Nurses' experiences of busyness in their daily work.

The purpose of this study is to explore and illuminate the phenomenon of busyness as experienced by nurses. The daily work of nursing practice is often characterized by a hectic pace in the execution of tasks. Previous research shows that busyness can potentially lead to a reduction in the quality of nursing. Little has been explored about nurses' own experiences of busyness. This study has a qualitative design. The method chosen is a phenomenological hermeneutical exploration of personal experiences. Results reveal that busyness is experienced as a disparity between perceived necessary tasks and time available to accomplish them. Busyness has an outer dimension of events and a dimension of internal processes. Busyness is experienced as acceptable to some extent, but feels strongly uncomfortable if important tasks remain undone. The intolerable busyness raises negative emotions, steals energy and weakens health. Coping with busyness seems to be a personal and individual struggle, even though health service enterprises are a collective matter.

Ethical challenges related to next of kin - nursing staffs' perspective.

BACKGROUND: Patients in clinical settings are not lonely islands; they have relatives who play a more or less active role in their lives. OBJECTIVES: The purpose of this article is to elucidate the ethical challenges nursing staff encounter with patients' next of kin and to discuss how these challenges affect clinical practice. RESEARCH DESIGN: The study is based on data collected from ethical group discussions among nursing staff in a nursing home. The discussions took place in 2011 and 2012. The data were analysed and interpreted by using hermeneutic methodology. ETHICAL CONSIDERATIONS: All the data have been anonymised and handled with confidentiality. Written informed consent was obtained from all participants. FINDINGS: Ethical challenges relating to patients' next of kin were found to be an issue frequently discussed in the groups. Our findings indicate that next of kin have different characteristics, categorised as 'the professionals' and 'the shadows'. In this article, we will describe the next of kin's characteristics and the ethical challenges and practical implications that nursing staff experience in this connection. DISCUSSION: We will discuss the findings in the light of the four basic principles of medical ethics and propose interventions to help nurses manage ethical challenges related to next of kin. CONCLUSION: The study reveals the need to enhance nursing staffs' communicative and ethical skills on an individual level, but most importantly, to establish routines in clinical settings for informing and following up next of kin in a systematic and structured way.

The issue of being touched.

The purpose of this empirical paper is to shed light on the phenomenon of being touched in professional care practice. The study has a qualitative design and is a phenomenological hermeneutical exploration based on the story of a care provider. In her story, she describes how her interactions with a substance abuser touched her. The narrative data stems from dialogue with her colleagues and demonstrates a moral appeal and challenge in practical care. Investigations reveal that being touched is about allowing one's self to be awakened by the suffering of others. Being touched by others' suffering thus provides the ability "to see" what is at stake. Identifying with one's suffering and the awareness of what is at risk may be factors that "tip" a person's decision toward acting in the best interest of another person. Being touched may muster an individual's courage to engage in "risk-taking" actions in care. This process paves the way to care and represent essential practical knowledge for health care professionals.

Ethical challenges in everyday work with adults with learning disabilities.

BACKGROUND: Healthcare providers caring for learning-disabled individuals in institutions face challenges of what is right or wrong in their daily work. Serving this group, it is of utmost importance for the healthcare staff to raise awareness and to understand how ethical values are at stake. RESEARCH QUESTION: What ethical challenges are discussed among healthcare providers working with adults with learning disabilities? RESEARCH DESIGN: The study had a qualitative and investigative design. PARTICIPANTS AND RESEARCH CONTEXT: The study was conducted in a community institution for adults with learning disabilities. Participants were healthcare providers joining regular focused group discussions. Two groups participated and each group consisted of six participants. The conversations were taped and transcribed. ETHICAL CONSIDERATIONS: The study was reported to Norwegian Social Science Data Services and was approved by the regional ethics committee. FINDINGS: Findings are presented in four themes: (a) feeling squeezed between conflicting actions, (b) being the client's spokesman, (c) searching shared responsibility, and (d) expecting immediate and fixed solutions. The healthcare providers wanted to be the clients' advocates. They felt obliged to speak up for the clients, however, seeking for someone with whom to share the heavily experienced responsibility. Data likewise revealed that the group discussions created expectations among the healthcare providers; they expected smart and final solutions to the problems they discussed. DISCUSSION: The discussion focuses on everyday ethical challenges, the meaning of being in-between and share responsibility, and the meaning of ethical sensitivity. CONCLUSION: Ethical challenges can be demanding for the staff; they might feel squeezed in-between contradictory attitudes or feel alone in decision-making. Frequent conversations about ethical challenges do not solve the ethical problems here-and-now, but they do visualize them. This also visualizes the staff's need for support.

Ethical problems related to intravenous fluids in nursing homes.

BACKGROUND: Intravenous fluids and/or antibiotics are applied to only a limited extent in Norwegian nursing homes, and the patients are often sent to hospital in these situations. A transfer and a stay in hospital may be unnecessary strains for frail older patients. Given this background, a collaborative research project was initiated in a Norwegian county in 2009. A teaching programme was developed, which aimed to strengthen the awareness of ethics, assessments and practical procedures related to intravenous fluid and/or antibiotics among healthcare professionals. OBJECTIVES: This qualitative study aimed to increase our knowledge of the ethical problems experienced by nursing home nurses in situations related to the administration of intravenous fluids and/or antibiotics. RESEARCH DESIGN: An exploratory design was used, and five focus group interviews were conducted with 26 registered nurses. A hermeneutic analytic approach was applied. ETHICAL CONSIDERATIONS: This study was reported to the Norwegian Social Science Data Services in May 2010. The Regional Committee for Medical and Health Research Ethics approved the collaborative research project. FINDINGS: The analysis showed that the nurses experienced difficult decision-making situations, which were interpreted as external pressure and internal pressure. External pressure emerged in interactions with patients and relatives. Organizational factors were also interpreted as external pressure. Internal pressure was interpreted as the nurses' experience of feeling inadequate in situations where it was difficult to protect the dignity of patients. DISCUSSION: These findings correspond with international studies, which show that ethical problems often arise during decision-making situations. CONCLUSION: In agreement with the definition of an ethical problem, we found that the nurses experienced uncertainty and disagreements about how situations should be managed. External and internal pressures related to intravenous fluids and/or antibiotics in nursing homes have not been reported in previous studies. Thus, these findings merit further exploration.

Teaching and learning care--exploring nursing students' clinical practice.

Care has always been a key element of nursing. This paper presents findings from research on the following issue: What opportunities and limitations do nursing students encounter when learning nursing care? The study has a qualitative design with field methodology and the study of documents. Six nursing students have been closely monitored during their clinical studies in hospitals, nursing homes and home-based nursing. The study shows that nursing students are likely to possess the potential to provide care for sick and unknown people. The motivation for their commitment to patients may contain an egoistical orientation and runs contrary to former ideals of the nurse's self-sacrificing altruism. Moreover the study shows that there is a potential in the clinical field and in the university college to reflective considerations on experience of care. While clinical practice often has focus on practical problem-solving and procedures, the college tends to focus on abstract theory. Both of these promote the privatisation and neglect of the students' experience of care. The paper concludes with a call for teaching and learning strategies targeting the use of nursing students' personal experience of care.

Picture of Norwegian clinical learning laboratories for undergraduate nursing students.

Clinical preparation for practice is a vital part of undergraduate education in nursing. This study explored contemporary constructions of clinical skills laboratories in two nursing undergraduate programs in Norway using qualitative collective case study methods. Data were gathered using individual and group interviews and observation during site visits. The data revealed slightly different ways of organizing teaching and experimenting with use of pedagogical methods to facilitate learning of technical skills as well as encouraging students to activate relevant theoretical knowledge. While there was a lively and striking enthusiasm among staff about the way learning was managed within the laboratories, the pedagogical underpinnings for their particular approaches were less certain amongst participants. The paper concludes with the necessity to provide evidence for the outcome of laboratories learning and investigate suitable pedagogical methods for effective teaching and learning of practice skills. Hence, a need for research on transfer of knowledge and skills between the different sites (academy, clinical settings, and laboratories) is identified.