Men in nursing: A thematic analysis of male nursing students experiences of nursing education in regional New Zealand

There is considerable debate about the effects the inclusion of men in nursing have on the quality of patient care and the profession itself. Whilst nursing is seen as a predominately female orientated career, it is often forgotten that the patron saint of nursing is actually a man – St Camillus of Lellis, a 16th century Italian Monk. However, evolution both politically and religiously had meant that the contemporary male figure within the nursing fraternity slowly gave way to women as men became more engaged with careers more befitting their social standing such as medicine, the church or the military Surprisingly, opinion about whether men are suitable within the profession continues to be a divided issue. Men enter the profession for a multitude of reasons, yet barriers whether emotional, verbal or sexual are still present. However, nursing is attractive because the variety of work enables an easy transition between specialties and the scope for career advancement is exciting both clinically and academically especially with the recent inception of nurse practitioner and nurse consultant roles.

Losing the rural nursing workforce: Lessons learnt from resigning nurses

Background Australian workforce planning predicts a shortfall of nurses by 2025 with rural areas being most at risk. Rural areas have lower retention rates of nurses than metropolitan areas, with remote communities experiencing an even higher turnover of nursing staff. There have been few studies that examine the impact of nurse resignations on rural nursing workforces. Objective This paper is abstracted from a larger study into the reasons why nurses resign from rural hospitals and explores the resignation period. Design A qualitative study using grounded theory methods. Following in-depth interviewing and transcription, data analysis occurred with the assistance of NVivo software. Setting Rural NSW. Participants Twelve registered nurses who had resigned from rural NSW hospitals and not for reasons of retirement, maternity leave or relocation; two participants were re-interviewed. Results While the overall study identified a grounded theory which explained rural nurses resign from hospitals due to a conflict of values, three additional themes emerged about the resignation practices at rural hospitals. The first theme identified a ‘window period’ which was an opportunity for the nurse to be retained. The second theme identified that nurses who had resigned were not involved in formal exit processes such as exit interviews. The third theme captured the flow-on effect from rural nurse resignations resulting in nurses leaving the profession of nursing. Conclusion To facilitate nurse retention, it is important that rural hospitals manage nurse resignations more effectively. This includes re-examining resignation procedures, how nurses are treated and collecting meaningful data to inform retention strategies.

Case study 1: Nursing informatics and eHealth in Australia

There are currently many changes happening in nursing and healthcare in Australia. Healthcare reform has been high on the national government agenda and has created many changes in healthcare including eHealth. Healthcare information technologies and informatics are providing many challenges and excitement for the future of healthcare in Australia. The challenge for professional nursing organisations and nursing leaders of Australia is to be proactive in developments and initiatives for nursing to remain visible and viable in health care systems to safeguard the profession for the future as health care reform is implemented.

Identifying advanced practice: A national survey of a nursing workforce

Background The size and flexibility of the nursing workforce has positioned nursing as central to the goals of health service improvement. Nursing's response to meeting these goals has resulted in proliferation of advanced practice nursing with a confusing array of practice profiles, titles and roles. Whilst numerous models and definitions of advanced practice nursing have been developed there is scant published research of significant scope that supports these models. Consequently there is an ongoing call in the literature for clarity and stability in nomenclature, and confusion in the health industry on how to optimise the utility of advanced practice nursing. Objectives To identify and delineate advanced practice from other levels of nursing practice through examination of a national nursing workforce. Design A cross-sectional electronic survey of nurses using the validated Advanced Practice Role Delineation tool based on the Strong Model of Advanced Practice. Participants Study participants were registered nurses employed in a clinical service environment across all states and territories of Australia. Methods A sample of 5662 registered nurses participated in the study. Domain means for each participant were calculated then means for nursing position titles were calculated. Position titles were grouped by delineation and were compared with one-way analysis of variance on domain means. The alpha for all tests was set at 0.05. Significant effects were examined with Scheffe post hoc comparisons to control for Type 1 error. Results The survey tool was able to identify position titles where nurses were practicing at an advanced level and to delineate this cohort from other levels of nursing practice, including nurse practitioner. The results show that nurses who practice at an advanced level are characterised by high mean scores across all Domains of the Strong Model of Advanced Practice. The mean scores of advanced practice nurses were significantly different from nurse practitioners in the Direct Care Domain and significantly different from other levels of nurse across all domains. Conclusions The study results show that the nurse practitioner, advanced practice nurse and foundation level registered nurse have different patterns of practice and the Advanced Practice Role Delineation tool has the capacity to clearly delineate and define advanced practice nursing. These findings make a significant contribution to the international debate and show that the profession can now identify what is and what is not advanced practice in nursing.

A comparative study of nursing attitudes towards young male survivors of brain injury: A questionnaire survey.

Background The attitudes members of the nursing profession hold towards survivors of brain injury may impact on the level of help, and degree of involvement they are willing to have. Given that the manner in which an individual receives their brain injury has been shown to impact on public prejudices, the importance of exploring nursing attitudes to this vulnerable group, and the subsequent impact this may have on the caring role, requires investigation. Objective To investigate the attitudes held by members of the nursing profession towards young male survivors of brain injury whose behaviour either contributed, or did not contribute, to their injury. Design Independent groups design. Setting and participants Ninety trainee and sixty-nine qualified nurses respectively drawn from a university in the south west of England and the emergency, orthopaedic and paediatric Departments of the Royal Devon and Exeter Hospital, UK. Methods Participants were randomly assigned to one of four fictional brain injury scenarios. A young male character was portrayed as sustaining a brain injury as a result of either an aneurysm, or through drug taking, with their behaviour being either a contributory or non-contributory factor. On reading these, participants were asked to complete the prejudicial evaluation scale, the social interaction scale and the helping behaviour scale. Results Analysis of variance showed that qualified nurses held more prejudicial attitudes than student nurses towards survivors of brain injury. Mean scores indicated that individuals seen as contributing towards their injury were likely to experience more prejudice (blame total = 42.35 vs. no blame total = 38.34), less social interaction (blame total = 37.54 vs. no blame total = 41.10), and less helping behaviour (blame total = 21.49 vs. no blame total = 22.34) by both groups. Conclusions Qualified nurses should be mindful of the impact their attitudes and judgements of survivors of brain injury may have on the subsequent care they provide. Greater emphasis on the effects of negative attitudes on patient interactions during training may provide nurses with the understanding to recognise and avoid challenges to their caring role in the future.

A cross-national cross-sectional survey of the attitudes and perceived competence of final-year medicine, nursing and pharmacy students in relation to end-of-life care in dementia

Background:Little is known about the attitudes of healthcare professional students' perceived competence and confidence in treating those with dementia who are at the end of life.Aim:To explore the attitudes of final year medical, nursing and pharmacy students towards people with dementia and to evaluate their perceived competence and confidence dealing with biomedical and psychosocial issues within the context of palliative care provision to patients with dementia.Design:Cross-sectional survey using a questionnaire.Setting/participants:Final-year students in each profession from Queen's University Belfast (Northern Ireland) and the University of Iowa (USA) were recruited.Method:Three versions of an online questionnaire (containing the Attitudes to Dementia Questionnaire and a series of questions on end-of-life care in dementia) were distributed.Results:A total of 368 responses were received (response rate 42.3%). All respondents reported positive attitudes towards people with dementia. US nursing students reported significantly more positive attitudes than the medical students of United States and Northern Ireland. Medical students were more likely to report low confidence in discussing non-medical aspects of dying, whereas nursing students were most likely to feel prepared and confident to do this. Medical and nursing students reported low confidence with aspects of medication-related care; however, data from the pharmacy samples of Northern Ireland and United States suggested that these students felt confident in advising other healthcare professionals on medication-related issues.Conclusions:While healthcare students hold positive attitudes towards people with dementia, some clinical tasks remain challenging and further basic training may be of benefit.

Gender, gender roles and completion of nursing education:a longitudinal study

The current worldwide nursing shortage and high attrition of nursing students remain a challenge for the nursing profession. The aim of this paper was to investigate how key psychological attributes and constructions differentiate between completers and non-completers of nursing education. A questionnaire including measures of gender role identity and perceived gender appropriateness of careers was administered to 384 students early in the first year of the course. At the end of the programme attrition rates were obtained. The findings indicate that males were more likely to leave the course than females. Furthermore, those who completed the course tended to view nursing as more appropriate for women, in contrast to the non-completers who had less gender typed views. The female-dominated nature of nursing, prevalent stereotypes and gender bias inherent in nursing education seem to make this an uncomfortable place for males and those with less gendered typed views. Whilst it is acknowledged that attrition is undoubtedly a complex issue with many contributing factors, the nursing profession need to take steps to address this bias to ensure their profession is open equally to both female and male recruits.

Attitudes of second year diploma nurses in three community colleges toward the use of computers in the nursing role /

The effectiveness of various kinds of computer programs is of concern to nurse-educators. Using a 3x3 experimental design, ninety second year diploma student nurses were randomly selected from a total population at three community colleges in Ontario. Data were collected via a 20-item valid and reliable Likert-type questionnaire developed by the nursing profession to measure perceptions of nurses about computers in the nursing role. The groups were pretested and posttested at the beginning and end of one semester. Subjects attending College A group received a computer literacy course which comprised word processing with technology awareness. College B students were exposed to computer-aided instruction primarily in nursing simulations intermittently throughout the semester. College C subjects maintained their regular curriculum with no computer involvement. The student's t-test (two-tailed) was employed to assess the attitude scores data and a one-way analysis of variance was performed on the attitude scores. Posttest analysis revealed that there was a significant difference (p<.05) between attitude scores on the use of computers in the nursing role between College A and C. No significant differences (p>.05) were seen between College B and A in posttesting. Suggestions for continued computer education of diploma student nurses are provided.

Management decision-making in nursing

This study developed a new, valid and reliable evaluation instrument to measure the level, type and pattern of management decisions of fifteen nursing students. The management decision score achieved using this instrument was correlated with two psychological determinants of management decision making: creativity and problem-solving ability. The instrument was a written patient management problem in case format, answered by a free form written response. The student responses were classified for type of management decision according to the sub-categories of technical, inter-personal, environmental and unique. Using statistical analysis a significant difference was found in the type of management decisions most frequently selected by the study sample. The students predominantly selected technical type decisions. This preference for one type of management decision may be due to a number of psychological and environmental factors. These factors may program and mold the type of management decisions student nurses make early in their career. Low but positive correlations were found between the total management score and the two psychological tests. This finding supports the authors cited in the literature who state that although creativity augments the type of management decision making, it is not present or encouraged widely in the nursing profession. These factors are worth considering when the profession becomes concerned over ritualization and lack of individuality in patient care. The tool is easy to administer, lends itself to a variety of professional settings and shows promise with further refinement for computer application.

Nursing staffs' perceptions of a generic service manager position

The recent reengineering within the health care industry has challenged many assumptions regarding traditional structures and roles. Within a product-line management structure, the traditional viewpoint that those who manage patient care areas must have a nursing background, is an example of one such assumption being challenged. The nursing profession is often seen as the greatest obstacle to the implementation of a product-line management structure and generic manager positions (does not require a nursing background), due to the perceived loss of professional identity. This qualitative study focused on how nursing staff within a chronic care and rehabilitation facility perceived a generic service manager position. Focus groups were conducted in three phases, over a 14 month period of time. The data collected from the focus groups were then coded according to common themes. Each phase was analyzed independently, with the study concluding with an analysis and interpretation of the collective results. The results of this study revealed a significant shift in how the nursing staff perceived their professional identity and accountability in light of the implementation of the generic Service Manager position. Initial reactions of personal and professional vulnerability and resentment were seen to transform into an increased ability to explicitly articulate the role of nursing. Changes in behavior that were described included: increased consultation and collaboration with other

Empowering Nursing Leaders to Facilitate Healthy Work Environments: First Steps

The purpose of this project was to examine the literature for perspectives on healthy work environments (HWE). HWEs have been identified as important factors in the nursing profession to enhance recruitment, retention, job satisfaction, and accountability. This paper identifies that the front line manager is an essential role within organizations, and directly impacts work environments. Within this paper it has been pointed out that professional organizations have provided some general recommendations for improving work environments which include increasing nurses’ accountability and teamwork, providing opportunities for shared decision making, having supportive leadership, providing recognition, educational support, and adequate staffing. However, enacting them all can be difficult due to front line manager capacity, the impending nursing shortage, organizational resources and barriers. Based on the literature, conclusions have been drawn and recommendations for future research have been identified. HWE strategies have been developed with implementation plans for my practice area.

Contraintes vécues, idéal normatif et actions déployées en vue de transformer l’exercice de la profession infirmière en centre hospitalier : une étude exploratoire auprès d’infirmières québécoises politiquement engagées

Les changements socioéconomiques des dernières décennies ont profondément transformé le rapport qu’entretient le Québec avec ses professionnels de la santé. En ouvrant le champ à l’accumulation privée du capital dans les années 1990, se met en place au sein de la fonction publique une philosophie politique issue du monde des affaires. Dès lors, le paradigme de la gouvernance investit les hôpitaux, où exerce 65 % de l’effectif infirmier québécois. Des chercheurs ont investigué les contraintes et torts subis par les infirmières consécutivement à la restructuration du système de santé, cependant, peu d’entre eux ont tenu compte des rapports de force et des structures de pouvoir dans lesquels s’enracine le vécu des infirmières. La présente étude a pour but d’explorer les expériences vécues d’infirmières soignantes politiquement engagées qui exercent en centre hospitalier (CH), de rendre compte de l’ordre social existant au sein de cette institution, de décrire la façon dont elles aimeraient idéalement exercer et de répertorier les idées qu’elles ont et les actions qu’elles mettent en place individuellement ou collectivement de façon à favoriser la transformation de l’ordre social et de l’exercice infirmier en CH. Épistémologiquement, notre étude qualitative s’inscrit dans cette idée que la réalité est complexe, mouvante et dépendante de la perception des personnes, proposant une orientation compréhensive et contextualisée de l’action humaine et du politique; c’est ainsi que le point de vue politique des infirmières participantes est pris en compte. L’articulation des expériences vécues, de l’idéal normatif et de l’action politique des participantes est explorée suivant une perspective postmoderniste, praxéologique et dialectique issue de la théorie critique qui réfléchit non seulement sur ce qui est, mais également sur ce qui est souhaitable; une réflexion qui sous certaines conditions s’ouvre sur l’action transformatrice. Les notions de pouvoir, de rapport de force, de résistance et d’émancipation influencent notre analyse. Au terme de cette étude, les résultats indiquent la présence d’une déprofessionnalisation graduelle en faveur d’une technicisation du soin infirmier et d’une dérive autoritaire grandissante au sein des CH s’arrimant au registre sémantique de l’économie de marché à partir des notions d’efficacité, de performance et d’optimisation. Les infirmières soignantes perçues comme des « automates performants » se voient exclues des processus décisionnels, ce qui les prive de leurs libertés de s’exprimer et de se faire critiques devant ce qui a été convenu par ceux qui occupent les hautes hiérarchies du pouvoir hospitalier et qui déterminent à leur place la façon dont s’articule l’exercice infirmier. Le pouvoir disciplinaire hospitalier, par l’entremise de technologies politiques comme la surveillance continue, les représailles et la peur, la technicisation du soin et le temps supplémentaire obligatoire, concourt à la subjectivation des infirmières soignantes, en minimisant l’importance de leur jugement clinique, en affaiblissant la solidarité collective et en mettant au pas l’organisation syndicale, ce qui détournent ces infirmières de la revendication de leurs droits et idéaux d’émancipation les ramenant à une position subalterne. Nos résultats indiquent que les actions politiques que les participantes souhaitent déployer au sein des CH visent l’humanisation des soins et l’autodétermination professionnelle. Toutefois, nombre des actions répertoriées avaient pour finalité fonctionnelle la protection et la survie des infirmières au sein d’un dispositif hospitalier déshumanisant. Certaines infirmières soignantes s’objectent en conscience, déploient des actions de non-coopération individuelles et collectives, font preuve d’actes de désobéissance civile ou souhaitent agir en ce sens pour établir un rapport de force nécessaire à la prise en compte de leurs revendications par une gouvernance hospitalière qui autrement ferait la sourde oreille. Le pouvoir exercé de façon hostile par la gouvernance hospitalière doit à notre avis être contrecarré par une force infirmière collective égale ou supérieure, sans quoi les politiques qui lui sont associées continueront de leur être imposées. Le renouvellement radical de la démocratie hospitalière apparaît comme la finalité centrale vers laquelle doivent s’articuler les actions infirmières collectives qui permettront l’établissement d’un nouveau rapport de force puisque c’est à partir de celle-ci que les infirmières soignantes pourront débattre de l’orientation que doit prendre l’exercice infirmier.

Complementary therapies or 'luxury' therapies? A nurse's experience in the use of complementary therapies in nursing practice

Complementary therapies have an increasing popularity. This case study explores the experience of a nurse who practises complementary therapies within the health care system where there is a still a widespread of skepticism within the medical profession. It is considered by the nurse that it is a 'luxury' to include these therapies in nursing practice.

On the fast track speeding nurses into the future: a two year Bachelor of Nursing for graduates of other disciplines

It has been suggested in nursing literature that a bachelor's degree should be the pre-requisite to professional nursing education and registration. The perceived advantages of graduates entering the nursing profession led faculty in the School of Nursing La Trobe University to introduce in 1997 an innovative two-year Bachelor of Nursing (BN) program, believed to be the first in Australia, for graduates of other disciplines. A problem-based learning (PBL) approach was selected to facilitate the teaching learning process. Data to evaluate the progress of the accelerated students were collected by examining their previous degree background, conducting a focus group discussion mid year and comparing the students' academic results with those completing the traditional three-year course. Findings indicate that students in the accelerated course were highly motivated but experienced significant stress. In part the stress emanated from the need to identify their own learning needs. However, despite their concerns most accelerated students scored at least as well both clinically and academically as traditional students. Moreover, in six of the seven final year subjects each group studied the accelerated students performed better.

Key stakeholders' expectations of educational outcomes from Australian critical care nursing courses: a Delphi study

Background
Educational preparation for critical care nursing in Australia varies considerably in terms of the level of qualification resulting in a lack of clarity for key stakeholders about student outcomes.

Objectives
The study aim was to identify and reach consensus regarding the desired learning outcomes from Australian post-registration critical care education programs as demonstrated through the graduate's knowledge, skills and attitudes.

Design
A Delphi technique was used to establish consensus between educators, managers, clinicians and students regarding learning outcomes expected of graduates with a Graduate Certificate, Graduate Diploma and Master level qualification in critical care nursing.

Participants
A total of 164 critical care nurses (66 clinicians, 48 educators, 32 managers and 18 students) participated and 99 questionnaires were returned in the first round (response rate 60%). Fifty-seven questionnaires were returned for Round 2 (response rate 58%).

Methods
Learning outcomes were obtained from the Australian College of Critical Care Nurses Competency Standards for Specialist Critical Care Nurses. Some statements included more than one characteristic, and these were split to create learning outcomes with one characteristic per item. A survey of Australian higher education providers of critical care education provided additional learning outcomes, for a total of 73 learning outcomes for the first Delphi round.

Results
Findings suggest that patient comfort, safety, professional responsibility and ethical conduct are deemed most important for all three levels of educational preparation. There was a lack of emphasis on clinical practice issues for all levels. Participants placed higher emphasis on learning outcomes related to complex decision-making, leadership, supervision, policy development and research for Graduate Diploma and Master level programs.

Conclusion
The findings have implications for curriculum development and the profession with regards to the level of educational preparation required of critical care nurses and suggest that further work is required before clear recommendations can be made for desired educational outcomes from critical care nursing programs in Australia.