Nursing assistants' perceptions of their role in the resident experience.

The aim of this study was to examine nursing assistants' perspectives of their role in the nursing home resident experience. Recent efforts to improve nursing home quality are focused on providing person-centered care and improving the resident experience. However, the literature on nursing home quality lacks the perspective and experiences of nursing assistants themselves, despite their crucial role in the resident experience. Semistructured interviews were conducted with 25 nursing assistants from 17 organizations and seven states. Data were analyzed using an interpretive approach that identified relevant codes and themes. Respondents perceived that they play a pivotal role in the resident experience by providing choices, communicating important information, comforting, and living within the daily reality of cognitively impaired residents. Nursing assistants' challenges included using non-verbal communication, balancing personal care while maintaining boundaries, and dealing with a perceived lack of trust. Nursing assistants are integral to interpersonal engagement with residents and relationship-based activities, such as communication, caring, and protecting. Increased nursing assistant input into programs and policies to improve the resident experience is warranted. Quality assessment should incorporate direct input from residents and nursing assistants regarding person-centered care.

UK women's experiences of breastfeeding and additional breastfeeding support: a qualitative study of Baby Café services.

BACKGROUND: Whilst 81 % of UK women initiate breastfeeding, there is a steep decline in breastfeeding rates during the early postnatal period, with just 55 % of women breastfeeding at six weeks. 80 % of these women stopped breastfeeding sooner than they intended, with women citing feeding difficulties and lack of adequate support. As part of efforts to increase breastfeeding continuation rates, many public and voluntary organisations offer additional breastfeeding support services, which provide practical support in the early postnatal period and beyond. This paper focuses on the qualitative experiences of UK users of Baby Café services to examine their experiences of breastfeeding and breastfeeding support. METHODS: The study was based upon in-depth interviews and focus groups with users of eight Baby Café breastfeeding support groups across the UK. Thirty-six interviews and five focus groups were conducted with a total of fifty-one mothers using the service. Interviews and group discussions were analysed using N Vivo software to draw out key themes and discussions. RESULTS: Whilst each mother's infant feeding journey is unique, reflecting her own personal circumstances and experiences, several themes emerged strongly from the data. Many women felt that they had been given unrealistic expectations of breastfeeding by professionals keen to promote the benefits. This left them feeling unprepared when they encountered pain, problems and relentlessness of early infant feeding, leading to feelings of guilt and inadequacy over their feeding decisions. Mothers valued the combination of expert professional and peer support provided by Baby Café services and emphasised the importance of social support from other mothers in enabling them to continue feeding for as long as they wished. CONCLUSIONS: The research emphasises the need for realistic rather than idealistic antenatal preparation and the importance of timely and parent-centred breastfeeding support, particularly in the immediate postnatal weeks. The findings suggest that effective social support, combined with reassurance and guidance from skilled practitioners, can help women to overcome difficulties and find confidence in their own abilities to achieve their feeding goals. However, further work is needed to make sure such services are readily accessible to women from all sectors of the community.

What nurses are talking about: content and community within a nursing online forum.

There is little research on the use of online forums by nursing professionals as a way of creating community and exchanging professional knowledge. The purpose of this study is to analyze the content of an online nursing forum to determine the potential of online forums to constitute a community of practice among nurses. We examined one month of thread topics from a nursing focused general discussion forum and categorized (294 discussion threads) according to content. The most frequent topics of discussion were advice regarding career planning and clinical/technical questions. The majority of posts dealt directly with the domain of nursing. The finding that nurses are seeking information about clinical tasks from unverified anonymous online sources raises concerns about the safety culture of health care institutions.

Research ethics in accessing hospital staff and securing informed consent.

Qualitative researchers cannot rely on research ethics to be a static practice. In this article we discuss how observation of guidelines for inquiry and international agreements on the dignity of health care research are not sufficient on their own to ensure that the challenges inherent in the everyday management of a project are regulated. We focus in particular on ethics in accessing participants and the construction of informed consent. During our study, important contrasts emerged between the ideal presented for the standard ethics review process and practical ethics. As a result, we focused on building open communication with the participants through rigorous project management. We analyzed the data and wrote this article collaboratively to represent the empirical reality of a team of researchers aiming to take ethical challenges seriously while collecting data in three National Health Service Trusts in the United Kingdom.

Facilitators and barriers to clinical practice guideline use among nurses.

BACKGROUND: Clinical practice guidelines, which are designed to encourage consistent, efficient applications of scientific evidence in the daily practice of clinicians, are often underutilized. The majority of research concerning their implementation and use has focused on the work of physicians; more research concerning their use by nurses is needed. OBJECTIVES: We sought to learn more about nurses' perceptions of facilitators and barriers to the use of clinical practice guidelines. METHODS: This study examined free-text responses to two open-ended survey questions provided by 575 RNs working at 134 Veterans Affairs medical centers nationwide. We performed conventional content analysis on these data, which allowed thematic categories and subcategories of responses to emerge. RESULTS: A majority of identified facilitators and barriers to nurses' use of clinical practice guidelines were external (outside the individual nurse's control). The most frequently mentioned facilitators and barriers were in the categories of communication, education/orientation/training, and time/staffing/workload. CONCLUSIONS: Social and organizational factors appear to play critical roles in nurses' adoption and use of guidelines. Health care leaders seeking to improve clinical practice guideline use among nurses should ensure that facilitators and barriers-particularly those that are social and organizational-are considered and addressed.

Sinner Ladies and the gospel of good taste: geographies of food, class and care.

Set against a background of continuing state, media and public concerns regarding obesity, this article examines the media event of the 'Sinner Ladies', in Rawmarsh, England. Between 2006 and 2008 three women sparked a controversy that illustrates not only the contradictions inherent in health promotion and surveillance, especially in relation to diet, parenting and care, but also the ways in which such debates touch upon older understandings of social class and locality. Healthy eating policies, including those that stress individual responsibility, need to be contextualised in the cultures and environments in which they are received. Drawing upon notions of health, place, inequality and celebrity, we argue that identity and history continue to play a key role in competing notions of care in relation to family and food.

Constructions of pregnant and postnatal embodiment across three generations: mothers', daughters' and others' experiences of the transition to motherhood.

The academic study of the 'body' has come to occupy the foreground over the past two decades and the differential influences of physical and social worlds particularly upon body management practices have become fundamental to the 21st-century 'project' of the body. In this article we explore three generations of women's accounts of living in/with a pregnant and postnatal body which is now both visible and 'public' as women 'leave' the home for work. However this now takes place in the context of public surveillance (and self-surveillance) particularly about food/eating, 'health' and 'beauty'.

Tanning, skin cancer risk, and prevention: a content analysis of eight popular magazines that target female readers, 1997-2006.

The majority of tanning bed users in the U.S. are women. Previous health communication research frequently focused on the risk of skin cancer, but few studies assessed the mediated communication environment that may surround women's beliefs and behaviors relevant to tanning. A content analysis of articles in eight magazines targeting girls, young women, older women, and women who are interested in fitness during the ten-year period of 1997-2006 was conducted. The amount of coverage of tanning bed use consequences was less than 50% of the coverage of tanning benefits. About 40% of the tanning benefits coverage touted looking healthy. The coverage of prevention methods focused on sunscreen use (55%), while the more important methods (e.g., protective clothing use) were rarely featured. Longitudinally, the coverage of the risk and prevention relevant issues increased between 1997 and 2006. The data indicate that the coverage of tanning benefits also increased during the same period.

A critical examination of the U.S. nursing shortage: contributing factors, public policy implications.

BACKGROUND. Despite short-lived periods of adequacy in nurse availability, the nursing shortage has endured. In order to better understand the myriad factors that influence the current shortage of nurses, as well as possible solutions, this project addresses the influence of social factors and government policy on nurse staffing inadequacy. When the government intervenes in a philosophically free-market economy, the assumption is that a problem, such as the current nursing shortage, could not be solved without such intervention. PURPOSE. Nursing care arguably falls into the realm of protecting the common good, and therefore requires government oversight. We provide a critical analysis of policy intervention efforts into the nursing shortage debate by examining the passage of legislation, the provision of educational assistance, and the establishment of minimum staffing requirements and minimum quality standards for reimbursement, which all impact nursing supply and demand. RESULTS. Arguments supporting and opposing policy intervention in general, and its impact on the overall provision of nursing care in the United States, were examined. Without policy incentive to place financial value on the quality of care provided by nurses, a simple increase in the number of available nurses is unlikely to solve the current problem. IMPLICATIONS. Important considerations that should be factored into policy creation include measurement and compensation for quality care, the nature of recruitment efforts of new nurses, and the complex nature of a nursing work.