Research Articles Base: Nursing Profession

Nursing Profession still in-demand

Introduction             Nursing is one of the in-demand professions in the field of health care today. Through the years, the nursing profession has gone through a lot of challenges. Despite the challenges, there are still many people who take up nursing education in the hope of helping the sick and injured individuals. Another reason for individuals taking up nursing is that the pay is high. There are even some professionals from other fields and retired individuals who are taking up nursing.               The need for nursing professionals is so great that there are some countries that are experiencing nursing shortages. Nurses from other countries go to countries which offer higher salaries. For this reason the country where they left would also experience nursing shortage. And thus the cycle will continue.               This paper attempts to examine two pictures which represent the nursing profession. Issues will be raised from the two pictures and logical arguments produced. This paper will also attempt to demonstrate historically the change of issues within both pictures and document the progression or non-progression of issues between the two pictures. The paper will then attempt to relate these issues to contemporary nursing practice – about whether there has been change or no change between the issues in each picture.   Body   The first photograph is actually an advertisement in nursing featuring male nurses. The photograph is in black and white. It has nine male nurses in the photograph who are nurses. Written below each person are their names, their former occupations or other professions. These nine men are of different ages and different ethnicities. Looking at them, you would never guess they are nurses. Judging by their faces, these men could be at any other profession other than in nursing. Some of the men are wearing nursing outfits while the others were wearing ordinary clothes and the others still in clothes suited for their sports or hobbies.   On the photograph, the words are written in big bold letters: Are you man enough to be a Nurse? At the bottom of the photograph are written the words: If you want a career that demands intelligence, courage, and skill, and offers unlimited opportunity, consider nursing. Below it are the words: For information about careers in nursing, and educational and financial resources in Oregon, go to www.oregoncenterfornursing.org. Beside these two lines is the logo for Oregon center for nursing.   From the first photograph, there are three issues I can think of. First is the increasing number of male nurses. The second issue is the one of male nurses as the minority in the nursing profession. The last one is the issue of professionals from other fields changing to nursing profession.   Social, political, and economic systems continue to perpetuate the image of nursing as a female-dominated profession. It is mostly females we see in pictures as nurses, dressed in white uniforms with white shoes, white stockings and a white nurse cap. Seldom do we see men as nurses. But although social, political and economic systems perpetuate nursing as a female-dominated profession, it doesn’t cover the truth that there are many working male nurses out there.   Since the majority of the nursing field is predominantly women, the presence of a male nurse is a bit unusual. Nursing is now seen as a profession for men as well as women and this has been helped by popular TV programs which show male nurses. These TV programs make the viewing population aware that health care is more diverse than it used to be.   There is a problem though with male nurses and this has been seen in a study. Although increased numbers of men are joining the ranks of professional nursing, disproportionate numbers of male nurses are leaving nursing, compared to female nurses.   The experience of male nurses as a minority group seems to be that of encountering a lack of social approval, acceptance, and adequate role models beginning in nursing school. Perceptions of threats to sexuality, role strain, social isolation, and different performance expectations reported by male nursing students indicate that little has changed within nursing programs to enhance feelings of belonging to the nursing profession (Ament, 2006).   A man’s career transition from say a US army as can be seen in the photograph to being a nurse is hard to describe. Male nurses are a minority. Men are discouraged from showing their emotions, while a nurse’s willingness to share emotions is part of the profession. This man worked hard to make patients comfortable, always making extra effort to demonstrate his caring attitude. A nurse’s excellence should be judged by the quality of care for their patients, not by their gender (Davidson, 1996).   Although we see too many jumping to the nursing bandwagon, we could not really tell if they are in it because they love to care for the sick or they are in it for the money. This is not a gender-related issue but rather one which depends on the caring attitude of a person. A man could have been a Harley rider and still be nurse, what matters is that he’s got what it takes to be a good nurse.               Although nursing is a female-dominated profession, research in nursing management lacks a gender perspective. Gender as a social context variable has been studied mostly in male-dominated organizations. Therefore, viewing nursing administrative processes using gender as a variable warrants attention (Valentine, 2001).             Research on gender differences in approaches to conflict management has shown that differences in orientations and normative expectations resulted in women and men perceiving and handling conflict differently. Women were more likely to help in expressive ways while men were more likely to use instrumental methods. Men tended to use social influence and persuasion while women preferred negotiation and mediation. Generally women were better able to empathize with the other’s perspective (Valentine, 2001).               Gender theories make visible theory and practice of organizations that otherwise would be invisible. Gender as a social construction is relevant for nursing, a women-dominated profession. By studying organizations and relationships concerning gender perspectives, nurses and others can better understand nursing administrative processes such as conflict management (Valentine, 2001).               In a field dominated by women, some men say they are valued more for their brawn than brains and face discrimination in promotions. Despite these challenges, they add, they find their career choice fulfilling (Bass, 2000).               Why would military men, factory workers and other macho types leave their rugged jobs for pioneering roles in the world of nursing? The simple answer is opportunity. Without compromising a shred of masculinity, a growing number of Black men have tapped their gentler, more compassionate side, and are finding fulfillment and job security in what has his torically been called “woman’s work” (Townsel, 1996).               Even now, nursing remains a mostly White, mostly female profession. But as society becomes more accepting of men in non-traditional roles, the number of men in nursing, Black men in particular, continues to rise. According to the most recent Department of Health and Human Services nursing survey, Black men and women make up a mere 4 percent of the profession and only a scant 4.3 percent of the 1,853,024 total are males (Townsel, 1996).               Registered nurses represent the largest segment of the professional health care work force. To become an RN, candidates must graduate from a state-approved school of nursing through two-year associate degree programs, three-year hospital-based diploma programs or four-year university programs.               Like their female counterparts, male RNs work in practically all facets of the nursing profession, including managed care, ambulatory care, home care, public health care and nursing care. The majority of male nurses can be found hard at work in the emergency rooms, operating rooms, intensive care units, maternity wards and general care areas of major metropolitan hospitals (Townsel, 1996).               Unlike women in the field, male nursing professionals must find ways to deal with female patients who are uncomfortable with their care, women colleagues who feel threatened by their presence, and the public, which tends to assume that all male nurses are homosexuals (Townsel, 1996).               With all of these added pressures, why would men still want to pursue nursing careers? For the same reason most women do. These highly skilled and compassionate professionals say they are just as committed to the field as women, and just as earnest about helping those in need. Solid salaries, flexible hours add the medical scene’s fast-paced, high-tech environment, which is always full of life-and-death drama, also help to attract the adventurous, thrill-seeking male crowd (Townsel, 1996).               For these men, the nursing field is a second lease on life. Many who solely used their hands to make a living before are finding that it takes both hands and heart to succeed in this business.               The second picture is one of several nurses together. By the looks of it, this picture is taken during the war. These are wartime nurses who served the soldiers during the war, although we cannot guess where from the picture alone. The picture is a very old one and is in black and white.               Health care systems around the world are facing very significant challenges as they restructure and “reinvent” themselves in an effort to make more efficient use of available resources. As health care is a labor-intensive industry, the stresses experienced by these systems inevitably affect their employees (Clark & Clark, 2003).   From the second picture, three issues can be presented: (1) nurses usually work with other nurses in the provision of health care services, (2) in the provision of these services, other individuals could be involved – even if these individuals are not health care professionals, and (3) if we compare this picture to pictures of group nurses or team nurses at present, we can conclude that this team in the picture comprises more nurses than most nursing teams at present. This only goes to show that perhaps there is a growing shortage of nurses at present.               Nurses, as the most highly trained caregivers with regular patient contact, are at the heart of any health care system. Widespread anecdotal evidence suggests that the problems in health care have had a particularly negative effect on the workplace experience of nurses. News accounts regularly report on the challenges nurses face in the workplace.   These range from low pay in Ireland, to safety and health problems in South Africa, to emigration in the Philippines, to mandatory overtime in the United States. These stories suggest that nursing is a profession in crisis and that this crisis extends around the world. However, there is little systematic, comparative evidence available as to the nature and extent of the problems nurses face and the strategies they employ to deal with those problems (Clark & Clark, 2003).             Since the late 1800s, nurses around the world have been organizing to promote the interests of their profession and its members. Most of the earliest nurses’ organizations took the form of professional associations, with trade unions being a more recent development (Clark & Clark, 2003).               Wartime nursing is particularly stressful because of the age and the severity of injury seen in the patients. It is easier to accept disability, even death, in the elderly than in the young. An elderly person has experienced work, friends and family, sports and good books, health and illness, seasons and holidays. A young person is only on the verge of such a life (Norman, 1990).               The women felt maternal and protective instincts toward their young patients. These feelings often turned to anguish and anger when the nurses realized their patients would never be normal, functioning adults. It was emotionally wrenching for the nurses to look on row after row of comatose, brain damaged young soldiers (Norman, 1990).               The public perception was that nurses who served in war were safe in hospitals, on ships, or in aircraft. They were not supposed to experience the raw reality of war. However, nurses, of courses, did experience “war” — not the harsh conditions of a combat soldier, but war nonetheless, with all its emotional toll. “Must women fight in combat to be considered equal?” one woman asked (Norman, 1990).               Analyzing the nurses’ interviews made it clear that there also was a contradictory quality to the experience of being women in a war. The nurses were valued as professionals, yet exploited as women. They were both appreciated and used. Military leaders needed nurses to staff hospitals and care for patients but did little to accommodate the practical needs of the women (Norman, 1990).   Nurses can work alone. But nurses can also work in groups. Collaboration, they say, is the key to success. Nurses working together can provide a better quality of service, thus improving patient’s health also. In most cases, nurses work in groups or in teams where there is a leader assigned to take in charge and lead the group.               Other individuals are involved in the provision of health care services by the nurses. By this, we do not mean other health care professionals but ordinary citizens or even the patients themselves. People had a right and a duty to participate individually and collectively in the planning of their health care. This highlight the importance of nurses looking at their practice critically and maintaining up-to-date research-based knowledge, illustrating that healthcare professionals need to be empowered to empower others effectively.   Conclusion               Nurses have continually evolved over the years. Once a female dominated profession, it is now fast becoming a place for males too. Although there are some patients who aren’t used to male nurses, especially female patients, they are somehow fast becoming used to male nurses. The duty of nurses is not only limited to hospital work but they are also involved of countless services outside of the hospital, say for example some nurses have even served in the war to treat wounded and injured soldiers. All in all being a nurse is a challenging profession which should be appreciated by people.     References: Ament, P. 2006, Acceptance of Male registered Nurses by Female Registered Nurses. Journal of Nursing Scholarship. Bass, N. 2000, Male Nurses Challenge Field’s Gender Stereotypes. Knight Ridder/Tribune Business News. Clark, D.A. & Clark, P.F. 2003, Challenges Facing Nurses’ Associations and Unions: A Global Perspective. International Labour Review. Davidson, M.R. 1996, Not a Male Nurse, A Real Nurse. Nursing Forum. Norman, E.M. 1990, Women at War: The Story of Fifty Military Nurses Who Served in Vietnam. University of Pennsylvania Press. Townsel, L.J. 1996, Male Nurses: An Increasing Number Find Fulfillment and Security in Non-Traditional Field. Ebony. Valentine, P.E.B. 2001, A Gender Perspective on Conflict Management Strategies of Nurses. Journal of Nursing Scholarship. Credit:ivythesis.typepad.com

Nursing Profession still in-demand

Introduction Nursing is one of the in-demand professions in the field of health care today. Through the years, the nursing p...

Sample Essay Nurses Agenda for the Future: Work Environment

Nurses Agenda for the Future: Work Environment   Introduction             The American nursing community has joined hands around a sharedvision for the future of the nursing profession and has developed acomprehensive strategic plan – Nursing’s Agenda for the Future – to address the increasing nursing shortageand the factors contributing to it. This strategic plan corresponds to the shared vision of more than 60 organizations of nurses in the United States thathave put forward strategies to address the factors driving the increasing shortage of nurses. Nursing’s Agenda for the Future concentrates on various strategies aimed at moving the profession towards greater heightsand at the same time making certain that consumers have access to high quality healthcare. The nurses hope to collaboratewith other stakeholders in strengthening the profession through the development of the Nursing’s Agenda for the Future, and in the processmake certain that the consumers will still have access to high qualityhealth care and a safe health care environment (Nursing’s Agenda for the Future, 2006).   Domain             Nursing’s Agenda for the Future included the work environment as one of the domains which needed strategies in order for the nursing profession to move on to greater heights. In the strategic plan presented by the Nursing’s Agenda for the future, the work environment is viewed as an area so basic to nursing’s future. Improving the work environment of nurses can optimize the quality of patient care and there will also be retention of the professional nursing staff (Nursing’s Agenda for the Future, 2006).             The deterioration of healthcare work environments is a major problem of concern to the nurse leader or manager. A healthy work environment is necessary to bring about quality healthcare service to the clients. An unhealthy work environment would create a devastating impact not only to the nurses and the clients but most importantly on the effectiveness of the entire healthcare system.m.             The possible root causes for this apparent deterioration of healthcare work environments are outlined in the succeeding sentences. (1) The nurses are placed in leadership positions even if they are not adequately prepared and without adequate support for their roles. (2) Each individual nurse is assigned to handle many clients than they can handle. (3) Decision-making within the work environment is done only by one department, without consultation of all the other parties that are involved.             The resulting environment created by these situations brings about many negative results in the working environment. When inadequate leaders are placed in positions, there will be dissatisfaction and high turnover for nurse leaders and the staff as well. When each nurse is assigned to handle many clients, this would result in confusion and the clients are placed at risk for errors and injury. The nurses are also frustrated, angry and stressed out. Decisions that are made without consulting all the parties involved places everyone involved – clients, nurses, managers and other staff – at risk. The overall quality of care offered by the healthcare service would be diminished. The nursing staff and managers are the ones responsible for the problem. The lack of leadership skills is one major factor. In order to solve this problem, focus should be given to the nursing leaders and managers. Leadership training programs should be offered and nursing managers and leaders should be required to attend. These managers and leaders in turn should perform their responsibilities of teaching and guiding the rest of the staff in promoting a healthy work environment.   Theoretical Foundations Change appears to be a driving force in society today and the American healthcare system is no exception. In addition to the need for change in today’s society, the importance of creativity in bringing about needed change must also be considered. An organization will quickly lose strategic advantages that it has worked hard to gain unless it invests in innovation and creativity, and consequently, change (Redmond, et al, 1999). With the particular problem concerning the deterioration of the work environment, a change is needed. This change would include on a large scale the leadership and management styles within the work environment. Aside from that, there should also be empowerment for all the parties involved in the work environment. Nursing organizations must empower their staff to deliver client-focused care. Empowerment is defined as “moving decision making down to the lowest level where competent decisions can be made” (Szaloczy, 1998).  In the hospital setting, this would most commonly be at the point of direct client care or staff nurse level; however, this kind of empowerment requires an environment of autonomy where mutual trust and respect are encouraged. The empowerment process requires that staff be prepared to accept and effectively use expanded decision-making responsibilities (Szaloczy, 1998). To start changing the work environment into a healthy one, there should first be mutual trust and encouragement in all the parties involved. Each and every opinion should be respected and given consideration in the decision-making process. There should also be an all-out support for this desire for change.             Effective leadership style is an integral part of creating an environment that nurtures the development of an empowered nursing staff. Chemers (1997) defines leadership as “a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task.”    The major points of this definition are that leadership is a group activity, is based on social influence, and revolves around a common task. Although this specification seems relatively simple, the reality of leadership is very complex. Intrapersonal factors (i.e., thoughts and emotions) interact with interpersonal processes (i.e., attraction, communication, influence) to have effects on a dynamic external environment (Chemers, 1997). The professional accountabilities of the empowered nurse includes having a sense of value about their work and willingness to provide the full scope of practice as well as ability to work as equal members of a comprehensive interdisciplinary team. In order to move into a fully empowered position, professional nurses need mentoring, education, awareness of political activism opportunities, and networking skills (Szaloczy, 1998). In order to achieve all these, shared leadership should be employed. Shared leadership is a nursing management model that supports staff nurses in extending their influence about decisions that affect their practice, work environment, professional development, and self-fulfillment (Walker, 2001). As previously mentioned, leadership is a group activity. In shared leadership, every voice is heard and given consideration. Shared leadership is a collaborative team process in which team members share key leadership roles (Storey, 2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today’s organized health care delivery systems. Employees must develop or refine new behaviors and skills in empowerment, facilitation, negotiation, systems thinking, and accountability on behalf of patients (George, et al, 2002). Shared leadership is a way to strengthen continuous learning and enhance relationships between leaders/managers, staff and clients, which are the foundation upon which the nurses can develop a new type of relationship with management and with each other. This in turn could significantly improve the work environment. There is an emphasis on ‘relationships’ since these relationships can be tenuous at times as both managers and staff members adopt attitudes of contention and competition with each other. Aside from shared leadership, the transformational leadership theory can be employed. The transformational nurse leader typically inspires followers to do more than originally expected. Transformational leadership theories predict followers’ emotional attachment to the leader and emotional and motivational arousal of followers as a consequence of the leader’s behavior. Transformational leaders broaden and elevate the interests of followers, generate awareness and acceptance among the followers of the purposes and mission of the group and motivate followers to go beyond their self-interests for the good of the group (Koopman, 1997). Many staff nurses are said to have the natural characteristics of transformational leaders, but these characteristics must first be nurtured and allowed to blossom. The nurse managers/leaders have a responsibility to encourage and support this growth, as this is very important in the transformation of the work environment (Grindel, 1998). A practice/work environment in which transformational leaders strive to create new visions for enhancing patient care and nursing practice is a better environment to work. Various authors have discussed the use of transformational leadership. Many researches also suggest that all nurses could use this leadership style to enhance their practice environment (Grindel, 1998). The workplace can be transformed by creating a work environment that ensures quality patient care. This transformation can be achieved by nurses becoming transformational leaders in the workplace. The demands of the health care environment have brought about changes that have not always contributed to positive work environments, and nurses have been concerned about the impact this has had on client care. Managers have had to develop ways to achieve expected outcomes and meet targets required by their organizations. To address all these issues, nurses need to focus on developing relationships that facilitate working with each other from strengths and not just criticizing weaknesses (Walker, 2001). Developing an empowering culture in which positive relationships are nurtured, leadership capabilities are developed, and professional practice is supported can improve the work environment and satisfaction of staff nurses (Walker, 2001). Simply put, collaborative work relationships should be actively enhanced and promoted in order to create a positive work environment.   Planning             In the current work environment, the people should be ready for a new way to share the power and the responsibility that goes with it. They should be ready for partnering relationships, collaborative work relationships and shared leadership. For this particular problem, shared leadership has to be employed. Shared leadership provides an organizational framework that offers the nursing staff maximal participation in decisions about work and the work environment. Every staff has to be given a chance what he or she thinks about a current situation and what they think can help such issues. When implementing new policies or rules, or even with simple matters, the staff should be allowed to contribute to the decisions to be made. Goals have to be set also. To support the nurses’ use of shared leadership behaviors in the clinical setting, the nurses will be mentored by the manager and clinical nurse specialist to apply the shared leadership skills during their daily work to achieve the goals that are set. The creating and sharing of this setting and achieving of goals is a key implementation challenge, and also calls for transformational leadership. Through effective communication and persuasion, and confidence building, the transformational leader encourages the adoption of new values and beliefs, endorses the goal of organizational effectiveness, and sustains the effort to realize the improvement of work environment. The transformational leader could be a staff nurse. But first he or she has to be educated on the responsibilities that the role entails. Aside from that, he or she must also be open to change. To be included with the overall plan for achieving a positive and healthy work environment is the training of the nurses for empowerment. Training nurses for empowerment must include leadership techniques to prepare the nurse for the integrative and collaborative role. The environment in which the professional nurse works is influential in developing empowered behavior (Szaloczy, 1998) since professional nurses do not function in a vacuum. They need an environment that encourages empowerment. The professional nurse cannot reach empowerment if there are unsatisfied needs within the working environment. Incorporated within the concept of empowerment is the individual’s willingness to see the vision and make the personal changes necessary to connect with that vision. It is how the concept of shared leadership works (George, et al, 2002). All management staff plays an important role in leading the emergence of legitimacy of this “new professional authority.” The encouragement of individual nursing staff to establish individual goals that achieve more self-direction, more knowledge and self-confidence, and more networking ability by the process of shared leadership leads to a more committed employee. A more committed employee in turn contributes to a positive and healthy work environment.             In this proposed approach, negative consequences may also present. Shared leadership may present a conflict and ambiguity of roles. Some of the staff might revel in the shared power to the point that they will forget what the essence of shared leadership is all about. Some staff might also take advantage of such opportunity and this creates competition and jealousy within the staff. All of these wouldn’t be in line with the goal of creating a positive and healthy environment.             To minimize such problems, there should be an ongoing monitoring of the staff. Although they are given the rights to take part in decision-making, they should also not forget where they really belong. The staff should also be constantly reminded by the managers that this effort needs teamwork and this is done for the improvement of the work environment. Perhaps motivation would also work in minimizing this problem.   Evaluation             Outcomes have to be measured in order to know if the clients are satisfied with the services and products. In the case of the problem regarding work environment, outcomes have to be measured because the work environment plays a significant part in the job performance and satisfaction of the nurses. If the work environment continues to be negative or diminished, this could significantly affect the quality of care that nurses give their clients. The main gauge for identifying if the plan or solution proposed is successful is when there is a significant positive change in the relationships of clients, staff and managers/leaders. This fosters a positive and healthy work environment. The managers or leaders can identify if the plan or solution is working if they can see the results with their eyes – like increased work performance of the nursing staff.             Aside from that, the change can also be evaluated by various tools for measuring outcomes which are available – like questionnaires and surveys that the staff, managers and even the clients can answer. In evaluating the outcomes, it is important to note that in addition to a strong and committed leadership (shared and transformational leadership), the success of improving the work environment depends on a receptive environment, strategy, structure, and culture.   Conclusion             In every profession, not only for the nurses, the work environment is deemed crucial for the provision of quality services. In the case of the nurses, the focus on work environment is very important since this could affect the performance of the nurses and this in turn can jeopardize the lives of their clients.             The Nursing’s Agenda for the Future supports the improvement of work environment as one of the domains that is necessary for further progression of the nursing profession as well as the quality of care that they offer to their patients.             In some healthcare setting, there is a deterioration of the work environment which contributes to the deterioration of patient care also. There is a need to improve this and in this paper I have proposed a shared leadership strategy to overcome this problem. Shared leadership is a collaborative team process in which the team members all share key leadership roles. A positive and healthy work environment needs the support of everyone working within the environment.             Implementing this program of improvement for the work environment should be constantly monitored so as to determine if progress is made, and if progress is made, there should still be monitoring so that this progress is maintained. Progress can be gauged if there is a significant improvement not only in the relationships of the nurses and other staff but also of the quality of patient care.             The transformation of the work environment to make it an environment where stress levels are less high and morale levels of the nurses improve would require a transformational leader who is willing to get involved. A staff nurse could be such a leader, but he or she would first need conscious awareness of how the role is approached, a positive attitude and a mind open to change. A staff nurse can create a vision for better patient care, perhaps not on a big scale, but in the nursing care team. After all, this is a collaborative process. In conclusion, the Nursing’s Agenda for the Future presents strategies designed for the work environment in the goal of minimizing the increasing incidence of nursing shortage. The deterioration of the work environment vastly contributes to the nurse’s job performance and satisfaction, which can ultimately lead to the problem of nursing shortage. Thus, there are various strategies that can help in improving the work environment and ultimately patient care.           Credit:ivythesis.typepad.com

Sample Essay Nurses Agenda for the Future: Work Environment

Nurses Agenda for the Future: Work Environment Introduction The American nursing community has joined hands around a shar...

Professional Nursing – Journal Article Annotation

Professional Nursing – Journal Article Annotation   Nurses face an endless variety of situations which involves clients, family members, health care staff, and peers. Each of the situations that nurses face pose new experiences and problems involving clients’ care, different approaches to resolving problems, and different results as to whether approaches were successful. Each clinical situation that nurses face everyday requires careful and thoughtful analysis for accurate and sound clinical decisions and plans to be developed for each client.             The article argues that critical thinking is indeed an essential part of the nursing profession. It is not enough that a nurse has abstract knowledge; he or she also has to develop the intellectual capacity to contextualize and to adjust what he/she knows in particular cases. The key ideas that the authors  are trying to communicate in this article are the relationship of critical thinking and intuitive practice to the expertise in nursing. It is true that aside for developing this while still a student nurse, nurses also gain knowledge through their experiences. Every clinical experience becomes a lesson which will serve as a guide and information for the nurse. It is not only the authors that consider critical thinking and intuitive practice as important, but other authors in the nursing discipline as well. In every clinical situation, it is important for a nurse to think critically and make sound judgments so that clients ultimately receive the very best nursing care. Critical thinking is not a simple step-by-step, linear process that can be learned overnight. It is a process acquired only through hard work, commitment, and an active curiosity toward learning. Nurses are responsible for making accurate and appropriate clinical decisions. Critical thinking is very important as no two clients have the same needs. The nurse after assessment and diagnosis has to employ critical thinking skills for a client’s particular condition. Intuition is simply a result of common experiences and applied to new ones. After a nurse has been exposed to a certain situation and is exposed to another similar situation, the nurse uses her intuition along with her critical thinking skills to develop an approach for the client. Intuition in nursing thus develops as a nurse’s clinical experience increases. A nurse is always challenged to observe each of his or her clients closely, search for and examine ideas and judgments about the problems that the clients face. Additionally the nurse has to consider scientific principles that he/she have learned and relate this to the clients’ problem, recognize the problems, and develop the right approach to nursing care as appropriate to the situation and problem of the client. Intuition is thus considered by authors as a trigger which brings about in the nurse an analytical process that leads them in a search to acquire data that confirms what they have sensed in the client or in a particular situation. Intuition thus triggers the nurse to apply his/her critical thinking skills in a situation in order to come up with the right thing to do or the right answer to a problem being presented. Nurses must not make snap judgments just by their intuition alone. This could jeopardize the client’s situation and perhaps affect the nursing quality of care for the patient. As a student nurse, knowing and understanding what critical thinking is and its importance very important. The article points out that a student nurse has to develop this skill. Critical thinking begins for a student when the student seriously asks questions, and in continuing way attempts to answer questions like “what do I really know about this nursing care situation?” or “how do I know it?” This is actually a process which is developed within the student nurse with the aid of other individuals like the educators. Students in nursing must learn nursing by consciously practicing reasoning skills needed in nursing. Students in nursing must also critically reason their way through nursing principles, concepts and theories as much as possible so that appropriate and accurate application of knowledge occurs naturally in clinical practice. As stated in the article, the purpose of reflective, critical thinking is to ensure that the nurse has the depth of knowledge necessary to immediately comprehend the practice situation so that safe, effective, quality nursing care is provided to the clients. Intuitive practice and critical thinking can significantly affect the quality of care delivered by the nurses to their patients. It is important to remember that the quality of nursing practice depends on the nurse’s ability to use all types of cognitive and emotional cues associated with a situation to trigger critical thinking and then to select effective nursing interventions. A nurse cannot safely act on intuition alone that is why critical thinking and intuition both have to go together in order to achieve expertise in the nursing profession. Intuition requires critical thinking as much as critical thinking needs intuition.   Credit:ivythesis.typepad.com

Professional Nursing – Journal Article Annotation

Professional Nursing – Journal Article Annotation Nurses face an endless variety of situations which involves clients, family members...

Nursing

Introduction: Enhancing Nursing Care   Nursing is the process of caring for, or nurturing, for an individual known as the ‘patient’. More specifically, nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses became more particular in enhancing their knowledge through integrating with health and biological sciences (1993).               According to the Code of Professional Conduct (2002), a registered nurse, midwife or health visitor is accountable for what they practice. Furthermore it noted that the following should be followed when caring for patients and clients:   o        “respect the patient or client as an individual o        Obtain consent before you give any treatment or care o        protect confidential information o        co-operate with others in the team o        maintain your professional knowledge and competence o        be trustworthy o        act to identify and minimize risk to patients and clients”.               On the other hand, according to the  (2003), the nursing profession has the following interrelated standards:   1)     “ Accountability – the registered nurse is accountable to the public for competent , safe and ethical nursing practice 2)     Continuing Competence – the registered nurse attains and maintains competencies relevant to own scope of nursing practice 3)     Application Knowledge, Skills and Judgment – the registered nurse demonstrates competencies relevant to own scope of nursing practice 4)     Professional Relationships and Advocacy – the registered nurse establishes professional therapeutic relationships with clients and advocates for clients in their relationship with the health system 5)     Professional Leadership – the registered nurse demonstrates professional leadership in the delivery of quality nursing and healthcare services to the public 6)     Self – Regulation – the registered nurse assumes personal accountability to practice nursing competently and ethically.”               According to an interview with a hospital lead nurse (assigned in older people’s acute care) people published in the  (2004, November 8) good nursing practice is defined as:               “Good nursing practice is all about providing holistic, personalized care that is respectful of the individual and nurses are at their best when caring for older people”   The individual healthcare professional’s ability to do what is proposed with proper competence and skill is, of course, crucial in ensuring safe clinical care. But professional competence is only part of the picture. Good people, with good skills and good intentions, sometimes make mistakes. As part of this professional issue, to be a nurse is to observe a dynamic process of caring based on a theoretical body of knowledge.   The role of the nurse as a vital member of the healthcare team through collaborative professional practice must always give priority through caring its patient. The primary goal of being a nurse is to assist individuals in the achievement of an optimal level of wellness. The focus of nursing practice is on individuals’ specific needs based on their healthcare choices related to physiological, psychological, socio-cultural, developmental and spiritual dimensions of individual lifestyles.               Therefore, a good nursing practice is one that involves the patient in his own care. The patient’s role in his own care must be acknowledged and given importance by the healthcare professional   A specific example of a good nursing practice I have witnessed is having an open (and effective) communication between the patient (and / or the patient’s family) and the healthcare professional. First and foremost, the healthcare professional consults the patient about what are his preferences regarding his care and / or treatment. This is of significance in the patient – healthcare professional relationship; because it will prevent any misunderstanding that might arise when a decision regarding the patient’s care and / or treatment must be made. The patient is also given accurate and / or truthful information of his condition. Furthermore, the information regarding the patient’s condition is not relayed on very technical terms but rather using terms and / or language that is easily understood by the patient. This provides a better understanding for the patient on his medical condition. If in case a patient refuses to accept or undergo a treatment, the patient’s wishes are respected and followed by the healthcare professional.   Furthermore, a patient’s consent is first obtained before any treatment (and / or operation) is performed on the patient. The patient is informed of the effects and / or benefits of the treatment.  And if the patient refuses the treatment and / or operation, his wishes are respected. And in cases such as that (a patient refuses treatment), the patient is informed of the consequences of the non-treatment and at the same time, possible alternative treatments (in place of the refused treatment) and the possible consequences and / or effects of the alternative treatments. In case, the patient was not able to give his consent an able (and legal) representative of the patient will be informed of the patient’s condition and asked for consent on the proposed treatment.    This is significant so that the healthcare professional will not be made liable on possible unfortunate consequences of the treatment or non-treatment; since it is the patient’s decision that has been respected and obeyed. Aside from that, the patient will have a better understanding of his condition and would feel more responsible about his health. Furthermore, he would be able to think over his refusal of the treatment and might concede to the healthcare professionals’ opinion or decision.   Another aspect of patient’s consent is his consent regarding on his medical records. Not only a patient is informed of his medical records but at the same time, he is informed on who has access to it and / or who knows about his medical records and how the information on his medical records are used in relation to his care and / or treatment.  Furthermore, the patient’s consent is obtained regarding on who among his family members or other relations should learn of his medical condition and / or have access on his medical records.   Aside from that, the healthcare professional works as a team. Each and every healthcare professional that works in relation to a patient’s care and / or treatment coordinates with one another. Each and every one of them respects each other’s abilities, skills and opinions regarding the patient’s medical condition. A harmonious relationship lessens if not totally avoid misunderstandings, conflicts and tensions within the healthcare institution. Thus, a harmonious relationship in the medical team produces better results in the patient’s medication. Aside from that, a harmonious relationship amongst the healthcare professionals improves their performance which leads to better service and / or care to the patient.   Hand Washing as an Infection Control In the healthcare surroundings, hand washing is frequently referred to as the main weapon in the disease control arsenal. The principle of hand washing in the healthcare setting is microbial diminution in an attempt to diminish the risk of nosocomial infections. Hand sanitation can also be a dilemma in demanding health centers and clinics where patients are seen both in growing numbers and taken care of in rapid series.  Deterrence and control of communicable actions are intended to limit the increase of contamination and give protected surroundings for all patients, in spite of the locale.In light of the materialization of antibiotic defiant organisms, useful infection control measures, such as hand washing, are necessary to avoidance. Hand sanitation is commonly recognized to be the only most essential activity for reducing the spread of illness, however facts imply that many health care professionals do not disinfect their hands as frequently as they require to or utilize the right method which means that spots of the hands can be missed. Hands should be disinfected before direct contact with patients and after any activity or contact that infects the hands, as well as following the removal of gloves. While alcohol hand gels and rubs are a practical alternative to soap and water, alcohol is not a cleaning agent. Hands that are visibly dirty or potentially grossly contaminated must be washed with soap and water and dried thoroughly. Hand preparation increases the effectiveness of decontamination. Adequate hand washing facilities must be available and easily accessible in all patient areas, treatment rooms, sluices and kitchens. Basins in clinical areas should have elbow or wrist lever operated mixer taps or automated controls and be provided with liquid soap dispensers, paper hand towels and foot-operated waste bins ( 2002).Alcohol hand gel must also be available at ‘point of care’ in all primary and secondary care settings (2004). All health care workers should bring any lack of, or inappropriately placed facilities to the notice of their managers (or matron). They also have a duty of care to patients and themselves and must use facilities provided to prevent cross infection.   Infection control is significantly significant to the successful condition and organization of healthcare services. On the other hand, it is a locale of nursing theory and practice that has been inadequately studied and has gone nearly uncontested (1996). Contamination control needs a vital understanding of the epidemiology of diseases caused by frequently encountered micro-organisms, of the danger that augment patients’ vulnerability to infection by these micro-organisms, and the exercises, measures and cures that encourage infections (1981). In the study of (1983) a small number of nurses inquire about principles, clinical practices or educational programs in infection control. Paradoxically, this took place at a time when disease control teams are progressively more moving away from the everyday gathering of hospital infection rates towards target observation programs. Nurses have the opportunity to practice infection control as an integral part of patient care on a day-to-day basis (1983). However, the results of several studies suggest an overall lack of understanding of the components that make up informed infection control care (1992). Hospital-acquired infections are often related to inappropriate patient care practices. This may be due largely to non-compliance with infection control policies, which in turn is attributed to poor knowledge, a lack of motivation and low awareness of the need for infection control. It is important, therefore, that infection control personnel understand what factors influence compliance and how compliance can best be achieved (1988). A review of nosocomial infection control indicated that the incidence and subsequent cost of hospital infections can be reduced significantly by implementing an active infection control program (1993). One solution that could encourage change in infection control practice is the development of an infection control audit program. The aim of clinical audit is to improve the delivery of care to patients as well as promote multidisciplinary working in clinical teams. It involves simply taking note of what nurses do, learning from it and changing practices if necessary (1993). Clinically-based audits ensure that the infection control nurse can examine practices where care is actually being delivered. A standardized infection control audit tool could be used by all care providers. This would furnish purchasers with a measurable standard in relation to quality in infection control (1992). The risk to patients of infection is much higher than for the general population, partly due to under- lying intrinsic risk factors and the need for invasive therapy. The spread of infection is also increased when patients with existing infections are in close proximity to other susceptible patients (1992). Assessment of infection status can be divided into two distinct categories, the patient who has an infection which could spread to another patient, and the patient who is at risk of acquiring infection. These findings reveal that the majority of hospitals included in the study assessed the risk of infection through the nursing process. However, the nursing process does not necessarily offer a framework for risk assessment for infection control. Only one hospital had an infection control risk assessment tool applied by the clinical nurses and evaluated by the infection control nurses. (1988) suggested that the rate of infection can be altered significantly by staff awareness and the risk of infection reduced by a number of recognized healthcare practices, including risk assessment. Often guidelines for infection control precautions are standardized and based on a medical model of care (1991). Infection control is also perceived as ‘rules and routines’ that are grafted onto care plans. In reality, infection prevention and control is the basis of all care. Findings from this study demonstrate that the nurses’ approach to applying infection control precautions in the clinical setting was inconsistent. Infection control nurses in each of the six hospitals viewed the hand washing technique of nursing staff as poor, with insufficient time allowed for the procedure. The seriousness of this finding was reinforced by a study on compliance with treatment by patients undergoing isolation nursing. The researcher found, among other things, that a failure by nurses to wash their hands after contact with patients known to be potentially infectious meant that the acquisition of pathogens was highly likely (1992). While no harm is likely to befall a patient as a result of hand washing, one potential adverse effect of hand washing for healthcare workers is skin irritation. Indeed, skin irritation constitutes an important barrier to appropriate compliance with hand washing guidelines (1985). Soaps and detergents can damage the skin when applied on a regular basis. Alcohol-based preparations are less irritating to the skin, and with the addition of emollients, may be tolerated better (1999). Another potential harm of increasing compliance with hand washing is the amount of time required to do it adequately. Current recommendations for standard hand washing suggest 15-30 seconds of hand washing is necessary for adequate hand hygiene (1995). Given the many times during a nursing shift that hand washing should occur, this is a significant time commitment that could potentially impede the performance of other patient care duties. In fact, lack of time is one of the most common reasons cited for failure to wash hands.11 Since alcohol-based hand rubs require much less time, it has been suggested that they might resolve this concern. In fact, a recent study which modeled compliance time for hand washing as compared with alcoholic rubs, suggested that, given 100% compliance, hand washing would consume 16 hours of nursing time per standard day shift, while alcohol rub would consume only 3 hours (1991). Conclusion             Nursing a profession that has been around since the middle ages, that began from health restoration of ill and wounded persons in wars, is now an institutionalized profession that faces a lot of issues, but is never the less stable in enhancing their skills through training and studies.       Based on the analysis, we can conclude that nursing is a sacred profession for it aims to help patients/ clients gain insight and access to their subjective experience.              Indeed it is no argument in saying that in time, the nurses have increased their roles in the society. This is proven by the numerous specializations that were made in the past years that were employed in the field. Through periods of rapid changes in industrialization, and in the present day information technology, nursing institutions have designed nursing care appropriate to expectations of the patients and clients. Theoretical and practical management has evolved in this institution from the time it was formed ( 1995).             Even in the event of modern thinking and high technology, the latest gadgets that enhance medical practices and the theories taught in the universities cannot replace the effectiveness of actual and personal involvement of the nurses to their patients. The nurse-patient involvement is crucial for wellness of the patient for it is one of the few interactions of the patient to other people while recuperating. Human interaction avoids the patient from being depressed. Furthermore, nurse-patient interaction provides the nurse with additional experience and promotes professional growth. Practical knowledge (1979) supports praxis for it is indispensable, in the nursing field. A nurse needs to integrate his skills, experience and technical knowledge to result into a better and effective performance. Praxis has many implications in the field of nurturing and caring. Despite criticisms and complex issues, the theory Clinical Effectiveness should be present in a nurse’s profile for him to handle situations with patients in distress. Technical knowledge supports evidence based practice, practical knowledge endorses practical knowledge and emancipatory knowledge gives both nurses and patients interaction and ease.  All health care professionals who have a clinical responsibility for patients must include infection prevention and control as part of their every day practice. The RCN believes all health care staff should receive mandatory infection control training as part of their induction and on an ongoing annual basis. It is particularly important that knowledge and skills are continually updated. The training should cover all the general principles of infection prevention and control, to emphasize the key role that health care professionals play in minimizing the spread of infection; to highlight what can happen as a result of bad practice and underline the importance of good communication.                         Credit:ivythesis.typepad.com

Nursing

Introduction: Enhancing Nursing Care Nursing is the process of caring for, or nurturing, for an individual known as the ‘patient’. Mor...

RESEARCH FOR REGISTERED NURSES

Criticizing individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization in their area belies a simplistic approach to the problem.   Introduction   Health care is continually changing in the way health care professionals like individual practitioners and clinical managers organize and deliver care to the patients. For this reason, health care knowledge must continuously grow and expand to keep health care approaches relevant, current and appropriate. Without new knowledge, health care professionals cannot improve techniques for therapies and even management.   One important source of knowledge is research. Research is viewed in most professional circles as necessary for the continuous development of the scientific body of knowledge, which is the hallmark of a profession. The essence of evidence-based practice is the provision of quality and cost-effective health care to the health consumer (2003).   Research provides a solid foundation on which health care professionals base their practice. The scientific knowledge base for professional health care practice is developed through scholarly inquiry of the research literature, use of existing research findings, and the actual conduct of research (2004).   The gap between research and its translation to practice in the healthcare arena became a focus for policy discussion in some healthcare organizations in the last decade. Studies have continued to reveal that the gap between research and practice seems to be most obvious in the nursing profession. It is disheartening, however, to note that regardless of the millions of dollars spent on funding clinical research, the integration of the findings into practice has been relatively slow among nurses (, 2003).   There have been previous attempts at improving research utilization among nurses worldwide. The disparity in the conduct of research and its integration into practice became an international nursing concern. Various groups are made in the attempts at reducing the research conduct and utilization gap.   Integrating the findings of research to improve clinical practice should be a vision for most health care professionals – the nurses, who form the largest proportion of care providers at the bedside. There is a need to search for the missing link between the dissemination and implementation of research findings for evidence-based practice among nurses (2003).   There are several studies focusing on the barriers to research utilization among nurses but few on attitudes toward research. Researchers noted that where ability was higher, attitudes toward research activities were more positive, and vice versa. Attitude and availability of research reports were related to research utilization.   Although interest in research-based practice seemed to be present among a majority of the health care professional population, the reality of the situation suggests that it is not occurring as frequently as desired. The statistical section of a research study could be intimidating to the beginning researcher.   In a nationwide study focusing on the state of research utilization in the United States, it revealed that the culture of healthcare institutions does not value research utilization. The study noted that nurses without a baccalaureate degree did not fully understand or value research, while some of the baccalaureate-prepared nurses who had classes on research in their program complained that the way in which nursing research was taught in the schools turned them off (2003).   These are just some examples that depict the increasing lack oaf awareness and utilization of may health care professionals. The purpose if this paper is to identify the main reasons why nurses do not utilize research in their practice; discuss three of these reasons and why they exist; and make evidenced based recommendations for future nursing practice to overcome each of these three barriers.   Body   Nursing has long been urged to base care on research findings rather than tradition and ritual. The rapid growth of doctorally prepared nurse researchers has enabled the scientific base for nursing practice to grow (2004)   There are, however, barriers to utilization of research in clinical settings. This includes individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization. Barriers limit the potential of identifying clinical outcomes in nursing care (, 2004). However, recognizing and acknowledging the existence of these barriers enable to implement change in practice in a timelier manner.   The reasons why nurses do not utilize research evidence in their clinical practice are complex and multi-factorial. Studies focusing mainly on barriers to research utilization noted that the following reasons answer why most nurses so not utilize research: (a) characteristics of the nurse, which revolves around poor knowledge of research; (b) characteristics of the research presentation, with statistical terms beyond the level of the average nurse; and (c) characteristics of the organization settings in clinical areas constitute barriers.   In particular, barriers to research utilization revealed by studies include nurses’ lack of time and independence in the organization, together with lack of support from nurse managers. Organizational characteristics were noted to present one of the greatest barriers to nursing research utilization in the practice setting (1998). The conclusions of many previous studies revealed that, in addition to the limitations in the workplace settings, the resistance among more senior nursing staff and the research values and skills of the nurses were important in research utilization (2003).   Most of these studies, however, have been conducted with samples consisting of nurses working mostly in urban settings, but the more one ventures out of the large urban medical centers, the less one hears about research and its utilization. Studies on nurses working in rural areas is paramount, if we are to “leave no nurse behind” in our professional struggle for evidence-based practice (, 2003).   For this paper, three reasons why nurses lack utilization and awareness of research will be discussed. These are: (1) lack of support from administration to implement new practices and fund research, (2) lack of time to investigate research findings, and (3) lack of interest and knowledge on the part of the nurses themselves.   Nurses encounter these three major barriers: lack of time for investigating and implementing research, lack of knowledge on the nurses’ part, and lack of support by the administrators and other health care professionals. All these barriers have been documented in other studies.   The finding that the desire for research utilization among nurse administrators was affected by their lack of support and budget for research from administration, needs closer consideration. Making no budget allowance for research in the nursing division could be seen as reflective of the importance attached to research by the nurse leaders. It is pertinent, however, to note that qualitative comments by the nurses in this study who were utilizing research showed that support by the administrators was an encouraging facilitator in their use of scientific findings in their practice settings. This supports previous studies that revealed one of the most effective facilitators for research utilization was the increased support and encouragement from administrators (2003).   Under this barrier of lack of support is uncooperative physicians, which seems to be an international problem. This is unfortunate because nurses and physicians work together closely and, in some cases, nurses are dependent on physicians to implement research findings in the any health care setting (2004).   Lack of time to read research articles and to investigate and implement research findings in practice is the second barrier. This is congruent with findings of other studies. One researcher found that time was an important factor to improve research use in clinical practice.   Perioperative nurses in one study reported that heavy activity and workload gave them neither time nor energy to do research-related activities. The administrative requirement to improve efficiency and long waiting lists press the surgical team to treat more patients. This pressure, acute procedures, and lack of personal resources increase nurses’ workload. Perioperative nurses have no authority to administer their time at work, and the possibility of finding time for research activities in practice depends on nurse leaders. Only nurse leaders can organize the OR team so that perioperative nurses have on-duty time to perform research activities (2004).   Recommendations   Developing a favorable attitude among nurses that encourages the integration of research evidence into nursing practice at the health care setting needs the cooperation of nurse leaders and other health care professionals in the clinical areas.   It is time for nurses to stop projecting nursing research as an academic exercise and start perceiving it as a scientific base for evidence-based practice. There is a need to stress support for nursing research as one of the important means of providing scientific evidence for practice in every forum for nurse executives (2003).   It is interesting to note the enthusiasm with which research results are presented in nursing conferences locally, nationally, and internationally. However, it becomes very frustrating when the wide gap between the enthusiastically presented research findings and what actually occurs in clinical practice remains for many years after the dissemination of such evidence reports and clinical guidelines. The existence of the gap between research and practice should continuously be a concern for researchers/educators and nurse administrators (2003).   Educators and administrators in healthcare organizations need to create collaborative strategies that emphasize the importance of research in enhancing evidence-based practice in the clinical setting, especially in the rural areas. Whatever approach is taken, if we are to improve nursing practice through scientific evidence, it will take the commitment and collaboration of educators/researchers, clinicians, and administrators to see that no nurse is left behind in the march toward evidence-based practice (2003).   There are several reasons why nurses should implement research findings. Using research increases the quality of nursing care’ and provides increased efficiency in patient care, as well as personal and professional growth for nurses. Most nurses are required by individual governments to work in accordance with scientific knowledge. Patients and their relatives increasingly expect nurses to incorporate research findings into their everyday practice, and most nursing councils all over the world require that nursing practice be evidence based. The health care setting continues to become more technologically challenging, and nurses must combine use of new technology with knowledgeable and safe patient care so patients do not experience complications (2004).   It is recommended that nurses have to be given study days for the lack of time they have in research investigation and implementation. Competence in the research process, statistics, and research methodology can help nurses argue for use and evaluation of research findings. This may improve support and collaboration from the physicians and other health care administrators.               To determine whether research findings can be used as a basis for nursing practice, the nurse should consider the scientific worth of the study, the substantiating evidence provided in other studies, the similarity of the research setting to the nurse’s own clinical practice setting, the status of current nursing theory, and factors affecting feasibility of application.   Conclusion               The utilization and awareness of research in nursing profession is a basis for scholarly and professional decision making in clinical practice and is essential in providing competent, efficient, and state-of-the-art nursing care.               Advances in care through research are meaningless unless they reach nurses at the point of care. Nurses should utilize these research findings if they are to improve the quality of care that they offer to their clients. Nurses must therefore read publications like journals and textbooks and other source which contain research reports in nursing and other related fields in the provision of health care.               Unfortunately, there are many barriers that prevent the nurses from utilizing these research finding. Among these are the lack of time and interest on the part of the nurses to investigate and implement research findings, the lack of support from the health care administration and other health care professionals, and the lack of knowledge of the nurses on the significance of research findings and its implementation. These barriers have to be overcome by the nurses with the help of the administration and other health care professionals.               Nurses in all health care settings must continue to seek knowledge by taking time to review research and practice findings, critique research studies, and discuss with fellow nurses the implications of using and not using new knowledge in nursing practice.             Nursing research is important and it addresses issues that are important to the discipline of nursing. Nurses must therefore be aware and use research findings in there practice. Acquisition and application of new knowledge is very important in contributing to nursing practice and patient care.                       REFERENCES     Credit:ivythesis.typepad.com

RESEARCH FOR REGISTERED NURSES

Criticizing individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization ...