There is a recognized nursing shortage in Canada, including specialty areas such as critical care (CC). Nursing shortages impact health care delivery, including economic, patient, and nursing outcomes. Job satisfaction is one of the most significant outcomes affected by the nursing shortage. Recruitment of inexperienced nurses in CC is a relatively new hiring practice and has resulted in a more diverse level of clinical expertise among CC nurses. Little is known about how differences in level of clinical expertise affect job satisfaction. The purpose of this study was to explore the relationship between CC nurses’ self -reported level of clinical expertise and job satisfaction. Interrelationships between additional influencing factors, such as organizational climate and personal factors were also explored. Utilizing a web based online survey, a cross-sectional survey was sent to all 788 Manitoba hospital based CC nurses, via the College of Registered Nurses of Manitoba. Respondents (N = 188) completed the Critical Care Nurse Retention Survey, which operationalized the key study variables. Sixty-five percent of the sample reported overall job satisfaction. Based on multivariate analysis, the most influential factors affecting CC nurses’ job satisfaction were nursing management, control over practice, and level of clinical expertise. Nursing management plays a vital role in facilitating optimal nursing practice. Control and autonomy may reflect a sense of satisfaction in the achievement of the knowledge and skills necessary for effective decision-making in CC. Finally, this study provides pioneering data on the importance of advancing clinical expertise to improve job satisfaction in CC nurses.

Emergency departments (EDs) are often thought of solely as places where life-saving interventions occur. However, EDs are also places where dying patients receive end of life care. Though research examining expert nurse behaviours in care of the dying has been conducted in a variety of care settings, little is known about this topic as it relates to care of the dying adult in the ED. A descriptive exploratory study was conducted with registered nurse experts (n = 6) in two urban EDs in Western Canada. Five expert nurse behaviours deemed essential in care of the dying adult patient in the ED were identified: 1) providing comfort; 2) honouring the personhood of the patient; 3) responding to the family; 4) responding after the death of the patient; and 5) responding to colleagues. These findings contribute to the empirical evidence concerning expert nursing care of the dying.

One Flew Over the Cuckoo’s Nest (1962) written by Ken Kesey tells the story at a ward where the patients who reside at the ward are exposed of oppression and humiliation by Nurse Ratched. One Flew Over the Cuckoo’s Nest: A Play in Two Acts (1963) written by Dale Wasserman is a theatrical play which is based on Kesey’s novel. The purpose of this essay is to argue that Nurse Ratched’s character is pictured as more evil in the novel than the play. In this essay, Ratched’s personality and outer looks was discussed as well as her methods she uses to humiliate and control the inmates. It was argued that Wasserman may have excluded information about Ratched’s character, so the actors have a chance to develop a personal view of Ratched. It was also argued that Ratched may have appeared as unnaturally evil if Wasserman had included all her evil traits, and thus picture her as a larger than life character.

När individen upplever stress i samband med att inte kunna agera i enlighet med sitt samvete uppstår samvetsstress. Denna stress är vanligt förekommande hos sjuksköterskor. Om stressen blir långvarig kan den övergå till kronisk stress, vilket kan ge allvarliga konsekvenser. Syftet med denna studie var att beskriva när och hur sjuksköterskan upplever samvetsstress. Metoden var litteraturstudie som innefattade tio kvalitativa studier samt en kvantitativ studie som svarade på studiens syfte. Studierna söktes i databaserna CINAHL och MEDLINE. Resultatet redovisades i två teman med subteman. Tema 1 var orsak till samvetsstress med subteman brist på stöd, dåligt samarbete och tidsbrist. Tema 2 var beskrivning av upplevelsen av samvetsstress med subteman frustration, maktlöshet och otillräckligt och ensamhet. Slutsats Om sjuksköterskans förmåga att ge god omvårdnad äventyras kan patientsäkerheten riskeras. Genom att sjuksköterskan kräver mer stöd, respekt samt hjälp kan upplevelsen av samvetsstress minska. Klinisk betydelse Litteraturstudiens resultat kan leda till en ökad förståelse av vad som orsakar samvetsstress. / When the individual experience stress associated with not being able to act according to one’s conscience, stress of conscience occurs. This type of stress is common among nurses. If the stress becomes prolonged and becomes chronic it can lead to severe consequences. The aim of this study was to describe when and how nurses’ experience stress of conscience. The method used was a literature study which involved ten qualitative studies and one quantitative study that answered to the aim. The searches were made in the databases CINAHL and MEDLINE. The result was presented in two themes. Theme 1 was cause of stress of conscience with subthemes lack of support, bad cooperation and lack of time. Theme 2 was description of the experience of stress of conscience with subthemes frustration, powerlessness and inadequacy and loneliness. Conclusion If the nurses ability to provide good care compromises patients safety can be at risk. By demanding more support, respect and help the perception of stress of conscience can be reduced. Clinical significance The literature study’s result can lead to a better understanding of the causes stress of conscience.

Bakgrund: De senaste åren har antalet suicid och suicidförsök ökat. Livsvärlden i relation till hälsa och ohälsa var bärande begrepp i denna studie då detta ansågs vara av vikt för både hur sjuksköterskan och patienten kom att uppleva mötet efter ett suicidförsök. I bakgrunden beskrevs dessutom vikten av stöd för sjuksköterskan samt vilken roll hon eller han hade gentemot patienter som gjort ett suicidförsök. Syfte: Syftet var att beskriva sjuksköterskans upplevelser i mötet med patienter efter ett suicidförsök. Metod: Vald metod var en litteraturöversikt. Artiklar söktes via databaserna CINAHL och MEDLINE, vilket genererade i 153 träffar totalt. Av dessa användes fem artiklar till studiens resultat. Resterande sex artiklar framkom via frisökning. Resultat: Resultatet presenterades genom tre kategorier, vilka delades in i sju underkategorier. Kategorierna benämndes som Upplevelsen av negativa känslor i mötet, Upplevelsen av positiva känslor i mötet samt Faktorer som påverkar upplevelsen av mötet. Diskussion: För att sjuksköterskans upplevelser skulle bli så bra som möjligt i mötet med patienten var det viktigt att denne inte påverkade hur mötet kom att bli genom sin egen negativa inställning. Reflektion sågs som ett viktigt hjälpmedel för att sjuksköterskans upplevelser av mötet skulle bli goda. / Background: In recent years, the numbers of suicides and suicide attempts increased. Lifeworld in relation to health and disease is bearing concept in this study, as it´s considered to be of importance for how both the nurse and the patient experienced the meeting after an attempted suicide. In this essay a description of the importance of support for the nurse as much as her/his role towards patient who attempted suicide. Aim: The purpose is to describe nurses´ experiences in meeting with patients after suicide attempt. Method: This study is a literature review. The articles were searched via the databases CINAHL and MEDLINE, which generated a total of 153 hits. Five of these articles were used for the study results. The six rest where found from a free search. Results: The result is introduced throw three different categories, which was divided into seven subcategories. The categories were named as The experience of negative emotions in the meeting, The experience of positive emotions in the meeting and Factors that affect the experiences of the meeting. Discussion: For a nurses´ experiences to be as good as possible in a meeting with patient who attempted suicide, it´s important that the nurses´ own negative impression don´t effects. Reflection is seen as an important accessibility for the nurses’ experience to become good.

Background: First Line Managers are expected to create a health promoting work environment. Research has shown that the prerequisites for accomplishing a health promoting leadership are not always the best. Aim: The aim was to elucidate the prerequisites for a health promoting leadership as First Line Manager at a University hospital in Sweden based on competence, role, support structures and own durability. Results: First Line Managers at the chosen hospital seems to have rather good conditions for conducting a health promoting leadership. All respondents did have a university degree and most thought that their competence corresponded well with the role. Only two percent of the working time was spent on updating of skills, but all respondents (n=95) felt they developed in the role. The majority felt the role definition was good. Three out of four participants in the study spent less than two hours per week with their manager and half of them under one hour per week. Yet, most participants were satisfied with the managerial support and also with other support structures. The respondents health is good even though many regularly experiences some stress, fatigue or sleeping problem. Method: The study design was descriptive quantitative crossectional. The selection/sample was active first line managers at a University hospital in Sweden. The study was made with a web-based questionnaire. Some questions was taken from the Quality-Work-Competence-method and one from the Karolinska Sleep Questionnaire. Statistical evaluation was made with the Statistical Package for the Social Sciences. Data was analyzed with descriptive statistics, Chi-square test and Spearmans rank correlation test. Conclusion: First Line Managers are quite content with their working situation and have good conditions for conducting a health promoting leadership at the investigated University hospital. There are however developing potential for the First Line Managers durability and possibilities for performing a health promoting leadership, through developing competencies, managerial support and support structures. / Bakgrund: Första linjecheferna förväntas skapa en god och hälsofrämjande miljö på arbetsplatsen. Forskning visar att det finns stora brister i vilka förutsättningar som ges för att utöva ett hälsofrämjande ledarskap. Syfte: Syftet med föreliggande studie var att undersöka vilka förutsättningar som finns för att utöva ett hållbart och hälsofrämjande ledarskap som första linjens chef vid ett universitetssjukhus i Sverige utifrån kompetens, rolltydlighet, stödfunktioner och egen hållbarhet. Resultat: Huvudresultatet visar att första linjecheferna vid det aktuella sjukhuset generellt sett har ganska goda förutsättningar att bedriva ett hälsofrämjande ledarskap. Alla respondenterna hade någon form av högskoleutbildning och de flesta ansåg att kompetensen överensstämde med arbetsuppgifterna. Endast två procent av den sammanlagda arbetstiden läggs på egen kompetensutveckling. Trots detta upplevde alla respondenterna (n=95) att de utvecklades i sin yrkesroll. En majoritet tyckte att rolltydligheten var god. Tre av fyra i studien träffade sin chef mindre än två timmar per vecka och ungefär hälften mindre än en timma per vecka. Huvudelen av de svarande tyckte ändå att de kände sig nöjda med ledarstödet. Respondenterna ansåg även att stödstrukturerna var på en tillfredställande nivå. Respondenternas hälsa är genomgående god, trots att många regelbundet upplever någon form av stress, utmattning eller sömnproblem. Metod: Design deskriptiv kvantitativ tvärsnittsstudie. Urvalet bestod av verksamma första linjechefer vid ett universitetssjukhus i Sverige. Studien är utförd med hjälp av webbenkät. Ett antal frågor (index) har hämtats från Quality-Work-Competence-metoden och en fråga (index) är hämtad från Karolinska Institutets sömnfrågeformulär, Karolinska Sleep Questionnaire. Övriga frågor är konstruerade för att besvara studiens frågeställningar. Statistisk bearbetning av data är utförd med hjälp av programmet Statistical Package for the Social Sciences. Data är analyserade med deskriptiv statistik, Chi2-test (C2) och Spearmans rangkorrelationsanalys. Slutsats: Första linjenscheferna är ganska nöjda med sin arbetssituation och det finns goda förutsättningar för dessa att bedriva ett hälsofrämjande ledarskap vid det undersökta universitetssjukhuset. Det finns dock utvecklingspotential för första linjechefernas hållbarhet och möjlighet till ett hälsofrämjande ledarskap, genom skapandet av förutsättningar rörande utveckling av kompetens, ledarstöd och stödstrukturer.

A posttest only experimental design was used to determine the effect of specific training in human relations skills on empathic understanding, self-concept, and the clinical performance of sophomore student nurses in a baccalaureate program.Forty-six students were randomly assigned to one of two treatment groups, or a control group. The Microcounseling System of Ivey and Gluckstern was used to provide two levels of human relations training in ten one-hour sessions. Experimental group 1 (El) received training through group exercises, manual and videotaped models, practice including videotaping, and evaluation and feedback. Experimental group 2 (E2) was only provided with a manual and videotaped materials. The control group (Cl) met for the same number of sessions, but did not receive any training.Carkhuff's Index of Discrimination (SEU) was used to measure empathic understanding. Four subscales of the Tennessee Self-Concept Scale (TSCS), total positive, self-criticism, net conflict, and total conflict were used to assess self-concept. The Clinical Evaluation Tool (CET) used to measure clinical performance was developed from Myrick and Kelly's Counselor Evaluation Rating Scale and the current sophomore clinical evaluation form.Six hypotheses were tested with significance for all tests set at the .05 level. A single classification analysis of variance was used on all data to determine whether groups differed on any test variable. The results of the statistical analyses failed to reach significance.Post hoc comparisons were then carried out to determine if El>C1 on any test variable. These tests revealed significance (p<.05) in empathic understanding, in TSCS self-criticism, and in clinical performance.The following conclusions were drawn:1. Sophomore student nurses exposed to specific training in human relations skills demonstrated a higher level of empathic understanding.2. Sophomore student nurses exposed to specific training in human relations skills were more aware of self-critical perceptions.3. Sophomore student nurses exposed to specific training in human relations skills received higher ratings on clinical performance.As a result of this study a decision was made to include human relations training for student nurses at the sophomore and junior levels.

A major purpose of the study was to determine whether differences exist between perceptions about sources of power by deans of colleges of nursing in medical centers and deans in non-medical centers. Discernible differences attributable to position title and years of administrative experience were also investigated. A subsidiary purpose of the study was to explore relationships between expert and referent power and among coercive, legitimate, and reward power.Data were collected from 206 out of 300 administrators of National League for Nursing accredited baccalaureate and higher degree programs. A Power Assessment Instrument measuring the five sources of social power as formalized by French and Raven, and a Demographic Data Sheet were utilized for data collection.Decisions about three null hypotheses were made at the 0.05 level by use of multivariate and univariate analysis and, where appropriate, post hoc Newman -Keuls procedures. Findings for a fourth hypothesis were drawn from a Pearson Product-Moment correlation analysis.Major findings included:1. No differences were observed in perceptions about sources of power between deans in medical centers and deans in non-medical center settings.2. Coercive and referent power emerged as significant variables in comparing deans to all chairmen and deans to chairmen reporting directly to the chief academic officer. Deans perceive presence of more coercive power than chairmen while chairmen perceive referent power than deans. Deans and chairmen not reporting directly did not differ.3. Administrators with eleven or more years of administrative experience perceive presence of expert power more than administrators with ten years or less of experience.4. All five sources of power were highly correlated with no discernible tendencies for grouping between expert and referent power or among coercive, legitimate, and reward power.Additional observations, while not empirically supported by the data, were presented. Also presented were recommendations for further explorations pertaining to nursing education and power assessment.

“Power” is a concept that has been discussed by nurse scholars and leaders within the nursing literature. The literature surrounding power concurs that power is necessary within the practice of nursing so that nurses are able to support patients and move the profession of nursing forward. There is a scarcity of research, however, regarding nurses’ perception of power within their own practices. Advanced practice nurses (APNs) are in positions in which they apply graduate education, specialized knowledge, and expertise to improve health care outcomes. Therefore, a qualitative study using an interpretive hermeneutic phenomenological approach was undertaken to discover APNs’ lived experience of power within their practices. In-depth, tape-recorded interviews were conducted with eight APNs from a large tertiary care facility. All of the participants agreed to a follow-up interview to review the summary of the study results. van Manen’s (1990) approach was used to analyze the data by subjecting the transcripts to a thematic analysis and reflective process. The overarching theme of the interviews is “building to make a difference” and the APNs’ perceived that this happened by “building on,” building with,” and “building for.” The APNs built on their knowledge and expertise, built with others in relationships and built for the capacity to make a difference. Power was a part of the everyday practices of these APNs and was described as “soft power,” a power that they shared to bring about change for the better. This shared power was reflected back on them resulting in increased power within their practices, a process described by the APNs as power creep.

There is a recognized nursing shortage in Canada, including specialty areas such as critical care (CC). Nursing shortages impact health care delivery, including economic, patient, and nursing outcomes. Job satisfaction is one of the most significant outcomes affected by the nursing shortage. Recruitment of inexperienced nurses in CC is a relatively new hiring practice and has resulted in a more diverse level of clinical expertise among CC nurses. Little is known about how differences in level of clinical expertise affect job satisfaction. The purpose of this study was to explore the relationship between CC nurses’ self -reported level of clinical expertise and job satisfaction. Interrelationships between additional influencing factors, such as organizational climate and personal factors were also explored. Utilizing a web based online survey, a cross-sectional survey was sent to all 788 Manitoba hospital based CC nurses, via the College of Registered Nurses of Manitoba. Respondents (N = 188) completed the Critical Care Nurse Retention Survey, which operationalized the key study variables. Sixty-five percent of the sample reported overall job satisfaction. Based on multivariate analysis, the most influential factors affecting CC nurses’ job satisfaction were nursing management, control over practice, and level of clinical expertise. Nursing management plays a vital role in facilitating optimal nursing practice. Control and autonomy may reflect a sense of satisfaction in the achievement of the knowledge and skills necessary for effective decision-making in CC. Finally, this study provides pioneering data on the importance of advancing clinical expertise to improve job satisfaction in CC nurses.