Measuring nursing support during childbirth.

PURPOSE: To examine the amount of support being provided by nurses to women during childbirth and factors that influence the provision of support. STUDY DESIGN: Exploratory, descriptive. METHODS: Work sampling method was used to determine the percentage of time nurses spend in supportive care activities. Twelve nurses were observed over six nonconsecutive day shifts on a birthing unit of a Canadian teaching hospital in Quebec. A total of 404 observations were made. Nurses were also interviewed to determine their perceptions of what constitutes supportive nursing care and the factors that facilitate or inhibit the provision of this care. RESULTS: Nurses spent only 12.4% of their total time providing supportive care to laboring women. Interviews with nurses suggested that perceptions of the components of supportive care were comparable to this study's operational definition of support, namely: physical, emotional, and instructional/informational support and advocacy. Barriers to providing support identified by nurses included lack of time and insufficient staff. However, further content analysis of the interview data revealed that healthcare providers had a pervasive sense of control over laboring women and their partners. CLINICAL IMPLICATIONS: Although nursing support has been identified as an important aspect of nursing care in childbirth, this study demonstrated an incongruity between what nurses perceived as being supportive care and the amount of support that was actually provided. Barriers to the provision of supportive care in the practice setting as well as suggestions for its enhancement are discussed.

Family assessment tools: a review of the literature from 1978-1997.

Traditionally, nursing practice in critical care settings has been focused on recognizing and addressing the needs of the patient with an acute and serious health problem and individual family members. Little progress has been made in understanding how families manage this hospitalization experience; however, family health has been reported to be a significant factor in the patient's recovery. The purpose of this article is to review the literature from 1978 to 1997 that has examined family assessment tools in a variety of clinical settings. The ultimate goal of the review is to determine their usefulness for critical care environments and their congruence with family systems nursing, which is aimed at the cognitive, behavioral, and affective domains of family functioning. The following characteristics are used to review each of the selected instruments: theoretical framework; purpose; description; the unit of analysis; ease of administration and scoring; reading level; psychometric evaluation; and utility to guide clinical practice and research. Although the instruments have a variety of strengths, none of them are congruent with the philosophy of family systems nursing. Therefore instruments need to be developed that would guide assessment and interventions for nurses in critical care settings.

The experience of pain in persons with HIV/AIDS.

A phenomenological design was used to elicit data about the experience of pain caused by HIV from 21 men and 1 women who attended ambulatory clinics. Data were generated through open-ended interviews. The phenomenon of pain appeared to be interpreted by the participants in a broad manner. The four themes that emerged from the data were physical pain, painful losses, the pain of not knowing, and social pain. In addition, coping strategies used to deal with pain are identified in this study. This study offers nurses a view into the phenomenon of pain in people with HIV that goes well beyond physical pain and associated-pain syndromes.

Pediatric intensive care nurses and their grief experiences: a phenomenological study.

OBJECTIVE: To describe the grief experience of pediatric intensive care nurses when their patients die. DESIGN: Heideggerian phenomenological approach; nonprobability, purposive sampling; semistructured interviews; data analyzed using Colaizzi's method of phenomenology. SETTING: Pediatric intensive care unit within a Canadian pediatric metropolitan university teaching hospital. PARTICIPANTS: Six registered nurses, currently working in the pediatric intensive care unit, who had experienced the death of at least three children for whom they had cared. Nursing experience ranged from 2 to 20 years, intensive care nursing experience from 9 months to 19 years, and tenure on the unit from 9 months to 15 years. RESULTS: Data were analyzed for recurring themes according to the procedure outlined by Colaizzi. These nurses acknowledged they suffered multiple exposures to children's death and experienced grief. The interviews revealed eight themes that included one about their grief responses--hurting; two that described the influencing contextual factors--nurse-family unit relationship and dissonance; and five that related to coping strategies used to manage their feeling of grief--self-expression, self-nurturance, termination of relationship activities, engaging in control-taking activities, and self-reflection. Further analysis revealed that managing grief effectively was an experiential learning process for the participants. CONCLUSIONS: These results demonstrate that pediatric intensive care nurses' grief is different from that of surviving family member grief. Further research is required to document in further depth the experiential learning process to coping with multiple, accumulated losses for these professional caregivers. The findings of this study also could encourage further research that examines interventions designed to enhance the type of education and support needed in relation to the grief experience of nurses.

Patient controlled analgesia and intramuscular injections: a comparisons of patient pain experiences and postoperative outcomes.

Despite relatively widespread use of various forms of patient controlled analgesia (PCA), there remain conflicting results in the literature as to the efficacy of PCA. This study was conducted to assess the efficacy and postoperative outcomes of intravenous PCA compared to intramuscular (IM) injections in 73 patients who received major abdominal surgery. These patients were randomly selected and randomly assigned preoperatively to receiving IM or PCA modes of analgesia postoperatively. The following factors were compared: amount of pain; amount of analgesia use; degree of patient satisfaction with pain control both while on parenteral analgesia and after switching to oral; length of time to first ambulation; and length of stay in hospital. Results of the study did not demonstrate a statistically significant difference in any of these, using a P-value of 0.01. The PCA patients took an average of 4.5 hours longer than the IM patients to ambulate postoperatively and the IM patients received at least three times as much antiemetic (P = 0.001). Locus of control was not found to be a major factor in satisfaction or pain levels. Subsequent meta-analyses have also failed to yield significant differences between IM and PCA groups except in patient satisfaction. It is recommended that expansion of PCA programmes with abdominal surgery patients be considered only in cases where there is fiscal advantage or where patient satisfaction can be a driving force.

Cultural differences in Canadian-Chinese nursing.

The Schools of Nursing of Tianjin Medical College and the University of Ottawa have been partners in a Canadian-Chinese linkage project funded by the Canadian International Development Agency (CIDA) and the Chinese Government since 1989, at teh instigation of Canadian faculty member Nancy Johnson who saw the need for academic support for the Chinese nursing community.

Nursing criteria for patient progression post myocardial infarction.

Nurses play a pivotal role in the evaluation of patients with coronary artery disease, since many symptoms are subtle and arise while carrying out activities. Consistency among nursing staff in interpreting patient readiness for activity is crucial to ensure that patients are progressing steadily or to determine if a delay in their progression is warranted. While there have been studies on patient reaction to myocardial infarction and on the physiological effects of activity and/or nursing interventions on myocardial patients, no studies could be found that have examined the criteria used by nurses to assess when patients are ready to increase, decrease or maintain a level of activity according to specific activity protocols. This descriptive study examined the criteria utilized by experienced staff nurses in determining post myocardial patients' readiness to progress through the institution's designated activity levels. The results indicated that in-depth criteria were utilized by these experienced nurses and that patient situations existed whereby it was difficult to determine patient readiness. Factors were discovered that were perceived to enhance or inhibit patient's progression through designated activity levels. Recommendations from this study support the need to (a) examine the use of current activity protocols for their utility in nursing decision making, (b) consider the experiential base of practicing nurses as well as the working environment in any further development of activity protocols.

A comparative study of intensive therapy unit and hospice nurses' knowledge on pain management.

Caring for patients in pain is a pivotal function of nursing practice. In particular, pain control is a primary concern of hospice nurses in order to ensure comfort in the terminal phase of the person's life, and also for nurses in intensive therapy units caring for patients who may have substantial pain related either to pathologic conditions or treatment interventions and who have difficulty communicating their pain. This paper reports on a study which aimed to identify and compare the knowledge and the perceived adequacy and acquisition of knowledge of intensive therapy and hospice nurses pertaining to the theoretical, pharmacological and non-pharmacological aspects of pain and its management using multiple-choice, short-answer and open-ended questions. The sample consisted of 52 intensive therapy and 48 hospice nurses who were further divided into beginners and experts. The findings indicated that although the hospice nurses received higher knowledge scores than the intensive therapy nurses, both groups demonstrated lack of knowledge in specific content areas. In addition, the findings demonstrated few differences between the beginners and experts. The subjects, in general, were not confident about their knowledge of analgesics, nor did they believe that their basic nursing education had prepared them adequately to care for patients in pain. The working environment and clinical work in hospital since qualification were perceived by the subjects to be the most influential experiences in learning about pain and its management.

Using the OSCE to measure clinical skills performance in nursing.

The measurement of clinical skills performance continues to pose a challenge for nurse educators. This paper will report on the use of the objective structured clinical examination (OSCE) to measure the psychomotor learning outcomes of a programme designed to assist students to learn to conduct a nursing neurological examination. The OSCE has a tradition in medicine, having been developed by Ronald Harden in Scotland and first reported in the British Medical Journal in 1975. The University of Ottawa has the longest North American experience with this type of evaluation procedure and there is an increasingly rich medical literature referring to the OSCE. Although the OSCE appears to be a promising method for evaluating competence in the performance of clinical skills, there are no studies in the nursing literature examining the use of the OSCE as a method for evaluating the performance of clinical skills by nurses. Our experience suggests that the OSCE may be a powerful tool in the evaluation of clinical competence in nursing and that it may also be an effective facilitator for learning to perform clinical skills in nursing.