Caring in the wake of the rising tide: Moral distress in residential nursing care of people living with dementia.

Objective Moral distress is increasingly being recognized as a concern for health care professionals. The purpose of this study was to explore the nature and prevalence of moral distress among nursing staff who care for people living with dementia. Methods This study was focused on nursing staff caring for people with dementia in long-term care and assisted living sites. The Moral Distress in Dementia Care Survey instrument was distributed to 23 sites and nursing staff rated the frequency and severity of situations that were identified as potentially causing moral distress. Results Moral distress is prevalent in the nursing staff who provide dementia care. Nursing staff reported experiencing moral distress at least daily or weekly. Both frequency and severity of moral distress increased with proximity to (amount of time spent at) the bedside. Moral distress had negative psychological and physiological effects on nursing staff, and affected intention to quit.

Nursing Students Achieving Community Health Competencies through Undergraduate Clinical Experiences: A Gap Analysis.

In Canada, it is widely believed that nursing practice and health care will move from acute care into the community. At the same time, increasing numbers of nursing students are engaged in non-traditional clinical experiences for their community health rotation. These clinical experiences occur at agencies not organizationally affiliated with the health care system and typically do not employ registered nurses (RNs). What has yet to be established is the degree to which nursing students are actually being prepared for community health nursing roles through their community health clinical rotations. In this paper we report the findings of a mixed method study that explored the gap between desired and observed levels of competence in community health of senior nursing students and new graduates. The gap was quantified and then the nature of the gap further explored through focus groups.

Disconnects in pedagogy and practice in community health nursing clinical experiences: Qualitative findings of a mixed method study.

BACKGROUND: Many baccalaureate schools of nursing are using non-traditional placements for undergraduate community health clinical rotations. These placements occur at agencies not organizationally affiliated with the health care system and they typically do not employ registered nurses (RNs). OBJECTIVES AND DESIGN: In this paper, we describe the qualitative findings of a mixed method study that explored these gaps as they relate to pre-registration nursing students' preparation for community health roles. RESULTS: While non-traditional community health placements offer unique opportunities for learning through carefully crafted service learning pedagogy, these placements also present challenges for student preparation for practice in community health roles. The theory-practice gap and the gap between the expected and actual performance of new graduates are accentuated through the use of non-traditional community clinical experiences. These gaps are not necessarily due to poor pedagogy, but rather due to the perceptions and values of the stakeholders involved: nursing students, community health nursing faculty, and community health nurses. CONCLUSIONS: New ways must be developed between academe and community health practice areas to provide students with opportunities to develop competence for practice.

New Rural Acute Care Nurses Speak Up: "We're it" But We're Not Ready.

Many novice registered nurses feel ill-prepared for rural nursing practice. Using a mixed method design, an assessment of the learning needs of new graduate nurses (NGNs) working in rural hospitals in Alberta, Canada, was undertaken. NGNs in rural practice indicated that they struggle with becoming "multispecialists." Consequently, administrators and nurse educators need to tailor workplace structures by establishing collaborative programs with urban facilities and using orientation tailored to the learning needs of NGNs.

Baccalaureate nursing education: has it delivered? A retrospective critique.

Despite political support for the baccalaureate degree as entry to practice, historical concerns over nursing education - the value of education versus service, professional versus vocational identity and theoretical versus practical knowledge - persist. The authors challenge the notion of a "two-tiered" nursing system and call for a nationwide curriculum review to help the profession adapt to the changing needs of the Canadian healthcare system.

Competence and competency-based nursing education: finding our way through the issues.

The language of competence is widely utilized in both the regulation of nursing practice and curricular design in nursing education. The notion of competence defines what it means to be a professional, although it is not the only way of describing nursing practice. Unfortunately, there is much confusion about the concepts of competence, competency, and competency-based education. As well, the notion of competence, despite its global popularity, has flaws. In this paper we will disentangle these terms and critique the use of competence frameworks in nursing education.

Doctors' orders and the language of representation.

The term doctors' orders or physicians' orders is endemic to nurses' work, to the degree perhaps that few nurses give the term much thought. The nursing profession has progressed over its historical trajectory, from a level of considerable dependence upon physicians' directives, in its beginning, to much greater professional autonomy. However, the term order remains a stronghold in nurses' professional reality, despite the fact that this term is laden with anachronistic ideological interests that are embedded within the historical, sociopolitical and gendered contexts in which health care occurs. In this essay I consider the term order through multiple philosophical and semantic lenses. I explore the endowment of power within the word order and how this term disadvantages nurses. I examine how the word order demarcates roles and establishes perceived value of the item represented by the originator of the order. The concept of doctors' orders carries powerful meanings, affirms the power-as-knowledge hierarchy so entrenched in the nurse-physician relationship, and can inhibit nurses' full participation as partners in health care.

Towards culturally relevant nursing education for aboriginal students.

Aboriginal nursing students face numerous challenges in North American nursing educational programs, as reflected in the relatively high attrition rate of these students. In this paper, the authors argue that nurse educators need to create more culturally relevant curriculum and instructional approaches for Aboriginal students. Such approaches would help nursing educators to ensure that current aboriginal nursing programs--which are largely assimilative in nature--can be more successful and transformative in nature.

Aboriginal nursing education in Canada: an update.

Canada does not have enough aboriginal nurses and aboriginal nursing faculty. Consequently, there is an inadequate number of nurses to meet both on- and off-reserve and community health care staffing needs. In 2002, Health Canada asked the Canadian Association of University Schools of Nursing to facilitate a national task force that would examine aboriginal nursing in Canada. The task force engaged in an extensive literature review, conducted a national survey of nursing programs, and explored recruitment and retention strategies. In 2007, the association prepared an update on the current status. In this article, the authors review the progress made during the intervening five years in the recruitment, retention and education of aboriginal nursing students.

Lets Do Lunch? The ethics of accepting gifts from the pharmaceutical industry.

When nurses think of ethical issues, debates on assisted suicide or maternal versus fetal rights often come to mind. A less obvious but undoubtedly more common ethical issue is whether or not sponsored lunches, educational events and other forms of gift giving should be accepted from pharmaceutical companies. The authors review the nature of pharmaceutical marketing and gift giving and examine some of the potential ethical issues that arise when nurses accept these gifts.