RESUMEN
Nursing roles and administrative responsibilities have changed over the past 10 years. Although nurses' choices in graduate educational programs have been documented by the American Association of Colleges of Nursing and the National League for Nursing, little empirical data exist related to specific role changes. The purpose of this study was to describe current responsibilities of nurse administrators and their perceptions regarding role changes in their organizations. This study also identified educational recommendations of nurse administrators for nurses pursuing graduate degrees with implications and recommendations for nurse leaders.
Asunto(s)
Enfermeras Administradoras/tendencias , Enfermería/organización & administración , Educación de Postgrado en Enfermería/normas , Humanos , Perfil Laboral , Liderazgo , Programas Controlados de Atención en Salud/organización & administración , Enfermeras Administradoras/educación , Enfermeras Administradoras/psicología , Enfermeras Practicantes/educación , Enfermeras Practicantes/organización & administración , Enfermería/tendencias , Percepción , Estados UnidosRESUMEN
OBJECTIVES: The authors describe factors that facilitate positive changes in dementia care as perceived by long-term care employees. BACKGROUND: Creating positive changes in dementia care is a complex undertaking involving multiple variables. The perspectives of long-term care employees may provide important insight and direction for a successful change process. METHODS: A convenience sample of 181 long-term care employees utilized a q-sort methodology to provide data for this descriptive study. Results were analyzed using rankings and Spearman's rho correlation coefficient. RESULTS: The facility factors most often cited as important for making positive changes in dementia care involved teamwork, administrative support, staff attitude, and knowledge. There was little congruence between facility factors identified as ideal for providing dementia care and those identified as actually evident at the subjects place of employment. Personal characteristics that were identified as most important for facilitating positive changes in dementia care include genuinely liking people with dementia, being flexible, kindness, calmness, and having a positive attitude. The correlations between ideal and real personal factors were higher than for the facility factors. CONCLUSIONS: This study supports the idea that the fundamental tenets of good leadership--communication, involvement, and empowerment--are foundational for real change in dementia care to be attained and sustained.
Asunto(s)
Actitud del Personal de Salud , Demencia/enfermería , Casas de Salud/organización & administración , Personal de Enfermería/psicología , Innovación Organizacional , Percepción , Adulto , Anciano , Femenino , Humanos , Relaciones Interprofesionales , Cuidados a Largo Plazo/organización & administración , Cuidados a Largo Plazo/normas , Masculino , Persona de Mediana Edad , Enfermeras Administradoras/organización & administración , Casas de Salud/normas , Personal de Enfermería/organización & administración , Personal de Enfermería/normas , Admisión y Programación de Personal , Estados UnidosRESUMEN
The use of guided imagery in the classroom or clinical setting has traditionally been directed at decreasing anxiety or increasing skill performance (Rodriguez, 1991; Stephens, 1992; Tuyn, 1994). This article describes an innovative use of imagery as a teaching strategy to unearth and possibly reframe, what Senge (1990) has identified as "mental models." The approach described differs from traditional uses of imagery related to decreasing anxiety and increasing skill performance. This approach is directed at increasing critical thinking and has offered new insights for both students and faculty. By using both guided imagery as a teaching strategy and Senge's concepts of mental models, educators can encourage students to become critical thinkers and what Senge calls "systems thinkers." Mental models are deeply ingrained, often unacknowledged, assumptions or images that individuals develop as a result of their life experiences. These images influence values, thoughts, and actions, albeit at times, unknowingly. These images, or mental models, also influence the ability to learn and translate learning into action. Lack of knowledge and awareness of one's mental models can be an obstacle to high-quality critical thinking. The concept of mental models has been best articulated by Senge (1990), who is known for his work in systems-thinking. Senge believed that new insights are rarely followed with substantive action because the new learning, at some level, conflicts with deeply held, internal images. One way to remove this gap between insight and action is to examine mental models that may prohibit both insight and action.
Asunto(s)
Educación en Enfermería , Imágenes en Psicoterapia , Enseñanza/métodos , Humanos , Modelos Psicológicos , Terapia por RelajaciónRESUMEN
Managed care has changed role expectations for front-line nurses. Roles now include outcome management, team coordination, and guardianship of patient's continuity along the continuum. Organizations are investing in leadership development training for non-management nurses in hopes that such competencies will enhance their value-added competitive edge, but data are needed to validate the value of such training to the organization. Authors report the self-perceived competencies in leadership understanding and ability (in a study of 87 participants) before and after leadership development training that focused on: planned change, communication, conflict, group dynamics, systems theory, and oppressed group behavior. Significant increases were reported in both understanding and ability to perform stated competencies both immediately after and 3 months after 3 days of training. Self-perceptions of both leadership understanding and ability before leadership training were higher for those with advanced degrees and/or those in management positions. However, some of these differences became insignificant after training.
Asunto(s)
Competencia Clínica/normas , Educación Continua en Enfermería/organización & administración , Liderazgo , Enfermeras Administradoras/educación , Supervisión de Enfermería , Desarrollo de Personal/organización & administración , Humanos , Programas Controlados de Atención en Salud , Evaluación de Programas y Proyectos de SaludRESUMEN
This study examines perspectives of a broad group of nursing home employees, regulators, advocates, and professional associations to describe progress made since the 1990 implementation of the Nursing Home Reform legislation (OBRA '87) and to determine whether the legislation is perceived as effecting positive change for nursing home residents. Interviews were conducted with 132 professional and non-professional staff in six states and 56 residents. Important issues about nursing home staffing and quality of care are explored. In general, OBRA '87 is viewed as positive, with all groups of respondents indicating that nursing staff or quality have not deteriorated; administrators, licensed nurses, and certified nursing assistants indicate the quality of nursing care provided and the nursing staff levels have improved since OBRA '87 implementation. Regulators agree that quality of nursing care has improved, but nursing home advocates, regulators, and professional association staff indicate mostly no change or no opinion. There is a danger in interpreting that quality and staffing are adequate from these results. While both may have improved, they may not be adequate.
Asunto(s)
Actitud del Personal de Salud , Regulación y Control de Instalaciones/legislación & jurisprudencia , Casas de Salud/normas , Calidad de la Atención de Salud , Humanos , Casas de Salud/legislación & jurisprudencia , Encuestas y CuestionariosRESUMEN
This study examines perspectives of a broad group of nursing home employees, regulators, advocates, and professional associations to describe progress made since the 1990 implementation of the Nursing Home Reform legislation (OBRA '87) and to determine whether the legislation is perceived as affecting positive change for nursing home residents. Interviews were conducted with 59 residents and 132 professional and non-professional staff in six states. Important quality of care issues of resident rights, resident dignity, restraint use, resident assessment, as well as perspectives of residents themselves are explored. In general, OBRA '87 is viewed as positive, with all groups of respondents indicating that residents have benefited from it. They identify the focus on resident rights as the most important accomplishment. Empowerment of residents through involvement in care decisions is noted by many as an important achievement. Many conclude that quality of care has improved and restraint use has decreased. The MDS is a useful tool from the standpoint of nursing home staff and regulators. This appraisal sharply contrasts their opinions about the Preadmission Screening and Resident Review (PASARR) screening tool. We believe that PASARR should be reexamined and that changes should be made in the process and/or implementation of the tool.
Asunto(s)
Regulación y Control de Instalaciones/legislación & jurisprudencia , Reforma de la Atención de Salud/legislación & jurisprudencia , Casas de Salud/normas , Calidad de la Atención de Salud , Actitud del Personal de Salud , Evaluación Geriátrica , Humanos , Casas de Salud/legislación & jurisprudencia , Satisfacción del Paciente , Encuestas y Cuestionarios , Estados UnidosRESUMEN
As nurses prepare for their place in health care reform, it is becoming more important than ever to be clear about the unique contribution nurses make to health care outcomes. In our technology-driven society, however, some of nursing's most powerful contributions go unacknowledged. An unexpected finding of a study on nurse experts' perceptions of synchrony revealed that nurses themselves frequently do not document or even dialog about important contributions if they cannot be captured within the dominant paradigm of high-technology care. The article describes nurses "little secret" that must be exposed.
Asunto(s)
Relaciones Enfermero-Paciente , Atención de Enfermería/métodos , Registros de Enfermería , Humanos , Pacientes/psicología , Valores SocialesRESUMEN
In summary, measurement of standards needs to be reframed and rearticulated. If nurses move toward using measurable standards as well as holistic standards, the goal of standards will be refocused appropriately. The standards will articulate the specifics and the whole of nursing to members of society in need of health care. Nurses will also be able to hold each other accountable not only for specific procedures but also for delivering caring, as perceived by the client. The latter is unfortunately lacking in present performance appraisals. There needs to be increasing value given to nursing's unique holistic contribution to the health care of humans, which should be evident in standards. Nurses need not be at the mercy of the quantitative paradigm; neither should they alienate themselves from it. Nurses can use this paradigm to support its value and can become courageous enough to attempt describing our holistic contribution, then to research resulting outcomes. Nurses can and should relate resource consumption, not only to established quality indicators, but also to clients' perceptions of receiving holistic nursing care. As expressed by the ANA in the 1973 standards, the main reason for standards is to hold nurses accountable to what nursing is and to communicate to our clients and other disciplines what they can expect from nurses. If nursing's voice supporting holistic quality of care is to be heard in a consumer-driven health care market, it must not be shy about giving voice to its contribution through articulation of holistic standards. The foundation provided by the ANA and the subsequent work of Paulen, Benner, AHNA, and the upcoming revisions of the ANA standards are applauded.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Salud Holística , Atención de Enfermería/normas , Práctica Profesional/normas , Garantía de la Calidad de Atención de Salud , HumanosRESUMEN
The list grows longer as exploration continues. This model of measuring climate and job satisfaction in the transformation to shared governance is providing a deeper understanding than traditional modes of inquiry. The authors are eager to continue this exploration and look forward to sharing their results. They also look forward to reviewing the results of other nursing leaders who are engaged in creating new models within their divisions of nursing, and who are creatively attempting to explore and understand the paradigm shifts within nursing in the new age.