Nurse empowerment is a well-researched area of nursing practice yet the quality of work environments continue to be eroded, and interactions between nurses and nurse managers continue to be fragile. Power is integral to empowerment, yet the exercise of power between nurses and their managers have been under-investigated in the nurse empowerment literature. To advance our knowledge in the empowerment literature, the study explored the process of how power is exercised in nurse-manager relationships in the hospital setting. Strauss and Corbin’s (1998) grounded theory methodology informed the study. Multiple qualitative fieldwork methods were utilized to collect data on staff nurses about how the manager’s role affected their ability to do their work. The researcher conducted semi-structured interviews and participant observations with 26 participants on three units within a tertiary hospital in Western Canada. Seeking connectivity was the basic social process in which nurses strive to connect with their manager to create a workable partnership in the provision of quality patient care while responding to the demands in the organizational context. Conditions, actions, and consequences formed the theory of seeking connectivity as an extension of nurse empowerment theory. The overarching finding is that the manager plays a critical role in modifying the work environment for nurses and as such, nurses seek connection with their manager to accomplish their work. Institutional policies and practices combined in various ways to influence nurses’ thinking and shaped their actions. The first pattern of the process was characterized by the absence of meaningful engagement with the manager. Power was held over nurses restricting discussions with the manager, and nurses employed a variety of resistance strategies. In the second pattern of the process when managers provided guidance, advocated for nurses, and engaged nurses as collaborators, nurses were better able to problem solve and make decisions with the manager to positively influence patient outcomes. The theory of seeking connectivity is the explanatory framework emerging from the study that reveals how power is exercised in social relations between nurses and managers. Seeking connectivity is a recursive process that continues to evolve. The results of this study advance nurse empowerment primarily from a structural perspective and secondarily from a critical social perspective, suggesting nurses’ perceptions and abilities shape their work role and are foundational to promoting change through collective action. Study implications for research, practice and policy are addressed.

“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.

Background: Approximately 300 children get a malign cancer diagnosis every year in Sweden, 80 % of them survive. Parents of the children who have a cancer diagnosis experienced that they didn't have mental health, nurses care of parents are to keep a mental health so they can handle their parent role. Nurses should meet families through their life-world because caring should be done with dignity and integrity. Aim: The aim of this study was to describe how parents experience the daily life with a child who has a cancer diagnosis. Method: The method used in this study was a literature study based on autobiography, which means analysis of autobiographies. Four books were analyzed. Results: Four categories emerged from the analysis of the autobiographies, experience of powerless, desire of a regular, experience of anxiety and fear, to experience joy and have hope. Conclusion: This study shows how life changes when a child in the family gets a cancer diagnosis and how it affected the parents. The study points out the importants to create a great relationship between the nurses and the family so they can have a good care.

Organizational restructuring and reform in the health care system has impacted the ability of Clinical Nurses (CNs) to participate in and influence decision making that affects the delivery of patient care. Clinical nurses maintain and advocate a professional responsibility to practice according to specific standards, policies and procedures, and to meet the needs of the patient and family members. Clinical nurses participation in decision making at the patient, unit and administrative levels recognizes their abilities and skills as professionals; however, CNs continue to experience a limited role in the decision making and control over nursing practice at all of these levels.<p> The literature overview examines control over nursing practice including how this complex concept is difficult to define and undervalued within the CNs professional practice environment. It is evident in the literature that control over nursing practice is important to the CNs professional practice environment ultimately affecting job satisfaction, recruitment/retention, and patient outcomes. Control over nursing practice is explored in relation to internal and external factors that affect the professionalism of the CN. Internal factors are those that are more closely related to the CNs scope of practice and include professionalism (influence in decision making including policies and procedures, collegial relations, and professional development), CN satisfaction (workload, scheduling, health, safety and security concerns, supportive management, and opportunities for leadership), safe quality patient care (staffing, education, and specialization), empowerment, and autonomy. The external factors are outside the immediate scope of the CN yet directly and indirectly affect the CNs control over nursing practice including health care restructuring, organizational influence, work environment models (shared governance and magnet hospital environments), and nursing leadership. <p>This study provided CNs employed in the provincial hospitals in Saskatchewan an opportunity and a voice to share their perceptions of who governs their professional practice environment including control over nursing practice. This mixed method descriptive survey design used Hess Index of Professional Nursing Governance ([IPNG], 1998) along with five questions geared to elicit qualitative responses to study the perceptions of who governs CNs professional practice environment including control over nursing practice in provincial hospitals in Saskatchewan. Section one of the IPNG contains a demographic section including information on age, gender, nursing education, and employment information. The second section of IPNG consists of 86 questions that are further divided into six subscales asking respondents to indicate who has control over nursing practice in a number of areas within their particular health facility. The six subscales include Subscale I Professional control relating to who has control over professional practice in the organization, Subscale II Organizational influence examining who participates in governance activities within the organization, Subscale III Organizational recognition identifying who controls nursing personnel and related structures, Subscale IV Facilitating structures indicating who determines and participates in governance decisions within the organization, Subscale V Liaison exploring who influences the resources that support professional practice, and Subscale VI Alignment identifying who sets and negotiates conflict within the organization. These questions are rated on a 5 point Likert scale according to the following response possibilities: 5 = staff nurses only; 4 = primarily staff nurses with some nursing management/administration input; 3 = equally shared by staff nurses and nursing management/administration; 2 = primarily nursing management/administration with some staff nurse input; 1 = nursing management/administration only. Section three the qualitative questions, contained one closed ended and four open ended questions that provided CNs an opportunity to share a more personal perspective regarding their perceptions of control over nursing practice in their work environment. These questions included: 1. What does control over nursing practice mean to you? 2. How could control over your practice be changed significantly? 3. Do you feel you have enough control over practice in your work environment? 4. What limits your control over practice in an area that interests you? and What enables your control over practice in an area that interests you? <p>The total population of 1804 CNs in provincial hospitals in Saskatchewan was invited to participate in this study. One hundred and seventy two CNs (9.53%) responded to this study, including 118 from Saskatoon (11.8%) and 54 from Regina (6.7%). The descriptive data provides data on gender and average age of CNs that is similar to Canadian Institute for Health Information ([CIHI], 2006) and Health Canada (2006a). A greater number of CN respondents indicated their basic nursing education was a diploma and more CNs had attained a baccalaureate degree as their highest level of education when compared to the CIHI data. Twice as many CNs indicated having specialty certification and a higher number were working full time in comparison to the CIHI data. The quantitative data obtained from the IPNG subscales indicates CNs perceive limited control over nursing practice and this is by in large held mainly by nursing management/administration (1) and nursing management with some staff nurse input (2). The subscale results include Professional control (M = 1.72), Organizational influence (m = 2.13), Organizational recognition (M = 1.73), Facilitating structures (M = 1.82), Liaison (M = 2.1), and Alignment (M = 2.1). Overall, the results from the IPNG subscales provide scores of less than 3 on the Likert scale indicating CNs perceive limited control over nursing practice in their professional practice environment. There were no significant differences within the provincial hospitals or between the health regions regarding CNs perceptions of control over nursing practice. In their qualitative responses, CNs provided information related to both the internal and external factors as discussed in Chapter Two. Clinical nurses indicate they face many challenges regarding control over practice including lack of influence in decision making in issues related to policy and procedure, quality patient care, staffing ratios, self-scheduling, and educational opportunities. They also identified external factors affecting their control over nursing practice including a lack of support by management in relation to decision making, a lack of provision of and access to an adequacy of resources, and a lack of communication and collaboration. Many CNs indicated their only influence in decision making was related to direct patient care. Clinical nurses described that being valued, supported, and recognized for their experience and education in decision making positively affects control over nursing practice and more specifically, quality patient care. <p> Study results offer government officials, practitioners, regulatory bodies, researchers, administrators, educators, nurses, the public, professional association, employers, unions, and any other stakeholders information that provides an opportunity to increase their awareness and understanding of the impact that control over nursing practice has for CNs in their practice environment. If stakeholders are serious in their attempts to recognize CNs concerns regarding control over nursing practice in their work environment, the results from this study will provide information facilitating change in the CNs control over nursing practice. Ultimately, this affects the CNs professionalism and ability to provide quality patient care.

Background: Relatives are those persons who are closest to the patient, regardless of relationship and included into the patient´s life world. When a person is in a palliative stage this affects not only the patient but also the relatives, as it implies such a big change in life for all. The nurse has an important role for both the patient and the relatives.  Aim: The aim is to highlight the relative´s needs of support for palliative care.  Method: A literature review based on previous research. Ten articles were found, nine with a qualitative approach and one with both qualitative and quantitative approach.  Results: The analysis resulted in six themes, these were the result of the study. The six themes were, “to be seen an confirmed”, “good communication”, “continuous information”, “availability and continuity”, “to participate” and “to share responsibility with the staff”.  Conclusion: As a nurse we come in contact with relatives of patients in a palliative setting in any form. Our result is useful in all types of care not only in palliative care. It´s much a question of attitude in our performance and attitude is such a large and vital component in health care.

I vården av suicidala patienter ställs sjuksköterskan inför många utmaningar samtidigt som den suicidala patienten är i behov av ett omsorgsfullt bemötande som skapar trygghet och känslor av acceptans. De attityder som sjuksköterskan har mot patienterna är därför av stor betydelse. Syftet med denna studie var att undersöka vilka attityder till suicidala patienter som förekommer hos sjuksköterskor samt att utforska om det finns faktorer som har betydelse för sjuksköterskans attityder. Metoden var en litteraturstudie där resultatet från tolv vetenskapliga studier har analyserats och sammanställts i olika teman. Resultatet visar att sjuksköterskor utifrån kognition, affekt och beteende, uppvisade både positiva och negativa attityder mot suicidala patienter. Faktorer som till exempel sjuksköterskornas utbildning, kunskap, förståelse och upplevelse av svårigheter och otillräcklighet visade sig ha betydelse för sjuksköterskans attityd. Slutsats: Sjuksköterskan uppvisar attityder mot suicidala patienter som är både positiva och negativa. Negativa attityder som ilska och avståndstagande försvårar vården för patienten medan positiva attityder som empati och stöd skapar en trygg situation för patienten. Betydelsen av sjuksköterskans utbildning kan inte förbises utan är viktig för att få förståelse för patienten och att kunna hantera de svårigheter som uppstår i vården / In the care of suicidal patients the nurse is confronted by many challenges. At the same time the suicidal patient is in need of a caring attitude that creates safety and feelings of acceptance. Therefore the nurse´s attitudes towards the patients are of great importance. The aim of this study was to explore which attitudes nurses hold against suicidal patients and also to explore whether there are factors that are important for nurses´ attitudes. The method was a literature study where the results from twelve scientific articles was analyzed and compiled in different themes. The results showed that nurses, both cognitively, affectively and behavioral, held positive and negative attitudes towards suicidal patients. Factors such as education, knowledge, understanding, and nurses´ experiences of difficulties and shortcomings were found to have an impact on nurses´ attitude. Conclusion: The nurses hold both positive and negative attitudes towards suicidal patients. Negative attitudes such as anger and rejection complicate the nursing care while positive attitudes like empathy and support create a safe environment for the patient. The importance of the nurse´s education cannot be overlooked as it is important for gaining understanding and handling the difficulties that emerge in the care of the suicidal patient.

Background: The amount of elderly patients who’s suffering from dementhia increases every year. Many of these patients develop and decrease in their cognitive ability. The development can lead to people's communication skills deteriorate. It can be a problem for the nurse to communicate with these patients. It´s there fore of great importance for the nurse to learn communiations skills that can increase the communication with elderly patiants suffering from dementia. Aim: The aim of this study is to illuminate the significance of communication in nursing care of elderly patients with dementia. Which communication strategies can the nurse use and what are the consequences for nursing care? Method: To study the selected study area a litterature review was selected. This review was based on five qualitative articles, five quantitative articles and one qualitative-quantitative article. The authors looked for differences and similarites in results of the articles. Results: The results showed that the communication was of great significance in the nursing care between nursing staff and older patients with dementia. It showed that specific communication strategies increaseed many of the patients security, participation and facilitated cooperation between nursing staff and the patients with dementia. Three main themes emerged from the articles: the spoken language, music and pictures. Conclusion: By using specific communication strategies nurses could help patients to express themselves and participate in nursing care and conversations.

Distriktssköterskans roll är av stor betydelse vid införandet av ett empowerment baserat förhållningssätt gentemot den äldre individen med diabetes typ 2. Empowerment är ett begrepp som uppkommit i samband den humanistiska människosynen och används i syfte att öka patienternas egenvårdsförmåga och självstyre i skötseln av sin diabetes. Livskvalitén ökar av individens delaktighet och självbestämmande, att själv kunna ansvara för sin sjukdom med stöd av distriktssköterskan. Empowerment baserad utbildning i grupp vid återkommande träffar för att få riklig kunskap om diabetes typ 2, med möjlighet till individuella träffar där individerna skapar sina egna mål är av största vikt för att bedriva egenvård. Lagar och författningar som styr distriktssköterskans arbete genomsyras av humanism. Distriktssköterskan behöver få utbildning i att använda sig av ett empowerment baserat arbetssätt och de behöver arbetsledningens stöd då det krävs ökade resurser vid införandet av ett nytt arbetssätt. Empowerment baserad grupputbildning ger en ökad förbättring av den glykemiska kontrollen för äldre individer. Diabetes typ 2 är en sjukdom som ökar i takt med att befolkningen blir äldre. Studien har genomförts som systematisk litteraturstudie.

The research is to inquire into the circumstances and correlation among role perception and organizational commitment to the elementary school nurses in Kaohsiung county.For acquiring objective factual data, the researcher also studied whether there was an evident discrepancy of elementary school nurses¡¦ role perception and organizational commitment in different situations. The study chose the school nurses of the elementary school in Kaohsiung county as the subjects.The tool was self-edited¡¥The Questionnaire of The School Nurses¡¦Role Perception and Organizational Commitment of The Elementary School¡¨;the researcher interviewed also part of the subject to deeply explore the reality of the circumstances.The data were analyzed by the method of descriptive,t-test,one-way ANOVA,Pearson¡¦s product-moment correlation and Stepwise multiple regressions. According to the outcome of data analysis,the research provides some suggestions for improvement: 1.The scores are above middle on elementary school nurses¡¦role percept,the best value of work on¡§health service¡¨. 2.The scores are above middle on elementary school nurses organizational commitment,the best value of work on¡§hard-working¡¨. 3.The nurses whose school nurse working years are from 6 to 15 years,working in the small scale school and medium scale school,the higher role perception they have. 4.The nurses whose married, working in the small scale school and medium scale school,the higher organization commitment they have. 5.The higher role perception elementary school nurses have, the higher organization commitment they have. 6.There were significant differences existed among variables of school nurse working years and school size on role perception . 7.There were significant differences existed among variables of marital status and school size on organization commitment. 8.The school nurse working years,marital ststus and school size are significantly predictive to organization commitment. 9.Role perception can efficiently predict organization commitment,and¡§health counselor¡¨is the most powerful predictor among all variables for organization commitment. According to the results above,the research has provided some suggestions to the administrative organizations of education,schools,school nurses, and future research.

Due to under intense competitions and uneven resource allotments, many medical institutes are not only being pushed ahead with their medical technology but also constantly improving their medical management and efficiency for achieving higher medical quality. In Taiwan, it takes ten years to train a doctor; however, it is possible to have a NP (Nursing Practitioner) to substitute partial capacity of a resident; as long as the NP has equivalent working experiences, a short-term training and also to pass exams as well. Therefore, using a qualified NP in medical institutes is a more economical and practical way of utilizing human resource benefits; as far as for the medial caring services it also has a substantive significance. This study is a research that is based on a certain southern teaching medical hospital¡¦s doctors, nurses, patients, medical services and other medical related people.It is divided into two parts to proceed: first, collect information from quality based researching interviews of targeting people in order to study their perspectives toward to the system of NP. Then, a quantifiable survey is being designed according to the result of the interviews and some other verified literature content; therefore, the merit of NP can be proven by the medical hospital¡¦s human resource efficiency trend.Further discussion on whether medical professional personnel attributes can affect theperception of NP; to anticipate an establishment of independent NP system in the future medical system. According to the research results: (1) 51.8% participants of the interviews think that the establishment of independent NP system is not only a demand from hospitals, doctors as well as the patients. It may even promote overall hospitals management efficiency. The demand 28.4% accounts come from doctors; to a certain extent that many participants believe to establish an independent NP system can possible to share an appropriate amount of doctors¡¦ workloads. 47.2% participants believed that the act of NPs in medical system is ¡§Physician Assistant¡¨. In addition, about 50% participant thought that the NPs can substitute residents and they can cut down cost,be economized the use of manpower training time, improve efficiency, promote medical service quality and so on. (2) A remarkable difference in ¡§Expanding System Construction Interface¡¨¡]F=3.495¡Ap=.018¡^is found because the participants come from different age groups. The younger participants are, the lower they score. Thus, it is possibly to say when come to develop nursing care network and community medical caring Expanding System Construction Interface that the younger medical professionals are, the lower understanding and less recognizing they are. (3) According to different seniority of every single interface variance analysis; the differences of seniority medical professionals in ¡§Expanding System Construction Interface¡¨¡]F=4.153¡Ap=.008¡^, after comparing with Scheffe¡¦s method,has scored above an average: above five years > 3-5. In comparison, one who has more seniority has obtained a higher score. (4) Monthly income in the SubstitutionConstruction Interface (F=3.174, p=.046) has a remarkable difference. According to the description of personnel attributes; doctors who have the average monthly income above 120,000NTD have occupied the majority (38.2%). However, in comparing with other categories; to provide resident's immediate supports, as well as others¡¦ understanding and recognizing of the NPs have obtained a lower score. The purpose of this research is to believe that there should be more explicit direction and further related implementation in all the future hospital policy, in order to enable the NPs to make full use of their ability. At the moment, there is a rather vague definition of NPs¡¦ job in Taiwan; in fact, the establishment of NPs¡¦ system has not much explication either. Therefore, while evaluating overseas¡¦ system, method and training, it may not be approved by the present medical professionals without envisaging a thoughtful systematic construction first. However, according to the findings of this research; it is necessary to have a further discussion. It is to suggesting a future specific and comprehensive plan: expanding case acceptance throughout all level of hospitals in Taiwan to promote the result of inference; designing a further discussion survey of focusing on NPs¡¦ beneficial results as for the future research foundation.