Shift report: a ritual play on a residential adolescent psychiatric unit.

The author conducted an ethnographic study of an adolescent residential psychiatric unit which revealed a category of behaviour--the shift report. A questionnaire was administered to staff to reveal further meanings. Reporting was found to schematize knowledge according to common referents, promote and validate insider roles through language, offer a means of personal reintegration and catharsis, and provide a forum for the symbolic enactment of democratic values which permeated every aspect of culture on the unit. Staff members were categorically in favour of their verbal and private shift report. There was little partitioning of informal and formal aspects of report in the interest of saving time. Instead, socializing and 'catching up' were important aspects of shift report and constituted a large part of team building. The informal nature of report, particularly in the use of language allowed staff to come to terms with frustrations rather than constituting patient stereotyping. As a ritual, the shift report fostered behavioural synchrony, individual empowerment and a democratic 'all-channel network' of communication. It is hoped that this account will encourage more practising nurses and managers to view their shift report as something more than a simple 'handover'; that is, a ritual play of core values, roles and relationships.

Creating a climate for critical thinking in the preceptorship experience.

The impact of the learning climate on students' ability to think critically during preceptorship cannot be underestimated. The success of students in learning to think critically rests largely with the tone set by preceptors and staff (Myrick 1998). Students must be led gently into the active role of discussing, dialoguing, and problem solving (Meyers 1986). They watch very carefully how respectfully preceptors and staff field their comments, quickly notice nonverbal cues that indicate how open, approachable and supportive the preceptors and the staff are to their questions and contributions, and then discern how valued they are as colleagues. When preceptors genuinely value, support, and work with students in the practice setting and staff accept them as part of the team, a climate that is conducive to learning and critical thinking is established. This is due to the fact that students feel safe enough to question, to challenge and be challenged, and to be creative in their problem solving. The purpose of this paper is threefold: a) to identify key factors in the preceptorship experience that contribute to the creation of a climate that is conductive to critical thinking; b) to provide important insights into the role of the preceptor and the staff within that context; and c) to discuss how nursing faculty can more actively contribute to ensuring that such a learning climate is achieved in the preceptorship experience.

Logs as adjuncts to therapy for adolescents in a residential psychiatric program.

As part of a 3-year ethnography of an adolescent residential psychiatric program, staff, patients, and occasionally family members were observed communicating using written logs. Using participant observation and opportunistic interviewing, and reading the logs, the researcher was able to determine the advantages, disadvantages, and direct value of the logs to patients and staff. Logs, when used judiciously after patient assessment, demonstrated patient responsiveness to treatment and promoted patient-centered care. Writing in logs increased patients' identification of thoughts and feelings, mirrored their developmental state, and demonstrated staff members' skills in communication. They are an invaluable adjunct to therapy for certain adolescent patients.

Variables and designs in psychiatric/mental health nursing research articles published from 1982 to 1992.

Research designs and variables of interest were classified in 194 mental health psychiatric articles published between 1982 and 1992. Common variables only could be identified in 100 articles and independent and dependent variables were identified in the remaining 94 articles. The majority of research designs were descriptive. The variables pertained to diverse interests from nurse and patient perspectives, specifically including patients' behavioural responses to illness, care and caregivers. These variables were then compared by the writers to the current research foci as identified in the recent literature. As listed, these are: biological psychiatry; working with the chronically and persistently mentally ill; shifting of care to the community; working with consumers; and outcome research. There is some link between research published between 1982 and 1992 and current trends in design and a few variables of interest. However, current researchers in mental health psychiatric nursing need to change foci and their relationships with other disciplines to ensure relevancy in their research programmes.

Assessing and preparing students for distance preceptorship placements.

Preparing students for distant preceptorship placements requires knowledge of individual students through formal and informal mechanisms. Since they receive support via telephone, fax or mail, the first onus is on students to manage their preceptorship situations effectively. In order to enhance their abilities in preceptorship situations, students can be assessed for their learning and personality styles. Findings from two style assessment tools, Kolb's Learning Style Inventory and Myers-Briggs Type Indicator, can be used to gain insight into students' interactions with preceptors and to assist instructors in giving the right kind of support and direction after students are placed.

A systematic review of the psychiatric/mental health nursing research literature 1982-1992.

The purpose of this study was to assess the quality of quantitative psychiatric/mental health nursing research articles published in English between 1982 and 1992, worldwide. Criteria for selection of articles included nurse authorship or co-authorship, use of a quantitative design and pertinence to an aspect of the nursing process with psychiatric/mental health patients. One hundred and ninety-four articles met these criteria. The quality of each article was assessed by two nurse experts using Duffy's Research Appraisal Checklist (RAC). Forty-six point nine per cent of the articles were rated as superior, 50% as average and 3.1% as below average. Other findings identified journals that published research articles, countries in which research was completed, applicability of funding and qualifications of the authors. The major implications of this study are that nurses can be directed to superior articles; more publication of research by nurse authors is warranted, research is being completed with little financial support, highly rated research publications tend to get funding and editorial policies affect the quality of publication.

Preceptors evaluating nursing students.

In this exploratory, descriptive survey of 295 nursing preceptors it was found that 98.3 per cent had evaluated nursing students. They cited numerous reasons as to why they should be involved in the evaluation process. Only 28.8 per cent had been taught to evaluate and 5.4 per cent had failed students. There is a discrepancy between how little preceptors are prepared for the evaluation role and how frequently they are expected to do so. Consequently, there is an onus on nurse educators to prepare clear evaluation forms, to assess students for suitability for preceptorship experiences, and to recognize evaluation as part of the preceptor's professional relationship with the student.

Through the eyes of the preceptor.

This study highlights some of the issues for preceptors and assists in clarifying the role of preceptors, students and nurse educators. Through a survey of 295 nursing preceptors in the province of Alberta, it was found that most preceptors rated their orientation to their role as adequate to very adequate, the greatest advantage was re-examining their knowledge and the most common problem was having a student with poor nursing skills. Only 30 percent used nursing frameworks. The implications are: nursing educators need to take more responsibility in the areas of preceptor and student orientation, assess the student, preceptor and agency prior to placement, and understand that the preceptor may not be using a nursing framework. Nurses working as preceptors do have the advantage of knowledge since working with students can be a form of continuing education. This study highlights some of the issues for preceptors and assists in clarifying the role responsibilities of preceptors, students and nurse educators.

The lifeworld of the chronic mentally ill: analysis of 40 written personal accounts.

In this study, chronicity in mental illness has been investigated as it is lived rather than how it might be conceptualized. Published first-hand accounts have provided the mechanism for direct access in coming to know the life of persons, their circumstances, and the meanings they associate with a life of persistent and enduring mental illness. These are unique and particular human experiences, and there are no empirical generalizations or law-like statements that can give such an understanding. Therefore the disclosure of meaning was sought through a hermeneutic-phenomenologic process. Four lifeworld existentials provide the framework for a combined description and interpretation of what it means to "live" chronic mental illness. The article concludes with a brief discussion of some implications for nursing practice, and commentary is made on the relevance of such insights to health care providers in both acute and community care settings.

Collaborative research by graduate students.

PURPOSE: Educators are challenged to prepare graduate students for future cooperative efforts by fostering collaboration. ORGANIZING FRAMEWORK: Assumptions and beliefs about collaborative research are examined and a definition and ethical considerations are suggested. A sample letter of agreement is also provided. CONCLUSIONS: Effective collaborative research is accomplished through planning and organization, and cannot be left to chance.

Acknowledging preceptors: not an easy task.

Educators commonly discuss the need to reward nurse preceptors. A survey of 295 preceptors teaching nursing students found 118 nurses (36.6%) did not feel a reward was appropriate, while the remainder felt it was. When asked if they had enough support, 68 (22.9%) reported "no" and 213 (73%) reported "yes." Recommendations stemming from this research include: the need to redefine "reward" to be more congruent with the preceptor's perceptions; to provide acknowledgment to preceptors reflective of their educational and professional role; and to recognize that the ongoing communication and feedback with nursing faculty is a crucial factor in preceptors' perceptions of support.

Developing trusting, caring relationships: home care nurses and elderly clients.

Trusting as an area of research has not been critically examined in nursing research literature. In this study, nurses working in home care and elderly clients were interviewed to ascertain the process of developing a trusting relationship. Data were obtained from seven home care nurses and six elderly clients who were interviewed from one to three times. The data were analysed using grounded theory methodology and sorted using Microsoft Word software on a Macintosh computer. The core category which was identified in the data was labelled 'trusting, caring relationships'. This core category encompassed trusting which is developed and the caring which the nurses provide. Home care nurses and elderly clients moved through four phases: initial trusting; connecting; negotiating; and helping. The findings have implications for novice nurses working with elderly people, as well as for programme development and education. More research needs to be done on trust in different contexts to assist all nurses in establishing nurse-client relationships.

What psychiatric nurses say about constant care.

As part of a qualitative research project on constant care, 8 psychiatric nurses described their perceptions of the constant care experience and its purposes and values. One of the major domains that emerged from the interviews was "nursing"; it consisted of nine themes, some of which indicated that constant care alters the passage, meaning, and use of time, is a dynamic rather than a static relationship, and enhances a nurse's sense of powerfulness. The findings showed that constant care is a dynamic, and to some, distorting, experience. It demands extra work from the nurses, yet constrains them from doing counseling or other higher-order interventions. Having more nursing experience was seen as an advantage in preparing for constant care, controlling angry feelings, and discriminating for potentially dangerous situations. Also, due to the interactive nature of constant care, a nurse could not merely guard a patient because the nurse is also on constant care. These findings have implications for making patient assignments, teaching novice nurses how to do constant care, affirming current practice even though it is against hospital policies, and illustrating how nurses can be aware of and resourceful when constant care is stressful.

Exploring empathy: a conceptual fit for nursing practice?

After three decades, the efficacy of empathy in the clinical setting remains undocumented. Recently, concerns have been raised that the concept may be inappropriate and even harmful to the nurse-patient relationship. An analysis of the concept indicates that empathy consists of moral, emotive, cognitive and behavioral components. By tracing the integration of this concept into nursing, we suggest that empathy was uncritically adopted from psychology and is actually a poor fit for the clinical reality of nursing practice. Other communication strategies presently devalued, such as sympathy, pity, consolation, compassion and commiseration, need to be reexamined and may be more appropriate than empathy during certain phases of the illness experience. Directions for future research are suggested.