Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study.

AIM: To describe nurses' and specialist nurses' experiences of moral distress and how it affects daily work in surgical care. DESIGN: A qualitative descriptive study design was used. METHODS: A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis. FINDINGS: Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care. CONCLUSIONS: The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk. IMPACT: Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution.

Better Together: Collaboration to Enhance the Nursing Workforce.

Nursing is a demanding profession that calls for nurses to devote time, energy, advocacy, and compassion to improving clients' lives while providing safe, efficient care. Nurses make personal sacrifices to meet their clients' needs, which do not come without costs to their well-being. An increased migration of novice nurses out of the profession and the need to increase the volume of the nursing workforce by an average of 8% annually to address the projected nursing shortage presents a compelling need for immediate action. Reimagining the concept of academic-service partnerships to provide exposure to opportunities that can equip and empower novice nurses as they emerge into professional practice cannot be underestimated. Implementing approaches to assess, support, and nurture the health and well-being of nurses and health care organizations is foundational to retention.

Nursing is not like organised crime: A theoretically informed commentary.

AIM: This article aims to contest misrepresentations and distortions of sociological writings on the nursing profession. BACKGROUND: During the latest ICN congress in Montreal, it has been suggested that professions, and the nursing profession for that matter, are thought of by sociologists in a similar way as organised crime, meaning that it is like a 'money sponge' sucking resources out of society, without however giving anything in return. Allegedly, there would be a distinct branch of sociology depicting the professions in this light. DISCUSSION: By sketching out relevant sociological ideas, including the sociology of nursing, I explain that there is no tradition portraying the professions as mafias. I demonstrate that while both the professions and organised crime are socially organised, they are radically different in legitimacy. The caring professions are themselves different in ethos from the classic professions, all the more so from criminal organisations. A distinct stream of research in sociology has been devoted to nursing, without however suggesting such an analogy. CONCLUSION: I lament that attendees to the ICN congress were indeed given an inaccurate representation of sociological thinking. Sociologists addressing nursing as a profession tend to highlight processes of emancipation, autonomy, vindication and social justice, as care work is essential to the broader socioeconomic order. IMPLICATIONS FOR NURSING POLICY: While nursing as a profession is socially organised, the power devices and tactics it deploys in the sociopolitical arena are characterised by their legitimacy. Unlike organised crime, nursing policymaking is situated within a framework of lawfulness, fairness and transparency.

A Comparison of the 2023 Magnet® Manual and the 2020-2030 Future of Nursing Report.

The Magnet Recognition Program® completed a crosswalk between the National Academy of Medicine (NAM) recommendations in the 2020-2030 Future of Nursing report and the recently released 2023 Magnet Application Manual. In comparing the 2 documents, it was determined the Magnet® framework aligns with several of the NAM recommendations. Both the NAM and Magnet program emphasize health equity and diversity in patient care, education, and nurse wellness. In this column, one can learn how both documents establish guidelines for empowering the nursing profession as the primary means to improving health equity and outcomes for the 21st century.

Phlebological compression bandaging competence: comparing performance of nurses before and after one-off training.

OBJECTIVES: To investigate the differences in applying phlebological compression bandaging (PCB) in nurses before and after one-off training, and to compare the performance of subgroups. METHODS: Participants received training teaching the correct application of PCB. Participants' competence was measured using the newly developed control score of compression bandaging (CCB score) before and after training, one and three months later. Subgroup analyses compared participants (work setting, wound certification, PCBs applied per week). RESULTS: In total, 47 participants took part (mean age 40.7 years, 85.1% female, 59.6% outpatient nurses, 59.6% >10 years' working experience, 55.3% with a wound certificate). The CCB score improved after training. In all subgroups, the score differed significantly over time (p≤0.002 in all cases) except for participants applying the highest number of PCBs (p=0.241). In hospital-based participants, the CCB score three months after training was considerably, but non-significantly, higher than before training (2.84 versus 4.21, respectively; p=0.068). In participants working in outpatient settings, with and without a wound certificate, and applying a low (<5) and medium (5-10) number of PCBs per week, the CCB score remained significantly higher than before training (p≤0.011 in all cases). CONCLUSION: All subgroups benefited from training, mostly significantly, and maintained gains in competence for three months. Frequently applying these skills may improve performance. Previously published results showed that ideal pressure-related parameters are rarely achieved. Regular training should be offered, including the use of pressure-measuring devices, allowing nurses to gain experience and develop deeper understanding of correct PCB application.

A Review of Exoskeletons Considering Nurses.

Daily tasks of nurses include manual handling to assist patients. Repetitive manual handling leads to high risk of injuries due to the loads on nurses' bodies. Nurses, in hospitals and care homes, can benefit from the advances in exoskeleton technology assisting their manual handling tasks. There are already exoskeletons both in the market and in the research area made to assist physical workers to handle heavy loads. However, those exoskeletons are mostly designed for men, as most physical workers are men, whereas most nurses are women. In the case of nurses, they handle patients, a more delicate task than handling objects, and any such device used by nurses should easily be disinfected. In this study, the needs of nurses are examined, and a review of the state-of-the-art exoskeletons is conducted from the perspective of to what extent the existing technologies address the needs of nurses. Possible solutions and technologies and particularly the needs that have not been addressed by the existing technologies are discussed.

The best of both worlds - entering the nursing profession with support of a transition programme.

BACKGROUND: Transition into clinical practice for newly graduated nurses is a difficult time, with high stress levels defined by a demanding period of personal and professional acclimatisation. Transitions are complicated and multi-dimensional, and to understand this process, it is crucial to identify the factors that facilitate or stand in the way of a healthy transition. AIM: The phenomenological study aimed to describe newly graduated nurses' expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme, including education, supervision, and critical reflection with peers. METHOD: The study was based on seven group interviews with newly graduated nurses. The interviews utilised open-ended and follow-up questions and were carried out as a dialogue to enable reflection on the phenomenon of interest. This was explored and illuminated using the reflective lifeworld research approach, based on phenomenological epistemology. FINDINGS: "Expectations of transition into the nursing profession via the Clinical Nursing Introduction Programme" is signified by an oscillating movement between uncertainty, security, challenge, and growth on the threshold of a new identity. The phenomenon is constituted by the courage to grow, responsibility and fear, belonging and vulnerability, and support and challenge. CONCLUSION: Transitioning into the nursing profession via the Clinical Nursing Introduction Programme means having the best of both worlds. Newly graduated nurses have the opportunity to receive education and structured support at the same time as they work independently in clinical practice.

Nurses as agents of disruption: Operationalizing a framework to redress inequities in healthcare access among Indigenous Peoples.

Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma- and violence-informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing framework of equity-oriented care for primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma- and violence-informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice.

Nurse staffing in large general hospitals in China: an observational study.

BACKGROUND: The appropriate staffing of nurses not only reflects the situation of nursing management of human resource, but also is related to the nursing quality in hospitals. This study investigated the staffing of nurses in large general hospitals in China. METHODS: In this study, a database established by the National Centre for Nursing Care Quality Control, which conducted a national survey of the staffing of nurses in China mainland in 2017, was analysed. The time-point survey data of 20 375 departments in 668 large general hospitals in China were obtained, including the information of nurses and patients during the day (10:00 am) and at night (10:00 pm). Then, the staffing of nurses was evaluated by calculating the nurse to patient ratio (the average number of patients assigned to a nurse, NTP ratio). The Kruskal-Wallis test was performed to compare the NTP ratios during the day and at night among different regions and departments. RESULTS: In large general hospitals, a nurse takes care of eight patients (NTP ratio = 1:8.0) during the day and 23 patients at night (NTP ratio = 1:23) on average. There were significant differences between day and night. In terms of different regions, a nurse in the hospitals in the western region takes care of 7.8 patients during the day (NTP ratio = 1:7.8) on average, and the nursing resource in the western region is more adequate than that in the eastern (1:8.0) and central (1:8.0) regions. At night, the eastern region has a higher level of NTP (1:23.0). In terms of departments, a nurse working in the ICU takes care of two patients during the day (NTP ratio = 1:2.0) and 2.9 patients at night (NTP ratio = 1:2.9). The level of NTP in the oncology department is relatively higher: 9.3 during the day and 34.0 at night. Other departments including internal medicine, surgery, obstetrics and gynaecology, paediatrics, and geriatrics have NTP ratios of 1:7-8 during the day and 1:18-25 at night. CONCLUSIONS: In China, the nurse staffing of large general hospitals has some regional and departmental patterns. The low level of nurse staffing at night may be a problem worthy of attention; the Chinese government needs to establish standards for different periods and departments to improve efficiency and quality of nursing.

"What a nurse suffers": Care left undone in seventeenth-century Madrid.

Care left undone, interchangeably referred to as missed care, unfinished nursing care and task incompletion, is pervasive in contemporary healthcare systems. Care left undone can result in adverse outcomes for the patient, nurse and organization. The rhetoric that surrounds care left undone infers it is a contemporary nursing phenomenon; however, a seventeenth-century Spanish nursing treatise, Instruccion de Enfermeros (Instructions for Nurses), challenges this assumption. Instruccion de Enfermeros was an instructional guide that was written for members of the Congregation of Bernardino de Obregon who worked as nurses at the Madrid General Hospital. The treatise provides a historical commentary on the daily roles, responsibilities and working conditions of the Obregonian nurses. Its content and context suggest the Obregonian nursing resource was consistently time poor due to a confluence of internal and external stressors. Consequently, the Obregonians were under considerable role strain resulting in inferior patient care. This article explores the antecedents of care left undone through a historical lens using exemplars from the 1625 edition of Instruccion de Enfermeros. Factors contributing to care left undone in Obregonian nursing will then be examined to offer insights into the similarities between what a nurse suffered 400 years ago and what exists in contemporary nursing practice.

BJN Awards 2019: Nurse of the Year-runner up.

Kairen Griffiths, Cystic Fibrosis Nurse Specialist, NHS Grampian, discusses her role caring for people with cystic fibrosis and why she feels lucky to have worked in this field for over two decades.

Nurses deserve to be honoured in the NHS Parliamentary Awards.

Emeritus Professor Alan Glasper, University of Southampton, explains why nurses should be among those recognised in the 2019 NHS Parliamentary Awards that reward staff who have made a difference to patient care.

Reflections on a methodology for analyzing professional practice and its possible use in nursing.

In order for nursing work not to become mechanistic, the team needs to develop a critical eye to its knowledge, its know-how and its know-to-be. The training of nursing professionals from a critical and reflective perspective motivated this study, which was based on the theoretical reference and the experience of the authors with use of the analytical methodology of the Groupe Entraînement de Analyze de Situations Éducatives (Training Group to Analyze Educational Situations) professional practice. This methodology aims to analyze professional situations in a group with the presence of a facilitator. The objective is to analyze the contributions of the Groupe Entraînement de Analyze de Situations Éducatives to train reflective professionals in nursing. The steps, rules of operation and the role of the participants are explained in order to promote a safe environment for all, enabling group members to develop hypotheses to understand the situation and develop analysis and reflection skills. It is concluded that this methodology offers the opportunity to open a space for reflective thinking, respecting the different roles and times intended for the speech of each participant, building their professional identity.

[The expertise of medical nurse care as a basis of medical care quality management].

The strategy focused on activating and strengthening human resources, including nurses, is extremely relevant in the modern health care of the Russian Federation. In this regard, the issue of the medical organization performance provides an emphasis on the problem related to the status of medical personnel, which is especially significant in the context of the need to implement new approaches and innovative management techniques. The purpose of study is to develop an expertise system for quality evaluation of nursing care. Three available approaches were applied: structural, procedural and end-point estimation. The structural approach was based on the quality indicators of the professional competence of nurses, their accreditation and certification, as well as personal qualities that determine the level of organizational culture and self-discipline. The procedural approach was based on the assessment of the technological processes carried out by nurses, consistency, timeliness and adequacy of their accomplishment. The result assessment approach was based on evaluation of the degree of compliance of the actual results achieved with the approved normative value. The article presents the elaborated genuine model of quality assessment, which allows to evaluate objectively all areas of the nurse's professional activities, taking into account the proposed criteria to identify defects that influence the performance efficiency of the nurse; to determine the factors influencing the level of patient satisfaction with medical care, which resulted in the development a quality management system for nursing care, allowing to evaluate the resources, the technological process and the final result of nursing care.

Institutional effects on nurses' working conditions: a multi-group comparison of public and private non-profit and for-profit healthcare employers in Switzerland.

BACKGROUND: In response to the need for competitive recruitment of nurses resulting from the worldwide nursing shortage, employers need to attract and retain nurses by promoting their competitive strengths in their working conditions (WCS) and by addressing their competitive weaknesses. This study investigated workplace differences between public hospitals (PuHs), private for-profit hospitals (PrHs), socio-medical institutions (SOMEDs), home care services (HCs), private medical offices (PrOs) and non-profit organisations (NPOs), helping to provide a foundation for competition-oriented institutional employer branding and to increase transparency in the labour market for nurses. METHODS: Data from the Swiss Nurses at Work study of the career paths of 11 232 nurses who worked in Switzerland between 1970 and 2014 were subjected to secondary analysis, assessing the effect of institutional characteristics on self-reported determinants of job satisfaction (such as WCS) using multivariate linear regression and post hoc tests with Bonferroni-adjusted significance levels. Principal component analysis was used to reduce the number of WCS in the original study. RESULTS: Nurses at PuHs and PrHs were less likely to experience autonomy, flexibility of work hours and participation in decision-making than those at other workplaces. Although PuHs were rated higher than PrHs in terms of satisfaction with salary and advancement opportunities, they were associated with more alienating work factors, such as stress and aggression. SOMED workplaces were significantly more often associated with alienating conditions and low job satisfaction, but were rated higher than the other institutions in terms of participation in decision-making. The nurses' ratings implied that PrO workplaces were more likely to offer a mild work environment, social support and recognition than other institutions, but that advancement opportunities were limited. NPO workplaces were associated with the highest degree of autonomy, flexibility, participation, recognition, organisational commitment and job satisfaction. In these respects, HC and NPO workplaces received similar ratings, although the HC workplaces were associated with a significantly lower organisational commitment and significantly lower job satisfaction. CONCLUSIONS: Due to their structural characteristics, NPOs, SOMEDs and HCs can attract nurses seeking greater self-determination, PuHs can attract career-oriented nurses, and PrOs and PrHs are likely to attract nurses through offering less-stressful working conditions.