Educated Caring: The Emergence of Professional Identity Among Nurses

This article examines the formation of occupational identity in a nursing program. The normative and ideological dimensions of this process are revealed in the program’s goals and the views of educators and students through qualitative data from observations and 30 in-depth interviews. Educators seek to socialize students toward professionalism to raise the occupation’s status by emphasizing the scientific and technical basis of nursing. Yet students uphold a gendered discourse by identifying a normative dimension of caring as central to their occupational identity. The dilemma between professionalism and caring is reconciled as students construct an occupational identity based on “educated caring,” where these two dimensions are equally valuable and significant.

The nature,extent and determinants of violence against psychiatric personnel

Violence against psychiatric staff seems to be on the increase. Such abuse can lead to mental health consequences for the staff and a reluctance to be closely involved with patients. Few Swedish investigations have examined violence against mental nurses and psychiatrists, or undertaken comparative studies between them. In this study we examined the extent, nature and determinants (i.e. risk factors) of violence against psychiatric nurses (n = 731) and psychiatrists (n = 320) working in the eight health care districts of Stockholm. These caregivers were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. violence and work environment). The majority of the participants (85%) reported having been exposed to violence during their careers, with 57% being victimized in the past 12 months. Physical violence was common, and factors such as negative attitudes to work and diminished sense of autonomy were associated with an increased vulnerability to violence. Nurses and psychiatrists did not differ in violence variables. In spite of the weaknesses of the design (cross-sectional self-selecting sample), this study corroborates previous findings and identifies personal factors associated with violence that have received little attention in the literature (e.g. lack of respect for the organization of care).     

Psychophysical conditions and hormonal secretion in nurses on a rapidly rotating shift schedule and exposed to bright light during night work

The psychophysical conditions of 15 young female nurses, working in a rapidly-rotating shift system (2-2-2-2), modified according to some psychophysiological criteria, and exposed to short period (4 × 20 min) of bright light (2350 Lux) during their night duty, were studied in order to evaluate their adaptation to night work and to test a possible positive effect on it of bright light. Subjective evaluations of work load and psychophysical conditions, performance measures, hormonal excretion (cortisol, 6-sulphatoxymelatonin and catecholamines), oral temperature and activity-sleep logs were taken during the shiftwork cycle, comprising one morning, one afternoon and two consecutive nights under normal and bright light. The results showed that this rapidly-rotating shift system had little effect upon the normal circadian rhythms of the body. Moreover, the lengthening of the night shift to 10 h can be considered to be acceptable, provided that work load is reduced and there are sufficient rest pauses available. On the other hand, the reduction to 7 h of the length of the day shifts and delayed start of the morning shift to 07:00 h appeared to be convenient both in relation to the work load and sleep duration. Some positive effects of bright light upon psychophysical conditions and performance efficiency were noted, while hormonal excretion and body temperature did not show any effect of bright light; in particular, melatonin excretion was not suppressed appreciably by the bright light used.     

The nature, extent and determinants of violence against psychiatric personnel

Violence against psychiatric staff seems to be on the increase. Such abuse can lead to mental health consequences for the staff and a reluctance to be closely involved with patients. Few Swedish investigations have examined violence against mental nurses and psychiatrists, or undertaken comparative studies between them. In this study we examined the extent, nature and determinants (i.e. risk factors) of violence against psychiatric nurses (n = 731) and psychiatrists (n = 320) working in the eight health care districts of Stockholm. These caregivers were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. violence and work environment). The majority of the participants (85%) reported having been exposed to violence during their careers, with 57% being victimized in the past 12 months. Physical violence was common, and factors such as negative attitudes to work and diminished sense of autonomy were associated with an increased vulnerability to violence. Nurses and psychiatrists did not differ in violence variables. In spite of the weaknesses of the design (cross-sectional self-selecting sample), this study corroborates previous findings and identifies personal factors associated with violence that have received little attention in the literature (e.g. lack of respect for the organization of care).     

Violence in the nursing profession: Occupational and lifestyle risk factors in Swedish nurses

Abstract

In a national study of the work environment, physical, and mental well-being of more than 2600 Swedish nurses, 30% reported having experienced violence at work. Possible association between violence and a range of occupational, demographic, and lifestyle characteristics were studied. Stepwise multiple linear and logistic regressions were used to further examine risk factors for violence. Occupational factors with significant correlations to workplace violence were nursing discipline (type of ward or facility), years of work experience, supervisory responsibilities, night work, work dissatisfaction, work-related musculoskeletal injury, and frequency of patient handling. Demographic/lifestyle factors related to violence were age, gender, smoking, coffee consumption at work, and use of alcohol to relax after work. The best fit linear regression model explained 17% of the variance in violence, 13%, of the variance in threat of violence. The logistic regression model confirmed an increased risk of violence and threats in psychiatric and geriatric settings. However, much remains unexplained about the aetiology of violencc in health carc settings. This report provides the basis for a pilot intervention study currently in progress.     

Book reviews and books received

Abstract

In the field of stress research it is often assumed that social support as well as coping behaviour contributes to feelings of health and well-being. However, until now it has not been altogether clear whether a main-effect model or a buffer model was the more appropriate for explaining the role of these factors in response to stressful situations. In this paper, a research project is described in which both the direct and indirect effects of social support and coping were studied in the work situation of nurses. The results offer more support for a main-effect model than for a buffer or moderating-effect model, especially with regard to the coping strategies ‘active problem-solving’ and ‘palliative behaviour’. However, some moderating effects on nurses‘ reactions to their work situation were found for social support and for ‘comforting cognitions’ as a coping strategy.     

Violence in the nursing profession: Occupational and lifestyle risk factors in Swedish nurses

In a national study of the work environment, physical, and mental well-being of more than 2600 Swedish nurses, 30% reported having experienced violence at work. Possible association between violence and a range of occupational, demographic, and lifestyle characteristics were studied. Stepwise multiple linear and logistic regressions were used to further examine risk factors for violence. Occupational factors with significant correlations to workplace violence were nursing discipline (type of ward or facility), years of work experience, supervisory responsibilities, night work, work dissatisfaction, work-related musculoskeletal injury, and frequency of patient handling. Demographic/lifestyle factors related to violence were age, gender, smoking, coffee consumption at work, and use of alcohol to relax after work. The best fit linear regression model explained 17% of the variance in violence, 13%, of the variance in threat of violence. The logistic regression model confirmed an increased risk of violence and threats in psychiatric and geriatric settings. However, much remains unexplained about the aetiology of violencc in health carc settings. This report provides the basis for a pilot intervention study currently in progress.     

Everything changes to stay the same: persistent global health inequalities amidst new therapeutic opportunities and mobilities for Filipino nurses

ABSTRACT

The global migration of Filipino nurses has received significant attention, yet little is known of these healthcare workers’ experiences and mobilities within the Philippines. I explore the experiences and narratives of Filipino nurses living in Manila, some of whom have no desires to migrate. I uncover the often novel forms of therapeutic mobilities undertaken by these nurses, focusing on call centre nursing and entrepreneurship as key alternative career pathways within the realms of ‘therapeutics’. Through interrogating the various mobilities undertaken by nurses – physical mobilities and migration, socioeconomic mobilities and occupational mobilities in the form of a career change – it becomes clear that international physical mobility is no longer key. Nevertheless, Filipino nurses continue to provide care in global contexts in novel ‘therapeutic’ industries and doing so allows them to increase their socioeconomic mobility.     

Does shift work lead to poorer health habits? A comparison between women who had always done shift work with those who had never done shift work

Shift work has been reported to predict health problems, and a possible explanation is that shift work may lead to poorer health habits, thereby increasing a person's vulnerability to illness. This study examined the association between shift work and health habits, as indicated by smoking, alcohol intake, physical activity and by being overweight. A questionnaire was sent to all 2795 female nurses working in the 10 hospitals of two Finnish health care districts. From the 2299 respondents, we selected those 506 shift workers who reported having always done shift work and those 183 day workers who had never done shift work. Shift workers were found to smoke more and to be overweight more often than day workers. These differences gradually increased in each successive age group, being 1.94 pack-years in smoking and 0.9 kg m^-2 in body mass index among nurses over 45 years of age. Shift work was not associated with alcohol intake or sedentary lifestyle. This evidence is compatible with the possibility that shift work in nurses increases smoking and being overweight to a degree that contributes to health problems, including coronary heart disease.     

Performance and burnout in intensive care units

Abstract

The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit performance. Subjective performance measures relate negatively to burnout levels of nurses, whereas an objective performance measure relates positively to burnout. Furthermore, subjectively assessed personal performance (i.e. personal accomplishment) is more strongly related to burnout than subjectively assessed unit performance. A model test of the relationship between both types of subjective performance and burnout reveals that nurses' perception of unit performance is indirectly related to burnout through perception of personal performance. This model holds similarly for objectively well- and poor-performing ICUs.