Mark Gillespie

Barriers to support for new graduated nurses in clinical settings: A qualitative study

BACKGROUND New graduated nurses often find the transition to registered nurse a traumatic experience and studies suggest that within some countries this process is inadequately supported. The reasons for this inadequacy remain unclear. OBJECTIVES The current study was conducted to identify barriers impeding the provision of support to new graduated nurses in clinical settings within Iran. METHODS AND PARTICIPANTS This is a qualitative study conducted through unstructured and semi-structured interviews with 18 licensed nurses (experienced nurses) recruited through purposive sampling. Data were collected at various hospital centers in Iran. All interviews were recorded and transcribed and analysis was completed through the use of content analysis. RESULTS Barriers to support new graduated nurses included a lack of support-seeking behaviors, management weaknesses, ineffective communication, personal characteristics, and cultural barriers. CONCLUSIONS Understanding the problems and barriers likely to prevent goal attainment is an important step toward reaching those goals. The present study provides a greater and more focused understanding of the barriers impeding the support of new graduated nurses within clinical settings. These barriers mainly include deficiencies in the organizational structure, management, and personal characteristics of colleagues and new graduated nurses. This study will have been a successful undertaking if it can help resolve these barriers.

Experiences of Iranian Nurses that Intent to Leave the Clinical Nursing: a Content Analysis.

Introduction: Despite the current shortage of nurses, it is important to know the reasons nurses want to leave the clinical setting. The purpose of this study was to explore the experiences of nurses who intend to leave clinical nursing. Methods: In a qualitative content analysis study, data obtained from 13 in-depth face-to-face semi-structured interviews with nurses working in hospitals affiliated to the Tabriz and Urmia University of Medical Sciences in Iran, selected through purposive sampling. A conventional content analysis was used for data analysis. Results: Four categories and eleven subcategories emerged during data analysis. The extracted categories and sub categories consisted of (I) Entry routes into nursing (implicitly entry, targeted entry), (II) Defects in dignity (lack of professional vision toward the nurses, social status of nurses), (III) Work in non-ideal working environment (lack of support, discrimination, conflict, lack of opportunities for advancement), and (IV) Dissatisfaction with working conditions (heavy workload, lack of power, unusual working hours). Conclusion: The findings of this qualitative study reflect professional turnover as a complex, ongoing, multidimensional process. By identifying the factors responsible, it could be possible to retain nurses in the field.

Emotional Support for New Graduated Nurses in Clinical Setting: a Qualitative Study.

Introduction: Newly graduated nurses experience many stressful situations during transition to practice. The provision of emotional support from more experienced nurses can ameliorate such work-related tension. Studies have not clearly specified the means through which such support could be most effectively provided; therefore the present study was conducted to explore the experiences of qualified nurses around the provision of emotional support to newly graduated nurses. Methods: This qualitative study was conducted through semi-structured interviews with 18 qualified nurses. A purposive sampling approach was used for selection of participants. Interviews were transcribed verbatim and analyzed by the conventional content analysis method. The study took place from 2014-2015 in six teaching hospitals in the northwest of Iran. Results: Emotional supports emerged in four following main-categories: Assurance, creating a sense of relaxation and security, lifting spirits, and emotional belonging and involvement. Conclusion: These results can help to establish an effective source of emotional support for newly graduated nurses. This can play an important role in reducing their stress and anxiety, in increasing their self-confidence and in forming a constructive relationship between them and qualified nurses.

Threats to nurses' dignity and intent to leave the profession

Background: It is essential to pay attention to and respect the dignity of nurses to maintain them in their profession while they deliver skilled nursing care. Little is known, however, about how a sense of dignity influences the practitioner. Objectives: The purpose of this study is to describe nurses’ experiences of threats to their dignity occurring within clinical settings, which generates an intention to leave clinical practice. Research design and method: The study was performed using qualitative content analysis. The participants were 21 clinical nurses with work experience who were employed across a range of clinical posts. Data obtained from the semi-structured interviews were analyzed and interpreted using a content analysis approach. Ethical considerations: The study was approved by the Ethics Committee of Tabriz University of Medical Sciences and was guided by the ethical principles of voluntary enrolment, anonymity, privacy, and confidentiality. Findings: Within data analysis, three main themes and nine categories were extracted as follows: (1) lack of professional pride (physician’s dominance, intangible nature of nursing, and negative attitude toward clinical nurses); (2) oppressive work environment (high workload, disrespect, discrimination, and lack of support); and (3) suppression of progressivism (lack of appreciation and attention to meritocracy). Discussion: Almost all of the participants have experienced some degree of disrespect and violation of dignity. In general, attempts made by the participants to show their objection to the threats and to support and protect their dignity have not been effective and in fact made them more inclined to leave the clinical work. Conclusion: According to the views of nurses themselves, identification of the factors threatening nurses’ dignity can be one of the appropriate solutions for the broader and deeper investigation of this phenomenon and can help promote and support nurses’ dignity and their retention within the profession.

Caregivers’ perception of dignity in teenagers with autism spectrum disorder:

Introduction: Maintaining dignity is one of patients is one of the main ethical responsibilities of caregivers. However, in many cases, the dignity of patients, especially autistic teenagers is not maintained. The extent to which dignity needs are met for this group within the Iranian care system is difficult to determine as dignity is an abstract concept, and there are few related research studies reported. Objectives: The objective of this study is to find out caregivers perspectives on dignity in teenagers with autistic spectrum disorder. Research design: This study uses a qualitative research design. The data were collected through individual, semi-structured interviews and field notes developed during the interviews. In order to analyze the data, qualitative conventional content analysis was used. Participants and research context: In all, 16 professional caregivers for autistic teenagers working in public hospitals were recruited based on a targeted sampling method to reach data saturation from February 2016 to July 2017. Findings: The findings of this study were presented in three main themes, “privacy,” “respecting individual identity,” and “comprehensive support,” and 11 categories. Ethical consideration: This study’s protocol was approved by the Research Ethics Committee of medical universities located in Southeast of Iran and the required ethical principles were followed throughout. Discussion and conclusion: Based on the findings of this study from the perspective of caregivers, autistic teenagers need to be cared for and educated in a respectful environment where their privacy is maintained, their individual identities are respected, and they receive comprehensive familial, social, and financial support. These conditions would maintain the dignity of such teenagers and would result in appropriate behavioral outcomes. Therefore, it is suggested that a cultural, professional and institutional background in which all components of the autistic teenager’s dignity are protected and emphasized be provided.

Facilitators and barriers to the privacy of Iranian hospitalized patients in government hospitals

Background Privacy is one of the essential needs of humans, and is therefore crucial in effective healthcare systems. There is limited research clearly addressing the facilitators and barriers underpinning privacy for hospitalized patients. Aims This study aimed to explore Iranian patients’ perceptions and experiences with the facilitators and barriers of privacy in government hospital in-patients. Methods This qualitative study was conducted on 22 patients admitted to the in-patient departments of government hospitals in Tehran, Iran, in 2016. The study population was selected through purposive sampling technique. The data were collected using individualized semistructured interviews, which were recorded and transcribed. Data analysis was performed by means of an inductive content analysis approach. Results The analysis of the experiences of the hospitalized patient’s extraction of six themes. These themes included the ethical and legal backgrounds of privacy, multi-dimensional design of privacy, perceived vulnerability, patriarchal care, conflict between privacy and care, individual backgrounds, nature of disease, and informed consent. Conclusion The privacy of the hospitalized patient is affected by complicated factors. These factors are facilitators and barriers and should be considered in the design of care.

The Effect of Group Discussion-based Education on Self-management of Adults with Type 2 Diabetes Mellitus Compared with Usual Care: A Randomized Control Trial

Objectives We sought to determine the effect of group discussion-based education on the self-management capability of patients with type 2 diabetes in Iran. Methods This randomized control trial was conducted on 90 patients with type 2 diabetes. Participants were allocated randomly into one of two groups; intervention and control. The intervention group received the group discussion-based education while the control group received routine care only. The Lins self-management questionnaire was completed at baseline and three months post-intervention. Results Statistical analysis, including the use of independent t-test, identified that in comparison to the control group, significant increases were observed in the scores of self-organization (t =11.24, p < 0.001), self-adjustment (t = 7.53, p < 0.001), interaction with health experts (t = 7.31, p < 0.001), blood sugar self-monitoring (t = 6.42, p < 0.001), adherence to the proposed diet (t = 5.22, p < 0.001), and total self-management (t = 10.82, p < 0.001) in the intervention group. Conclusions Sharing experiences through group discussions and receiving instructive feedback can improve the ability to self-manage diabetes.

A qualitative exploration of facilitators and inhibitors influencing nurses' intention to leave clinical nursing

OBJETIVO Este estudo teve como objetivo determinar as barreiras e facilitadores que definem o desenvolvimento de uma intencao de abandonar a profissao de enfermagem, sob a perspectiva de enfermeiros clinicos do Ira. METODO O estudo foi realizado atraves da analise de conteudo qualitativo e incluiu 21 participantes que eram enfermeiros clinicos com vasta experiencia de trabalho em uma variedade de cargos clinicos. A coleta de dados foi realizada atraves de entrevistas semiestruturadas, e os dados obtidos com as entrevistas foram analisados e interpretados atraves do metodo da analise de conteudo. RESULTADOS Durante a analise dos dados, 2 temas principais, 5 categorias e 12 subcategorias foram obtidos como indicado a seguir. Os facilitadores incluem: (I) identidade debilitada (status social vulneravel e violacao da dignidade), (II) frustracao (sentimento de subordinacao, incluindo falta de reconhecimento) e (III) experiencia de trabalho arduo (estresse ocupacional, trabalho arduo e trabalho por turnos). Os inibidores incluem: (I) gestao de comportamentos positivos (recompensas e sistemas de apoio) e (II) ser util (satisfacao espiritual, eficiencia e desenvolvimento de habilidades profissionais). CONCLUSAO Com base nos achados, pode-se concluir que supervisores responsaveis podem impedir os enfermeiros de abandonarem a enfermagem clinica, delegando-lhes atividades pertinentes e aumentando sua motivacao e satisfacao.