Evaluation of an intervention on socio cultural communication skills of international nurses

International nurses face a myriad of challenges in their transition, adaptation, and integration into the U.S. health care environment. This pilot intervention study examined socio-cultural competence regarding communication in a sample of international nurses working in two community hospitals in southern Nevada. Significant improvement in communication behaviors of the sampled international nurses with regard to socio-cultural skills of communication after the workshop intervention were not found. Similarly, there were no remarkable differences in standardized patient comments for most items on the checklist. However, the sampled international nurses demonstrated some highly desirable qualities such as being very personable, caring, and compassion that appeared to lay a foundation for an effective nurse-patient relationship.     

Shift work in nursing: is it really a risk factor for nurses' health and patients' safety?

There is evidence in the scientific literature of the adverse physiological and psychological effects of shift work, including disruption to biological rhythm, sleep disorders, health problems, diminished performance at work, job dissatisfaction, and social isolation. In this study, the results of health problems and sleep disorders between female and male nurses, between daytime and shift nurses, and between sleep-adjusted and non-sleep-adjusted shift nurses were compared. Also the relationship between adjustment to shift work and organizational outcomes (errors and incidents and absenteeism from work) was analyzed. Gender, age, and weight were more significant factors than shift work in determining the well-being of nurses. Shift work by itself was not found to be a risk factor for nurses' health and organizational outcomes in this study. Moreover, nurses who were identified as being "non-adaptive" to shift work were found to work as effectively and safely as their adaptive colleagues in terms of absenteeism from work and involvement in professional errors and accidents. This research adds two additional findings to the field of shift work studies. The first finding is that female shift workers complain significantly more about sleep disorders than male shift workers. Second, although high rates of nurses whose sleep was not adapted to shift work were found, this did not have a more adverse impact on their health, absenteeism rates, or performance (reported errors and incidents), compared to their "adaptive" and "daytime" colleagues.     

Implications of nurse-physician relations: report of a successful intervention

Given the evidence linking medical errors to ineffective communication, strategies for improving communication among health care professionals must be implemented. The purpose of this article was to examine the effect of a collaborative intervention on improving communication patterns between nurses and physicians on two study units. The intervention consisted of two nurses and two physicians (per unit) meeting together (8 hours total) to collaboratively develop a solution to communication issues on their respective units. Physicians scored significantly higher on reports of openness of communication within groups, openness between groups, accuracy between groups, and collaboration between groups. Collaboration reported among nurses and physicians improved for both professions, with significance reached for physicians (p = 0.031). Strategies must be identified to break down the barriers set by the current culture, and that expedite the development of a team-centered culture supporting collaborative relations among health care professionals.     

A magnetic strategy for new graduate nurses

With the shortfall of nurses, more health care organizations are actively recruiting new graduate nurses. To translate active recruitment to successful retention, however, these newest nurses need support to make the adjustment from the security of a protected academic environment to the demands of a professional nursing career. Nursing turnover occurs when their role transition is unsuccessful. A unique model implemented in 2003 transformed new graduate nurses into confident staff nurses in an acute care setting. The insights gained and the investments required for a "magnetic" strategy to make new graduate nurses successful new staff nurses who stay with the organization are revealed.     

Job preferences of students and new graduates in nursing

This article investigates the preferences of student and newly graduated nurses for pecuniary and nonpecuniary aspects of nursing jobs. It is the first study applying methods based on discrete choice experiments to a developed country nursing workforce. It is also the first to focus on the transition through university training and into work. This is particularly important as junior nurses have the lowest retention levels in the profession. We sample 526 individuals from nursing programmes in two Australian universities. Flexible and newly developed models combining heteroscedasticity with unobserved heterogeneity in scale and preference weights are estimated. Overall, salary remains the most important feature in increasing the probability that a job will be selected. ‘Supportive management/staff’ and ‘quality of care’ follow as the most important attributes from a list of 11 nonpecuniary characteristics. However, the subset of new graduates rank ‘supportive management/staff’ above salary increases, emphasizing the importance of a supportive workplace in the transition from university to the workplace. We find substantial preference heterogeneity and some attributes, such as the opportunity for clinical rotations, are found to be attractive to some nurses while seen as negative by others. Nursing retention could be improved by designing different employment packages to appeal to these different tastes.     

Measuring teamwork and patient safety attitudes of high-risk areas

Patient care leaders recognize that substantial reductions in health care errors will not come until more attention is given to human solutions, such as improving teamwork in health care teams. The authors introduce a short, valid, and reliable instrument to measure teamwork and patient safety attitudes in hospital high-risk areas, namely the emergency department, the operating room, and the intensive care unit. The instrument was tested among nurses in four hospitals and the results showed that the nurses favored the team approach, while recognizing that teamwork in their departments is not very advanced and that communication with some key team members is problematic. This situation seems ideal for the design of a team training intervention in these settings.     

Violence against nurses and its impact on stress and productivity

The purpose of this study was to examine how violence from patients and visitors is related to emergency department (ED) nurses' work productivity and symptoms of post-traumatic stress disorder (PTSD). Researchers have found ED nurses experience a high prevalence of physical assaults from patients and visitors. Yet, there is little research which examines the effect violent events have on nurses' productivity, particularly their ability to provide safe and compassionate patient care. A cross-sectional design was used to gather data from ED nurses who are members of the Emergency Nurses Association in the United States. Participants were asked to complete the Impact of Events Scale-Revised and Healthcare Productivity Survey in relation to a stressful violent event. Ninety-four percent of nurses experienced at least one posttraumatic stress disorder symptom after a violent event, with 17% having scores high enough to be considered probable for PTSD. In addition, there were significant indirect relationships between stress symptoms and work productivity. Workplace violence is a significant stressor for ED nurses. Results also indicate violence has an impact on the care ED nurses provide. Interventions are needed to prevent the violence and to provide care to the ED nurse after an event.     

Value-added care: a paradigm shift in patient care delivery

Spiraling costs in health care have placed hospitals in a constant state of transition. As a result, nursing practice is now influenced by numerous factors and has remained in a continuous state of flux. Multiple changes within the last 2 decades in nurse/patient ratio and blend of front-line nurses are examples of this transition. To reframe the nursing practice into an economic equation that captures the cost, quality, and service, a paradigm shift in thinking is needed in order to assess work redesign. Nursing productivity must be evaluated in terms of value-added care, a vision that goes beyond direct care activities and includes team collaboration, physician rounding, increased RN-to-aide communication, and patient centeredness; all of which are crucial to the nurse's role and the patient's well-being. The science of appropriating staffing depends on assessment and implementation of systematic changes best illustrated through a "systems theory" framework. A throughput transformation is required to create process changes with input elements (number of front-line nurses) in order to increase time spent in value-added care and to decrease waste activities with an improvement in efficiency, quality, and service. The purpose of this pilot study was two-fold: (a) to gain an understanding of how much time RNs spent in value-added care, and (b) whether increasing the combined level of RNs and unlicensed assistive personnel increased the amount of time spent in value-added care compared to time spent in necessary tasks and waste.     

The nursing shortage: can information technology help?

There is no doubt that the nursing shortage is a real and valid concern for the medical community. American Hospital Association President Dick Davidson reports: "America needs up to 126,000 nurses now, as well as more pharmacists, lab technicians, support staff and others. We need immediate action to help alleviate this situation" (American Hospital Association, 2001). Clinical information systems can be one of those immediate actions that can help nurses feel more confident about the care they are delivering. In addition to preventing medical errors, streamlining workflow and communications, and reducing redundant data entry, these systems can have a lasting and positive effect on overall job satisfaction, providing a significant influence on retaining our invaluable nursing resources.     

生态翻译学视阈下《玉米》译本的研究

毕飞宇的《玉米》是现代中篇小说创作中的一篇佳作,赢得了人们的普遍喜爱。葛浩文更是凭借《玉米》英译本获得2010年英仕曼亚洲文学奖,这也是葛浩文译作第三次获此殊荣。论文从语言维、文化维、交际维三方面分析葛浩文夫妇英译《玉米》的过程,在一定程度上弥补了该领域的空白,旨在让人们对译者翻译过程中的主体地位和主导作用有更清晰的认识,并为后人研究该问题及其理论提供一定的借鉴。     

The MISSCARE Survey-Turkish: psychometric properties and findings

One measure of the process of nursing care is missed nursing care, which refers to any aspect of required care that is omitted either in part or in whole or delayed. Little is understood about how the quality and processes of nursing care differs among countries around the world. The aims of this study were (a) to test the psychometric properties of the MISSCARE Survey-Turkish and (b) to compare the extent and type of missed care as well as reasons for missing care between Turkey and the United States. There was less missed care reported by Turkish nurses as compared to U.S. nurses (p < 0.0001). Turkey nurses identified more problems with inadequate staffing resources (p < 0.0001), materials resources (p < 0.0001), and communication/teamwork (p < 0.0001) as reasons for missed nursing care than did U.S. nurses. Missed nursing care is a critical problem that needs to be addressed in both countries.     

Interest-rate volatility and volatility spillovers in emerging Europe

While many transition economies – particularly those that hope to join the Euro – have seen their economies converge to Europe’s, this process is by no means complete. Considerable macroeconomic volatility persists. This study examines the variability of the short-term nominal interest rates of ten transition economies, finding that eight of them exhibit time-varying volatility that can be modeled as a GARCH or Exponential GARCH process. Incorporating various measures of external volatility into the models, we find that those economies with fixed or managed exchange rates tend to experience more volatility spillovers, particularly from the Eurozone, regardless of the degree of transition. Only Estonia has a fixed exchange rate and remains free of international contagion.     

Evaluation of a client care delivery model, Part 2: Variability in client outcomes in community home nursing

Using similar variables, Part II explores variation in client outcomes such as OMAHA knowledge, behavior, and SF-36 scores. Medical and nursing diagnoses explained large variations in client outcomes. Clients cared for by degree-prepared nurses improved knowledge and behavior scores. Unanticipated case complexity was negatively associated with client outcome even with nursing intervention. The study revealed that "for every unit increase in assignment of baccalaureate-prepared nurses, clients will on average demonstrate an 80% greater likelihood of improvement in knowledge scores and a 120% greater likelihood of improvement in behavior scores in relation to their health condition at discharge." This two-part study has offered insight into the controllable variables influencing the cost and quality of home care services.     

Evolution of the chronic care role of the registered nurse in primary care

High-quality, accessible, and efficient primary care is needed as the U.S. health care system undergoes significant change. Advancing the role of registered nurses in the primary care setting is important to the solution. A large academic health center implemented five initiatives to improve the care of chronically ill patients through the expanded role of RNs in the context of the health care team. Role evolution of nurses in the pilots required some continuing education and some additional nursing support to release the pilot nurses from their usual duties. These strategies allowed the nurses to apply interventions that enhanced the coordination of care and promoted patient self-management skills. Some short-term improvements in health status were realized and barriers to self-care were identified and resolved.     

Measures of cost containment, impact of the economical crisis, and the effects perceived in nursing daily practice: an Italian crossover study

A qualitative/quantitative study in two phases was undertaken to describe the economical crisis intensity, cost-containment interventions adopted locally, and their effects perceived in daily practice by Italian nurses. The main economic crisis effects reported by nurses were (a) the staff stress level has increased, (b) patients with social problems have increased, and (c) the workload has increased. Overall, nurses perceived moderate disadvantages due to the economical crisis; several cost-containment measures have been adopted at different levels of the National Health Service. atients in general seem frailer and nurses working in the community centers also seem frailer compared with nurses working at the hospital level. Changes in daily nursing practice both at the hospital and community levels are warning signs that should be monitored carefully for both their short and long-term negative impacts on patients, nurses, and the National Health Service.     

The importance of employment status in determining exit rates from nursing

To mitigate nurse shortages, health care decision makers tend to employ retention strategies that assume nurses employed in full-time, part-time, or casual positions and working in different sectors have similar preferences for work. However, this assumption has not been validated in the literature. The relationship between a nurse's propensity to exit the nurse profession in Ontario and employment status was explored by building an extended Cox Proportional Hazards Regression Model using a counting process technique. The differential exit patterns between part-time and casual nurses suggest that the common practice of treating part-time and casual nurses as equivalent is misleading. Health care decision makers should consider nurse retention strategies specifically targeting casual nurses because this segment of the profession is at the greatest risk of leaving. Nurse executives and nurse managers should investigate the different work preferences of part-time and casual nurses to devise tailored rather than "one-size fits all" nurse retention strategies to retain casual nurses.     

Making a play in the policy and politics arena: nursing and the national election

With health care surfacing in political campaigns across the country and referencing virtually every one of the policy topics discussed here, nurses have an important opportunity to share their views regarding both policy substance as well as engage in the political arena. For those nurses not yet ready to run for elective office, participating in grassroots efforts of campaigns, on advisory panels, and making financial contributions to preferred candidates are important opportunities not to be missed. Given the interest in and challenges ahead associated with health care broadly and nursing specifically, there is a great deal at stake.     

Chinese rural reform in 30 years: An analysis in terms of institutional economics

Both from history and logic, the rural reform is the starting point for China’s overall economic reform. The gradualism, inherent logical evolution and interest conflict of reform in China all have their origins in rural reform. The thirty-year’s rural reform can be viewed as the adjustment of urban-rural relations by different period. This study adopts the analytical framework of institutional economics to clearly demonstrate the whole logic process of institutional transition, then from the international comparative perspective, generalizes some basic experiences in China’s rural reform and the lessons for developing and transitional countries. On the basis of judging different stages of economic development, this paper also sums up the new challenges faced by rural reform and discusses its prospects for the next reform.     

Can state language policies distort students’ demand for education?

We exploit a recent natural experiment in Ukraine’s school system to study how stricter requirements for proficiency in the state language affect linguistic minority students’ demand for education. The reform obligated linguistic minority students to take a standardized school exit test in Ukrainian, thus denying them access to translated versions of the test. We study the implications of this reform for students in schools with Hungarian and Romanian/Moldovan languages of instruction. Using school-level data and employing difference-in-difference estimation techniques, we find that the reform resulted in a decline in the number of subjects taken by minority students. They particularly withdrew from linguistically-demanding subjects such as History and Biology, taking more Math instead. Given the implications for minority students’ fields of future study, the reform may have affected their educational outcomes in a distortive way.