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Wu Y, Wang X, Gào X, Xu L, Wang B, Cai Z. Prognostic factors in Chinese patients with immunoglobulin light chain amyloidosis: a scoping review and meta-analysis. Ann Med 2024; 56:2386635. [PMID: 39129426 PMCID: PMC11321117 DOI: 10.1080/07853890.2024.2386635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVE This scoping review and meta-analysis aimed to map the evidence regarding prognostic factors in Chinese patients with immunoglobulin light chain (AL) amyloidosis and to identify current research gaps. METHODS We searched EMBASE, PubMed, and CNKI databases from their inception to 15 September 2021. All studies investigated the association between any prognostic factor and target outcomes, including overall survival (OS), progression-free survival (PFS), and end-stage renal disease (ESRD) in Chinese patients with AL amyloidosis. RESULTS This scoping review included 52 studies, of which 44 with 6,432 patients contributed to the multivariate prognostic analysis. Multivariate analysis identified a total of 106 factors that correlated with OS, 16 factors with PFS, and 18 factors with ESRD. Five prognostic factors were significantly associated with PFS, and 11 prognostic factors were significantly associated with ESRD. Meta-analysis was only available for prognostic factors without heterogeneous cutoff values, for which hazard ratios (HRs) and their 95% confidence intervals (CIs) were reported. Meta-analysis showed that bone marrow plasma cells (BMCs) (HR: 1.96, 95% CI: 1.21-3.19, p < 0.05) and interventricular septal thickness (IVST) (HR: 1.23, 95% CI: 1.10-1.38, p < 0.05) were independently associated with OS. CONCLUSION The significant prognostic factors associated with OS, PFS, and ESRD in Chinese patients with AL amyloidosis were related to plasma cell tumor load, biological characteristics, cardiac involvement, renal involvement, population characteristics, and treatment. Further studies should explore additional prognostic factors in patients with AL amyloidosis to develop prognostic models.
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Affiliation(s)
- Yu Wu
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Wang
- Xi’an Janssen Pharmaceutical Ltd, Beijing, Chaoyang District, China
| | - Xīn Gào
- Xi’an Janssen Pharmaceutical Ltd, Beijing, Chaoyang District, China
| | - Lingjie Xu
- Xi’an Janssen Pharmaceutical Ltd, Beijing, Chaoyang District, China
| | - Bin Wang
- Xi’an Janssen Pharmaceutical Ltd, Beijing, Chaoyang District, China
| | - Zhen Cai
- The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Xu X, Wang Y, Meng J, Xia X, Cao W, Liu Y. The Relationship Between Moral Sensitivity, Missed Nursing Care and Moral Distress Among New Nurses: A Cross-Sectional Study. J Clin Nurs 2024. [PMID: 39209794 DOI: 10.1111/jocn.17420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 08/13/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
Moral sensitivity, missed nursing care and moral distress among healthcare professionals have received considerable attention in recent years. These factors represent important healthcare challenges for new nurses (graduation to 2 years of work experience). However, studies on the relationships among these variables in the context of new nurses in China remain lacking. AIMS To explore the relationships among moral sensitivity, missed nursing care and moral distress in the context of new nurses in China. RESEARCH DESIGN A cross-sectional descriptive survey was conducted. PARTICIPANTS AND RESEARCH CONTEXT A total of 228 new nurses were recruited from three tertiary hospitals in Qingdao, Shandong Province, China. Participants provided their sociodemographic and professional information and completed the Chinese Moral Sensitivity Questionnaire-Revised Version, the Chinese Missed Nursing Care Survey Version and the Chinese Moral Distress Scale-Revised Version. The data were analysed using Spearman's correlation analysis and multiple linear regression analysis. RESULTS The means and standard errors of moral sensitivity, missed nursing care and moral distress were 40.71 (0.39), 9.82 (0.78) and 34.87 (2.41), respectively. The variable of missed nursing care exhibited a significant negative relationship with moral sensitivity and a significant positive relationship with moral distress. Regression analysis revealed that the main factors influencing new nurses' moral distress were educational background, nature of job, current unit, frequency of night shifts and the dimensions of moral strength and responsibility. These factors can explain 14.9% of the total variation. CONCLUSION The findings revealed that higher rates of missed nursing care were associated with lower moral sensitivity and greater moral distress among new nurses. Therefore, developing interventions to reduce missed nursing care may be a promising strategy for improving moral sensitivity and preventing moral distress among new nurses. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE In hospitals, moral distress can be improved by focusing on modifiable factors such as staffing resources, leading to better promoting new nurses' health and improving the quality of care. This study can highlight practices accounting for moral sensitivity and missed nursing care in nursing research and training programmes. REPORTING METHOD Strengthening the reporting of observational studies in epidemiology (STROBE) statement. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Xiaobing Xu
- School of Nursing, Qingdao University, Qingdao, China
| | - Yan Wang
- Qilu Hospital, Shandong University (Qingdao), Qingdao, China
| | - Juntong Meng
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Xiaolin Xia
- School of Nursing, Qingdao University, Qingdao, China
| | - Wanlu Cao
- School of Nursing, Qingdao University, Qingdao, China
| | - Ye Liu
- Qilu Hospital, Shandong University (Qingdao), Qingdao, China
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Chiappinotto S, Bayram A, Lupi T, Basaran-Acil S, Gurkovà E, İspir Demir Ö, Kohanová D, Özsaban A, Grassetti L, Palese A. Unfinished nursing care occurrence, priority order and reasons as perceived by nursing students: An international study. Nurse Educ Pract 2024; 79:104100. [PMID: 39173395 DOI: 10.1016/j.nepr.2024.104100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/05/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
AIM The study aimed to measure and compare differences (a) in the unfinished nursing care interventions overall and the order in which they are left unfinished; and (b) in the underline reasons, as perceived by Italian, Slovak and Turkish nursing students. BACKGROUND In recent years, in the nursing education context a novel line of research in the field of unfinished nursing care as those interventions required by patients, but omitted or delayed, has emerged. However, no studies have been conducted at the international level. DESIGN An international, comparative cross-sectional study was performed in 2022-2023 and reported here according to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. METHODS A multinational research network was formed with a convenient sample of 13 universities and 60 campuses (4595 students). The Unfinished Nursing Care Survey for Students (UNCS4S) was administered. A total of 1850 students participated. RESULTS According to the UNCS4S total score, Italians reported an average 50.9 out of 110 unfinished nursing care interventions (CI95 % 47.6-54.1), Slovakians 54.9 (CI95 % 53.7-56.1) and Turkish students 50.4 (CI95 % 49.2-51.5) (p<0.001). Some interventions were reported more often as unfinished across countries as supervising the task assigned to the nursing aides, going to the patient without being called, spending the required time with the patient and their caregivers and emotionally supporting patients and their caregivers. In terms of reasons, total scores were statistically different across countries (Italy: 45.92 out of 90, CI95 % 43.91-47.9; Slovakia: 62, CI95 % 61.02-62.98; Türkiye: 72.29, CI95 % 71.13-73.45; p<0.001); however, at the factor level, communication issues, lack of material resources and issues in supervision of nursing aides were reported in all countries as the most important reasons of the unfinished nursing care. CONCLUSIONS Students learn to shape and set priorities early in their nursing careers with similar order in what to leave unfinished as first, despite the different educational structures, care cultures and healthcare systems. Among the unfinished nursing care reasons perceived, the most influential were similar across countries, suggesting common areas for improvement. How to better prepare students to be resilient and capable of managing the challenges posed by unfinished nursing care episodes due to the lack of resources and communications issues should be considered as a priority by nurse educators.
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Affiliation(s)
| | - Aysun Bayram
- Karadeniz Technical University, Faculty of Health Sciences, Department of Fundamentals Nursing, Trabzon, Türkiye.
| | - Tommaso Lupi
- University of Udine, Department of Medicine, Udine 33100, Italy.
| | - Seher Basaran-Acil
- Hacettepe University Faculty of Nursing, Nursing Services Administration Department, Ankara, Türkiye.
| | - Elena Gurkovà
- Elena Gurkova, University of Prešov, Faculty of Health Care, Department of Nursing, Prešov 08001, Slovakia.
| | - Öznur İspir Demir
- Osmaniye Korkut Ata University, Faculty of Health Sciences, Department of Gerontology, Osmaniye, Türkiye
| | - Dominika Kohanová
- Constantine the Philosopher University in Nitra, Faculty of Social Sciences and Health Care, Department of Nursing, Nitra 949 01, Slovakia.
| | - Aysel Özsaban
- Karadeniz Technical University, Faculty of Health Sciences, Department of Fundamentals Nursing, Trabzon, Türkiye.
| | - Luca Grassetti
- University of Udine, Department of Economy and Statistic, Udine 33100, Italy.
| | - Alvisa Palese
- University of Udine, Department of Medicine, Udine 33100, Italy.
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Bahador RS, Dastyar N, Ahmadidarrehsima S, Rafati S, Rafati F. The patients' lived experiences with equitable nursing care. Nurs Ethics 2024; 31:859-874. [PMID: 37867260 DOI: 10.1177/09697330231209293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Equitable care is a fundamental value in the nursing profession. Healthcare workers have both a moral and professional duty to ensure that they do not discriminate. AIM This study aimed to explore how patients perceive equitable nursing care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT This descriptive phenomenological qualitative research study used purposeful sampling to select 17 patients from various departments of a general hospital in southern Iran. The participants were then interviewed using a semi-structured in-depth interview format, which aimed to delve into their experiences with equitable nursing care. The collected data were analyzed using Colaizzi's seven-step method and MAXQDA20 software. ETHICAL CONSIDERATIONS Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Ethics Committee of Jiroft University of Medical Sciences. FINDINGS The data analysis of the study identified three main themes and six subthemes that were related to the experiences of patients with equitable nursing care. The first theme, equitable care, encompassed subthemes such as nurses' dedicated efforts to facilitate patient recovery and adherence to ethical behavior. The second theme, unconscious causes of inequitable nursing care, included subthemes such as unintentional discrimination stemming from organizational constraints and unconscious biases resulting from a lack of knowledge and skills. The third theme, discriminatory care, comprised subthemes such as deliberate discrimination based on personal traits and selective discrimination. CONCLUSION The study findings indicate that achieving equitable nursing care requires a multifaceted approach. This includes effective hospital management, organizational reforms, and regulatory enhancements. Additionally, it is crucial to pay close attention to the needs of patients, enhance nurses' theoretical and practical skills in providing equitable care, fostering a culture of equality within healthcare settings, and consider the personality dimensions and moral characteristics of nurses.
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Affiliation(s)
- Raziyeh Sadat Bahador
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Neda Dastyar
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Sudabeh Ahmadidarrehsima
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Shideh Rafati
- Social Factors in Health Promotion Research Center, Hormozgan Health Research Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Foozieh Rafati
- Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
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Tiryaki Sen H, Taskiran Eskici G, Ciftcioglu G. A cross-sectional study of the relationship between missed nursing care and conscientious intelligence in hospital nurses. Int Nurs Rev 2024. [PMID: 39051554 DOI: 10.1111/inr.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
AIM To examine the relationship between missed nursing care and conscientious intelligence. BACKGROUND Missed nursing care is a globally common patient safety issue that threatens quality nursing care. Current studies mainly focus on the relationship between missed nursing care and external factors such as nurse, unit and hospital characteristics. However, internal factors, such as the conscientious intelligence of nurses, are also very important for missed nursing care. Moreover, the relationship between missed nursing care and conscientious intelligence has not been examined so far. This study will contribute to filling this gap in the literature. METHODS This is a descriptive correlational study. The study sample consisted of 514 nurses working in a city in the southeastern region of Türkiye, reached by convenience sampling method. Study data were collected between 30 January and 30 June 2021. Descriptive statistics, difference statistics, Pearson correlation analysis and multiple regression analysis were performed. RESULTS Nurses missed nursing care at an occasional level (1.66 ± 0.63), and their conscientious intelligence score was high (131.26 ± 19.24). Conscientious intelligence alone accounted for 10.6% of the variance in missed nursing care. As nurses' conscientious intelligence levels increase, the level of missed nursing care decreases. Gender, education level, satisfaction with being a nurse and patient-to-nurse ratios had a statistically significant effect on missed nursing care scores. CONCLUSION Missed nursing care decreased as nurses' conscientious intelligence increased. Although nurses need to be knowledgeable and competent in caregiving, it is also necessary to consider their conscientious intelligence in patient care. IMPLICATIONS FOR NURSING AND HEALTH POLICY Organizations and nurse managers could improve nursing care by implementing strategies to increase nurses' conscientious intelligence. For this, they would need to encourage nurses to receive training on sensitivity, awareness, ethical decision-making and ethical sensitivity. Moreover, nurse managers should be role models and leaders in compliance with personal and professional values and ethical standards to improve nursing care.
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Affiliation(s)
- Hanife Tiryaki Sen
- Department of Nursing Administration, Hamidiye Faculty of Nursing, University of Health Sciences Türkiye, Istanbul, Türkiye
| | - Gulcan Taskiran Eskici
- Department of Nursing Administration, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Türkiye
| | - Gulcan Ciftcioglu
- Department of Midwifery, Faculty of Health Sciences, Mardin Artuklu University, Mardin, Türkiye
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Sist L, Pezzolati M, Ugenti NV, Cedioli S, Messina R, Chiappinotto S, Rucci P, Palese A. Nurses prioritization processes to prevent delirium in patients at risk: Findings from a Q-Methodology study. Geriatr Nurs 2024; 58:59-68. [PMID: 38762972 DOI: 10.1016/j.gerinurse.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND This study aimed at (a) exploring how nurses prioritise interventions to prevent delirium among patients identified at risk and (b) describing the underlying prioritisation patterns according to nurses' individual characteristics. METHODS There was used the Q-methodology a research process following specific steps: (a) identifying the concourse, (b) the Q-sample, and (c) the population (P-set); (d) collecting data using the Q-sort table; (e) entering the data and performing the factor analysis; and (f) interpreting the factors identified. RESULTS There were involved 56 nurses working in medical, geriatric and log-term facilities (46; 82.2 %). The preventive intervention receiving the highest priority was 'Monitoring the vital parameters (heart rate, blood pressure, oxygen saturation)' (2.96 out of 4 as the highest priority; CI 95 %: 2.57, 3.36). Two priority patterns emerged among nurses (explained variance 44.78 %), one 'Clinical-oriented' (36.19 %) and one 'Family/caregiver-oriented' (8.60 %) representing 53 nurses out 56. CONCLUSION Alongside the overall tendency to prioritise some preventive interventions instead of others, the priorities are polarised in two main patterns expressing two main individual characteristics of nurses. Knowing the existence of individual patterns and their aggregation informs how to shape educational interventions.
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Affiliation(s)
- Luisa Sist
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Sviluppo Professionale e Implementazione della Ricerca nelle Professioni Sanitarie (SPIR), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | | | - Nikita Valentina Ugenti
- Sviluppo Professionale e Implementazione della Ricerca nelle Professioni Sanitarie (SPIR), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Cohen M, Drach-Zahavy A, Srulovici E. The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design. J Clin Nurs 2024. [PMID: 38923756 DOI: 10.1111/jocn.17322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
AIMS To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress. DESIGN Nested diary study. METHODS Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model. RESULTS Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses. CONCLUSION The study highlights accountability's dual role-safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff. IMPACT By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes. REPORTING METHOD The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Mirit Cohen
- Department of Nursing, The University of Haifa, Haifa, Israel
- Baruch Padeh Medical Center, Poriya, Israel
| | | | - Einav Srulovici
- Department of Nursing, The University of Haifa, Haifa, Israel
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Demir M, Håkansson E, Drott J. Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study. J Adv Nurs 2024; 80:2080-2090. [PMID: 37975326 DOI: 10.1111/jan.15966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
AIM To describe nurses' and specialist nurses' experiences of moral distress and how it affects daily work in surgical care. DESIGN A qualitative descriptive study design was used. METHODS A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis. FINDINGS Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care. CONCLUSIONS The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk. IMPACT Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
- Maria Demir
- Department of Surgery, Department of Biomedicine and Clinical Sciences, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Elin Håkansson
- Department of Surgery, Regional Hospital of Växjö, Växjö, Sweden
| | - Jenny Drott
- Department of Surgery, Department of Biomedicine and Clinical Sciences, County Council of Östergötland, Linköping University, Linköping, Sweden
- Division of Nursing Science and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Gehri B, Ausserhofer D, Zúñiga F, Bachnick S, Schwendimann R, Simon M. Nursing care left undone in psychiatric hospitals and its association with nurse staffing: A cross-sectional multi-centre study in Switzerland. J Psychiatr Ment Health Nurs 2024; 31:215-227. [PMID: 37697908 DOI: 10.1111/jpm.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 07/27/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Nursing care left undone occurs when nurses omit activities because of resource shortfalls. Higher levels of nursing care left undone are associated with worse nurse staffing and organizational factors. Plentiful evidence from acute, long-term and community care supports such associations; however, mental healthcare settings are under-studied. AIM The aim of the study was to describe nursing care left undone's frequency in mental health inpatient settings and explore its association with nurse staffing levels. METHOD As part of the multi-centre cross-sectional MatchRN Psychiatry study, data were collected by questionnaire from 114 units in 13 Swiss psychiatric hospitals. Nursing care left undone was analysed describing frequencies descriptively and used linear mixed models to assess its association with staffing. RESULTS Data from 994 nurses were analysed. The most commonly omitted activities were evaluating nursing processes (30.5%), formulating nursing diagnoses (27.4%) and defining care objectives (22.7%). Nursing care left undone was higher in units with low staffing levels. DISCUSSION As in somatic care settings, in psychiatric hospitals, 'indirect' care activities are most commonly omitted. IMPLICATIONS FOR PRACTICE This study highlights factors affecting the frequency of nursing care left undone, including staffing levels and perceived leadership. The findings emphasize the importance of nurse managers taking action to improve work environment factors.
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Affiliation(s)
- Beatrice Gehri
- Nursing Science (INS), University of Basel, Basel, Switzerland
- University Psychiatric Clinics Basel, Basel, Switzerland
| | - Dietmar Ausserhofer
- Nursing Science (INS), University of Basel, Basel, Switzerland
- College of Health-Care Professions Claudiana, Bozen, Italy
| | | | - Stefanie Bachnick
- HS Gesundheit, University of Applied Sciences Bochum, Bochum, Germany
| | - René Schwendimann
- Nursing Science (INS), University of Basel, Basel, Switzerland
- University Hospital Basel, Basel, Switzerland
| | - Michael Simon
- Nursing Science (INS), University of Basel, Basel, Switzerland
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Byrne AL, Harvey C, Baldwin A. The discourse of delivering person-centred nursing care before, and during, the COVID-19 pandemic: Care as collateral damage. Nurs Inq 2024; 31:e12593. [PMID: 37583275 DOI: 10.1111/nin.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
The global COVID-19 pandemic challenged the world-how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person-centred care (PCC) is the philosophical premise upon which models of health care are developed and implemented. Given the strain that COVID-19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic.
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Affiliation(s)
- Amy-Louise Byrne
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Townsville, Queensland, Australia
| | - Clare Harvey
- School of Nursing, Massey University, Wellington, New Zealand
| | - Adele Baldwin
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Townsville, Queensland, Australia
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11
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Zali M, Rahmani A, Hassankhani H, Namdar-Areshtanab H, Gilani N, Azadi A, Ghafourifard M. Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis. BMC Nurs 2024; 23:150. [PMID: 38433187 PMCID: PMC10910715 DOI: 10.1186/s12912-024-01814-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care. AIM This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period. METHODS A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis. RESULTS Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients. CONCLUSION Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers.
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Affiliation(s)
- Mahnaz Zali
- Nursing faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Nursing faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Hadi Hassankhani
- Nursing faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Neda Gilani
- Health faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arman Azadi
- Nursing faculty, Ilam University of Medical Sciences, Ilam, Iran
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Ghobadi A, Sayadi L, Nayeri ND, Shabestari AN, Varaei S. The nurses' perception of the factors influencing professional misconduct: A qualitative study. Nurs Ethics 2024; 31:281-295. [PMID: 37599451 DOI: 10.1177/09697330231184469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Professional misconduct undermines safe and quality care; however, little is known about its nature and influential factors. AIM This study aimed to explain the factors influencing professional misconduct in nurses. RESEARCH DESIGN This qualitative study was conducted using the conventional content analysis method. PARTICIPANTS AND RESEARCH CONTEXT Data were collected using semi-structured interviews with 19 nurses working in the hospital selected through a purposeful method and analyzed by Graneheim and Lundman approach. ETHICAL CONSIDERATIONS The ethics committee of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. Informed consent was obtained from all participants. Participants were assured of confidentiality. FINDINGS Factors influencing professional misconduct by nurses were categorized into three main categories: human factors (nurses' professional characteristics, personal characteristics of nurses and patient/companion, patient's clinical condition), procedural factors (procedural conditions, possibility of proving misconduct), and organizational factors (recruitment process, conditions of resources, managing misconduct, bureaucracy, and ward characteristics). CONCLUSION This study assists in explaining the factors influencing professional misconduct by nurses. Therefore this study's results can help managers and planners develop interventions to prevent and correct factors that contribute to misconduct and strengthen factors that prevent misconduct in order to ensure quality and safe patient care.
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Affiliation(s)
- Akram Ghobadi
- Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Sayadi
- Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shokoh Varaei
- School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
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13
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Hackman P, Häggman-Laitila A, Hult M. Prioritization decision-making of care in nursing homes: A qualitative study. Nurs Ethics 2024:9697330241230513. [PMID: 38320980 DOI: 10.1177/09697330241230513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Prioritization decision-making arises when nurses encounter intricate situations that demand ethically challenging judgments about care. This phenomenon has rarely been studied in nursing homes. Prioritization decision-making may lead to instances where individuals in social and healthcare may not receive all services they need. Making prioritization decisions and awareness of their consequences can increase nurses' workload. AIM To describe prioritization decision-making regarding unfinished nursing care in nursing homes. RESEARCH DESIGN A qualitative descriptive study conducted through individual theme interviews. Participants were recruited through social media. The data was analyzed using inductive content analysis. PARTICIPANTS AND RESEARCH CONTEXT Nurses (n = 23) working in nursing homes for the elderly people in Finland. Data were collected between June 2022 and February 2023. ETHICAL CONSIDERATIONS Finnish legislation does not mandate an ethical review or research permits, as the participants took part as private individuals. [ask authors to make reference here to informed consent process and anonymity]. FINDINGS Nurses stated that the need for prioritization decision-making arises from challenges associated with nurses' engagement with person-centered care, the culture of the work community, the burden due to workload and challenges associated with the leadership. Prioritization decision-making was based on the interests of residents, striving for an efficient workflow and nurse's personal interests. Nurses did not receive support for decision-making regarding unfinished care, and protocols for prioritization had not been established in their work communities. Prioritization decision-making and unfinished care were concealed and left unspoken. CONCLUSION Nursing leaders should address this hidden phenomenon, making it visible through discussions with nurses and by involving them in the development of protocols. The findings can be utilized for developing new approaches to support nurses and reduce their workload and for enhancing the quality and person-centeredness of nursing care in nursing homes.
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Affiliation(s)
| | | | - Marja Hult
- University of Eastern Finland
- South-Eastern University of Applied Sciences
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14
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Eklund Saksberg M, Bielsten T, Cahill S, Jaarsma T, Nedlund AC, Sandman L, Jaarsma P. Nurses' priority-setting for older nursing home residents during COVID-19. Nurs Ethics 2024:9697330241226597. [PMID: 38317371 DOI: 10.1177/09697330241226597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents. AIM The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. ETHICAL CONSIDERATIONS Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). FINDINGS We identified an overarching theme-nursing home nurses struggling on multiple fronts, "just do it"-and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. CONCLUSIONS Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize.
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Papathanasiou I, Tzenetidis V, Tsaras K, Zyga S, Malliarou M. Missed Nursing Care; Prioritizing the Patient's Needs: An Umbrella Review. Healthcare (Basel) 2024; 12:224. [PMID: 38255111 PMCID: PMC10815730 DOI: 10.3390/healthcare12020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
The objective of this review of reviews was to identify the reasons for missed nursing care and to shed light on how nurses prioritize what care they miss. Missed nursing care refers to essential nursing activities or tasks that are omitted or not completed as planned during a patient's care. This omission can result from various factors, such as staffing shortages, time constraints, or communication issues, and it can potentially compromise the quality of patient care and safety. Identifying and addressing missed nursing care is crucial to ensure optimal patient outcomes and the well-being of healthcare professionals. To be included, reviews had to use the systematic review process, be available in the English language, examine missed care in hospitals and at home, and include participants who were over eighteen years old. The review intended to answer the following questions: 'Why nursing care is missed?' 'How nurses prioritize what care they missed?'. An umbrella review was developed guided by the JBI methodology and using PRISMA-ScR. A total of 995 reviews were identified. According to the inclusion criteria, only nine reviews were finally evaluated. The findings indicate that care is missed due to staffing levels, organizational problems, and the working climate. Prioritization of care depends on acute care needs as well as educational and experiential background. Missed nursing care is associated with patient safety and the quality of provided nursing care. Specifically, it has negative impacts on patients, healthcare professionals, and healthcare service units. Organizational characteristics, nursing unit features, and the level of teamwork among nursing staff affect Missed Nursing Care. Individual demographic characteristics of the staff, professional roles, work schedules, and adequate staffing may potentially contribute to the occurrence of Missed Nursing Care, which is why they are under investigation. However, further consideration is needed regarding the management of patient needs and nurse prioritization.
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Affiliation(s)
- Iokasti Papathanasiou
- Department of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.P.); (V.T.); (K.T.)
| | - Vasileios Tzenetidis
- Department of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.P.); (V.T.); (K.T.)
| | - Konstantinos Tsaras
- Department of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.P.); (V.T.); (K.T.)
| | - Sofia Zyga
- Department of Nursing, University of the Peloponnese, 22131 Tripolis, Greece;
| | - Maria Malliarou
- Department of Nursing, University of Thessaly, 41500 Larisa, Greece; (I.P.); (V.T.); (K.T.)
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Zali M, Rahmani A, Powers K, Hassankhani H, Namdar-Areshtanab H, Gilani N. Nursing core competencies for postresuscitation care in Iran: a qualitative study. BMJ Open 2024; 14:e074614. [PMID: 38216202 PMCID: PMC10806684 DOI: 10.1136/bmjopen-2023-074614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE This study explored nurses' perceptions of the core competencies required for providing postresuscitation care in both in-hospital and out-of-hospital cardiac arrest. DESIGN Qualitative conventional content analysis. PARTICIPANTS 17 nurses selected with purposeful sampling method. SETTING Three educational hospitals in northwest of Iran. DATA COLLECTION AND ANALYSIS Semi-structured interviews were used for data collection and they were analysed using conventional content analysis. RESULTS Seven main categories have emerged from the data. The core competencies for nurses providing postresuscitation were identified as: quality assurance, providing evidence-based care, monitoring and presence, situation management, professionalism, positive attitude and providing family centred care. CONCLUSIONS The postresuscitation period is a unique and critical time requiring highly competent nursing care. Several core competencies for providing high-quality nursing care during postresuscitation period were identified through nurses' experience in caring for patients postresuscitation.
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Affiliation(s)
- Mahnaz Zali
- Department of Medical-Surgical, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Department of Medical-Surgical, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kelly Powers
- School of Nursing, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Hadi Hassankhani
- Department of Medical-Surgical, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Neda Gilani
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
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17
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Kerkez M, Öztürk MH. The Effect of Nurses' Holistic Competence in Chronic Disease Management on Their Attitudes Toward Caregiver Roles. J Holist Nurs 2023:8980101231217374. [PMID: 38058133 DOI: 10.1177/08980101231217374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
The purpose of this study was to investigate the impact of nurses' holistic nursing competence in chronic disease management on their attitudes toward caregiving roles. The sample of the study, which was carried out in descriptive design, consists of 114 nurses (52.6% female and 47.4% male). The research data were gathered with sociodemographic characteristics form, the Holistic Nursing Competence Scale (HNCS), and the Attitude Scale for Nurses in Caregiving Roles (ASNCR). The influence of HNCS, gender, years of job, working style, professional status, weekly working time, and difficulty caring for chronic patients on ASNCR explained 38.1% of the variance. The impact of the ASNCR, gender, years of work in the job, working type, weekly working hours, and having difficulties caring for chronic patients on HNCS explained 54.5% of the variance. Our findings demonstrated the impact of holistic competence on nurses' positive attitudes toward the role of caregiver.
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18
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Sundler AJ, Hedén L, Holmström IK, van Dulmen S, Bergman K, Östensson S, Östman M. The patient's first point of contact (PINPOINT) - protocol of a prospective multicenter study of communication and decision-making during patient assessments by primary care registered nurses. BMC PRIMARY CARE 2023; 24:249. [PMID: 38031004 PMCID: PMC10685613 DOI: 10.1186/s12875-023-02208-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND A major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses' initial assessment of patients' health problems in primary care, examine working mechanisms in good practices and develop feasible solutions. METHODS Project PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses. DISCUSSION This research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients' level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses' communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT06067672.
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Affiliation(s)
- Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden.
| | - Lena Hedén
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sandra van Dulmen
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karin Bergman
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
| | - Sofia Östensson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
| | - Malin Östman
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Region Västra Götaland, Närhälsan Källstorp Healthcare Centre, Trollhättan, Sweden
- Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Research, Sweden
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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19
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Munkeby H, Bratberg G. Registered nurses' exposure to high stress of conscience in long-term care. Nurs Ethics 2023; 30:1011-1024. [PMID: 37163482 PMCID: PMC10710004 DOI: 10.1177/09697330231167542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND In long-term care, registered nurses and other care providers often experience tensions between ideals and realities in the delivery of services, which can result in stress of conscience. Burnout, low quality of care and a tendency to leave the profession are perceived as consequences. OBJECTIVES This study aimed to identify the socio-demographic and work-related factors associated with a high level of stress of conscience, particularly between nursing occupations. RESEARCH DESIGN A cross-sectional survey was conducted among care providers who worked in Norwegian nursing homes and home care services in the spring of 2021. The sample consisted of 950 registered nurses and 1143 other care providers. Data were collected online using the Stress of Conscience Questionnaire (SCQ). ETHICAL CONSIDERATIONS Participation was voluntary and based on consent. The study was approved by the Norwegian Center for Research Data. RESULTS Registered nurses were nearly twice as likely to report high levels of stress of conscience compared to other care providers in long-term care. In addition, being a female, living alone, caring for their own children, working in an institution (versus home based), working >75% time, working shifts, not having scheduled meetings for ethical reflection and working in municipalities with a higher population density were factors associated with a high level of SCQ score. DISCUSSION Knowledge of factors that increase the risk of high SCQ scores in registered nurses provides opportunities for prevention. Managers in long-term care should pay more attention to how work is distributed between the occupational groups and should facilitate real opportunities for ethical reflection. CONCLUSIONS The results of this study show that registered nurses have particular exposure to high levels of stress of conscience compared to other care providers in long-term care. Particular attention should be paid to registered nurses working in nursing homes.
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Affiliation(s)
- Hilde Munkeby
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Grete Bratberg
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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20
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Taşkıran N, Turk G. The relationship between the ethical attitudes and holistic competence levels of intensive care nurses: A cross-sectional study. PLoS One 2023; 18:e0287648. [PMID: 37440592 PMCID: PMC10343054 DOI: 10.1371/journal.pone.0287648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Intensive care units are directly associated with the competency level of nurses and are units where ethical problems are frequently experienced. This research aims to determine the relationship between intensive care nurses' ethical attitudes and holistic competence levels. METHODS This study was conducted as a cross-sectional design using self-report questionnaires distributed to 131 intensive care nurses in Turkey. The data of the study were collected with the "Nurses Information Form," "Holistic Nursing Competence Scale" and "Ethical Attitude Scale for Nursing Care". RESULTS The total mean score of the Holistic Nursing Competence of the nurses was 6.89±0.95. Holistic Nursing Competence level was significantly lower for those who had experienced less than one year in the profession, and it was higher for those who worked in the emergency intensive care unit and the nurses whose clinics had 21 and above nurses. The total mean score of the nurses' ethics attitude toward nursing care was 59.36±29.09. Ethical Attitude for Nursing Care was significantly lower for those who had a master's degree, and the nurses whose clinics had 21 and above nurses scored higher. There was a weak and negative correlation between the nurses' Holistic Nursing Competence Scale and the total mean score of the Ethical Attitude Scale for Nursing Care. The ethical attitude was predicted in 13.2% of the Holistic Nursing Competence of nurses. CONCLUSIONS It was concluded that nurses' holistic competence levels were high, their ethical attitudes were negative, and there was a weak negative correlation between their holistic competence levels and their ethical attitudes toward care.
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Affiliation(s)
- Nihal Taşkıran
- Department of Fundamentals of Nursing, Aydın Adnan Menderes University College of Nursing, Aydın, Turkey
| | - Gulengun Turk
- Department of Fundamentals of Nursing, Aydın Adnan Menderes University College of Nursing, Aydın, Turkey
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21
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Li HQ, Xie P, Huang X, Luo SX. The experience of nurses to reduce implicit rationing of nursing care: a phenomenological study. BMC Nurs 2023; 22:174. [PMID: 37208756 DOI: 10.1186/s12912-023-01334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/10/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Implicit rationing of nursing care can adversely affect patient safety and the quality of care, and increase nurses' burnout and turnover tendency. Implicit rationing care occurs at the nurse-to-patient level (micro-level), and nurses are direct participants. Therefore, the strategies based on experience of nurses to reduce implicit rationing care have more reference value and promotion significance. The aim of the study is to explore the experience of nurses to reduce implicit rationing care, thereby to provide references for conducting randomized controlled trials to reduce implicit rationing care. METHODS This is a descriptive phenomenological study. Purpose sampling was conducted nationwide. There are 17 nurses were selected and semi-structured in-depth interviews were conducted. The interviews were recorded, transcribed verbatim and analyzed via thematic analysis. RESULTS Our study found that nurses' reported experience of coping with implicit rationing of nursing care contained three aspects: personal, resource, and managerial. Three themes were extracted from the results of the study: (1) improving personal literacy; (2) supplying and optimizing resources and (3) standardizing management mode. The improvement of nurses' own qualities are the prerequisites, the supply and optimization of resources is an effective strategy, and clear scope of work has attracted the attention of nurses. CONCLUSION The experience of dealing with implicit nursing rationing includes many aspects. Nursing managers should be grounded in nurses' perspectives when developing strategies to reduce implicit rationing of nursing care. Promoting the improvement of nurses' skills, improving staffing level and optimizing scheduling mode are promising measures to reduce hidden nursing rationing.
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Affiliation(s)
- Hui Qin Li
- Mental Health Center, West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan Province, 610041, P.R. China
| | - Peng Xie
- Surgical Anesthesia Center, West China School of Nursing, West China Hospital, Sichuan University, No. 28 Telecom South Street, Chengdu, Sichuan Province, 610041, P.R. China
| | - Xia Huang
- Mental Health Center, West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan Province, 610041, P.R. China.
| | - Shan Xia Luo
- Mental Health Center, West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan Province, 610041, P.R. China.
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O'Donnell C, Markey K, Murphy L, Turner J, Doody O. Cultivating support during COVID-19 through clinical supervision: A discussion article. Nurs Open 2023. [PMID: 37149892 DOI: 10.1002/nop2.1800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/06/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023] Open
Abstract
AIM This article aims to discuss how clinical supervision is an important approach in supporting frontline nurses and students during and post COVID-19 through the lens of the nursing metaparadigms. DESIGN Discussion article. METHODS Discourse of the literature considering the importance of working collaboratively with healthcare and educational organisations in operationalising clinical supervision. RESULTS The evidence base supporting clinical supervision as an effective support strategy for nurses exists, however, its implementation and practice has become sporadic. A resurgence is required to support student's and nurse's during this pandemic. It is timely for nurse educators to creatively engage with clinical partners in supporting clinical supervision to enhance both nurses and students pandemic practice experiences. Clinical supervision is proposed as one strategy to support and guide both nurses and students to develop, strengthen and challenge the effectiveness of their care during COVID-19.
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Affiliation(s)
- Claire O'Donnell
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louise Murphy
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - James Turner
- Department of Nursing and Midwifery, College of Health and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
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23
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Hunter KF, Dahlke SA. Fast thinking: How unconscious bias and binary language contribute to rationing of care to older persons. Int J Older People Nurs 2023; 18:e12538. [PMID: 37013362 DOI: 10.1111/opn.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Binary or categorical thinking is a way of thinking in which the brain unconsciously sorts the masses of information it receives into categories. This helps us to quickly process information and keeps us safe through pattern recognition of possible threats. However, it can also be influenced by unconscious and conscious biases that inform our judgements of other people and situations. OBJECTIVES To examine nursing practice with older people through the lens of unconscious bias. METHODS In this critical analysis, using Kahneman's fast and slow thinking, we argue that nurses working with hospitalised older people often rely on thinking quickly in hectic work environments, which can contribute to unconscious and conscious bias, use of binary language to describe older persons and nursing tasks, and ultimately rationing of care. RESULTS Binary language describes older persons and their care simplistically as nursing tasks. A person is either heavy or light, continent or incontinent, confused or orientated. Although these descriptions are informed in part by nurses' experiences, they also reflect conscious and unconscious biases that nurses hold towards older patients or nursing tasks. We draw on explanations of fast (intuitive) and slow (analytical) to explain how nurses gravitate to thinking fast as a survival mechanism in environments where they are not supported or encouraged to think slow. CONCLUSIONS Nurses survival efforts in getting through the shift using fast thinking, which can be influenced by unconscious and conscious biases, can lead to use of shortcuts and the rationing of care. We believe that it is of paramount importance that nurses be encouraged and supported to think slowly and analytically in their clinical practice. IMPLICATIONS FOR PRACTICE Implications Nurses can engage in journaling and reflecting on their practice with older people to examine possible unconscious bias. Managers can support reflective thinking by supporting nurses through staffing models and encouraging conversations about person-centered care in unit practices.
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Affiliation(s)
- Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry Ann Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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24
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Saralegui-Gainza A, Soto-Ruiz N, Escalada-Hernández P, García-Vivar C, Rivera D, Martín-Rodríguez LS. Assessing the Reliability and Validity of the Spanish Version of the Actual Scope of Nursing Practice Scale. Healthcare (Basel) 2023; 11:healthcare11081170. [PMID: 37108005 PMCID: PMC10138610 DOI: 10.3390/healthcare11081170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Nursing workforce shortage is one of the main challenges for healthcare organizations and it is important to determine if nurses are fulfilling their full scope of practice. There is a questionnaire that measures the activities carried out by nurses, but there is no version available for the Spanish context. The purpose of this study was to develop a cross-cultural adaptation of the "Actual Scope of Nursing Practice" questionnaire by D'Amour et al., and to assess the psychometric characteristics of the Spanish version. An exploratory sequential research design was used. The cross-cultural adaptation was performed using translation, back-translation, review, and pre-testing. Psychometric properties were assessed to determine its construct validity and internal consistency. Among the 501 eligible nurses from the three main hospitals in the region, the first 310 nurses to respond to an online questionnaire were included in our study. The response rate was 61.9%. They were invited via email and completed the survey using the SurveyMonkey platform. The Spanish version of the questionnaire was obtained. A final scale with twenty items and two factors was confirmed with an adequate fit, with the item scores demonstrating that all items were optimally related to their respective latent construct. The alpha coefficients for the Spanish ASCOP scale were robust and revealed good internal consistency. This study showed that the Spanish version of the scale, "Scope of Nursing Practice", has a good degree of validity and reliability. This questionnaire can support nurse managers in realising nursing activities within their organisations and in promoting desirable work outcomes among nurses.
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Affiliation(s)
- Amaia Saralegui-Gainza
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
| | - Paula Escalada-Hernández
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
| | - Diego Rivera
- Department of Health Sciences, Public University of Navarre (UPNA), 31008 Pamplona, Navarra, Spain
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Bahun M, Jeriček Klanšček H. Doživljanje neizvedene zdravstvene nege pri medicinskih sestrah. OBZORNIK ZDRAVSTVENE NEGE 2023. [DOI: 10.14528/snr.2023.57.1.3173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Uvod: Stiske zaradi zdravstvene nege, ki ostaja zaradi različnih razlogov neizvedena, so pri medicinskih sestrah pogosto spregledane in neprepoznane. Namen integrativnega pregleda literature je pregledati najnovejše raziskave, ki opisujejo, kako se neizvedena zdravstvena nega izraža na duševnem počutju medicinskih sester.Metode: Uporabili smo integrativni pregled literature, izveden v skladu s PRISMA smernicami v podatkovnih bazah PubMed, CINAHL, Wiley, COBISS.SI in Google Učenjak. Potek iskanja in analize literature je prikazan s pomočjo PRISMA diagrama. Zadetke smo razvrstili glede na raven dokazov. Uporabili smo tematsko analizo vsebine.Rezultati: Skupaj je bilo identificiranih 175 in v končno analizo vključenih 11 virov. Identificirano je bilo 96 kod združenih v 4 kategorije: (1) Telesno, duševno in čustveno počutje, (2) Moralno etične dileme, (3) Sprejemanje odločitev pri delu – prilagajanje, (4) Poklicne in osebne vrednote.Diskusija in zaključek: Neizvedena zdravstvena nega je za medicinske sestre pomemben izvor stisk in stresa, saj zaradi neizvajanja vseh potrebnih aktivnosti v zdravstveni negi prihajajo v neskladje s svojimi osebnimi in poklicnimi vrednotami. Naši rezultati dodajajo vsebinski kontekst in boljše razumevanje posledic neizvedene zdravstvene nege pri medicinskih sestrah. Vsakodnevno odločanje, katere aktivnosti bo potrebno izpustiti, vpliva ne samo na slabše počutje, nezadovoljstvo in izgorelost, ampak celo na zapuščanje delovnih mest in poklica.
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Hackman P, Hult M, Häggman-Laitila A. Unfinished nursing care in nursing homes. Geriatr Nurs 2023; 51:33-39. [PMID: 36878129 DOI: 10.1016/j.gerinurse.2023.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023]
Abstract
This study aimed to describe unfinished nursing care activities in nursing homes. The study was conducted as a cross-sectional survey and employed the BERNCA-NH-instrument and one open-ended question. The participants were care workers (n=486) in nursing homes. The results showed that an average of 7.3 nursing care activities out of 20 were unfinished. A large share of the unfinished activities were related to residents' social care and the documentation of care. Female gender, age, and the amount of professional experience were found to increase the likelihood of unfinished nursing care. The unfinished care was the result of insufficient resources, residents' characteristics, unexpected situations, non-nursing activities, and challenges in organizing and leading care. The results indicate that all of the necessary care activities are not performed in nursing homes. Unfinished nursing activities might affect residents' quality of life and diminish the visibility of nursing care. Nursing home leaders have a significant role to play in decreasing unfinished care. Future research should address how to reduce and prevent unfinished nursing care.
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Affiliation(s)
- Pauliina Hackman
- Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1, Kuopio 70210, Finland.
| | - Marja Hult
- Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1, Kuopio 70210, Finland
| | - Arja Häggman-Laitila
- Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1, Kuopio 70210, Finland
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Translation and validation of the PPSC-PNP instrument to measure parental satisfaction with care from pediatric nurses in China. J Pediatr Nurs 2023; 70:47-53. [PMID: 36801624 DOI: 10.1016/j.pedn.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE To modify and translate the Parents' Perceptions of Satisfaction with Care from Pediatric Nurse Practitioners instrument into Chinese, culturally adapt and initially test it to assess parental satisfaction with care from all levels of pediatric nurses in a pediatric inpatient care context. DESIGN AND METHODS The instrument was translated and culturally adapted following a standardized guideline for the translation and cross-cultural adaptation of self-report measures. Content validity, discriminative validity, internal consistency and test-retest reliability were examined. RESULTS Four main issues were identified in the translation and cultural adaptation stage. Modifications were therefore made to the Chinese Parents' Perceptions of Satisfaction with Care from Pediatric Nurses instrument. The item-level content validity indexes for the Chinese instrument ranged between 0.83 and 1.0. The Cronbach's alpha coefficient was 0.95, and the intra-class correlation coefficient for test-retest reliability was 0.44. CONCLUSION The Chinese Parents' Perceptions of Satisfaction with Care from Pediatric Nurses instrument has good content validity and internal consistency and can be considered a suitable clinical evaluation tool to measure parental satisfaction with care from pediatric nurses in pediatric inpatient settings in China. PRACTICE IMPLICATIONS The instrument is anticipated to be useful in strategic planning for Chinese nurse managers responsible for patient safety and quality of care. Additionally, it has the potential to serve as a tool to enable international comparisons in parental satisfaction with care from pediatric nurses after further testing.
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Jakobsen L, Olsen RM, Brinchmann BS, Devik SA. Developing and Testing Digital Ethical Reflection in Long-Term Care: Nurses' Experiences. SAGE Open Nurs 2023; 9:23779608221150725. [PMID: 36654853 PMCID: PMC9841835 DOI: 10.1177/23779608221150725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/17/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Nurses working in municipal long-term care face ethical challenges that can lead to moral distress and discomfort for the nurse and affect the quality of patient care. Tools and methods that contribute to increased ethical awareness and support for nurses dealing with moral issues are lacking. Technological innovations may be suitable for ethics work, but little research has been conducted on how such solutions could be designed or their potential benefit. Therefore, this study contributes knowledge about the development and testing of a digital tool for ethics support among nurses. Objective To investigate how digital ethical reflection can support ethics work among nurses working in long-term care. Methods A digital ethical reflection tool was designed and tested in nursing homes and home nursing care in collaboration with two Norwegian municipalities. The study used sequential explanatory mixed-methods design. Over a 6-week period, at the end of each shift, nurses digitally reported the ethical challenges they had experienced. Their responses and experiences were described using descriptive statistics. Additionally, focus group interviews were conducted and analyzed using reflexive thematic analysis (TA). Results During the study period, 17 nurses reported a total of 223 registrations, with 24.8% stating that they had been in an ethically difficult situation. The digital reporting was perceived as practically applicable and helped to increase nurses' awareness of morally charged situations. The value of the registrations was found to depend on manager participation and the application of the obtained information. The participating nurses become aware that they lacked an arena for meaningful dialogue with and recognition from their manager. Conclusions Information obtained through digital reflection can form the basis for ethical reflections at the departmental level. Digital reflection has the potential to become a tool for managers in their support for employees facing ethical challenges when providing long-term care.
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Affiliation(s)
- Lena Jakobsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway,Lena Jakobsen, Faculty of Nursing and Health Sciences, Nord University, PO Box 1490, 8049 Bodø, Norway.
| | - Rose Mari Olsen
- Centre for Care Research Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| | - Berit Støre Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, Norway and Nordland Regional University, Bodø, Norway
| | - Siri Andreassen Devik
- Centre for Care Research Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
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Chiappinotto S, Coppe A, Palese A. What are the reasons for unfinished nursing care as perceived by hospitalized patients? Findings from a qualitative study. Health Expect 2022; 26:256-267. [PMID: 36415161 PMCID: PMC9854295 DOI: 10.1111/hex.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/02/2022] [Accepted: 10/23/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Unfinished nursing care (UNC), as the care required by patients that delayed or not delivered, has been investigated mainly from the perspective of nurses, while little is still known from the side of patients. Some studies have involved patients to measure which elements of care are mostly unfinished (e.g., mouth care), whereas a few studies have investigated the reasons for UNC as perceived by them. Their involvement in understanding the reasons for UNC is crucial to advance the knowledge and co-develop possible strategies to prevent or minimize UNC. METHODS This is a descriptive qualitative study performed according to COnsolidated criteria for REporting Qualitative research guidelines in 2022. A purposeful sample of Italian hospitalized patients in two medical and two surgical units was involved. A face-to-face semistructured interview was used to merge reasons for UNC. Qualitative content analysis was conducted to merge subthemes and themes as factors leading to UNC according to the experience of patients. RESULTS A total of 23 patients (12 surgical and 11 medical) were involved (12/23 male) with an age average of 66.2 years, educated mainly at secondary school, and with previous hospitalizations (20/23), and dependent on nursing care in daily activities (14/23). Reasons for UNC have been identified at four levels: (1) 'New health-care system priorities' and 'Pre-existing frailty of health-care facilities' were reasons identified at the health-care system level; (2) 'Lack of resources attributed to wards', 'Ineffective ward organization' and 'Leadership' were identified at the unit level; (3) 'Nurses' attitudes and behaviour' were reported at the nurses' level and (4) 'Increased nursing care expectations' were pinpointed at the patient level. CONCLUSION Patients can be involved in identifying UNC, but also in recognizing the underlying reasons. Engaging them in such investigations might broaden our understanding of the phenomenon and the possibility of identifying strategies to minimize and prevent UNC. PATIENT OR PUBLIC CONTRIBUTION Patients from four hospital units (two medical and two surgical) were involved in face-to-face interviews to merge the reasons perceived by them as triggering UNC. All factors (as themes and subthemes) have derived from their words, thus enhancing the evidence available from the side of the patients.
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Affiliation(s)
| | - Alberto Coppe
- Health Care Professionals ServiceAULSS 2 Marca TrevigianaTrevisoItaly
| | - Alvisa Palese
- Department of Medical SciencesUniversity of UdineUdineItaly
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Bjornsdottir K, Ceci C. Home care nursing practice for older persons with heart failure living at home. J Clin Nurs 2022. [DOI: 10.1111/jocn.16575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Kristin Bjornsdottir
- Department of Nursing, School of Health Sciences University of Iceland Reykjavik Iceland
| | - Christine Ceci
- Faculty of Nursing University of Alberta Edmonton Alberta Canada
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Jordal K, Saltveit V, Tønnessen S. Nursing leadership and management in home care: A qualitative scoping review. J Nurs Manag 2022; 30:4212-4220. [PMID: 36223165 PMCID: PMC10091940 DOI: 10.1111/jonm.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/19/2022] [Accepted: 10/02/2022] [Indexed: 01/04/2023]
Abstract
AIM The purpose is to identify and synthesize the challenges of first-line nurse managers in home care concerning their managerial and leadership role, as described in current qualitative research literature. BACKGROUND Increased responsibilities and shifting tasks in home care lead to challenges for first-line nurse managers. These challenges must be identified and evaluated to ensure quality care provision. EVALUATION A scoping review mapped current qualitative research on first-line nurse managers in home care, focusing on their managerial and leadership role. A systematic search was conducted in CINAHL, Medline, EMBASE, and SweMed+. A thematic analysis was conducted on the four included studies. KEY ISSUE(S) First-line nurse managers' role in home care involves multiple responsibilities. Four themes emerged: "professional responsibilities," "relational responsibilities," "economic and organizational responsibilities," and "juggling responsibilities-a demanding balance." CONCLUSION(S) Findings provide new knowledge on how first-line nurse managers balance responsibilities in their role in the home care context-a complex context different from institutional settings like hospitals and long-term care. A focus on first-line nurse managers' support needs is necessary. Furthermore, an extensive research gap concerning first-line nurse managers' leadership and management role in home care indicates a need to increase knowledge from a range of perspectives. IMPLICATIONS FOR NURSING MANAGEMENT To develop sustainable and robust nursing leadership and management in home care, there is a need to (a) clarify first-line nurse managers' role and set boundaries around their responsibilities and (b) strengthen support from superiors, which will help empower first-line nurse managers in their daily work.
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Affiliation(s)
- Kristin Jordal
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Vibeke Saltveit
- Department of Research and Internationalisation, Library, University of South-Eastern Norway, Norway
| | - Siri Tønnessen
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
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Redley B, Douglas T, Hoon L, de Courten B, Hutchinson AM. Nurses' harm prevention practices during admission of an older person to the hospital: A multi-method qualitative study. J Adv Nurs 2022; 78:3745-3759. [PMID: 35799461 PMCID: PMC9796868 DOI: 10.1111/jan.15351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nurses' harm prevention practices during the admission of older persons to hospital have important consequences for patient safety, preventable patient harm and length of hospital stay. Novel solutions are needed to assist nurses to balance complexity, high workload burden and patient safety during admission processes. AIM Explore the nurses' experiences of harm prevention practices during the admission of an older person to the hospital. DESIGN A multi-method qualitative study informed by frameworks of behaviour change and human-centred co-design. METHODS The purposive sample included 44 nurses, 5 clinicians from other disciplines and 3 consumers recruited from five general medicine wards across three hospitals of a large public health service in metropolitan Melbourne, Australia. Data were collected over 12 h of naturalistic observations of nurses during eight patient admissions, and during four participatory human-centred co-design workshops between August 2019 and January 2020. Observation, field notes and workshop artefact data were integrated for qualitative content and thematic analysis. RESULTS Analysis revealed a 5-step journey map, with a temporal logic, that captured nurses' experiences, as well as the enablers and barriers to harm prevention practices when admitting an older person to the hospital. The consensus was reached on three priority features to assist nurses to implement harm prevention practices when they admit an older person to the hospital: (1) prioritize important care; (2) tailor care to the individual and (3) see the big picture for the patient. CONCLUSION The novel research approach identified five steps in nurses' activities and harm prevention practices during admission of an older person to the hospital, and key features for a solution to assist nurses to keep patients safe. The findings provide the foundation for further research to develop interventions to assist nurses to manage high workloads during this complex activity.
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Affiliation(s)
- Bernice Redley
- Centre for Quality and Patient Safety Research – Monash Health Partnership, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Tracy Douglas
- Centre for Quality and Patient Safety Research – Monash Health Partnership, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Leonard Hoon
- Applied Artificial Intelligence InstituteDeakin UniversityBurwoodVictoriaAustralia
| | - Barbora de Courten
- Department of Medicine, School of Clinical SciencesMonash UniversityClaytonVictoriaAustralia,Monash HealthClaytonVictoriaAustralia
| | - Alison M. Hutchinson
- Centre for Quality and Patient Safety Research – Monash Health Partnership, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
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Suvarnakich P, Montrikul Na Ayudhaya B. Compliance with the ethical competence framework by head nurses. Nurs Ethics 2022; 29:1304-1317. [PMID: 35724976 DOI: 10.1177/09697330221105634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Head nurses have duties in providing nursing care and ethical supervision to the nurses in the unit. Compliance with the ethical competence framework for head nurses is essential in fostering an ethical climate in the organization. OBJECTIVE The objective of this research is to study the head nurses' compliance with the ethical competence framework by the Thailand Nursing and Midwifery Council (TNMC). METHODS The study is a qualitative research, using in-depth interviews conducted among 20 head nurses practicing in a super tertiary hospital in Bangkok, Thailand. The sample was selected using a criterion sampling method. The head nurses' ethical experience relating to work practice was analyzed by thematic analysis. ETHICAL CONSIDERATIONS The ethical approval of this study was obtained from the Committee for Research Ethics (Social Sciences), Mahidol University, and from the Institutional Review Board of the hospital in which the study was conducted. RESULTS From the thematic analysis of the ethical experience practiced by the head nurses, 8 themes and 16 sub-themes were categorized across 5 ethical competencies based on the ethical competence framework by the TNMC. It was found that all the identified themes and sub-themes conformed to the ethical competence framework, and demonstrated the head nurses' compliance with the framework. DISCUSSION Head nurses' ethical experience in practice conforms to the ethical competence framework by the TNMC. The framework that is based on the Code of conduct and the nursing culture that places the importance of the seniority system may facilitate the compliance with the ethical competence framework. CONCLUSION Head nurses demonstrated compliance with the ethical competence framework by the TNMC. Nevertheless, improvements could be done to the framework by adding details such as more examples of ethical decision-making scenarios, personnel's rights, and social media usage guidelines.
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Affiliation(s)
- Photchana Suvarnakich
- Faculty of Social Sciences and Humanities, 26685Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Boonwadee Montrikul Na Ayudhaya
- Department of Humanities, Faculty of Social Sciences and Humanities, 26685Mahidol University, Salaya, Nakhon Pathom, Thailand
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A Delphi study to explore clinician and lived experience perspectives on setting priorities in eating disorder services. BMC Health Serv Res 2022; 22:788. [PMID: 35715780 PMCID: PMC9206284 DOI: 10.1186/s12913-022-08170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Due to scarce resources and high demand, priority setting in mental health services is necessary and inevitable. To date, no study has examined priority setting in eating disorder (ED) services specifically. Here, we evaluate the level of consensus and perceived relative importance of factors used to determine patient prioritisation in ED services, amongst clinicians and individuals with lived experience (LE) of an ED. Methods A three round Delphi study and a ranking task were used to determine the level of consensus and importance. Consensus was defined as > 80% agreement or disagreement. Items that reached consensus for agreement were ranked in order of importance from most to least important. Participants were 50 ED clinicians and 60 LE individuals. Participant retention across rounds 2, 3, and 4 were 92%, 85%, and 79%, respectively. Results Over three iterative rounds, a total of 87 statements about patient prioritisation were rated on a 5-point Likert-scale of agreement. Twenty-three items reached consensus in the clinician panel and 20 items reached consensus in the LE panel. The pattern of responding was broadly similar across the panels. The three most important items in both panels were medical risk, overall severity, and physical health deteriorating quickly. Clinicians tended to place greater emphasis on physical risk and early intervention whereas the LE panel focused more on mental health and quality of life. Conclusions Eating disorder services tend to prioritise patients based upon medical risk and severity, and then by the order in which patients are referred. Our findings align in some respects with what is observed in services, but diverge in others (e.g., prioritising on quality of life), providing important novel insights into clinician and LE opinions on waiting list prioritisation in EDs. More research is warranted to validate these findings using multi-criterion decision techniques and observational methods. We hope these findings provide a foundation for future research and encourage evidence-based conversations around priority setting in ED services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08170-4.
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AKÇOBAN S, GÜNGÖR S. Attitudes and job satisfaction of intensive care nurses regarding their caregiver roles. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1046744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: This study was conducted to evaluate the attitudes and job satisfaction of intensive care nurses towards their caregiver roles.
Methods: The descriptive study was completed between 28 August 2021 and 28 October 2021 with 200 intensive care nurses. "Nurse Introductory Information Form", "Nurses' Attitudes towards Caregiver Roles" and "Nurse Job Satisfaction Scale" were used as data collection forms. Data were collected online in electronic form (Google Forms). Data analysis was done in SPSS 25.0 package program. A p
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Affiliation(s)
- Sümeyye AKÇOBAN
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, KIRIKHAN MESLEK YÜKSEKOKULU, SAĞLIK BAKIM HİZMETLERİ BÖLÜMÜ, EVDE HASTA BAKIMI PR
| | - Serap GÜNGÖR
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, SAĞLIK HİZMETLERİ MESLEK YÜKSEKOKULU, TIBBİ HİZMETLER VE TEKNİKLER BÖLÜMÜ, İLK VE ACİL YARDIM PR
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Işik MT, Özdemir RC, Serinkaya D. Ethical Attitudes of Intensive Care Nurses during Clinical Practice and Affecting Factors. Indian J Crit Care Med 2022; 26:288-293. [PMID: 35519912 PMCID: PMC9015944 DOI: 10.5005/jp-journals-10071-24143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Technological advances in critical care contribute to patient survival, but healthcare professionals working in these units, which require technical expertise, experience highly challenging ethical decision-making processes. Aim The aim of this study is to determine the attitudes of intensive care nurses toward ethical problems they face during clinical practice and the affecting factors. Method The study included a total of 294 nurses working in the intensive care units at a city hospital. Data was collected using the Personal Information Form and Ethical Attitude Scale for Nursing Care. Findings About 58.8% of the participants were females and 71.1% had undergraduate degrees. The total scale score was 56.48 ± 15.98. A statistically significant difference was found between participants’ gender, weekly working hours, ethical definition status, and scale score averages. Conclusion More than half experienced frequent ethical problems and tried to solve them on their own. Trainings aimed at developing ethical sensitivity and participation in symposiums/conferences that address ethical issues specific to intensive care are recommended. How to cite this article Işik MT, Özdemir RC, Serinkaya D. Ethical Attitudes of Intensive Care Nurses during Clinical Practice and Affecting Factors. Indian J Crit Care Med 2022;26(3):288-293.
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Affiliation(s)
| | - Rana Can Özdemir
- Department of Medical History and Ethics, Akdeniz Üniversitesi, Antalya, Turkey
- Rana Can Özdemir, Department of Medical History and Ethics, Akdeniz Üniversitesi, Antalya, Turkey, e-mail:
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Abdelhadi N, Drach‐Zahavy A, Srulovici E. Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability. Nurs Open 2022; 9:309-319. [PMID: 34612602 PMCID: PMC8685781 DOI: 10.1002/nop2.1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
AIM To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC). DESIGN A qualitative descriptive design. METHODS Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis. RESULTS A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.
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Affiliation(s)
- Nasra Abdelhadi
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Anat Drach‐Zahavy
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
| | - Einav Srulovici
- The Cheryl Spencer Department of NursingUniversity of HaifaHaifaIsrael
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Tohmola A, Elo S, Mikkonen K, Kyngäs H, Lotvonen S, Saarnio R. Nursing students' competence profiles in gerontological nursing-A cross-sectional study. Nurs Open 2022; 9:199-209. [PMID: 34534403 PMCID: PMC8685838 DOI: 10.1002/nop2.1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
AIM The study aimed to describe and explain the self-assessed gerontological nursing competence levels of Finnish nursing students and factors relating to it. DESIGN A cross-sectional study design, reported by The Strengthening the Reporting of Observational studies in Epidemiology guidelines. METHODS Data were collected with the GeroNursingCom instrument, which features 53 items relating to 11 competence factors. The K-clustering technique and the Chi-squared, Kruskal-Wallis and Mann Whitney tests were used to analyse the data. RESULTS Seven hundred and ninety-nine nursing students from nine randomly selected higher education institutions were invited to participate in 2019. Three distinct student profiles were identified according to the data (N = 274): Profile A-lower intermediate competence (23.1% of students), Profile B-intermediate competence (45.8%) and Profile C-high competence (31.1%). The strongest competence area for all students was appreciative encounter and interaction, and the weakest was supporting the older person's sexuality. Nursing students have diverse backgrounds and their overall competence in gerontological nursing is shaped in part by their previous education, motivations and work experience. RELEVANCE TO CLINICAL PRACTICE Recognizing students' different gerontological nursing competence profiles enables the implementation of targeted education to improve competence in clinical practice.
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Affiliation(s)
- Anniina Tohmola
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
- Lapland UASKemiFinland
| | | | - Kristina Mikkonen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOulu University HospitalOuluFinland
| | - Sinikka Lotvonen
- Research Unit of Nursing Science and Health ManagementGeroNursingCentreUniversity of OuluOuluFinland
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Meneses-La-Riva ME, Suyo-Vega JA, Fernández-Bedoya VH. Humanized Care From the Nurse-Patient Perspective in a Hospital Setting: A Systematic Review of Experiences Disclosed in Spanish and Portuguese Scientific Articles. Front Public Health 2021; 9:737506. [PMID: 34926369 PMCID: PMC8678081 DOI: 10.3389/fpubh.2021.737506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022] Open
Abstract
Nowadays, humanized care is an essential component in the field of health because the professional work of nursing seeks to provide quality services to patients who are suffering and fear illness or the dying process. Nurses recognize the need to incorporate humanized care into their daily work, as supported by Jean Watson, who states that caring entails establishing an adequate nurse–patient therapeutic relationship, where health education is a tool that promotes self-care in the patient, family, and community. The main objective of this work was to find scientific evidence on humanized care from the perspectives of nurses and hospitalized patients. To meet those research objectives, an exploratory systematic review of articles published in high-quality scientific journals from 2016 to 2020 using the PRISMA methodology in the Scopus and Scielo databases was conducted, yielding 26 studies that were analyzed. The findings show that nurses and patients perceive the need to remove the barriers that limit the advancement of humanized care in hospital institutions because they urgently demand that health professionals in all settings, especially critical ones, strengthen their humanizing role by sharing cordial, empathetic health experiences, and respecting their customs and beliefs during the hospitalization process. As a conclusion of the findings, the nurse–patient professionals agree that health personnel training is critical to providing humanized attention with quality in the hospital context, emphasizing that professional training should develop in practice soft skills, communication, safety environment, and human values.
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Rykkje L, Holm AL, Hem MH. Norwegian Nurses' Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis. SAGE Open Nurs 2021; 7:23779608211057938. [PMID: 34869863 PMCID: PMC8640321 DOI: 10.1177/23779608211057938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Internationally, aging populations have increased needs for health care services, and often specialized care is required. However, services for older people tend to be underfunded, resulting in lack of qualified staff and poor quality care. Resource shortages lead to ethical challenges and insufficient nursing care. Therefore, quality in daily care for older people also depends upon the nurses’ ability to make complex, ethical decisions in their practice. Objectives To explore ethical challenges experienced by nurses caring for older people in clinical practice, and to provide examples of management for the challenges. Methods The data collected were written reflection notes by Norwegian continuous education students in advanced gerontology. Forty two of 83 notes were included and a thematic analysis in six steps was utilized. Findings There are three main themes: (1) meeting vulnerability, discomfort, and suffering, (2) collaboration with relatives, and (3) struggling to perform professional care. Conclusion Nurses strive to “do what is in the patients’ best interest”, and this is fostered through collaboration, professionalism, care, and presence. Nurses’ ethical competencies may develop when reflecting upon their own care performance. Building ethical competencies should be a priority in both nursing education and clinical practice. However, to improve care quality, nurses also need professional knowledge about older people care and ethical awareness should be supported by the workplace.
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Affiliation(s)
- Linda Rykkje
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | - Anne Lise Holm
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Marit Helene Hem
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Moilanen T, Suhonen R, Kangasniemi M. Nursing support for older people's autonomy in residential care: An integrative review. Int J Older People Nurs 2021; 17:e12428. [PMID: 34601784 DOI: 10.1111/opn.12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/14/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nurses play a crucial role in enabling older people's autonomy in residential care. However, there is a lack of synthesised knowledge about how nurses can support older people. OBJECTIVE The aim of this study was to identify and synthesise nursing support for older people's autonomy in residential care. METHODS An integrative review was carried out by searching the CINAHL, Philosopher's index, PubMed, SocINDEX, Scopus and Web of Science databases, supplemented by manual searches. The searches focused on peer-reviewed scientific empirical research papers published in English, without date limitations. The constant comparison method was used for the analysis. RESULTS The review identified 24 papers, and these showed that older people's autonomy was based on dignity. Nurses protected older people's autonomy in eight different ways. They protected their right to make their own decisions, acted as advocates, respected their wishes, provided opportunities for autonomy, fostered independence, gave information to residents and relatives, provided individualised care practices and protected older people's safety. However, there were also barriers that needed to be overcome. CONCLUSIONS Nurses used multiple, individually tailored activities to support older people's autonomy, but they also had different reasons for supporting or hindering it. Work and leadership structures are needed to ensure that older people's autonomy is driven by ethical practices. IMPLICATIONS FOR PRACTICE The results of this review can help nurses who provide residential care for older people to recognise the different nursing activities that can be used to support older people's autonomy and to develop strategies to apply them in different daily care situations. However, further research is needed to determine how these activities can be realised in daily care and how they cover different aspects of older people's lives in residential care.
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Affiliation(s)
- Tanja Moilanen
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, Faculty of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
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Arslan GG, Özden D, Göktuna G, Ertuğrul B. Missed nursing care and its relationship with perceived ethical leadership. Nurs Ethics 2021; 29:35-48. [PMID: 34396804 DOI: 10.1177/09697330211006823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determination of the factors affecting missed nursing care and the impact of ethical leadership is important in improving the quality of care. AIM This study aims to determine the missed nursing care and its relationship with perceived ethical leadership. RESEARCH DESIGN A cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT The sample consisted of 233 nurses, of whom 92.7% were staff nurses and 7.3% were charge nurses, who work in three different hospitals in Turkey. The study data were collected using a personal and professional characteristics data form, the Missed Nursing Care Survey, and the Ethical Leadership Scale. ETHICAL CONSIDERATIONS The study was approved by the non-interventional ethics committee of Dokuz Eylül University Ethics Committee for Noninvasive Clinical Studies. All participants' written and verbal consents were obtained. FINDINGS The most missed nursing care practices were ambulation, attending interdisciplinary care conferences, and discharge planning. According to the logistic regression analysis, sex, the number of patients that the nurse is in charge of giving care, the number of patients discharged in the last shift, and satisfaction with the team were determined as factors affecting missed care. No significant relationship was found between ethical leadership and missed nursing care (p > 0.05), and a weak but significant relationship was found between the clarification of duties/roles subscale and missed nursing care (r = -0.136, p < 0.05). DISCUSSION Ethical leaders should collaborate with policy-makers at an institutional level to particularly achieve teamwork that is effective in the provision of care, to control missed basic nursing care, and to organize working hours and at the country level to determine roles and to increase the workforce. CONCLUSION The results of this study contribute to the international literature on the most common type of missed nursing care, its reasons, and the relationship between the missed care and ethical leadership in a different cultural context.
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Franck E, Haegdorens F, Goossens E, van Gils Y, Portzky M, Somville F, Abuawad M, Slootmans S, Van Bogaert P. The Role of Coping Behavior in Healthcare Workers' Distress and Somatization During the COVID-19 Pandemic. Front Psychol 2021; 12:684618. [PMID: 34367005 PMCID: PMC8342849 DOI: 10.3389/fpsyg.2021.684618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Constantly searching for a balance between work demands and their own physical and psychological health has challenged medical and nursing staff during the immediate wake of this COVID-19 viral epidemic leading to acute stress reactions and psychosomatic symptoms. Coping behavior might be a buffer for work-related stress in relation to mental well-being. The present study aims to evaluate the role of positive and negative stress-reducing activities on healthcare workers' mental and physical well-being. Methods: This was a cross-sectional study using an online survey that was sent out using our network of healthcare workers at the University of Antwerp and through social media. Socio-demographic data, coping behavior with the Palliative Pallet Scale (P3), and distress and somatization using the Four-dimensional symptom checklist were collected. Surveys were completed by 1,376 participants. Results: The results clearly showed that positive stress-reducing activities are related to fewer symptoms of distress and somatization. Providing direct care to COVID-19 patients was associated with a higher decrease of applying positive stress-reducing activities during the peak of the pandemic compared to the ideal situation. Finally, fewer symptoms of distress and somatization were associated with the following activities: reading, mind sports games, keeping a hobby collection, studying; engaging in sexual activities with your partner; cleaning the house, tidying up, working in the garden, doing household chores; exercising alone; walking, or taking a trip together with someone; exercise together with someone; watching TV, listening/playing (to) music/, playing computer games; playing a card game or other board game; and preparing something extra tasteful outside regular meals. Conclusion: Our study demonstrated an association between concrete coping behaviors and distress and somatization in healthcare workers during the first peak of the COVID-19 pandemic. The results provide relevant and additional insights to develop and investigate interventions among others in personal leadership and resilience.
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Affiliation(s)
- Erik Franck
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Filip Haegdorens
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Eva Goossens
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Yannic van Gils
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Michael Portzky
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Francis Somville
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Emergency and Traumatology, AZ St. Dimpna, Geel, Belgium
| | - Majed Abuawad
- Community and Primary Health Care Centers, United Nations Relief and Works Agency, Brussels, Belgium
| | - Stijn Slootmans
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Van Bogaert
- Department of Nursing Science and Midwifery, Centre For Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Saar L, Unbeck M, Bachnick S, Gehri B, Simon M. Exploring omissions in nursing care using retrospective chart review: An observational study. Int J Nurs Stud 2021; 122:104009. [PMID: 34298321 DOI: 10.1016/j.ijnurstu.2021.104009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 05/30/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Omissions in nursing care can compromise patient safety. To date, this phenomenon has been investigated almost exclusively via nurse surveys. However, such surveys restrict the range of activities which can be assessed for omissions, and patient level analysis. As an alternative, retrospective chart review methodology has been used successfully in other research fields, but not yet for omitted nursing care. OBJECTIVES To describe characteristics and frequency of omitted nursing care using a retrospective chart review methodology. DESIGN, SETTING AND PARTICIPANTS Observational single center study in two German neurological inpatient units. A random sample of 100 patient admissions was used. METHODS A structured chart review protocol to detect nursing omissions was developed and applied. The full range of expected nursing care activities were assessed regarding the importance of documenting them and whether they had been fully or partially omitted. Vital sign measurements were assessed regarding both the measurement target number and the number of measurements recorded. RESULTS In total, 1885 activities-a mean of 19 per patient-were identified. Of the reviewed activities, 52% (n = 971) were fully or partially omitted. Patients experienced between one and 22 omitted nursing care activities during their hospital stay (8-84% of expected care activities). Ranging from 6% to 100% some activities were more commonly omitted than others during admission. The most frequently omitted nursing activity was giving emotional care (88%, n = 66); the least frequently omitted was teaching (10%, n = 29). Vital signs were recorded only 50% (n = 141) of the targeted number of times. CONCLUSIONS Using a retrospective chart review protocol to identify omissions in nursing care allows the assessment of a broad range of nursing activities. Additionally, this is the first-time patient-level data on a broad range of activities have been analyzed. The newly developed chart review methodology can complement established survey methods and provide a new perspective on the phenomenon of omitted nursing care.
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Affiliation(s)
- Lili Saar
- Department of Neurology, Universitätsklinik Freiburg, Breisacherstrasse 64, Freiburg im Breisgau D-79106, Germany.
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun SE-791 88, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm SE-171 77, Sweden.
| | - Stefanie Bachnick
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Nursing Science, University of Applied Sciences (hsg Bochum), Bochum, Germany.
| | - Beatrice Gehri
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Psychiatry, University Hospital Basel, University of Basel, Basel CH- 4002, Switzerland.
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Nursing, Nursing Research Unit, Inselspital Bern University Hospital, Bern 3010, Switzerland.
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DeBoer RJ, Mutoniwase E, Nguyen C, Ho A, Umutesi G, Nkusi E, Sebahungu F, Van Loon K, Shulman LN, Shyirambere C. Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource-Limited Context. Oncologist 2021; 26:e1189-e1196. [PMID: 33969927 PMCID: PMC8265342 DOI: 10.1002/onco.13818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background Moral distress and burnout are highly prevalent among oncology clinicians. Research is needed to better understand how resource constraints and systemic inequalities contribute to moral distress in order to develop effective mitigation strategies. Oncology providers in low‐ and middle‐income countries are well positioned to provide insight into the moral experience of cancer care priority setting and expertise to guide solutions. Methods Semistructured interviews were conducted with a purposive sample of 22 oncology physicians, nurses, program leaders, and clinical advisors at a cancer center in Rwanda. Interviews were recorded, transcribed verbatim, and analyzed using the framework method. Results Participants identified sources of moral distress at three levels of engagement with resource prioritization: witnessing program‐level resource constraints drive cancer disparities, implementing priority setting decisions into care of individual patients, and communicating with patients directly about resource prioritization implications. They recommended individual and organizational‐level interventions to foster resilience, such as communication skills training and mental health support for clinicians, interdisciplinary team building, fair procedures for priority setting, and collective advocacy for resource expansion and equity. Conclusion This study adds to the current literature an in‐depth examination of the impact of resource constraints and inequities on clinicians in a low‐resource setting. Effective interventions are urgently needed to address moral distress, reduce clinician burnout, and promote well‐being among a critical but strained oncology workforce. Collective advocacy is concomitantly needed to address the structural forces that constrain resources unevenly and perpetuate disparities in cancer care and outcomes. Implications for Practice For many oncology clinicians worldwide, resource limitations constrain routine clinical practice and necessitate decisions about prioritizing cancer care. To the authors’ knowledge, this study is the first in‐depth analysis of how resource constraints and priority setting lead to moral distress among oncology clinicians in a low‐resource setting. Effective individual and organizational interventions and collective advocacy for equity in cancer care are urgently needed to address moral distress and reduce clinician burnout among a strained global oncology workforce. Lessons from low‐resource settings can be gleaned as high‐income countries face growing needs to prioritize oncology resources. Oncology providers in low‐ and middle‐income countries face resource priority setting decisions on a routine basis. This article describes the moral experience and recommendations of oncology clinicians, advisors, and program leaders engaged in clinical priority setting at a cancer center in Rwanda.
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Affiliation(s)
- Rebecca J DeBoer
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | | | - Cam Nguyen
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Anita Ho
- Program in Bioethics, University of California, San Francisco, California, USA.,University of British Columbia, Vancouver, Canada
| | - Grace Umutesi
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Eugene Nkusi
- Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mateo-Martínez G, Sellán-Soto MC, Vázquez-Sellán A. The construction of contemporary nursing identity from narrative accounts of practice and professional life. Heliyon 2021. [DOI: 10.1016/j.heliyon.2021.e06942
expr 851849274 + 851121935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Moilanen T, Kangasniemi M, Papinaho O, Mynttinen M, Siipi H, Suominen S, Suhonen R. Older people's perceived autonomy in residential care: An integrative review. Nurs Ethics 2021; 28:414-434. [PMID: 33000683 PMCID: PMC8151558 DOI: 10.1177/0969733020948115] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people's perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher's Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people's individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples' autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people's choices. Professionals' characteristics, such as education and attitudes, and the older people's living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people's perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved.
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Affiliation(s)
| | | | - Oili Papinaho
- 8058University of Turku, Finland; Oulu University Hospital, Finland
| | | | | | | | - Riitta Suhonen
- 8058University of Turku, Finland; Turku University Hospital, Finland; City of Turku Welfare Division, Finland
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Evripidou M, Merkouris A, Charalambous A, Karanikola M, Zavrou R, Papastavrou E. Missed Nursing Care Among Patients With Dementia During Hospitalization: An Observation Study. Res Gerontol Nurs 2021; 14:150-159. [PMID: 34039149 DOI: 10.3928/19404921-20210326-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Patients with dementia (PwD) are characterized as a vulnerable group as they are unable to communicate their needs, putting them at risk for care omissions. The current study aimed to explore care toward PwD and detect if any aspects of care are omitted. An observation study was conducted in three medical-surgical adult wards of an acute general hospital. Data were collected by an observer, through field notes, and were analyzed with content analysis. A face scale was used to assess PwD's mood. Thirteen PwD were observed for 90 hours. Four thematic areas were identified: (a) Unmet Fundamental Patient Needs, (b) Human Right to Dignity and Respect, (c) Communication Deficiencies, and (d) Implementation of Nursing Interventions. Nurse-patient contact lasted from 5 to 7 minutes and numerous care omissions were noted. The face scale assessment revealed that most PwD looked very sad after nursing care. This study enriches insight for the care of PwD during hospitalization and emphasizes the need for health care workers' education and support. [Research in Gerontological Nursing, 14(3), 150-159.].
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Mateo-Martínez G, Sellán-Soto MC, Vázquez-Sellán A. The construction of contemporary nursing identity from narrative accounts of practice and professional life. Heliyon 2021; 7:e06942. [PMID: 34007932 PMCID: PMC8111597 DOI: 10.1016/j.heliyon.2021.e06942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/11/2021] [Accepted: 04/23/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To explore the contemporary narrative of nursing identity in Spain. METHOD This qualitative study was conducted between 2018 and 2020. Eleven registered nurses were interviewed. The conversations were recorded in audio, were semistructured, and held in a mental health clinic affiliated with a Catholic institution. Narrative analysis of the data was carried out. FINDINGS Two themes were identified: How do I construct my professional life?, with the subthemes 'Training and initiation in care practice', 'Ways of living the professional care experience', 'The sculpting of care' and 'Self-image and future projection'; and What do I know about my practice?, with the subthemes 'Nursing experience: shift, days, years', 'Strategy in the field of nursing care', 'Some foundations of caregiving practice', 'The specificity of the gesture of care' and 'Voice and recognition of nursing within the institution'. CONCLUSION Contemporary nursing identity is built in reflections on the epistemology of care, confronting the weight of tradition and breaking into new modes of self-image where the profession is legitimized and projected from historical consciousness. This claim can be used to support reflective practice in academic and healthcare settings as well as to promote a paradigm shift.
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Affiliation(s)
- Ginés Mateo-Martínez
- Faculty of Medicine of Autonomous University of Madrid (Doctoral Student), Spain
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