Secondary emotional labor: How female nurses respond to the contradictions of caring.

Prior research suggests that caring is in tension with a financially incentivized, technologically-driven healthcare system. Nevertheless, employers, the public, and nurses expect nurses to be caring when providing care to patients and families. This article focuses on nurses' emotional labor strategies when managing emotions related to organizationally imposed interference with caring. We analyzed 27 semi-structured interviews with nurses and found that the unsuccessful performance of emotional labor spills over into the women's relationships at and outside of work. We apply Di-Cicco-Bloom and DiCicco-Bloom's concept of secondary emotional labor to examine our findings and how secondary emotional labor further develops the alienation and exploitation concepts of Hochschild's emotional labor theory. We suggest a structural change in nurses' job design that remedies contradictory caring expectations and supports their emotional labor to prioritize a climate of caring for patients.

Caring as a scripted discourse versus caring as an expression of an authentic relationship between self and other.

As health care has become increasingly complex, the human caring associated with nursing has become eclipsed by financial bottom lines and managed care initiatives. Because patients and others expect a caring health care system, hospitals have responded in varying ways to re-infuse caring into the patient's experience. This article examines two approaches (the Jean Watson Caring Science Approach and the Studer Group Approach) and considers the effect of each on the authenticity of the nurse patient relationship.

Expanding the scope of psychiatric nursing practice: devaluing the essence of psychiatric nursing?

Psychiatric Nurse Practitioners are quickly becoming sought after employees, especially in public mental health systems where a shrinking number of psychiatrists necessitate alternate access to prescribers. In addition, new guidelines necessitate greater attention to the follow up and monitoring of the medical problems of psychiatric patients. These events are occurring in the midst of declining reimbursement and rising litigation concerns in psychiatry. At the same time there is an increased focus on a recovery orientation to psychiatry alongside the primacy of psychotropic medicine as the most cost effective treatment, which can become competing aims for practitioners. It is important for psychiatric nurses and psychiatric nurse practitioners to consider how these opportunities might also have a negative impact on the core foundation of psychiatric nursing.

Interactional influence of fatigue and task difficulty on cardiovascular response: demonstrations involving an aerobic exercise challenge.

Experiments were executed to provide new evidence relevant to the recent suggestion that fatigue should augment or retard cardiovascular response depending on the difficulty of the challenge at hand. Participants walked on a treadmill while wearing a vest fitted with 5 or 25 pounds of weight. Later, they mounted a recumbent stationary bicycle and were asked to pedal with the chance to earn a modest incentive if they attained a low or high cycling standard (i.e., if they met an easy or difficult cycling challenge). Analysis of CV responses during the cycling period indicated expected interactions for systolic blood pressure and heart rate. Whereas responses were stronger for the Heavy-Vest (i.e., high-fatigue) group when the standard was low, they were weaker for this group when the standard was high. Experiments 2 and 3 evaluated a nonfatigue interpretation of the main results and yielded findings that supported the fatigue interpretation.

"She took the time to make sure she understood": mental health patients' experiences of being understood.

The foundation of psychiatric/mental health nursing is the relationship between nurse and patient. Caring for persons with mental illness within the context of this relationship requires knowledge of the individual. To gain this knowledge, understanding the patient's perceptions and concerns is essential. Research suggests that this understanding does not always occur. The study reported here examined what it means to individuals with mental illness to be understood. In-depth phenomenological interviews revealed three predominant themes: "I was important," "it really made us connect," and "they got on my level." Nurses can use these findings to improve the care of those with mental illness.

The interpretive research group as an alternative to the interpersonal process recording.

In the spirit of trying something new, we abandoned the traditional interpersonal process recording for an entirely new way to teach students about communication--an interpretive research group. We propose the interpretive research group as a strategy for teaching communication and analysis that encourages active student-faculty participation, provides for more egalitarian student-teacher relationships, and creates a liberating learning environment.

Facilitating communication: how to truly understand what patients mean.

1. Patients experience greater satisfaction with nursing care when they are truly understood. 2. Being aware of taken-for-granted meanings and committing the time to seek clarification and explore meanings are two basic principles that can facilitate understanding. 3. Techniques nurses can use to facilitate understanding include restating what was heard to ensure understanding and to demonstrate active listening, asking open-ended questions, and checking for understanding.

"It's the people that make the environment good or bad": the patient's experience of the acute care hospital environment.

A review of contemporary nursing research reveals a tendency to focus on select aspects of the hospital environment such as noise, light, and music. Although studies such as these shed light on discrete aspects of the hospital environment, this body of literature contributes little to an understanding of the entirety of that world as the patient in the sickbed experiences it. The purpose of the study detailed in this article was to describe the patient's experience of the acute care hospital environment. Nondirective, in-depth phenomenological interviews were conducted, then transcribed verbatim, and analyzed for themes. Against the backdrop of "I lived and that's all that matters," there were 3 predominant themes in patients' experience of the acute care environment: (1) disconnection/connection, (2) fear/less fear, and (3) confinement/freedom. In this environment, human-to-human contact increased security and power in an environment that was described as sterile, disorienting, and untrustworthy. Acute and critical care nurses and other caregivers can use the findings to create less noxious hospital environments.

The Recruit assessment Program: a program to collect comprehensive baseline health data from U.S. military personnel.

Pilot testing has begun on the Recruit Assessment Program (RAP). The RAP is a proposed Department of Defense (DoD) program for the routine collection of baseline demographic, medical, psychosocial, occupational, and health risk factor data from all U.S. military personnel at entry into the armed forces. The RAP currently uses an optically scannable paper questionnaire, which will provide data for the first building block of an electronic medical record within the DoD and the Department of Veterans Affairs. The RAP will serve several important functions, including automating enrollment into the military health care system, improving patient care and preventive medicine efforts, and providing critical data for investigations of health problems among military personnel and veterans. If the feasibility of the RAP is demonstrated and the program is fully implemented throughout the DoD, it could provide a substantial improvement in health care delivery. For the first time, DoD and Department of Veterans Affairs physicians, public health officers, and researchers will have access to comprehensive baseline health status data.