Health Sciences

Aim: To evaluate the maximum number of patients per nurse before quality and safety outcomes deteriorate in medical-surgical settings. Design: A secondary analysis of cross-sectional survey data. Conclusion: The findings provide preliminary evidence in support of minimum nurse-to-patient ratios of 1:4 in British Columbia's medical-surgical areas. Policy-makers and decision-makers should augment minimum nurse-to-patient ratios with other nurse-driven tools and nurse-management staffing methods that provide more flexibility to better meet fluctuating environmental, patient and staffing needs. No patient or public involvement: This study did not include patient or public involvement in its design, conduct, or reporting.

Background Emotional labour (EL) can take a significant toll on nurses’ mental health and well-being and has serious implications for the retention of nurses in the workforce. Nurse educators have struggled to prepare novices to manage EL or find serviceable resources with which to do so within the body of nursing literature, which is dominated by essentially unhelpful narratives and is absent of the practical, real-world wisdom of elder nurses. Purpose This exploratory research study illuminated elder nurses’ experiential knowledge and beliefs of what is important for novices to learn about EL. Methods Conventional Content Analysis (CCA) of qualitative survey data from 688 nurses with 20+ years of experience. Results CCA generated descriptive categories and sub-categories: What the elders themselves learned as student nurses, and their advice to novices in the individual realm, (“It's a Thing,” healthy disengagement, supporting mental and physical well-being, reframing self-reproach), team realm (peer support, mentors), and institutional realm (structural barriers to mentors’ support of novices, building novices’ capacities for self-advocacy, resources to support health and well-being). Conclusions The elders’ data confronted and reframed legacy individuated narratives in the literature by supporting and contextualizing nurses’ emotional work. Elders advised novices that EL is a reality requiring concrete strategies to manage it throughout their practices. Elders extended their focus for management of EL beyond the individual to include peer support, mentorship, and the structural conditions in which nurses perform their EL, highlighting the need to empower nurses by building their capacity for self-advocacy of their workers’ rights.

Acetaminophen is a widely used analgesic that can cause acute liver failure when consumed above a maximum daily dose. Certain patients may be at increased risk of hepatocellular damage even at conventional therapeutic doses. We report a case of a 34-year-old man on carbamazepine for complex partial seizures who developed acute liver and renal failure on less than 2.5 grams a day of acetaminophen. This raises caution that patients on carbamazepine should avoid chronic use of acetaminophen, and if required use at lower doses with vigilant monitoring for signs of liver damage.

Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. [ABSTRACT FROM AUTHOR]

When nurses have problems with substance use and are reluctant to seek treatment, their health and wellness are put at risk and their care provision to the public is potentially compromised. Nurses’ substance-use problems and their management through professional organizations’ treatment programs are under-researched and poorly understood overall, and particularly from a Canadian perspective. The disjuncture I experienced between my own embodied experiential knowledge as a nurse and the conceptually based, decontextualized, individuated “official accounts” of the issue I found in the professional and scholarly literature became the problematic that I explored in a multi-phase, manuscript-based doctoral study. I carried out a critical integrative review of the literature on nurses’ substance-use problems, followed by an institutional ethnographic inquiry, in which I aimed to discover (a) how dominant discourses in nurses’ talk about their everyday worlds organized their substance-use practices and (b) how nurses’ experiences were managed in a regulatory treatment program. I utilized data from interviews with 12 standpoint informants (nurses in a regulatory program for substance-use problems) and six secondary informants from different standpoints in the institution, as well as analyses of relevant institutional texts. This work yielded significant original findings. Dominant individuated, moralistic, decontextualized discourses in nurses’ talk about their everyday worlds and in professional and scholarly texts silenced nurses’ experiences of work stress. Employers’ roles in nurses’ working conditions were obscured. Nurses’ substance-use practices, particularly alcohol, were organized in ways that enabled them to silently manage their distress and keep working. Nurses gaining capacities to self-advocate for improved working conditions was linked to their recovery from substance-use problems. The standardized regulatory treatment program studied was not based on current norms of practice; did not afford nurses the right to choose treatments; privileged physicians while silencing and subordinating nurses; and was rife with conflicts of interest, power imbalances, and private corporate benefits—all acritically accepted by the regulatory body. The important new nursing knowledge gained informs prevention, treatment, regulatory, and education processes aimed to address nurses’ substance-use problems. It does so from nurses’ everyday knowledge and standpoint, furthering their interests and those of other disciplines concerned with professional power and domination.