Focus groups in nursing research: Methodological perspectives

A Survey of Neonatal Clinicians' Use, Needs, and Preferences for Kangaroo Care Devices

BACKGROUND

Decades of research supports the benefits of kangaroo care (KC) for the parent and newborn. Supportive KC devices may be an important tool clinicians can use to assist parents with KC. In recent years, there has been a rise in the availability of KC devices. However, the use, needs, and preferences for these supportive devices by neonatal clinicians have not been documented.

PURPOSE

To survey clinicians' use, needs, and preferences of KC supportive devices, and examine whether differences exist based on clinician and organizational characteristics.

METHODS

A cross-sectional, online survey was sent through neonatal organization Web sites, conferences, and social media.

RESULTS

Many clinicians (n = 68, 43%; N = 158) facilitated KC with a supportive device, with 81% of devices provided by the clinician's employer. The most important "Must Have" feature of a KC device was "Safety: Reduces patient falls if caregiver sleeps or needs to use hands" (84% of respondents) followed by washability (82%), and "immediate, effective access to the baby" (78%). Clinicians' responses did not differ based on hospital setting, type of unit, KC experience, or experience using a KC device.

IMPLICATIONS FOR PRACTICE

To support safe use of KC devices in neonatal intensive care unit (NICU) clinical care, a device must hold the proper KC position consistently, allow immediate access to the infant, and hold the infant in place without the parent's hands to prevent falls. Training is needed to ensure safe device use.

IMPLICATIONS FOR RESEARCH

Future research should evaluate the safety, efficacy, and cost-effectiveness of these devices.

Needs, issues, and expectations on dementia care at home across Europe to inform policy development: Findings from a transnational research study

This qualitative descriptive study explored needs, issues, and expectations on dementia care at home as expressed by relatives of people living with dementia (PwD), health and social care professionals (HSCPs), and members of civil society organisations (CSOs) from four European countries. A focus group methodology integrated with individual semi-structured interviews was adopted to collect data by employing a purposeful sampling method. A total of 13 focus groups and 12 individual interviews were conducted in 2019, involving 65 relatives of PwD, 32 HSCPs, and 23 members of CSOs. Deductive content analysis and findings triangulation were performed to analyse data, and a subgroup of participants confirmed the findings. Relatives need to be (a) informed and trained to cope with changes in PwD, (b) recognised for their caregiving role, and (c) assisted by specialised HSCPs. Professionals who work in partnership with PwD and their relatives call for a reorganisation of available services. CSOs compensate for the lack of proper support, promoting networks, and cooperation with local communities. Several commonalities emerged across countries, highlighting the chance to inform and develop common policies to improve the quality of life of PwD and their relatives across Europe. Policies improving person- and family-centred care and spreading dementia-friendly community concepts and practices are suggested. Strong collaborations between formal and informal services and communities are also needed as well as information on educational strategies to improve the use of resources, promote PwD care, and support PwD relatives' needs.

Experiences of nursing students under the unprecedented abrupt online learning format forced by the national curfew due to COVID-19: A qualitative research study

BACKGROUND

The unprecedented abrupt shift to remote online learning (OL) within the context of the national lockdown due to the 2019 coronavirus disease (COVID-19) highlights the importance of addressing students' preparedness in managing their first experiences with OL.

PURPOSE

To investigate the experiences of undergraduate nursing students during their first uses of OL to increase the understanding of their encountered opportunities and challenges.

DESIGN

A descriptive qualitative design guided by a phenomenological approach was used.

METHODS

The study used a purposive sampling technique to recruit 18 undergraduate nursing students from two universities. Data were collected using two focus group discussions, and the discussions with participants were audio/video recorded through the online platform Zoom due to the national imposed curfew. Content analysis employed Colaizzi's steps to derive the themes/categories.

RESULTS

The study revealed four themes: experience of helplessness, burdens, and burnout; the need for social and technical support to manage OL; the propensity to consider OL as a positive opportunity; and the deficiency of OL in fulfilling the educational outcomes of clinical courses.

CONCLUSIONS

Abrupt remote OL was a challenge to clinical encounters. This format was very stressful; however, it was also useful. The current study highlighted the need for further research on the effectiveness of remote OL platforms in regard to the achievement of the intended learning outcomes of clinical courses.

Virtual Focus Groups as an Answer to Research During a Pandemic: Implications for Nursing Professional Development

Focus groups are a standard method of qualitative data collection and an excellent method for data collection in nursing professional development. Advances in technology, virtual health care, and the COVID-19 pandemic increase the opportunities to use virtual focus groups for rich data collection. In this perspective article, the authors promote virtual focus groups as an answer to challenging data collection, while exploring ways that privacy and confidentiality can be maintained in an online environment.

Interprofessional Collaboration in a New Model of Transitional Care for Families with Preterm Infants - The Health Care Professional's Perspective

Background

Families with preterm infants find life after hospital discharge challenging and need tailored support to thrive. The “Transition to Home (TtH)”-model offers structured, individual support for families with preterm infants before and after hospital discharge. TtH improves parental mental health and competence, promotes child development and fosters interprofessional collaboration (IPC).

Aim

Evaluate the TtH-models’ structure and implementation process and its associated interprofessional collaboration from the healthcare professional’s (HCP) perspective.

Methods

This qualitative explorative study thematically analyzed four focus group interviews (n=28 HCP) and an open-ended questionnaire with general pediatricians (n=8).

Results

The main themes of the thematic analysis were the benefits of the TtH-model, tailored parental support, the challenges of changing interprofessional collaboration, facilitators and barriers to successfully implementing the model, and feasibility and health economic limits. HCP acknowledge that continuous family-centered care led by an advanced practice nurse (APN) supports, strengthens, and relieves families with preterm infants in the transition from hospital to home. Families in complex situations benefit most. The TtH-model incorporates key aspects of integrated care like shared decision-making, considering family preferences, and defining the APN as the family’s main contact. HCP want network collaboration but found communication, cooperation, and reorganization challenging in the new IPC process. IPC challenges and involving many HCP in family care can create parental oversupply, negatively affect treatment outcomes, and raise health care costs.

Conclusion

These challenges need to be addressed to ensure sustainable implementation of the model. The roles and tasks of HCP should be clearly distinguished from each other, and HCP must have time to learn this new form of IPC. Learning requires time, effective communication strategies, and leadership support. Political action is also required to implement new models of care, including regulating advanced practice roles and developing new financing models.

We are not heroes-The flipside of the hero narrative amidst the COVID19-pandemic: A Danish hospital ethnography

Aim

To explore how the media and socially established hero narrative, affected the nursing staff who worked in the frontline during the first round of the COVID19‐pandemic.

Background

During the COVID19‐pandemic, both media, politicians and the public have supported and cheered on the frontline healthcare workers around the world. We have found the hero narrative to be potentially problematic for both nurses and other healthcare workers. This paper presents an analysis and discussion of the consequences of being proclaimed a hero.

Design

Hospital ethnography including fieldwork and focus groups.

Method

Empirical data was collected in a newly opened COVID19‐ward in a university hospital in the urban site of Copenhagen, Denmark. Fieldwork was performed from April until the ward closed in the end of May 2020. Succeeding focus group interviews with nursing staff who worked in the COVID19‐ward were conducted in June 2020. The data were abductively analysed.

Results

The nursing staff rejected the hero narrative in ways that show how the hero narrative leads to predefined characteristics, ideas of being invincible and self‐sacrificing, knowingly and willingly working in risk, transcending duties and imbodying a boundless identity. Being proclaimed as a hero inhibits important discussions of rights and boundaries.

Conclusion

The hero narrative strips the responsibility of the politicians and imposes it onto the hospitals and the individual heroic health care worker.

Impact

It is our agenda to show how the hero narrative detaches the connection between the politicians, society and healthcare system despite being a political apparatus. When reassessing contingency plans, it is important to incorporate the experiences from the health care workers and include their rights and boundaries. Finally, we urge the media to cover a long‐lasting pandemic without having the hero narrative as the reigning filter.

Medication adherence, self-efficacy and health literacy among patients with glaucoma: a mixed-methods study protocol

INTRODUCTION

As the world population ages, glaucoma is becoming an increasingly significant cause of blindness. A key component in the management of glaucoma is the use of prescribed medications and the adherence to treatment. However, there is evidence of low adherence to prescribed medication in chronic diseases, such as glaucoma. This study aims to explore the level of medication adherence, self-efficacy, social support and health literacy among the patients with glaucoma and to determine if there are any correlations between them. The ultimate aim is to use the information to develop an educational programme for patients with glaucoma at a later stage.

METHODS AND ANALYSIS

This is a mixed-methods study which includes two stages: a descriptive study (stage 1) and focus group discussions (stage 2).

SAMPLE

Patients with glaucoma or ocular hypertension, using at least one kind of drops, from two ophthalmology clinics. Selected measures include: The Glaucoma Treatment Compliance Assessment Tool, The European Health Literacy Survey Questionnaire, The Glaucoma Medication Self-Efficacy Questionnaire and The Multidimensional Scale of Perceived Social Support. Two focus groups will be used for the collection of qualitative data, aiming to enrich the study with the patients' experiences. The data will be analysed with SPSS, using descriptive and inferential statistics for stage 1 whereas content analysis will be used for the data from the focus group discussions (stage 2).

ETHICS AND DISSEMINATION

Permission to conduct the study was received from the National Bioethics Committee and the board of management of the two ophthalmology clinics. All participants will be informed fully on the purpose and methods of the study. Consent forms will be signed and at any time participants will have the right to withdraw. Confidentiality and the protection of data will be respected at all times.

Daily functioning support - a qualitative exploration of rehabilitative approach in acute hospitalised care

OBJECTIVES

Hospitalised patients are at risk of temporary or permanent loss of functioning which impacts their future independence. Implementation of a rehabilitative approach in everyday nursing in the acute care setting may produce good therapeutic results and promote independent daily living of patients. Thus, the aim of the study was to explore and understand the patterns of a rehabilitative approach in acute hospital wards from the perspective of interdisciplinary team members. Specifically, our aim was to identify the factors promoting and preventing a rehabilitative approach.

METHOD

We conducted four focus group interviews with 21 participants, including multidisciplinary team members from acute hospital wards. Data were analysed with conventional inductive content analysis.

RESULTS

The findings highlighted that the rehabilitative approach, as a personal way of working and personal working attitude, was a part of comprehensive nursing. The main goals of the rehabilitative approach were to support the physical functioning of the patients and their independent initiative and individuality during clinical care in hospital ward. The promoting and preventing factors that influenced the development of the rehabilitative approach consisted of personal factors, organisational factors and the physical settings of the hospital wards.

CONCLUSION

The findings of this study indicate that the rehabilitative approach in nursing focused on supporting the physical functioning, independence and self-confidence of the patient. The staff highlighted that interdisciplinary teamwork was one feature of the rehabilitative approach. The rehabilitative approach in nursing should be established as a part of everyday activity in clinical practice.

School Nurses' Perceptions, Learning Needs and Developmental Suggestions for Mental Health Promotion: Focus Group Interviews

School nurses have a key role in promoting the mental health of adolescents at school. However, there is still a lack of comprehensive understanding of the role and experiences of school nurses as they promote mental health at schools. A qualitative research design employing focus group interviews was used. School nurses (n = 21) were purposively sampled from one city in Southern Finland. The data were analyzed using inductive content analysis, resulting in seven categories describing school nurses’ perceptions, needs and suggestions for development of mental health promotion in school health care. School nurses perceived health care at school as a low-threshold service. Mental health problems are often first identified by a school nurse. However, school nurses felt that extra effort is needed to recognise mental health problems, build trusting relationships, and motivate adolescents to attend regular health check-ups. Specific core learning competencies such as communication skills, being present, keeping confidentiality, and the ability to motivate adolescents to regularly visit the school health clinic are needed. However, school nurses often lack basic resources for mental health promotion. The areas of mental health development included cooperation with stakeholders and parents, and development of anonymous, easy-access services. It is important that school nurses have the skills needed and enough resources to fulfil their demanding tasks in school health care services.

Understandings of and experiences with evidence-based practice in practice among nurses in a surgical department: A constructivist approach

AIM AND OBJECTIVES

To explore nurses' constructions of the concept of evidence-based practice through their understandings of and experiences with evidence-based practice in a clinical care setting.

BACKGROUND

The primary purpose of evidence-based practice is high-quality patient outcomes. However, the adoption of evidence-based practice is described as a complex process, and research shows that evidence-based practice is not translated into practice. Research often explores facilitators and barriers of implementing and adopting evidence-based practice. Yet there is limited knowledge on how nurses construct the concept in practice.

DESIGN

This study has a constructivist approach and follows COREQ guidelines.

METHOD

Ten semi-structured interviews with 26 nurses were conducted in 2019. Data were analysed with an emic and inductive approach.

RESULTS

Three key constructions emerged. Understandings of evidence-based practice were based on the original concept of evidence-based medicine. This included the hierarchy of evidence which was perceived as an inflexible concept not encompassing the nursing care. However, while not using the term evidence-based practice, the nurses were doing evidence-based practice portrayed through outcomes from management-supported nursing-based projects and incorporated reflections and discussions into weekly meetings. A discrepancy between a theoretical understanding and a practical doing of evidence-based practice appeared and was especially evident when the nurses' primary evidence sources consisted of the immediate options, for example asking colleagues or following accessible guidelines. Searching for evidence was central in their theoretical understanding but not an incorporated part of their daily work tasks.

CONCLUSION

The nurses' constructions of evidence-based practice indicate a discrepancy between the theoretical understanding of evidence-based practice and the practical doing of evidence-based practice, which hinders the basis of working according to the concept.

RELEVANCE TO CLINICAL PRACTICE

Theoretical discussions of evidence-based practice within the nursing field remain academic, as nurses in practice construct the concept on standards from evidence-based medicine.

Strategies to prevent missed nursing care: An international qualitative study based upon a positive deviance approach

AIM

To identify the strategies to prevent missed nursing care (MNC) that can be implemented by nurse managers/directors on a daily basis.

BACKGROUND

Only few recommendations have been established to date aiming at supporting nurse managers/ directors in preventing MNC. However, several strategies are implemented on a daily basis, suggesting that a body of tacit, practical and wise knowledge is already in place.

METHOD(S)

An international qualitative descriptive study based on the positive deviance approach conducted in 2019-2020 and reported according to the Consolidated Criteria for Reporting Qualitative Research. A purposeful sample of 35 nurse managers/directors working in hospitals in Cyprus, Italy, Germany and Switzerland was involved. Codes were extracted from each country, and a thematic analysis was performed at the transnational level to identify strategies and interventions preformed to prevent MNC.

RESULTS

Eight strategies and 22 interventions, mainly with preventive intent and designed at the hospital level, affecting both the processes and the structural dimensions, have been reported as effective in preventing MNC.

CONCLUSION

Nurse leaders are involved daily in implementing strategies to minimise MNC at the nursing and at the hospital system levels, integrated with each other.

IMPLICATIONS FOR NURSING MANAGEMENT

Preventing MNC should be a core value of the entire hospital, and not merely a nursing issue. Therefore, complex interventions at the system level are required.

Deciding about the use of a Personal Safety Alerting Device-The need for a legitimation process: A qualitative study

Aims

To explore reasons, thoughts, motives, and influencing factors regarding the use or non‐use of Personal Safety Alerting Devices (PSADs) in the daily lives of community‐dwelling older persons.

Design

A qualitative descriptive study design was used.

Methods

Six focus groups were conducted with a total of 32 older persons between February–August 2016. Data analysis followed the Qualitative Analysis Guide of Leuven.

Results

The participants described the use or non‐use of PSADs as a decision resulting from a “legitimation process”. This process implies that a person needs to perceive the necessity for a PSAD and then determine the right moment at which to start using it. During this process, each person weighs her or his “ageing self” and “perception of technology” then decides whether to start using a device or to delay its use. “Critical events” initiate this process, compelling the person to consider their own safety and their possible need for assistance.

Conclusion

The legitimation process suggests that the initiation of PSAD use represents a turning point in life. Using a PSAD is not simply a matter of obtaining one. It is a complex decision‐making process establishing legitimation for its use, which is interwoven with one's individual ageing, self‐perception, and the meaning attributed to the device.

Impact

Older persons need to be supported; in particular, they require time to go through the legitimation process for PSAD use. Nurses can empower them in this process, such that they perceive using a PSAD as a means to restore their frailty balance and feel enabled to (re)gain control over their own life and thus to preserve their independence.

Acute care delivery to persons with cognitive impairment: a mixed method study of health professionals' care provision and associated challenges

Objectives: Cognitive impairment is common among older persons admitted to hospital and associated with adverse outcomes. Inadequate care has been widely reported, with health professionals tending to be ill-equipped to meet the specific needs of this patient group. This study aimed to investigate health professionals' care provision to persons with cognitive impairment and associated challenges.Design and Setting: A concurrent, cross-sectional mixed method study was conducted at two university-affiliated hospitals.Participants: A total of 339 health professionals participated in the study.Measurements: An online survey (n = 312) determined the extent to which health professionals perceived their care provision to be person-centered and evidence-based (POPAC-R), and experience distress in looking after this patient group (NPI-D). Four focus group interviews (n = 27) explored health professionals' experience of care provision.Results: More than half of the health professionals reported to act always or very frequently in person-centered and evidence-based ways, and two third experienced challenging behaviors as moderately to very distressing. Health professionals working in acute geriatric wards demonstrated statistically significant higher levels of person-centered and evidence-based care provision, and lower distress. Their caring practices pertained to building a relationship, addressing specific needs, involving family members, and working collaboratively.Conclusions: Findings suggest that geriatric models of care delivery support staff in meeting the needs of persons with cognitive impairment. Health professionals require an acute care culture that values relational, collaborative and coordinated care as essential to patient safety and quality of care, and supports the consistent implementation of evidence-based practices for this patient group.

Stakeholder perceptions of curriculum design, development and delivery for continuing e-learning for nurses

BACKGROUND

This paper reports the qualitative findings from stage 5 of an action research project which involved the redesign of continuing professional education (CPE) courses in one organisation.

AIM

The aim of this study was to explore key stakeholders perceptions of the teaching, learning and outcomes of a new curriculum design for CPE involving e-learning.

METHOD

This project used participatory action research, involving stakeholders as participants in a process of inquiry about the change. The study took place in an academic teaching hospital and consisted of three focus group interviews with a total of 20 nurses. Participants included stakeholders who had developed curricula and managers from clinical areas where CPE courses had been undertaken.

FINDINGS

Four main themes emerged, revealing staff perceptions on the process of change and their own 'lightbulb moments' experienced during this process. Results also indicate that the change has resulted in learner-focused CPE, with a range of opportunities for continued educational development in future.

CONCLUSION

Key stakeholders' experience is seldom reported in studies related to CPE. This study provides an insight into the experiences of key stakeholders in relation to the development and delivery of CPE courses. Stakeholders indicated that they were able to see the benefits of implementing new CPE curricula they had contributed to. They also commented that clinical-pertinent and competence-based courses were more learner focused as a result of combining online content with supported workshops.

Perception on the mind-nurse program among nursing students: A descriptive qualitative study

BACKGROUND

Nursing undergraduates are susceptible to stress from academic and clinical matters. We developed the MIND-NURSE program for nursing students.

OBJECTIVES

This study aimed to explore students' perceptions towards the program.

METHODS

This was a descriptive qualitative study. A convenience sampling was used to recruit nursing undergraduates from a university in Singapore. Participants attended the eight-week MIND-NURSE program. Each session comprised two components: Education and mindfulness practice. Three focus group interviews were conducted after completion of the program, using a semi-structured interview guide. Thematic analysis was used to identify emerging themes and subthemes.

RESULTS

Twenty students participated in the study. Overall, they reacted positively to the MIND-NURSE program, albeit some concerns raised regarding the mindfulness practice. Six themes were derived from the data including: a) enhanced awareness of the present moment; b) increased serenity through mindfulness practice; c) triad of thoughts, emotion and behaviors; d) working towards interpersonal mindfulness; e) adapting mindfulness into nursing practice; and f) overcoming the challenges for mindfulness practice.

CONCLUSIONS

Mindfulness benefited the students in personal and professional ways. More research should be conducted to implement the program on nursing students in other universities.

Translating dignity principles into practice for continence care for older people in care homes: A study protocol

AIM

To develop, implement, evaluate, and disseminate an evidence-based, person-centred education program to protect the dignity of care-dependent older people with dementia and continence care needs in care homes.

DESIGN

A mixed method two-phase design underpinned by integrated knowledge translation.

METHODS

An education program that frames dignity as the main goal of continence care will be co-designed with a purposive sample of care home staff who provide or supervise continence care for care-dependent older people with dementia in care homes and resident relatives. The program will then be implemented and evaluated in a representative sample of care home staff to determine its clinical relevance, feasibility, acceptability, and effects on staff ratings of dignity in continence care; self-reported continence care practices and the person centeredness of the environment. Data analysis will include descriptive statistics (survey data) and thematic analysis (focus groups). Funding obtained November 2018. Ethics approval obtained May 2019.

DISCUSSION

This protocol outlines a mixed methods integrated knowledge translation protocol designed to translate principles about dignity into practice to improve the care of older people who are at risk of violations to their dignity in care homes. The outcome will be a contextually appropriate, evidence-based education program that protects the dignity of care-dependent older people who have dementia and continence care needs.

IMPACT

Based on a sound theoretical model, the education program will be contextually appropriate for use in the care homes setting and contribute to improving the overall quality and safety of care in this setting. It could also support and inform continence care for other individuals who are care dependent. Adopting an integrated knowledge translation approach to the design and delivery of the education program and piloting it will ensure the program is contextually relevant and sustainable.

Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study

OBJECTIVES

To investigate family and health professional experience with a nurse-led family support intervention in intensive care.

DESIGN

Qualitative evaluation study.

SETTING

A twelve-bed surgical intensive care unit in a 900-bed University Hospital in Switzerland.

MAIN OUTCOME MEASURES

Data were collected through 16 semi-structured interviews with families (n = 19 family members) and three focus group interviews with critical care staff (n = 19) and analysed using content analysis strategies.

FINDINGS

Four themes related to the new family support intervention were identified. First, families and staff described it as a valuable and essential part of ICU care. Second, it facilitated staff-family interaction and communication. Third, from staff perspective, it promoted the quality of family care. Fourth, staff believed that the family support intervention enabled them to better care for families through increased capacity for developing and sustaining relationships with families.

CONCLUSIONS

An advanced practice family nursing role coupled with a family support pathway is an acceptable, appreciated and beneficial model of care delivery in the inttensive care unit from the perspective of families and critical care staff. Further research is needed to investigate the intervention's effectiveness in the intensive care unit.

Spiritual Care und chronischer Schmerz: Die Sicht von Fachpersonen. Eine qualitative Untersuchung

Chronischer Schmerz ist ein komplexes Phänomen, das alle Lebensdimensionen betrifft: die psychische, soziale und spirituelle nicht weniger als die physische. Diesem Umstand muss in der Behandlung dieser Patientengruppe Rechnung getragen werden. Wir untersuchten, an welche Voraussetzungen dafür im Deutschschweizer Raum bereits angeknüpft werden kann. An fünf Studienzentren wurden insgesamt 34 Fachpersonen in interprofessionell gemischten Fokusgruppen dazu interviewt, welche spirituellen Anliegen und Bedürfnisse von Patient/-innen mit chronischen Schmerzen sie wahrnehmen und wie diese im Behandlungsprozess berücksichtigt werden können. Eine thematische Analyse zeigte drei Kernthemen: die Relevanz spiritueller Aspekte in der multimodalen Schmerztherapie, handlungsleitende Überzeugungen und die Kompetenz zu Spiritual Care. Die Befragten waren der spirituellen Thematik gegenüber generell aufgeschlossen. Aus ihrer Sicht stellt die Integration spiritueller Anliegen und Bedürfnisse im Behandlungsprozess einen Mehrwert für die Behandlungsqualität in dieser Patientengruppe dar. Dies konsequent umzusetzen, stellt sie jedoch vor teilweise ungelöste Herausforderungen. Hier braucht es Befähigung und institutionelle Unterstützung, um Spiritual Care den entsprechenden Raum zu geben.

Senior nurses' perceptions of junior nurses' incident reporting: A qualitative study

AIM

To develop an understanding of senior nurses' ranking and perceptions of incident reporting by junior nurses.

BACKGROUND

Nurses must be encouraged to report incidents to nursing management. It is important to ascertain how senior nurses perceive their concerns, as it is crucial to ensuring that patient safety is managed.

METHOD

Qualitative study. Four focus groups explored senior nurses' perceptions of risks identified by nurses from a live incident reporting database. Data were analysed using framework analysis.

RESULTS

Five themes emerged demonstrating the differences in opinions in relation to the classification of events by senior and non-senior nurses. Senior nurses held the view that some junior nurses use incident reporting to 'vent frustration.'

CONCLUSION

There is a mismatch between senior nurses' and junior nurses' perceptions of safety incidents. Nurses need to develop the writing style and use language that red flags incidents when reporting incidents. Senior nurses need to create a positive culture where risk from incident reporting is used to improve patient safety and subsequently a positive work environment. Implications for Nursing Management Our research identified the need for joint training to promote a shared understanding among nurses as to how incident report should be completed to promote patient safety.

"Difficult patients" in the advanced stages of cancer as experienced by nursing staff: A descriptive qualitative study

PURPOSES

"Difficult patients", as labelled by staff members, have been studied for their peculiarities in primary care, family and internal medicine, physiotherapy, psychiatry, dermatology, and dentistry. However, no data has been documented on "difficult patients" in hospice care settings. The aim of the study was to address the following research questions: (a) When do nursing staff label a patient suffering from advanced cancer as "difficult" in a hospice care setting? (b) What are the problems that the nursing staff face in dealing with them, and (c) What are the specific strategies that nursing staff adopt in their daily practice to overcome issues and improve their relationship with "difficult patients"?

METHODS

A qualitative descriptive study design was performed in 2018 and reported according to the COnsolidated criteria for REporting Qualitative research. Three focus groups were conducted in three hospice settings in Northern Italy by involving 10 nurses and six nurses' aides. Three trained researchers performed interviews based on a set of open questions. Qualitative content analysis of the data collected was then performed by the same researchers.

RESULTS

Participants were labelled "difficult patients" according to three main themes: (1) "Feeling rejected"; (2) "Feeling uncomfortable with the life story experienced by the patient" and (3) "Experiencing the limits of the profession". Participants reported feeling "Frustrated", "Exhausted", "Powerless", "Overwhelmed" or "Embarrassed" when dealing with "difficult patients". Strategies to overcome these issues emerged.

CONCLUSIONS

As in other settings, hospice care nursing staff perceive some patients as "difficult". However, differently from other contexts, "difficult patients" are perceived as such also due to their relatives, who are perceived, in some cases, as being even more "difficult" than the patients themselves. Nursing staff should be aware of their personal attitudes and emotions in caring for patients perceived as "difficult" in order to identify and timely apply strategies to overcome issues that may compromise the therapeutic relationship and quality of care.

Implementing Family Systems Care Through an Educational Intervention With Nurses and Midwives in Obstetrics and Gynecological Care: A Mixed-Methods Evaluation

This mixed-methods study examined Family Systems Care (FSC) implementation through a 1-day educational session combined with 4 months of guided application of FSC knowledge and skills in obstetrics and gynecology settings. Nurses and midwives' (n = 47) attitudes toward families and their practice skills with families were assessed before the educational intervention began (Time 0), after the completion of the 1-day educational session (Time 1), and after 4 months of the FSC guided implementation phase that included coaching and mentoring (Time 2). Four focus groups with the nurses and midwives explored their FSC implementation experiences. Participants reported an initial drive to implement FSC, which faltered over time. A perceived fit to the needs of families in obstetrics and gynecology, a supportive context, and facilitated learning on the units promoted FSC uptake. Participants understood FSC as: (a) involving family members in care, a practice they felt confident about; (b) assessing families' situations, needs, concerns, which were practices that were new and stressful; and (c) offering family nursing interventions, which they felt insufficiently prepared for. Practice skills in FSC increased after the 1-day educational session but decreased to baseline after the FSC guided implementation phase. Attitudes of the nurses and midwives toward the families did not change. Following the education and guided implementation, participants' ability to work with families in a relational, systemic way could not be fully established or sustained.

Investigating The Implementation of a Collaborative Learning in Practice Model of Nurse Education in a Community Placement Cluster: A Qualitative Study

Background:

Attracting new graduate nurses to work in the community is problematic, and this has contributed to shortages in this sector in the United Kingdom and internationally. This paper reports the findings of a pilot study to implement Collaborative Learning in Practice in one region of the United Kingdom, which was intended to increase placement capacity, introduce students to this sector, and accelerate their learning and development of key skills and behaviors.

Study Aim:

To investigate the views of student nurses and the staff supporting them on placement about their experiences of implementing Collaborative Learning in Practice.

Methods:

We conducted four focus group interviews between winter 2018 and spring 2019, with 31 staff and students in two English counties in the South West of England. These were transcribed and analysed using the Framework Method; themes were discussed and agreed by the research team.

Results:

Three themes emerged: Peer support, which concerned the benefits of being in placement with other students; Developing and learning, which was about the acquisition of skills including leadership; and Organisation, which related to issues and concerns involved in the preparation and daily management of the collaborative learning in practice experience.

Conclusion:

Some positive aspects were reported, particularly in relation to hospice and General Practice Nursing placements. Most clear was the supportive potential for peer learning fostered by Collaborative Learning in Practice. Less positive aspects were the potential for horizontal violence and some aspects of nursing home experiences. We believe more work needs to be done to make nursing homes an attractive option for students and new graduates, and regarding visual materials for pre-placement preparation.

Technological Frames and Care Robots in Eldercare

Care robots are often portrayed as an exciting new technology for improving care practices. Whether these robots will be accepted and integrated into care work or not, is likely to be affected by the assumptions, expectations and understandings held by potential end users, such as frontline staff and the people that are cared for. This paper describes how the conceptual framework of technological frames was used to identify the nature of care robots, care robots in use and care robot strategy as shared group level assumptions, expectations and understandings of care robots among care staff and potential care receivers. Focus groups were conducted with 94 participants. These groups consisted of line managers, frontline care staff, older people and students training to become carers. The technological frame of the nature of care robots revealed two complementary components: care robots as a threat to the quality of care, and care robots as substitute for humans and human care, held together by imaginaries of care robots. The technological frame of care robots in use revealed aspects of prospective end-users’ uncertainty of their ability to handle care robots, and their own perceived lack of competence and knowledge about care robots. In addition, the following potential criteria for successful use of care robots were identified: adequate training, incentives for usage (needs and motives), usability, accessibility and finances. The technological frame of care robot strategy was revealed as believed cost savings and staff reduction. The novelty of the results, and their relevance for science and practice, is derived from the theoretical framework which indicates that adoption of care robots will be dependent on how well societies succeed in collectively shaping congruent technological frames among different stakeholders and aligning technological development accordingly.

The key success factors in focus group discussions with the elderly for novice researchers: a review

Purpose

This study aimed to discuss the key success factors in focus group discussions among the elderly as a means of supporting novice researchers and also to share the experiences of novice researchers with focus group discussions.

Design/methodology/approach

This study used a literature review of previous studies that revealed three themes regarding the key success of focus group discussions with the elderly. Focusing on issues published between 2009 and 2019, four health-related databases, namely the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ScienceDirect, PsycARTICLES and Thaijo were investigated using keyword searches, both individually and in combination, and the inclusion criteria used in selecting relevant articles as primary sources included research written in the English and Thai languages.

Findings

The literature review involved eight published articles related to this topic in the nursing field. Three themes for key successes were identified as follows: good planning and convenient organization, being accepting and flexible concerning their opinions and good management.

Originality/value

Focus group discussions with the elderly are complex and challenging for novice researchers. It is necessary that a novice researcher in the nursing field builds up the skills of a moderator in conducting focus group interviews if he or she wishes to obtain rigorous data.

"They Don't Trust Us": The Influence of Perceptions of Inadequate Nursing Home Care on Emergency Department Transfers and the Potential Role for Telehealth

In this descriptive, qualitative study, we conducted eight focus groups with diverse informal and formal caregivers to explore their experiences/challenges with nursing home (NH) to emergency department (ED) transfers and whether telehealth might be able to mitigate some of those concerns. Interviews were transcribed and analyzed using a grounded theory approach. Transfers were commonly viewed as being influenced by a perceived lack of trust in NH care/capabilities and driven by four main factors: questioning the quality of NH nurses' assessments, perceptions that physicians were absent from the NH, misunderstandings of the capabilities of NHs and EDs, and perceptions that responses to medical needs were inadequate. Participants believed technology could provide "the power of the visual" permitting virtual assessment for the off-site physician, validation of nursing assessment, "real time" assurance to residents and families, better goals of care discussions with multiple parties in different locations, and family ability to say goodbye.

Project 20: Midwives' insight into continuity of care models for women with social risk factors: what works, for whom, in what circumstances, and how

INTRODUCTION

Continuity of care models are known to improve clinical outcomes for women and their babies, but it is not understood how. A realist synthesis of how women with social risk factors experience UK maternity care reported mechanisms thought to improve clinical outcomes and experiences. As part of a broader programme of work to test those theories and fill gaps in the literature base we conducted focus groups with midwives working within continuity of care models of care for women with social factors that put them at a higher chance of having poor birth outcomes. These risk factors can include poverty and social isolation, asylum or refugee status, domestic abuse, mental illness, learning difficulties, and substance abuse problems.

OBJECTIVE

To explore the insights of midwives working in continuity models of care for women with social risk factors in order to understand the resources they provide, and how the model of care can improve women's outcomes.

DESIGN

Realist methodology was used to gain a deeper understanding of how women react to specific resources that the models of care offer and how these resources are thought to lead to particular outcomes for women. Twelve midwives participated, six from a continuity of care model implemented in a community setting serving an area of deprivation in London, and six from a continuity of care model for women with social risk factors, based within a large teaching hospital in London.

FINDINGS

Three main themes were identified: 'Perceptions of the model of care, 'Tailoring the service to meet women's needs', 'Going above and beyond'. Each theme is broken down into three subthemes to reveal specific resources or mechanisms which midwives felt might have an impact on women's outcomes, and how women with different social risk factors respond to these mechanisms.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Overall the midwives in both models of care felt the service was beneficial to women and had a positive impact on their outcomes. It was thought the trusting relationships they had built with women enabled midwives to guide women through a fragmented, unfamiliar system and respond to their individual physical, emotional, and social needs, whilst ensuring follow-up of appointments and test results. Midwives felt that for these women the impact of a trusting relationship affected how much information women disclosed, allowing for enhanced, needs led, holistic care. Interesting mechanisms were identified when discussing women who had social care involvement with midwives revealing techniques they used to advocate for women and help them to regain trust in the system and demonstrate their parenting abilities. Differences in how each team provided care and its impact on women's outcomes were considered with the midwives in the community-based model reporting how their location enabled them to help women integrate into their local community and make use of specialist services. The study demonstrates the complexity of these models of care, with midwives using innovative and compassionate ways of working to meet the multifaceted needs of this population.

Living with a Severe Allergy: Lived Perspectives from Swedish Adolescents and their Parents

BACKGROUND

During adolescence, the young person should gradually develop independence from his or her parents. However, having a chronic disease like a severe allergy may add stress and challenges beyond normal development and involves a struggle between adapting socially, feeling healthy, and managing the disease.

OBJECTIVE

To describe experiences of living with a severe allergy from the perspective of adolescents and their parents.

METHOD

A qualitative study with six focus group interviews were performed, two with adolescents and four with their parents (10 adolescents, 10-16 years old and 21 parents). The transcribed data were analyzed using systematic text condensation.

RESULT

Four themes emerged: Feeling different (adolescents and parents), shift in responsibility (adolescents and parents), the importance of parents (only adolescents) and the importance of healthcare providers (only parents). The adolescents relied on their parents, while also taking responsibility for managing their disease. The parents expressed a need to protect their children; but they did not seem to be aware of the responsibility their children took. The parents highlighted the importance of support from healthcare providers but this was not mentioned by the adolescents.

CONCLUSION

This study showed that both the adolescents and their parents stated that they took responsibility for managing the disease, but in different ways. For healthcare providers, this needs to be taken into account in order to support both adolescents and parents for self-management and shift in responsibilities which begins during adolescents.

An Evidence-Based, Nursing Handover Standard for a Multisite Public Hospital in Switzerland: Web-Based, Modified Delphi Study

BACKGROUND

Ineffective communication procedures create openings for errors when health care professionals fail to transfer complete, consistent information. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability, can have severe consequences for hospitalized patients. Clinical handovers are practiced every day, in many ways, in all institutional health care settings.

OBJECTIVE

This study aimed to design an evidence-based, nursing handover standard for inpatients for use at shift changes or internal transfers between hospital wards.

METHODS

We carried out a modified, multiround, web-based, Delphi data collection survey of an anonymized panel sample of 264 nurse experts working at a multisite public hospital in Switzerland. Each survey round was built on responses from the previous one. The surveys ended with a focus group discussion consisting of a randomly selected panel of participants to explain why items for the evidence-based clinical nursing handover standard were selected or not selected. Items had to achieve a consensus of ≥70% for selection and inclusion.

RESULTS

The study presents the items selected by consensus for an evidence-based nursing handover standard for inpatients for use at shift changes or internal transfers. It also presents the reasons why survey items were or were not included.

CONCLUSIONS

This modified Delphi survey method enabled us to develop a consensus- and evidence-based nursing handover standard now being trialed at shift changes and the internal transfers of inpatients at our multisite public hospital in Switzerland.

Using Focus Groups to Explore Evolving Perceptions of Student Pharmacists' Curricular Experiences

Objective. To explore student pharmacists' shared experiences as they transitioned through the first three years of a Doctor of Pharmacy curriculum, from dependent learners to autonomous contributors. Methods. The researchers used interpretive phenomenology to examine the lived experiences of student pharmacists. Previously gathered focus group data for 309 student pharmacists from the 2015-2016 academic year were explored. A step-wise approach to data analysis was used to perpetuate the natural emergence of themes and alignment with theory. Utilizing Arthur Chickering's Seven Vectors of Identity Development as a lens, the researchers analyzed findings related to self-realization and identification of purpose. Results. The research team identified several themes associated with the teaching and learning process: professionalism, autonomy, and managing the expectations of the curriculum. A connection between the researchers' findings and Chickering's seven vectors was seen as students' comments demonstrated their progress along the vectors over three academic years. Conclusion. This exploration provided a glimpse into the lived experiences of student pharmacists at three different stages in their journey from dependent learners to autonomous contributors. By comparing students in one year with those in the next, the researchers were able to see the evolution that occurred over time as students became self-authored individuals, which is the ideal outcome for pharmacy graduates.

The student experience of a 'kidney CAMP' as a primary care clinical placement for undergraduate nursing students

BACKGROUND

Historically clinical placements have been within acute care settings. In a more contemporary society, the future focus of health care is primary care, with an emphasis in expanding primary care clinical placements, to meet the needs of increasing workforce requirements. An innovative collaborative educational model was designed to provide a high quality learning experience and to increase numbers of students experiencing a primary care clinical placement.

OBJECTIVE

To explore student nurses' lived experiences within an innovative primary care setting.

METHODS

A qualitative case study was undertaken to analyse nursing students' experiences at the Kidney Kids Camp primary care clinical placement.

FINDINGS

Participants described how the primary care placement changed their view of nursing and the nurses' role. Five themes emerged from the research: developing knowing through children's eyes; entering the world of primary care; facing a journey of self-discovery; it's all in the way you communicate and; it makes you think differently about nursing.

DISCUSSION

The experience of this primary care placement enabled nursing students to enter the world of children living with chronic illness. Immersing students into this unique environment enabled them to gain a greater insight into primary care through the eyes of the children.

CONCLUSION

Kidney Kids camp experiences presented nursing students with an enhanced appreciation of primary care nursing, working with children, and an understanding of the impact of chronic health illnesses, through the primary care lens.

Challenges for nurses when communicating with people who have life-limiting illness and their families: A focus group study

AIMS AND OBJECTIVES

The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life-limiting illness?

BACKGROUND

Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession.

DESIGN

A qualitative descriptive design was used.

METHODS

Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study.

RESULTS

In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life-limiting illness; (b) interacting with family members adds complexity to care of patients who have life-limiting illness; and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families.

CONCLUSIONS

Caring for individuals with life-limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being hampered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions.

RELEVANCE TO CLINICAL PRACTICE

Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families.

End-of-life and palliative care of patients on maintenance hemodialysis treatment: a focus group study

BACKGROUND

Despite complex illness trajectories and a high symptom burden, palliative care has been sub-optimal for patients with end-stage kidney disease and hemodialysis treatment who have a high rate of hospitalization and intensive care towards end of life. There is a growing awareness that further development of palliative care is required to meet the needs of these patients and their family members. In this process, it is important to explore healthcare professionals' views on provision of care. The aim of this study was therefore to describe nurses' and physicians' perspectives on end-of-life and palliative care of patients treated with maintenance hemodialysis.

METHODS

Four focus group interviews were conducted with renal nurses (17) and physicians (5) in Sweden. Qualitative content analysis was used to analyze data.

RESULTS

Participants were committed to giving the best possible care to their patients, but there were challenges and barriers to providing quality palliative care in nephrology settings. Professionals described palliative care as end-of-life care associated with hemodialysis withdrawal or palliative dialysis, but also identified care needs and possibilities that are in line with an earlier integrated palliative approach. This was perceived as complex from an organizational point of view. Participants identified challenges related to coordination of care and different perspectives on care responsibilities that impacted symptom management and patients' quality of life. Communication issues relating to the provision of palliative care were revealed where the hemodialysis setting was regarded as an impediment, and personal and professional experiences, beliefs and knowledge were considered of major importance.

CONCLUSIONS

Nurses and physicians identified a need for the improvement of both late and earlier palliative care approaches. The results highlighted a requirement for and possibilities of training, counselling and support of health care professionals in the dialysis context. Further, multi-professional palliative care collaborations should be developed to improve the coordination and organization of end-of-life and palliative care of patients and their family members. A climate allowing conversations about advance care planning throughout the illness trajectory may facilitate the gradual integration of palliative care alongside life-prolonging treatment for improved support of patients and families.

Health-Care Professionals Perceived Barriers to Effective Cancer Pain Management in the Home Hospice Setting: Is Dying at Home Really Best?

Hospice health-care professionals (HCP) evaluate and manage cancer pain in patient homes. This study explores HCP's perceptions of barriers that affect pain management for home hospice cancer patients. A convenience sample of 20 experienced hospice HCP were recruited from a regional hospice agency. Data were collected through two focus groups using semistructured interviews and analyzed using a constant comparative approach to generate themes. An unexpected finding revealed patient's religious and cultural beliefs about suffering and family caregiver's beliefs that patients deserve to suffer due to past actions are barriers to pain management in home hospice. Hospice HCP can identify patients at risk for suffering at the end of life. Interventions targeting spiritual suffering and needs are needed. Home hospice HCP have an ethical obligation to address undue suffering through family's withholding of necessary pain medications and should consider alternative placement when home is not suitable for a peaceful death.

Processes toward the end of life and dialysis withdrawal Physicians' and nurses' perspectives

BACKGROUND

Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory.

AIM

The aim was to explore physicians' and nurses' perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease.

RESEARCH DESIGN AND PARTICIPANTS

A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data.

ETHICAL CONSIDERATIONS

Ethical approval was obtained (Dnr 2014/304-31).

FINDINGS AND DISCUSSION

Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient's decision-making process, The challenge awaiting the family members' processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress.

CONCLUSION

There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient's possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.

Learner and educator experiences and priorities in paediatric airway education: A qualitative study

Paediatric airway management is a challenging area of anaesthesia practice to learn. Techniques and skills required need modification from adult practice and gaining experience through exposure takes considerable time. Preparation to manage airway emergencies can be particularly difficult as these events are rare in paediatric practice. This study aimed to examine what educational approaches health professionals of varying backgrounds find useful when learning or teaching paediatric airway management. This qualitative study involved the conduct of five interdisciplinary focus groups; each group consisted of four to six health professionals from nursing, anaesthetic, simulation and critical care backgrounds. After transcription, focus group content was analysed using a qualitative method to identify common themes expressed within the interviews. Five themes were most prominent. These included the high value of hands-on learning, the challenges created by variability in exposure, the importance of developing basic airway skills, the potential for simulation to cover rare situations, and the problems of current airway models. These themes were evident in comments from both experienced and novice practitioners, clinicians with different subspecialty backgrounds and both medical and nursing staff. Learners and educators have similar priorities in airway education. This includes a strong recognition of the importance of spending time mastering basic airway techniques, a role for simulation in building non-technical skills and noted deficiencies in current airway models.

Surgical nurses' perceptions and experiences of a medications and oral restrictions policy change: A focus group study

AIMS AND OBJECTIVES

To explore the perceptions and experiences of surgical nurses before and after introducing the Medications and Oral Restrictions Policy (the Policy).

BACKGROUND

The Policy was developed following extensive consultation, and evidence-based strategies were considered for its implementation. However, it is possible uptake did not meet expectations.

DESIGN

Focus group interviews.

METHODS

Three focus groups were conducted in November 2015 around 'what worked, what didn't and why, before and after hospital-wide implementation of the Policy.' Data were coded and analysed using an inductive-deductive thematic analysis approach. The COREQ checklist guided reporting.

RESULTS

The three groups consisted of 16, 14 and six surgical nurses. Before the Policy, there was confusion, lack of clarity and guidance, and lack of experience and confidence in managing medications when patients had oral restrictions. After the Policy rollout, there was a sense of 'knowing what to do' because of improved clarity and decision support; but there were also problems with: not everyone knowing about the policy, particularly due to staff movement and turnover; and, individual interpretation of the policy including use of its signs outside of context, and decision-making processes.

CONCLUSION

Exploration of nurses' perceptions of a medication-related policy change found that while the Policy provided clarity and decision support for some, it made little difference for others. Limited reach of the policy was an issue despite an effort to address this at the outset, as well as variations in interpretation of the policy and subsequent decision-making.

RELEVANCE TO CLINICAL PRACTICE

How individuals interpret information and their understanding of the context behind the policy or guideline may affect implementation and should be considered alongside other barriers when implementing medication-related initiatives. Furthermore, implementation strategies that are independent of ongoing resources and/or key champions to sustain should be prioritised for all initiatives.

E-portfolio functional requirements for the final semester baccalaureate practicum course: A qualitative research study

BACKGROUND

The purpose of the nursing practicum course is to enable students to integrate cognitive, psychomotor, and affective skills into professional competencies prior to clinical work. With advances in information technology, e-portfolio focusing on individualized learning, reflection, and self-management has received positive consideration. The nursing profession has since adopted it as part of nursing education.

PURPOSE

This study explored the needs and perceptions of students in a baccalaureate nursing program regarding the use of e-portfolio in the final semester practicum course.

METHOD

This study used semi-structured focus group interviews and applied the principles of content analysis to interview content.

RESULTS

Four key research themes were revealed: (1) anticipated functions achieved, (2) ease of uploading data and showcasing learning results (3) functionality extensions to enhance mobile learning, and (4) policy guidelines for mandatory use and plagiarism prevention.

CONCLUSION

E-portfolio assists in integrating knowledge, practical skills, and achievement recognition into the learning process. The use of e-portfolio with upgrades can enable learning of clinical competencies by students in preparation for clinical nursing practice.

Using Reflexive Thinking to Establish Rigor in Qualitative Research

BACKGROUND

Reflexivity can be helpful in developing the methodological rigor necessary to attaining trustworthy qualitative study results.

OBJECTIVES

The aim of this study was to evaluate strategies of critical reflexive thinking during a qualitative enquiry rooted in a mixed-methods study.

METHODS

Guided by the questions of Rolfe and colleagues from 2001 ("what," "so what," and "now what"), we applied reflexive thinking to all aspects of the investigation.

RESULTS

Critical reflexive thinking strongly supported our efforts to establish methodological rigor and helped reveal shortcomings.

DISCUSSION

Effective strategical use of reflexive thinking takes concerted effort. Both time and space are essential to applying reflexive thinking throughout the qualitative research process.

Undergraduate student nurses' perspectives of an integrated clinical learning model in the mental health environment

Providing nursing students with appropriate clinical practice during their undergraduate programme is critical to ensuring that graduates meet the competency requirements to gain registration as a nurse. In response to the predicted nursing workforce shortage, universities have been significantly increasing the enrolment of undergraduate nurses into Bachelor of Nursing courses. This has placed a demand on the availability of clinical placements and often universities struggle to find appropriate places. In this study, a Bachelor of Nursing course incorporated an Integrated Clinical Learning Model (ICLM) for the first time during a mental health placement. The model offered students the flexibility of attending their clinical placement over a 16-week period instead of a traditional block of 4 weeks. The aim of this study was to evaluate the student perspective of this model and whether it prepared them for the nursing workforce. Focus groups were conducted with undergraduate nursing students following their mental health clinical placement at an acute and extended care inpatient unit. Data were analysed using thematic analysis. Main themes included preparedness for practice, maintaining a work-life balance, and perceiving they were part of a team. The ICLM deepened students' knowledge and had a positive impact on their overall clinical learning.

Exploring pathways towards improving patient experience of robot-assisted radical prostatectomy (RARP): assessing patient satisfaction and attitudes

OBJECTIVE

To determine patient satisfaction and experience after robot-assisted radical prostatectomy (RARP) for prostate cancer, using a convergent mixed-method qualitative analysis approach.

PATIENTS AND METHODS

412 patients who underwent RARP between January 2014 and June 2016 were mailed questionnaires and invited to participate in focus groups. Qualitative data was thematically analysed using NVivo. Descriptive statistics were obtained from the questionnaire using SPSS.

RESULTS

214 patients responded (52% of sample size) of whom 97.6% were satisfied and 91.1% would likely recommend RARP. Key themes from the qualitative data highlighted the psychosocial impacts of the diagnosis and RARP process. The importance of early recovery, the benefits of pelvic floor exercises and educational resources were emphasised.

CONCLUSION

Patients were overwhelmingly satisfied with RARP, largely due to relevance and timeliness of the information and support provided both before and after surgery. With an increased understanding of the factors and outcomes that are most important to patients regarding all aspects of hospital care, we can create more targeted care pathways. Key themes will help inform the implementation of an enhanced recovery after surgery (ERAS) protocol to further improve recovery and early return to function.

Spiritual Uncertainty Among Hospice Providers: "There Were Tensions"

How providers of end-of-life care perceive spirituality both within themselves and for others can directly impact their ability to provide spiritual care to patients and families. Uncertainty about spirituality can contribute to the awkwardness of spiritual care. Spiritual uncertainty includes the questions, worries, and doubts people have about the meaning, beliefs, connections, self-transcendence, and value that comprise spirituality. This article reports qualitative findings from a mixed-methods study that sought to understand spiritual uncertainty among hospice providers. Data were collected from 28 hospice team members (nurses, physicians, social workers, and expressive therapist) using focus groups, reflective journals, and one-on-one interviews. An overarching theme emerged that described the tensions perceived by providers caring for hospice patients. Those tensions were further categorized as being interpersonal, intrapersonal, and transpersonal in nature. The identification of tension as a source of strain for providers delivering spiritual care is necessary to the development of future interventions that can assist providers and patients navigating end-of-life spirituality.

Intensive Interaction and discourses of personhood: A focus group study with dementia caregivers

INTRODUCTION

Societal discourses of dementia are medicalised and dehumanising. This leads to a social problem: the loss of personhood in dementia care. The communication technique Intensive Interaction, however, honours personhood. The current study aimed to explore how paid caregivers of people with dementia enact societal discourses of dementia, with and without the context of Intensive Interaction. This was to explore ways to address the loss of personhood in dementia care.

METHOD

Paid caregivers from two residential care homes attended an Intensive Interaction training day. Caregivers participated in focus groups before and after training. Transcripts of the focus groups were analysed with Critical Discourse Analysis, an approach which relates discourse to social power.

RESULTS

Before Intensive Interaction training, carers accessed medical discourses of loss, non-communication and lack of personhood. 'Being with' people with dementia was framed as separate to paid work. After training, caregivers accessed discourses of communication and personhood. Intensive Interaction reframed 'being with' people with dementia as part of 'doing work'. Family caregivers were largely absent from discourses. Care home hierarchies and the industrialisation of care were barriers towards honouring personhood.

CONCLUSIONS

Medical discourses of dementia reinforce a status quo whereby interpersonal interactions are devalued in dementia care, and professional 'knowledge' (thereby professional power) is privileged over relationships. Intensive Interaction may enable paid caregivers to access person-centred discourses and related practices. However, this requires support from management, organisational structures, and wider society. More research is needed to identify ways to involve families in residential care and to explore the effects of using Intensive Interaction in practice.