Lauretta Luck

Trial and retribution: a qualitative study of whistleblowing and workplace relationships in nursing

Abstract This paper reports a study aiming to present and describe the effects of whistleblowing episodes on nurses’ workplace relationships. Eighteen participants with direct experience of whistleblowing were recruited into the study, which was informed by a qualitative narrative inquiry design. Findings were clustered into four main themes, namely: Leaving and returning to work—The staff don’t like you; Spoiled collegial relationships—Barriers between me and my colleagues; Bullying and excluding—They’ve just closed ranks; and, Damaged inter-professional relationships’I did lose trust in doctors after that. Findings suggest a need to facilitate a climate in which it is safe for nurses (and others) to raise concerns about patient care or organisational wrongdoing, and to eliminate the existing belief that whistleblowing is a negative act fuelled by revenge or sedition.

Key Stakeholders in Clinical Learning and Teaching in Bachelor of Nursing Programs: A Discussion Paper

Abstract Since the transfer in Australia of preparatory nurse education from the hospital to the university sector, debate and discussion have continued regarding the perceived benefits and failings of the current system. In this paper we consider issues related to student clinical practicum from the perspectives of the student learner, the educational provider, the health service sector, the health consumer and the profession as a whole. The aim of this paper is to generate further discussion about clinical learning, a critical component of undergraduate nursing education. We argue that all stakeholders have a role to play in contributing to optimising all the clinical learning experiences for students in Bachelor of Nursing programs – the professional nurses of the future.

Understanding avoidant leadership in health care: findings from a secondary analysis of two qualitative studies

AIM To illuminate ways that avoidant leadership can be enacted in contemporary clinical settings. BACKGROUND Avoidance is identified in relation to laissez-faire leadership and passive avoidant leadership. However, the nature and characteristics of avoidance and how it can be enacted in a clinical environment are not detailed. METHODS This paper applied secondary analysis to data from two qualitative studies. RESULTS We have identified three forms of avoidant leader response: placating avoidance, where leaders affirmed concerns but abstained from action; equivocal avoidance, where leaders were ambivalent in their response; and hostile avoidance, where the failure of leaders to address concerns escalated hostility towards the complainant. CONCLUSIONS Through secondary analysis of two existing sets of data, we have shed new light on avoidant leaderships and how it can be enacted in contemporary clinical settings. Further work needs to be undertaken to better understand this leadership style. IMPLICATIONS FOR NURSING MANAGEMENT We recommend that organizations ensure that all nurse leaders are aware of how best to respond to concerns of wrongdoing and that mechanisms are created to ensure timely feedback is provided about the actions taken.

PRN psychotropic medications: The need for nursing research

Abstract This paper highlights the inadequacy of existing research for the purposes of evidence-based prn (Latin, pro re nata or ‘as needed’) medication practice in psychiatric settings and notes the absence of relevant evidence-based clinical practice guidelines and policies, both nationally and internationally. The professional, ethical and legal importance of PRN medication practices is also discussed, and shown to add to the urgency of developing a research agenda which will serve as an adequate basis for good clinical practice. This paper summarises the relevant research and identifies problems that can arise for clinicians involved in the administration of prn medications in mental health settings. It concludes by highlighting key issues which urgently require empirical investigation.

The efficacy of family support and family preservation services on reducing child abuse and neglect: what the literature reveals.

Globally, child protection services are under-resourced and unable to meet the demands associated with the increasing numbers of families who are being exposed to child abuse and neglect. Family support and family preservation interventions are the methods cited within the literature as those employed by child protection services to address this issue. Intensive family preservation services and cognitive behavioural therapy are discussed as the most effective interventions currently used by child protection services. This article presents a review of the literature on the efficacy of family-centred interventions for child abuse and neglect. Revealed in this review is that such efficacy remains controversial, with literature affirming that the most successful practice is a combination of interventions applied simultaneously. The literature reviewed suggests that more contemporary research around family-centred interventions for child abuse and neglect is required.

Conveying caring: Nurse attributes to avert violence in the ED

Violence towards nurses in Emergency Departments is a world wide problem that some contend is increasing in severity and frequency, despite the many strategies implemented to prevent violent events. This paper presents the findings of an instrumental case study in a busy rural Emergency Department. Twenty Registered Nurses participated in the study and data from 16 unstructured interviews, 13 semi-structured field interviews, and 290 h of participant observation were thematically analysed. In addition, 16 violent events were observed, recorded via a structured observation tool and analysed using frequency counts. Thematically there were five attributes rural emergency nurses were observed to use to avert, reduce and prevent violence. The five attributes were being safe, being available, being respectful, being supportive and being responsive. We argue that these attributes were embodied in the emergency nurses routine practice and their conceptualization of caring.

Mosaic of verbal abuse experienced by nurses in their everyday work

AIMS To report observational data collected as part of a multi-phased study examining violence in the health sector. The findings presented detail the nature of verbal abuse experienced by nurses during their everyday interactions with patient, their families, or companions. BACKGROUND Nurses have unacceptably high levels of exposure to violence, which commonly includes verbal abuse. However, relatively little is known about the nature of verbal abuse against nurses. DESIGN Observational design. METHODS During 2010, 1150 hours of observation resulted in data on 220 patients displaying cues for physical violence and 210 qualitative observational notes. These observational notes constitute the data for this paper and reveal the nature of verbal abuse experienced by nurses in their everyday work. RESULTS A mosaic of abuse was revealed through three major categories: a discourse of gendered verbal abuse that was largely sexual; insults, ridicule, and unreasonable demands; and hostility, threats, and menacing language. CONCLUSIONS For the nurses observed in this study, everyday nursing practice occurred in a backdrop of verbal abuse and hostility, which had a strong theme of gendered and sexualized overtones. We recommend that interventions that target verbal abuse should address the gendered and sexualized nature of the abuse experienced by nurses.

Treading the clinical pathway: a qualitative study of advanced practice nurses in a local health district in Australia

BackgroundCareer planning in nursing is often haphazard, with many studies showing that nurses need personal motivation, education, and the support of workplaces, which are often dominated by political and fiscal agendas. Nurses often need institutional and personal support to plan their careers and make decisions regarding their career aspirations.MethodA descriptive qualitative design was used. Data were gathered using semi-structured digitally recorded interviews and analysed for common categories. Twenty seven (n = 27) participants were interviewed.ResultsThere were four categories revealed by the participants who described their career progression experiences: moving up the ladder, changing jobs for career progression, self-driven and the effects of institutional environments.ConclusionMany of the participants’ careers had been shaped serendipitously. Similar to other studies, these nurses felt political, institutional and financial factors impacted on their career opportunities. There are implications for nursing managers with more support required for nurses to plan their career trajectories. In addition to an organisation centred approach to career planning, nurse leaders and managers must take into account the personal and professional requirements of their nurses. Nurses themselves also need to take personal responsibility for career development. Greater support for nurses’ career planning and personal drive will help organisations to plan their future workforce needs.

Determining the frequency, kinds and cues of violence displayed by patients in an acute older person ward environment: findings from an observational study

BACKGROUND Workplace violence is one of the most complex and significant occupational hazards experienced by nurses in healthcare settings. Verbal abuse and physical violence are particularly prevalent in older person assessment wards, owing to the prevalence of illnesses involving cognitive dysfunction; the high frequency and nature of contact with staff; and the frustration caused by high levels of disability. AIM To determine the frequency, kinds and cues of violence displayed by patients towards nurses in an acute older person assessment ward environment using a structured observational tool - the Violence Assessment Tool (VAT). DESIGN Observational study. METHOD Non-participant structured observations of behavioural cues for violence towards nurses in an acute older person hospital ward were gathered and analysed. RESULTS One hundred and twelve hours of observations were undertaken, resulting in 95 behavioural cues for violence in 19 patients. Four of these patients subsequently escalated to physical violence. Pacing around the bed was the only commonality in the behavioural cues of patients who became violent. All patients who became violent had previously demonstrated showing. CONCLUSIONS To date, the assessment of potentially violent older patients has not been adequately addressed. The VAT may be one way of addressing this challenge through early identification of the more subtle behavioural cues that could indicate potential for violence. Further research on the VAT using a larger data set could determine its predictability for physically violent acts displayed by older people.

Child Protection Workers: What They Do

Abstract Child protection organisations face the challenge of ensuring provision of adequate child protection, while maintaining a stable workforce. It is essential therefore, to appreciate the daily work demands of Child Protection Workers (CPWs). This paper draws from a larger case study which aimed to investigate CPW work practices and the challenges they cause for the workers. Specifically, this paper describes what CPWs do in their daily work. A mixed methods approach to data collection and analysis was used in the study where 15 CPWs participated in both observations and interviews. The results demonstrated that while the majority of worker job tasks are client focused, the time spent by CPWs on non-therapeutic job tasks and worker actions are substantial, and the ability to multitask was revealed as a vital CPW skill. Findings suggest a need for child protection policy makers, organisations and other key stakeholders to consider implementing time effective and efficient strategies for managing the challenges that multi-tasking presents to CPWs.