Telephone 'emergencies'. How to respond appropriately and effectively.

While the appropriateness of giving medical advice on the telephone could be debated, this discussion is based on the assumption that few physicians can avoid providing this service to their patients. In fact, most physicians must respond often to telephone requests for advice. A large portion of these "emergency" calls result from the caller's psychological experience of powerlessness and helplessness in a situation that he or she perceives as health-related. An understanding of the dynamics of helplessness is essential for the physician to respond therapeutically. A five-step interviewing strategy--including listening, clarification, exploration of self-help, support, and advice--can then be followed in sequence. These steps are applicable not only to medical situations but to any telephone situation in which crisis and helplessness are major components.

How nursing students explain their success and failure in clinical experiences.

Student motivation is a faculty concern at all strata of the educational process. A major issue in motivation is the student's perception of the situation and explanation of the cause of success or failure. The education literature indicates little research on how student nurses actually perceive and explain their success and failure. This paper addresses success and failure issues by reviewing attribution theory and describing a study of attribution made by student nurses following completion of clinical nursing courses in one school. Explanations were obtained for success and failure both of nursing care provided and for mastery of theory. The data obtained reveal some interesting patterns and indicate the need for further research in this area.

Confronting employees. A positive management tool.

Nurse managers who confront employees in an appropriate manner leave no doubt about their expectations. They demand excellent and consistent performance and do not settle for less. A manager who uses confrontation shows that he or she cares enough about the employee to challenge poor performance. When the manager confronts an employee about his or her performance, the manager is sending a message to all employees that mediocre work is not acceptable. The method of confrontation used by the manager ultimately determines how the criticism is received and how effective it is. The manager's attitude toward the employee and his or her ability to verbalize expected outcomes significantly influences how confrontation is accepted. Managers who are derogatory, angry, or arrogant find that confrontation is ineffective in motivating their staff to improve. Managers who show respect, empathy, and support toward their employees and establish firm expectations find confrontation to be a useful tool in staff motivation.

Accepting criticism. A positive process.

Criticism often has negative connotations, even when it is a planned supervisory technique and is part of a comprehensive approach aimed at improving employee behavior without damaging employee morale. The nurse may be the target of criticism from a variety of other people that he or she encounters in the health care setting. The nurse's response to criticism is important to optimal conflict resolution and to maintaining relationships with integrity. The nurse's actions and attitudes in response to criticism should be planned deliberately and directed at resolving the conflict.

Enjoying management. The positive benefits of liking the job.

Enjoying one's work is a state of mind that is integrated in the manager's personality. Although some individuals are born with an optimistic perspective on life, others have to develop it. A manager can cultivate an appreciation for the ordinary and learn to use humor as a communication tool and coping technique. Cultivating this orientation cannot be limited to the work setting but must be developed in relation to life. Health care agencies are complex and turbulent organizations. Whether the nurse manager is climbing the career ladder or just trying to be successful on the job, enjoying work can be a key ingredient to success. Nurse managers must both manage and lead. An attitude of enjoyment and pleasure at work is a trait that allows the manager to extend administration from managing to leading.

Avoiding self-defeating feelings. Tips for managers.

The feelings identified in this article are self-defeating and harmful to the OR nurse and the nursing profession. To be successful in the operating room, a nurse manager needs skill in reacting to stressful situations so that he or she can deliver quality, cost-effective care.

The immature employee. A manager's challenge.

Skill in managing immature employees is seldom learned in nursing management classes and is usually developed as a result of difficult experiences. A technique in which limits are set is most effective. As with other difficult management situations, the manager cannot expect immediate rewards. The immature employee who has trouble with authority will not readily offer appreciation to his or her manager. The manager's reward is knowing that he or she handled the situation well.

New managers: establishing a niche with former peers.

Being a well-prepared manager involves having managerial and interpersonal skills. Establishing a proper distance with subordinates is one of the interpersonal skills that gives a new manager the most difficulty. Following the guidelines in this article for establishing healthy interpersonal distancing can benefit all managers--experienced, new, and would-be.

Black American folk medicine health care beliefs: implication for nursing plans of care.

Even in this age of information, some African Americans equate good health with luck or success. An illness or disease, viewed as undesirable, may be equated with bad luck, chance, fate, poverty, domestic turmoil, or unemployment, and in such case, Black Americans will consult a physician only after attempts with home remedies have failed. It is important for the nurse when working with Black patients, remember that when this patient enters the traditional bio-medical health care delivery system, it is best to assume that all known and available cultural home remedies have been tried. According to Bloch (1976), some Black Americans believe that the nurse should recognize cultural medical practices and the western medical remedies based on these beliefs. It is essential that the nurse determine whether these home remedies will interact or interfere with orthodox medical approaches. If home remedies are found to be efficacious or neutral. they may be kept at the patient's bedside. However, if they are found to be harmful, the nurse should assist the patient in developing an understanding about the remedies' dangers. With an emphasis on education, the patient can be navigated toward modern medical preventive techniques and cures, and the nurse may observe and judge the variety and efficacy of age-old culturally entrenched health care practices. Future studies may just substantiate the science behind the folklore.

Increasing self-confidence through self-talk.

There are varied opinions on the commonness of self-talk. Some feel self-talk is engaged in more by persons who feel insecure and question their performance (Cauchon, 1994). Others feel self-talk is a process people use continually to describe and interpret the world, accurate or inadequate as the case may be. (Hansen, Rhode, and Wolf-Wilets, 1991; Braiker, 1989). Regardless of how much self-talk the nurse is aware of in interacting with clients and intrapsychically, it is important to assess thoughts for their logic or illogicality. Illogical thoughts should be replaced by positive words of encouragement, which will in turn raise the client's or nurse's self-concept and level of self-confidence. Making self-talk positive is always good nursing practice.

Using humor to cope with stress in home care.

Home care and hospice nurses constantly face stressful situations with patients and caregivers, working from the field and meeting the expectations of the workplace and their own personal and family goals. This article explores the many ways humor can be used by the nurse in relieving stressors encountered every day.

Delegating to a transcultural team.

Six cultural phenomena must be considered when delegating to staff with a culturally diverse background. Communication, space, social organization, time, environmental control and biological variations encourage an understanding of unique cultural values, beliefs and practices.

Ten strategies to get work, or keep it.

As fiscal restraints tighten around the Canadian health care sector, new graduates find it increasingly difficult to find full-time work. Even experienced nurses who have lost their jobs may find they have to take casual or part-time work.