Disappearing expertise in clinical automation: Barcode medication administration and nurse autonomy

Objective Using the case of barcode medication administration (BCMA), our objective is to describe the challenges nurses face when informatics tools are not designed to accommodate the full complexity of their work. Materials and Methods Autonomy is associated with nurse satisfaction and quality of care. BCMA organizes patient information and verifies medication administration. However, it presents challenges to nurse autonomy. Qualitative fieldwork, including observations of everyday work and interviews, was conducted during the implementation of BCMA in a large academic medical center. Fieldnotes and interview transcripts were coded and analyzed to describe nurses’ perspectives on medication safety. Results Nurses adopt orienting frames to structure work routines and require autonomy to ensure safe task completion. Nurses exerted agency by trusting their own judgment over system information when the system did not consider workload complexity. Our results indicate that the system’s rigidity clashed with adaptive needs embodied by nurses’ orienting frames. Discussion Despite the fact that the concept of nurse as knowledge worker is foundational to informatics, nurses may be perceived as doers, rather than knowledge workers. In practice, nurses not only make decisions, but also engage in highly complex task-related work that is not well supported by process-oriented information technology tools. Conclusions Information technology developers and healthcare organization managers should engage and better understand nursing work in order to develop technological and social systems to support it.

The Role of Hospital Management to Enhance Nursing Job Satisfaction

Introduction: Hospital management must strive to create a work environment that can build nurse autonomy at work empowerment carried out by management in the workplace will be a crucial way to support nurse autonomy so that nursing job satisfaction can be created. The study aimed to identify the relationship between the role of hospital management with nurse job satisfaction. Methods: This research was conducted using a cross-sectional design, with a correlation analytic study design, and the sampling technique used was simple random sampling. The total samples in this study were 41 people. Data collection on hospital management roles was collected using the CWEQ II (Condition for Work Effectiveness-II) questionnaire, while nurse job satisfaction used MMSS (The McCloskey / Mueller Satisfaction Scale). The data analyzed by Pearson Rho. Results: Based on the results of the study obtained, the majority of respondents aged 21-40 years (63.4%), most respondents had vocational education background (73.2%), and most respondents had work experience > 10 years (58.5%). Based on the results of the Pearson correlation test obtained p-value < 0.05 (0.005), so it means that there was a relationship between the role of hospital management with nursing job satisfaction. Conclusions: Nurse managers can consider structural empowerment in the work environment for their employees. The quality of the nurse's work environment at the work unit level is not only important to improve the quality of service to patients, but also has an important role in improving the welfare of individual nurses themselves.

Validation of a moral distress instrument in nurses of primary health care

ABSTRACT Objective: to validate an instrument to identify situations that trigger moral distress in relation to intensity and frequency in primary health care nurses. Method: this is a methodological study carried out with 391 nurses of primary health care, applied to the Brazilian Scale of Moral Distress in Nurses with 57 questions. Validation for primary health care was performed through expert committee evaluation, pre-test, factorial analysis, and Cronbach’s alpha. Results: there were 46 questions validated divided into six constructs: Health Policies, Working Conditions, Nurse Autonomy, Professional ethics, Disrespect to patient autonomy and Work Overload. The instrument had satisfactory internal consistency, with Cronbach’s alpha 0.98 for the instrument, and between 0.96 and 0.88 for the constructs. Conclusion: the instrument is valid and reliable to be used in the identification of the factors that trigger moral distress in primary care nurses, providing subsidies for new research in this field of professional practice.

Comparative study of representations of professional autonomy produced by first and last-period undergraduate nursing students

ABSTRACT Objective: to compare the social representations of professional nurse autonomy produced by first and last-period undergraduate nursing students. Method: qualitative, descriptive and exploratory study, based on the structural approach of social representations, the Central Core Theory, carried out with 171 students from three federal public universities, using the free association technique on the object “professional nurse autonomy”. The data were submitted to EVOC 2005 software and to similarity analysis. Results: care was the central core of the representational structure identified among the students of the first period. Among last-period students, knowledge stood out as a core element. The term responsibility was identified as common to both central cores. Conclusion: regarding professional autonomy, the results point to an overlapping process of the reified and consensual universes during the undergraduate course. However, responsibility, inherent in the profession, remains cross-sectional. For the first period students, autonomy is resignified in a practical and attitudinal way, whereas for the last period students, the knowledge acquired stimulates them to assign meaning to professional autonomy with a cognitive and attitudinal representation. The data can support the use of innovative teaching practices in nursing undergraduate courses.

Online Instruction as a Caring Endeavor

Online instruction has been approached with caution by nursing. Concerns range from unfamiliarity with online pedagogy to the potential for decreased student connectedness. Being unfamiliar with the online format can be overcome through a series of self-training, taking courses online, and dedication to the process. Student connectedness is basic to nursing and a caring and compassionate profession. It has been argued that an online format will create an atmosphere of disconnectedness and isolation. To combat this disconnectedness and isolation, an atmosphere of caring is required in the online classroom. This article considers the basics of both creating an atmosphere of caring and concepts that support the online pedagogy. Caring is the essence of nursing and should be conveyed in the instruction of nurses. Online instruction can facilitate a caring atmosphere, when done properly, and promote growth for student nurses. Grounding this notion is a brief discussion of various nursing concepts and theories on caring, and how the key elements of some of these theories relate directly to the outcomes of online instruction. In addition to the concept of caring and relating this to online instruction, a connection to the supporting concepts of trust and professional nurse autonomy are intimately connecting to caring and online instruction. This connection illustrates the foundational results of online instruction and how these are indeed the same elements of the concept of caring.