Rebuilding and guiding a care community: A grounded theory of end-of-life nursing care practice in long-term care settings

AIMS

To investigate the end-of-life (EOL) nursing care practice process in long-term care (LTC) settings for older adults in Japan.

DESIGN

A qualitative study based on grounded theory developed by Corbin and Strauss.

METHODS

Sampling, interviewing, and analysis were performed cyclically, with results for each stage used as the basis for data collection and next-stage analysis decisions. Semi-structured interviews were conducted from March 2015-March 2019 with 22 nurses from eight LTC settings. Analysis was performed using coding, constant comparison, and emerging categories.

RESULTS

The core category, "guiding the rebuilt care community to assist the dying resident" comprised five categories: "assessing the resident's stage," "harmonizing care with the dying process," "rebuilding a care community," "helping community members care for the resident," and "encouraging community members to give meaning." The participants were described as "traditional village elders" who were the integral members of the care community, as well as guides who helped and encouraged the community.

CONCLUSION

Results revealed the holistic process of EOL nursing-care practice in Japan. Nurses aimed to allow LTC residents to die as social human beings, surrounded by people, and not just responding physical and psychological distress. Such practice requires nursing expertise, healthcare skills, and leadership qualities to build and serve care communities. Nurses must also consider residents' uncertainties and vulnerabilities as well as their cultural backgrounds.

IMPACT

This study showed that the nurses hold unique roles in providing dying people with care from a community. These findings can potentially be applied for developing a universal model for LTC nurses in many aging populations, to modify their EOL care practice, educate new LTC nurses, and collaborate with other healthcare professionals.

End-of-life nursing care practice in long-term care settings for older adults: A qualitative systematic review

AIM

To synthesize qualitative evidence on nurses' end-of-life care practices in long-term care settings for older adults.

BACKGROUND

Qualitative evidence on how nurses describe their own end-of-life care practice has not been reviewed systematically.

DESIGN

Qualitative systematic review.

DATA SOURCES

Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese.

METHODS

The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta-aggregation.

RESULTS

Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork.

CONCLUSION

Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end-of-life care that ensures residents die with dignity.

Exploring sociodemographic factors related to practice, attitude, knowledge, and skills concerning evidence-based practice in clinical nursing

AIM

This study aimed to explore sociodemographic factors related to evidence-based practice (EBP) competency in Japanese nurses in university hospitals.

METHODS

In March 2016, a survey was distributed to 843 clinical nurses who directly provide nursing care at two university hospitals in Japan. Multiple regression analyses were conducted on data received from 472 nurses using the Evidence-Based Practice Questionnaire (Japanese version).

RESULTS

Sociodemographic factors related to EBP competency were experience with conducting nursing research as a part of continuing education, education about EBP, advanced practice certification (certified nurse specialists/certified nurses), and years of experience in clinical nursing. These factors differed across the four subscales of the questionnaire: Practice, Attitude, Knowledge of Research and Practice, and Skills of Research and Practice. Specifically, experience with two or more nursing research activities was significantly positively associated with Attitude and Knowledge/Skills Concerning Research and Practice of EBP, but not related to the implementation of EBP itself. Advanced practice certification was significantly positively associated with Practice and Attitude of EBP.

CONCLUSIONS

Our study quantitatively identified sociodemographic factors including experience with conducting nursing research and advanced practice certification status that were found to be related to EBP competency and these factors were differently associated with the four subscales of the Evidence-Based Practice Questionnaire (Japanese version). EBP education should depend on nurses' levels of EBP competency, and nursing educators and managers need to be cognizant of their nurses' sociodemographic factors when providing EBP education.

Factors associated with depressive symptoms in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A prospective cohort study

AIM

To identify the association between possible factors and depression among post-percutaneous coronary intervention patients with acute coronary syndrome.

DESIGN

Prospective cohort study.

METHODS

Sixty-eight post-percutaneous coronary intervention patients with acute coronary syndrome were enrolled between January 2016 - June 2017. The Hospital Anxiety and Depression Scale scores at 1-3 months after discharge were regressed onto uncertainty in illness and other clinical factors based on the Roy Adaptation Model.

RESULTS

Thirty-six patients were included in the final analysis. Higher baseline depression scores, higher changes in uncertainty in illness and feeling annoyed by troublesome tasks after discharge were associated with higher depressive scores at 1 month after discharge. Careful observation and support of patients' ineffective responses in self-concept mode may be effective in preventing depression.

The development and validation of the Evidence-Based Practice Questionnaire: Japanese version

AIM

To develop and test the validity and reliability of a Japanese version of the Evidence-Based Practice Questionnaire.

METHODS

The Evidence-Based Practice Questionnaire was translated into Japanese, and a back-translation was performed. In March 2016, the survey was conducted among 843 nurses in 2 university hospitals in Japan. After 2 weeks, the same questionnaire for test-retest reliability was distributed to 197 nurses. We evaluated construct validity by factor analysis: convergent, discriminant, criterion-based and known-group validity, and reliability (internal consistency via Cronbach' alpha and test-retest reliability).

RESULTS

A total of 533 (66%) of nurses who agreed to our study returned the completed questionnaire, and 108 nurses (55%) agreed to the test-retest. Factor analysis confirmed that the original model of the Evidence-Based Practices Questionnaire was not statistically appropriate for Japanese nurses. Therefore, the final version of the Japanese version adopted 18 items and 4 subscales including practice, attitudes, and knowledge/skills related to research and practice. In the final version, the validity and reliability were moderate (Cronbach alpha = .90).

CONCLUSION

The Japanese version of the Evidence-Based Practices Questionnaire is a reliable and valid tool and can be used to assess evidence-based practice, attitudes, and research knowledge/skills in Japan.

Nurse managers' attributes to promote change in their wards: a qualitative study

Aim

The aim of this study was to explore the processes that nurse managers use to promote change in their wards.

Design

Qualitative research.

Methods

A grounded theory approach was used. Participants were 23 nurse managers and 17 nurses in Japan. Interviews were conducted between March 2014 – December 2015. Mainly, nurse managers’ data was analysed.

Results

The change process led by the nurse managers was depicted as a four‐phased process of “having beliefs and empathizing with staff nurses to achieve goals explored by self.” Four attributes of nurse managers, “having both micro and macro perspectives,” “respecting own beliefs and external standards,” “being proactive,” and “having empathy for staff nurses,” were identified as indispensable factors promoting change in their wards.

Nursing administrators should support the cultivation of nurse managers’ attributes for successful change.

Caring for Clients and Families With Anxiety: Home Care Nurses' Practice Narratives

This study elucidated Japanese home care nurses’ experiences of supporting clients and families with anxiety. We interviewed 10 registered nurses working in home care agencies and analyzed the data using grounded theory to derive categories pertaining to the nurses’ experiences of providing care. We conceptualized nurses’ approaches to caring for anxiety into three categories: First, they attempted to reach out for anxiety even when the client/family did not make it explicit; second, they tried to alter the outlook of the situation; and third, they created comfort in the lives of the client/family. The conceptualizations of nurses’ strategies to alleviate client/family anxiety may reflect Japanese/Eastern cultural characteristics in communication and their view of the person and social care system, but these conceptualizations may also inform the practice of Western nurses by increasing awareness of skills they may also have and use.

Predictors of Depression in Patients Diagnosed with Myocardial Infarction after Undergoing Percutaneous Coronary Intervention: A literature review

AIM

This study identified the factors associated with depression in patients diagnosed with myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI).

METHODS

We searched the literature using PubMed and CINAHL from their inception in 1946 to December 2014. The search terms were "myocardial infarction," "depression," and "percutaneous coronary intervention." Studies which investigated factors associated with depression in patients diagnosed with MI who underwent typical medical procedures were searched.

RESULTS

Eleven studies met our inclusion criteria. None of these limited their samples to patients with MI who underwent PCI. Twenty-one factors were identified as possible risk factors for depression in patients who were diagnosed with MI and underwent PCI: gender; negative illness beliefs; neuroticism; autonomy; baseline depression scores; previous diagnosis of depression, anxiety, or stress; smoking; marital status; Type D personality; procedure; length of hospital stay; fat intake; functional disability; time engaged in physical activity; social support; and a history of angina, MI, coronary artery bypass graft surgery, PCI, diabetes mellitus, and stroke.

CONCLUSIONS

This review suggests that these 21 factors should be considered in future studies as possible independent variables or covariates of depression among MI patients who have undergone PCI.

Examining Posttraumatic Growth Among Bereaved Family Members of Patients With Cancer Who Received Palliative Care at Home

OBJECTIVE

The present study examines the factor structure of the Japanese version of the Posttraumatic Growth Inventory (PTGI-J) among bereaved family members who lost loved ones to cancer after home-based palliative care in Japan. It evaluates the relationships between total score, each PTGI-J domain, and participants' having a religious belief, gender, age, relationship to the patient, and time since patient death.

PROCEDURE

Bereaved family members (n = 849) completed the PTGI-J and a demographic questionnaire. The factor structure was tested using confirmatory factor analysis (CFA), and univariate analysis was used to test hypotheses.

RESULTS

Confirmatory factor analysis showed that the current sample moderately fitted to both 4-factor and 5-factor models. Univariate analysis revealed that having a religious belief and gender were associated with all domains and total PTGI-J score. Age, time since patient death, and relationship to the patient showed significant differences with the domains of PTGI-J.

CONCLUSION

Clinicians may be able to adjust the support they provide based on patients' personal characteristics. Future research should look at the mechanisms of PTG by examining the role of rumination, social support, and emotional distress among bereaved family members of patients with cancer.

Posttraumatic Growth Among Japanese Parentally Bereaved Adolescents: A Web-Based Survey

Objective:

The aim of this study was to explore the factors associated with posttraumatic growth (PTG) among adolescents bereaved owing to parental cancer in Japan.

Methods:

An anonymous cross-sectional Web-based survey was conducted, enrolling adolescents bereaved because of parental cancer in the previous 5 years. Posttraumatic growth, number of social support members, support from medical staff, and behaviors after bereavement were measured. Multiple linear regression was performed to explore the association between total PTG score and possible related factors.

Results:

We assessed 57 participants in this study. Mean age was 19.3 (standard deviation [SD] = 2.0) years, and most participants were female (75.4%). Mean total score of the Japanese version of the PTG inventory was 43.0 (SD = 25.6). Participants’ mean number of social support members was 2.1 (SD = 1.3), and these support members were the surviving parent (66.7%), friends (38.6%), and siblings (36.8%). The multiple linear regression model explained 45% of the variance in PTG. In this model, the following 3 behaviors after bereavement were associated with PTG: “putting palms together in front of a parent’s picture or an altar” (β = .36, P = .006), “visiting a parent’s grave” (β = .29, P = .03), and “having fun with friends” (β = .25, P = .04).

Conclusion:

Parentally bereaved adolescents in Japan experience PTG. Specific behaviors after bereavements might be recommended for PTG among Japanese adolescents bereaved because of parental cancer.

Developing an instrument to self-evaluate the Discharge Planning of Ward Nurses

Aims

To develop the Discharge Planning of Ward Nurses (DPWN), a Japanese self‐evaluation instrument for ward nurses' discharge planning practices.

Design

Cross‐sectional survey.

Methods

Participants were 624 ward nurses from six hospitals in Japan with a discharge planning department. Items about discharge planning practices were collected from literature and interviews with nurses and researchers. Construct validity, concurrent validity, internal consistency and test–retest reliability were tested.

Results

Initially, 55 items were collected. Examination of the floor effect, item‐total, good–poor analyses and exploratory factor analysis yielded a four‐factor model with 24 items (‘teaching home‐care skills with community/hospital professionals,’ ‘identifying clients’ potential needs early in the discharge process,’ ‘introducing social resources’ and ‘identifying client/family wishes and building consensus for discharge’). The four‐factor structure was supported by confirmatory factor analysis. The DPWN correlated with scales ascertaining similar concepts, supporting concurrent validity. Internal consistency and test–retest reliability were generally satisfactory.

How nurse managers in Japanese hospital wards manage patient violence toward their staff

AIM

This study explores nurse managers' experiences in dealing with patient/family violence toward their staff.

BACKGROUND

Studies and guidelines have emphasised the responsibility of nurse managers to manage violence directed at their staff. Although studies on nursing staff have highlighted the ineffectiveness of strategies used by nurse managers, few have explored their perspectives on dealing with violence.

METHODS

This qualitative study adopted a grounded theory approach to explore the experiences of 26 Japanese nurse managers.

RESULTS

The nurse managers made decisions using internalised ethical values, which included maintaining organisational functioning, keeping staff safe, advocating for the patient/family and avoiding moral transgressions. They resolved internal conflicts among their ethical values by repeating a holistic assessment and simultaneous approach consisting of damage control and dialogue. They facilitated the involved persons' understanding, acceptance and sensemaking of the incident, which contributed to a resolution of the internal conflicts among their ethical values.

CONCLUSIONS

Nurse managers adhere to their ethical values when dealing with patient violence toward nurses. Their ethical decision-making process should be acknowledged as an effective strategy to manage violence.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisational strategies that support and incorporate managers' ethical decision-making are needed to prevent and manage violence toward nurses.

Cross-sectional online survey of research productivity in young Japanese nursing faculty

AIM

To investigate the factors affecting the research productivity of young nursing faculty in Japan.

METHODS

An online survey targeting young nursing scholars (aged ≤ 39 years) who were members of the Japan Academy of Nursing Science was conducted from October to November 2012. Of 1634 potential respondents, 648 completed the survey (39.7%), and 400 full-time faculty of a baccalaureate degree program were selected for the analysis. The numbers of English-language and Japanese publications in the past 3 years were regressed onto personal characteristics, such as academic degree and type of university.

RESULTS

The mean numbers of publications in English and Japanese in the past 3 years were 0.41 and 1.63, respectively. Holding a doctoral degree was significantly related to a higher number of publications in English and Japanese (e(β) = 5.78 and e(β) = 1.89, respectively). Working at a national university (e(β) = 2.15), having a research assistant (e(β) = 2.05), and the ability to read research articles in English (e(β) = 2.27) were significantly related to more English-language publications. Having the confidence to conduct quantitative research (e(β) = 1.67) was related to a larger number of Japanese publications. The lack of mentoring (e(β) = 0.97) and university workload (e(β) = 0.96) were associated with a lesser number of Japanese publications.

CONCLUSION

The research productivity of young nursing faculty appeared to be quite low. Strategies to enhance research productivity in young nursing faculty, such as encouraging the achievement of a doctoral degree or enrichment of research resources, should be undertaken.