Nurses experiences of using clinical competencies a qualitative study

Nephrology nurses' perspectives working with patients experiencing needle-related distress

BACKGROUND

A key skill of nephrology nursing is cannulation of patients receiving haemodialysis. Traumatic and unsuccessful cannulation experiences, particularly in the initial weeks of haemodialysis, may contribute to the onset of needle distress for patients.

OBJECTIVES

To identify the key knowledge, skills and attitudes of nephrology nurses working with haemodialysis patients and the competencies relevant to nephrology nursing working with patients with needle-related distress.

DESIGN

A qualitative study involving semistructured interviews. Interviews were audio-recorded, transcribed and deductive, and inductive thematic analysis applied.

PARTICIPANTS

Nephrology nurses (n = 17) were interviewed from a tertiary kidney service in South Australia. Nurses had varying roles and years of experience (range 1-30 years) working with dialysis patients within the service.

RESULTS

Two overarching themes, (1) Flexibility in Practice and Care and (2) Responsibility of Nephrology Nursing, were identified as relevant across all knowledge, skills and attitudes of nephrology nurses working with patients with needle-related distress. Thirty-six knowledge, skills and attitudes were identified; 12 related to knowledge, 14 related to skills and 10 were identified as attitudes and were summarised under seven broad competencies.

CONCLUSION

This study identifies potential knowledge, skills and attitudes and competencies required for nephrology nurses working with patients with needle-related distress. It highlights strategies that may prevent the onset and worsening of needle-related distress, as well as reduce it. It also brings to light that nurses desire additional education regarding strategies to improve the patient experience of cannulation and nurse confidence and skill in this area.

Technological machines and artificial intelligence in nursing practice

This article is a theoretical discourse about technological machines and artificial intelligence, highlighting their effective interactive outcomes in nursing. One significant influence is technological efficiency which positively affects nursing care time, enabling nurses to focus more on their patients as the core of nursing. The article examines the impact of technology and artificial intelligence on nursing practice in this era of rapid technological advancements and technological dependence. Strategic opportunities in nursing are advanced, exemplified by robotics technology and artificial intelligence. A survey of recent literature focused on what is known about the influence of technology, healthcare robotics, and artificial intelligence on nursing in the contexts of industrialization, societal milieu, and human living environments. Efficient, precision-driven machines with artificial intelligence support a technology-centered society in which hospitals and healthcare systems become increasingly technology-dependent, impacting healthcare quality and patient care satisfaction. As a result, higher levels of knowledge, intelligence, and recognition of technologies and artificial intelligence are required for nurses to render quality nursing care. Designers of health facilities should be particularly aware of nursing's increasing dependence on technological advancements in their practice.

Developing Competencies of Nurses in Wound Care: The Impact of a New Service Delivery Model Including Teleassistance

BACKGROUND

The implementation of a new wound care model of service delivery, including training and teleassistance, provided us with the opportunity to study nursing competencies in a primary health care context.

METHOD

A mixed-methods study was chosen to address the complexity related to the development of competencies from two complementary perspectives.

RESULTS

Nurses' self-perceived knowledge and skills improved immediately after training. Factors identified as influencing the development process were grouped into three themes: Acquired Skills and Knowledge, Personal Factors, and Work Organization Factors.

CONCLUSION

Our study demonstrates that the skills and knowledge can be enhanced through integrated continuing education efforts, and brings a deeper understanding of factors that influence the competency development. Finally, the research team highlighted the potential of telehealth technologies. [J Contin Educ Nurs. 2020;51(12):547-555.].

Paediatric nursing management of renal replacement therapy: Intensive care nursing or dialysis nursing?

BACKGROUND

Children who develop Acute Kidney Injury may start renal replacement therapy (RRT) in Paediatric or Neonatal Intensive Care Units (hereafter PICU or NICU); RRT can be delivered either by paediatric dialysis nurses or by critical care nurses. In both case, nurses devoted to this task must have a high level of competence in providing care to children receiving haemodialytic treatment in a specific technological environment.

AIM

The objective of this research was to investigate which models have been adopted to organize nursing care in RRT management in different Italian PICU and NICU, and to explore the training of ICU nurses on the management of RRT.

METHODS

A multi-centre survey was conducted through an online questionnaire directed to the Italian PICU and NICU nurse coordinators.

RESULTS

A total of 15 Intensive Care Units (12 PICU and 3 NICU) in 12 hospitals were involved. The mean nurse/patient ratio in these units is 1:3. In 72.7% of critical care units, dialysis treatment is delivered by critical care nurses belonging to the unit itself, while in 27.3% of units paediatric dialysis nurses are in charge of dialysis treatment in collaboration with critical care nurses. In 25% of surveyed units there is some structured form of collaboration between Paediatric Dialysis nurses and critical care nurses. However, 75% of units did not respond to this specific question. The different units adopt various forms of RRT training for nursing staff.

CONCLUSION

The scenario resulting from this analysis showed how in our sample of Italian hospitals there is no standard practice for RRT nursing management. In addition, although various forms of training for nursing staff exist, a proper educational programme and/or a standardized specific training about RRT management for nursing staff is not in place in the surveyed hospitals.

RELEVANCE TO CLINICAL PRACTICE

The lack of standardized protocols or guidelines for RRT delivery to critically ill children can compromise their safety. The structuring of these protocols and the production of best clinical practice guidelines would allow standardization of the nursing management of the RRT and of the corresponding training. This may help to provide the proper care and to guarantee the patients' safety.

Characteristics of expert nurses' assessment of insertion sites for peripheral venous catheters in elderly adults with hard-to-find veins

AIM

To clarify the characteristics of expert nurses' assessments when selecting an insertion site for a peripheral venous catheter (PVC).

METHODS

Participants were 11 competent (control group) and 13 expert nurses. Using a simulated patient, we recorded the procedures participants followed when selecting a site for a PVC insertion. The researchers interviewed the nurses after the procedure by asking targeted questions about the site selection to clarify the factors influencing that selection. During the interview, a video of that nurse's procedure was observed, and each step performed during the procedure was investigated.

RESULTS

We identified three assessment characteristics specific to expert nurses that influenced their PVC site selection: (a) focusing on a patient's unique characteristics and choosing the appropriate procedure for that individual; (b) avoiding complications and paying attention to the patient's daily self-care needs; and (c) carefully considering the patient's fear and fatigue during site selection and catheter insertion. Other assessments, based on the general knowledge and skill acquired by nurses in selecting a PVC site, were common to both groups: arm selection based on the patient's preference and site selection to avoid nerve injuries or complications. The control group's approach was assessed on the basis of their confidence in selecting a site for a PVC insertion.

CONCLUSIONS

Expert nurses assessed the patient's individual characteristics and daily self-care needs and helped mitigate the patient's anxiety. Our findings provide a basis for educational programs that share how expert nurses assess sites for a PVC insertion.