Quality nursing care and opportunities for improvement: insights from patients and family members.

A study was undertaken to delineate patients' and families' experiences and perceptions associated with their nurse-patient therapeutic relationships and nursing care. Data were analyzed using a directed content analysis approach. Two key themes emerged: patients and family members described primarily receiving excellent nursing care and to a lesser extent substandard care. Study findings have implications for nurse leaders to enhance nurses' therapeutic relationships with patients and family members and patient-centered care within their organizations.

The Acceptability and Feasibility of Implementing an Online Educational Intervention With Nurses in a Provincial Prison Context.

BACKGROUND: Correctional nursing requires a strong knowledge base with access to continuing education (CE) to maintain and enhance competencies. Nurses working in provincial prisons have reported many challenges in accessing CE, with online learning being identified as a potential solution. Limited research was found, however, which examined the correctional context in the development and delivery of online learning for nurses. The purpose of this study was to develop an online educational intervention tailored to correctional nurses and determine the feasibility and acceptability of implementing the intervention in a provincial prison context. METHODS: A sequential mixed methods study was conducted. Participants included nurses from three correctional settings in the province of Ontario, Canada. Semistructured interviews examined contextual factors and educational needs. Delphi surveys determined the educational topic. Preintervention and postintervention questionnaires examined the context, educational content, and intervention's acceptability and feasibility. RESULTS: The online intervention focused on mental health and addictions with two 30-minute webinars delivered back-to-back over 15 weeks. Respondents expressed satisfaction with the convenience of online learning at work using short webinars, as well as the topics, relevance of information, and teaching materials, but dissatisfaction with presentation style. The feasibility of the intervention was limited by access to technology, time to attend, education space, and comfort with technology. DISCUSSION: The findings from this study provide insight to guide the future development of online CE for correctional nurses. If changes are made within correctional facilities in collaboration with nurses and managers, online learning holds the potential to facilitate access to ongoing professional development.

Respect in forensic psychiatric nurse-patient relationships: a practical compromise.

The context of forensic psychiatric nursing is distinct from other psychiatric settings as, it involves placement of patients in secure environments with restrictions determined by the courts. Previous literature has identified that nurses morally struggle with respecting patients who have committed heinous offences, which can lead to the patient being depersonalized and dehumanized. Although respect is fundamental to ethical nursing practice, it has not been adequately explored conceptually or empirically. As a result, little knowledge exists that identifies how nurses develop, maintain, and express respect for patients. The purpose of this study is to analyze the concept of respect systematically, from a forensic psychiatric nurse's perspective using the qualitative methodology of focused ethnography. Forensic psychiatric nurses were recruited from two medium secure forensic rehabilitation units. In the first interview, 13 registered nurses (RNs) and two registered practical nurses (RPNs) participated, and although all informants were invited to the second interview, six RNs were lost to follow-up. Despite this loss, saturation was achieved and the data were interpreted through a feminist philosophical lens. Respect was influenced by factors categorized into four themes: (1) emotive-cognitive reactions, (2) nonjudgmental approach, (3) social identity and power, and (4) context. The data from the themes indicate that forensic psychiatric nurses strike a practical compromise, in their understanding and enactment of respect in therapeutic relationships with forensic psychiatric patients.

Learning in the simulated setting: a comparison of expert-, peer-, and computer-assisted learning.

PURPOSE: To compare the effectiveness of expert-assisted learning (EAL), peer-assisted learning (PAL), and computer-assisted learning (CAL) on participants' procedural skills acquisition in the simulated setting. METHOD: Sixty medical and nursing students practiced urinary catheterization in an expert-, peer- or computer-assisted, simulation-based, learning environment. Effectiveness of training was evaluated in the simulated setting using an immediate posttest and, one week later, on a retention and standardized patient-based transfer test. Measures included number of breaks in aseptic technique and blinded expert assessments. RESULTS: All groups performed similarly on the pre-, post-, and retention tests. At transfer, the EAL group performed significantly better than the PAL group as measured by global clinical performance, catheterization checklist scores, and number of breaks in aseptic technique (P < .05). Communication and catheterization global ratings were equivalent for all groups (P > .05). CONCLUSIONS: CAL is as effective as expert feedback for teaching procedural skills to novices in the simulated setting. When extrinsic feedback is provided, the expertise level of the teacher seems to be a critical factor influencing effectiveness of training, with EAL being more effective than PAL.

Respect for patient autonomy in forensic psychiatric nursing.

A fundamental issue that forensic psychiatric nurses struggle with is respect for patient autonomy, as the two liberal prerequisites for autonomy, liberty and rationality, are either absent or compromised in forensic psychiatric settings. In this paper, a contemporary feminist perspective of autonomy, relational autonomy, will be advanced as an alternative approach to the traditional liberalist, Kantian, perspective of autonomy. The concepts of autonomy, paternalism, and justice will be discussed in relation to forensic psychiatric nursing.