Nursing practice issues in Jordan: student-suggested causes and solutions.

BACKGROUND: The causes of the worldwide shortage of registered nurses are complex and require a multifaceted approach to the solution. It is imperative that issues of the practice environment are addressed because creating quality practice environments is essential to provide high-quality care and to persuade nurses to remain in practice. AIMS: The aims of this paper are to describe an international collaborative relationship, and to identify, describe and suggest solutions to three nursing practice issues relevant to Jordanian nursing. METHOD: Two faculty members, one from Jordan and one from Canada, collaborated via e-mail to develop a fourth-year course on nursing leadership and management, which was then jointly taught by them. A student assignment required students, working in groups, to identify a nursing practice issue in Jordan and suggest contributing causes and solutions. CONCLUSION: The issues identified by the students were: unclear role expectations, burnout and turnover, all of which were viewed as contributing to problematic practice settings. The students suggested possible solutions to the practice environment issues.

Nurses' experience of violence in Alberta and British Columbia hospitals.

This study examined responses to a survey on violence in the workplace from a sample of 8,780 registered nurses practising in 210 hospitals in the Canadian provinces of Alberta and British Columbia. Findings relate to the frequency of violence against nurses, reported as the number of times they experienced a violent incident in the workplace. Nearly half (46%) of those surveyed had experienced 1 or more types of violence in the last 5 shifts worked. Frequency varied by type: emotional abuse 38%, threat of assault 19%, physical assault 18%, verbal sexual harassment 7.6%, sexual assault 0.6%. Further, 70% of those who had experienced violence indicated they had not reported it. Patients constituted the main source of all types of violence. The most prevalent type, emotional abuse, was further explored for its possible determinants. This was also the type of violence most evenly distributed among sources (patients, families, co-workers, physicians). Multiple regression modelling using the individual nurse as the unit of analysis showed the significant predictors of emotional abuse to be age, casual job status, quality of care, degree of hospital restructuring, type of unit, relationships among hospital staff, nurse-to-patient ratios, and violence-prevention measures; using the hospital as the unit of analysis the predictors were found to be quality of care, age, relationships with hospital staff, presence of violence-prevention measures, and province. These findings illustrate important differences in models that use the individual and the institution as the unit of analysis. Implications include targeting prevention strategies not only at the nurse but, perhaps more importantly, at the hospital. Overall, the findings suggest that health-care institutions are not always healthy workplaces and may increasingly be stressful and hazardous ones.

Stigma of visible and invisible chronic conditions.

Nurses deliver care to people with various forms of chronic illnesses and conditions. Some chronic conditions, such as paraplegia, are visible while others, such as diabetes, are invisible. Still others, such as multiple sclerosis, are both visible and invisible. Having a chronic illness or condition and being different from the general population subjects a person to possible stigmatization by those who do not have the illness. Coping with stigma involves a variety of strategies including the decision about whether to disclose the condition and suffer further stigma, or attempt to conceal the condition or aspects of the condition and pass for normal. We present a beginning framework that describes the relationship between the elements of stigma and the decision to disclose or hide a chronic condition based on its visibility or invisibility. The specific aims were to combine the results from a meta-study on qualitative research with a review of the quantitative literature, then develop a theoretical framework. Although an understanding of how patients cope with stigmatizing conditions is essential for nurses who aim to deliver comprehensive individualized patient care, there is little current literature on this subject. The relationship between visibility and invisibility and disclosure and non-disclosure remains poorly understood. A framework to facilitate a deeper understanding of the dynamics of chronic illnesses and conditions may prove useful for practice.

Living with chronic illness: the interface of stigma and normalization.

Traditionally, researchers have studied and interpreted the chronic illness experience through a lens of either stigma or normalization, but rarely both simultaneously. When chronic illness is examined through a stigma lens, the findings tend to focus on the manner in which the individual suffers from the stigma. When it is examined through a normalization lens, the findings tend to articulate the ways in which the individual achieves normalcy despite having a chronic condition. This paper discusses the implications of assuming either of the two perspectives independent of the other. The authors argue that, in order to capture and understand the dynamic and evolving experience of people with chronic conditions, researchers should consider the interdependence of the two perspectives and avoid assumptions that derive from stigma or normalization alone. Considering stigma and normalization aspects of a chronic illness experience, in interaction over time, will facilitate a broader and more accurate understanding of the complex experience of people coping with chronic conditions.

Quality of life for family caregivers of people with chronic health problems.

The trend toward community-based care, along with advances in medical technology, has resulted in increased numbers of individuals with complex healthcare needs being cared for at home by their families. This shift from hospital to community care places increased demands on family caregivers. Families are now providing long-term care for chronically ill people with a variety of conditions. Caregiver research has, for the most part, explored burden, stress, and depression as outcomes of caregiving. There is little research assessing the quality of life (QOL) of long-term caregivers. In the research on quality of life, the patient is most frequently the focus. With the increased demand on families as caregivers, quality of life needs to be included as a variable in studying family caregivers for chronically ill individuals. The purpose of this paper is to discuss issues in studying quality of life in family caregivers of persons with chronic conditions. Conceptualization of quality of life is explored, measurement of quality of life examined and the research on quality of life reviewed, with a focus on the quality of life of the family caregiver.

Managing within a culturally diverse environment.

Canada has long been a multicultural nation, but the increasing ethnic diversity of new Canadians has shifted our multicultural make-up. In 1967, the top five countries from which immigrants came to Canada were Britain, Italy, United States, Germany and Greece. Almost 30 years later, in 1995, the top five sources were Hong Kong, India, the Philippines, China and Sri Lanka.

Job sharing at the managerial level.

Job sharing restructures a full-time position-two individuals share the responsibilities and the benefits of the position. If nurses are committed to making it work, this arrangement can succeed at the managerial level.

Decentralization as a determinant of autonomy, job satisfaction, and organizational commitment among nurse managers.

The purpose of this study was to test a theoretical model of the following variables, decentralization, professional autonomy, job satisfaction, and organizational commitment. Data were collected through a comprehensive survey of first-line nurse managers (N = 200) in acute care hospitals with more than 100 beds in British Columbia, Canada. The final model excluded all explored personal characteristics of the nurse manager-gender, health or vitality status, marital status, age, education, and years of supervisory or management experience. Job satisfaction was found to be an important predictor of organizational commitment. However, decentralization was most important because it affected organizational commitment directly, as well as indirectly, through professional autonomy and job satisfaction.

First-line managers: scope of responsibility in a time of fiscal restraint.

Fiscal restraint and government cost control have contributed to the downsizing and restructuring of Canadian health care organizations. As key players in the hospital sector, the role and responsibilities of first-line nurse managers have been significantly affected by these changes. This paper presents data from a survey of 200 first-line nurse managers in British Columbia which investigated the current scope of the first-line manager's role, the number of hierarchical levels within nursing departments, and views on managerial union membership.

Assisting families of head-injured survivors through a family support programme.

The purpose of this project was to develop, implement and evaluate a community-based education/support programme for families of head-injured survivors. Three measures were used in evaluating the programme: (a) a written evaluation by the participants, (b) the clinical impressions of the programme facilitators and the principal investigator, and (c) the three outcome measures: coping, self-esteem, and well-being. A pretest-posttest quasi-experimental design was used to test the effect of the intervention (the programme) on the outcome measures. Data yield mixed results and suggest that the programme had considerable practical but not statistical significance.

Emergency shelters in Vancouver, Canada.

The shelter experiences, employment history, income and social service needs utilization were examined among 124 emergency shelter users in Vancouver, British Columbia. Thirty-six (30.5%) reported this as their first experience with living in a shelter; the length of stay in the present shelter ranged from one to 90 days. Reasons for shelter use included: eviction from last place of residence, loss of job, or suffering from health problems rendering one unable to work. The highest unmet service needs were finding affordable housing and finding a job. This combination of scarcity of low-cost housing, health problems, and difficulty in finding employment have led to a situation where emergency shelters have become extended places of residence, a "home" to many.

Mental and physical health of homeless persons who use emergency shelters in Vancouver.

OBJECTIVES: Homelessness is often associated with deinstitutionalization of chronic mentally ill people, but estimates of the number of mentally ill people in the homeless population vary. The purpose of the study was to determine the extent of psychiatric problems among the users of shelters for homeless persons in Vancouver, British Columbia. In addition, the study documented the demographic and physical health characteristics of shelter residents. METHODS: Researchers surveyed 124 emergency shelter users about their self-reported physical and mental health status and assessed their mental health status using the Brief Psychiatric Rating Scale (BPRS). RESULTS: Shelter users in Vancouver were predominantly a young, male, single mobile population. About half reported a current physical health problem, 44 percent reported use of nonprescribed drugs, and 69 percent reported use of alcohol. Nineteen percent reported a current mental or emotional problem, with schizophrenia and bipolar disorder the most common diagnoses reported. BPRS scores indicated that depression, anxiety, and tension were common problems. CONCLUSIONS: Although the number of individuals with mental illness in the population surveyed was lower than in similar populations in the United States, the presence of mentally ill people in Vancouver shelters suggests that shelters should address mental health issues as well as provide services to ensure residents' basic survival.

Use of the brief psychiatric rating scale by nurses.

1. Nurses are intimately involved in the assessment of patients in inpatient clinical settings and in community settings--and nurses have a role to play in the systematic rating of severe psychopathology. 2. The Brief Psychiatric Rating Scale (BPRS) provides a means of assessing mental health status from an interview using 16 rating concepts. Analysis of BPRS rating profiles obtained from a variety of patients and settings have consistently revealed four syndromes: withdrawal-retardation, anxious depression, hostile-suspiciousness, and thinking disturbance. 3. Once properly trained regarding the BPRS, nurses can use the scale effectively in the assessment and ongoing monitoring of patient conditions. The scale is an added tool for nurses to use in monitoring the effectiveness and outcome of both medical and nursing interventions.