as adjusting for shift work, attending to medical procedures or improving nurses' emotional exhaustion and perceptions regarding care quality.

The impact of medical technology on sense of security in the palliative home care setting

The increase in the use of medical devices in palliative home care requires that patients and next-of-kin feel secure. Therefore, the aim was to describe medical technology's impact on the sense of security for patients, next-of-kin and district nurses. Deductive content analysis was conducted on data from three previous studies, using the theoretical framework 'palliative home care as a secure base'. The use of medical technology was shown to have an impact on the sense of security for all involved. A sense of control was promoted by trust in staff and their competence in managing the technology, which was linked to continuity. Inner peace and being in comfort implied effective symptom relief facilitated by pain pumps and being relieved of responsibility. Health care professionals need to have practical knowledge about medical technology, but at the same time have an awareness of how to create and maintain a sense of security.

A poststructural rethinking of the ethics of technology in relation to the provision of palliative home care by district nurses

Technology and its interfaces with nursing care, patients and carers, and the home are many and varied. To date, healthcare services research has generally focussed on pragmatic issues such access to and the optimization of technology, while philosophical inquiry has tended to focus on the ethics of how technology makes the home more hospital like. However, the ethical implications of the ways in which technology shapes the subjectivities of patients and carers have not been explored. In order to explore this, poststructural theory, in particular the work of Butler, Foucault, and Deleuze, is used to theorize the relationship between subjectivity and materiality as ethically mandated on producing rather than precluding the development of subjectivities in novel ways. This theoretical understanding is then utilized through a process of 'plugged in' as described by Jackson and Massie that aims to link empirical data, research, and philosophical inquiry. Through this process, it is suggested that power, which the empirical data demonstrate, is frequently exercised through medical discourses and restricts patients' and carers' ability to shape the material environment of the home as a place to live and be cared for in palliative stages of illness. Alternative discourses are suggested both from the empirical data as well as other research, which may offer patients and carers the possibility of reclaiming power over the home and their subjectivities. Finally, the dichotomy between the home and hospital, mediated via technology, is posited as being problematic. It is argued the dichotomy is false and should be moved away from in order to allow an ethical embrace of technology in palliative care.