Background: Effective communication is vital to establish a patient-nurse relation and in order for the nurse to deliver good nursing care. Mistakes and errors are more frequent when there is a language barrier between the nurse and the patient. Method: The study was made as a qualitative interview study with a phenomenological analysis. Aim: Describe how Malaysian nurses deal with language barriers during meetings with patients with another language. Result: To deliver good nursing care to patient with another language could be difficult depending on what strategies the nurses used: how nurses experience the effectiveness of non-verbal communication, how interpreters were used and who interpreted during the patient meeting, strategies nurses used when interpreter was not an option, nurses’ interest in learning about the patient’s culture. Conclusion: To overcome language barriers is complex and often more than one strategy is needed. Patient safety is compromised when there were language barriers between the nurse and the patient.

Trata-se de um estudo quase-experimental que teve como propósito avaliar o efeito da música como terapia complementar sobre variáveis de expressão do estresse em pacientes renais crônicos, durante o tratamento hemodialítico. Como objetivos específicos o estudo buscou comparar as variáveis fisiológicas (cortisol salivar, frequência cardíaca, pressão arterial, frequência respiratória e temperatura cutânea) e escores de ansiedade mensurados pela forma estado do Inventário de Ansiedade Traço - Estado (IDATE), em dois momentos (dia 1: observação da linha de base; dia 2: observação antes e após intervenção). Outros objetivos complementares foram: a avaliação de presença de ritmo circadiano do cortisol, a correspondência entre o cortisol salivar e plasmático e a avaliação da aceitação da intervenção. A variável de manipulação foi a audição da seleção musical de preferência dos sujeitos por 30 minutos. O estudo foi realizado em dois momentos distintos: no primeiro houve a determinação do perfil das variáveis de interesse em um procedimento padrão de hemodiálise, sem intervenção; no segundo momento foi observado o efeito de uma intervenção musical no perfil das variáveis de interesse, em um procedimento padrão de hemodiálise. Participaram do estudo 55 pessoas, 52,7% do sexo masculino, com idade média de 49,6 anos (DP=15,7 anos), com média de tempo de tratamento de 47,9 meses (DP= 47,5 meses), a maioria em primeiro tratamento de substituição renal (83,6%). Não houve diferença entre as médias de concentração do cortisol salivar dos sujeitos do estudo nos dois momentos (dias 1 e 2) e nas duas fases do dia de intervenção (antes e após intervenção), nos três turnos de HD. O primeiro e segundo turnos de HD apresentaram curva gráfica do cortisol com subida acentuada ao final da hemodiálise, enquanto no terceiro turno a curva apresentou-se em discreto declínio do início até o término da sessão de HD. Apesar de a maioria dos sujeitos ter apresentado baixo nível de ansiedade, em todas as fases do estudo, verificou-se diferença significativa (p<0,001) entre as médias de ansiedade nas fases pré e pós intervenção. Não se observou diferença estatística para as variáveis frequência cardíaca, frequência respiratória, temperatura e pressão arterial sistólica entre os momentos pré e pós intervenção. A pressão arterial diastólica apresentou diferença entre as médias dos momentos pré e pós intervenção (p=0,0006). Foi verificado presença de correlação entre o cortisol plasmático e o cortisol salivar (r = 0,722 e p < 0,0001), além disso, observou-se presença de ritmo circadiano do cortisol em 85,4% dos participantes do estudo. Os participantes mostraram boa aceitação da intervenção com música. Conclui-se que nas variáveis sinais vitais e cortisol não se observou diferença com a intervenção empregada, entretanto, pelos escores do IDATE, foi evidenciado um efeito redutor da ansiedade por meio da música, nos três turnos de HD, o que reforça o uso desta intervenção / The objective in this quasi-experimental study was to assess the effect of music as complementary therapy on stress expression variables in chronic renal patients during hemodialysis treatment. As specific objectives, the study aimed to compare the physiological variables (salivary cortisol, cardiac frequency, arterial pressure, respiratory frequency and cutaneous temperature) and anxiety scores measured using the State-Trait Anxiety Inventory (STAI) at two moments (day 1: observation of baseline; day 2: observation before and after the intervention). Other complementary objectives were: evaluation of the presence of circadian rhythm of cortisol, correspondence between salivary and plasmatic cortisol and assessment of the acceptance of the intervention. The manipulation variable was the hearing of the music selection the subjects preferred during 30 minutes. The study was undertaken at two distinct moments: first, the profile of the variables of interest was determined in a standard hemodialysis procedure, without intervention; second, the effect of a music intervention on the profile of the variables of interest was observed in a standard hemodialysis procedure. Fifty-five persons participated in the study, 52.7% male, with a mean age of 49.6 years (SD=15.7 years), with a mean length of treatment of 47.9 months (SD=47.5 months), mostly undergoing the first renal replacement treatment (83.6%). No difference was found between the mean concentration levels of the study subjects\' salivary cortisol at the two moments (days 1 and 2) and in the two phases of the intervention day (before and after the intervention), in the three HD shifts. The first and second HD shifts showed a graphic cortisol curve with a steep rise at the end of the hemodialysis while, in the third shift, the curve showed a slight decline from the start until the end of the HD session. Although most subjects showed low anxiety levels in all study phases, a significant difference was observed (p<0.001) between the mean anxiety levels in the pre and post-intervention phases. No statistical difference was observed for the variables: cardiac frequency, respiratory frequency, temperature and systolic blood pressure between pre and post-intervention. The diastolic blood pressure showed a difference between the mean levels at pre and post-intervention (p=0.0006). The presence of correlation between plasmatic and salivary cortisol was verified (r = 0.722 and p < 0.0001). In addition, the presence of a circadian rhythm of cortisol was observed in 85.4% of the study participants. The participants showed good acceptance of the music intervention. In conclusion, in the variables vital signs and cortisol, no difference was observed as a result of the intervention employed, but the STAI scores evidenced that music reduces anxiety, in the three HD shifts, which reinforces the use of this intervention

O presente estudo teve por objetivo avaliar atitudes e conhecimentos de profissionais de enfermagem sobre cuidados a pacientes com transtornos mentais. Trata-se de estudo descritivo, de abordagem quantitativa, realizado em unidade de urgência e emergência psiquiátrica de um pronto-socorro municipal no interior de São Paulo. Os dados foram coletados por meio da aplicação de um questionário, com uma amostra de 69 técnicos de enfermagem, caracterizados predominantemente pelo sexo feminino, adultos, com ensino médio e nível superior, atuantes em apenas um emprego e tempo de trabalho na instituição, na mesma equipe de enfermagem, entre 2 e 5 anos. À maioria havia sido disponibilizado conteúdo teórico sobre identificação de sinais e sintomas de transtornos mentais, grande parte demonstrava interesse pelo processo de educação continuada, mas menos da metade recebeu informações sobre a sistematização da assistência de enfermagem. Os sentimentos positivos expressos em relação a pacientes com transtornos mentais foram: compaixão e aceitação, e os negativos, insegurança e tristeza. As pessoas com transtornos mentais são percebidas como normalmente imprevisíveis e que necessitam de cuidados constantemente. Os sujeitos consideraram-se confortáveis em atender pessoas com transtornos mentais e afirmaram que o local mais adequado para essas pessoas é o hospital. Temas como saúde mental, violência doméstica e doenças infectocontagiosas foram sugeridos para futura abordagem na educação continuada. Os participantes consideraram o uso de drogas psicoativas a principal causa das doenças mentais. Ressalta-se que instrumentos validados para avaliar conhecimentos, atitudes e sentimento de profissionais de enfermagem ainda são escassos. Os resultados apontam a necessidade de capacitação continuada sobre assistência de enfermagem a pessoas com transtorno mental nas unidades de urgência e emergência / This present study aimed to evaluate attitudes and knowledge of staffs of nurses on nursing care to patients with mental disorders. This is a descriptive study of a quantitative approach. The study was conducted in an urgency and emergency psychiatric unit of a emergency hospital of interior of São Paulo. The instruments used were: socio-demographic information related to professional training; attitudes and knowledge on identifying signs and symptoms; feelings and nursing assistance for individual with mental disorders. The data were collected before the first class of the course of capacitation in mental health, which was divided into six themes related to the most common mental disorders (mental signs/symptoms, nursing care with emphasis on interpersonal relationships). The sample consisted of 69 nursing professionals, characterized by being predominantly female, adults with high school and college level, with only one job, and work in the institution, on the same team and in nursing from 2 to 5 years. More than a half of the sample had received theoretical content about identifying signs and symptoms of mental disorders, but fewer than half received information about the systematization of nursing care, in addition that beneficiaries announce interest in the continuing education process. The positive feelings expressed towards to patients with mental disorders were compassion and acceptance, and the negative, insecurity and sadness. Individuals with mental disorders are perceived as usually unpredictable and constantly requiring care. Feeling comfortable in helping people with mental disorders and the most appropriate place for these people is the hospitals have been evidenced. Topics such as mental health, domestic violence and infectious diseases were suggested to be working in the future in continuing education. Psychoactive drugs were considered as the main cause of mental illness. Validated tools to assess knowledge, attitudes and feelings of nursing professionals are still scarce. The results to point to need for continued capacitation in nursing assistance for people with mental disorders in urgency and emergency units

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Os recÃm-nascidos (RN) com malformaÃÃo congÃnita (MC) requerem dos profissionais de enfermagem atenÃÃo e cuidados especÃficos e individualizados. O estudo objetivou avaliar a prevalÃncia dos recÃm-nascidos com malformaÃÃes congÃnitas em instituiÃÃes pÃblicas e a assistÃncia de enfermagem prestada a essas crianÃas internadas na Unidade Neonatal (UN) nas primeiras 24 horas de vida. Estudo descritivo, transversal, quantitativo, realizado em trÃs Unidades Neonatais de instituiÃÃes hospitalares (A, B e C) de Fortaleza, Brasil. A amostra foi composta de 159 recÃm-nascidos, sendo 75 na instituiÃÃo A; 44 na B; e 40 na C. Os dados foram coletados em 2012, de janeiro a junho em A e B, e de marÃo a agosto em C. Investigou-se prontuÃrios e documentos nas unidades referidas e, posteriormente, eles foram registrados em formulÃrios prÃprios contendo variÃveis maternas e neonatais, apÃs a aprovaÃÃo pelos ComitÃs de Ãtica. Os resultados revelaram prevalÃncia de 3,3%, 2,1% e 3,6% de RN malformados nas instituiÃÃes, respectivamente. Da amostra, 53% eram masculinos, 57% com 37 a 41,6 semanas gestacionais, 52% pesando entre 2.500g e 3999g, 66% com estatura de 39 a 49 cm, Apgar no 1Â(60%) e 5Â(79%) minutos de sete a dez. Dentre as terapias implementadas ao RN, sobressaÃram-se oxigenoterapia sob Oxi-hood (42%); Dieta zero (37%); hidrataÃÃo venosa (36%); punÃÃo de acesso venoso central para infusÃes (44%); manuseio de trÃs em trÃs horas (89%) e nÃo realizaram cirurgias no perÃodo (75%). Dentre os curativos, o local destacado foi a regiÃo sacral (54%) e a cobertura com compressa estÃril (21%). As malformaÃÃes congÃnitas diagnosticadas foram categorizadas conforme classificaÃÃo do CID â 10, prevalecendo aquelas pertencentes ao Sistema Osteomuscular (30%) e Sistema Nervoso Central (SNC) (21,1%), ressaltando o PÃ torto congÃnito, Polidactilia, Hidrocefalia e Mielomeningocele. Destacaram-se as malformaÃÃes isoladas (61%) e os registros de cuidados de enfermagem envolvendo exames (24,4%) e oxigenoterapia (16,9%). Ocorreram associaÃÃes estatisticamente significantes entre as categorias de malformaÃÃes e algumas variÃveis especÃficas: (MC do SNC) x (IG, Terapia Medicamentosa); (MC do olho, ouvido, face, pescoÃo) x (IG, Uso de drogas e Escolaridade); (MC Aparelho CirculatÃrio) x (Uso de drogas e Terapia Medicamentosa); (MC Aparelho RespiratÃrio) x (Idade materna e Uso de drogas); (Fenda labial ou palatina) x (Idade materna e Uso de drogas); (Outras MC do Aparelho Digestivo) x (Modalidade VentilatÃria, Forma de NutriÃÃo e Cirurgia); (MC dos ÃrgÃos Genitais) x (Sexo, Renda familiar e Forma de NutriÃÃo); (MC Osteomuscular) x (NÃmero de GestaÃÃes e Modalidade VentilatÃria); (Outras MC) x (IG e Peso); e (Anomalias CromossÃmicas) x (Idade materna), todos com p<0,05. Concluiu-se que ainda se faz prevalente o nÃmero de MC em RN e que a equipe de enfermagem implementa cuidados de acordo com as condiÃÃes clÃnicas, da patologia e equilÃbrio hemodinÃmico de cada RN e nÃo especificamente para cada tipo de malformaÃÃo. / The newborns (NB) with congenital malformation (CM) requires from nursing professionals the performance of specific and individualized care. This study aimed at evaluating the prevalence of newborns with congenital malformation in public institutions and the nursing care provided to these children admitted to the Neonatal Unit (NU) in the first 24 hours of life. This is a descriptive, cross-sectional and quantitative study, which was conducted in three Neonatal Units of hospitals (A, B, C) from the city of Fortaleza-CE/Brazil. The sample was composed of 159 newborns; from which 75 belong to institution A; 44 to B; and 40 to C. The data were collected in 2012, from January to June in A and B, and from March to August in C. Records and documents were investigated in the aformentioned units and, subsequently, they were recorded in the proper forms containing maternal and neonatal variables, after approval by the Ethical Committee. Results showed prevalence of 3.3%, 2.1% and 3.6% of malformed newborns in the institutions, respectively. Of the sample, 53% were male, 57% with 37 to 41,6 gestation weeks, 52% weighing between 2,500 g and 3999g, 66% with height 39-49 cm, Apgar score at 1st (60%) and 5th (79%) minutes from seven to ten. Among the implemented therapies to the NB, it should be highlighted oxygenotherapy in Oxy-hood (42%); Zero diet (37%); intravenous hydration (36%); central venous access puncture for infusions (44%); handling for every three hours (89%) and did not undergo surgery throughout the period (75%). Among the dressings, the highlighted location was the sacral region (54%) and the coverage with sterile compress (21%). The diagnosed congenital malformations were categorized according to the classification of the ICD â 10, prevailing those ones belonging to the Musculoskeletal System (30%) and to the Central Nervous System (CNS) (21.1%) highlighting the Congenital clubfoot, Polydactyly, Hydrocephalus and Myelomeningocele. It should also be highlighted the isolated malformations (61%) and the nursing care records involving examinations (24.4%) and oxygenotherapy (16.9%). There were statistically significant associations between the malformations categories and some specific variables: (CM of the CNS) x (GI, Drug Therapy) (CM of the eye, ear, face, neck) x (GI, Drug use and Schooling); (CM of the Circulatory System) x (Maternal age and Drug use) (CM of the Respiratory System) x (Drug use and Drug therapy); (Cleft-lip and palate) x (Maternal age and Drug use); (Others CM of the Digestive System) x (Ventilation modality and Nutrition and Surgery forms); (CM of the Genitalia) x (Gender, Family Income and Nutrition form); (Musculoskeletal CM) x (Number of pregnancies and Ventilation modality); (Others CM) x (GI and weight), and (Chromosomal Abnormalities) x (Maternal age), all with p <0.05. We have concluded that the number of NB with CM it is still prevalent and the nursing staff implements the healthcare according to the clinical conditions, pathology and hemodynamic balance of each NB and not specifically for each type of malformation.

Trata-se de uma pesquisa~ comparativa entre a aplicação do Processo de Enfermagem em sub-programas de saúde materna e os registros habituais no processo das clientes. São conhecidas algumas características da populaçio, tais como: idade, escolaridade, ocupação, residência, cor da pele, estado civil, religião, primeiro contato com o centro de saúde na gestação em curso e paridade. Processo de Enfermagem é um termo aplicado a um sistema de intervenções específicas da enfermagem na saúde das gestantes. Detalhadamente, envolve o uso de método científico, para identificar os problemas de saúde e de enfermagem e consequentemente as necessidades de saúde das gestantes; utilizar estas selecionando as que podem mais efetivamente ser solucionadas pelos cuidados de enfermagem; também inclui planejamento para encontrar essas necessidades, providenciar cuidados (encaminhando os que não dizem respeito à enfermagem) e avaliar os resultados. Os instrumentos de pesquisa foram aplicados a cento e dezenove gestantes (quatro amostras probabilísticas sistematicas chamadas A, B, C e D com 32, 27, 30 e 30 gestantes) que representam 50 por cento da populaçio total de gestantes em cada centro de saúde. Através de uma análise estatística em termos quantitativos utilizando média, moda, desvio padrão, amplitude de variação e em termos qualitativos utilizando qui-quadrado (x2), coeficiente de Yule e amostras emparelhadas (teste de hipóteses) ao nível de significancia de 5 por cento , confirmámos as duas hipóteses formuladas. As principais conclusões foram: 1) A utilização do Processo de Enfermagem permitiu encontrar 1405 problemas de saúde e de enfermagem e nos registros nas fichas havia registrados 223. 2) Depois de encontrar os problemas, identificâmos as Necessidades Humanas Básicas afetadas: as psico-biológicas 1003 vezes e as psico-sociais 1069 vezes. 3) A utilização do plano assistencial permitiu fazer: - 887 orientações de saúde; - 372 supervisões em saúde; - 593 encaminhamentos para consulta médica e instituições ligadas à habitação e saneamento do meio. 4) Parece existir uma associação entre a procura do centro de saúde para seguimento da gestação desde o 1º mês e estar no grupo etário 15-29 anos (ao nível de significancia de 5 por cento ). 5) O papel da enfermagem e principalmente de educador e supervisor de saúde na enfermagem de saúde pública - saúde materna. 6) Este estudo demonstra que o corpo de conhecimentos da enfermagem está discriminado no planeamento das ações de saúde necessárias, de forma a responder à problemática das gestantes. 7) É evidente a importancia da pesquisa em enfermagem como a maior contribuição para encontrar as necessidades de saúde e bem-estar das pessoas. / This is a comparative survey between the application of the Nursing Process on the Maternal Health sub-programmes and the normal registrations in the file card. There are known some characteristics of the population such as: age, scolarity, occupation, residence, skin colour, marital status, religion, first contact with the health care center during pregnancy and offspring. Nursing process is a term applied to a system of characteristic nursing interventions in the health of the pregnant women. In detail, it involves the use of scientific methods for identifying health and nursing problems and, consequently, the health needs of the pregnant women and for using the latter to select those which can most effectively be met by nursing care. It also includes planning to meet those needs, providing the care and evaluating the results. The research instruments were applied to one hundred and nineteen pregnant women (four probabilistic and systematic samples called A, B, C and D with 32, 27, 30 and 30 pregnant women), who represents 50 per cent of the total population of pregnant women. By means of statistical analysis in quantitative terms, utilizing mean, mode, standard deviation, range of scores and, in qualitative terms, utilizing chi-square (x2), Yules\' coefficient and paired samples (hypothesis test - 5 per cent level of significance), we confirmed the two hypothesis formulated. The main research finding were: 1) Through the use of Nursing Process one find 1,405 health and nursing problems, on the other hand through the normal registrations in the file card one finds only 223. 2) After encountering problems, we can identify the Basic Human Needs affected: psycho-biological: 1,003 and psycho-social: 1,069. 3) The use of care planning permits one to deal with the foi lowing: - 887 subjects for health education; - 372 subjects for health supervision; - 593 subjects for guidance, specicilly regarding medical consultations and institutions of basic sanitation and housing. 4) lt seems to exist a significant relationship between the demand for the health care center by women, during the first three months of pregnancy in the 15 to 29 year old age group. 5) The nursing role is mainly health educator and health supervisor of public health nursing - maternal health. 6) This study demonstrates that the body of knowledge nursing is revealed in the planning of necessary health action in arder to answer to the problematics of pregnancy. 7) It is evident the importance of nursing research as a major contribution in meeting people is health and welfare needs.

O presente estudo teve por objetivo avaliar atitudes e conhecimentos de profissionais de enfermagem sobre cuidados a pacientes com transtornos mentais. Trata-se de estudo descritivo, de abordagem quantitativa, realizado em unidade de urgência e emergência psiquiátrica de um pronto-socorro municipal no interior de São Paulo. Os dados foram coletados por meio da aplicação de um questionário, com uma amostra de 69 técnicos de enfermagem, caracterizados predominantemente pelo sexo feminino, adultos, com ensino médio e nível superior, atuantes em apenas um emprego e tempo de trabalho na instituição, na mesma equipe de enfermagem, entre 2 e 5 anos. À maioria havia sido disponibilizado conteúdo teórico sobre identificação de sinais e sintomas de transtornos mentais, grande parte demonstrava interesse pelo processo de educação continuada, mas menos da metade recebeu informações sobre a sistematização da assistência de enfermagem. Os sentimentos positivos expressos em relação a pacientes com transtornos mentais foram: compaixão e aceitação, e os negativos, insegurança e tristeza. As pessoas com transtornos mentais são percebidas como normalmente imprevisíveis e que necessitam de cuidados constantemente. Os sujeitos consideraram-se confortáveis em atender pessoas com transtornos mentais e afirmaram que o local mais adequado para essas pessoas é o hospital. Temas como saúde mental, violência doméstica e doenças infectocontagiosas foram sugeridos para futura abordagem na educação continuada. Os participantes consideraram o uso de drogas psicoativas a principal causa das doenças mentais. Ressalta-se que instrumentos validados para avaliar conhecimentos, atitudes e sentimento de profissionais de enfermagem ainda são escassos. Os resultados apontam a necessidade de capacitação continuada sobre assistência de enfermagem a pessoas com transtorno mental nas unidades de urgência e emergência / This present study aimed to evaluate attitudes and knowledge of staffs of nurses on nursing care to patients with mental disorders. This is a descriptive study of a quantitative approach. The study was conducted in an urgency and emergency psychiatric unit of a emergency hospital of interior of São Paulo. The instruments used were: socio-demographic information related to professional training; attitudes and knowledge on identifying signs and symptoms; feelings and nursing assistance for individual with mental disorders. The data were collected before the first class of the course of capacitation in mental health, which was divided into six themes related to the most common mental disorders (mental signs/symptoms, nursing care with emphasis on interpersonal relationships). The sample consisted of 69 nursing professionals, characterized by being predominantly female, adults with high school and college level, with only one job, and work in the institution, on the same team and in nursing from 2 to 5 years. More than a half of the sample had received theoretical content about identifying signs and symptoms of mental disorders, but fewer than half received information about the systematization of nursing care, in addition that beneficiaries announce interest in the continuing education process. The positive feelings expressed towards to patients with mental disorders were compassion and acceptance, and the negative, insecurity and sadness. Individuals with mental disorders are perceived as usually unpredictable and constantly requiring care. Feeling comfortable in helping people with mental disorders and the most appropriate place for these people is the hospitals have been evidenced. Topics such as mental health, domestic violence and infectious diseases were suggested to be working in the future in continuing education. Psychoactive drugs were considered as the main cause of mental illness. Validated tools to assess knowledge, attitudes and feelings of nursing professionals are still scarce. The results to point to need for continued capacitation in nursing assistance for people with mental disorders in urgency and emergency units

Western nursing has been deeply influenced by Christianity and more latterly by the Nightingale ideal of the good nurse. Both views have, as their foundation, the belief that there is an objectively knowable good way to live. This belief presents problems to the modern nurse and has, in large part, been rejected. However, the rejection of this objective moral foundation for nursing has resulted in a crisis of confidence about the best way to articulate what it is to be a good nurse. Two new ways have emerged in recent times. A scientific approach to nursing has elevated the work of nursing to increasingly complex levels and resulted in significantly improved health outcomes for patients. This scientific approach to nursing has manifested itself in two ways. It has resulted in the development of theories of nursing based on psychological concepts. Parallel to this approach has been the tendency for nursing itself to become increasingly scientific and nurses in turn to be technologists. It was thought that nursing that was increasingly shaped in scientific terms would achieve professional status because it presented a scientifically verifiable knowledge base. At the same time, however, it has resulted in an understanding of what counts as being a good nurse being reduced to the nurse’s ability to perform tasks to a high level of clinical precision. Alternatively, nursing as a care-based activity has made a caring attitude the moral centre point of nursing. On this view objective standards of practice are regarded as secondary to the emotional care that the nurse brings to the patient. This belief arose in part because notions of the objectivity of science were challenged as ideological rather than the dispassionate form of knowledge that scientists claimed. It was fostered by the emergence and dominance of phenomenology and the influence of the feminist care ethic. There was also some anxiety about what had been lost in nursing by the embrace of science. In addition, the care ethic seemed to promise the possibility of defining nursing in its own terms in order to make nursing a distinct professional body. However, the demands of an ethic of care have proven elusive and, in the minds of some, unattainable. Given these criticisms of both these ways of thinking about nursing it is proposed that nursing think of itself as a virtues-based activity. Virtues theory incorporates within it the strengths of the two formerly mentioned ways of describing nursing without being subject to the limitations of each. Virtues such as love friendliness, compassion , courage and conscientiousness and the intellectual virtue of prudence or practical wisdom enable nurses to realise that goal in their practice. In this thesis virtue theory will be analysed and applied to nursing in the following way. Some Aristotelian concepts will be identified and their application t professional ethics by contemporary virtue theorists will be discussed. This involves and explication of some virtues that enhance shared conceptions of the practice of nursing. The significance of the good nurse in the shaping of good nursing practice will be considered alongside a reflection on the place of moral luck in nursing practice. It is argued that when nurses think of themselves as participating in a tradition of health care they find meaning in their work, Finally an understanding of nursing as a virtue-based activity clarifies good practice in such a way that nurses are able to elicit from it the qualities needed for its good practice.

This thesis explored the relationship between the discourses of nursing care, the nursing care provision, and the perceived nursing care needs of three highly dependent residents in a residential aged care facility in Australia. Residential aged care in this country has undergone major reforms since 1987 and the nursing profession has struggled with these changes because of the documentation, validation, and accreditation requirements; the inadequate determination of dependency on nursing care for funding; the Registered Nurse (RN) being removed from the bedside to a role of scribe and delegator; the increasing acuity and complexity of the residents' needs; an increase in the turnover of residents; a rise in the nursing staff attrition rate; the delivery of care by untrained and unqualified persons; the RN being accountable and responsible for the care given by 'non-nurses' from a distance; and, the inadequate skill mix and staff to resident ratios provided in these institutions. The interest of this thesis was to research gerontological nursing practice in the context of residential aged care. Residential Aged Care Facilities (RACFs) in Australia that care for the highly dependent elderly were identified in the thesis as disciplinary institutions that used 'subjectivation' as a means to control the efficiency and effectiveness of the labour force and the 'docile' bodies of the residents, whilst at the same time the government rhetoric is that of the quality of life standards and the rights of residents in these institutions. As well as the discourse analysis, an historical overview of the aged care reforms in Australia was undertaken for the period from 1975 to 2006 that demonstrated the effects the reforms have had on the voice of nurses and nursing care in these institutions. This analysis highlighted where nurses have been silenced and found the federal government determining what is nursing care and what is not nursing care, and also who is providing this nursing care. Using a case study approach and discourse analysis each of the three residents was studied using data from five sources namely the resident or relative, a RN, a careworker (CW), the current documentation pertaining to the resident's nursing care, and the non-participant observation of the nursing care provided. These discourses on the nursing care and perceived residents' nursing care needs were analysed using the theoretical base developed from the philosophy and research interest of Michel Foucault (1926-1984), who questioned the apparatus and institutions of Western cultures and searched for discontinuities in the practices of what he termed 'disciplines'. The results of the discourse analysis found nursing care practices that were alarming around the residents' perceived nursing care needs, the documentation of the nursing care provision, and the observed 'actual' nursing care provided. A questionable standard of nursing care was evidenced even though this facility had recently been accredited. A custodial level of mechanistic care was provided to residents in an extremely noisy and public environment within a culture of haste and bustle by unknowledgeable CWs, under the distant gaze of a RN, and the direction of the government documentation requirements. This resulted in unsafe, unethical, unprofessional, and negligent practices, as well as fraudulent, illegal, and dangerously out of date documentation practices. This was ultimately affecting each resident's quality of life, nursing care, and wellbeing and was an added burden on the residents' relatives. Many discontinuities, dissonances, conflicts, and contradictions in nursing practice were uncovered for these three highly dependent residents that may be transferable and similar to other highly dependent residents in this and other institutions. Indeed it may mirror other disciplines that provide care services, such as mental health care, acute care, and disability care provision. The concerns for the nursing profession have epistemological, ethical, and political ramifications for the residents and their relatives, the nurses, the non-nurses doing nursing work, the government, and the industry. Epistemologically new nursing 'knowledges' were being developed that were not resident focussed or based on evidence. Ethically, the legislated rights of residents were not being supported, despite the accreditation, funding, and complaint mechanisms in place - and this has the potential to have punitive ramifications for the industry. Professionally and politically, CWs were identified as non-nurses doing nursing work of a poor standard. This care was not based on accepted nursing practice, but developed through the documentation requirements of the federal government department, the applied constraints, and the CWs themselves. Furthermore, the documentation requirements were found to be a pretence in regard to funding through validation and accreditation, as well as a charade in nursing practice. There is presently a substantial third level of nurses who are identified legally and political as non-nurses doing non-nursing work (known as 'personal' care); but these non-nurses are doing nursing work and are identified by the nursing profession and the public as 'nurses' doing nursing work. These non-nurses who provided nursing care are not educated, licensed, or regulated, and are not accountable professionally to nurses or legally to the public. It is proposed that CWs are in need of licensing under nurses' boards requiring at the very least a minimum of training and education. It is further proposed that documentation requirements resort back to professional nursing documentation; funding be dependent on an predetermined minimum skill mix and staff/resident ratio; and the funding of residents be based on a minimum data set and untied from nursing practice. The professional nursing practice of assessment, planning, implementation, and evaluation of nursing care needs resorting to a nursing domain of knowledge, practice, accountability, responsibility, and documentation. If an acceptable quality of life is to be realised for residents in the residential aged care system, given that highly dependent residents are reliant on quality nursing care that is fundamentally imperative to their very quantity and quality of life, then changes in the residential aged care system and the nursing profession will be necessary. This thesis will contribute to opening up such dialogue between the government, the industry, and the nursing profession in Australia, and it also highlights areas of aged care nursing practice in need of further research.

<p>Trots att det finns en lag om att bevara patientens rättigheter, finns ändå bemötandeproblem i vården som har varit en följetong i svensk media. Bemötande i vården bör anpassas till patientens behov, där empati är en grundläggande aspekt inom vården. Syftet med denna studie var att studera hur bemötande sker mellan vårdpersonalen och de äldreboende. Fyra timmars fältobservationer gjordes med tio vårdpersonalen och fyra intervjuer med fyra vårdanställda på ett äldreboende. Rådata analyserades och en triangulering gjordes med grundad teori. Resultaten visade att bemötande skedde med empati och kärnprocessen handlade om att empati är bundet till psykisk samt fysisk närhet. Det förhållningssätt som uttrycks i lagar, policybeslut och i själva professionen samverkar med vårdpersonalens individuella attityder och värderingar i hur man bemöter människor i beroendeställning. I studien diskuteras hur empati och närhet är en förutsättning för att vårdpersonalen ska lyckas i sitt arbete som professionella hjälpare.</p>

<p>Inom akutsjukvården är en stor del patienterna 65 år och äldre, vilket innebär att en stor del av vården vid en akutmottagning omfattas av bemötande och omhändertagande av äldre patienter. <strong>Syfte: </strong>Syftet med denna studie var att belysa hur äldre personer beskriver att deras behov av omvårdnad blir tillgodosett av omvårdnadspersonal vid akutmottagning. <strong>Metod: </strong>Studien genomfördes som en litteraturstudie där 13 artiklar granskades. <strong>Resultat: </strong>Resultatet visade att många äldre hade en negativ upplevelse av sin vistelse på akutmottagningen. Många fick vänta länge och fick inte sina basala behov tillgodosedda såsom t.ex. mat och dryck. Äldre patienter kände sig oroliga, övergivna och rädda under väntetiden och önskade mer uppmärksamhet och en mer kontinuerlig uppföljning under väntetiden. Resultatet visade också att information till patienten var väldigt viktig. Fick de äldre på akutmottagningen information om vad som skulle hända, hur undersökningar skulle gå till och varför de fick vänta kände de sig nöjda och trygga. Det fanns enligt resultatet en hög respekt för sjuksköterskornas professionella kompetens och omvårdnadspersonalens uppträdande på akutmottagning värderades högre av äldre patienter än av yngre patienter.</p> / <p>In the emergency department a big part of the patients are 65 years old and older, which means that a great deal of the medical care at the emergency department consists of meeting and caring for older patients. <strong>The aim</strong>: The aim with this study was to enlighten how the older patients describe that nurses at the emergency department provide for their need of care. <strong>Method: </strong>The study was done as a study of literature where 13 articles were reviewed. <strong>Result: </strong>The result showed that several older patients had a negative experience of their stay at the emergency department. Many of them had to wait for a long time and did not get their needs provided for. Older patients felt worried, abandon and scared during their time waiting and wished for more attention and more continual checkups during waiting time. The result also showed that information to the patients where very important. If the older patients at the emergency department got information about what was going to happen, how the examinations should proceed and why they had to wait they got more satisfied and secure as patients. There was, according to the result, a high respect for the nurse’s professional competence, and the older patients valued the staff’s behaviour higher than the younger patients.</p>