Nurses, the Oppressed Oppressors: A Qualitative Study

Delegating care as a double-edged sword for quality of nursing care: a qualitative study

BACKGROUND

Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care.

METHODS

This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985).

RESULTS

In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword".

CONCLUSIONS

The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

Critical consciousness of public health nurses: A descriptive, comparative survey

BACKGROUND

Public Health Nurses (PHN) caring for vulnerable populations amid systemic inequality must navigate complex situations, and consequently they may experience serious moral distress known to be detrimental to PHN wellbeing.

OBJECTIVE

Given PHN awareness of social inequities, the study aimed to determine if PHNs were motivated to enact social change and engage in social and political action to address inequality.

DESIGN AND SAMPLE

A survey of 173 PHNs was conducted in fall 2022. The convenience sample was mainly female (96.5%), White (85%), had associate/bachelor's degrees (71.7%), and worked in governmental public health settings (70.7%).

MEASURE

The study employed the Short Critical Consciousness Scales' subscales: Critical Reflection, Critical Motivation, and Critical Action.

RESULTS

PHNs were highly motivated to address inequities (Critical Motivation = 20.83; SD = 3.16), with similarly high awareness (Critical Reflection = 17.89; SD = 5.18). However, social and political action scores were much lower (Critical Action = 7.13; SD = 2.63). A subgroup of PHNs with strong agreement regarding the impact of poverty were more likely to be younger (p = .039) and work in a community setting (p = .003); with higher scores across subscales (p < .001).

CONCLUSIONS

High critical reflection and motivation among PHNs aligned with literature. Lower Critical Action scores warrant investigation into validity for PHNs, and possible role constraints.

Nurses' experiences of working while pregnant: A qualitative descriptive study

BACKGROUND

Healthcare work environments are fraught with occupational hazards that can impact nurse health as well as patient care. However, little is known about how these hazards impact nurse health during pregnancy, and the experiences of nurses in the work environment during pregnancy and upon their return postpartum.

OBJECTIVE

To describe registered nurses' (RNs') experiences of working while pregnant and returning to work postpartum. Specifically, their experiences related to the work environment and work-related hazards.

DESIGN

A qualitative descriptive design was utilized to describe nurse experiences at work, occupational hazards during pregnancy, and experiences of returning to work after pregnancy.

PARTICIPANTS AND SETTING

A convenience sample of twenty nurses working in direct patient care roles across the United States were recruited for virtual semi-structured interviews.

METHOD

Participants were interviewed using a semi-structured question guide to explore nurse experiences, specifically occupational hazards at work during pregnancy and upon returning to work. Interview transcripts were analyzed using deductive and inductive content analysis.

RESULTS

Deductive findings for occupational hazards and risks during pregnancy and postpartum included exposure to infectious diseases, imaging, physical tasks (e.g., lifting and performing CPR), cleaning products, patient violence, and medication administration. Inductive thematic findings included: support needed avoid occupational hazards and make necessary modifications; desire to be 'supernurses' and put the patient first even when it meant taking risks for our health and that of their child; and fear of the consequences of occupational hazards and exposures.

CONCLUSIONS

Occupational hazards experienced by nurses during pregnancy that may impact their health and that of their baby were broader than previously studied. Pregnant nurses should receive education from their healthcare providers early in their pregnancies about the occupational hazards themselves and the potential modifications they should seek. Managers, occupational health and other health system leaders, and policymakers should be aware of occupational hazards for nurses, including pregnant nurses, and support workplace modifications. Future research should focus on assessing the prevalence of these hazards, the longitudinal impact of exposures that can lead to negative consequences for nurse and fetal health, and reducing the risk of exposure to these hazards for pregnant nurses.

TWEETABLE ABSTRACT

RNs described a variety of occupational hazards of working while pregnant and postpartum. Inconsistent ability to modify work to protect self and baby leads to completing work demands known to be hazardous.

Nursing colonialism in America: Implications for nursing leadership

The purpose of this paper is to explore the nurse leader's role in understanding the impact of American colonialism - specifically racism, a product of colonialism - as a key determinant in shaping the education of nursing students and its influence on practicing nurses. American values have been grounded in its colonialism and continue to be influential in shaping beliefs, attitudes, behaviors, and policies within the United States. Like racism, American colonialism depends on its perceived death for its survival - this is its paradox. Historic roots of the nursing profession evolved within this context of American colonialism which has shaped the lens of individuals who are the leaders and practitioners in our profession. Therefore, it is important to examine strategies that challenge and decolonize the nursing profession and to become an accomplice, clarifying and addressing inclusion/exclusion in our profession's leadership machine including: hiring/promotion practices, confrontation of White silence, critiquing design and dissemination of knowledge development, and fostering widespread change in nursing education/curriculum. Understanding the invisible internalization and manifestation of racism within our profession must be addressed if we are to advance the integrity and quality of education and practice in the nursing profession and to promote equity of healthcare among all individuals in the United States.

Equity in nursing care: A grounded theory study

BACKGROUND:

Equity in providing care is also a major value in the nursing profession. Equitable care aims to provide the entire population with safe, efficient, reliable, and quality nursing services at all levels of health.

OBJECTIVES:

This study was conducted to explain the process of the realization of equity in nursing care.

RESEARCH DESIGN:

This qualitative study uses Glaser's approach to grounded theory.

PARTICIPANTS AND RESEARCH CONTEXT:

Sample selection began with convenience sampling and continued with purposive sampling. A total of 27 people were ultimately selected as the study subjects. Data were mainly collected through unstructured in-depth individual interviews plus observation and field notes. The data were then analyzed using the "Six C's" coding family of Glaser.

ETHICAL CONSIDERATIONS:

The study protocol was approved by the Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all subjects.

FINDINGS:

According to the findings, participants' main concern in providing equitable care is the rationing of nursing care. The identification of participants' main concern led to the emergence of the core category of the study, that is, "nurses' domination." The other categories revolving around the core category were conceptualized according to the six C's coding family: "nurses being dominated," "nurses' ineffective power in the health system," "low attention to equitable care in health system," "lack of clarity in measuring equitable care," "the health structure's inconsistency with equity," and "the inefficiency of the care system."

CONCLUSION:

There is a mutual relationship between providing fair care and nurses' perceptions of equity. Nurses who have themselves experienced equity can provide their patients the experience of equity. This mutual relationship is actualized in a context in which fair care is clearly defined and demanded.

Professionalism and Occupational Well-Being: Similarities and Differences Among Latin American Health Professionals

Context: Empathy, teamwork, and lifelong learning are described as key elements of professionalism. The first recipients of their benefits are professionals themselves. Paradoxically, scarce studies have reported association between professionalism and occupational well-being. The main purpose of this study was to characterize the influence that empathy, teamwork, and lifelong learning, play in the occupational well-being of physicians and nurses working in Latin American healthcare institutions. Materials and Methods: The Jefferson Scale of Empathy, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, the Jefferson Scale of Physicians Lifelong Learning, and the Scale of Collateral Effects (somatization, exhaustion, and work alienation), were administered to 522 physicians and nurses working in institutions of Mexico, Colombia, Ecuador, and Argentina. Internal reliability was calculated. Gender and discipline were used as explanatory variables in comparison analysis. Two-way analysis of variance was performed to examine differences due to the main effects of the gender, and discipline, and to determine possible combined effects. Correlation analysis was performed to measure associations between collateral effects and age, and between collateral effects and professionalism. Results: A total of 353 (68%) surveys were returned fully completed. Adequate reliability was confirmed in all instruments. No differences were found among countries for collateral effects. Correlation analysis confirmed in physicians an inverse association between empathy and collateral effects (P = -0.16; p < 0.05), and between collateral effects and lifelong learning (P = -0.18; p < 0.01). In nurses, this association was confirmed only for empathy (P = -0.19; p < 0.05). Important differences in the development of professionalism and in its effects on occupational well-being appeared associated to inter-professional collaboration and work roles. An inverse correlation between age and collateral effects was confirmed in physicians (P = -0.22; p < 0.001) and in nurses (P = -28; p < 0.001). Comparison by gender confirmed higher somatization in women physicians and nurses than in men groups (p < 0.001). On the other hand, comparison by discipline confirmed higher exhaustion and alienation in physicians than in nurses (p < 0.01). Conclusion: The findings support the importance that empathy, teamwork, and lifelong learning have in practitioners' health and welfare, and the role that cultural behaviors, associated to work professional models and social stereotypes, play in the interaction between professionalism and occupational well-being.