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Nurses’ perceptions of the difference they make in the lives of patients and families Den Toom, Sheila Johanna

Abstract

Registered nurses are faced with the task of providing quality nursing care in environments where the workload has increased and resources have diminished. In order to maintain their role in caring for patients and families, it is important that nurses describe the essential services they provide in our health care system because those services are not well understood and often go unrecognized. Narrative inquiry methods were used in this study to gain information and understanding about how nursing practice makes a difference to patients and families. A sample of 12 registered nurses working in critical care areas of a large urban hospital in British Columbia volunteered to participate. Data was obtained through interviews that were audiotaped and transcribed verbatim. Nurses were asked to share stories about how their nursing practice made a difference to patients and families. Four narratives and one sub-narrative made up the findings. The narratives were as follows: 1) Making a difference every day; 2) Going the extra mile; 3) Putting myself in their shoes; and 4) Staying composed in hopeless situations. The sub-narrative was It's not me, I'm part of a team. In the first narrative, nurses' stories were about providing competent routine nursing care ranging from life-saving events to the little things that nurses did that resulted in clear demonstrations of appreciation by patients and families. In the second narrative, nurses' stories reflected how nurses made a difference to patients and families by doing everything in their power to make the hospital experience as positive as possible. In these stories nurses emphasized how they challenged norms, went against hospital policies, and sometimes confronted colleagues and other health care members to ensure patients and families received the care they needed. In the third narrative, nurses' stories of making a difference involved imagining what it was like for their patients and families to be in the hospital. Nurses described how they used this strategy to anticipate what patients and families needed in planning their care. In the fourth narrative, nurses' stories described situations where they provided support to patients and families throughout the dying process by remaining realistic yet positive and always kind. Because nurses stayed composed they were able to focus on ensuring patient and family dignity throughout the grieving process. The sub-narrative revealed stories about how nurses were able to make a difference to patients and families by working as members of nursing teams and health care teams. Findings from this research suggest that autonomous decision-making, along with increased levels of clinical expertise, and knowledge and commitment to work as a member of a team contributed to nurses' abilities to make a difference. The findings suggest important implications to nursing practice, nursing education, and future nursing research.

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