Advocating for LGBTQ+ older adults: a review of the role of executive nurses

Over the past four decades, the number of people aged over 60 years has increased worldwide, and within this population there has been a proportional increase in people with diverse sexual orientations and gender identities. Executive nurses have an important leadership role in challenging heterocisnormative care practices in healthcare environments that affect the well-being of older adults who are lesbian, gay, bisexual, transgender, queer or questioning and others (LGBTQ+). This article reports on the findings of a secondary analysis of data extracted from an earlier scoping review to provide recommendations for executive nurses on how to advocate for LGBTQ+ older adults and create safe and inclusive healthcare environments for them.

Bio-behavioural research in a rare disease population: a doctoral student's experience

BACKGROUND

Novice researchers who aspire to contribute to the body of knowledge concerning rare diseases face unique challenges in developing and conducting studies. These include unknown effect sizes in previous research, limitations in recruitment and enrolment, and managing data from a multi-site sample.

AIM

To describe the challenges in researching rare diseases and possible solutions using a doctoral student exemplar from a cross-sectional correlational study of fatigue.

DISCUSSION

The authors discuss the lessons learned from the study, including the challenges in recruitment, communication, collecting biological data and managing data in general. They posit possible solutions, including improving multi-site coordination, feasible methods for exploring sleep and stress, and measures to prevent equipment and data loss.

CONCLUSION

Rare populations, such as young survivors of childhood brain tumours, deserve a voice in building the body of knowledge needed for more precise, personalised healthcare. It is possible with foresight for the novice researcher to make such a contribution.

IMPLICATIONS FOR PRACTICE

Improved knowledge and assessment of symptoms during childhood will improve the detection of health risk factors and enable earlier intervention.

Expanding the emergency nurse role to meet demand: nurse and physician perspectives

BACKGROUND

Emergency departments (EDs) in New Zealand are experiencing growing demand because of rising attendances, and this is having a negative effect on patients, staff and organisations. The expansion of traditional nursing roles is one solution that has been explored internationally to ameliorate the adverse effects of increasing patient attendances.

AIM

To explore the attitudes of registered nurses and physicians employed in emergency medicine towards an expanded role for registered nurses in the ED setting.

METHOD

A mixed-methods approach was adopted, in which data were collected in two phases, using interviews and questionnaires. Semi-structured, face-to-face interviews were held with clinical and non-clinical staff employed in emergency medicine, and questionnaires were distributed to 140 physicians and nurses employed in one ED. The data were analysed to identify themes and to determine the differences between nurse and physician respondents.

FINDINGS

Ten ED staff were interviewed, including non-clinical managers (n=4), physicians (n=2) and nurses (n=4). Analysis of the interviews identified five themes: driving change; expanded nurse role; optimal environment; facilitating change; and optimising outcomes for patients. A total of 70 questionnaires were returned, with 63 from nurses and seven from physicians. Nurse respondents were more supportive than their physician colleagues of the need to expand the nursing role in the ED.

CONCLUSION

The existing New Zealand nursing scope of practice has the capacity to develop roles, with nurses supporting this change more than physicians. If role expansion is undertaken, serious consideration needs to be given to developing clear professional boundaries to maintain patient safety and department flow.

Nursing students' perspectives on observed weight bias in healthcare settings: A qualitative study

BACKGROUND

Weight bias continues to be problematic within the healthcare setting among practicing healthcare providers (HCPs). These HCPs serve as influential role models for nursing students when immersed in the clinical environment. However, if HCPs are demonstrating bias toward patients with obesity, this may influence nursing students' beliefs and practices.

AIMS

This study aimed to explore nursing students' reflections of observed weight bias within the healthcare setting.

MATERIALS & METHODS

A descriptive qualitative study design was used involving reflective journaling and qualitative content analysis. Two cohorts of third-year baccalaureate nursing students (n = 197) participated in weight sensitivity training and submitted reflective journals over one academic semester.

RESULTS

Reports of weight bias were categorized into three themes-(1) Direct Impact: Observed Implicit and Explicit Provider Weight Bias; (2) Indirect Impact: Weight Bias Due to Skills, Equipment, or Staffing/Environmental Deficits; and (3) Reactions toward HCP Weight Bias: Conflict Between Weight Bias Training and Real-World Healthcare Experiences.

DISCUSSION

Weight bias was observed in some HCPs within the healthcare setting. Student reflections explored weight bias and the opposing messages between weight sensitivity training and real-world practices.

CONCLUSION

Preventing bias through continuing education for HCPs is crucial to provide compassionate care and instill ethical values in the next generation nurses.

The Fifth International Survey of Critical Care Nursing Organizations: Implications for Policy

Purpose

To examine the activities, concerns, and expectations of critical care nurses and professional critical care nursing organizations worldwide.

Design

A descriptive survey methodology was used. This study is the fifth worldwide quadrennial review of its type to monitor variations in critical care nursing needs and provide robust evidence to inform policy related to critical care nursing practice.

Methods

The fifth World Federation of Critical Care Nurses international survey of critical care nursing organizations was emailed to potential participants from countries with critical care nursing organizations or known critical care nurse leaders. Data were collected online. Responses were entered into SPSS version 23 software (IBM Corp., Armonk, NY, USA) and analyzed by geographical region and national wealth group.

Findings

Eighty‐two national representative respondents participated in the survey, of whom two thirds (n = 56, 68%) had an established critical care nursing organization in their country. The five most important issues identified were working conditions, teamwork, staffing levels, the need for formal practice guidelines and competencies, and wages. The top five critical care nursing organization services that were considered to be of most importance were professional representation, as well as provision of workshops and education forums, national conferences, practice standards and guidelines, and local conferences. The most important contributions expected from the World Federation of Critical Care Nurses were standards for clinical practice and professional practice, international conferences, professional representation, and study and education grants.

Conclusions

The results highlight priority areas for critical care nursing and reinforce the need to address factors that can inform critical care nursing policy and practice. Results of this survey should be incorporated into strategic action plans at the national and international levels.

Clinical Relevance

Nursing leaders, policymakers, and other interested stakeholders should consider these findings when planning critical care workforce requirements. Interested parties should work collaboratively to inform recommendations for further policy and action.

Reflecting on nursing practice during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant challenges for nurses, both professionally and personally. In these unprecedented times, new opportunities to reflect on practice have emerged. Through reflection, whether individually or with others, nurses can explore areas of their practice that could be developed and improved. This article outlines the types of reflection and discusses its benefits and challenges, explaining how it is linked to nurses' regulatory revalidation processes. It also details various models and activities that nurses can use to reflect on their practice during the COVID-19 pandemic and beyond.

Using change management to implement barcode medicines administration technology

Confirming the patient's identity is one of the most important elements in medicines administration, with research showing that medication errors are one of the most common sources of harm caused to patients. This article discusses the implementation of a barcode medicines administration system using two change management models. A complex project such as the implementation of barcode medicines administration technology, requires staff engagement at all levels. The adoption rates of the new workflow patterns in this project showed the benefits of using various change management models during different phases of a project. The project also demonstrated how nurse leaders must use a range of resources to effectively implement a new project.

A day in the life of an advanced clinical practitioner in older people's care

Advanced clinical practitioners (ACPs) are master's-level educated, experienced and competent nurses or allied healthcare professionals who practise a high degree of autonomy and undertake complex decision-making. This article offers a reflective account of advanced clinical practice in an older person's unit specialising in rehabilitation and complex discharge planning. It illustrates how ACPs work autonomously with medical colleagues to provide patient-focused care, enhance the multidisciplinary team and provide safe, high-quality care. The article also describes various aspects of the role for nurses or allied healthcare professionals who might consider this career path.

Imposter syndrome- why is it so common among nurse researchers and is it really a problem?

BACKGROUND

Imposter syndrome is common among early career nurse researchers and often has a considerable impact on those affected. It can cause various problems, including anxiety, self-doubt and feelings of inadequacy, and therefore has significant potential to adversely affect personal and professional development.

AIM

To critically explore the concept of imposter syndrome among early-to-mid career nurse researchers.

DISCUSSION

There may be several reasons why imposter syndrome is common among nurse researchers. Evidence suggests it is ubiquitous in other academic disciplines across the higher education sector, particularly in early-to-mid career researchers. It is unclear how or why nurse researchers are affected by this phenomenon, and whether feeling like an imposter is problematic in this context.

CONCLUSION

Imposter syndrome can be deeply unsettling, particularly at times of specific exposure or peer review. It is relatively normal for even the most experienced, successful researchers to feel like this. Related feelings of self-doubt and critical self-reflection are essential in appropriate measures to research and can reduce researchers' potential for making significant mistakes.

IMPLICATIONS FOR PRACTICE

When managed appropriately, imposter syndrome can be important in scholarly activity and ongoing personal and professional development. Recognising this is an important first step in mitigating related feelings of inadequacy.

Treating buckle fractures in children with a soft cast and home removal: a quality improvement initiative

Buckle fractures of the distal radius are unique to children and a frequent presentation in the emergency department (ED). In University Hospital Waterford, Ireland, the treatment of buckle fractures followed the traditional method involving a rigid cast and a follow-up hospital appointment. However, the latest literature indicates that buckle fractures are stable and heal without complication, so a minimalist approach to treatment is recommended. Therefore, the advanced nurse practitioners in the ED introduced a change in protocol at the hospital. This involved the use of a soft cast for removal at home, with verbal and written discharge information and no follow-up appointment. An audit was conducted to ensure that this new protocol was safe and effective, and the time and distance saved by patients through avoiding a return hospital visit was estimated. Treatment in a soft cast with verbal and written discharge information revealed a successful outcome for all 88 patients included in the audit. Avoiding return hospital visits resulted in significant travel time and distance savings for patients and families.

Professional intimacy in nursing practice: A concept analysis

AIM

This paper provides a critical analysis of the concept of professional intimacy in nursing practice.

BACKGROUND

Professional intimacy is a key attribute to the therapeutic nurse-patient relationship. However, there is a lack of clarity on the concept from a nursing perspective and little research has been done to explore the multiple dimensions of professional intimacy. Because of this, there is tentativeness in enacting and openly discussing this concept.

DESIGN

The concept analysis approach of Walker and Avant (2011) was used to guide this manuscript.

REVIEW METHODS

The eight steps described by Walker and Avant (2011) were implemented to identify antecedents, defining attributes, empirical referents, and consequences of professional intimacy using the literature published both historically and currently.

RESULTS

The review identified 11 articles and based on analysis of the included articles, professional intimacy is the therapeutic relationship between a nurse and a patient that fosters closeness, self-disclosure, reciprocity, and trust at physical, psychological, and/or spiritual levels.

CONCLUSION

This concept analysis shows that professional intimacy influences nursing satisfaction and promotes optimal patient outcomes. Nurses need to recognize that professional intimacy does not involve a crossing of professional boundaries and is vital to quality care.

Understanding the role of spirituality in providing person-centred care

An awareness of the concept of spirituality is integral to the provision of person-centred holistic care. However, the nurse's ability to provide spiritual care is often impeded by time pressures and the prioritisation of clinical tasks. Confusion about the meaning of spirituality and its relationship to religion may also compound the challenges involved in providing spiritual care, and nurses often feel ill-equipped to address this area of care. This article discusses the challenges associated with the concept of spirituality, and describes the competencies and personal qualities that nurses require to achieve spiritually competent practice. It also explains the concepts of availability and vulnerability, which can support the personal development required for nurses to become spiritually competent.

Management of cardiac arrest following blunt trauma: a critical evaluation of resuscitative thoracotomy

Survival rates in patients who sustain cardiac arrest following blunt trauma are suboptimal. Although resuscitative thoracotomy is advocated for managing patients who present with penetrating trauma, its use in blunt trauma is controversial because it has been consistently shown to produce suboptimal outcomes. This article examines some of the challenges associated with decision-making regarding the management of patients with cardiac arrest following blunt trauma, critically evaluates the role of resuscitative thoracotomy and considers some novel interventions that may provide clinicians with alternative management options.

Effective drain care and management in community settings

The literature indicates that drain monitoring is a frequently undervalued aspect of patient care, and that the drain care provided is often inconsistent and inadequate. There are numerous potential implications of suboptimal drain care for patients, nurses, teams and healthcare organisations. Since acute care is increasingly being delivered in the community, there is a greater need for nurses to have an understanding of effective drain care. This article describes the rationale for drain insertion and its associated complications. It uses a case study to illustrate how suboptimal drain monitoring and documentation can negatively affect patient care and safety. This article also discusses several important issues raised in the case study, such as suboptimal documentation, and how these may have consequences for nurses, teams and healthcare organisations. Recognition of these elements supports initiatives that nurses could apply to practice to reduce the occurrence of similar incidents.

Promoting and supporting healthy eating among nurses

Maintaining a healthy diet is important for health and longevity. Many diets are recommended for their health-promotion properties. Despite their role in providing health education to patients, nurses do not always maintain healthy diets themselves. The literature shows that a significant number of nurses are overweight or obese. This article reviews the recommended healthy eating guidance and explores why nurses may not always eat healthily. It appears that several characteristics of the nursing role and workplace - notably shift work, fatigue, stress, and suboptimal facilities and availability of healthy foods - make it increasingly challenging for nurses to maintain healthy diets. The article also discusses strategies employers can use to adapt the work environment to support healthy eating.

Effective nurse leadership in times of crisis

The emergence of coronavirus disease 2019 (COVID-19) has meant that nurse leaders need to respond rapidly and decisively to the demands and challenges of a pandemic in a context of increased staff shortages and limited resources. This article suggests essential leadership skills and characteristics that nurses can use to underpin effective leadership in a crisis, emphasising the importance of decision-making and emotional intelligence. It also addresses two important questions: 'what do leaders in a crisis need to do that differs from any other time?' and 'what does effective leadership look like in a crisis?'

A preceptorship toolkit for nurse managers, teams and healthcare organisations

The transition from student to newly qualified nurse can be challenging. A period of preceptorship is recommended to support newly qualified nurses in their new work environment, and to give them time to adapt and gain confidence. Researchers have developed a toolkit based on previous research that contains several resources that nurse managers, teams and organisations can use to develop and improve preceptorship for newly qualified nurses. The toolkit includes an organisational support tool, a managerial support framework, a supernumerary time tool and a local culture of support tool. This article describes these resources and gives an example of how the toolkit can be adapted locally.

Nurses' attitudes towards caring for people with dementia in acute hospital settings: a literature review

People with dementia are often admitted to acute hospital settings and it is essential that nurses recognise their complex needs. However, research shows that this patient group often experiences suboptimal care in acute hospital settings as well as increased mortality rates. This article reports the findings of a literature review into the attitudes of nurses who care for patients with dementia in acute hospital settings. It sets out the findings under four themes: the unworthy patient, safety before care, breaking routines and knowledge in dementia care. These themes detail nurses' negative attitudes towards these patients, but also identify that a person-centred approach can support more positive attitudes. The review concludes that acute hospital nurses require education about caring for people with dementia to foster more positive attitudes. Also, there is a need for further research into why nurses hold various attitudes to people with dementia and the association between these attitudes and care outcomes.

Understanding and applying personality types in healthcare communication

Understanding personality types can assist nurses in enhancing their understanding of themselves and their colleagues, which in turn can support effective communication. This article outlines the principles of the Myers-Briggs Type Indicator (MBTI) - a personality inventory that aims to improve the understanding of psychological types - and details the characteristics of the MBTI's 16 different personality types. The article explores how these 16 personality types can influence communication within healthcare teams and between healthcare professionals. It also discusses how these personality types affect styles of nurse leadership and how an understanding of personality types can improve nurses' communication with patients.

Should we use preceptorships in undergraduate nursing education?

BACKGROUND

Clinical learning experiences are the cornerstone of undergraduate nursing education as they allow students to apply theory to practice and help them develop as competent practitioners who are prepared for the realities of diverse, complex, and ever-changing practice environments.

PROBLEM

The traditional clinical teaching model, where small groups of students work with educators who are on-site facilitating learning, has numerous issues and thus there have been calls for reform. This Creative Controversy focuses on one reform option, the alternative clinical teaching model of preceptorships, which has gained popularity in recent years.

APPROACH

Current evidence surrounding preceptorships in undergraduate education was examined and critiqued.

CONCLUSION

Despite their popularity, there is a lack of robust evidence surrounding preceptorships and the motivations for using this model remain questionable. Future study is needed so preceptorships are implemented according to evidence-based teaching practices and not clouded by inappropriate motivations. The author challenges readers to question their practices and work to positively contribute to the science and practice of nursing education.

'This Is Not a Patient, This Is Property of the State': Nursing, ethics, and the immigrant detention apparatus

This paper opens with first-hand accounts of critical care medical interventions in which detainees, in the custody of U.S. Immigration and Customs Enforcement (ICE), are brought to the emergency department for treatment. This case dramatizes the extent to which the provision of ethical and acceptable nursing care is jeopardized by federal law enforcement paradigms. Drawing on the scholarship of Michel Foucault and Giorgio Agamben, this paper offers a theoretical account of the power dynamics that inform the health care of patients who find themselves caught in the custodial scaffolding of a vast immigration and detention apparatus. It offers an analysis of the display of sovereign and biopolitical power over the lives (and deaths) of detainees (Foucault), as well as the ways these individuals are reduced to "bare life" under the political pretext of an emergency or "state of exception" (Agamben). Our purpose here is both theoretical and practical: to better understand the often hidden agency or impersonal "will" exercised by the immigrant detention system, but also to equip clinicians in these and cognate facilities (e.g., prisons) with the critical tools by which they might better navigate incommensurable paradigms (i.e., care vs. custody) in order to deliver the best care while upholding their ethical duties as a care provider. This is all the more pressing because hospitals are not sanctuaries and given the incursion of federal law enforcement agents, nurses may find themselves conscripted as de facto agents of the state.

Advanced ophthalmic nurse practitioners: the potential to improve outcomes for older people with cataracts

An ageing population has led to a substantial increase in the prevalence of visual impairments, which can compromise lifestyle, health and general physical and psychological well-being. Age-related cataracts can have a negative effect on older people's quality of life but can be corrected by surgery. It is imperative that older people have access to cataract surgery and, given government objectives of NHS efficiency gains, advanced level nurse practitioners have the potential to increase capacity for and access to cataract surgery. This article outlines the aetiology of cataracts, developments in ophthalmic nursing and the broadened scope of practice of advanced ophthalmic nurse practitioners (AONPs). It explores how the AONP is well-placed to provide high quality care to the older person who requires cataract surgery. Professional drivers for role development are explored in relation to older people.

Exploring the challenges of using electronic health record systems in nursing research

BACKGROUND

Electronic health records (EHRs) provide an interesting potential data set for nursing research. However, they can present challenges when collecting data, as EHR systems are not designed with research in mind.

AIM

To present an example of collecting data using EHRs that was conducted as part of a study of the role of the school nurse in safeguarding children.

DISCUSSION

Data were successfully obtained from EHR systems to understand school nursing caseloads and interventions with vulnerable children and young people. Major limitations included variances in EHR systems, such as different nomenclature for interventions. These limitations were addressed by reviewing organisational guidance on record-keeping and through a working knowledge of the different EHR systems.

CONCLUSION

Conducting research using EHRs has provided important learning about the potential of this type of data and the promise they hold for future research.

IMPLICATIONS FOR PRACTICE

Organisations willing for existing data to be used in research might consider embedding pathways for collecting data that are easy for potential researchers to navigate. EHR systems need to be sensitive to research, but not at the expense of efficiency in clinical practice.

The use of faculty policy teams for advancing policy advocacy and colleagueship

Policy changes that impact nursing occur at multiple levels. The scope and pace of policy changes make it impossible for one faculty member to fill the role of policy advocate. Faculty are frequently reticent to participate, yet, policy work can be very rewarding for faculty. When engaged in policy advocacy, nursing faculty can be a valuable resource to the university, to legislators, and to other stakeholders. This article discusses the team approach to policy advocacy activity and outlines key steps in the policy process. Strategies for overcoming barriers when merging academic and advocacy responsibilities are identified. An example of a college of nursing faculty policy team that utilized nursing presence and their combined intellectual, social, and political capital is provided. In this example, the policy team influences policy discussions on issues impacting both the university community and citizens throughout the state. The strategies provided and the policy process steps discussed are applicable to policy changes at the local, state, and federal levels. Nursing faculty are positioned to engage students, alumni, practice leaders, and community stakeholders in interdisciplinary and transdisciplinary efforts that influence policy initiatives.

Exploring the knowledge, attitudes and perceived learning needs of formal carers of people with dementia

BACKGROUND

An appropriate level of knowledge, a positive attitude and awareness of learning needs are essential to provide high-quality care to people living with dementia.

AIM

To explore the knowledge, attitudes and perceived learning needs of formal carers of residents living with dementia in one long-term care facility.

METHOD

Questionnaires were sent to nurses and nursing assistants working in one long-term care facility in Malta. A total of 207 completed responses were received from these formal carers. The questionnaire comprised scales: the Alzheimer's Disease Knowledge Scale, the Dementia Attitude Scale and the Dementia Learning Needs Assessment tool.

RESULTS

Formal carers' knowledge about dementia was satisfactory. Increased knowledge was associated with being a nurse and working on a specialist dementia unit. Overall, formal carers' attitudes towards people with dementia were positive. Nurses identified managing behaviour that challenges as the most important learning need, while for nursing assistants it was how to assist family caregivers in coping with Alzheimer's disease. Nurses and nursing assistants considered learning about the use of technology to be the least important learning need. Being a nurse and working in a specialist dementia unit were predictors of better knowledge. Working in specialist dementia units was also a predictor of positive attitudes towards people with dementia.

CONCLUSION

Policymakers should be aware that continued investment in specialist dementia units should be an intermediate and long-term goal because of the projected increase in the number of people living with dementia and the need to ensure these individuals receive optimum care.