Understanding how nurse managers see their role in supporting ICU nurse well-being-A case study.

AIM: To explore how nurse managers perceive and experience their role in supporting the well-being of intensive care nurses. BACKGROUND: While it is known that nurse manager behaviours affect nurse well-being, literature indicates that intensive care nurses may not receive the support they require. Understanding how nurse managers see their role in supporting nurse well-being is crucial to offer recommendations for improvement. METHODS: Qualitative multiple case study design. Twelve semi-structured, in-depth interviews were conducted with nurse managers from Australian intensive care unit settings. Data were analysed using thematic analysis. RESULTS: Nurse manages felt unsure about what their supportive role involved, lacked training on how to support nurse well-being and called for organisational backup to carry out their role effectively. The study also provided insight into the strategies that enabled nurse managers to support nurse well-being. CONCLUSION: There is currently no consensus on the role of the nurse manager in supporting nurse well-being resulting in inconsistencies and wide practice variations. Furthermore, nurse managers need support and training if they are required to support nurse well-being. IMPLICATIONS FOR NURSING MANAGEMENT: A clear definition of the nurse manager supportive role describing the purpose and core functions involved in this role must be developed to support nurse well-being.

The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review.

INTRODUCTION: The number of patients requiring admission into intensive care units (ICUs) is increasing worldwide. Concurrently, recruitment and retention of the ICU nursing workforce is becoming a major challenge due to the high intensity environment, heavy workloads, and decreasing nurse wellbeing. Nurse unit managers play a vital role in promoting and supporting ICU nurse wellbeing, yet little is known about perceptions and experiences of this role. OBJECTIVES: To examine the perceived and experienced role of the nurse unit manager in supporting the wellbeing of ICU nurses. REVIEW METHODS: A comprehensive review of the literature was undertaken using Whittemore and Knafl's five stage approach: (i) problem identification, (ii) literature search, (iii) quality appraisal, (iv) data analysis, and (v) presentation of findings. DATA SOURCES: The following databases were searched for literature published between January 2007 and December 2017: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Informit, Joanna Briggs Institute Library of Systematic Review, ProQuest, PubMed, Scopus, and Wiley online library digital databases. Variations and synonyms of key words included: nurse unit manager, ICU, compassion fatigue, burnout, stress, job satisfaction, bullying, wellbeing, and work environment. RESULTS: Rigour and trustworthiness of the included studies were assessed using the Critical Appraisal Skills Program qualitative research checklist,71 a modified Critical Appraisal Skills Program Cohort study checklist for quantitative research,72 and the Mixed Methods Appraisal Tool for mixed-method studies.73 The critical review guidelines by Shenton74 and Polit and Beck75 were also used to make judgements about the worth of the evidence. All of the 11 qualitative studies provided moderate to strong evidence. The overall quality of the quantitative studies was lower, with three of seven studies providing only adequate evidence. The majority of the 19 included studies represented the voices of ICU nurses. Three major themes emerged from the analysis; '1) building professional relationships', '2) leading the way' and '3) satisfying the needs of ICU nurses'. CONCLUSION: Nurse unit manager behaviours clearly affect the wellbeing of ICU nurses. However, the role of supporting ICU nurses is complex and challenging. More research is needed to investigate the needs of ICU nurses and the facilitators and barriers nurse unit managers face when supporting the wellbeing of nurses in their unit.

Can Nursing Students Practice What Is Preached? Factors Impacting Graduating Nurses' Abilities and Achievement to Apply Evidence-Based Practices.

BACKGROUND: In order to meet national Australian nursing registration requisites, nurses need to meet competency requirements for evidence-based practices (EBPs). AIMS: A hypothetical model was formulated to explore factors that influenced Australian nursing students' ability and achievement to understand and employ EBPs related to health care provision. METHODS: A nonexperimental, descriptive survey method was used to identify self-reported EBP efficacy estimates of 375 completing undergraduate nursing students. Factors influencing participants' self-rated EBP abilities were validated by Rasch analysis and then modeled using the partial least squares analysis (PLS Path) program. RESULTS: Graduating nursing students' ability to understand and apply EBPs for clinical improvement can be directly and indirectly predicted by eight variables including their understanding in the analysis, critique and synthesis of clinically based nursing research, their ability to communicate research to others and whether they had actually witnessed other staff delivering EBP. LINKING EVIDENCE TO ACTION: Forty-one percent of the variance in the nursing students' self-rated EBP efficacy scores is able to be accounted for by this model. Previous exposure to EBP studies facilitates participants' confidence with EBP, particularly with concurrent clinical EBP experiences.

Experiences of registered nurses who supervise international nursing students in the clinical and classroom setting: an integrative literature review.

AIMS AND OBJECTIVES: To examine the literature reporting the experiences and perceptions of registered nurses who supervise international nursing students in the clinical and classroom setting. BACKGROUND: Nursing education relies on clinical experts to supervise students during classroom and clinical education, and the quality of that supervision has a significant impact on student development and learning. Global migration and internationalisation of nursing education have led to increasing numbers of registered nurses supervising international nursing students. However, a paucity of relevant literature limits our understanding of these experiences. DESIGN: An integrative literature review. METHODS: Comprehensive database searches of CINAHL, Informit, PubMed, Journals@Ovid, Findit@flinders and Medline were undertaken. Screening of 179 articles resulted in 10 included for review. Appraisal and analysis using Whittemore and Knafl's (Journal of Advanced Nursing, 52, 2005, 546) five stage integrative review recommendations was undertaken. RESULTS: This review highlighted some unique challenges for registered nurses supervising international nursing students. Identified issues were, a heightened sense of responsibility, additional pastoral care challenges, considerable time investments, communication challenges and cultural differences between teaching and learning styles. CONCLUSION: It is possible that these unique challenges could be minimised by implementing role preparation programmes specific to international nursing student supervision. Further research is needed to provide an in-depth exploration of current levels of preparation and support to make recommendations for future practice, education and policy development. RELEVANCE TO CLINICAL PRACTICE: An awareness of the specific cultural learning needs of international nursing students is an important first step to the provision of culturally competent supervision for this cohort of students. There is an urgent need for education and role preparation for all registered nurses supervising international nursing students, along with adequate recognition of the additional time required to effectively supervise these students.

Torn between dual roles: the experiences of nurse-family members when a loved one is hospitalised in a critical condition.

AIMS AND OBJECTIVES: To understand and interpret the experiences of nurse-family members when a family member or loved one is hospitalised in a critical condition. BACKGROUND: Having a family member hospitalised with a critical illness is a traumatic stressor, often with long-term sequelae. Providing holistic care for family members who are also nurses makes the provision of care more complex because of their professional expertise; yet few studies have explored this issue. DESIGN: In this descriptive study, qualitative data were collected using a questionnaire and analysed using van Manen's (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990, State University of New York Press, London, ON) six-step approach. METHODS: Twenty nurse-family members completed an online questionnaire in June 2013. Qualitative findings from 19 participants were included in the analysis. The phenomenological analysis approach described by van Manen (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990, State University of New York Press, London, ON) was used to describe and interpret nurse-family member experiences. RESULTS: Nurse-family members experience significant dual role conflicts between their personal and professional personas due to their specialised knowledge, need for watchfulness and competing expectations. Our findings describe how dual role conflicts developed and were managed, and reveal the resultant emotional toll and psychological distress as nurse-family members struggled to resolve these conflicts. CONCLUSIONS: Nurse-family members require a different type of care than general public family members, yet their unique needs are often unmet, leading to increased anxiety and distress that could potentially be minimised. An increased awareness and emphasis on the nurse-family member experience can ensure health care professionals are better placed to provide appropriate and targeted care to minimise distressing dual role conflicts. RELEVANCE TO CLINICAL PRACTICE: There is a need for targeted and specialised communication appropriate to each nurse-family members' needs and level of understanding, and to clarify expectations to ensure nurse-family members' professional knowledge and skills are recognised and respected without being exploited.

Nurses' experiences of the hospitalisation of their own children for acute illnesses.

BACKGROUND: The hospitalisation of a child is a stressful event for parents. Parents who are also nurses may face additional challenges not encountered by other parents; yet, scant attention has been given to this issue in the literature. AIM: To explore the experiences of Nurse-Parents whose children were hospitalised for acute illnesses. METHODS/DESIGN: Using a case-study design, semi-structured interviews were conducted with six registered nurses and thematically analysed. RESULTS/FINDINGS: Nurse-Parents experienced significant conflicts between their parental role and nurse persona as they were 'torn between dual roles'. Nurse-Parents' specialised knowledge prompted them to elevate the care their child needed, leading to increased stress and anxiety as they struggled to balance these roles. CONCLUSION: Nurse-Parents want and need a different type of input into their children's care than non-nurse-parents. An increased awareness among healthcare professionals is the first step to ensuring that effective and individualised support is provided to Nurse-Parents.

Qualitative systematic review: the unique experiences of the nurse-family member when a loved one is admitted with a critical illness.

AIM: To interpret and synthesize nurse-family member experiences when a critically ill loved one is admitted to hospital. BACKGROUND: Having a family member hospitalized in a critical condition is an important stressor. When the family member is also a nurse, the provision of care is more complex, yet little research exists on this issue. DESIGN: Systematic review using Thomas and Harden's approach to thematic synthesis of qualitative research. DATA SOURCES: Primary studies were located by searching CINAHL, Proquest, Journals@Ovid, SCOPUS, Cochrane Library and Google Scholar. No date restrictions were applied due to a lack of relevant literature. All studies that met inclusion criteria were retrieved (n = 1717) and seven met the review aim. REVIEW METHODS: Following critical appraisal, seven studies from 1999-2011 describing the nurse-family member's experience were reviewed and synthesized. RESULTS: Six characteristics of the nurse-family member experience were identified: specialized knowledge; dual-role conflicts; competing expectations; building relationships; being 'let in'; and healthcare setting. CONCLUSION: Nurse-family members experience important stressors that can negatively affect their psychological health and experience as a healthcare consumer. Nurse-family members want a different type of care than other healthcare consumers. Acknowledging nurse-family members' specialized knowledge and dual role, keeping them fully informed and allowing them to be with the patient and feel in control can reduce their fear and anxiety. Further research is needed to develop a deeper understanding of the unique experiences, challenges and needs of nurse-family members to provide them with an enhanced level of care.

Nurses' perceptions and experiences of caring for patients who die in the emergency department setting.

INTRODUCTION: The number of people dying in emergency departments (EDs) is increasing. However, EDs are not well designed or resourced for safe and effective End-Of-Life (EOL) care encounters, and there is little evidence regarding clinicians' perceptions and experiences of providing such care when the death is sudden and unexpected. AIM: This study explored nurses' perceptions and experiences of caring for patients who die suddenly and unexpectedly in the ED. METHODS: Open-end responses were collected as part of a larger descriptive survey design. The qualitative data were analysed thematically. RESULTS: 211 ED nurse completed the online survey. Within the qualitative data, five themes were identified during analysis: 1) key elements of EOL care, 2) systemic and environmental barriers, 3) educational deficits, 4) role ambiguity, and 5) emotional impact. Participants identified communication, a standardised approach, and better educational preparedness as the most important elements of EOL care when the death was sudden and unexpected. CONCLUSIONS: ED nurses want to provide high quality care to dying patients and their families. However, their efforts are hampered by systemic and environmental barriers outside their control. There is a need for a culture shift to overcome the barriers that currently obstruct ED nurses from providing meaningful and effective EOL care in the ED.

Coding, Constant Comparisons, and Core Categories: A Worked Example for Novice Constructivist Grounded Theorists.

Grounded theory method has been described extensively in the literature. Yet, the varying processes portrayed can be confusing for novice grounded theorists. This article provides a worked example of the data analysis phase of a constructivist grounded theory study that examined family presence during resuscitation in acute health care settings. Core grounded theory methods are exemplified, including initial and focused coding, constant comparative analysis, memo writing, theoretical sampling, and theoretical saturation. The article traces the construction of the core category "Conditional Permission" from initial and focused codes, subcategories, and properties, through to its position in the final substantive grounded theory.

Nursing students' perceptions regarding the amount and type of written feedback required to enhance their learning.

Effective feedback can enhance student learning, but limited evidence exists on whether nursing students actually use and learn from written feedback. This descriptive survey explored nursing students' perceptions regarding the amount and type of written feedback required to enhance their learning. In stage one, 362 students completed a 28-item questionnaire regarding feedback experiences and preferences; in stage two, 227 students selected a preferred feedback option for a final topic assignment. Findings revealed that many of the students wished to be engaged with the feedback process and believed effective written feedback can and does enhance their learning. However many students also reported learning barriers-including absent, inadequate, ambiguous, inconsistent, and ineffective feedback-indicating a significant disconnect between desired and actual feedback. Recommendations include a greater focus on engaging nursing students in the feedback process and evaluating the effectiveness of written feedback for individual students.