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Aims: The aims of this study were: (1) to understand the implicit and explicit perceptions of accountability from the perspective of bedside nurses and their managers; (2) to identify the factors that facilitate accountability behaviours., Background: Despite the importance attributed to accountability in nursing education and practice, empirical research lacks clarity regarding how nurses perceive accountability and decide whether or not to act accountably., Design: Qualitative study., Method: Data of a purposeful sample of 23 nurses were collected through in-depth semi-structured interviews during 2015. They were tape-recorded, transcribed verbatim and content analysed., Results: Nurses agreed that accountability, more particularly responsibility, was crucial to nursing professionalism. However, they perceived the demands for transparency and answerability as unjustified. Bedside nurses held this view more than nursing managers. Still, accountability was not considered an integral organizational norm but the choice of each nurse and his or her assessment of risks or benefits of acting accountably., Conclusions: Nurses' individual accountability was insufficient to generate accountability behaviours. They tended to weigh up the unit's accountability level in gauging risks and benefits before acting accountably. Risks of accountability behaviour included isolation, resistance and bullying, while benefits included professionalism, empowerment and pride., (© 2016 John Wiley & Sons Ltd.)

Aim: The aim of this study is to explore ethical dilemmas inherent in two potentially conflicting roles: practising nurse and researcher. Background: Ethical guidelines for practice and research in nursing have been widely discussed. Yet examining ethical dilemmas that emerge from engaging in the dual role of nurse–researcher is rare. Method: A qualitative approach was employed, using semi‐structured interviews with 15 nurse–researchers. Data were analysed using thematic analysis. Results: One theme emerged with three subthemes of nurse–researcher role definitions: primarily nurse, primarily researcher and combined nurse–researcher. Each subtheme had three dimensions: (a) how ethical dilemmas were expressed in encounters with role colleagues, (b) coping strategies and (c) implications for nurse–researchers. Conclusion: Primarily nurses or primarily researchers experienced conflict in encounters with role colleagues, developed less effective coping strategies and reported impaired well‐being. Conversely, combined nurse–researchers said each role nourished the other. Implications for nursing management: Nursing policymakers and managers should support the nurse–researcher role by developing a code of ethics that acknowledges the dual role's inherent dilemmas, assimilate organisational routines and roles that support nursing research and encourage forums for discussing staff dilemmas. [ABSTRACT FROM AUTHOR]

Aim: To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC). Design: A qualitative descriptive design. Methods: Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute‐care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis. Results: A preponderant theme emerged—the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs. [ABSTRACT FROM AUTHOR]

Aims: To understand the distinctive experience and use of strategies of high‐ and low‐resilience nurses aiming to prevent patient falls. Background: Falls among inpatients continue to threaten patient safety in the hospital. Nurses may have the greatest impact on reducing patient falls. However, little is known about whether nurses' personal resilience is associated with patients' fall prevention strategies. Method: The study employed a descriptive mixed‐methods design combining quantitative (questionnaires) and qualitative (observations, semi‐structured interviews). Results: One major theme, from maintaining routine to taking control over patients' falls, and three subthemes, scepticism, anticipation and proactivity representing feelings, cognitions and behaviours characterizing high‐ versus low‐resilience nurses emerged from the findings. Conclusion: Three successive resilience strategies, starting with hunches that elicit scepticism, through cognitions of anticipation the worst‐case scenario that could happen to the patient, and concluding with proactive behaviours characterize resilient nurses, helping them to prevent patients' falls. Implication for Nursing Management: Nursing managers seeking to decrease the devastating rate of patient falls can encourage nurses to have an inquiring mind (scepticism), be alert for the unexpected (anticipation) and take control over the environment (proactive behaviours) to make things happen instead of watching them happen. [ABSTRACT FROM AUTHOR]

Aims: To explore nurses' perspectives regarding the decision-making processes that lead to missed nursing care and to identify the personal and contextual attributes involved in these processes. Design: A qualitative study was undertaken between April - October 2018. Methods: A total of 28 registered nurses working in different wards in hospital settings participated in nine focus groups with semi-structured interviews. An interview guide encouraged nurses to share perceptions of missed care and the personal and contextual attributes shaping their decision-making. Results: Content analysis revealed three themes related to nurses' decision-making processes for whether to omit or delay care. First, nurses emphasized the role of nurses' agency, suggesting explicit or implicit rationing of care, regardless of scarce resources. Second, nurses distinguished between two modes of thinking that they labelled "automated thinking," activated in routine situations and "effortful thinking," initiated in more novel situations. Finally, nurses identified situational factors triggering fluctuations in their awareness such as task type, difficult patients and the presence of relatives and the head nurse. Conclusions: Nurses are aware of the processes guiding a decision to omit or delay care. They pointed to patient, nurse and ward conditions that serve as cues in their decision whether to miss care. Identifying these cues supports Hammond's cognitive continuum theory of decision-making and may serve in the development of training programmes for nurses aimed at limiting the phenomenon. Impact: The study addressed missed nursing care through a decision-making lens. The findings pointed to nurses' agency as shaping decisions about whether to miss care and identified the personal and contextual cues that guide nurses' decisions. These findings call for organizational training programmes encouraging nurses to identify barriers and facilitators of missed nursing care and how to overcome them. [ABSTRACT FROM AUTHOR]

Research into violence against health care staff by patients and their families within the health care services shows a rising frequency of incidents. The potentially damaging effects on health care staff are extensive, including diverse negative psychological and physical symptoms. The aim of this qualitative study was to examine how hospital workers from different professions reacted to patients' and visitors' violence against them or their colleagues, and how they regulated their emotional reactions during those incidents. The research question was as follows: How do different types of hospital workers regulate the range of their emotional reactions during and after violent events? Participants were 34 hospital workers, representing several professional sectors. Data were collected through in-depth semistructured interviews, which were later transcribed and thematically content analyzed. Five themes were revealed, demonstrating several tactics that hospital workers used to regulate their emotions during incidents of violent outbursts by patients or visitors: (1) Inability to Manage Emotion Regulation, (2) Emotion Regulation by Distancing and Disengagement Tactics, (3) Emotion Regulation Using Rationalization and Splitting Tactics, (4) Emotion Regulation via the Use of Organizational Resources, and (5) Controlling Emotions by Suppression. Hospital workers who experienced dissonance between their professional expectations and their emotional reactions to patients' violence reported using various emotion regulation tactics, consequently managing to fulfill their duty competently. Workers who did not experience such dissonance felt in full control of their emotions and did not manifest responses of emotion regulation. Others, however, experienced intense emotional flooding and failed to regulate their emotions. We recommend developing health care staff's awareness of possible emotional implications of violent incidents, for themselves as people and for their intact functioning at work. In addition, we recommend further development of health care staff training programs for coping with violent patients and enhancement of formal and informal organizational support. [ABSTRACT FROM AUTHOR]

Aims and objectives In this study, we aimed to understand how nurses manage handovers at shift change and to identify the working strategies they employ to maintain patients' safety. Background Nursing handovers at shift change are potentially hazardous for patients' quality of care. The nurses on the outgoing and incoming shifts need accurate understanding of the patient's current state, under circumstances that are frequently turbulent and time constrained. Design Qualitative study. Method Eighteen nurses working in a central Israeli hospital participated in the study. Data were collected through in-depth semi-structured interviews, conducted over a 10-month period in 2011-2012. The interviews were tape-recorded and transcribed verbatim. Content analysis method was used. Results We revealed three interrelated themes: (1) Adaptation of declared handover goals to goals, which better fit the day-to-day routine of the ward; (2) Contextual turbulent circumstances, and (3) Strategies to optimise care for patients. Nurses on the outgoing shift developed organising strategies, ensuring efficient transmission of all important information; nurses on the incoming shift used cross-checking strategies to verify the accuracy of the received information. Conclusion A nursing handover is both vulnerable and resilient, given its imposed constraints. The handover should be restructured, assuring resilience in patients' care while also limiting the risk for vulnerability. Relevance to clinical practice Handover should be restructured so that it creates opportunities to cross-check the information against as many sources of information as possible. During handover, special time should be devoted to reading written reports and notes, preferably when the outgoing nurses are still on the ward or are accessible via e-mail or telephone. Team discussions should focus on achieving agreement about the order and manner of delivering concise information and facilitating shared understanding and trust among nurses. [ABSTRACT FROM AUTHOR]

Aims To describe the quality and scope of patients' participation in the handover process, in relation to their personal attributes (the big-5 model of personality) and the handover encounter's characteristics (presence of the head nurse, escorts, ward overload-namely nurse-patient ratio). Background The scant research, previously addressing patient participation during a nursing handover, generally indicated that there is stillroom for improvement. Design A quantitative and qualitative cross-sectional design. Method During 2012-2013, we collected data on 100 handovers in five surgical wards. Data on factors of the handover encounter were collected through structured observations of the event and data on personality attributes and demographics were assembled through validated questionnaires; we content-analysed transcriptions of the handover's verbal content for typical content, frequency and quality of the communication. Findings Patient participation proved bi-directional, consisting of patient's initiative and nurse's initiative. Whereas patient's initiative improved when the head nurse and escorts were present and the unit was less loaded, nurse's initiative was facilitated by the presence of escorts and less overload. As for personality attributes, whereas patient's imitative improved with patient's high neuroticism, high agreeableness and low openness to experience, nurse's initiative decreased with patient's high neuroticism, extraversion and conscientiousness. Conclusion Findings illustrated the different communication preferences of patients with different personal attributes, as well as the different approaches by nurses to each of these different personalities. Nurses should be taught about communication and ways to engage patients during handover. Patients' education is also warranted including how and when to approach the different caregivers. [ABSTRACT FROM AUTHOR]

Psychiatric patient assaults on staff are a serious problem, affecting staff, patients, and organizations. To understand the etiology of aggressive events, researchers have documented characteristics of aggressive patients, their victims, and to a lesser degree, the patient–provider interaction. Missing in the literature is how staff’s different perceptions of aggressive incidents might impact their reactions. In this study, we conducted in-depth, semistructured interviews with 11 health care professionals working in a psychiatric ward in one Israeli psychiatric hospital. Through content analysis, we revealed two main themes: patients’ and providers’ controllability over patients’ aggression. From the intersection of these two themes, four prototypes of the aggressive encounter emerged: the power struggle, the therapeutic encounter, inverse power relations, and victim-to-victim encounters, each distinctively characterized by different emotional, cognitive, and behavioral responses. We discuss our findings in light of attribution theory, which carries important theoretical and practical implications for handling aggression. [ABSTRACT FROM PUBLISHER]

In examining whether a leader's professionalism implies more or fewer helping behaviors for followers, this study designed a model integrating attributional theory explanations with professionalism to predict helping behaviors. Four distinct helping behaviors were conceptualized: supporting, motivating, referral, and rejection. Qualitative methods used in the study consisted of content analysis of interviews with 12 superiors at healthcare organizations concerning their means of helping staff, and the circumstances. Quantitative data were gathered by an experimental design in which four case studies were presented to each of 171 healthcare superiors, who were asked to deal with a distressed staff nurse whose stability and controllability of the distress were rated either high or low. Superiors' professionalism was assessed. Results indicated that the relationship between professionalism and helping was complex, and critically dependent upon the type of helping behaviors provided, the help provider's professionalism, and attributions of the help seeker's controllability and stability. The qualitative and quantitative results favor attribution explanations, and imply that highly professional superiors provide higher levels of supporting, motivating, and rejecting helping behaviors as means to maintain professionalism of staff. [ABSTRACT FROM AUTHOR]