Strengthening health systems through nursing: Evidence from 14 European countries. Spain.

CAPÍTULO 12 Spain‘Who is a nurse?’ and ‘What is nursing?’ seem to be simple questions yet the answers are strangely elusive. This book explores the variations in structure and organization of the nursing workforce across fourteen different countries in Europe. This diversity, and the reasons for it, are of more than academic interest. The work of nurses has always had a critical impact on patient outcomes. As health systems shift radically in response to rising demand, the role of nurses becomes even more important. The lessons learned from comparative case-study analysis demonstrate wide variation in every dimension of the workforce. It examines what a nurse is; nurse-to-doctor and nurse-to-population ratios; the education, regulation and issuing of credentials to nurses; and the planning of the workforce. While comparative analysis across countries brings these differences into sharp relief, it also reveals how the EU functions as an important ‘binding agent’, drawing these diverse elements together into a more coherent whole. This book is part of a two-volume study on the contributions that nurses make to strengthening health systems. This is the first time that the topic of nursing has been dealt with at length within the Observatory Health Policy Series. The aim is to raise the profile of nursing within health policy and draw the attention of decision-makers. Volume 1 is a series of national case studies drawn from Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden, and Switzerland. The countries were chosen as the subject of a large EU-funded study of nursing (RN4Cast). Lithuania and Slovenia were added to provide broader geographical and policy reach. Volume 2 will provide thematic analysis of important policy issues such as quality of care, workforce planning, education and training, regulation and migration

Jordanian paediatric nurses' views on compliance with Standard Precautions : a qualitative study

INTRODUCTIONCompliance with evidence-based Standard Precautions Guidelines (SPGs) among healthcare practitioners is essential to combat Healthcare Associated Infections (HCAI). However, it is widely understood that non-compliance with these precautions remains a common problem in paediatric nursing practice. Most existing studies into this problem have used quantitative methods. However, these studies have failed to explain noncompliant behaviour or address the issues that are specific to paediatric clinical areas.AIMThis study is designed to investigate paediatric nurses' perceptions and experiences of infection control measures and to achieve a better understanding of the factors that influence nurses’ compliance with SPGs.METHODSThis qualitative study used an adapted constructivist grounded theory approach. The study was conducted in five Jordanian hospitals. Thirty one (n=31) qualified paediatric nurses from different paediatric areas were reccruited to the study. Data were gathered using face-to-face semi-structured audio-taped interviews, which were transcribed and coded through constant comparative analysis.RESULTSThis study identified causes of enduring failure by nurses to comply fully with SPGs. Four themes emerged (Children are different; Nurses are human first; Limited professional status; The challenges of the working environment). Paediatric nurses claim to be willing to comply with SPGs, but sometimes fail to achieve this. Risk of exposure to microorganisms was perceived as a major factor in compliance. Paediatric nursing practice was seen as different to adult practice and nurses construed the need for SPGs differently.DISCUSSIONA key issue is the fact that nurses were reluctant to see themselves as change-agents to improve practice. This resulted in problems with SPGs being well understood but not acted on. Nurse’s prioritised compliance with the nursing culture in their specific clinical area, over more general principles of care, such as SPGs. Nurses did appreciate that compliance with SPGs was suboptimal and did sometimes criticise this situation. However, most nurses had a value system, which militated against the proper use of Standard Precautions and which served to diminish the influence of them.IMPLICATIONThe chief implication of this study is that infection control is unlikely to improve further until nurses feel empowered to initiate change. Nursing in this area of the world is essentially semi-professional in nature. Nursing needs to develop to become fully professional in its orientation so that nurses take full responsibility for their actions. Only when nurses see their actions and behaviour as fully their responsibility, will nursing issues such as this be properly addressed. Until this occurs, the imposition of rules and guidelines, documentation and policies, will not be sufficient to progress care in this important area of practice

Nursing and Society

The year 2020 is considered by the World Health Organization to be the International Year of the Nurse and Midwife. This book supports the visibility of the contribution of nurses to society. We have included 30 articles on high-quality original research or reviews that provide solid new discoveries that expand current knowledge

A survey of intention to leave, job stress, burnout and job satisfaction among nurses employed in the Ha'il region's hospitals in Saudi Arabia

Nurses in Saudi Arabia, as in other Arabian Gulf countries, may be nationals or non-nationals. Frequently, non-national nurses predominate in a workplace, and as they are contracted, there is a high turnover among them. Similarly, Saudis do not readily accept a nursing career, and they find it difficult in a mixed gender working environment that is incongruent with their cultural and Islamic practices. This study identified the nurses’ intention to leave using psychometric measures of job stress, burnout and job satisfaction within a population of nurses (N=297) working in the northern province of Ha’il, in the Kingdom of Saudi Arabia. A survey design method was employed using a descriptive correlational analysis and factor analysis to test relationships within and between the four concepts: job stress, burnout, job satisfaction and intention to leave. A questionnaire containing these measures was used as the research instrument. The questionnaire was in six parts; however the dominant instruments used were the Maslach Burnout Inventory (Maslach& Jackson, 1984) and Price and Mueller’s (1981) job satisfaction survey. The study results are that intention to leave is significantly associated with job satisfaction, job stress (uncertainty on treatment) and burnout (emotional exhaustion and personal accomplishment). However, survey questions asking whether the respondents intended to stay or intended to leave received a mixed response, with a majority of respondents intending to leave as soon as possible and a similar majority intending to stay. The results show an association between nurse job satisfaction and burnout, although there was no relationship between job satisfaction and job stress. Respondents who are emotionally exhausted and depersonalised tended to have low job satisfaction. In terms of stress and burnout, as expected, those who reported higher burnout levels tended to also report high stress levels particularly for factors such as workload and uncertainty on treatment. The demographics and the work profiles for the Hail nurse participants were within the Kingdom’s statistical norms, although there was a higher proportion of Saudi nationals. The participants were predominantly women under 30 years of age who held a diploma of nursing, had fewer than 10 years of nursing experience and had thus spent fewer than 10 years with their employer. The minority of non-nationals were predominantly from the Philippines and India. The implications of these findings are that Ha’il nurses were largely dissatisfied with their jobs. The Ministry of Health is aware of the healthcare issues, which were high insurance premiums and low standards of healthcare; international competition for a small pool of registered nurses; national nurse remuneration based on factors other than competency and concentration of healthcare in Riyadh, Jeddah, Makkah and Dammam. Future research could utilise this study’s model to examine the correlation of job stress, burnout, job satisfaction and intention to leave among registered nurses on a broader scale in other work environments, in other regions within the Kingdom of Saudi Arabia and globally to strengthen generalisability

How does virtual simulation impact on nursing students’ knowledge and self-efficacy for recognising and responding to deteriorating patients? A mixed methods study.

Background: Preparing undergraduate nursing students effectively for safe clinical practice continues to present significant challenges due to the impact of the Covid-19 pandemic, global nursing shortages, greater competition for quality clinical placements, and no guarantee that nursing students will have exposure to a deteriorating patient during their clinical placements. This is a concern because early warning signs of clinical deterioration are often not detected by nurses in a timely manner, and recognition and response to deteriorating patients is recognised globally as a major safety challenge (Haddeland et al., 2018). Aim: To explore the impact of using interactive virtual simulation case studies with facilitated debriefing (Eppich and Cheng, 2015) on nursing students’ knowledge and self-efficacy for recognising and responding to early signs of clinical deterioration in patients. Design & Methods: Mixed methods study with quasi-experimental pre/post design and focus groups. A convenience sample (n=88) final year undergraduate nursing students with half the sample at each sites randomly allocated to a treatment or control group. The treatment group received a virtual simulation intervention, debriefing, and participated in a focus group. Results: The treatment group had statistically significant higher levels of clinical self-efficacy from pre to post survey scores (65.34 and 80.12) compared to the control group (62.59 and 70.73) and significantly increased levels of knowledge in recognizing and responding to the deteriorating patient scores from pre to post survey (11.30 to 13.1) in comparison to the control group (10.33 and 9.92). Conclusions: study findings demonstrated the positive impact of a the virtual simulation intervention on knowledge and confidence of undergraduate nursing students from geographically diverse areas

Registered Nurses' Perceptions of Workplace Stress in Paediatric Intensive Care Units in Saudi Arabia: a Mixed-Method Research Study

Background: Workplace stress among nurses in Intensive Care Units (ICU) has been shown to variously affect their health, the quality of nursing care, healthcare delivery and national healthcare costs (Mokhtar et al., 2016). Although this is equally true for Paediatric Intensive Care Units (PICUs), research into this environment has remained scarce and no previous studies have focused on workplace stress in PICUs within a Saudi Arabian (SA) context. The current research study addressed this omission. Aims: This research study used a mixed-method approach to explore and understand workplace stress and its sources among nurses working in public hospital PICUs in Riyadh and Dammam, SA. Methods: In this mixed-method research study, 172 Registered Nurses from six PICUs in large public hospitals completed questionnaires in Phase 1 (quantitative data collection). These questionnaires comprised of the Expanded Nursing Stress Scale (ENSS) and personal characteristic questions. In the subsequent Phase 2 (qualitative data collection), 24 of the original 172 participants from Phase 1 took part in face-to-face semi-structured interviews. Results: The majority of the nurses suffered from a medium level of workplace stress; this was associated with tangible personal characteristics, such as gender, nationality and academic nursing qualifications. Sources of workplace stress related to ‘workload’, ‘caring for critically ill children’, ‘cultural challenges’ and ‘nursing management and nursing colleagues’. However, nurses in PICUs (both SA and expatriates) practiced effective coping strategies that were both individual to each person as well as work related – these helped them to deal with workplace stress and remain working in a PICU environment for several years. The results of this research study led to the development of the dynamic model of workplace stress; this illustrates the complexity of workplace stress within a PICU context and highlights the interactions between both the sources and consequences of it. Conclusion and Implications: This research study found that nurses in public hospital PICUs in the cities of Riyadh and Dammam in SA, reported a medium level of workplace stress. However, interestingly, and importantly, the nurses perceived the PICU environment to be a most rewarding place to work. The results have implications for policy and practice for SA stakeholders in terms of how to enhance the working environment for nurses, raise healthcare professionals’ cultural awareness, provide insight into coping strategies and promote respect for the nursing profession in SA. These measures would potentially facilitate a reduction in PICU workplace stress and thus improve both the nurses’ health as well as the quality of the nursing care

Patients' and nurses' perspectives on patients' experience for coronary care unit stressors using a mixed method approach

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Background: Getting admitted to CCU is viewed as a stressful event by patients. However, numerous studies have indicated that nurses do not always accurately perceive the stressors of their clients. Therefore, it is important for nurses to know what seems most stressful from the patients‘ perspective so that appropriate nursing measures can be directed towards minimizing such stressors. Objectives: The purpose of this study was to explore the perception of CCU stressors experienced by patients from both patients and nurses perspective and to compare between them, identify the effect of socio-demographic characteristics of participant's on the level of stress perception and to what extent clinical guidelines fulfil CCU needs. Methodology: A mixed method approach (qualitative and quantitative) was applied. Purposive random sampling was used to recruit data. Ethical approval was obtained prior to data collection. Data was collected from three CCUs within the West and Northwest NHS Trusts. Participants who met the inclusion criteria were interviewed and asked to rank the Environmental Stressor Questionnaire (ESQ). Qualitative data was analyzed using Gorgi's method of analysis. A quantitative data was analyzed using the SPSS software version 15. Results: There was some consistency in the data where patients and nurses provided same ranking for CCU stressors. Consistently nurses ranked physiological stressors higher than psychological stressors. Patients showed consistency in the findings between what they ranked in the ESQ and their narratives more than their counterparts. Perception of stress was affected by participant's socio-demographic characteristics. A key finding is that the current guidelines do not serve patients and nurses needs. Conclusions: Nurses should be well equipped with knowledge and experience to overcome stressful situations. Educational programs should be made available for nurses to improve stress management. Nurses should assess patient's needs by applying effectively communication skills