A longitudinal, mixed methods investigation of newly qualified nurses' workplace stressors and stress experiences during transition.

AIM: To investigate transition in newly qualified nurses through an exploration of their stressors and stress experiences during their first 12 months postqualifying. BACKGROUND: Globally, thousands of new nurses qualify annually. They are crucial for the profession and healthcare service delivery. Work-related stress has multiple serious consequences, yet there is a lack of robust, empirical evidence that directly analyses newly qualified nurses and the stress they feel and experience in the workplace. Understanding what causes newly qualified nurses' stress is vital to retaining and nurturing this vital component of the workforce. DESIGN: Longitudinal, explanatory sequential mixed methods, cohort study. METHODS: At the point of qualification (n = 288), 6 months postqualifying (n = 107) and 12 months postqualifying (n = 86), newly qualified nurses completed the Nursing Stress Scale, with 14 completing a one-to-one interview at 12 months postqualifying. Data were collected from 2010 - 2012. Inferential statistics, "thematic analysis" and "side-by-side comparisons in a discussion" were used for analysis. RESULTS: Workload was consistently the highest reported stressor with inadequate staffing and managing multiple role demands given as explanations. Incivility within the workplace was a noted stressor. Conversely, being part of "a good team" provided a civil, supportive, facilitative work environment. Entering nurse education with previous healthcare experience had a mediating effect on the reported frequency of stressors. CONCLUSIONS: Newly qualified nurses encounter multiple work-related stressors over their first 12 months postqualifying, which are intrinsically entwined with their transition. Employing organizations need to be more proactive in managing their workload and addressing workplace incivility.

Failing a student nurse: a new horizon of moral courage.

The factors preventing registered nurses from failing students in practice are multifaceted and have attracted much debate over recent years. However, writers rarely focus on what is needed to fail an incompetent pre-registration nursing student in their final placement. This hermeneutic study explored the mentor experience of failing a pre-registration nursing student in their final placement. A total of 19 mentors were recruited from 7 different healthcare organisations in both inner city and rural locations in the southeast of England. Participants took part in individual reflective interviews about their experience of failing a pre-registration nursing student in their final placement. These experiences were interpreted through a hermeneutic discovery of meaning. The new horizon of understanding which developed as a result of this research is framed within the context of moral stress, moral integrity and moral residue with the overall synthesis being that these mentors' stories presented a new horizon of moral courage.

Contemporary nursing wisdom in the UK and ethical knowing: difficulties in conceptualising the ethics of nursing.

This paper's philosophical ideas are developed from a General Nursing Council for England and Wales Trust-funded study to explore nursing knowledge and wisdom and ways in which these can be translated into clinical practice and fostered in junior nurses. Participants using Carper's (1978) ways of knowing as a framework experienced difficulty conceptualizing a link between the empirics and ethics of nursing. The philosophical problem is how to understand praxis as a moral entity with intrinsic value when so much of value seems to be technical and extrinsic depending on desired ends. Using the Aristotelian terms poesis and praxis can articulate the concerns that the participants as well as Carper (1978) and Dreyfus (in Flyvbjerg, 1991) among others share that certain actions or ways of knowing important for nursing are being devalued and deformed by the importance placed on quantitative data and measurable outcomes. The sense of praxis is a moralized one and most of what nurses do is plausibly on any account of normative ethics a morally good thing; the articulation of the idea of praxis can go some way in showing how it is a part of the discipline of nursing. Nursing's acts as poesis can be a part of how practitioners come to have praxis as phronesis or practical wisdom. So to be a wise nurse, one needs be a wise person.

South Asian cultural concepts in diabetes.

BACKGROUND: Type 2 diabetes is a significant health problem in the South Asian community. AIM: To extract messages from primary research reports to improve nurses' cultural understanding so they are better able to promote self-management among people of South Asian origin with type 2 diabetes. METHOD: A review was conducted of studies describing people from this group, cultural concepts of their diabetes management and the impact of culturally sensitive care. RESULTS: Eight studies involved adults of South Asian origin, with three focused solely on the Bangladeshi community. They all explored cultural perceptions of diabetes and self-management. CONCLUSION: Cultural beliefs play an important role in attitudes towards diabetes among people of South Asian origin. Understanding their beliefs improves the care provided to this community.

Expert Nurses' Perceptions of the Relevance of Carper's Patterns of Knowing to Junior Nurses.

This study explored with expert nurses in the UK how nursing wisdom can be developed in new and junior nurses. Carper's patterns of knowing and Benner's novice-to-expert continuum formed the theoretical framework. Employing a constructionist research methodology with participant engagement in co-construction of findings, data were collected via 2 separate cycles comprising 4 consecutive sessions followed by a nationally advertised miniconference. Empirical, ethical, personal, and esthetic knowing was considered evident in junior nurses. Junior nurses in the UK seem to lack a previously unrecognized domain of organizational knowing without which they cannot overcome hegemonic barriers to the successful development of nursing praxis.

Evaluation of how a curriculum change in nurse education was managed through the application of a business change management model: A qualitative case study.

BACKGROUND: Curriculum changes are a regular feature of nurse education, yet little is known about how such changes are managed. Research in this arena is yet to emerge. OBJECTIVE: Evaluation of how a curriculum change in nurse education was managed through the application of a business change management model. METHOD: A qualitative case study: the single case was the new curriculum, the Primary Care Pathway. PARTICIPANTS AND SETTING: One executive, three senior managers, two academics and nineteen students participated in this study in one faculty of health and social care in a higher education institution. RESULTS: The findings suggest that leadership was pivotal to the inception of the programme and guiding teams managed the change and did not take on a leadership role. The vision for the change and efforts to communicate it did not reach the frontline. Whilst empowerment was high amongst stakeholders and students, academics felt dis-empowered. Short-term wins were not significant in keeping up the momentum of change. The credibility of the change was under challenge and the concept of the new programme was not yet embedded in academia. CONCLUSION: Differences between the strategic and operational part of the organisation surfaced with many challenges occurring at the implementation stage. The business change model used was valuable, but was found to not be applicable during curriculum changes in nurse education. A new change model emerged, and a tool was developed alongside to aid future curriculum changes.

Palliative care services and settings: comparing care.

The focus of this project was to review palliative care literature on services and settings to establish whether they meet needs of patients and expectations of care providers. In the first part of this two-part article, issues such as the actual and preferred location of death, the quality of care given and comparison of different care settings providing palliative care are identified. The studies were fairly consistent in the information provided regarding care for the terminally ill patient. Primarily, hospice and hospice-based home care teams emerged as the providers of best care. The literature highlighted the fact that dying is a complex process which hinders researchers by making measurement difficult; consequently research assessing the effectiveness of palliative care has been limited. Since palliative care is multi-dimensional, it cannot be easily encompassed by one means of assessment and results gained in one care setting are not necessarily applicable to others. Given the variety of services available, purchasers, providers and users need to know for which patients hospice is most effective and which care models work best. There is therefore a need to design and carry out studies which advance the understanding of dying and the care that will influence this process.

Palliative care services and settings: improving care.

The first part of this review focused on identifying studies which compared services and settings (O'Henley et al 1997). In the second part, the results of efforts to improve care in the areas previously identified as deficient are highlighted including communication, symptom control and support services. The guidelines that have been developed for palliative care are discussed along with the inherent difficulties faced by investigators when conducting research with the terminally ill. Nonetheless, more research is required to clarify which services work best for which kinds of patients and families in which circumstances.

Peer bullying in a pre-registration student nursing population.

Peer bullying is a major problem in schools and workplaces including the National Health Service. Although there are a few published studies exploring the incidence of peer bullying among university students, none is specific to pre-registration nursing students. Nursing programmes are delivered across two campuses of the university however students registered at individual campuses do not mix which makes the experiences of each campus individual. The aim of this study was to explore the incidence and manifestation of peer bullying amongst pre-registration nursing students in the university setting. The study describes the reported incidence of the three types of peer bullying behaviour: physical, verbal and non-verbal bullying. Participants in their final year of adult nurse education were asked to explore their perceptions of peer bullying, the frequency of witnessed or experienced behaviour and the location of where this behaviour occurred on the university campuses via a quantitative questionnaire. In total 190 students were surveyed with 156 (82%) responding. Participants reported peer bullying is experienced by student nurses on university premises and that academic members of staff are sometimes present when this behaviour is demonstrated. Reported levels of bullying decreased during their 2nd and 3rd years of the course compared to the foundation year. This decrease may have been in response to the university's strong anti-bullying stance.

Students' and facilitators' perceptions of simulation in practice learning.

In the United Kingdom (UK), there have been concerns about nursing students' clinical competence at registration; whether simulation can enhance practice learning is under consideration. This paper presents results from an evaluative study of students' and facilitators' perceptions of simulation and its application to clinical practice. A project was conducted, involving 267 pre-registration nursing students; 179 students, in eight sub-groups, experienced a simulation programme and a further 88 undertook their usual clinical placements. Facilitator and student data were collected through questionnaires and were entered into SPSS v13 and analysed using descriptive statistics. Chi-square was used to examine associations where appropriate. Facilitators and students evaluated the simulation programmes very positively. Students perceived that simulation increased their ability and confidence in their clinical placements and they did not feel disadvantaged by the reduced clinical placement hours. At the end of their placements, most simulation group students were confident about their skills and many made comments about how the experience had increased their confidence. There was no significant difference between the perceived confidence of simulation and comparison group students at the end of placement. In conclusion, undertaking simulated learning during a clinical placement appears to be at least as effective as learning during practice placement without simulation.

A survey of first year student nurses' experiences of learning blood pressure measurement.

Blood pressure (BP) measurement is an important clinical nursing skill. Informal evaluation triggered concerns about first year student nurses' opportunities to practise it. Therefore 447 first year pre-registration nursing students completed evaluative questionnaires following two 6-week clinical placements. The data were analysed using SPSS v.13 for analysis; open comments were analysed thematically. A third of the respondents (n=137) had pre-course experience in measuring BP. Ninety-five percent (n=425) attended the university skills laboratory session. Only 36% (n=158) of students measured BP using both electronic and manual equipment in both placements and 6% (n=27) did not practise this skill in either placement. Students undergoing non-hospital placements reported fewer practice opportunities. A large number of students reported never having been supervised while measuring BP; they were more likely to be supervised while measuring BP manually than electronically. Students' self-confidence in BP measurement increased over the first year but larger number of students were confident in electronic BP. To conclude, experiences of learning BP measurement varied in terms of opportunities to practise, equipment used, supervision levels and self-confidence. Students' experiences of learning other clinical skills may also differ, which has implications for healthcare education generally.