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Does international nurse recruitment influence practice values in U.S. hospitals?

PURPOSE: To determine if both U.S. and international nurses place high value on organizational attributes that comprises the elements of professional nursing practice and if the absence of these attributes is associated with high levels of burnout in both U.S. and international nurses. DESIGN: A secondary analysis of survey data was conducted with a sample of 799 nurses; 547 were born in the United States (US) and 252 were from 34 other countries. METHODS: Culture of origin was coded according to Hofstede's classification system. Nursing values related to the professional practice environment were measured using the Nursing Work Index, and burnout was measured using the Maslach Burnout Inventory. Analysis of variance and least-squares regression procedures were used to test hypotheses. FINDINGS: No significant differences were found between U.S. and international nurses in the overall degree to which they valued a professional nursing practice environment. A professional practice environment had a significant, inverse effect on job-related burnout on both U.S. and international nurses. CONCLUSIONS: These findings challenge a prevailing sentiment that international nurses hold values inconsistent with professional practice models as defined in the U.S. context. These findings also show that absence of a professional practice environment will produce similar high levels of burnout in both U.S. and foreign-born nurses. To address the nursing shortage, administrators should ensure that organizational attributes are consistent with a professional nursing practice environment.

Emigration and Immigration↗

Service and education share responsibility for nurses' value development.

This article examines professional values of senior baccalaureate nursing students and practicing nurses. An important finding was that practicing nurses rated behaviors reflecting values in the American Nurses Association (ANA) Code for Nurses as more important than did senior students, thereby supporting the notion that practice contributes to value formation. The ongoing development and internalization of the nursing professions' values requires active involvement by staff development educators. The phenomena of value formation and development of professional values appear to mirror the novice to expert model.

Attitude of Health Personnel↗

Individual vs aggregate good: ethical tension in nursing practice.

In this paper the ethical tension between the obligation to benefit the individual client and the obligation to benefit society is critically examined. Descriptions of both obligations in nursing practice as found in professional statements on practice standards, social policies and codes of ethics are discussed. Theoretical foundations for both ethical obligations are described and their implications for nursing practice are discussed. Since promoting one good over the other has serious implications for requirements of moral accountability in nursing practice, several strategies for the distribution of nursing resources and the balancing of the two obligations are proposed. It is concluded that meeting requirements for moral accountability in today's health care delivery system means being answerable for how the nurse determines the justifiability of promoting one good over the other and for articulating justifiable reasons for limiting the provision of either individual or aggregate good in specific nursing care situations.

American Nurses' Association↗

Results of the international field trial with the Reason for Encounter Classification.

The Reason for Encounter Classification (RFEC) was designed by a WHO Working Party to classify the reasons why patients seek care at the primary care level. It is designed along two axes: Chapters and Components. Each chapter carries an alpha-code which is the first character of the basic 3-character alphanumeric code. Each chapter is subdivided into seven "components" carrying 2-digit numeric codes. The field trial was undertaken by family physicians and nurses in: Australia, Barbados, Brazil, Hungary, Malaysia, the Netherlands, Norway and the US. 90497 RFE's were analysed. Their distribution over the chapters and components characterize the content of international primary care. Listings with the most common RFE's in the participating countries reflect the cultural differences. It is concluded that the RFEC is not only feasible to classify reasons why patients seek care but also to classify the diagnosis and the process of primary care. As a result of this, the International Classification of Primary Care (ICPC) succeeds the RFEC.

Diagnosis↗

Changes in the ICNP Version 1.0 from Beta 2.

The International Classification for Nursing Practice (ICNP) Programme focuses on terminology for nursing practice and acknowledges that nursing practice is not static but changing and dynamic. A number of major revisions were made to the Beta 2 to develop the ICNP Version 1.0. Although the Beta 2 Version functioned to compare and combine data from different sources, there were many recommendations for improvement. In this paper, we examined the ICNP Version 1.0 and identified the changes from the Beta 2 Version. A major change was the use of new technology for development of the ICNP Version 1.0 using description logics. Another change to the new version is the single classification structure that was refined into representation of a 7 Axis Model. The new coding system and new guidelines for composing statements that were developed using an International Organization for Standardization (ISO) Standard are also discussed.

Nursing Informatics↗

The future nursing voice.

Based on some articles in the journal Nursing Ethics, the author outlines some of the areas of major importance for nursing in the future. These areas--the care of elderly people, long-term home-based care, genetics, international research and conflict and war--demand a new voice of nursing, which is a political voice. The rationale for a political voice is the ICN Code of ethics for nurses and the fourfold responsibilities laid on nurses: to promote health, to prevent illness, to restore health, and to alleviate suffering. Some indications are given on how nurses can engage in political work.

Aged↗

The epidemiology, clinical characteristics, and natural history of older nursing home residents with a diagnosis of Parkinson's disease.

OBJECTIVE: To determine the epidemiology, clinical characteristics and natural history of nursing home residents with a diagnosis of Parkinson's disease (PD). DESIGN: A cohort study with 18-month follow-up utilizing resident assessments from the National HealthCorp 1991-1992 dataset. SETTING: Seventy-one National HealthCorp nursing homes. PARTICIPANTS: A total of 5020 nursing home residents older than age 55 were studied. Residents with primary and secondary diagnoses of PD were identified from the population using the International Classification of Diseases, Ninth Revision, Clinical Modification code 332.0. MEASUREMENTS: Baseline demographic and clinical characteristics were compared for residents with and those without Parkinson's disease. Outcome measures over the course of 18 months included death and functional status. RESULTS: The prevalence of a diagnosis of PD was 6.8%. Significant factors associated independently with PD included: younger age (79 +/- 7 vs 81 +/- 9 years; P < .001), male sex (32% vs 23%; P < .001), severe dependence in activities of daily living (OR = 1.26; 95% CI 1.08-1.46), impared body control (OR = 1.38; 95% CI 1.03-1.68), symptoms of depression (OR = 1.29; 95% CI 1.02-1.64), and the number of daily medications (OR = 1.23; 95% CI 1.08-1.44). Residents with a diagnosis of PD had a faster rate of functional decline over 18 months (P < .001) but did not have a higher mortality rate than residents without PD. CONCLUSIONS: Parkinson's disease is a relatively common diagnosis among nursing home residents and is associated with increased functional disability. There are several potentially modifiable conditions associated with PD that may offer an opportunity to design specific interventions and health services to improve the quality of life and slow functional decline in this frail population.

Activities of Daily Living↗

Professional ethics and patients' rights: past realities, future imperatives.

The nature and application of professional ethics in relation to patients' rights is not always clearly understood by healthcare professionals. As a result, patients' rights are not always respected or upheld in a way that they ought to be. An undersirable consequence of this has been that patients have suffered otherwise avoidable harms. The issue of professional ethics and patients' rights is one of concern to all healthcare professionals. It is of particular concern to nurses since they are the ones who are often caught in situations involving abuses of patients' rights. This paper briefly examines the failure of professional ethics to prevent patients' rights' abuses in healthcare contexts. It also makes recommendations on how the nursing profession could respond to this problem.

Altruism↗

Nursing informatics: the key to unlocking contemporary nursing practice.

Nursing informatics is a relatively new nursing specialty. Recognized by the American Nurses' Association in 1992, this field within nursing has grown exponentially. Once the purview of highly specialized individuals, nursing informatics has now crept into all dimensions of nursing, from domain of advanced nurse practitioners to prominence in critical care nursing. Nowhere is the management and processing of health-related information more important than in the care of the critically ill patient. Fast-paced environments, split-second decision making, wireless communications, monitoring systems run with computerized backbones, and computerized ordering and documentation, all things unimaginable just a decade ago, are now fundamental to nursing practice. Each requires a baseline understanding of informatics for true mastery. The domain of nursing informatics continues to grow as nursing incorporates expanded roles and new technology into practice. Education for nurse informaticians includes preparation from the baccalaureate level through the doctorate level and national board certification. Areas of practice are expansive, including hospitals, industry, education, policy-making, research, administration, and international settings. Although informaticians work with computers, computing technology is not the heart of the domain. Computers are simply tools that are used. Examples of informatics tools include handheld devices, point-of-care documentation, computerized provider order entry, and bar code medication administration. Nursing informatics plays an essential role in the future directions of healthcare by defining the relationship between nurses and information technology as well as the knowledge that can be gained when these domains work together.

Biomedical Technology↗

To kill or not to kill: a question of wartime ethics.

In this article, the author describes ethical decision-making in unique circumstances. A dichotomy exists between the dual roles of nurse and disaster manager in a wartime setting. The circumstances of the situation had never been faced before and no precedents existed for the type of decisions being made. Clearly, professional codes of conduct existed along with international conventions with reference to war. The circumstances required the author to challenge the concepts of teleology and deontology in a search for the most fitting answers to a unique problem. His aim was to try to create the greatest good out of an impossible situation. The author reflects on his actions in the light of ethical thinking and considers whether his decisions were right.

Codes of Ethics↗

New developments in international nursing ethics.

This article has described numerous activities in nursing ethics at international levels. It acknowledges the larger context within which nurses practice by focusing on selected issues involved in resource allocation and death and dying, cross-culturally. The questions raised about universally shared moral principles reflects the larger questions of cultural and ethical relativism. The discussions of new developments in international nursing ethics focuses on international conferences, the teaching of nursing ethics, national nursing associations, and other professional groups that are actively involved in health care or nursing ethics. Finally, the development of international nursing ethics research studies is providing new knowledge about the scope of ethics within nursing and the nature of nursing care worldwide. Nurses are involved in some aspects of these new developments in nursing ethics in all countries. As they examine and reflect on ethical principles, virtues, and on an ethics of caring, they bring a new dimension to their work as nurses. This new dimension stands as one of the oldest and most central foundations in professional nursing.

Advisory Committees↗