Qualitative evaluation in nursing interventions-A review of the literature

Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study

AIM

To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention.

DESIGN

A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions.

METHODS

We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact.

RESULTS

Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information.

CONCLUSION

Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists.

RELEVANCE TO CLINICAL PRACTICE

Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change.

REPORTING METHOD

We adhered to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

We interviewed patients on study wards pre and post intervention.

Assessing the incorporation of the 'Five Moments for Hand Hygiene' into nursing procedure textbooks

AIM

Our aim was to conduct a thorough comparison between the hand hygiene information included in international nursing textbooks and the Slovenian nursing textbook's equivalent content as it relates to nursing procedures.

BACKGROUND

Hand hygiene practices are crucial in preventing healthcare-associated infections, which affect millions of patients annually. The idea behind "Five Moments for Hand Hygiene" is to encourage assessing success and boosting self-efficacy.

DESIGN

Comparison of hand hygiene content in international nursing textbooks with the content in a Slovenian nursing textbook.

METHODS

A study was conducted between March 2023 and March 2024 to compare hand hygiene content in international nursing textbooks. The study included textbooks from the USA and UK, as well as Slovenian (SI) textbooks. The final phase involved comparing hand hygiene performance practices against the WHO Five Moments for Hand Hygiene.

RESULTS

The study reviewed 470 nursing procedures across three textbooks, identifying four common ones: female indwelling urinary catheterisation, small-bore feeding tube insertion, enema administration and subcutaneous injections. The USA textbook had the highest number of steps, while the UK textbook had the lowest. Clean protective gloves are not recommended for all nursing procedures, only for small-bore feeding tube insertion and enema administration. The US textbook omitted 12 steps for the female indwelling urinary catheter procedure, while the UK textbook included 10 steps. The SI textbook omitted 8 steps.

CONCLUSIONS

Hand hygiene is crucial for healthcare infections prevention and control. The study found differences in the frequency of hand hygiene in these nursing procedures. WHO's Five Moments for Hand Hygiene guidelines are not universally accepted, with inadequate hygiene often observed before patient contact. Future research should review foreign textbooks and update existing ones.

Individual and organizational interventions to promote staff health and well-being in residential long-term care: a systematic review of randomized controlled trials over the past 20 years

BACKGROUND

Staff in residential long-term care (RLTC) experience significant physical and mental work demands. However, research on specific interventions to promote staff health and well-being in RLTC facilities is limited. This systematic review aimed to synthesize the current evidence on health promotion interventions among RLTC staff.

METHODS

A comprehensive systematic literature review was conducted on studies published between January 2000 and April 2023. Four electronic databases were searched, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PsychArticles via EBSCO. The review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The methodological quality of the included studies was assessed using the Risk of Bias Assessment tool (RoB 2).

RESULTS

A total of 26 publications, referring to 23 different interventions with a randomized controlled design were included. Among these interventions, ten used training/educational approaches, six used behavioral approaches, and seven employed a multimodal approach. Significant improvements in health and well-being outcomes were found in four interventions using a training/educational approach, three interventions using a behavioral approach, and four interventions using a multimodal approach. Within the interventions studied, twelve specifically targeted the reduction of job demands, while only one intervention exclusively addressed job resources among RLTC staff. Furthermore, ten interventions addressed primary outcomes that encompassed both job demands and job resources.

CONCLUSION

Current evidence for health promotion interventions among RLTC staff is still limited, but research suggests that there is potential to improve certain outcomes related to RLTC staff health and well-being. Future research is recommended to contemplate a tailored intervention design that encompasses both individual-level and organizational-level approaches, and gender-specific physiological and sociological characteristics of RLTC staff. Moreover, detailed reporting of the development process, and research on the interaction between job demands and resources of RLTC staff are also recommended.

A primary care psychoeducational group intervention for patients with depression and physical comorbidity: A qualitative study with a gender perspective

OBJECTIVE

To explore the experiences and emotions of individuals with depression and physical comorbidity within the context of psychoeducational group interventions led by primary care nurses in Catalunya (Spain).

METHOD

A psychoeducational group intervention was conducted in the first semester of 2019 with 13 primary care teams (rural/urban) and 95 participants with depression and physical comorbidity. The qualitative research and phenomenological perspective were based on 13 field diaries and 7 semi-structured interviews carried out with the observer nurses. The interviews were recorded and transcribed. Codes were identified by segmenting the text into citations/verbatim accounts and emerging categories/subcategories by regrouping the codes. The results were triangulated among the researchers to identify and compare similarities and differences.

RESULTS

Four major themes were found: (a) gender differences; (b) coping strategies and changes observed during the intervention; (c) functions of the group as a therapeutic element; and (d) the nurses' perceptions of the group experience. Gender differences were identified in relation to experiences and emotions.

CONCLUSIONS

As some patients acquired skills/behaviours during the intervention that helped them initiate changes and the nurses were satisfied with the intervention, it is important to include this information when planning effective interventions for patients with this profile.

Family member's experiences with and evaluation of an ICU Liaison Nurse Service: A qualitative study

BACKGROUND

Family members of critically ill patients often experience anxiety when their relatives are transferred from ICU to another level of care. ICU liaison nurse (ICULN) visits have been associated with improved support for patients, their families and nursing staff but has not been extensively studied in the non-English speaking setting. Yet, cross-country variations such as how hospital care is delivered and by who means that innovations such as the ICULN may not be able to be simply transferred to other contexts and may not have similar outcomes.

AIM

The aim of this study was to investigate family member's experiences with and evaluation of ICULN support service in one Swedish ICU.

STUDY DESIGN

A qualitative evaluation study was undertaken, recruiting family members of former ICU patients. Audio-taped in-depth interviews were conducted. Data were analysed by content analysis.

FINDINGS

Fifteen family members were interviewed. Two categories: Minds the gap between intensive care and the next care level and providing stability in an uncertain situation were identified. The ICULN supported the family members both directly, when the ICULNs listened to their questions and met their needs, and indirectly, when the ICULNs took responsibility for the patients and their physical and psychological conditions and wellbeing.

CONCLUSION

Families valued and were satisfied with the ICULN service but also gave suggestions to improve the service in this particular hospital context.

RELEVANCE TO CLINICAL PRACTICE

The study showed that an ICULN support service met several needs of family members and therefore was a beneficial way to support patients and family members in the transition from the ICU to the ward.

Evaluation of the effectiveness of nursing interventions in research from Brazilian postgraduation programs

PURPOSE

The purpose of this study was to evaluate research from Brazilian postgraduate students who provide evidence of effectiveness for Nursing Interventions Classification (NIC).

METHODS

We conducted a literature review study of thesis and dissertations available in the Brazilian Digital Library of Dissertations and Theses (D/T) in May 2021 regardless of the year they were conducted. In those studies that did not utilize the NIC in the effectiveness evaluation, the cross-mapping methodology was employed between NIC and the interventions used by the authors of the studies.

RESULTS

Using a systematic process, we identified 91 studies. Twenty-seven met a priori inclusion and exclusion criteria. We found an increase in studies that focused on nursing interventions in the last 10 years (n = 19), a large proportion of clinical trials (n = 16), and the majority of articles from the Southeast region of Brazil (n = 20). The areas of focus were adult and elderly care, and with a special interest in the behavioral domain (n = 11). Two sensitivity criteria were identified in all D/T (n = 27), and each study presented evidence of effectiveness of a minimum of three criteria simultaneously.

CONCLUSIONS

Based on the effectiveness criteria, the Brazilian scientific production in postgraduate programs carried out by nurses provides evidence of the effectiveness for NIC nursing interventions.

IMPLICATIONS FOR NURSING PRACTICE

It is recommended to conduct further research that uses the NIC in the planning, conduct, and evaluation of interventions, based on effectiveness criteria of nursing sensitivity.

Perceptions of an educational intervention for family caregivers of palliative care patients

BACKGROUND

Nursing interventions aimed at family caregivers of palliative cancer patients require not only an objective evaluation, but also subjective consideration of their contributions, and a qualitative evaluation that provides an in-depth understanding of these interventions.

AIMS

This study aimed to explore the perceptions that family caregivers of palliative cancer patients had of the nursing intervention, PalliActive Caregivers, in reducing the uncertainty associated with illness and improving the caregiver's quality of life.

METHODS

A qualitative approach with content analysis was used. Telephone interviews were conducted with 23 caregivers who participated in the intervention.

FINDINGS

Five themes emerged from the content analysis: consolidating physical care, adopting a positive attitude, strengthening the support available to the caregiver, strengthening spirituality and strengthening relationships.

CONCLUSION

The themes showed a positive impact of the intervention on aspects such as the caregiver's ability to cope, spirituality and social support of caregivers. The results also indicated the possibility of conducting this type of study to identify other assessment variables for future interventions.

The need for integration nursing theories into pressure ulcer care in the community

Pressure ulcers are injuries to the skin requiring integrated care, particularly when patients are at home. Pressure ulcers have been a nursing concern for years, and several strategies have been proposed for its prevention and management. Nursing theory, which is essential for nursing practice, recommends plausible approaches to health problems. However, literature describing steps to integrate nursing theory into pressure ulcer care has not yet been explored. For this reason, this article discusses the six steps on how to apply nursing theory in community practice. A case study is also discussed to help gain a better understanding of these steps.

Therapeutic writing in a programme for binge eating disorder-A tool to come closer to clarifying feelings

INTRODUCTION

Therapeutic writing involving affect consciousness (AC) can be used to put difficult topics into words. In this study, we investigated how patients with binge eating disorder (BED) experienced therapeutic writing and AC in the context of cognitive behavioural therapy. The elements were included in an existing cognitive behavioural therapy group programme and the participants' experiences investigated qualitatively.

AIM

To investigate therapeutic writing as experienced by patients in the context of a BED group programme focusing on AC.

METHOD

A phenomenological, hermeneutic design with semi-structured interviews was employed. Eight participants were recruited after completing the BED programme at a Community Mental Health Centre on the West Coast of Norway.

FINDINGS

Four sub-themes emerged: Struggling to achieve a flow in the writing process, Deeper understanding of eating patterns through writing, Moving specific feelings towards the surface by writing and Greater insight into oneself as a human being by shared writing. Based on the sub-themes, one main theme was developed: Therapeutic writing in a binge eating disorder programme means focusing on oneself as a human being by becoming closer to one's feelings.

CONCLUSION

Therapeutic writing offered in treatment for BED involves individual movements at different levels, including processes of awareness of feelings, cognitions and oneself as a human being.

Australian residential aged care home staff experiences of implementing an intervention to improve palliative and end-of-life care for residents: A qualitative study

Access to high-quality and safe evidence-based palliative care (PC) is important to ensure good end-of-life care for older people in residential aged care homes (RACHs). However, many barriers to providing PC in RACHs are frequently cited. The Quality End-of-Life Care (QEoLC) Project was a multicomponent intervention that included training, evidence-based tools and tele-mentoring, aiming to equip healthcare professionals and careworkers in RACHs with knowledge, skills and confidence in providing PC to residents. This study aims to understand: (1) the experiences of healthcare professionals, careworkers, care managers, planners/implementers who participated in the implementation of the QEoLC Project; and (2) the barriers and facilitators to the implementation. Staff from two RACHs in New South Wales, Australia were recruited between September to November 2021. Semi-structured interviews and thematic data analysis were used. Fifteen participants (seven health professionals [includes one nurse, two clinical educators, three workplace trainers, one clinical manager/nurse], three careworkers and five managers) were interviewed. Most RACH participants agreed that the QEoLC Project increased their awareness of PC and provided them with the skills/confidence to openly discuss death and dying. Participants perceived that the components of the QEoLC Project had the following benefits for residents: more appropriate use of medications, initiation of timely pain management and discussions with families regarding end-of-life care preferences. Key facilitators for implementation were the role of champions, the role of the steering committee, regular clinical meetings to discuss at-risk residents and mentoring. Implementation barriers included: high staff turnover, COVID-19 pandemic, time constraints, perceived absence of executive sponsorship, lack of practical support and systems-related barriers. The findings underline the need for strong leadership, supportive organisational culture and commitment to the implementation of processes for improving the quality of end-of-life care. Furthermore, the results highlight the need for codesigning the intervention with RACHs, provision of dedicated staff/resources to support implementation, and integration of project tools with existing systems for achieving effective implementation outcomes.

Improving patient-centred care through a tailored intervention addressing nursing clinical handover communication in its organizational and cultural context

Aims

To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient‐centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover.

Design

Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention.

Methods

Pre‐intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital‐acquired complication data.

Results

Notable changes post‐intervention included a shift to involve patients in bedside handovers, improved ward‐level communication and culture, and an associated decrease in reported hospital‐acquired complications.

Conclusions

Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient‐centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success.

Impact

Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient‐centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital‐acquired complications. The intervention has been rolled out to a further five wards across two hospitals.

Patients' Experience of Attending a Binge Eating Group Program - Qualitative Evaluation of a Pilot Study

We developed a group program for patients with binge eating disorders (BED), comprising cognitive therapy, affect consciousness, and therapeutic writing. We wished to investigate how therapeutic writing and affect consciousness were experienced by the patients when integrated in a cognitive behavioral therapy (CBT) program. To our knowledge, such an intervention has not been tried in patients with BED. Aim: To explore patients’ experience of attending a binge eating group program comprising therapeutic writing, affect consciousness, and CBT. Research question: How do patients evaluate their experience of attending an integrative binge eating group program? Method: A qualitative design using an evaluative focus group interview with participants (four women and two men) who had completed the pilot program. Results: Three themes emerged: Enhanced self-awareness about the meaning of feelings; A more generous attitude towards oneself; and On the path to a better grip on the eating difficulties. Discussion: We interpreted the three themes in light of transition processes. The program was described as an essential part of the healing process and seems valuable for enabling new approaches leading to therapeutic changes when suffering from BED.

An Implementation Process Evaluation Based on an Integrated Psychosocial Support Program of Colorectal Cancer Couples in China: A Pilot Study

Studies have shown that the qualitative process assessment of cancer couple-based psychosocial interventions is often ignored. This article aims to evaluate the implementation process of an integrated psychosocial program developed for colorectal cancer couples. Semi-structured qualitative interviews were conducted with eight colorectal cancer couple participants and two intervention facilitators. Normalization Process Theory was used to guide the data collection and analysis. Data analysis was conducted using a directed content analysis approach within a framework approach. Participants had a good understanding of the program significance. For most participants, the intervention duration was appropriate, and was well integrated into daily life. A lack of understanding of psychological nursing, and a lack of confidence in the use of online platforms and other personal factors, inhibited participants' experience of participating in the intervention. The facilitator's challenge in the implementation process was being flexible in dealing with situations occurring outside of the framework plan. Face-to-face and online psychological interventions require more flexibility, and participant cognition of psychosocial care was the key to the successful implementation of the intervention. Future research should consider raising participants' awareness of psychological care to better integrate this type of intervention into participants' daily lives and routine care.