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Center for Health Ethics, the University of Missouri-Columbia, USA.
Department Editor.
Royal Hobart Hospital, Tasmania, Australia.
Ethics is a hot topic these days. Home health care providers need not be ethicists, however they do need to be able to identify problems quickly, and know how to address them. This paper explores the ethical issues arising from a narrative analysis involving an advanced cancer patient receiving Total Parenteral Nutrition (TPN) at home. It shows how complicated it is today to make nutrition support decisions that would have been customary less than 30 years ago. For and against arguments of TPN for advanced cancer patients are reviewed. Ethical positions adopted by the medical and nursing professions are explored and contrasted. The importance of patient autonomy, within a holistic notion of care, including decisions incorporating quality of life, are affirmed, providing a challenge to monitoring the status quo in approaches to decision making.
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Faculty of Nursing & Midwifery, University of Sydney, Sydney, Australia.
Aim. This paper is a report of a study to explore the way in which Registered Nurses relate to and interact with each other in the workplace, and to identify factors that influence nurses' interactions with each other. Background. Intraprofessional relations are an important topic both for nurses and nursing as we face the ongoing challenges of nurse shortages. Poor colleague relationships, together with workplace conflict, cause job dissatisfaction. As a consequence, some nurses leave the profession while others continue working but remain chronically unhappy. Method. An explanatory multiple case study design was adopted. Data were collected from multiple sources on three different wards within one hospital in Australia between July 2005 and January 2006. Findings. The workplace can be a difficult place for both very experienced and less experienced nurses, regardless of the clinical environment. Nurses navigate their way in the workplace through a series of complex negotiations with each other and develop skills to assess the potential success of an interaction before approaching another nurse. Some also develop a resilience to conflict in their workplace, accepting it as part of working life. Conclusion. Creation of a more positive work environment requires increased understanding of the way nurses relate to each other and appreciation of the factors in the environment that contribute to conflict and a negative atmosphere. This appreciation is a necessary prerequisite to developing a more satisfying and productive workplace enhancing the recruitment of new nurses and the retention of experienced nurses.
Decker School of Nursing, Binghamton University, and Our Lady of Lourdes Memorial Hospital, Ascension Health System, Binghamton, New York, USA.
Aim. This paper is a report of a study to (1) ascertain the relationship among self-nurturance, perceived Magnet features and life satisfaction and (2) evaluate the predictive effects of self-nurturance and Magnet features on life satisfaction. Background. Promoting health is a global priority for nurses and for the public who depend upon them to provide quality care. Health gains can be realized by modifying the work environment and by modifying lifestyle choices (self-nurturance). A study of nurses that examined perceptions of workplace features that enable nurses' professional practice (Magnet features), self-nurturance and healthy outcomes (life satisfaction) was not found in the literature. Methods. Survey data collected in May 2003 from a convenience sample of 310 Registered Nurses were used for this descriptive, correlational study. Findings. Self-nurturing nurses were more satisfied with life and perceived that more Magnet features were present in the workplace. Nurses with a master's degree were more self-nurturing than nurses without a baccalaureate degree. The synergistic effect of both self-nurturance and workplace factors predicted 29% of variance in nurses' life satisfaction. Conclusion. Higher levels of perceived Magnet features and frequent self-nurturance choices are important health influences on nurses' life satisfaction. Greater life satisfaction is known to reduce job dissatisfaction while improving retention. Approaches that incorporate both self-nurturance and workplace Magnet features are suggested to improve the health and retention of experienced nurses.
HOPE School of Nursing, Wuhan University, Wuhan, China, and Lambert & Lambert Nursing Consultants, Odenton, MD, USA.
Limited research exists on the workplace and personal factors that might be associated with the physical and mental health of nurses working in China. Therefore, the purposes of this study were to examine, in Chinese hospital nurses, the most frequently occurring workplace stressor, the most often used coping strategy, and the relationships that exist among workplace stressors, coping strategies, psychological hardiness, demographic characteristics, and physical and mental health. Four-hundred-and-eighty hospital nurses from five hospitals in three major Chinese cities were administered five self-report questionnaires. The findings indicated the most frequently cited workplace stressor was workload, while the most commonly used coping strategy was positive reappraisal. Numerous positive and negative correlations were found, suggesting the importance that workplace stress, coping strategies, psychological hardiness, and demographic characteristics play in relationship to each other, as well as to both the physical and mental health of Chinese nurses.
Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
Concerns about pending retirement of nurses working in the operating room (OR) are undeniable. The nurses' work environment and level of perceived support is part of the equation of why a nurse may choose to retire or stay in the workforce. This study compares nurses' perceptions of the work environment between OR nurses and nurses who work in other type units; and compares the work environment perceptions of OR nurses between institutions of two sizes (<300 beds and >300 beds). Findings include: OR nurses have better perceptions of their work environment than nurses in other type units and OR nurses in smaller hospitals are more satisfied with their work environment, workload and perceptions of organisational support. Implications for OR work environments are discussed.
University of KwaZulu-Natal, Faculty of Health Sciences, School of Nursing, Dalbridge.
TITLE: Hospital workplace experiences of registered nurses that have contributed to their resignation in the Durban Metropolitan Area. AIM: The purpose of this research was to explore and describe the hospital workplace experiences that had contributed to the resignations of Registered Nurses in the Durban Metropolitan Area. METHODOLOGY: The broad perspective governing this research is qualitative in nature. The researcher employed a phenomenological approach specifically because the researcher was interested in identifying, describing and understanding the subjective experiences of individual nurses at the two Private and two Provincial health care institutions selected to participate in the study - in respect of their decision (s) to resign from their employment, and/or to leave the nursing profession. Two semistructured interviews were conducted with each participant by the researcher. The researcher applied the principle of theoretical saturation and a total of fifteen participants were interviewed and thirty interviews were conducted. Experiential themes and subthemes in the data were identified by a process of meaning condensation, and the data were managed by means of a qualitative software package - NVIVO (QSR - NUD*IST). FINDINGS: The resignations of registered nurses in the Durban Metropolitan Area were found to be linked to their respective hospital workplace experiences. These experiences related to their physical working conditions and environment and included the following: unsupportive management structures, autocratic and dehumanizing management styles, negative stereotypy of nurses and the nursing profession, lack of autonomy in the workplace, professional jealousies and fractures within the profession, sub-optimal physical working conditions and shortage of staff, equipment and lack of appropriate surgical supplies, concerns regarding occupational safety e.g. the increasing exposure of health care personnel to HIV and AIDS; lack of opportunities for promotion or continuing one's professional education, the experience of workplace violence--predominantly in the form of verbal and psychological abuse, inaccurate systems of performance assessment (Joint Performance Management, Reports, Personal Profile systems)--compounded by favouritism and racism; and inadequate remuneration. CONCLUSION: In terms of the findings of this study, the participants' lived experiences in terms of their respective hospital workplace experiences indicated that neither the maintenance factors nor the motivator factors were optimally represented, experienced or enjoyed in their respective workplaces. In terms of Herzberg's Motivator-Maintenance theory, the registered nurses who participated in this study may be described as being 'not satisfied' and 'dissatisfied' with their hospital workplace experiences, physical conditions and environment. A number of recommendations pertaining to strategies for the retention of registered nurses were made for the consideration of both Provincial and Private health care authorities, hospital management structures and the nursing profession respectively. Recommendations for further nursing research were also made.
