Obtaining consensus about patient-centred professionalism in community nursing: nominal group work activity with professionals and the public

Patient perspectives on knowledge gaps in hypersensitivity pneumonitis

OBJECTIVES

Responding to prior research findings that lack of knowledge about their disease impacted patients' quality of life, the objective of this study was to identify and prioritise information gaps about hypersensitivity pneumonitis (HP) from the perspective of patients living with the disease.

DESIGN

This study used the nominal group technique, a semiquantitative and qualitative method to identify stakeholder priorities.

SETTING

Virtual group sessions were conducted in an academic medical centre in the USA.

PARTICIPANTS

21 patients diagnosed with HP participated in this study. Participants were eligible if they spoke English and had access to the internet and were excluded if they had cognitive impairment.

RESULTS

The patient statements were grouped into seven themes that were prioritised by participants in the following order: (1) natural history and prognosis; (2) current treatment options and therapeutic research; (3) epidemiology and aetiology of HP; (4) living well with HP; (5) origin and management of symptoms; (6) identifying and mitigating exposures and (7) methods of educating patients, clinicians and others about HP.

CONCLUSIONS

This study provides an understanding of patients' prioritisation of knowledge gaps in HP to inform targeted educational interventions and provide avenues for future research.

Exploring Nursing Professionalism: A Focused Ethnography of Community Nurses in Slovakia

Background: Professionalism is a multidimensional and dynamic concept that is a fundamental requirement to providing safe, quality nursing care. In the Slovak sociocultural context, professionalism is given only limited attention, and research in this area is completely lacking in community nursing. Purpose: To explore how community nurses (CNs) working in home care agencies understand professionalism in the context of their practice in Slovakia. Methods: This focused ethnography involved 10 CNs working in home care in two Slovak regions. The study was conducted between January and July 2022 and employed semistructured interviews, field notes, and reflexive thematic analysis. Findings: In this specific group and setting, understanding of professionalism was reflected through four themes: professional socialization, community service provision, job satisfaction, and professionalism in danger. Conclusions: The findings showed the need to improve the conditions of the working environment of nurses in the community setting. Implications for practice: The findings have implications for local policy, home care agency management, and nursing education in terms of strengthening professionalism in this specific nursing setting and cultural context.

Multiple Perspectives on Motivating Parents in Pediatric Primary Care to Initiate Participation in Parenting Programs

OBJECTIVE

To use multiple perspectives to identify the key components of pediatric primary care conversations for motivating parents to utilize parenting programs. We aim to develop an actionable framework that primary care clinicians (PCCs) can follow for effective conversations with parents.

METHODS

We conducted focus groups and interviews with researchers (n = 6) who have experience delivering parenting interventions through primary care, clinical personnel in federally qualified health centers (FQHCs) (n = 9), parents of 3-5-year olds who receive services at a FQHC pediatric clinic (n = 6), and parent educators (n = 5). Groups and interviews were informed by nominal group technique, and researchers triangulated consolidated strategies across the groups.

RESULTS

Key strategies for PCCs to motivate parents to utilize parenting programs followed three steps: 1) learning about a parent's questions and concerns, 2) sharing resources, and 3) following up. PCCs can learn about parents' needs by empathizing, listening and responding, and asking questions that acknowledge parents' expertise. When sharing resources, PCCs can motivate participation in parenting programs by explaining each resource and its benefits, providing options that support parents' autonomy, and framing resources as strengthening rather than correcting parents' existing strategies or skills. Finally, PCCs can continue to engage parents by scheduling follow-up conversations or designating a staff member to check-in with parents. We provide examples for each strategy.

CONCLUSIONS

Findings provide guidance from multiple perspectives on strategies to motivate parents in pediatric primary care setting for utilizing parenting programs.

Systematic development of quality indicators for skin cancer management in primary care: a mixed-methods study protocol

INTRODUCTION

Australia has the highest incidence of skin cancer in the world, with two out of three Australians expected to be diagnosed with skin cancer in their lifetime. Such incidence necessitates large-scale, effective skin cancer management practices. General practitioners (in mainstream practice and in skin cancer clinics) play an important role in skin cancer care provision, making decisions based on relevant evidence-based guidelines, protocols, experience and training. Diversity in these decision-making practices can result in unwarranted variation. Quality indicators are frequently implemented in healthcare contexts to measure performance quality at the level of the clinician and healthcare practice and mitigate unwarranted variation. Such measurements can facilitate performance comparisons between peers and a standard benchmark, often resulting in improved processes and outcomes. A standardised set of quality indicators is yet to be developed in the context of primary care skin cancer management.

AIMS

This research aims to identify, develop and generate expert consensus on a core set of quality indicators for skin cancer management in primary care.

METHODS

This mixed-methods study involves (1) a scoping review of the available evidence on quality indicators in skin cancer management in primary care, (2) identification and development of a core set of quality indicators through interviews/qualitative proforma surveys with participants, and (3) a focus group involving discussion of quality indicators according to Nominal Group Technique. Qualitative and quantitative data will be collected and analysed using thematic and descriptive statistical analytical methods.

ETHICS AND DISSEMINATION

Approval was granted by the university's Research Ethics Committee (HREC no. 520211051532420). Results from this study will be widely disseminated in publications, study presentations, educational events and reports.

Positive consequences of the hidden curriculum in undergraduate nursing education: An integrative review

Background:

Hidden Curriculum (HC) plays an essential role in nursing education and professionalism. However, its positive consequences have been overlooked. Thus, this study aimed to explore and discuss the positive consequences of HC in nursing undergraduate education.

Materials and Methods:

A comprehensive literature search was conducted to investigate articles published between January 2010 and December 2020. Furthermore, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to select articles, and Consolidated criteria for Reporting Qualitative research (COREQ) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) tools were employed to appraise qualitative and quantitative studies, respectively. The applied search strategy resulted in a final list of 16 articles out of a total of 132 articles. Next, the data were integrated and categorized using the Whittemore and Knafl methodology.

Results:

Three categories were identified: Individual Consequences; involving increased self-confidence, self-esteem, assertiveness, adaptation, autonomy, and lifelong learning. Social Consequences; involving enhanced socialization, cultural consciousness, and social interactions. Professional Consequences; involving professional socialization, professional identity, professional ethics, link theory and practice, and professional dignity.

Conclusions:

Altogether, we concluded that the emergence of HC and its positive and remarkable consequences in nursing knowledge helps the personal, social, and professional development in nursing.

Dispensing of antibiotics in community pharmacy in Iraq: a qualitative study

Objective

This study aimed to understand the dispensing practice of antibiotics in community pharmacy in Iraq, in addition to explore the community pharmacists' perception about dispensing antibiotics without prescription.

Methods

A qualitative design was conducted on community pharmacists in Baghdad, Iraq. Pharmacists were selected conveniently from different gender, age group, pharmacy type and years of experience. Face-to-face semi-structure interview was used with all the pharmacists to get in-depth understanding about their dispensing practice of antibiotics without prescription in community pharmacy. The data was coded and classified for thematic analysis.

Results

This study found that dispensing of antibiotics without prescription was a common practice in community pharmacy. Pharmacists' perception towards dispensing antibiotics without prescription was associated with the medical condition, safety and efficacy of antibiotics, patients request antibiotics by name, emergency cases, regular customer, promotions from pharmaceutical companies, saving time and cost, brand medications, and poor healthcare services. In addition, there were inadequate knowledge about antibiotic resistance and lack of awareness about antibiotic stewardship leading to inappropriate dispensing practice.

Conclusions

Community pharmacists have poor perception towards dispensing antibiotics without prescription. Educational interventions about antibiotics use focusing on community pharmacists are needed. This will help to optimize the practice of dispensing of antibiotics in the community. In addition, training programs about antibiotic resistance are important to enhance pharmacists' understanding about antibiotic stewardship.

Accessible and inclusive transportation for youth with disabilities: exploring innovative solutions

Background: Although access to reliable transportation is an essential component of quality of life, young people with disabilities encounter many transportation-related obstacles.Objective: To explore solutions to the challenges that youth with disabilities encounter in accessing and navigating transportation.Methods: A nominal group technique was used in two consultation workshops (one involving rehabilitation clinicians and accessible transportation stakeholders; and one with youth with disabilities and parents). Fifteen participants across two workshops took part and prioritized their solutions and we used a comparative analysis within and between groups to explore overarching themes.Results: The workshops resulted in 122 solutions (76 from youth/parents; 46 from stakeholders). Although there was considerable overlap within the ideas generated between the groups, they each prioritized them differently. The following themes emerged across the two group's prioritized solutions: training, funding, enhancing access, and improved efficiency.Conclusions: Our findings highlight that youth with disabilities, parents and key stakeholders offered many practical solutions for enhancing accessible transportation for youth with disabilities.Implications for RehabilitationClinicians and educators should explore different apps and transportation training programs that could help support youth with disabilities to enhance their independence and participation in the communityClinicians and educators should be involved in the development of disability awareness training programs for public transit and school bus drivers to enhance youth's inclusion and participation in society.Clinicians, educators, youth and parents should continue to advocate for inclusive, accessible, affordable and efficient transportation for people with disabilities.

A concept analysis of professional commitment in nursing

BACKGROUND

The concept of professional commitment is being widely studied at present. However, although it is considered an indicator for the most human part of nursing care, there is no clear definition for it, and different descriptors are being used indiscriminately to reference it.

OBJECTIVE

The aim of this study is to clarify the concept of professional commitment in nursing through the Rodgers' evolutionary concept analysis process.

DESIGN

Systematic search using English and Spanish descriptors and concept analysis. Studies published between 2009 and June 2015, front-to-back analysis of the Nursing Ethics journal and manual check of articles cited in studies related to the Nijmegen Professionalism Scale.

RESEARCH DESIGN

The procedure of concept analysis developed by Rodgers was used.

ETHICAL CONSIDERATIONS

Although the topic was not labeled as sensitive and subject to ethical approval, its realization was approved by the Ethical Committee of Clinical Research of Aragon (CEICA) approved the study on 18 March 2015 and also careful procedures have been followed according to ethics expressed in the Declaration of Helsinki.

FINDINGS AND DISCUSSION

A total of 17 published studies. A clear definition of the concept was made, and surrogate terms, concept dimension, differential factors related to the concept, sociocultural variations and consequences for nursing practice were identified.

CONCLUSION

There is a need for continuous advancement in the development of the concept, specific actions to encourage this and the improvement of evaluation methods for its study.

Patient-centred professionalism in pharmacy: values and behaviours

PURPOSE

Research on patient-centred professionalism in pharmacy is scarce compared with other health professions and in particular with pharmacists early in their careers. The purpose of this paper is to explore patient-centred professionalism in early career pharmacists and to describe reported behaviours. DESIGN/METHODOLOGY/APPROACH - This study explored patient-centred professional values and reported behaviours, taking a qualitative approach. In all, 53 early-career pharmacists, pharmacy tutors and pharmacy support staff, practising in community and hospital pharmacy in England took part; the concept of patient-centred professionalism was explored through focus group interviews and the critical incident technique was used to elicit real-life examples of professionalism in practice.

FINDINGS

Triangulation of the data revealed three constructs of pharmacy patient-centred professionalism: being professionally competent, having ethical values and being a good communicator.

RESEARCH LIMITATIONS/IMPLICATIONS

It is not known whether our participants' perspectives reflect those of all pharmacists in the early stages of their careers. The data provide meaning for the concept of patient-centred professionalism. The work could be extended by developing a framework for wider application. Patient-centred professionalism in pharmacy needs further investigation from the patient perspective.

PRACTICAL IMPLICATIONS

The findings have implications for pharmacy practice and education, particularly around increased interaction with patients.

SOCIAL IMPLICATIONS

The data contribute to a topic of importance to patients and in relation to UK health policy, which allocates more directly clinical roles to pharmacists, which go beyond the dispensing and supply of medicines.

ORIGINALITY/VALUE

The methods included a novel application of the critical incident technique, which generated empirical evidence on a previously under-researched topic.

'My mentor kicked a dying woman's bed…' analysing UK nursing students' 'most memorable' professionalism dilemmas

AIM

To provide depth and breadth in the analysis of nursing students' written narratives of 'most memorable' professionalism dilemmas.

BACKGROUND

While nursing students are taught professionalism through formal curricula, they commonly experience workplace-based professionalism dilemmas. Although non-UK studies have begun to explore students' lived experiences of dilemmas, they lack detail about when and where dilemmas occur, who is involved, what students do and why and how students feel.

DESIGN

Online survey of healthcare students including 294 nursing students from 15 UK nursing schools.

METHOD

Nursing students provided a written narrative of their most memorable dilemma (December 2011-March 2012) as part of a survey examining the impact of professionalism dilemmas on moral distress. We conducted thematic and discourse analysis of all narratives and narrative analysis of one exemplar.

FINDINGS

The most common themes were patient care dilemmas by healthcare personnel or students, student abuse and consent dilemmas. Of the dilemmas, 49·6% occurred over 6 months previously, 76·2% occurred in hospitals and 51·9% of perpetrators were nurses. 79·3% of students reported acting in the face of their dilemma. Of the narratives, 88·4% contained negative emotion talk and numerous significant relationships existed between types of emotion talk and dilemmas. Our narrative analysis demonstrates the impact of dilemma experiences through emotion talk and more subtle devices like metaphor.

CONCLUSION

Findings extend previous research with nursing and medical students. Nurse educators should help students construct emotionally coherent narratives to make sense of their experiences, actions and identities and to better prepare them for future professionalism dilemmas.

Using the hidden curriculum to teach professionalism in nursing students

Background:

Professionalism in nursing is critical for creating credibility and a positive image.

Objectives:

This study was carried out to explain the use of hidden curriculum in teaching professionalism in nursing students.

Materials and Methods:

This qualitative study was conducted through purposeful sampling strategy by the participation of 32 nursing students. The data were collected by using semi-structured interviews, and this process was continued until achieving data saturation and themes’ emergence. Content analysis method was used for data analysis.

Results:

Data analysis revealed three main themes: Development of understanding the professionalism elements, Variety of influenceability strategies, and Influenceability to various resources. Each theme consisted of some subthemes.

Conclusions:

The nursing students learnt the professionalism elements by different methods from different resources through the hidden curriculum. Therefore, exploration of the currently administered hidden curricula is suggested.

Nominal Group Technique consultation of a Pulmonary Rehabilitation Programme

OBJECTIVE

The purpose of the study was to determine what patients, professionals and significant others regarded as the most important positive- and challenging aspects of Pulmonary Rehabilitation Programmes for patients with Chronic Obstructive Pulmonary Disease (COPD) and to gain insight into how such programmes could be developed and improved.

METHOD

A modified Nominal Group Technique method was used in three consultation workshops (one with COPD patients who had recently undertaken a Pulmonary Rehabilitation Programme; one with 'significant others' of the same patients; one with secondary care professionals who deliver the Pulmonary Rehabilitation Programme).

RESULTS

Each of three workshops resulted in the production of approximately ten positive- and ten challenging aspects related to Pulmonary Rehabilitation Programmes.  These were further developed by a process of thematisation into seven broad themes.  The most important was ' the patient', followed by ' physical health'; jointly ranked as third were: ' mental health' and ' knowledge and education'.  ' The programme' and ' professional characteristics' were jointly ranked as fifth, with ' the future' being ranked as the least important theme.

CONCLUSIONS

The modified Nominal Group Technique method allowed the development of a ranked thematic list that illustrated the important positive- and challenging aspects of Pulmonary Rehabilitation Programmes for patients with COPD. These themes should be core to planning future Pulmonary Rehabilitation Programmes, particularly if patients and carer views are to be considered.

Consultation workshops with patients and professionals: developing a template of patient-centred professionalism in community nursing

The study aimed to clarify the notion of patient-centred professionalism through consultation with the public, stakeholders and professionals in order to develop a thematic template within nursing. The paper also examines innovative methodology informing eight template themes developed qualitatively. Patient-centred professionalism has had little coverage in nursing literature, whilst ‘patient-centredness’ is supporting patients through holistic care according to needs and expectations. The study took place in Wales, UK, between October 2009 and September 2010. Data collection entailed consultation workshops with newly qualifying nurses (13 participants), community nurses (nine participants), nursing stakeholders (six participants) and the public (six participants). Analysis involved summative and thematic approaches. Result were revealed through template themes, identified in rank order of significance: the patient, nursing ethos, community nurse as a person, knowledge and skills, working relationships, service delivery, training and information and environment. The patient comes first for nurses and was the major theme of the analysis. This almost goes without saying for nurses, whilst for patients this is a surprise, as they see themselves as marginalised. The patient in patient-centred professionalism has multiple identities, many of which contradict one another – recipient and object of care, a force of resistance and a focus of negotiation. In conclusion, a clearer understanding of the concept should play a central role in policy development for optimal care, informing education and training, and methodological strengths could be explored further by other researchers, across a wide range of contexts.