Ethical elements in priority setting in nursing care: A scoping review

The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design

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.

Nurses prioritization processes to prevent delirium in patients at risk: Findings from a Q-Methodology study

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.

Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study

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.

Nursing care left undone in psychiatric hospitals and its association with nurse staffing: A cross-sectional multi-centre study in Switzerland

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.

The discourse of delivering person-centred nursing care before, and during, the COVID-19 pandemic: Care as collateral damage

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.

Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis

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.

The nurses' perception of the factors influencing professional misconduct: A qualitative study

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.

Prioritization decision-making of care in nursing homes: A qualitative study

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.

Nurses' priority-setting for older nursing home residents during COVID-19

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.

Missed Nursing Care; Prioritizing the Patient's Needs: An Umbrella Review

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.

Nursing core competencies for postresuscitation care in Iran: a qualitative study

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.

The Effect of Nurses' Holistic Competence in Chronic Disease Management on Their Attitudes Toward Caregiver Roles

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.

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

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.

Registered nurses' exposure to high stress of conscience in long-term care

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.

The patients' lived experiences with equitable nursing care

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.

The relationship between the ethical attitudes and holistic competence levels of intensive care nurses: A cross-sectional study

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.

The experience of nurses to reduce implicit rationing of nursing care: a phenomenological study

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.

Cultivating support during COVID-19 through clinical supervision: A discussion article

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.

Fast thinking: How unconscious bias and binary language contribute to rationing of care to older persons

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.

Assessing the Reliability and Validity of the Spanish Version of the Actual Scope of Nursing Practice Scale

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.

Doživljanje neizvedene zdravstvene nege pri medicinskih sestrah

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.

Unfinished nursing care in nursing homes

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.

Translation and validation of the PPSC-PNP instrument to measure parental satisfaction with care from pediatric nurses in China

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.

Developing and Testing Digital Ethical Reflection in Long-Term Care: Nurses' Experiences

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.

What are the reasons for unfinished nursing care as perceived by hospitalized patients? Findings from a qualitative study

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.

Nursing leadership and management in home care: A qualitative scoping review

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.

Nurses' harm prevention practices during admission of an older person to the hospital: A multi-method qualitative study

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.

Compliance with the ethical competence framework by head nurses

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.

A Delphi study to explore clinician and lived experience perspectives on setting priorities in eating disorder services

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.

Attitudes and job satisfaction of intensive care nurses regarding their caregiver roles

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

Ethical Attitudes of Intensive Care Nurses during Clinical Practice and Affecting Factors

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.

Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability

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.

Nursing students' competence profiles in gerontological nursing-A cross-sectional study

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.

Humanized Care From the Nurse-Patient Perspective in a Hospital Setting: A Systematic Review of Experiences Disclosed in Spanish and Portuguese Scientific Articles

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.

Norwegian Nurses' Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis

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.

Nursing support for older people's autonomy in residential care: An integrative review

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.

Missed nursing care and its relationship with perceived ethical leadership

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.

The Role of Coping Behavior in Healthcare Workers' Distress and Somatization During the COVID-19 Pandemic

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.

Exploring omissions in nursing care using retrospective chart review: An observational study

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.

Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource-Limited Context

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.

Missed Nursing Care Among Patients With Dementia During Hospitalization: An Observation Study

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.].

The construction of contemporary nursing identity from narrative accounts of practice and professional life

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.

Unfinished Care in Residential Aged Care Facilities: An Integrative Review

BACKGROUND AND OBJECTIVES

When workload demands are greater than available time and resources, staff members must prioritize care by degree of importance and urgency. Care tasks assigned a lower priority may be missed, rationed, or delayed; collectively referred to as "unfinished care." Residential aged care facilities (RACFs) are susceptible to unfinished care due to consumers' complex needs, workforce composition, and constraints placed on resource availability. The objectives of this integrative review were to investigate the current state of knowledge of unfinished care in RACFs and to identify knowledge gaps.

RESEARCH DESIGN AND METHODS

We conducted a search of academic databases and included English-language, peer-reviewed, empirical journal articles that discussed unfinished care in RACFs. Data were synthesized using mind mapping techniques and frequency counts, resulting in two categorization frameworks.

RESULTS

We identified 17 core studies and 27 informing studies (n = 44). Across core studies, 32 types of unfinished care were organized under five categories: personal care, mobility, person-centeredness, medical and health care, and general care processes. We classified 50 factors associated with unfinished care under seven categories: staff member characteristics, staff member well-being, resident characteristics, interactions, resources, the work environment, and delivery of care activities.

DISCUSSION AND IMPLICATIONS

This review signifies that unfinished care in RACFs is a diverse concept in terms of types of unfinished care, associated factors, and terminology. Our findings suggest that policymakers and providers could reduce unfinished care by focusing on modifiable factors such as staffing levels. Four key knowledge gaps were identified to direct future research.

Factors related to implementation of nursing care ethical principles in Indonesia

Background: The implementation of ethical principles is crucial in carrying out nursing care, since it is part of the 12 basic competencies, that should be possessed by a nurse. This study aims to analyse the factors associated with the implementation of nurses’ ethical principles.

Design and Methods: This study used a quantitative research design, with a cross-sectional approach. The participants consisted of 389 nurses, working in the medical ward of the hospitals, in Indonesia. Data were analysed using the bivariate analysis, t-test, ANOVA and multiple linear regression test.

Results: There were no significant relationships between the demographic factors and the ethical behaviour. There was a relationship between caring behaviour and the application of ethical principles (p=0.000, and a correlation coefficient of 0.602).

Conclusion: Nurse ethical behaviour was improved, by increasing their caring attitude.

[Between care for others and self-care: intensive care nursing in times of the COVID-19 pandemic]

DEFINITION OF THE PROBLEM

The COVID-19 pandemic poses a considerable challenge to the capacity and functionality of intensive care. This concerns not only resources but, above all, the physical and psychological boundaries of nursing professionals. The question of how care for others and self-care of nurses in intensive care units are related to each other in the context of the COVID-19 pandemic has not been addressed in public and scientific discourse so far.

ARGUMENTS

The present contribution reflects this relationship with reference to the Code of Ethics of the International Council of Nurses, particularly considering principlism and the Care Ethics according to Joan Tronto. As a result, it shows a corridor of ethically justifiable care with several borders, above all: (1) self-care must not be given up completely for the benefit of care for others, and (2) a categorical subordination of care for others to self-care is ethically not justifiable.

CONCLUSION

The article makes an important contribution to a differentiated ethical consideration of the rights and responsibilities of intensive care nurses as moral actors within the pandemic in Germany. It, thus, provides a first starting point for a broad social and political discourse which is urgently needed not only during but also after the pandemic in order to improve the situation of intensive care nurses and those who are cared for.

Moral injury in healthcare professionals: A scoping review and discussion

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration.

Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization

There are continued challenges in achieving effective pain management for children and young people (CYP). Research has found several barriers to effective CYP pain management, which include, but are not limited to, deficiencies in knowledge among nurses and other healthcare professionals. Calls for improvements in and an increase in pain education ensue, in the expectation that an increase in knowledge will lead to an improved pain care for patients. Educational initiatives, as reported in the literature, have tended to focus on increasing empirical knowledge which has not resulted in the anticipated improvements in practice. An exploration of Carper's and Chinn & Kramer's five ways of knowing helps demonstrate why an over-reliance on empirics fails to equip nurses for the realities of clinical practice and does not facilitate knowledge mobilization or improvements in pain care for CYP. In this paper, we explore these ways of knowing to produce a model for knowledge mobilization in (pain) education. Our model puts forward a multifaceted approach to education using the active learning principles which supports and equip nurses to become effective pain practitioners.