Exploring resilience and workplace adversity in registered nurses: A qualitative analysis.

The aim of this study was to explore New Zealand registered nurses' experiences of resilience and workplace adversity. Resilience research in nursing has concentrated on quantitative and individual aspects. Contextual factors have been largely ignored. This study addresses this gap by qualitatively researching and documenting nurses' experiences of resilience and workplace adversity. An online survey of New Zealand registered nurses was conducted in 2018. Qualitative responses were analyzed using Braun and Clarke's thematic analysis method. Three themes emerged: (i) perseverance; (ii) how the past influences my present resilience; and (iii) things I do to stay strong. Nurses rely on personal resilience to overcome workplace adversity. Health service organizations must implement policies and procedures that (i) reduce workplace adversity, and (ii) encourage and develop strategies for nurses to individually and collectively face adversity with resilience. Future research needs to explore how healthcare organizations can modify existing systems and structures to align with nurses' efforts to sustain and develop resilience.

Rituals, ghosts and glorified babysitters: A narrative analysis of stories nurses shared about working the night shift.

Working the night shift can be fraught and experienced as demanding and, yet, is often dismissed as babysitting. Few researchers have explored the social and cultural meanings of night nursing, including storytelling rituals. In 2019, a narrative study was undertaken. The aim was to explore the stories recalled by nurses about working night shifts. Thirteen Australian nurses participated. Data were gathered using the Biographical Narrative Interview Method, and narrative analysis produced forty stories and three themes: strange and challenging experiences; colleagues can be mentors (or not); and textbook knowledge is only part of what is needed on night shift. Nursing students who engage with these stories may come to understand the challenges of the night shift, and the valuable work that nurses engage in throughout a 24-hr period, work that involves adept psychosocial and interpersonal skills alongside technical and physical competence.

Exploring Online Mentorship as a Potential Strategy to Enhance Postgraduate Mental Health Nursing Education through Online Delivery: A Review of the Literature.

The value of mentorship to professional development in nursing education has been consistently demonstrated in the literature. The benefits for mental health nursing are particularly noted for attracting nursing students and new graduates into this area of practice. The proliferation of online delivery of mental health nursing programs poses particular issues in providing mentorship to students. Despite changes to the mode of educational delivery, the mentorship literature primarily addresses face-to-face processes. The aim of this paper is to present a review of the literature pertaining to online mentorship. A literature search of the CinAHL, Medline, ProQuest and Google Scholar databases was undertaken to identify relevant literature. Hand searches of reference lists were also conducted. The findings demonstrate the paucity of literature addressing this topic. Evaluation of online mentorship programs are particularly scarce, small scale and usually conducted at one site only. Few descriptions of the content and structure are provided meaning that program development cannot benefit from existing knowledge and expertise. There is an urgent need for online mentorship accompanied by rigorous and systematic evaluation frameworks to maximize the benefits of mentorship to an online environment.

Illuminating nursing's shadow side through a Jungian analysis of the film Fog in August.

Fog in August is a German film based on Robert Domes' historical novel of the same name. The film provides a fictionalized account of the institutionalization and eventual killing of children and adults labelled as a burden on the State and unworthy of life. On one level, this is a story of good versus evil, where innocent patients are manipulated by callous doctors and nurses. At a deeper level, however, it is possible to read the characters as more complex and such a reading gives an insight into the paradox of how a genocidal policy was able to be systematically implemented by health care professionals who had previously taken an oath to provide care to all people. Carl Jung argued that powerful stories, told across generations, contain mythical archetypes that help drive the plot and convey beliefs about humanity. The aims of this paper are to explore Jungian ideas within Fog in August that help the historical story it is based on resonate with viewers today, and demonstrate how the application of these insights can help health care professionals more fully understand morally distressing events and, as a result, support and improve the safety of patients.

Psychological resilience in New Zealand registered nurses: The role of workplace characteristics.

AIM: To investigate the impact of workplace factors on psychological resilience in registered nurses. BACKGROUND: Nursing is characterized by persistent workplace adversity. Psychological resilience has been postulated as a means to mitigate the effects of workplace adversity. There is little research that examines the role of workplace factors (i.e., practice environment and bullying) in shaping resilience. METHODS: A cross-sectional survey was conducted among 480 registered New Zealand nurses. Psychological resilience was self-reported using the CD-RISC-10, while practice environment and workplace bullying were self-reported using PES-NWI and NAQ-R, respectively. RESULTS: For every point increase in PES-NWI and NAQ-R, there was an increase of 2.84 points (95%CI = 1.79, 3.89; p-value = <0.001) and a decrease of 0.07 points (95% CI = -0.12, -0.03; p-value = 0.002) in resilience, after controlling for demographic and job-related characteristics. These two factors explained for 12.6% of the variation in resilience. About 25.8% of registered nurses experienced bullying. CONCLUSION: Workplace factors are associated with psychological resilience in registered nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are key to transforming health care work environments to promote positive outcomes for nurses, the organisation and patient outcomes. Future efforts to promote psychological resilience in registered nurses need to enhance the practice environment and reduce workplace bullying.

Case Studies of Interprofessional Education Initiatives From Five Countries.

BACKGROUND: Although teamwork and interprofessional collaboration are critical to patient safety, nursing, medical, and allied health graduates often feel ill-prepared to confidently communicate and collaborate with other team members. While interprofessional education (IPE) has been advocated as a way of addressing this issue, there are multiple barriers to its systematic and sustained integration in undergraduate healthcare programs. Despite these challenges, examples of effective IPE initiatives have emerged. INNOVATION: This article profiles seven case studies of innovative interprofessional education activities that have been successfully implemented across five countries, for a variety of learners, using different delivery modalities, and with evaluation results attesting to their success. CONCLUSIONS: The case studies demonstrate innovative ideas that have the potential to overcome some of the barriers to IPE through the use of creative and targeted approaches. This article provides a wealth of ideas for the successful design and implementation of IPE initiatives and will be of benefit to educators wishing to expand their repertoire of teaching approaches. CLINICAL RELEVANCE: A body of research attests to the relationship between interprofessional communication, teamwork, and patient outcomes. IPE is imperative for facilitating the development of nursing graduates' communication and teamwork skills; however, innovative approaches are needed to overcome the perceived and actual impediments to its implementation.

Tainted love: Gothic imaging of nurses in popular culture.

AIMS: To discuss representations of nursing in popular culture using the Contemporary Gothic theory. BACKGROUND: Nursing is stereotypically known as a caring profession. Caring in both the natural and professional perspectives is inextricably attached to love and love, we are told, is universal. In popular culture, however, there are numerous examples of nurses being portrayed in ways where love-its expression and its practice-has been transgressed or tainted. Exploring this dark side of nursing, even if fictitious, is significant because it illuminates social and cultural tensions. DESIGN: Discussion paper. DATA SOURCES: CINAHL, Scopus and Humanities International Databases were searched for terms related to nursing, love, abject and the gothic, published between 1990-2016. Four popular culture texts which ranged in genre and gothic elements were selected for analysis. IMPLICATIONS FOR NURSING: The types of transgressive love these nurses express to patients ranges from the obsessive and the pornographic, to the monstrous. We suggest this positioning illuminates a hidden reality that nursing work is at once intimate and personal but also hidden, profane, repellent, horrifying and feared. Nursing's allure for storytellers may rest in its association with the abject. How nurses find redemption, satisfaction and meaning in these locations is relevant for how we can imbue our lives and work with greater humanity. CONCLUSION: The Contemporary Gothic is a useful tool in exposing and exploring ambiguous, challenging and taboo aspects of nursing in society. Such and analysis helps to explain phenomena-including nursing itself-which exists in the shadow of dominant and often stereotyped discourses.

Moving Beyond Routines in Teaching and Learning: Releasing the Educative Potential of Published Eating Disorder Memoirs.

Learning from the lived experience of disordered eating is vital for contemporary mental health practitioners. While mental health practitioners need to understand the psycho-biological issues that impact the person and family with an eating disorder, there is much about this complex condition that eludes and escapes a bio-medical perspective. Use of an aesthetic lens on the issue can illuminate various challenges, tensions and insights that people with disordered eating experience along the journey of their ill-health and on to their recovery, but which often remain unstated in the clinical context. Scholars within the creative arts discipline are experts in making judgements about the quality of artworks they encounter and have highly developed aesthetic knowing. Yet, the central skills and knowledges embodied in creative arts activity are not widely utilized outside that sphere. This article reports on how aesthetics can be applied to sensitize mental health practitioners to appreciate the lived experience of a mental health challenge such as an eating disorder. Such mental health practitioners play an important role in the health service, yet the widespread diffusion of the bio-medical model into mental health, once characterized for its equal emphasis on the psycho-social-cultural, has led to criticisms of an over-focus on illness identification, at the expense of accommodating the meanings of subjective and unique experiences of mental health, struggle and recovery. Using Kate Grenville's typology of the elements of effective creative writing, we show how these elements contribute to the aesthetic power and impact of particular eating disorder memoirs.

The stigmatisation of pregnancy: societal influences on pregnant women's physical activity Behaviour.

Many women going through the major life transition of pregnancy experience decreases in physical activity behaviour, which may compromise maternal and infant health and wellbeing. Although research suggests that the social environment plays a large role in influencing women's physical activity behaviour, little is known about the association between societal attitudes and physical activity behaviour during the course of pregnancy. Through a qualitative longitudinal study, we explored women's physical activity experiences throughout pregnancy and how these were formed, supported and/or opposed by their social environment. This research included telephone interviews with 30 pregnant participants, recruited via a regional public hospital. Using a feminist standpoint analysis incorporating modern dialectics, three major tensions were identified, reflecting dominant societal discourses around physical activity and pregnancy: (1) engaging in physical activity and keeping the baby safe, (2) engaging in physical activity and obtaining social approval and (3) listening to oneself and to others. These findings present previously unrecognised opportunities for developing tailored and effective physical activity interventions among pregnant women.

Vivian Bullwinkel: A model of resilience and a symbol of strength.

BACKGROUND: The story of one of Australia's most well-known women in history, Vivian Bullwinkel, is a symbol of strength for nursing. She and her companions who were prisoners of war during World War II, refused the position of victim and went on to contribute much to the world after their ordeal. DISCUSSION: These women embody important elements of resilience that it is our duty to convey to generations of nurses so that they may be inspired to rise above adversity, foster connection with like-minded others, use adaptive coping mechanisms and soft power, be gentle yet persistent in their resistance practices, and most of all to do good work throughout their nursing careers. This paper argues that oppression theory provides only a limited understanding of present woes affecting nursing. Resilience theory suggests future actions and is therefore further enlightening. By examining the experiences of Bullwinkel, students can be assisted to see that stress has been a constant theme across nursing history. However ways of rising above adversity can be illuminated by critically and deeply examining aspects of iconic leaders and heroic stories such as can be found in the life of Vivian Bullwinkel. Summary: Students who are offered the chance to examine this symbol of strength in our profession may decide to internalise some of the positive traits and resolve to use the behaviours she and her contemporaries used to help them create for themselves a fulfilling career, pride in their profession and strong sense of purpose.

The challenges of undergraduate mental health nursing education from the perspectives of heads of schools of nursing in Queensland, Australia.

The shortage of a skilled mental health nursing workforce is persistent and worsening. Research consistently demonstrates the inability of the comprehensive model of nursing education to meet nursing workforce needs in mental health. Introducing specialisation in mental health at undergraduate level has been suggested as a strategy to address this problem. Exploration of barriers to this educational approach is essential. The aim of this research is to examine with Queensland Heads of Schools of Nursing, the perceived barriers to a specialist mental health nursing stream within an undergraduate nursing programme. Qualitative exploratory methods, involving in-depth telephone interviews with Heads of Schools of Nursing in Queensland, Australia. Data were analysed thematically. Participants encountered a number of barriers revealed in five main themes: academic staffing; staff attitudes; funding and resource implications; industry support; entry points and articulation pathways. Barriers to the implementation of mental health nursing specialisation in undergraduate programmes are evident. While these barriers pose real threats, potential solutions are also evident. Most notably is the need for Schools of Nursing to become more co-operative in mounting mental health nursing specialisations in a smaller number of universities, where specialist expertise is identified. Quality mental health services rely on a sufficiently skilled and knowledgeable nursing workforce. To achieve this it is important to identify and implement the educational approach best suited to prepare nurses for practice in this field.

Illuminating and inspiring: using television historical drama to cultivate contemporary nursing values and critical thinking.

As the world prepares to commemorate the centenary of the First World War, it is timely to discuss meaningful learning activities that students of nursing could be engaged in to encourage them to reflect on the nurse's role then and now. Several films and television series about the war and featuring nursing have already been aired. No doubt there will be many more stories to come. Such stories have the potential to do more than eulogise nursing for students and practitioners. Stories, such as The crimson field, have potential to stimulate serious contemplation about values and cultural practices that have remained constant or have changed and to assist students to develop and articulate values that will be fitting for contemporary practice. Recently, excerpts from the series were examined with a group of nursing students and key learnings were found. These are shared in this paper for the benefit of educators planning to utilise public discourse as triggers to engage nursing students in discussions about nursing values, nursing history and representations of the profession.

Learning essentials: what graduates of mental health nursing programmes need to know from an industry perspective.

AIMS AND OBJECTIVES: To explore the perspectives of nursing directors in mental health in Queensland, Australia, regarding the skills and attributes of graduates of comprehensive nursing programme to provide an industry perspective and thus augment knowledge from theoretical and professional dimensions. BACKGROUND: There is a worldwide shortage of appropriately qualified nurses with the knowledge, skills and attitudes to work effectively in mental health services. Within Australia, this has been well documented since the introduction of comprehensive nursing education. The underrepresentation of mental health content in undergraduate curricula has been identified as the primary reason for nursing graduates not being adequately prepared for practice in this field. To date, this issue has primarily been addressed from the perspective of university academics, with the voice of industry relatively silent in the published literature. DESIGN: Qualitative exploratory. METHOD: In-depth telephone interviews with Director of Nursing (Mental Health) in Queensland, Australia. RESULTS: The concerns of participants were expressed in six main themes: (1) foundational knowledge of mental health and disorders, (2) recovery-oriented skills, (3) physical as well as mental health skills, (4) therapeutic strategies, (5) resilience and self-development and (6) advanced knowledge and skills. CONCLUSIONS: The education of comprehensive nursing education needs to be reviewed as a matter of priority to ensure graduates with the attributes required to provide high-quality care for consumers of mental health services. RELEVANCE TO CLINICAL PRACTICE: A skilled and knowledgeable workforce is an essential component of high-quality mental health services. Research highlighting the current deficits and issues is therefore of the highest priority.

Newton's cradle: a metaphor to consider the flexibility, resistance and direction of nursing's future.

Nursing faces an uncertain future as technological developments, structural changes within health systems and rapidly evolving health needs create new and challenging possibilities. This article draws on the results of a qualitative study undertaken with a range of Queensland nurse leaders to explore their perceptions of these changes. The study re-surfaced, and allows for a re-examination of, four issues that have long created tension within nursing and which continue to have a negative impact on the profession as a whole. These are as follows: professionalisation; preparation of graduates; myths and narratives of nursing; and leadership. We provide a metaphor that imagines all of these tensions operating in dynamic interplay. The image is that of a Newton's Cradle - a model for energy and momentum. The metaphor allows one to see the wide context of changes affecting nursing and the significance of the interconnections. If tensions within nursing maintain their own integrity through containment, understanding and development, they remain in alignment, and energy is conserved rather than wasted or misdirected. It suggests that with increased awareness and attention paid to internal challenges, and by taking a broad-based approach to systemic improvements, nursing could become more effective, progressive and proactive in shaping its own future.

The silence of mental health issues within university environments: a quantitative study.

A descriptive study was used to examine the attitudes and experiences of staff and students towards mental health problems. Staff completed the "Attitude towards mental illness survey", and students who self-identified having a mental health problem completed the "Stigma scale". Using an online collection process, data from 270 staff and 201 students showed that the "silence" surrounding mental health problems permeates the university environment and impacts on help seeking behaviors, the provision of support and on the recovery and wellbeing of affected individuals. Universities must decrease stigma and foster social inclusion to build self-esteem in people who have mental health problems.

The views of heads of schools of nursing about mental health nursing content in undergraduate programs.

Criticisms about the mental health nursing content of Bachelor of Nursing programs have been common since the introduction of comprehensive nursing education in Australia. Most criticism has come from the mental health nursing sector and the views of key stakeholders have not been systematically reported. Heads of Schools of Nursing have considerable influence over the content of nursing programs, and their perspectives must be part of ongoing discussions about the educational preparation of nurses. This article reports the findings of a qualitative exploratory study, involving in-depth interviews with Heads of Schools of Nursing from Queensland, Australia. Thematic data analysis revealed two main themes: Realising the Goal? and Influencing Factors. Overall, participants did not believe current programs were preparing graduates for beginning level practice in mental health settings. In particular, participants believed that the quality of mental health content was influenced by the overcrowded curriculum, the availability of quality clinical placements, the strength of the mental health team, and the degree of consumer focus. The findings suggest the current model of nursing education in Australia does not provide an adequate foundation for mental health nursing practice and alternative approaches should be pursued as a matter of urgency.

Perspectives of Australian nursing directors regarding educational preparation for mental health nursing practice.

There is an ongoing global shortage of mental health nurses. Within Australia, the principal strategy of offering a postgraduate education programme with various incentives to encourage nurses back to study has not been successful. This has led to the consideration of radical alternatives, including the return to pre-registration specialisation in mental health. The successful introduction of this strategy would require the full support of industry partners. To date, the voice of industry has not been heard in relation to this issue. The aim of this paper is to present the views of an Australian sample of mental health nursing directors regarding the resources and other factors required, should undergraduate specialist programmes in mental health be developed, to ensure they are relevant and likely to be successful. A qualitative exploratory research project was undertaken to explore the perspectives and opinions of industry partners. In-depth interviews were conducted with nursing directors (n = 12) in Queensland Australia. Five main themes were identified: relationships with universities; clinical placement preparation and support; workplace culture; facilitators and preceptors; and practical student learning. Genuine collaboration between the two organisations was considered crucial for delivering a quality programme and providing the required support for students. Transformative leadership could inform this collaboration by promoting acknowledgement of and respect for differences.

N²E: Envisioning a process to support transition from nurse to educator.

Rising health inequities, continuing nursing shortages, and overlooked professional development needs of nurse educators are three important issues facing nursing in Australia. This paper argues for an innovative and proactive strategy that could transform the nurse education workforce into one that is repopulated, reinvigorated and refocused. The problem facing nurse educators, and subsequently affecting nurses' preparation for practice and longevity in the profession, was identified by drawing on findings from the literature, extensive educational experience, and an exploratory study of nurse educators working in universities, colleges and health services. A solution has been devised by drawing together the tenets of critical social theory, transformative learning, communities of practice and social media. Nursing educators, refocused around a social justice agenda, may be the remedy that the Australian Health Care System requires to embark on effective action that can benefit everyone, from the health service staff to our most vulnerable groups in society. This refocusing can be achieved in a structured and strategic process that builds confidence and professional capabilities.

Using Dual-Coil TMS-EEG to Probe Bilateral Brain Mechanisms in Healthy Aging and Mild Cognitive Impairment.

Background: A widespread observation in the cognitive neuroscience of aging is that older adults show a more bilateral pattern of task-related brain activation. These observations are based on inherently correlational approaches. The current study represents a targeted assessment of the role of bilaterality using repetitive transcranial magnetic stimulation (rTMS). Objective: We used a novel bilateral TMS-stimulation paradigm, applied to a group of healthy older adults (hOA) and older adults with mild cognitive impairment (MCI), with two aims: First, to elucidate the neurophysiological effects of bilateral neuromodulation, and second to provide insight into the neurophysiological basis of bilateral brain interactions. Methods: Electroencephalography (EEG) was recorded while participants received six forms of transcranial magnetic stimulation (TMS): unilateral and bilateral rTMS trains at an alpha (8 Hz) and beta (18 Hz) frequency, as well as two sham conditions (unilateral, bilateral) mimicking the sounds of TMS. Results: First, time-frequency analyses of oscillatory power induced by TMS revealed that unilateral beta rTMS elicited rhythmic entrainment of cortical oscillations at the same beta-band frequency. Second, both bilateral alpha and bilateral beta stimulation induced a widespread reduction of alpha power. Lastly, healthy older adults showed greater TMS-related reductions in alpha power in response to bilateral rTMS compared to the MCI cohort. Conclusion: Overall, these results demonstrate frequency-specific responses to bilateral rTMS in the aging brain, and provide support for inhibitory models of hemispheric interaction across multiple frequency bands.