Online journal of issues in nursing
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Discussions about a culture of patient safety abound, yet nurse leaders continue to struggle to achieve such a culture in today's complex and fast-paced healthcare environment. In this article the authors discuss the concept of a patient safety culture, present a fictional scenario describing what happened in a hospital that lacked a culture of patient safety, and explain what should have happened in the above scenario. ⋯ Throughout, an emphasis is placed on leadership at the unit level. Nurse managers will find practical examples illustrating how leaders can help their teams establish a culture that offers the patient quality care in a safe environment.
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In this article the author examines the concepts of moral distress and moral courage within the context of nursing practice. Examples of challenging healthcare situations from the United Kingdom and Ireland are discussed in the light of the examination of these two concepts. ⋯ This requires an understanding of the complexity of clinical contexts and an appreciation of the fallibility and vulnerability of nurses and other practitioners. The goal of this article is to encourage healthcare organisations to create supportive structures and sensitive leadership that will enhance moral courage in the work setting.
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Online J Issues Nurs · May 2011
Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence.
At the core of both patient centeredness and cultural competence is the importance of seeing the patient as a unique person. For the purpose of this article, cultural competence is viewed as an expansion of patient-centered care. More specifically, cultural competence can be seen as a necessary set of skills for nurses to attain in order to render effective patient-centered care. ⋯ I will begin by offering a conceptual framework for cultural competence and a description of the cultural skill needed to formulate a mutually acceptable and culturally relevant treatment plan for each patient. Next I will describe effective approaches for cultural encounters. Finally I will present a vignette that illustrates how the nurse can deliver patient-centered care when the patient's health beliefs, practices, and values are in direct conflict with medical and nursing guidelines.
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A review of the literature on the health of nurses leaves little doubt that their work may take a toll on their psychosocial and physical health and well being. Nurses working in several specialty practice areas, such as intensive care, mental health, paediatrics, and oncology have been found to be particularly vulnerable to work-related stress. ⋯ While the emphasis of this article is on compassion fatigue and its theoretical conceptualization, the concepts of burnout and vicarious traumatization are also discussed. Two questions are posed for discussion: 1) Does compassion fatigue exist on a continuum of occupational stress? If so, is burnout a pre-condition for compassion fatigue; 2) What are the relationships between the types of occupational stress? To what extent does non-resolution of compassion fatigue increase the risk for developing vicarious traumatization? Case examples are provided to support this discussion.