Students' Observations of the Nursing Role in Seven Nations.

AIM: This exploratory, qualitative study was conducted to compare nursing tasks/roles in Ecuador, Finland, Ghana, Navajo Nation, Russia, Taiwan, and Tonga. BACKGROUND: The definition of nurse varies internationally, with little description of the specific tasks nurses perform. To better know the profession, nurses must understand what their counterparts do in different parts of the world. METHOD: Students and faculty traveled to seven nations to conduct an observational study. Students observed nurses (n = 71) over a period of three weeks using a checklist of basic tasks/skills, advanced skills, critical thinking, communication, public health, and professionalism. RESULTS: Similarities in nursing tasks/roles were found, with a few stark differences between countries. Autonomy of practice and communication styles varied; all nurses were found to be effective patient advocates. CONCLUSION: Sufficient nursing personnel, resources, patient load, and technology affect nursing tasks/roles.

Long-term effects on nursing alumni: Assessing a course in public and global health.

The impact of a cultural awareness course among nursing students may affect the particular person for years to come. Cultural awareness can be taught via many methods, often requiring study abroad and/or extreme investment of time, money and effort. There is little research on sustained effects on nursing alumni from such a course. The purpose of this descriptive survey study was to determine the long term outcomes of a cultural awareness course and 2) compare the long term effects between alumni who went abroad and those who chose to complete the course locally. One hundred and twenty-one nursing alumni completed the International Education Survey (IES) (Zorn, 1996) with additional open-ended questions. Quantitative and qualitative results concluded: 1) nursing alumni were influenced long term by a course dedicated to public and global health and 2) all alumni had statistically significant IES scores but alumni who studied abroad had the greatest increase.

Nurse retention and satisfaction in Ecuador: implications for nursing administration.

AIM: This study explores the characteristics of professional nursing work environments that may affect nursing turnover and satisfaction within a large Ecuadorian hospital. BACKGROUND: Nursing turnover is a challenge and may compromise patient care. Work dissatisfaction contributes to high turnover. Improving nurse satisfaction can contribute to better patient outcomes. METHOD: Eighty-eight nurses participated in a quantitative and qualitative survey focusing on nursing satisfaction, turnover and selected organisation characteristics. RESULTS: Issues that may affect nurse satisfaction and turnover were identified using questions from the Nursing Work Index: pay, insufficient number of nurses, undervaluing of nurses by public and the medical team, limited advancement opportunities, lack of autonomy and inflexibility in schedule. Other themes identified from qualitative data are reported. CONCLUSIONS: The top factor of decreased satisfaction was low pay as indicated by the Nursing Work Index. The qualitative results showed that low pay was the factor for nurse turnover. Additional factors related to nursing satisfaction can be addressed to improve nurse retention. IMPLICATIONS FOR NURSING MANAGEMENT: Along with increasing nursing pay, strategies to consider in decreasing turnover and increasing satisfaction included: providing opportunities for nursing advancement, promoting the value of nursing, creating clinical protocols and enhancing autonomy. This study adds to knowledge about nursing needs and satisfaction in South America.

Teaching the teacher program to assist nurse managers to educate nursing staff in Ecuadorian hospitals.

Continuing education for hospital staff nurses is a concern worldwide. Current research shows that continuing education among nurses can positively affect patient outcomes (O'Brien, T., Freemantle, N., Oxman, A, et al., 2002. Interactive continuing education workshops or conferences can improve professional practice and patient outcomes. Journal of Evidence Based Nursing. 26 (5)). Seeing a need for improved patient outcomes among hospitals in Ecuador, we conducted a teaching the teacher program to assist nurse managers to carry-out continuing education in their hospital system. This teaching the teacher program was established through the collaboration between one College of Nursing in Utah, USA and a large healthcare system in Guayaquil, Ecuador. The collaboration has been ongoing for five years, 2003 to present. Initial projects included classes for the nursing staff including technical skills, life-saving techniques, and nursing process and assessment. Collaborators from the US and Ecuador believed that in order to maximize the improvement of nursing care in the hospital system it was necessary to turn attention on the nurse managers and not just the staff nurses. This would allow for meaningful ongoing learning beyond the one-time classroom setting. Continuing education is not common in Ecuadorian hospitals as it is in the United States. The purpose of this paper is to describe the project and provide initial evaluative data on the response to the curriculum; including evidence of managers using the teaching principles they were taught. The underlying aim of the project was to achieve a sustainable impact by teaching the leaders of each unit how to be more effective teachers. In May 2007, a two-day "teaching the teacher" workshop was developed with the needs of the managers in mind. The participants in the course included the chief nursing officer and leaders of various units of the hospital. In May 2008 a follow-up class was taught, along with an evaluation by a verbal and written survey with open ended questions and an observation of an actual class being taught by the participants.

Emergency nurses' perceptions of obstacles and supportive behaviors in end-of-life care.

INTRODUCTION: Little is known about emergency nurses' perceptions of either obstacles or supportive behaviors for providing end-of life (EOL) care to dying patients. The purpose of this study was to determine the perceived obstacles and supportive behaviors in providing EOL care to dying patients in emergency departments. METHODS: In this survey research, a 73-item questionnaire regarding EOL care was mailed to a geographically dispersed national random sample of 300 members of the Emergency Nurses Association. Descriptive statistics were calculated for the 54 Likert-type items and demographic items. Two open-ended questions were analyzed using content analysis. RESULTS: Returns after 3 mailings yielded 169 usable questionnaires from 284 eligible respondents for a return rate of 59.5%. The greatest obstacles were: (1) emergency nurses having too great a work load to care for dying patients; (2) emergency nurses having to deal with angry family members; and (3) the poor design of emergency departments that do not allow for privacy of dying patients or grieving family members. The most supportive behaviors were: (1) good communication between the physician and RN caring for the dying patient; (2) physicians meeting in person with the family after the patient's death; and (3) an emergency department designed so that the family has a place to grieve in private. DISCUSSION: Having a better understanding of emergency nurses' perceptions of obstacles and supportive behaviors in providing end-of-life care could help decrease the stress of caring for dying patients. Actions could be taken to decrease the highest rated obstacles and increase the ratings of supportive behaviors that may ultimately result in better end-of-life care for dying patients and their families in the emergency setting.

Nursing education and service collaboration: making a difference in the clinical learning environment.

This article focuses on innovative collaborative steps that were identified in recent research conducted by these authors on the relationship between academia and service. These steps are currently being implemented in the hope of improving the important role that the clinical environment plays in student nurses' education. Few factors in nursing education are as important as the clinical environment in which students do their training. This article elaborates on these steps and offers practical suggestions for improving the relationship between academia and service.