| The tension between person centred and task focused care in an acute surgical setting: A critical ethnography Author links open overlay panelSandraSharpaPersonEnvelopeMargaretMcallisterbEnvelopeMarkBroadbentcEnvelope Show
ShareShare Cited ByCite https://doi.org/10.1016/j.colegn.2017.02.002Get rights and content AbstractProblemPerson centred care is a key indicator of quality care and a policy direction in many hospitals yet some patients experience care that falls short of this standard. BackgroundHealth services worldwide are prioritising the delivery of person centred in order to address historical concerns over patient safety and quality care and to improve workplace morale. Workplace culture is known to affect nurses’ care giving. QuestionThis research aimed to uncover the cultural factors that hindered or facilitated the delivery of person centred care in an acute setting and answer the question: How does workplace culture influence nurses’ delivery of person centred care? MethodsCritical ethnography provided the philosophical and methodological framework. Data were collected through participant observation, individual and focus group interviews, examination of care planning documents. Data were analysed hermeneutically and critically to make tacit cultural knowledge explicit and to suggest ways to reconstruct the culture of this specific nursing unit. FindingsNurses organised their work in response to the urgency of the task at hand and nursing routines. People who received that care were rarely included in planning care. DiscussionTask focused ways of working can predominate in workplace cultures where an emphasis is placed on efficiency. Efficiency is part of the neoliberalist health care agenda and it stands in contrast to ideals of person-centred effectiveness because the latter may actually slow down procedures and require holistic approaches, rather than segmented care. Efficiency in this study appeared to be reinforced by an embedded and naturalised cultural practice amongst the nurses, which was to value fast-paced and completed tasks, because of the recognition it would receive from peers. Yet it also constituted a tension and bind for the nurses because the failure to be person-centred meant their professional values were unmet, and this led to moral distress and workplace dissatisfaction. If nurses were assisted to develop recognition of competing discourses in their work, and rationales to support a values-based practice, it is likely that they could be empowered to resist the status-quo and actually achieve the aspirations outlined in person-centred care rhetoric. ConclusionOrganisations and individuals striving for person-centred care need to develop awareness of the social and political forces that shape and constrain practice, in order to approach their work more consciously and critically. Section snippetsSummary of relevanceIssue Person centred care is intrinsic to effective nursing practice and a key indicator of quality care. What is Already Known Nurses value person-centred care but are frustrated in their achievement of it. It remains unknown what specific factors occur in their working life and culture that act as barriers. What this Paper Adds Dominant, naturalised discourses that operate within health care, such as neoliberalism, value efficiency over effectiveness and are a potential barrier to the delivery of MethodCarspecken’s (1996) model of critical ethnography provided the framework for this research. Critical ethnographers emphasise the act of interpreting culture with the purpose of promoting cultural change (Greckhamer & Koro-Ljungberg, 2004). Examining a culture through the lens of power, privilege and authority uncovers unfair and unjust systems and reveals whose voice is heard and whose is silenced (Harrowing & Mill, 2010). The intent is to reveal the social and political forces that shape the DiscussionThis study supported previously reported arguments that nursing actions, and quality care, do not always arise because of individual activity, but from cultural pressures (Metlz and Hansen, 2014, Goodman, 2014). The nurses in this research delivered care in ways that contravened their personal values, and this illustrated that nurses are not always free agents and nor do they always make carefully considered ethical decisions. Rather, their beliefs and attitudes were influenced by the system in LimitationsAll studies have limitations and in this critical ethnography that was confined to one ward in a regional hospital, the findings may not be generalizable because the unit may have been unique and atypical. Also, observations were limited to nursing actions only and the contributions that the whole multi-disciplinary team had in influencing behaviour was not explored. That said the findings are consistent with those of similar studies that found tension between values and actions (Bolster and ConclusionThe key finding of this research is that despite an espoused commitment to person centred care based within a therapeutic relationship, this group of nurses practiced in ways where efficiency and the swift completion of tasks took priority and created dissatisfaction and stress for them. Thus a dichotomy is revealed between nurses’ values and their practice. It is important to recognise that nurses did not deliberately choose this behaviour; rather they were constrained by cultural expectations References (48)
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This study aimed to identify the self-reported EOL care practices of emergency care nurses and the factors influencing EOL care. An online survey was distributed to Australian emergency care nurses in August, 2020. Statistical analyses were undertaken to identify the most frequently undertaken EOL practices and factors influencing practice. There were 178 responses to the survey (response rate 11.3%). The most frequently reported EOL practices were environmental modification (M=4.4/5, SD=0.4) and information sharing practices (M=4.4/5, SD=0.4). Emotional support practices were the least frequently reported practices by emergency care nurses (M=3.6/5, SD=0.9). Participants reported a lack of resources (M=2.4/5, SD=0.8) and opportunities to gain end-of-life care knowledge (M=2.9/5, SD=0.9). However, a generally positive attitude towards EOL care was indicated as participants reported strong agreement to palliative values (M=4.6/5, SD=0.4). Results of this study suggest that most frequently reported EOL care practices of emergency care nurses require the least emotional engagement. The findings can inform areas of knowledge development and resources for emergency care nurses. 2022, Australian Critical Care Show abstractNavigate Down Internationally, rapid response systems have been implemented to recognise and categorise hospital patients at risk of deterioration. Whilst rapid response systems have been implemented with a varying amount of success, there remains ongoing concern about the lack of improvement in the escalation, and management of the deteriorating patient. It also remains unclear why some clinicians fail to escalate concerns for the deteriorating patient. The objective of this study was to explore clinicians’ attitudes towards the escalation, and management of the deteriorating patient. A cross-sectional online survey of conveniently sampled clinicians from the acute care sector in a regional health district in Australia was conducted. The Clinicians’ Attitudes towards Responding and Escalating care of Deteriorating patients scale, was used to explore attitudes towards the escalation and management of the deteriorating patient. Survey responses were received from medical officers (n = 43), nurses (n = 677), allied health clinicians (n = 60), and students (n = 57). Years of experience was significantly associated with more confidence responding to deteriorating patients (p < .001) and significantly less fears about escalating care (p < .001). Nurses (M = 4.16, SD = .57) and students (M = 4.11, SD = .55) in general had significantly greater positive beliefs that the rapid response system would support them to respond to the deteriorating patient than allied health (M = 3.67, SD = .64) and medical (M = 3.87, SD = .54) clinicians, whilst nurses and medical clinicians had significantly less fear about escalating care and greater confidence in responding to deteriorating patients than allied health clinicians and healthcare students (p < .001). Nurses and medical officers have less fear to escalate care and greater confidence responding to the deteriorating patient than allied health clinicians and students. Whilst the majority of participants had positive perceptions towards the rapid response system, those with less experience lacked the confidence to escalate care and respond to the deteriorating patient. 2021, The Lancet Haematology Show abstractNavigate Down 2 billion peripheral intravenous catheters (PIVC) are inserted into inpatients worldwide each year. Almost one in two PIVCs fail before completion of intravenous therapy. We aimed to determine the efficacy and costs of a multimodal intervention to reduce PIVC failure among hospitalised patients. PREBACP was a cluster-randomised, controlled trial done at seven public hospitals in Spain. Clusters (hospital wards) had at least 70% permanent staff and data were collected from patients aged 18 years and older with one or more PIVCs at the start of intravenous therapy. Clusters were randomly assigned (1:1) to the multimodal intervention or control group using a centralised, web-based randomisation software, and stratified by type of setting. We concealed randomisation to allocation, without masking patients or professionals to the intervention. An intervention using a multimodal model and dissemination of protocols, education for health-care professionals and patients, and feedback on performance was implemented for 12 months in the intervention group. The control group received usual care. The primary outcome was all-cause PIVC failure at 12 months (phlebitis, extravasation, obstruction, or infections). Subsequently, through an amendment to the protocol approved on July 25, 2021, we included dislodgement as part of PIVC failure. Analysis was by modified intention to treat, which included all randomly assigned hospital wards for whom data on the primary endpoint were available. This trial is registered with the ISRCTN Registry, ISRCTN10438530. Between Jan 1, 2019, and March 1, 2020, we randomly assigned 22 eligible clusters to receive the multimodal intervention (n=11 clusters; 2196 patients, 2235 PIVCs, and 131 nurses) or usual practice in the control group (n=11 clusters; 2282 patients, 2330 PIVCs, and 138 nurses). At 12 months, the proportion of PIVC failures was lower in the intervention group than in the control group (37·10% [SD 1·32], HR 0·81 [95% CI 0·72 to 0·92] vs 46·49% [2·59], HR 1·23 [1·04 to 1·39]; mean difference −9·39% [95% CI −11·22 to −7·57]; p<0·0001). Per-protocol-prespecified analysis of the primary outcome excluding dislodgement also showed the intervention significantly reduced PIVC failure compared with the control group at 12 months (33·47% [SD 2·98], HR 0·85 [95% CI 0·75 to 0·96] vs 41·06% [4·62], HR 1·18 [1·04 to 1·33]; mean difference −7·59% [95% CI −11·05 to −4·13]; p<0·0001). A multimodal intervention reduced PIVC failure, thereby reducing potentially serious complications for hospitalised patients. The findings of PREBACP enabled a deeper understanding of decision making, knowledge mobilisation, and sense making in routine clinical practice. The College of Nurses of the Balearic Islands. For the Spanish translation of the abstract see Supplementary Materials section. 2021, Collegian Show abstractNavigate Down Learning for patients and their families within nurses’ patient- and family-education practice is an important part of person- and family-centred care. Patients and their families must master health promotional or management strategies to optimise their health outcomes. Support is often provided by nurses, but how nurses facilitate each patient’s and their family’s learning, using cognitive learning principles, seems invisible in the nursing literature. This discussion paper examines the important role of cognitive learning within nurses’ patient- and family-education practice. How learning is enabled, the differences between teaching and learning and the role of learning principles are discussed. Shortcomings are identified and possible ways to address these within nurses’ practice are considered. The discussion draws on the limited current literature surrounding cognitive learning principles in nurses’ practice and nurses’ awareness of learning principles. Readers are encouraged to question their current conceptualisation of learning and their perceptions and use of learning principles in their practice. The learning process within nursing is overshadowed by explanations of teaching strategies, determinants of learning and the learning principles of one specific theorist. The principles of cognitive learning and their role in patient- and family-education are poorly described and possibly poorly understood. This creates a fundamental knowledge gap in nursing practice. A significant rethink about the role of learning principles within nurses’ patient- and family-education practice is overdue. These principles need to be explored further by involving nurses, patients and their families to identify how nurses are perceiving and using learning principles in their practice. 2022, Antimicrobial Resistance and Infection Control 2022, BMC Nursing Research article Collegian, Volume 25, Issue 1, 2018, pp. 1-2 Research article Collegian, Volume 25, Issue 1, 2018, pp. 39-43 Show abstractNavigate Down Bereavement follow up is an integral element of palliative care. However, little is known about the systems that link bereavement services with bereaved carers. To map how effectively a specialist palliative care service linked bereavement service to bereaved carers. A retrospective medical audit, using process mapping was undertaken within one Australian specialist palliative care service to identify the systems that linked bereavement services to a consecutive cohort of palliative care decedents (n=60) next of kin. Bereavement records were located for 80% of decedents. Nearly all (98%) had a nominated next of kin, with just over half (54%) of those nominated contacted by bereavement services. Incomplete or missing contact details was the main reason (75%) that the bereavement service was unable to contact the decedents’ next of kin. Having access to a designated bereavement service can ensure that bereaved next of kin are contract routinely and in a timely way. However the effectiveness of this type of service is dependent upon the bereavement service having access to all relevant contact information. There are numerous opportunities to refine and strengthen the recording of palliative care next of kin details to optimize follow up. Research article Collegian, Volume 25, Issue 1, 2018, pp. 57-63 Show abstractNavigate Down Self-efficacy in nursing is the nurses’ perception of their abilities to show caring orientations, attitudes, and behaviours and to develop caring relationships with patients. Self-efficacy is associated with years of experience, higher levels of job satisfaction and changes to nursing practices that conform with best practice. There is currently a paucity of evidence and no Australian studies were found examining the relationships between socio-demographic variables and self-efficacy in Australian nurses. The aim of this study was to examine if relationships existed between the socio-demographic variables, years of experience, age, gender, marital status, level of education, years employed in the same workplace, employment status, geographical location, specialty area, health sector and Australian state and the perceived self-efficacy of Australian registered nurses. Design Cross-sectional survey of Australian registered nurses. A stratified random sample of registered nurses was drawn from the database of a national industrial and professional organisation. The Caring Efficacy Scale (CES) was categorised into quartiles, and bivariate and multivariable relationships were examined using ordinal logistic regression. The proportion of nurses reporting low caring efficacy scores tended to decrease with years of experience and was lower in nurses who have been married. After adjustment in the final multivariable model, marital status and years of experience remained significantly related to caring efficacy (p < 0.05). A relationship exists between years of nursing experience, marital status and perceived self-efficacy among Australian registered nurses who belonged to an industrial and professional organisation. Targeted professional development programmes that support the improvement of perceived self-efficacy of all levels of nurses, might improve nurses’ confidences and abilities to develop caring relationships with patients. Research article Developing research priorities for nurses working in the gynaecology setting in Western AustraliaCollegian, Volume 25, Issue 1, 2018, pp. 73-80 Show abstractNavigate Down Nurses working in clinical settings are instrumental to translating research into practice. The Delphi approach has been used by clinicians worldwide to set research agendas relevant to their clinical work. To identify nursing research priorities at the tertiary women's hospital in Western Australia and to develop an agenda for gynaecological nursing research. A three-round Delphi study was used. Round one incorporated an open-ended questionnaire to generate ideas or issues important to gynaecology nurses. During round two, the 32 topics generated from the first round were prioritised into 12 topics with a final ranking performed in round three. Fifty-four nurses who work in gynaecology clinical areas at the study hospital were invited to participate with 18 (33.3%) participating in round one, 41 (75.9%) in round two and 40 nurses (74.1%) in the final round. The highest ranked research priorities were: managing trial of void; providing compassionate care to women who experience pregnancy loss – the role of the gynaecological nurse; and understanding a woman's journey of treatment following a diagnosis of gynaecological cancer. We explore potential factors from the literature around the identified gynaecology research topics plus challenges around the generation and translation of evidence into clinical practice. Establishing a partnership between researchers and gynaecology nurses has contributed to the development of a nursing research agenda. We anticipate that using the Delphi approach may facilitate future collaboration in implementing this research agenda and translating the findings into clinical practice. Research article Feasibility and acceptability of a nurse-led hypertension management intervention in general practiceCollegian, Volume 25, Issue 1, 2018, pp. 33-38 Show abstractNavigate Down Hypertension is the most frequently seen condition in Australian general practice. Despite the availability of effective therapies, many hypertensive individuals struggle to maintain adequate blood pressure control and are at increased risk of cardiovascular disease and premature morbidity. As such there is an urgent need for research to identify evidence based strategies to improve hypertension management in general practice. General Practice Nurses (GPNs) are conceptually ideally placed to support consumers to receive best practice care and achieve behavioural change. However, their specific role in managing hypertension is unclear. The purpose of this paper is to evaluate the acceptability and feasibility of a GPN-led intervention to manage hypertension in Australian general practice. Individuals with uncontrolled hypertension were identified from electronic medical records. GPNs provided 4 face-to-face appointments and 2 telephone support calls to deliver the intervention. Qualitative evaluation of the interventions’ feasibility and acceptability was achieved through semi-structured interviews with 6 GPs, 7 GPNs and 12 consumers. Thematic analysis revealed 5 themes, namely; pre-intervention training, GP/GPN roles, time and workload, acceptability and feasibility. Most GPNs appreciated the pre-intervention training, however the need for additional motivational interviewing education was identified. Consumers were satisfied with the intervention valuing the GPN as a ‘coach’, although they valued ongoing GP input. Issues relating to lack of time and competing work priorities were identified as barriers to successfully delivering the intervention, however, the intervention was perceived to be feasible and acceptable in practice. Despite the demonstrated acceptability and feasibility of the intervention, the ongoing sustainability of the model rests largely upon overcoming the organisational, educational and professional barriers that constrain the GPN’s role. Findings demonstrate great potential for GPNs to significantly contribute to improved health outcomes and play a more active role in hypertension management. This role could be optimised with the development of motivational interviewing skills, enhanced GP/GPN collaborative practice and increased opportunity for consumer follow up. Research article Organizational citizenship behaviour of men in nursing professions: Career stage perspectivesCollegian, Volume 25, Issue 1, 2018, pp. 19-26 Show abstractNavigate Down Women engage in organizational citizenship behaviour more frequently than men. Little research has investigated organizational citizenship behaviour in men and male nurses, especially from a career development stage perspective. To investigate work-related factors and organizational citizenship behaviour status as well as predictors of organizational citizenship behaviour of male nurses at different career stages. A total of 167 male nurses were selected by random sampling to complete a mailed questionnaire. Nurses were divided into the following career stages: exploration (clinical seniority < 2 years), establishment (clinical seniority = 2–5 years), and maintenance (clinical seniority > 5 years). Of the 167 male nurses who agreed to participate, 139 returned completed questionnaires, resulting in a response rate of 83.2%. The stage with the highest percentage of male nurses was the establishment stage. Nurses in the maintenance stage had the highest salaries, educational level, hospital position, organizational support, organizational identification, and organizational citizenship behaviour. Organizational identification was the only significant predictor of organizational citizenship behaviour for the three career stages. Hospital management should promote organizational citizenship behaviour for male nurses by increasing organizational identification, especially during the establishment stage. What is taskTask-orientated nursing refers to the act of a nurse focusing more an activity rather than the surrounding environments. A task-oriented nurse often has a list of things to do and is highly organized. Physician orders were carried out and rules were followed.
Which model of nursing care focuses on the task to be completed?Functional nursing is a task-oriented approach to delivering care. Tasks are delegated to individual members of the team. The team members are focused on their specific task(s) instead of the total patient.
Which type of delivery of nursing care is organized around tasks quizlet?"Functional nursing is organized around tasks." Which of the following statements shows the nurses understanding of primary nursing? "Primary nursing involves one nurse planning care for the patient."
What is functional care delivery model?The functional nursing model is hierarchical as the registered nurses take care of complex jobs while the junior staff and orderlies oversee the basic tasks. For example, one nurse may only administer medications while another nurse admits and discharges patients.
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