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Issue 135 - 24 May 2010


1. Leadership in nursing: current and future perspectives and challenges
By Carney, Marie. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p411-414
The article presents an introduction to the issue which deals with leadership in nursing, including styles, interpretations and trends from the global perspective.

2. Evidence-based human resource management: a study of nurse leaders' resource allocation
By Fagerstrom, Lisbeth. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p415-425
The aims were to illustrate how the RAFAELA system can be used to facilitate evidence-based human resource management.
Background: The theoretical framework of the RAFAELA system is based on a holistic view of humankind and a view of leadership founded on human resource management.
Methods: Nine wards from three central hospitals in Finland participated in the study. The data, stemming from 2006– 007, were taken from the critical indicators (ward-related and nursing intensity information) for national benchmarking used in the RAFAELA system. The data were analysed descriptively.
Results: The daily nursing resources per classified patient ratio is a more specific method of measurement than the nurse-to-patient ratio. For four wards, the nursing intensity per nurse surpassed the optimal level 34% to 62.2% of days. Resource allocation was clearly improved in that a better balance between patients’ care needs and available nursing resources was maintained.
Conclusions: The RAFAELA system provides a rational, systematic and objective foundation for evidence-based human resource management. Implications for nursing management Data from a systematic use of the RAFAELA system offer objective facts and motives for evidence-based decision making in human resource management, and will therefore enhance the nurse leaders’ evidence and scientific based way of working. [ABSTRACT FROM AUTHOR]

3. Managing the optimal workload by the PAONCIL method – a challenge for nursing leadership in care of older people.
By Frilund, Marianne & Fagerstrom, Lisbeth. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p426-434
The aim of the study was to test the ability of the professional assessment of optimal nursing care intensity level (PAONCIL)-method to establish the optimal nursing intensity (NI) per care giver within the care of older people by testing whether the method’s prerequisites for hospital settings can be fulfilled within the care of older people as well.
Background: The PAONCIL method is included in the RAFAELA system as a method for calculating personnel resources based on NI.
Method: The PAONCIL assessments were collected through questionnaires (n = 3512). The data was analysed by simple linear regression analysis.
Results: It can be stated that the prerequisites for the PAONCIL method were fulfilled and that the optimal NI-level could be determined on seven participating units.
Discussion: It can be stated that the RAFAELA system is a useful system for measuring NI within the care of older people, but additional research is needed, especially within the home care setting.
Conclusion: Although an instrument never provides a complete overview of the patient’s care needs and need satisfaction, it provides information about the daily situation as well as gives guidelines for long-term strategic planning.

4. Public health nurses perception of clinical leadership in Ireland: narrative descriptions
By Carney, Marie. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p435-445
The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses’ in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery.
Background: Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method: Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results: Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions: Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers: Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.

5. Workplace empowerment, job satisfaction and job stress among Italian mental health nurses: an exploratory study.
By Lautizi, Marina; Laschinger, Heather & Ravazzolo, Sandra. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p446-452

Aim: The purpose of the present study was to investigate the relationship between staff nurses’ structural empowerment, work stress and job satisfaction in two health care settings in Italy using Kanter’s Empowerment Theory
Background: With the current scarcity of economic resources and shortage of nurses, it is essential to empower nurses to perform at a high level to ensure high-quality patient care. Structural empowerment is a process that can optimize use of nursing skills and professional expertise, thereby increasing job satisfaction among nurses.
Method: A convenience sample of 77 nursing staff employed in the Department of Mental Health in central Italy was used in this study (return rate 64%).
Results: Structural empowerment was significantly related to their job satisfaction ( r = 0.506, P < 0.001), as was global empowerment ( r = 0.62). Empowerment also had a significant negative relationship to nurses’ work stress ( r = -0.28, P < 0.05).
Conclusion: The results of this study support Kanter’s theory of structural empowerment in an Italian nursing sample – a previously unstudied population. Implications for nursing management Organizational administration must make every effort to create organizational structures and systems that empower nurses to practice according to professional standards and optimize the use of their knowledge and expertise. [ABSTRACT FROM AUTHOR]

6. Assessment of nurse retention challenges and strategies in Lebanese hospitals: the perspective of nursing directors
By El-Jardali, Fadi et al. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p453-462
Assess nurse retention challenges and strategies as perceived by nursing directors in Lebanese hospitals.
Background: The Kampala Health Workforce Declaration stressed the importance of retaining an effective, responsive and equitably distributed health workforce, particularly nurses. Little is known about nurse retention challenges and strategies in Lebanon.
Methods: Nursing directors of 76 hospitals participated and were sent a two-page survey on perceived retention challenges and hospital-based retention strategies.
Results: Retention challenges included unsatisfactory salary, unsuitable shifts and working hours, as well as better opportunities in other areas within or outside Lebanon. Retention strategies included implementing financial rewards and benefits, a salary scale, staff development, praise and improving work environment. Nursing directors did not address all perceived challenges in their strategies. Implications for nursing management To better manage the nursing workforce, nursing directors should regularly measure and monitor nurse turnover rates and also their causes and predictors. Nursing directors should develop, implement and evaluate retention strategies. More information is needed on the management and leadership capacities of nursing directors in addition to their span of control.
Conclusion: Nursing directors are facing challenges in retaining their nurses. If these problems are not addressed, Lebanon will continue to lose competent and skilled nurses. [ABSTRACT FROM AUTHOR]

7. Ineffective participation: reactions to absentee and incompetent nurse leadership in an intensive care unit
by Rouse, Ruby. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p463-473
The aim of the present study was to analyse reactions to ineffective leader participation in an intensive care unit (ICU).
Background: Critical examination of leadership failures helps identify nurse manager behaviours to avoid.
Method: An online survey collected data from 51 interacting healthcare providers who work in an intensive care unit.
Results: Participants reported dissatisfaction with nurse leaders who were perceived as absent or ill prepared. Participants categorized intensive care unit productivity and morale as moderate to low. Multiple regression suggested the best predictor of perceived unit productivity was supervisor communication; the best predictor of
employee morale was perceived leader mentoring.
Conclusions: Intensive care unit nurses reported wanting active participation from their leaders and expressed dissatisfaction when supervisors were perceived as absent or incompetent. Ineffective leader participation significantly correlated with lower employee perceptions of productivity and morale. Implications for nursing management Senior managers should recruit and develop supervisors with effective participation skills. Organizations primarily concerned about productivity should focus on developing the communication skills of nurse leaders. Units mainly concerned with employee morale should emphasize mentorship and role modelling. Formal assessment of nurse leaders by all intensive care unit team members should also be used to proactively identify opportunities for improvement. [ABSTRACT FROM AUTHOR]

8. How can the clinical supervisor role be facilitated in nursing: a phenomenological exploration
By Williams, Lynne & Irvine, Fiona. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p474-483
To explore the nature of the nurse clinical supervisor role. Background: Although clinical supervision in nursing has been widely explored, few studies have considered the specific role of nurse clinical supervisors.
Method: A phenomenological approach was used to explore what it means to be a clinical supervisor. Focus groups interviews were conducted with 12 nurse clinical supervisors within one National Health Service (NHS) Trust.
Results: Three main categories of themes that represented the essence of the clinical supervisors’ role were uncovered.
Conclusions: The research demonstrated that nurses who undertake the clinical supervisor role are rarely offered guidelines for fulfilling the role. The findings reveal gaps in the structure of the clinical supervisor’s role which could be hampering successful clinical supervision. Implications for nursing management The study adds to the existing evidence base and serves to inform managers of the nature of the nurse clinical supervisor role and how it could be better facilitated. The data shed light on the needs of nurse clinical supervisors who often adopt this role in addition to their other clinical and professional commitments. The findings indicate that managerial support in the form of prioritizing training and offering support mechanisms help nurses to effectively fulfil the clinical supervisor role. [ABSTRACT FROM AUTHOR]

9. Academic leadership in nursing: legitimating the discipline in contested spaces
By McNamara, Martin. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p484-493
To investigate the potential of recent conceptual developments in the sociology of education for conceptualising academic leadership in nursing.
Background: During an investigation into the current status and future trajectory of academic nursing in Ireland, academic leadership emerged as a major concern for respondents.
Method: The languages of legitimation of academic leaders were elicited in in-depth interviews and analysed as expressions of underlying legitimation principles.
Results: The concept of legitimation principles provides a way of
thinking about how academic nursing is positioned in the health and higher education sectors, how its leaders construct its identity, practices and purposes, and clarifies the proper focus and goals of academic leadership in nursing.
Conclusions: Academic leadership is concerned with legitimating the discipline of nursing as an autonomous, coherent and distinctive professional and academic endeavour. This legitimacy must be secured in academic, clinical and wider contexts in which academic nursing is viewed with ambivalence; leaders must take account of the impact of nursing history on the current status and future trajectory of the discipline.
Implications for nursing leadership: The analytic tools facilitate a better understanding of the internal and external conditions under which academic nursing will flourish, or wither, in contemporary higher education. [ABSTRACT FROM AUTHOR]

10. Leadership and organisational effectiveness – lessons to be drawn from education?
By Joyce, Pauline. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p494-502
The aim of this paper is to present findings of a case study on organisational effectiveness in an education setting and draw similarities with a healthcare setting, focusing on the school principal and nurse leader.
Background: The study was carried out in a primary school setting and focuses on a principal (as leader). The school which will be named St Senan’s for the case study, is a typical tall structure has a staff of 30 (teachers and special needs’ assistants) and a student number of 117.
Methods: A case study methodology was used. Data was
collected by interviewing the principal, two teachers, two students and a parent, in this order. In addition, a Parents’ Council meeting was observed and document analysis was carried out on measurements which reflected some critical success factors for the school.
Results: Interviews from students and teachers in addition to observation notes indicate that the principal’s leadership impacts on organisational effectiveness in the school.
Conclusions: The findings are located in the context of education with similarities being drawn from nursing. It is how the leader leads in the context of the organisation setting which is paramount. In other words it is not possible to take a set of general critical success factors for a school or healthcare setting and apply these widely. The paper concludes by proposing the use of a quality framework to contextualise the findings of the case and promote further discussion in the context of nurse leaders.
Implications: The paper suggests that comparisons can be made between school principals and nurse leaders. [ABSTRACT FROM AUTHOR]

11. Leadership styles of Finnish nurse managers and factors influencing it
By Vesterinen, Soili et al. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p503-509
The purpose of the present study was to explore nurse managers’ perceptions of their leadership styles and factors influencing it.
Background: It is a challenge for nurse managers to retain nurses in hospitals and to ensure a high quality of care in nursing practice. Leadership style is an important part of leadership. Knowledge
concerning nurse managers’ resonant and non-resonant leadership styles provides nurse managers with tools to reflect on their own leadership style.
Method: Open-ended, tape-recorded interviews were conducted with 13 nurse managers from five Finnish hospitals and two long-term care facilities. The data were analysed using qualitative content analysis.
Results: Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. Factors that influence leadership style were identified: earlier superiors, values,
information, cooperation, employees and education.
Conclusions: The results of this study show that Finnish nurse managers use both resonant and non-resonant leadership styles. Implications for nursing management The findings of this study show that nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles and factors influencing it among nurse managers providing future leadership and management education. [ABSTRACT FROM AUTHOR]

12. The Australian experience of nurses' preparedness for evidence-based practice
By Waters, Donna et al. Journal of Nursing Management, May 2009, Vol. 17 Issue 4: p510-518
This study aimed to determine current knowledge and attitudes towards evidence-based practice (EBP) among pre- and post-registration nurses in New South Wales (NSW), Australia. Background: Educational and clinical strategies for EBP in nursing assume a readiness to interpret and integrate evidence into clinical care despite continued reports of low levels of understanding and skill in this area.
Method: Perceptions of EBP were examined through a self- complete, anonymous postal survey distributed to 677 (post-registration) clinical nurses and to 1134 final year (pre-registration) nursing students during 2002 and 2003.
Results: A completed survey was returned by 126 post-registration and 257 final year nursing students (combined 21% response rate). Both pre- and post-registration nurses had a welcoming attitude towards EBP. Pre-registration nurses expressed more confidence in their EBP skills but self-rated knowledge and skill were low to moderate in both groups.
Conclusion: Nurses in Australia are clearly supportive of EBP but it is incorrect to assume that even recent graduates have a level of knowledge and skill that is sufficient to permit direct engagement in evidence implementation. Implications for nursing management Among a range of clinical supports, nurse managers and leaders can contribute to evidence-based health care by understanding the EBP knowledge and skills of their workforce and demanding a more practical approach in nursing education towards evidence-based guidelines and summaries appropriate to the clinical context. [ABSTRACT FROM AUTHOR]

Journals Table of Contents

13. From the Journal of Continuing Education In Nursing, May 2010, Volume 41, Number 5
Special issue: Geriatric Nursing Education
Administrative Angles
A Peek at the Revised Nursing Professional Development: Scope and Standards of Practice
Clinical Updates
Phase 2 of the EMPOWER Project: Enhancing Communication for Paraprofessionals
Teaching Tips
13C. Twitter: Consider the Possibilities for Continuing Nursing Education
Guest Editorial
13D. Educating Nurses to Meet the Needs of an Aging Population
Original Article
13E. Birds of a Feather: Introducing a Virtual Learning Community for Geriatric Nurse Educators
13F. Enhancing the Capacity to Teach Gerontological Nursing: A Faculty Development Project
13G. Teaching the Teacher: The Faculty Learning About Geriatrics (FLAG) Program
13H. Development of a Scripted Unfolding Case Study Focusing on Delirium in Older Adults
13I. Preparing Those Caring for Older Adults to Report Elder Abuse

Latest news from Ministry of Health

14. Statement of Intent 2010-2013
- 20 May 2010

15. Health Targets 2009/10 - Quarter three report
- 20 May 2010

16. Preventing and Minimising Gambling Harm: Three-year service plan 2010/11–2012/13
- 13 May 2010

17. Preventing and Minimising Gambling Harm: Six-year strategic plan 2010/11–2015/16
- 13 May 2010

18. Issuing Permissions for Vertebrate Toxic Agents (VTAs): Guidelines for Public Health Units
- 12 May 2010

Latest news from ACC

19. Auckland man convicted of making fraudulent ACC claims (10 May 2010)

20. Hamilton man convicted of making fraudulent ACC claims (10 May 2010)

21. ACC Partners with Private Claim Managers (30 April 2010)

News – National

22. Pharmacists seeking costs of drug recall
New Zealand Herald - 24 May 2010
Pharmacists are taking drug manufacturer GlaxoSmithKline to court over its recall of a blood-thinning drug, saying they are bearing the company's expenses in carrying out the work. Pharmacist Ian Johnson, who owns Johnson's Pharmacy in Otara, Manukau City and is president of the Pharmacy Guild, served a civil notice of claim on GSK in the Manukau District Court

23. Patient care passes health check
Taranaki Daily News - 24 May 2010
The Taranaki District Health Board has done well in its latest report card. It remained steady or improved in five of the six key areas covered by the Government's health targets. The Ministry of Health has released its third-quarter results and the Taranaki DHB maintained its 100 per cent score for delivering radiation treatment to cancer patients within six weeks of their first specialist assessment.

24. What you said about the Budget
TVNZ - 21 May 2010
Finance Minister Bill English has delivered his Budget, taking what he calls a "balanced and moderate approach". Amongst other things, GST increases from 12.5% to 15%, while there are personal tax cuts across the board. The government promises an average family will be at least $25 a week better off, but Labour says it will be $30 worse off.

News - International

25. Firth knew of school heater dangers
Sydney Morning Herald - 24 May 2010
It's been revealed that Education Minister Verity Firth was warned by her department more than a year ago that unflued gas heaters in NSW schools were giving off indoor air pollution at "levels over that considered safe for human exposure". The Sydney Morning Herald says a ministerial briefing note it obtained, the accuracy of which was endorsed by senior bureaucrats, contradicts many of the public statements Ms Firth has since made about the health impacts of the heaters

26. Protein heart tests: A lifesaver or overhyped?
CNN - 22 May 2010
( -- Dianne has always worried about her heart health -- both her parents died of heart attacks -- yet her cholesterol has never been off the charts. All the same, the 59-year-old schoolteacher (who asked that her last name not be used) has been taking a cholesterol-lowering statin for more than two years. Why? In 2007, Dianne's cardiologist discovered that her blood contained abnormally high levels of C-reactive protein, a marker of inflammation. Dr. Yazid Fadl, a cardiologist at Clarian Cardiovascular, in Indianapolis, considered Dianne's high
CRP reason enough to prescribe a statin. "If her CRP were low, I would have advocated weight loss and exercise," he says

27. Can caring make you sick?
CNN - 20 May 2010
(CNN) -- Soon after Paul Coskie's bicycle collided with a car, it became clear to his mother that her son would be sick for a very long time, and indeed he was. The 13-year-old boy went into a coma for a month and spent six months total in the hospital. What his mother didn't know at the time was that Paul's collision would eventually claim another victim -- one who was nowhere near the accident scene. After taking care of her son for a year, Dixie Fremont-Smith Coskie started to lose her balance, stumbling at times when she walked. Then she became so weak she couldn't get out of bed.


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