Shona Thompson

Missed nursing care as an 'art form': The contradictions of nurses as carers.

This article draws on the free-text commentaries from trans-Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self-effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic analysis to examine why nurses allow themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task. The findings suggest an ambivalence and conflict confront nurses attempting to provide care within the New Public Management environment. This can be seen in the tensions that draw a line between care as an art, and care as a financial target, juxtaposed with the inherent clash of values arising from the way nursing care is conceptualised within two contradictory paradigms.

Aberrant Work Environments, Rationed Care as System Failure or Missed Care as Skills Failure?

Missed’ care has emotional, professional and legal connotations because, as one participant from our study noted, the environment can change so quickly and staffing is not allocated to accommodate this. This study used the MISSCARE survey distributed to nurses in New Zealand to find out what care was routinely missed, and why they missed it. The analysis of data returned from 199 nurses revealed that nurses routinely miss care and become frustrated because they are unable to use the knowledge and skill to provide the care; rather they are forced to prioritise care, some of which is either delayed or consciously missed. Whilst this study supported findings of previous research, the emergence of presenteeism as a factor that affects nurses missing care, was highlighted. This has wider implications to the nursing workforce related to their ability to provide safe and effective care, as well as to the organisations in terms of both budget and safety in care provision.

Development, implementation and evaluation of nurse-led integrated, person-centred care with long-term conditions

Purpose The purpose of this paper is to outline a conceptual plan for innovative, integrated care designed for people living with long-term conditions (LTCs). Design/methodology/approach The conceptual plan delivers a partnership between the health system, the person with LTCs (chronic), their family, and the community. The partnership aims to support people at home with access to effective treatment, consistent with the New Zealand Government Health Strategy. This concept of people-owned care is provided by nurses with advanced practice skills, who coordinate care across services, locations and multiple LTCs. Findings With the global increase in numbers of people with multiple chronic conditions, health services are challenged to deliver good outcomes and experience. This model aims to demonstrate the effective use of healthcare resources by supporting people living with a chronic condition, to increase their self-efficacy and resilience in accordance with personal, cultural and social circumstance. The aim is to have a model of care that is replicable and transferable across a range of health services. Social implications People living with chronic conditions can be empowered to manage their health and well-being, whilst having access to nurse-led care appropriate to individual needs. Originality/value Although there are examples of case management and nurse-led coordination, this model is novel in that it combines a liaison nursing role that works in partnership with patients, whilst ensuring that care across a number of primary and secondary care services is truly integrated and not simply interfaced.

Technology and the issues facing nursing assessment.

This article describes an investigation into the use of technology and the issues nurses face undertaking nursing assessment. It reports qualitative, descriptive research involving interviews with ten ward nurses from three hospitals in New Zealand. Thematic analysis of the data revealed three key issues: the impact of technology, the influence of early warning systems and nurse autonomy. Results show how clinical decision making around nursing assessment is influenced by technology and the Early Warning Score. These clinical decisions may not always be informed by critical thinking in complex healthcare environments. The article concludes that nurse autonomy, while supported and endorsed in theory, is frequently in conflict with hospital risk-management policies and the use of prescriptive algorithms.