Quality nursing care for hospitalized patients with advanced illness: concept development

Active listening, shared decision-making and participation in care among older women and primary care nurses: a critical discourse analysis approach from a gender perspective

BACKGROUND

Nursing care for older women represent a challenge worldwide due to its characteristics. When communication is impaired between primary care nurses and older women living alone, an imbalance in power relations occurs. The main objective of this study is to analyse the power relations between older women and primary care nurses in situations of active listening, shared decision-making and participation in care.

METHODS

We developed a qualitative study in southern Spain using a discursive and gender approach. We used purposeful sampling to interview older women who lived alone and received home nursing care. Simultaneously, we conducted focus groups with primary care nurses who provided home care to older women. A linguistic analysis of the transcripts was carried out.

RESULTS

Nine semi-structured face-to-face interviews were conducted with older women who lived alone and two face-to-face focus groups with four primary care nurses in each. The discourse of the participants demonstrated an imbalance in power relations. Influenced by work overload, active listening was considered a privilege in primary care nurses´ discourse. Regarding shared decision-making, older women´s discourses revealed "mirages" of real situations where they thought they were deciding. Participation in care was difficult since older women saw themselves as a nuisance in nurses´ presence, and primary care nurses did not facilitate older women's engagement. Older women weren´t considered when organising home visits and had interiorised a subordinated feeling. Similarly, a strict sense of identity made primary care nurses feel powerful in their relationships with older women.

CONCLUSIONS

The discourse of older women represented them as victims of a hostile panorama whilst they were sometimes satisfied with the deficient care received. The discourse of primary care nurses used more discursive strategies to represent themselves as professionals committed to caring. However, it also revealed deficiencies in care, discriminatory elements, and feelings of being limited by their working conditions. Active listening to older women and engagement in decision-making readjust empower the older women. Attending to the needs and concerns of primary care nurses could recalibrate the power imbalance between them and healthcare organisations.

Cardiovascular nurses and organizational well-being: a systematic review

AIMS

This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it.

METHODS AND RESULTS

The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive.

CONCLUSION

Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes.

REGISTRATION

PROSPERO: CRD42022355669.

The lived experience of Chinese medical tourists receiving cancer care: A qualitative study

AIM

The purpose of this study was to describe and explore the lived experience of Chinese medical tourists receiving cancer care in clinical settings in the United States.

DESIGN

A qualitative phenomenological design.

METHODS

In this study, Hermeneutic phenomenology was used to interview 11 participants on WeChat, a popular social media platform of China. Hermeneutic phenomenology methods and hermeneutic circles were used to analyse data.

RESULTS

Five themes identified were: the application process involves various challenges; overcoming transportation and language barriers; feeling content with healthcare received in the United States; nearly perfect experience, except for long waiting times; and high cost of being a medical tourist.

CONCLUSION

Despite the cost and complexity of cancer treatment, Chinese medical tourists valued their experience in US clinical settings. Although, they experienced real challenges, they overcame obstacles with self-determination and varied resources. Therefore, culturally appropriate healthcare is highly recommended.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study are relevant for clinical practice, particularly cancer care to medical tourists in the United States. To better support the Chinese medical tourists with cancer, various strategies and techniques, as reported in this study, could be helpful. It is highly recommended to provide healthcare providers to enable them to understand and respect the diversity norms of other cultures.

Nursing care as a systemic and entrepreneurial phenomenon

The objective is to produce a critical-reflexivity analysis of nursing care, from the perspective of complexity thinking and social entrepreneurship. Theoretical-reflective study, supported by the framework of complexity thinking and social entrepreneurship. The main characteristics that lead and support nursing care are analyzed from a systemic-entrepreneurial perspective. A parallel is conceived between vertical care, design from a hierarchical structure and nursing care in the systemic-entrepreneurial perspective, which leads to singularity, originality, circularity, complementarity and interactivity. The centrality of nursing care is reaffirmed as a tangible social good or not. Theoretical reflection on nursing care as a systemic and entrepreneurial phenomenon raises a unique and multidimensional perception of the human being/user, health, the nursing work process, in order to achieve an increasingly agile, dynamic, circular, complementary and interdependent care.

Nurses are leaving the nursing profession: A finding from the willingness of the nurses to stay in the nursing profession among nurses working in selected public hospitals of Wollega Zones, Oromia, Ethiopia

Background:

The willingness of nurses to stay in nursing profession is nurses stay in the nursing profession without having intention to shift their works to other professions. In healthcare systems, nurses are currently leaving their work. To give quality of health, nurses have to stay in their work. The aim of this study was to find the willingness of the nurses to stay in the nursing profession and associated factors.

Methods:

An institution-based cross-sectional study was employed among nurses in selected hospitals. After checking for completeness, the data were interred into Epi Data version 3 and exported to Stata SE version 14 for analysis. Then, the descriptive statistics were computed. To find association, logistic regression was computed. Covariates from binary logistic regression were a candidate for multivariate logistic regression at p-value ⩽ 0.25. Variables in the final model were selected by the stepwise backward selection procedure. In the end, variables with a p-value ⩽ 0.05 were considered as statistically significant.

Results:

In this study, 349 nurses have participated with a 100% response rate and more than half of the participants were male 188 (53.87%). The proportion of nurses who have the willingness to stay in the nursing proportion is 54.44% (95% confidence interval = 0.491, 0.59). Getting relatively high salary (adjusted odd ratio = 1.81 (95% confidence interval = 1.05, 3.11)), no presence of support among colleagues (adjusted odd ratio = 0.10 (95% confidence interval = 0.05, 0.22)), not having participation in training (adjusted odd ratio = 0.49 (95% confidence interval = 028, 0.86)), having relative low experience in nursing profession that is less than 6 years (adjusted odd ratio = 0.46 (95% confidence interval = 0.26, 1.81)), having good autonomy in the nursing profession (adjusted odd ratio = 0.41 (95% confidence interval = 0.23, 0.70)), and having a good sense of self-calling for the nursing profession among nurses (adjusted odd ratio = 2.85 (95% confidence interval = 1.64, 4.97)) are the factors related with willingness of the nurses to stay in the nursing profession.

Conclusion and recommendation:

To bring development in the nursing profession, it is a must to staying experienced nurses in the nursing profession. Therefore, to increase the willingness of nurses in the nursing profession, it is better to increase the salary of nurses, giving frequent training for the nurses, initiate the nurses to support one another, and encourage the nurses to have sense of self-calling for nursing profession. This is accomplished if there is a harmonious relationship between the governments, nurses, and other stakeholders in the healthcare delivery system.

O cuidado de enfermagem como fenômeno sistêmico e empreendedor

The objective is to produce a critical-reflexivity analysis of nursing care, from the perspective of complexity thinking and social entrepreneurship. Theoretical-reflective study, supported by the framework of complexity thinking and social entrepreneurship. The main characteristics that lead and support nursing care are analyzed from a systemic-entrepreneurial perspective. A parallel is conceived between vertical care, design from a hierarchical structure and nursing care in the systemic-entrepreneurial perspective, which leads to singularity, originality, circularity, complementarity and interactivity. The centrality of nursing care is reaffirmed as a tangible social good or not. Theoretical reflection on nursing care as a systemic and entrepreneurial phenomenon raises a unique and multidimensional perception of the human being/user, health, the nursing work process, in order to achieve an increasingly agile, dynamic, circular, complementary and interdependent care.

Knowledge Management-Based Nursing Care Educational Training: A Key Strategy to Improve Healthcare Associated Infection Prevention Behavior

Introduction

Knowledge management-based nursing care has a positive effect in preventing healthcare associated infections (HAIs). Therefore, nursing professionals can utilize key strategies of knowledge management to support clinical decision making, reorganize nursing actions, and maximize patient outcomes.

Objectives

The aim of this study was to determine the effect of knowledge management-based nursing care educational training on HAI prevention behavior at the High Care Unit (HCU) of Saiful Anwar Hospital Malang.

Methods

A quasiexperimental design with a pretest, educational training intervention, and posttest were conducted on 15 nurses in the HCU of Saiful Anwar Hospital Malang, which lasted for 16 days. Furthermore, observation of nursing care documentation, nurses’ handwashing compliance, and presence of infection-causing bacteria in the HCU staff and environment (hands rub handle, medical record, and patient's bed) was carried out pre (day 1–7) and post training (day 10–16). Subsequently, educational training related to knowledge management-based nursing care was conducted for 2 days (day 8–9) by the Doktor Mengabdi Team of Universitas Brawijaya.

Results

The knowledge level and completeness of the nursing care documentation in the HCU room significantly increased after the training (p < .05). Also, compliance to the six steps five moments of nurses’ handwashing increased after the training (p > .05). Infection-causing bacteria were found in the HCU environment and staff before and after the training involving Pseudomonas stutzeri, Sphingomonas paucimobilis, Enterobacter cloacae, Staphylococcus aureus, Acinetobacter baumannii, Pasteurella pneumotropica, and Acinetobacter lwoffii. Therefore, increased knowledge of HCU nurses and complete documentation (r = .890; p = .054), increased knowledge of HCU nurses and handwashing compliance (r = .770; p = .086), and handwashing compliance and bacterial presence (r = .816; p = .084) all had a positive correlation.

Conclusion

Knowledge management-based nursing care educational training increased infection prevention behavior in the HCU of Saiful Anwar Hospital Malang.

Intention to Care for COVID-19 Patients Among Nurses Working at Health Care Institutions of Debre Tabor Town, North Central Ethiopia

Background

Coronavirus disease 2019 (COVID-19) has caused many challenges for health care providers. Nurses meet patients with coronavirus disease and offer care for newly communicable diseases. Despite global and national efforts to prevent the spread, the outbreak is still on a rise, and studies on the health care behaviors of nurses were scarce in the study setting. Therefore, this study was intended in addressing nurses’ intention to care for coronavirus disease 19 patients and its determinants among nurses working at Debre Tabor town Health Care Institutions, 2020.

Methodology

An institutional-based cross-sectional study was conducted among 163 nurses working at health care institutions of Debre Tabor Town, from June 01 to 15/2020. The data were collected using tools with a self-administration questionnaire adapted from the theory of planned behavior and different kinds of literatures. All nurses working at Debre Tabor health care institutions were included. Data were entered using Epi-data 4.2.0.0 statistical software, and analysis was done by Stata version 14 statistical software. Binary logistic regression model was used for analysis. Strength of association was measured using the odds ratio with 95% CI, and the level of significance was estimated at P-value ≤0.05.

Results

Nurses’ intention to care for COVID-19 patient was 59.5% (95% CI; 58.7:60.3). Having better working experience (adjusted odds ratio (AOR) =2.3:95% CI; 1.120, 4.910), caring experience for infectious disease (AOR=2.5; 95% CI: 1.10, 5.50), good perceived behavioral control (AOR=2.33; 95% CI: 1.13, 4.8), and subjective norms (AOR= 2.14; 95% CI: 1.05, 4.36) were significantly associated with intention of caring behavior.

Conclusion

Nurses’ intention to care for COVID-19 patients was low. Working experience, the experience of caring for infectious disease, self-efficacy, and subjective norm were independently related with nurses’ caring intention. The government should work on improving nurse’s confidence in disaster management, design disaster management nursing education, and frequent support of nurses.

Perceived Quality of Nursing Care Among Cancer Patients Attending Hawassa University Comprehensive Specialized Hospital Cancer Treatment Center; Hawassa Southern Ethiopia: Cross-Sectional Study

Background

Cancer has become one of the most common and the second leading cause of death. According to grounded theory, quality care is meeting all the needs of the patients. Low-quality nursing care relates omission of nursing care required to meet patients' need. Quality of nursing care in oncologic setting was nursing practice area where studies are limited.

Objective

The aim of the study was to assess the perceived quality of nursing care among patients with cancer attending Hawassa University comprehensive specialized Hospital.

Methods

A quantitative Cross-sectional study was conducted. Among the proposed 422 patients with cancer, using a simple random sampling technique 415 patients were included in this study. Seven data were discarded due to incompleteness and inconsistency between collected data and patient medical record. Data were collected using structured questionnaires and Quality of Oncology Nursing Care Scale. We carried out statistical analysis using SPSS V-20. We used descriptive analysis to examine the quality of oncology nursing care.

Results

The mean age of patients was 42.51 (±14.24) years, among patients diagnosed with cancer more than one-third 148 (35.70%) had breast cancer. The majority of patients with cancer 173 (41.70%) were in stage-III. Nearly two-third 266 (64.10%) of patients were on chemotherapy. Among study participants on treatment, 249 (60.00%) perceived they received good quality of nursing care. The mean score related to the domain of support and confirmation is 62.73 ± 7.26. In terms of spiritual care, the mean score is 21.03 ± 5.37.

Conclusion

The perceived quality of nursing care was high however not all domains of oncology care were achieved. We recommend Detail and focused study to explore important predictors’ quality nursing care.

Understanding the Patient Experience of "as-Required" Medication in a Hospice In-Patient Unit

BACKGROUND

Timely administration of 'as-required' medication is important for managing patients' symptoms in palliative care. There are no national or local standards around the maximum length of time for the process to administer 'as-required' medication and little in the literature to inform practice. Our aim was to understand the patient experience of receiving these medications in the in-patient setting of a hospice.

METHODS

A survey of hospice patients who had been on the ward at least seven days was conducted over a fifteen-week period looking at current practice, the patient experience of requesting medication and how long it took to be administered.

RESULTS

Thirty-one responses were obtained. Patients made their requests in a variety of ways but 33% did not use their call bell. When looking at their most recent 'as-required' medication request, 87% of patients estimated that they received it within ten minutes. When considering their longest wait, 16% of patients reported waiting longer than twenty minutes.

CONCLUSION

This survey highlights the importance of there being a variety of ways for patients to request 'as-required' medication and staff being proactive with patients to facilitate these requests. Patients perceive nursing staff to be busy and do not want to bother them. Although usually patients get their medication within ten minutes, patients can be waiting more than twenty minutes. There is a need for national standards on time to administer as-required medication within a healthcare setting and a need for more data to inform such a standard.

Association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care: A panel study

BACKGROUND

Strengthening quality of care without compromising nurse job outcomes by building a safer health care system is a common concern worldwide including in China. Most of the current evidence comes from cross-sectional studies conducted in western countries, which limits inferences of causality and generalization.

OBJECTIVE

The objectives of this longitudinal study were to compare changes in quality of care, nurse job outcomes, nursing work environment, non-professional tasks, and nursing care left undone in acute hospitals in China between 2014 and 2018. Secondly, we wanted to determine the association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care.

DESIGN, SETTINGS, AND PARTICIPANTS

A prospective two-stage panel study conducted in 108 adult medical and surgical units from 23 hospitals in Guangdong province, China in 2014 and repeated in 2018.

METHODS

Work environment was measured by the Practice Environment Scale of the Nursing Work Index. Non-professional tasks were measured with a seven-item scale surveying the performance of and time spent on non-professional tasks. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse job outcomes included burnout, dissatisfaction, and retention. Quality of care was measured by four items indicating overall quality of care as assessed by nurses (three items) and patients (one item). Generalized estimating equations with linear regression were employed to analyze data.

RESULTS

In 2018, compared with 2014, the nursing work environment had improved, and non-professional workloads had decreased minimally. The average number of the 12 nursing care tasks left undone had increased to 6.5 from 5.6 in 2014. Fewer nurses reported job dissatisfaction or intention to leave. Quality of care was improved slightly as assessed by nurses and patients. As for the changes of hospital organizational factors on quality of care, a better nursing work environment was related to better nurse job outcomes and quality of care. More non-professional tasks were related to higher levels of nurse job burnout. Less nursing care left undone was associated with better nurse-assessed quality of care. Units with more nurses experiencing job burnout and dissatisfaction were likely to have poorer nurse-assessed quality of care.

CONCLUSIONS

Improving nursing work environment and supporting nurses to engage in professional and direct patient care as opposed to non-professional work may be beneficial to nurse job outcomes and promote quality of care.

Moving beyond the measure: Understanding patients' experiences of communication with nurses

Under Medicare's Value-Based Purchasing Program, scores derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey are used in the determination of incentive payments and financial penalties for healthcare organizations. Organizations, therefore, invest in approaches to improve the likelihood of positive patient responses. Evidence suggests that nurse communication as measured by HCAHPS influences overall patient satisfaction, yet little is known regarding what patients believe constitutes effective communication with nurses. In this qualitative descriptive study, we conducted phone interviews with 49 recently hospitalized patients to better understand patients' perceptions of their communication with nurses. Our findings indicate that patients perceived their communication with nurses to unfold via nurses' behaviors. Namely, nurses' engagement with patients, anticipation of patients' needs, responsiveness to patients' concerns, and teaching practices positively influence patient satisfaction with communication with nurses. These behaviors resonated most strongly with patients during particularly memorable moments of uncertainty and vulnerability over the course of a hospital stay. These findings suggest that focusing on the development of nurses' behaviors, ensuring processes are in place to support positive behaviors and creating organizational environments that position nurses to consistently apply these behaviors, can improve patients' perceptions of their communication with nurses. These findings also provide a foundation for further research focused on developing and testing specific behavioral interventions and their effect on communication perception.

Effects of nursing intervention in patients undergoing stent placement for gastrointestinal stenosis or obstruction

BACKGROUND

It has been found that the psychological status and quality of life of patients could be improved effectively by nursing intervention. The purpose of this study was to analyze the effects of quality nursing intervention in patients with gastrointestinal stenosis or obstruction.

AIM

To evaluate the effects of quality nursing intervention in patients with gastrointestinal stenosis or obstruction.

METHODS

From January 2016 to February 2020, 96 patients with gastrointestinal stenosis or obstruction at our hospital were selected, and all of them underwent endoscopic stent implantation. They were randomly divided into either a control group (receiving routine care) or an observation group (receiving high quality nursing intervention); the improvement of anxiety and depression, vital signs, nursing satisfaction, incidence of adverse reactions such as pain, and quality of life were compared between the two groups.

RESULTS

After intervention, the self-rating anxiety scale score and self-rating depression scale score in the observation group were 47.22 ± 3.51 and 45.80 ± 1.33, respectively, which were significantly lower than those of the control group (60.00 ± 3.14 and 55.23 ± 3.15, respectively; P < 0.05). The visual analogue scale score of the observation group was 3.15 ± 0.55, which was significantly lower than that of the control group (5.31 ± 0.67; P < 0.05). The vital signs, nursing satisfaction, and scores of physiological function, psychological function, mental state, and social function in the observation group were significantly higher than those of the control group, while the incidence of adverse reactions was significantly lower than that of the control group (P < 0.05).

CONCLUSION

High-quality nursing intervention has significant effects in patients with gastrointestinal stenosis or obstruction treated by stent placement.

Preliminary construction of evaluation indicator system for inpatients’ nursing service needs in tertiary general hospital

Objectives

To construct a comprehensive evaluation indicator system for inpatients’ nursing service needs in tertiary general hospital and to provide evidence for identifying and meeting the needs of inpatients’ nursing services.

Method

We used the Delphi method to conduct two rounds of expert consultations with 41 experts.

Result

The indicator system consisting of 5 first-level indicators and 48 second-level indicators was preliminarily constructed.

Conclusions

We formed an evaluation indicator system for inpatients’ nursing service needs in tertiary general hospital and classified it into five categories: hospital environment, nursing attitude, nursing skills, information exchange, and emotional support. The indicator system is scientific and reliable. It can provide a basis for nursing staffs to identify and meet the needs of inpatients’ care services.

Patients' and Nurses' Perceptions of What Constitutes Good Nursing Care: An Integrative Review

BACKGROUND

Differences between patients' and nurses' perceptions of good nursing might be one of the barriers to optimal nursing care that matches the preferences of patients. A better understanding of the attributes of Good Nursing Care across different settings, circumstances, and patient populations will provide an integrated idea about Good Nursing Care, which can contribute to nursing theory development and future research.

PURPOSE

This study aimed to integrate the literature on patients' and nurses' perceptions of what constitutes Good Nursing Care and thereby identify the similarities and differences in patients' and nurses' perceptions of Good Nursing Care.

METHODS

A literature search of PubMed, CINAHL, and MEDLINE was conducted for article published between January 2000 and June 2017. A total of 18 studies were identified and assessed using the Mixed Method Appraisal Tool. The studies were analyzed and synthesized using Swanson's theory of caring as the theoretical framework.

RESULTS

Some dissents and agreements were found between patients and nurses regarding the crucial attributes of Good Nursing Care. While "enabling," such as providing information, coaching, and guidance, was more emphasized by patients, "being with" (being present at the bedside) was more emphasized by nurses. "Doing for," especially expert performance and enhancing physical comfort, was the most frequently mentioned attribute of Good Nursing Care by both patients and nurses.

IMPLICATIONS FOR PRACTICE

Theoretical developments regarding Good Nursing Care-characterized by a balance between sufficient nursing knowledge and competent technical skills on one hand and patient empowerment based on trusting relationships on the other hand-would promote the provision of Good Nursing Care in clinical practice.

Spiritual Intelligence Roles to Improve the Quality of Nursing Care: A Systematic Review

Introduction: The quality of nursing care is the most significant predictor of patient satisfaction in care. But the fact is that nurses have not shown an increase in the quality of nursing care. Lack of sense of responsibility, sincerity, self-awareness and professionalism is an indicator of the poor quality of nursing care in the health care system. The aim of the systematic review was conducted to examine the role of spiritual intelligence to improve the quality of nursing care.Method: A systematic search was conducted in Pub Med, Science Direct, Research Gate, and Emerald Insight data based. The search was identified 15 relevant original articles and full text published between 2013 until 2018.Result: The result showed that Spiritual Intelligence could be improving the quality of nursing care. Nurse with high spiritual intelligence have more competence, personal meaningful about caring, moral performance, personal excellence and flexibility were effective in increasing the quality of care.Conclusion: Spiritual intelligence has strengthened the beliefs and personality of nurses and the desire to grow and learn, work more professionally in improving the quality of nursing care. Because there was a lack in the reviewed studies used the cross-sectional and correlation, well-designed such as randomised controlled trials or queasy experiment should be conducted to more objectively evaluated the effect of spiritual intelligence to improve the quality of nursing care

Healthcare Quality: A Concept Analysis

Worsening quality indicators of health care shake public trust. Although safety and quality of care in hospitals can be improved, healthcare quality remains conceptually and operationally vague. Therefore, the aim of this analysis is to clarify the concept of healthcare quality. Walker and Avant's method of concept analysis, the most commonly used in nursing literature, provided the framework. We searched general and medical dictionaries, public domain websites, and 5 academic literature databases. Search terms included health care and quality, as well as healthcare and quality. Peer-reviewed articles and government publications published in English from 2004 to 2016 were included. Exclusion criteria were related concepts, discussions about the need for quality care, gray literature, and conference proceedings. Similar attributes were grouped into themes during analysis. Forty-two relevant articles were analyzed after excluding duplicates and those that did not meet eligibility. Following thematic analysis, 4 defining attributes were identified: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these attributes, the definition of healthcare quality is the assessment and provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of optimal or desired health. This analysis proposes a conceptualization of healthcare quality that defines its implied foundational components and has potential to improve the provision of quality care. Theoretical and practice implications presented promote a fuller, more consistent understanding of the components that are necessary to improve the provision of healthcare and steady public trust.

The meaning of patient-nurse interaction for older women in healthcare settings: A Qualitative Descriptive Study

AIMS AND OBJECTIVES

The purpose of this study was to explore the meaning of patient-nurse interaction for older women receiving care in healthcare settings.

BACKGROUND

Older women are often overlooked or misunderstood by the nurses caring for them. Some research exists on nurses' perception of their interaction with patients, yet few studies have described the meaning of such interaction from the patients' perspective.

METHODS

This was a pilot study using qualitative description as a methodology. Data were filtered through a lens of critical feminist theory to interpret interactions taking place in healthcare settings that are often characterised by paternalism. Seven women between the ages of 66 and 81 were interviewed using a semi-structured guide.

RESULTS

Participants had a distinctive perspective on the experience of caring. Their expressions include stories of being cared for themselves by nurses as well as historical recalls of being the one-caring for family members. In these combined stories, the contrast between the nurses who held caring in primacy and those who were distinctly uncaring sheds light on the importance of cultivating a moral ideal of caring and respect for personhood.

CONCLUSION

A population of older women who potentially face disabling conditions must rely on direct, meaningful, interaction with nurses to successfully navigate the healthcare system. The findings suggest that these women did not have consistent access to such interaction.

IMPLICATIONS FOR PRACTICE

The gathering and interpretation of new narratives about patient-nurse interaction for older women could lead to a deeper understanding of power and civility as it impacts a caring relationship. Further research using a theoretical lens of critical feminism has implications for improving healthcare delivery for older women worldwide.

What establishes an excellent nurse? A focus group and Delphi panel approach

BACKGROUND

Over the past few years, the complexity of the health care system in which nurses are required to practice has increased considerably, magnifying the need for excellent professionals with a specific set of knowledge, skills and attitudes. However, the characteristics that distinguish an excellent nurse have not yet been clarified. The aim of this study was to determine nurses' perspectives regarding characteristics associated with an excellent nurse in order to elicit a conceptual profile.

METHOD

A focus group design followed by Delphi panel content validation was utilized. Information regarding nurses' perspectives was derived from six focus group discussions comprising 19 nurses involved in hospital practice and 24 nurses with experience in mental health care. The analysis of the focus group discussions resulted in nine domains whereby content validity was achieved with contributions from a Delphi panel survey with 26 professionals.

RESULTS

As determined by the survey, a combination of these specified aspects characterize an excellent nurse: analytical, communicative, cooperative, coordinating, disseminates knowledge, empathic, evidence-driven, innovative and introspective.

CONCLUSION

Determining what establishes an excellent nurse according to experienced nurses is valuable as this information can influence the broadening curriculum for educating future nurses to meet the needs in the professional field, contributing to the quality of care. This conceptual profile can be used as a reference guide for supervisors and professionals to personally improve their clinical practice as well as for education.

Moral competency: meta-competence of nursing care

Introduction

To follow the progress of technology and increasing domain of nurses’ duties, ethical challenges can be observed more than ever. Therefore, the growing and dynamic system of nursing requires nurses with professional and ethical competence who can provide optimal care. The aim of the present study was to define and explain dimensions of moral competency among the clinical nurses of Iran.

Methods

This qualitative content analysis study was carried out in the years 2014 and 2015 in Iran. Data were collected through in-depth semistructured interviews and field notes. The resulting data were analyzed by Graneheim and Lundman’s method of conventional content analysis. The participants were 12 clinical nurses who were selected using purposive convenient sampling and continued interviews until data saturation.

Results

Themes obtained in the present study were posited in three main categories of “moral character,” with subcategories of altruism, search for meaning, be pioneering, perfectionism, self-control, honesty, and forgiveness; “moral care” with subcategories of dignified care, safe care, fair care, and holistic care; and “moral decision-making” with subcategories of moral sensitivity, moral thinking, moral reasoning, and moral courage.

Conclusions

Findings of the present study suggest that nurses’ moral competency is an adorable character with a wide range that includes moral virtues and character, moral decision-making, and ultimately providing moral care; therefore, moral competency is a meta-competence in the field of nursing. Because there are many competencies in different fields.

Assessment of Parents' Perception of Quality of Pediatric Oncology Inpatient Care at Kenyatta National Hospital

OBJECTIVE

Adequate knowledge of parents' perception of quality of pediatric cancer care helps to identify the areas of care improvement which would contribute to disease outcome in regard to the quality of life and satisfaction with the care provided. The aim of the study was to assess the parents' perception of the quality of Pediatric Oncology Inpatient Care at Kenyatta National Hospital.

METHODS

A cross-sectional descriptive quantitative and qualitative study was undertaken using a pretested semi-structured questionnaire and a focused group discussion guide. Assessment of parents' perception of quality of care was done in relation to the institution's structures and care delivery processes. These included the ward environment, resources for cancer treatment, care processes, service providers, and parents' knowledge empowerment. Participants were systematically selected. Parents' perception was defined as satisfaction or dissatisfaction with the care provided. Data were analyzed using SPSS version 20.0 (Armonk, NY: IBM Corp.) and presented as frequencies and percentages. Chi-square was used to test the significant association between variables. Level of significance was set at a P ≤ 0.05.

RESULTS

A total of 107 respondents were interviewed and 57.9% were satisfied with the overall quality of care they received. The determinants of overall satisfaction in this study were found to be related to resources for cancer treatment (odds ratio [OR] =3.10; 95% confidence interval [CI] =1.39-6.90; P = 0.005), care delivery processes (OR = 2.87; 95% CI = 1.28-6.43; P = 0.009), and the ward environment (OR = 2.59; 95% CI = 1.17-5.74; P = 0.018).

CONCLUSIONS

The parents were moderately satisfied with the oncology care services their children received. The gaps identified in service delivery included those related to the availability of the required resources for efficient care delivery and also educational as well as psychosocial needs of the parents.

Effectiveness of standard of care protocol on patient satisfaction and perceived staff caring

BACKGROUND

Nurse caring has been linked to many clinical outcomes, including patient satisfaction, well-being, and healing. In addition, it is valued by nursing staff and viewed as being essential to clinical practice.

OBJECTIVES

The purpose of this program evaluation study was to determine the difference in patient satisfaction with overall nursing care and perceived nurse caring when a nursing staff standard of care protocol, which included caring activities, was implemented within a nursing department at a National Cancer Institute-designated comprehensive cancer center.

METHODS

A pre-experimental pre-/post-test design with comparison group and a post-test-only design were used to test the effect of the caring protocol on patient satisfaction with nursing care and perceived nurse caring. The study was conducted on seven inpatient units.

FINDINGS

Patient satisfaction with nursing care increased for some items, and perceived nurse caring was ranked highly immediately before discharge. Additional program evaluation studies involving a modified caring protocol may improve satisfaction with nursing care in other settings.

Adapting cognitive interviewing for nursing research

Cognitive interviewing (CI) has been used by instrument developers to examine how well an instrument generates the intended data when tested with prospective respondents. In using CI to test a new instrument to measure patients' perceptions of the quality of nursing care, the authors found challenges in applying a theory-based traditional CI approach derived from experimental psychology to more clinically oriented nursing research. The purposes of this article are to describe these challenges and the modifications of CI to capture the nursing care perspectives of hospitalized participants, and to present interpretive phenomenology as a theoretical orientation for clinically situated CI.

Nurses' knowledge and attitudes about pain in hospitalized patients

PURPOSE

The purpose of the study was to measure knowledge and attitudes of nursing about pain management in patients before education, immediately after, and 6 months later. The end-point measure was Hospital Consumer Assessment of Healthcare Providers and Systems quarterly scores and percentile rank.

DESIGN

This longitudinal, quasi-experimental, quantitative study used survey method with pretest and posttest scores to measure immediate learning and 6 months later to measure sustained changes in knowledge and attitudes for nurses in this facility.

SETTING

The setting was a 360-bed acute care community hospital in the midsouth.

SAMPLE

The sample consisted of approximately 206 bedside nurses who worked in an acute care facility and 164 final posttest participants.

METHODS

The survey was used in a group setting immediately prior to a didactic learning experience. Immediately after the session, a posttest survey was administered. The 6-month follow-up occurred via an online module developed by the principal investigator. A repeated-measures analysis of variance, a pairwise comparison with a paired t test, and a Bonferroni correction were performed to determine if sustained knowledge and attitudes have changed.

FINDINGS

Posttest scores were significantly higher than pretest scores on the Knowledge and Attitudes Survey Regarding Pain immediately after a didactic education session and 6 months later (P < .017).

CONCLUSIONS

Six months later, scores remained higher than pretest or immediate posttest scores.

IMPLICATIONS

Nurses with a stronger knowledge base may lead to better pain management, improved outcomes, and higher patient satisfaction scores.

Quality improvement in nursing: administrative mandate or professional responsibility?

For professionals, providing quality service and striving for excellence are ethical responsibilities. In many hospitals in the United States, however, there is evidence indicating that current quality improvement (QI) involving nurses is not always driven by their professional accountability and professional values. QI has become more an administrative mandate than an ethical standard for nurses. In this paper, the tension between QI as nurses' professional ethics and an administrative mandate will be described, and the implicit ideal-reality gap of QI will be examined. The threat to professional nursing posed by the current approach to QI will be examined, and ways to incorporate nursing professional values in a practical QI effort will be explored.