Nurse managers' professional networks, psychosocial resources and self-rated health.

BACKGROUND: Nurse managers act under constant pressure to develop strategies in response to professional challenges within a changing and restructured health care system. When such environmental stress is present, they need access to sufficient psychosocial recourse. AIM: The study aimed to investigate whether nurse managers' professional networks, psychosocial work conditions, job support, social network and support were associated with self-rated health, sick-leave and salary. METHODS: From a total of 268 Swedish nurse managers, active in management positions, 205 (77%) agreed to participate in the study by answering a self-report questionnaire. Cronbach's alpha was used to calculate internal consistency. Odds ratios were used to estimate the bivariate association between self-rated health and psychosocial resources. RESULTS: Nurse managers exposed to high job demands had significantly increased odds for low self-rated health. It was also found that low level of support from professional network, job support, social network and social support outside work displayed increased odds for low self-rated health, independently of age, gender and education. There were additive (but no synergistic) effects found for job demand in combination with professional networks, job support and emotional support and in relation to self-rated health. CONCLUSION: The study showed that nurse managers exposed to high job demands had elevated odds for low self-rated health, regardless of level of psychosocial resources within or outside work. Two-thirds of the nurse managers who were affiliated to professional networks did not consider this a supporting factor in their management work. Those with low job support had increased odds for sick-leave compared with those with high support. No significant associations were found between psychosocial characteristics and salary.

First-time mothers' satisfaction with early encounters with the nurse in child healthcare: home visit or visit to the clinic?

UNLABELLED: The aim of this study was to describe first-time mothers' views of satisfaction with their first encounter with the nurse, in order to investigate differences between home visits and clinic visits and between high/middle and low socioeconomic classification (SEC). A nation-wide postal questionnaire sent to 800 first-time mothers yielded the data for statistical analysis. Data were collected using a modified version of the questionnaire "Quality of Care from the Patient's Perspective", the part concerning child healthcare. The results showed that mothers who had received home visits were more content with the encounter than were mothers who had to visit the clinic. This particularly concerned advice on breastfeeding, being able to talk to the nurse in peace and quiet, and the fact that the nurse took time and was personal. In contrast, the mothers who had received a home visit were less content with the competence of the nurse when she examined the child. Mothers of low SEC were less satisfied with the first encounter than were mothers of high/middle SEC with regard to several points. CONCLUSION: Home visits were shown to have advantages over visits to the clinic. Mothers of low SEC were less satisfied with the first encounter with the nurse than were mothers in the high/middle SEC.

Nurses' first encounters with parents of new-born children--public health nurses' views of a good meeting.

The nurse's view of the first meeting with parents of new-born children ma have consequences for the quality of future contact. A good start will lay a soli foundation for a lasting relationship, and have an affect on the nurse's work to support parents and children and to promote health. We do not know wha nurses mean by a 'good meeting'. The aim of this study was to discover how nurses view the first meeting as a general preventive measure aimed at all parents and their new-born children. Four focus groups interviews were held with nurses from different primary health care areas in the county of Skåne, southernmost Sweden. Analysis of the content in the transcribed interview texts disclosed eight subcategories: good contact/reciprocal relationship; willingness to listen; guest/ equal roles; time/peace and quiet; the family in its environment; socio-cultural aspects; confirmation/support; and individual advice. Three categories were established: creating trust; creating a supportive climate; and creating a picture of the family's life situation. The home visit was seen as an important way to establish trust and obtain a picture of the family's life situation, which was in turn essential for creating a supportive climate.

Nurse managers' management direction and role over time.

This study illuminates how 27 nurse managers experienced management direction and roles over a time period of three years. Fourteen of the nurse managers worked full-time in management positions during the time, while 13 during the same time completed a professional development course in advanced nursing at master-degree level. Two main directions were identified. One focused on management from the perspective of power and power transference, and the other focused on management from the perspective of theoretical knowledge related to nursing development.

Women physicians' narratives about being in ethically difficult care situations in paediatrics.

This study is part of a comprehensive investigation of ethical thinking among male and female physicians and nurses. Nine women physicians with different levels of expertise, working in various wards in paediatric clinics at two of the university hospitals in Norway, narrated 37 stories about their experience of being in ethically difficult care situations. All of the interviewees' narrations were concerned with problems relating to both action ethics and relation ethics. The main focus was on problems in a relation ethics perspective. The most common themes in an action ethics perspective were overtreatment and withholding treatment. The more experienced physicians reasoned differently from the group of less experienced physicians and they coped with pressure in different ways. The less experienced physicians disclosed their professional experience yet seemed uncertain, while putting on an air of certainty, but the more experienced physicians disclosed both their professional and personal experience of caregiving and they seemed to allow themselves to feel uncertain in their certainty. Both groups emphasized a need for deep discussion between colleagues about their being in ethically difficult care situations.

Influence of nursing management education on management direction and role.

The authors discuss how 13 nurse managers in Sweden experienced management direction and the management role before and 1 year after a professional development course in advanced nursing at the masters-degree level. The nurse managers related theoretical knowledge to an increased awareness of further possibilities inherent in managerial positions. They stressed the importance of networking for future support and growth.

Management from four different perspectives.

AIM: This study intended to illuminate nursing management in a developing organization from the perspectives of nurse managers, chief physicians, hospital directors and politicians. BACKGROUND: Increased responsibility in a changing health care system makes it important that nurses occupy advantageous positions so that they may safeguard and facilitate the development of their core area. METHODS: Open-ended taped interviews were conducted with 15 nurse managers, 11 chief physicians, three hospital directors and three politicians from three Swedish cities. FINDINGS: The main theme found was power and three dependent themes were identified as; power within activities, being in power and freedom to act. CONCLUSION: The four professional groups related their opinion of nursing management to the needs and interests of their own group. Acceptance or nonacceptance between the groups was discussed in terms of the concept of knowledge, which was interpreted as being a more acceptable topic for discussion than the phenomenon of power.

Use of initial risk assessment and recording as the main nursing intervention in identifying risk of falls.

The consequences of falls among hospital patients are a great problem, for the patient, the family and society, and cost billions of dollars. In Sweden, almost one-third of all hip fractures occur in the hospital population. Despite this, very few prevention strategies have been developed and tested. In this study, a risk assessment and recording programme in relation to the risk of falling among patients in a geriatric department at a Swedish hospital was implemented. The records of all patients admitted to a geriatric unit during one year, and a stratified random sample of patient records, constituting the control group from the year before, were reviewed. No recording of assessments regarding the patients' risk of falling, and no preventive nursing interventions, were found in the records of the control group. The study group, however, increased the recording of risk assessment to 96%. Only implemented nursing interventions were found in the patients' records, despite the fact that Swedish law makes it obligatory for the registered nurse to record both the planning and implementation of nursing care. In the study group there were explicit descriptions of problems of concern for nursing regarding the patients' risk of falling in less than one-third of the records, the nursing care plans were rare, and the evaluations were not satisfactory. Nursing interventions consisted mostly of information or education, promotion of patient participation, and structuring of the environment. There was no agreement on any standard-care plan. Recording of falls was found more often in the study group than in the control group (probably due to more careful recording), but the proportion of injuries in relation to falls was higher in the control group. The results of this study may be used as a baseline for developing a nursing strategy and documentation relating to falls.

Pain pattern in pregnancy and "catching" of the leg in pregnant women with posterior pelvic pain.

STUDY DESIGN: A cross-sectional study of symptoms and signs in pregnant women. OBJECTIVES: To describe the clinical appearance of back pain in pregnancy and the relation between pain distribution and symptoms in women with posterior pelvic pain, in order to shed light on etiologic factors. SUMMARY OF BACKGROUND DATA: Back pain is common in the general population. During pregnancy, it is even more common, and back pain is experienced by about 50% of pregnant women. In the pregnant woman, differentiation between common low back pain and posterior pelvic pain is believed to be essential because these symptoms should be treated in different ways. METHODS: The women were interviewed with a questionnaire. Those with back symptoms completed a pain drawing and were examined by an orthopedic surgeon. Based on the symptoms and findings, the women were divided into three groups: thoracic pain, lumbar pain, and posterior pelvic pain. RESULTS: Of 335 pregnant women, 51% had back pain at the time of examination. The pain was more widespread compared with common low back pain. Seventy-one percent of the 171 patients examined by the orthopedic surgeon had a positive posterior pelvic pain test. These women more often had pain in the gluteal and posterior thigh regions. A "catching" feeling of the leg was described when walking by 44 of 122 these women, whereas only 1 of 49 women without a posterior pelvic pain test had such symptoms. CONCLUSIONS: The higher prevalence of back pain in pregnancy may be due to several factors. In women with posterior pelvic pain, there is a specific symptom-a catching of the leg when walking. The most probable explanation for the catching is that local nociception disturbs muscular function in women with posterior pelvic pain because changes in the sacroiliac joint range of motion, which is very small, cannot cause this symptom.

Retired registered nurses' stories about being in ethically difficult care situations.

Twelve retired nurses were asked to narrate a care situation in which it had been difficult for them as nurses to know what was the right and good thing to do. The transcribed interviews were examined by content analyses. Physicians were the central coactors in the nurses' stories. Colleagues were seldom mentioned. Other ward staff were mainly called "the girls". The patient was central and referred to with respect. All the nurses focused on experiential learning. Guiding ethical principles are listed.

Understanding the unperceivable: ideas about cholesterol expressed by middle-aged men with recently discovered hypercholesterolaemia.

OBJECTIVE: We aimed to describe the perception of hypercholesterolaemia among middle-aged, urban men who had recently received the diagnosis of moderate hypercholesterolaemia. METHOD: Within a project screening for risk factors for coronary heart disease among 453 men, 63 were identified as moderately hypercholesterolaemic. Among these, 62 agreed to tape-recording and transcription of the first counselling on lipid-lowering, supplied by a registered nurse. The counselling was tailored to fit the needs of the individual patient, taking a starting point in whatever questions the patient expressed. The transcripts of the counselling sessions were analysed for their content. RESULTS: Five major themes were addressed by the men. It was hard to understand and accept the concept of hypercholesterolaemia, as the men did not feel unwell, and thus they did not receive any cues to taking action. Obesity and smoking was regarded as causes of hypercholesterolaemia, although the link between life-style and cholesterol level was unclear. Some men were aware of heredity traits of hypercholesterolaemia. Treatment suggestions included weight reduction and drug treatment, although there were ambiguous feelings towards drugs. Numerous misconceptions about diet were found. Many men expressed resistance to life-style changes and questioned the benefits of risk reduction. Information about hypercholesterolaemia was regarded as unreliable, as different sources gave incongruent information, and the information from individual sources changed over time. CONCLUSION: Unless medical professionals counselling patients for asymptomatic risk factors make efforts to disclose patients' conceptions of the condition, patients may misunderstand and counselling may become ineffective.

Gender differences in moral reasoning among physicians, registered nurses and enrolled nurses engaged in geriatric and surgical care.

Physicians, registered nurses (RNs) and enrolled nurses (ENs) engaged in geriatric (n = 49) and surgical (n = 59) care at a large hospital in Sweden gave 180 accounts of morally difficult care episodes. In total, the ENs (n = 40) gave 78, the RNs (n = 38) 55 and the physicians (n = 30) 47 accounts; there were 83 from geriatric care and 97 from surgical care. Forty-nine participants were male, and 59 were female; there were no differences in gender in the form and content of the moral reasoning disclosed in either morally difficult care episodes or in the complete interviews when coded as mainly narrative or propositional, or as showing a care or a justice orientation. The ENs showed a care orientation, while RNs and physicians, to an equal degree, showed both a justice and a care orientation. The ENs also used narrative reasoning more often than RNs and physicians. No differences were seen between the two health care specialties.

The stories of physicians, registered nurses and enrolled nurses about ethically difficult care episodes in surgical care.

Twenty physicians, 19 registered nurses (RN), and 20 enrolled nurses (EN) working in surgical care in Sweden narrated their experiences of being in ethically difficult care situations. All three professional groups disclosed a strong wish to help patients. The narrations of the physicians and the ENs indicated that they were very much involved in their patients, while most of the RNs' stories were narrated from a distanced onlooker's perspective and disclosed a lot of moral outrage, mainly directed towards physicians. The physicians were the only group that emphasized the importance of acting in accordance with science and proven experience. Like RNs they emphasized the importance and difficulty of telling the truth to the patients and their families and being open to one's own and others' harsh experiences. RNs and ENs emphasized the patient's right to a death with dignity and the difficulties connected with being with dying patients, and they also described feelings of powerlessness and neglect of patients related to a heavy work load. ENs narrated difficulties related to providing patients with individualized but fair care.

Registered nurses' and physicians' reflections on their narratives about ethically difficult care episodes.

Thirteen registered nurses and eight physicians in medical and oncological care reflected on their previous narratives about ethically difficult care situations. Although the interviewees had narrated different kinds of stories there were more similarities than differences in their reflections. Common themes were: meeting death, balancing between being open to one's own and others' reactions and being sheltered, handling advanced medical technology and grasping care as a whole. The two groups, however, disclosed different cognitive styles and types of rationality. The nurses referred to their personal experience of giving care and also receiving care very much within a praxis perspective, while physicians referred to science and proven experience within a poiesis perspective.

Ethical reasoning in nurses' and physicians' stories about care episodes.

Twenty-three registered nurses and nine physicians reported 43 stories about ethically difficult care situations. Themes in nurses' and physicians' stories were described by means of narrative ethical theory. It turned out that nurses and physicians related different kinds of stories. They also seemed to use different kinds of ethical reasoning. This result was interpreted as mainly connected to the fact that the two professions have different tasks to accomplish and are trained in disciplines with different foci; nursing and medicine. The need to find a common frame story covering the two professional stories was stressed.

Elderly people in an orthopedic emergency room--assessment of quality.

About 25% of all outpatients in the emergency room at the department of orthopedics in Malmö are over 70 years of age. Fourteen per cent had no one to ask for help at home if needed. Seventy-two per cent understood the information given them correctly. About half of the patients reported satisfaction with the consultation. Three specific problems related to the service provided were identified; a long waiting time, a limited approach to the patients' problem and a lack of follow up care.

Hip fracture frequent in hospital.

In the year 1982, 112 hip fractures - cervical and trochanteric - were recorded in residents of Malmö after having been admitted to hospitals. During that same year, a total of 463 hip fractures occurred in the city. The risk of sustanining a hip fracture was 11 times greater in hospital patients aged 50 years or more than in persons of the same age who had not been admitted to hospitals.

Inpatient accidents in hospitals.

In patients admitted to the hospital in the city of Malmö altogether 499 accidents occurred in one year. More than half of the accidents occurred in patients in geriatric care. Seventy-two percent of the patients were unobserved when the accident occurred. Thirty percent had fallen at least once in the last two months. There were 299 fractures--127 were hip fractures--contributing about one-fourth of all hip fractures in the city. The mortality of the hospital accident group was twice as high as in age- and sex-matched hospital controls and three times as high as in the population of Sweden. The accident patients more often than hospital controls had suffered from dizziness and confusion but were more mobile. More or less obvious environmental factors were involved in one-third of the accidents. Hospital care may not protect the mentally and physically incapacitated elderly patients from all accidents unless special measures are taken, measures that may interfere with the personal integrity of the patients and with the ultimate goals of rehabilitation.