Mental health nurses’ attitudes, behaviour, experience and knowledge regarding adults with a diagnosis of borderline personality disorder:systematic, integrative literature review

Aims and objectives To establish whether mental health nurses responses to people with borderline personality disorder are problematic and, if so, to inform solutions to support change. Background There is some evidence that people diagnosed with borderline personality disorder are unpopular among mental health nurses who respond to them in ways which could be counter-therapeutic. Interventions to improve nurses’ attitudes have had limited success. Design Systematic, integrative literature review. Methods Computerised databases were searched from inception to April 2015 for papers describing primary research focused on mental health nurses’ attitudes, behaviour, experience, and knowledge regarding adults diagnosed with borderline personality disorder. Analysis of qualitative studies employed metasynthesis; analysis of quantitative studies was informed by the theory of planned behaviour. Results Forty studies were included. Only one used direct observation of clinical practice. Nurses’ knowledge and experiences vary widely. They find the group very challenging to work with, report having many training needs, and, objectively, their attitudes are poorer than other professionals’ and poorer than towards other diagnostic groups. Nurses say they need a coherent therapeutic framework to guide their practice, and their experience of caregiving seems improved where this exists. Conclusions Mental health nurses’ responses to people with borderline personality disorder are sometimes counter-therapeutic. As interventions to change them have had limited success there is a need for fresh thinking. Observational research to better understand the link between attitudes and clinical practice is required. Evidence-based education about borderline personality disorder is necessary, but developing nurses to lead in the design, implementation and teaching of coherent therapeutic frameworks may have greater benefits. Relevance to clinical practice There should be greater focus on development and implementation of a team-wide approach, with nurses as equal partners, when working with patients with borderline personality disorder

Unleashing Top-of-License Registered Nurse Practice: An Integrative Review

In light of a well-renowned report, “The Future of Nursing” released by the Institute of Medicine (2010), recommendations were suggested that nurses should practice at, and to, the full extent of their licensure, also referred to as top-of-license nursing practice. Transforming nursing care models coupled with strong leadership support is critical to fostering an environment where top-of-license practice can be fully achieved and sustained. This integrative review provides a compilation and synthesis of the available published evidence regarding the best practices for fostering environments conducive to top-of-license nursing practice. Results of these studies strongly supports the notion of nurses practicing to the full extent of their education and training

Horizontal Violence Effect on Nurse Retention

Horizontal violence is known by a variety of terms such as lateral violence, bullying, and incivility. Christie and Jones (2014) describe lateral violence as a problem in nursing where a behavior is demonstrated through harmful actions that occur between nurses. Studies have revealed how horizontal violence affects nurse retention. Horizontal violence is a relevant issue in the healthcare community, yet often goes undiscussed. Walrafen (2012) explains that an outcome of horizontal violence in nursing is directly proportional to a decrease in retention of nurses. Sherman (2012) proclaimed that nurses who are subjected to horizontal violence have low self-esteem, depression, excessive sick leave, and poor morale. As Wilson (2011) identified nurses, who witness or experience horizontal violence have an increased desire to leave the organization where the bullying takes place. Horizontal violence is a pervasive source of occupational stress with physical, psychological, and organizational consequences (Hauge, et al, 2010). Roy (2007) describes this as an unkind, discourteous manner in which nurses relate to their colleagues. As nurses seek to perform their daily tasks, other co-workers may embarrass them for their lack of knowledge, tease them as they participate in informal cliques, or demean them for their technique (Bakker, 2012). Creating excuses, taunting, and refusing to share information, nursing education or knowledge are examples of horizontal violence (Ball, 1996)

Redesigning Nursing Education: Lessons Learned from the Oregon Experience

Offers evaluation findings, lessons learned, and guidance from a coalition of community colleges and university nursing programs that offer a standard competency-based curriculum to enable students to make a seamless transition and raise skill levels

Advanced practice nursing role development: factor analysis of a modified role delineation tool

Aim his study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. Background Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third paper from a multi-phase Australian study aimed at assigning advanced practice roles. Methods A postal survey was conducted of a random sample of state government employed Registered nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbach’s alpha coefficient determined reliability of the overall scale and identified factors. Results There were 658 responses (42% response rate). The five factors found with loadings of ≥.400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbach’s alpha coefficient was .94 overall and for the factors ranged from 0.83 to 0.95. Conclusion Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment

Medication management in mental health: nurses’ perceptions of their work with service users and carers

Aim: This study aimed to ascertain registered mental health nurses’ perceptions of their role involving medication management interventions with clients and their carers. Medicine-related interventions include administration, assessment of therapeutic effect potential side-effects education, liaison with service users and influence in prescribing decisions. Design and methods: The study used a qualitative design. Ten registered nurses were interviewed. Findings: Three themes were identified all related to the nurse context of work, role and client and carer need: improved dialogue, information and education, and adherence issues. Practice implications: Nurses use their clinical expertise in medication management to help achieve optimum therapeutic outcomes

Registered Nurses\u27 Intention To Use Electronic Documentation Systems: A Mixed Methods Study

BACKGROUND: Home care in Ontario has become the fastest growing sector and cornerstone of the healthcare system. As a result of the increased shift to the home care sector in Ontario, there have been several health information technology (HIT) initiatives to improve the quality and delivery of health care services to patients. This is exemplified with the province-wide development and implementation of electronic documentation systems (EDS). Electronic documentation systems have the potential to ensure timely, up-to-date and comprehensive patient health and care-related information is available and accessible to healthcare providers such as registered nurses regardless of their physical location. Access to patient health and care-related information supports high-quality nursing care, decision-making, and care delivery processes. Despite the benefits of EDS (i.e., improved workflow, reduced diagnostic and laboratory tests and adverse drug events), low intention by registered nurses to use these systems is well documented. Existing evidence suggests that an expressed intention to use HIT such as EDS is a direct predictor and antecedent of behavioural usage. Despite the growing efforts to understand registered nurses’ perceptions and overall intention to use EDS in practice, there is limited knowledge about registered nurses’ intention to use EDS in the context of home care practice. AIMS: The purpose of this study was to understand and examine factors that influence nurses’ intention and overall perception of using EDS in their home care practice. The conceptual model framing this study was adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT) to delineate the relationships among factors that influence registered nurses’ intention to use EDS in home care practice. METHOD: A sequential, explanatory mixed methods design, using a sample of nurses from Ontario who are currently practicing within the home care sector were recruited to address the study’s objectives. Data were collected using both quantitative (online survey) and qualitative (semi-structured individual telephone interviews) methods. Quantitative data were analyzed with descriptive statistics and hierarchical multiple regression analysis and qualitative data were analyzed with content and inductive thematic analysis. RESULTS: Individual, technological and organizational / environmental characteristics were found to influence nurses’ intention, level of comfort and experience with EDS usage in home care practice. Additional factors found to influence home care nurses’ experience with EDS usage included: the development and employment of workarounds, the influence of nurse-patient interaction amidst system usage, and the ability to provide input towards the system design. CONCLUSION: Nurses play a significant role in the delivery of home health care services to Ontarians. The findings highlight the importance for: a) further exploration of the most appropriate model and / or adaptation of a model identifying a range of factors influencing nurses’ intention to use EDS in different healthcare contexts; b) continued integration of nursing informatics competencies within nursing curricula; c) an organizational culture that supports the use of EDS in nurses’ home practice (i.e., enlisting user champions and providing adequate training and IT support); and d) having representation of nurses in the EDS design and / or implementation processes through a user-centered design approach

Transitioning from acute to primary health care nursing: an integrative review of the literature

Aims and objectives This paper seeks to explore the transition experiences of acute care nurses entering employment in primary health care settings. Background Internationally the provision of care in primary health care settings is increasing. Nurses are moving from acute care settings to meet the growing demand for a primary health care workforce. While there is significant research relating to new graduate transition experiences, little is known about the transition experience from acute care into primary health care employment. Design An integrative review, guided by Whittemore and Knafl\u27s (2005) approach, was undertaken. Following a systematic literature search eight studies met the inclusion criteria. Methods Papers which met the study criteria were identified and assessed against the inclusion and exclusion criteria. Papers were then subjected to methodological quality appraisal. Thematic analysis was undertaken to identify key themes within the data. Results Eight papers met the selection criteria. All described nurses transitioning to either community or home nursing settings. Three themes were identified: (1) a conceptual understanding of transition, (2) role losses and gains and (3) barriers and enablers. Conclusion There is a lack of research specifically exploring the transitioning of acute care nurses to primary health care settings. To better understand this process, and to support the growth of the primary health care workforce there is an urgent need for further well-designed research. Relevance to clinical practice There is an increasing demand for the employment of nurses in primary health care settings. To recruit experienced nurses it is logical that many nurses will transition into primary health care from employment in the acute sector. To optimise retention and enhance the transition experience of these nurses it is important to understand the transition experience

Clinical support for new graduate nurses in acute care settings : the CLASSIC Project

Transitional support programs play a critical role in influencing job satisfaction and importantly, the retention of new graduate nurses. Early workplace experiences of new graduate nurses can be challenging, as they are required to adapt to a new practice environment and at the same time, acquire specialised skills specific to that clinical specialty. This transition may be particularly stressful in acute care settings characterised by increasing acuity of patient care and heavy workloads. While seemingly common sense, little is known about how personal and situational (environmental) factors interact in specific contexts to influence new graduate nurses’ intention to stay or leave the profession. This study examined new graduate nurses’ satisfaction with a 12-month transitional support program and their intention to remain working in their current ward or unit. The study used a sequential mixed methods design. New graduate nurses employed at an 877-bed tertiary level teaching hospital located in the south-western Sydney region of New South Wales, Australia were invited to complete a survey at baseline (8-10 weeks) and close to the end of their transitional support program (10-12 months). At follow-up, new graduate nurses were also invited to participate in face-to-face semi-structured interviews. As new graduates enter challenging practice environments, supporting a smooth transition is essential to promote job satisfaction and intention to remain in nursing. Findings from this study highlight both the effectiveness and limitations of formal transitional support programs for new graduate nurses. Specifically, this study showed the importance of a structured, unit-based orientation and clinical support, and at the same time highlighted the adverse effect of assigning new graduate nurses to critical care specialties in their first rotation. Importantly, the findings highlight the significance of mutable factors, also described as situational factors in this thesis, which need to be considered by management and policy makers who seek to promote job satisfaction and intention to stay in areas of need