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    ABSTRACT: In this paper the authors explore the centrality of both patient safety and person centred care when preparing student nurses for their role. By examining these two goals against the understanding of human factors, the concept of risk and the interpersonal elements of patient centred, compassionate care, the authors identify the challenges that nurse educators must recognise in preparing the nurses of the future who must achieve both. The authors introduce the notion of human factors and their role in promoting safe environments. Thereafter the authors explore the development of the student nurse in coming to understand that optimal patient care must primarily be safe but must also have the wishes of individual patients at its core. Finally the authors raise the challenge for nurse educators of supporting students’ growing understanding of safety, risk and how these must be balanced with individual needs and wishes.
    Nurse education today 01/2014;
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    ABSTRACT: To examine Nepali migrant nurses' professional life in the UK. In the late 1990s the UK experienced an acute nursing shortage. Within a decade over 1000 Nepali nurses migrated to the UK. A multi-sited ethnographic approach was chosen for this study. Between 2006 and 2009, 21 in-depth interviews with Nepali nurses were conducted in the UK using snowballing sampling. Nepali migrant nurses are highly qualified and experienced in specialised areas such as critical care, management and education. However, these nurses end up working in the long-term care sector, providing personal care for elderly people - an area commonly described by migrant nurses as British Bottom Care (BBC). This means that migrant nurses lack career choices and professional development opportunities, causing them frustration and lack of job satisfaction. International nurse migration is an inevitable part of globalisation in health. Nurse managers and policy makers need to explore ways to make better use of the talents of the migrant workforce. We offer a management strategy to bring policies for the migrant workforce into line with the wider workforce plans by supporting nurses in finding jobs relevant to their expertise and providing career pathways.
    Journal of Nursing Management 09/2013;
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    ABSTRACT: To compare how intensive care nurses in the UK and Australia (AU) perceive families in intensive care units (ICUs). International healthcare research and practice is often based on an underlying assumption of a person- or family-centred ideology. While nurses in ICUs acknowledge the importance of patients' families, a true integration of families as units of care is often not realised. Data from ICU nurses from two international studies: (1) a constructivist grounded theory study in the UK and (2) a quasi-experimental non-equivalent clinical study in AU. Data were collected in tertiary adult ICUs in the UK and AU. Nurse-to-patient ratio for high-acuity patients was 1:1 in both units. Twenty ICU nurses in five focus groups (UK study) and 197 surveys were sent out to ICU nurses in AU (response rate 26%). Evidence from both studies makes visible the contribution of family care in adult ICUs. Nurses remaining in control and initiating family member care involvement are less likely to perceive families as a burden. The AU study indicated that when nurses partner with families to deliver care, there was a minimal effect on their workload. The nurses concluded that inviting family members to be a part of the patient's care should be usual practice in ICUs. Nurses should promote, facilitate and invite the integration of families in care in today's healthcare system. This is mandatory as families are the caring resource for these patients during an often prolonged recovery trajectory. Families are more likely to be successfully integrated into a more active involvement with ICU patients when they are not perceived as a burden. Inviting and supporting family members is not necessarily time-consuming and starts the journey of supporting ICU survivors' recovery journey.
    Journal of Clinical Nursing 07/2013;
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    ABSTRACT: To establish what patients' expectations of postoperative pain were when undergoing open surgical repair of abdominal aortic aneurysm. A review of the relevant literature highlighted the fact that there had been no such studies conducted within a similar such homogenous group. Therefore, this study aimed to explore pain expectations prospectively and then compare these with the patients' actual experiences. It has long been established that high levels of satisfaction with pain management are very often reported in patients despite suffering from severe to moderate levels of pain. The reasons for these high satisfaction levels are not always as clear, although it is suggested that patients have an expectation of postoperative pain. The study set out to establish what expectations of pain patients had and the factors that might influence them within the abdominal aortic aneurysm subject group. A mixed methods approach was used. Pain expectations were gathered preoperatively using a Likert scale of pain scoring. These were then compared with the recorded postoperative pain scores. This was followed by a semi-structured interview. The study illustrated that patients expected to have postoperative pain as a natural consequence of their operations. Patients appeared to draw upon their previous experiences. Pain expectation levels were statistically significant, 60% of patients expected to have pain postoperatively. This study demonstrated that patients expect to have postoperative pain. Such expectations might influence the individual's relationship and experience of their postoperative management. The study highlights the need for nurses to evaluate the preoperative information given to patients and to listen to expectations they voice. Patient expectations of pain are sometimes that they expect to have pain, and it is the management of this pain that makes a difference to them.
    Journal of Clinical Nursing 07/2013;
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    ABSTRACT: Research into the patient's perspective on their care is being given increasing importance within health and nurse education policy, predicated upon the idea that the findings represent the patient experience. Researchers have power to silence the voices of research participants through the process of authorship. Exploring the arts as a means of presenting findings offers the opportunity problematize issues of power and authorship, and examine ways of decentring the researcher's voice. Re/presentation of patient experience in poetic form encourages readers to engage with that experience as they have to actively interpret the meaning of the poem. Researchers interested in examining and conveying the experience of others should be encouraged to problematize issues of authorship and consider the impact of their authority on the re/presentation of the experience of the other. The study aimed to understand the experience of being a patient on an acute psychiatric inpatient ward. A further aim was to open up spaces for the voices of participants to be heard. Contemporary government policy places patient experience at the centre of healthcare policy and service development. Despite this, those who occupy marginalized discourses struggle to be heard within the dominant discourse of health care. A qualitative approach was used, and narrative was conceptualized as representing experience. Sociolinguistic theories informed the development of the analytic framework treating meaning as contextual and arising from both content and structure of narratives. Concepts of representation, voice and authorship were problematized. Thirteen people who had been inpatients on an acute psychiatric inpatient ward participated. Narrative data were gathered using unstructured interviews. The data were analysed holistically using a method that attended to both the structure and content of the narrative. The product of these holistic narratives was the development of a poem representing each participant's experience. This paper focuses on the development of these poems as a method of decentring the authorial voice and opening up spaces for the voices of the participants to be heard.
    Journal of Psychiatric and Mental Health Nursing 07/2013;
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    ABSTRACT: This study aimed to (1) identify how leadership is perceived and experienced by community nurses, and (2) examine the interaction between recent policy and leadership development in community nursing in the United Kingdom (UK). Leadership is a 'hot topic' yet little is known about leadership in community nursing. Traditionally, the study of leadership is viewed from a leader-centric perspective in which the discussion of followership and its impact on leadership in theory and research is noticeable absent. A qualitative study using individual interviews (n = 31) and three focus groups (n = 13) was conducted. 'Following' is a complex process with a socially co-constructed view of leaders undertaken in a variety of ways through 'doing following''standing by' or 'resisting following'. Followers do not necessarily fit into one category but may move between categories depending on the situation. Future research into leadership requires consideration of leadership and followership as interdependent concepts. Successful leadership is dependent on the actions of many within organizations. Followers play an active role in leadership. Failure to consider differences amongst followers denies the impact followers have on the success (or failure) of the leadership process and ultimately on an organization's ability to achieve goals.
    Journal of Nursing Management 05/2011; 19(4):507-16.
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    ABSTRACT: This paper is a report of a study into how children and young people constructed their experiences of visiting a critically ill family member in an intensive care unit. Previous intensive care research has focused almost exclusively on adult family members, and so far children and young people have been excluded from family studies in this area. Consequently, very little is known about children's and young people's needs or their understanding when visiting an adult intensive care unit. Between 2002 and 2005, nine family interviews (12 adults and 12 children) were conducted. A constructivist grounded theory approach was employed in gathering and analysing data. The way in which children and young people discussed their intensive care visiting experiences suggest two different levels of understanding. Children tended to speak about intensive care on a concrete level, focusing on the environment (intensive care unit as environment). Young people, in contrast, understood their visiting experiences on an abstract level, focusing on the function of intensive care (intensive care unit as function). A structured and age-appropriate approach to support children visiting an adult intensive care unit still needs to be developed. It is time for nurses to reflect on current practice, challenge beliefs and attitudes towards child visitation. Crucially, nurses need education in listening skills and understanding children and young people's needs when an adult family member is in an intensive care unit. Further research is needed to develop appropriate support interventions and to investigate the importance and effects of intensive care unit visiting on children and young people.
    Journal of Advanced Nursing 04/2010; 66(4):868-77.
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    ABSTRACT: Advances in medical technology have led to increased survival rates for critically ill patients, resulting in the survival of patients with serious traumatic brain injury. These patients may suffer some permanent brain damage leading to an ambiguous loss in families. Ambiguous loss has two dimensions: (1) a loss that relates to the physical absence but psychological presence of the family member and (2) a loss that refers to the psychological absence but physical presence of the family member. The overall study aimed at exploring families' experiences with critical illness in intensive care and nurses' perception of families. This article presents findings of one specific aspect, namely, families who experienced an ambiguous loss following the patient's brain injury which resulted in permanent brain damage. Constructivist grounded theory that used focus groups as the method of choice. Reported data originate from nine family interviews (12 adults, 12 children/young people). Interviews were recorded, transcribed verbatim and imported into NVivo for data management and analysis. The principle approach in grounded theory, the constant comparative method, was followed. The findings suggest that 'the emergence of ambiguous loss' reflects the families' experiences with the second type of ambiguous loss, namely a loss that relates to a family member who was physically present but psychologically absent. 'Mapping the future' is a further dimension of this theme which underlines the impact of an ambiguous loss on everyday family life. Families where the patient had suffered permanent brain damage experience an ambiguous loss. In this situation a caring scenario emerged which had a fundamental impact on the family's future. The dimension of 'mapping the future' draws out these implications for different family members. Relevance TO CLINICAL PRACTICE: Nurses need to be aware of the implications an ambiguous loss can have on families.
    Nursing in Critical Care 03/2010; 15(2):66-75.
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    ABSTRACT: Smoking in the home is the major cause of exposure to second-hand smoke in children in the UK, particularly those living in low income households which have fewer restrictions on smoking in the home. Reducing children's exposure to second-hand smoke is an important public health and inequalities issue. Drawing on findings from a qualitative Scottish study, this paper identifies key issues and challenges that need to be considered when developing action to promote smoke-free homes at the national and local level. Two panels of tobacco control experts (local and national) from Scotland considered the implications of the findings from a qualitative study of smokers and non-smokers (who were interviewed about smoking in the home), for future action on reducing smoking in the home. Several key themes emerged through the expert panel discussions. These related to: improving knowledge about SHS among carers and professionals; the goal and approach of future interventions (incremental/harm reduction or total restrictions); the complexity of the interventions; and issues around protecting children. The expert panels were very aware of the sensitivities around the boundary between the 'private' home and public health interventions; but also the lack of evidence on the relative effectiveness of specific individual and community approaches on increasing restrictions on smoking in the home. Future action on smoke-free homes needs to consider and address these complexities. In particular health professionals and other key stakeholders need appropriate training on the issues around smoking in the home and how to address these, as well as for more research to evaluate interventions and develop a more robust evidence base to inform effective action on this issue.
    BMC Public Health 05/2009; 9:112.
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    ABSTRACT: Humour is a complex phenomenon, incorporating cognitive, emotional, behavioural, physiological and social aspects. Research to date has concentrated on reviewing (rehearsed) humour and 'healthy' individuals via correlation studies using personality-trait based measurements, principally on psychology students in laboratory conditions. Nurses are key participants in modern healthcare interactions however, little is known about their (spontaneous) humour use. A middle-range theory that accounted for humour use in CNS-patient interactions was the aim of the study. The study reviewed the antecedents of humour exploring the use of humour in relation to (motivational) humour theories. Twenty Clinical Nurse Specialist-patient interactions and their respective peer groups in a country of the United Kingdom. An evolved constructivist grounded theory approach investigated a complex and dynamic phenomenon in situated contexts. Naturally occurring interactions provided the basis of the data corpus with follow-up interviews, focus groups, observation and field notes. A constant comparative approach to data collection and analysis was applied until theoretical sufficiency incorporating an innovative interpretative and illustrative framework. This paper reports the grounded theory and is principally based upon 20 CNS-patient interactions and follow-up data. The negative case analysis and peer group interactions will be reported in separate publications. The theory purports that patients' use humour to reconcile a good patient persona. The core category of the good patient persona, two of its constituent elements (compliance, sycophancy), conditions under which it emerges and how this relates to the use of humour are outlined and discussed. In seeking to establish and maintain a meaningful and therapeutic interaction with the CNS, patients enact a good patient persona to varying degrees depending upon the situated context. The good patient persona needs to be maintained within the interaction and is therefore reconciled with potentially problematic or non-problematic humour use. Humour is therefore used to deferentially package concerns (potentially problematic humour) or affiliate (potentially non-problematic humour). This paper reviews the good patient persona (compliance, sycophancy), potentially problematic humour (self-disparaging, gallows) and briefly, non-problematic humour (incongruity). The middle-range theory differentiates potentially problematic humour from non-problematic humour and notes that how humour is identified and addressed is central to whether patients concerns are resolved or not. The study provides a robust review of humour in healthcare interactions with important implications for practice. Further, this study develops and extends humour research and contributes to an evolved application of constructivist grounded theory.
    International journal of nursing studies 03/2009; 46(8):1079-91.
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