Communication styles that promote perceptions of collaboration, quality, and nurse satisfaction.

Interdisciplinary collaboration has been identified as an essential element of quality health care. Often, however, the degree of interdisciplinary collaboration in health care settings is limited. This failure to collaborate is usually not due to ill intent, but rather to a lack of collaboration skills. This article notes the need for very tangible, behaviorally specific ways to describe collaboration. Norton's Theory of Communicator Styles was used as a framework to identify the effect of three specific communication behaviors (styles)--namely, dominant, contentious, and attentive styles--on nurses' perceptions of collaboration, quality of care, or satisfaction with the interaction. Suggestions for teaching these three styles to health care professionals are provided.

Prevention of venous ulceration by use of compression after deep vein thrombosis.

Venous ulcers may result from damage to the lining of the veins after an occurrence of deep vein thrombosis (DVT). As the pressure in the damaged venous system remains pathologically high, a result of DVT, swelling develops, hemosiderin staining develops around the ankle area, and varicosities often develop. These symptoms are part of the postphlebitic syndrome and are a precursor to formation of the chronic venous ulcer. The mainstay of treatment or prevention for venous ulcers remains compression therapy. In spite of the evidence that compression is necessary to reduce edema and allow the ulcer to heal, many patients still are not using compression after DVT to prevent ulcer formation. This article describes the prevalence, cost, etiology, and pathophysiology of postphlebitic syndrome and presents the nursing intervention of compression therapy as an ulcer prevention strategy for the patient with DVT. A variety of compression strategies are discussed. A case study of a patient in need of compression therapy is presented.

Discharge teaching. Work strategies of patients and families for care in the home.

PURPOSE: To better understand how care givers, and their care receivers who have experienced mobility limitations over a period of time, enhance the work of care in the home. DESIGN: The qualitative method of grounded theory was used to identify work strategies enacted by care dyads consisting of informal (family) care givers and their care receivers. SAMPLE: The sample consisted of 60 care dyads. METHOD: Data was collected via semi-structured interviews conducted in the care receiver's home. After leaving the home, interviewers completed end notes describing the care situation. MAIN RESEARCH CLASSIFICATION: Nursing Research, Orthopaedic Nursing, Home Health Nursing. FINDINGS: Content analysis revealed five interpersonal and informational work strategies, used by both care givers and care receivers, to facilitate the work of care: Sharing Ideas and Feelings, Delegating, Achieving a Common Goal, Identifying Sources of New Information, and Creative Problem Solving. End note data substantiated the benefits of using these strategies. CONCLUSION: Although providing care to a family member in the home is frequently thought of as "work," few analysts have described the nature of this work or considered the care receiver as a worker. This study identified the important role of the care receiver in the work of care in the home and delineated five specific Work Strategies used by informal care givers and their care receivers to facilitate such care. IMPLICATIONS FOR NURSING RESEARCH: Ongoing research is needed for further clarification of these strategies and for development of innovative ways to teach the strategies to informal care givers and their care receivers as they prepare to live with mobility limitations in the home setting.

The culture of the deaf.

The population of the United States includes over 1 million deaf people, the majority of whom have chosen to differentiate themselves in terms of a Deaf culture. These Deaf people share unique values and norms and use sign language for communication. The differences that exist between hearing and Deaf individuals necessitate that the nurse understand this population. This article will describe the Deaf culture using Leininger's Sunrise Model and present specific nursing actions in the modes of culture care preservation and/or maintenance, accommodation and/or negotiation, and repatterning or restructuring that enable the nurse to provide culturally congruent care for Deaf clients.

An action approach to redesigning a patient-centred unit.

Receptiveness to innovation is critical in orchestrating change and learning to use new technology in a redesigned work environment. The patient-centred unit redesign approach (PCURA) provides a guide for unit assessment in many healthcare settings. The backbone of the PCURA approach: work excitement and unit culture assessment.

Valuing authority/responsibility relationships. The essence of professional practice.

Central to the practice of professional nursing are the elements of accountability, autonomy, direct communication, and authority. The value that nursing work groups place on authority affects their level of acceptance of responsibility and accountability for clinical decision making. The authors examined the value that nurse managers and staff nurses on primary nursing and total patient care units place on authority/responsibility relationships. Results indicated that nurse managers and staff nurses on primary nursing units valued accountability, authority, and autonomy more than the nurse managers and staff nurses on total patient care units, a finding consistent with the professional practice model of primary nursing.

Understanding work group culture on rehabilitation units: the key to facilitating group innovation and promoting integration.

Understanding work group culture is essential for the smooth running of today's complex rehabilitation units. Failure to understand a unit's culture can impede necessary care delivery innovations and impair group integration. This article describes the phenomenon of work group culture and offers suggestions for assessing and understanding a given unit's culture. It also illustrates how an understanding of work group culture can facilitate innovation by reframing and tailoring a change and can promote integration by helping nurses adjust to a new unit.

Quality of life: its meaning to the long-term care resident.

1. While the physical and recreational environments have been shown to be important to the mental health of the long-term care resident, human relationships and social contact have been described as being far more important in determining quality of life. 2. This study identified two new findings as contributing to quality of life--caring for oneself and the importance of helping others. 3. Failure to accurately assess a resident's ability to provide self-care may lead to excess disability, a situation in which a resident may become more functionally disabled, in part, due to the staff performing more care than is actually needed.

Outcomes of nurses' job satisfaction.

Although the benefits of satisfying nurses in their jobs often are assumed, there is limited research evidence to support such assumptions. Administrators, basing their actions in job satisfaction theory, find that the anticipated benefits of satisfying nurses are not always realized. Changes intended to improve job satisfaction may be costly. The authors review the research and theoretical evidence for effects of job satisfaction on turnover, quality of care, and patient satisfaction and report the findings of a recent study of nurses' job satisfaction, quality of care, and patient satisfaction. Implications for nurse administrators who use job satisfaction as a management tool are discussed.

Computer-assisted instruction: a learner's viewpoint.

Computer-assisted instruction (CAI) is becoming increasingly common in nursing. Insight into factors that facilitate or impede this process was gained through interviews with nursing students who had used one of four computer programs. Content analysis of these interviews found that the CAI experience includes many components. Three overall categories of comments emerged, pertaining to (a) the learner, (b) the learning environment, and (c) software design, including interactive features, how the learning design uses these features to achieve the learning objectives, and the content. This paper discusses elements that facilitate or hinder learning in each area and illustrates each with quotes from the interviews. This article also suggests positive actions that can increase learning through CAI use.

Steps to collaboration.

Although collaboration is a much sought-after goal among health care professionals, minimal research has clarified the essential communication elements (behaviors) necessary for collaboration. This series of research studies, grounded in the pragmatic perspective, represents a beginning attempt to identify these behaviors. A total of 270 practicing physicians and nurses responded to open-ended questions and/or a survey assessing the communication elements of content; relationship (aggressive, affirming, and collaborative styles); and opportunity to communicate. Findings suggest elements necessary for collaboration include reliable presentation of relevant data, openness to information presented, and adequate time to communicate. Differences were noted between nurses and physicians as to the relative importance of these behaviors.

Facilitating innovation at the unit level through cultural assessment, Part 2: Adapting managerial ideas to the unit work group.

The culture of an organization is a powerful force to contend with in transforming a healthcare system. Culture can either drive or restrain innovation: sometimes cultural values support innovation; but culture can restrain innovation when there is conflict between the culture and the innovation. Part 1 of this series (April 1993) examined the concept of organizational culture fail to materialize when the work group culture is not considered while implementing change. This article uses research data to illustrate a five-step cultural innovation process. The creative nursing unit manager can use the process to implement a variety of practice patterns to help the healthcare organization remain competitive and increase the quality of its care. These practice patterns include team nursing, primary nursing, case management, managed care, patient-centered care, assistive personnel, and computer-assisted care.

Facilitating innovation at the nursing unit level through cultural assessment, Part 1: How to keep management ideas from falling on deaf ears.

The early hopes and expectations of organizational culture often fail to materialize because the nature of organizational culture is not understood. This article describes what culture is, explains where culture comes from, and analyzes the variety of subcultures that can exist in healthcare organizations. In so doing it explores why managerial ideas for change are not automatically implemented by organizational members. The importance of assessing a group's culture before implementing change is discussed. Tools for assessing the work group culture of a nursing unit are presented. Part 2 (May 1993) will describe a five-step process to strengthen the forces that drive cultural change and overcome forces that resist innovation.

Professional recognition and high-quality patient care through collaboration: two sides of the same coin.

Today's health care professionals frequently confront problems that lack a single right answer. Differing answers often result in interprofessional conflict. For example, nurses, physicians, and respiratory therapists may have different goals and responses in a cardiac arrest situation. Strategies to enhance nursing's unique contribution to these decisions and to facilitate collaboration among all the professionals are presented.

Using organizational culture to facilitate the change process.

Change in health care settings is occurring at an ever-increasing rate. One change is the implementation of new nursing care delivery systems. Although such changes are necessary responses to societal needs, they are not always welcomed by nursing personnel. Current organizational literature suggests that understanding a work group's culture can facilitate the change process. This article reports a qualitative research study that identified the work group culture of a renal unit and shows how the unit used an understanding of its unit culture to ease the change to primary nursing.