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Maloney KW. Seeking Common Ground: A Grounded Theory of the Nurse-Patient Relationship in Cancer Infusion Care. Cancer Nurs 2024; 47:299-306. [PMID: 36881641 DOI: 10.1097/ncc.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND The nurse-patient relationship represents a valuable connection in cancer care. Largely studied within inpatient settings, the nature and influence of this central relationship in ambulatory settings remain relatively unexamined. The notable shift to ambulatory settings like infusion centers warrants examination of the nurse-patient relationship in this context. OBJECTIVE The aim of this study was to develop a grounded theory of the nurse-patient relationship in ambulatory cancer infusion care. INTERVENTIONS/METHODS Using grounded theory methodology, 11 nurses were interviewed using a semistructured interview guide. Data collection continued until data saturation occurred with the primary concepts. RESULTS The grounded theory, entitled Seeking Common Ground, includes 6 primary concepts. The concepts "we are all human"; "we work in a busy, complex environment"; "we seek common ground with patients"; "we use connections to support meaningful encounters"; "we find meaning in the relationships created"; and "we are governed by the push and pull of time" abstract the nurse-patient relationship from the nurses' perspective, emphasizing fundamental human connections. CONCLUSIONS The grounded theory Seeking Common Ground depicts the profound connection that nurses form with their patients in the ambulatory infusion setting. Underscoring the value of the nurse-patient relationship as foundational to the nursing profession must be driven through practice, education, and policy. IMPLICATIONS FOR PRACTICE Consideration of educational aspects within nursing across all levels to influence clinical practice will remain key.
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Affiliation(s)
- Kristen W Maloney
- Author Affiliation: Department of Nursing, The Hospital of the University of Pennsylvania, Philadelphia
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Björk J, Hirsch A. An "ethics of strangers"? On knowing the patient in clinical ethics. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024:10.1007/s11019-024-10213-y. [PMID: 38850498 DOI: 10.1007/s11019-024-10213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
The shape and function of ethical imperatives may vary if the context is an interaction between strangers, or those who are well acquainted. This idea, taken up from Stephen Toulmin's distinction between an "ethics of strangers" and an "ethics of intimacy", can be applied to encounters in healthcare. There are situations where healthcare personnel (HCP) know their patients (corresponding to an "ethics of intimacy") and situations where HCP do not know their patients (corresponding to "an ethics of strangers"). Does it make a difference for normative imperatives that follow from central concepts and principles in medical ethics whether HCP know their patients or not? In our view, this question has not yet been answered satisfactorily. Once we have clarified what is meant by "knowing the patient", we will show that the distinction is particularly relevant with regard to some thorny questions of autonomy in healthcare (e.g., regarding advance directives or paternalism in the name of autonomy), whereas the differences with regard to imperatives following from the principles of justice and beneficence seem to be smaller. We provide a detailed argument for why knowing the patient is ethically valuable in encounters in healthcare. Consequently, healthcare systems should provide fertile ground for HCP to get to know their patients, and structures that foster therapeutic continuity. For this to succeed, a number of questions still need to be clarified, which is an important task for medical ethics.
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Affiliation(s)
- Joar Björk
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.
- Department of Research and Development, Region Kronoberg, Sweden.
| | - Anna Hirsch
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Munich, Germany
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Nyhagen R, Egerod I, Rustøen T, Lerdal A, Kirkevold M. Family Members' Engagement in Symptom Communication, Assessment, and Management in the Intensive Care Unit: A Qualitative Study. Dimens Crit Care Nurs 2024; 43:111-122. [PMID: 38564453 DOI: 10.1097/dcc.0000000000000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Opportunities for communication and participation in decision making are limited for critically ill patients, but family members serving as surrogates enable empowerment of these patients. OBJECTIVE The aim of this study was to explore family members' engagement in symptom communication in the intensive care unit. METHODS A qualitative descriptive design using fieldwork methodology with triangulation of participant observation and individual interviews was conducted. Nine mechanically ventilated patients were observed in interaction with family members and clinicians in the intensive care unit. Six of the observed patients, 6 family members, and 9 clinicians were interviewed after participant observation. Field notes and transcripts were analyzed using Braun and Clarke's method of thematic analysis. RESULTS Family members engaged actively in symptom communication, assessment, and management, and there were barriers and facilitators to family engagement. Three main themes and 9 subthemes describing family engagement emerged: (1) intermediary role (recognize and report symptoms, provide patient information, and assist in communication), (2) independent role (provide familiarity, manage symptoms, and promote patient communication), and (3) conditions for family engagement (intensive care unit environment, relationship with the patient, and patient preferences). DISCUSSION Family members have unique knowledge of the patient that differs from and complement the competence of the staff, and might contribute to improved symptom communication. Future research should examine how family members can contribute to symptom communication, assessment, and management.
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Kattouw CE, Aase K, Viksveen P. Stakeholder perspectives on the preferred service ecosystem for senior citizens living at home: a qualitative interview study. BMC Geriatr 2023; 23:576. [PMID: 37726648 PMCID: PMC10508029 DOI: 10.1186/s12877-023-04303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Most senior citizens want to live independently at home as long as possible. The World Health Organization recommends an age-friendly community approach by transforming the service ecosystem for senior citizens and basing it on the question "What matters to you?". However, there is limited research-based knowledge to determine the characteristics of the preferred service ecosystem from the perspectives of multiple stakeholders. Therefore, the aim of the study was to gain a deeper understanding of multiple stakeholder perspectives on the preferred service ecosystem for senior citizens living at home. METHODS Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study in 2019 and 2020: senior citizens, carers, healthcare professionals, and managers. Data were analysed according to qualitative content analysis. RESULTS Overall, there was considerable correspondence between the four stakeholder groups' perspectives on the preferred service ecosystem for senior citizens. Six themes were developed: (1) "self-reliance - living independently at home as long as possible"; (2) "remaining active and social within the community"; (3) "support for living at home as long as possible"; (4) "accessible information and services"; (5) "continuity of services"; and (6) "compassionate and competent healthcare professionals". CONCLUSIONS In order to adapt and meet changing needs, the preferred service ecosystem should support senior citizens' autonomy through interpersonal relationships and involvement. Healthcare managers and decision makers should consider a broader range of practical and social support services. Municipalities should plan for and develop age-friendly infrastructures, while healthcare professionals should rely on their compassion and competence to meet senior citizens' needs.
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Affiliation(s)
- Christophe Eward Kattouw
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway.
| | - Karina Aase
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway
| | - Petter Viksveen
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway
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Ji Y, Choi EK, Han SW. The association between nurse continuity and hypospadias repair patient outcomes: A retrospective study. J Adv Nurs 2023; 79:3513-3521. [PMID: 37073854 DOI: 10.1111/jan.15678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/03/2023] [Accepted: 04/07/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Recently, nurse continuity, the intensity and consistency of a patient's exposure to nurses during hospitalization, has been shown to be associated with patient outcomes. However, little is known about how nurse continuity is related to patients' surgical outcomes. AIMS To examine the association between nurse continuity and outcomes of hypospadias repair to clarify the importance of nurse continuity as a nursing practice. DESIGN This is a retrospective study. METHODS We analysed the data from electronic health records of patients under 1 year who had undergone proximal hypospadias repair between January 2014 and December 2016. Nurse continuity was measured using the Continuity of Care Index. Since approximately half of the patients reportedly needed further operations in the long term, the primary outcome was whether patients with proximal hypospadias repair had two or more additional operations within 3 years of discharge. RESULTS The rate of undergoing two or more follow-up operations in 3 years was significantly higher in patients with low nurse continuity-38.6% versus 12.8% for high continuity. CONCLUSION This study identified nurse continuity as an important factor related to patients' surgical outcomes. These findings suggest that nurse continuity be considered an important nursing strategy for patient outcomes and further research is needed on this topic. IMPACT STATEMENT As empirical evidence regarding the association between nurse continuity and patient outcomes grows, nurse managers and policymakers should view nurse continuity as a critical factor for positive patient outcomes when considering nursing workforce regulations. NO PATIENT OR PUBLIC CONTRIBUTION The data for this study were obtained from electronic health records, and the entire process of this study did not involve patient or public participation.
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Affiliation(s)
- Yoonhye Ji
- Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Eun Kyoung Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Sang Won Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Frontline Nurses' clinical judgment in recognizing, understanding, and responding to patient deterioration: A qualitative study. Int J Nurs Stud 2023; 139:104436. [PMID: 36731308 DOI: 10.1016/j.ijnurstu.2023.104436] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Early warning systems and rapid response teams have been widely implemented in hospitals worldwide to facilitate early recognition and response to patient deterioration. Unfortunately, evidence suggests that these interventions have made little impact on unexpected cardiac or respiratory arrest, hospital mortality, unplanned admission to intensive care units, or hospital length of stay. These programs depend on nurses recognizing at risk patients and initiating a timely response. Although physiologic abnormalities commonly precede serious adverse events, nurses often fail to recognize or respond effectively. Clinical judgment is a critical component in the effective response to deterioration, yet little is known about factors that influence nurses' clinical judgment in these situations. Noticing, interpreting, and responding are aspects of clinical judgment and are essential to preventing further patient deterioration and serious adverse events. OBJECTIVE To describe medical-surgical nurses' perceptions of factors that influenced their clinical judgment in situations of patient deterioration. DESIGN A qualitative descriptive design using individual, semi-structured interviews. Tanner's Clinical Judgment Model served as the framework for interview questions and data analysis. PARTICIPANTS A purposive sample of 20 medical-surgical registered nurses were recruited from 10 adult medical-surgical units at an academic medical center hospital in the United States. METHODS Telephone interviews occurred between March and July 2018. A directed approach to content analysis was used to code the transcribed data and identify themes. RESULTS Eight themes related to each aspect of clinical judgment emerged from the analysis: Knowing the patient, Experience matters, Lots of small points where the system can fail, Making sense of the data, Something doesn't go together, Caught in the middle, Culture of teamwork, and Increased nursing workload. An overarching theme was Nurses' keen sense of responsibility. Findings revealed that factors within the nurse, the patient, and the work environment influence each component of noticing, interpreting, and initiating an effective response to deteriorating patients. CONCLUSIONS Findings have implications for health care systems regarding interventions to support timely recognition and response to deterioration. Nurses' clinical judgment and factors that influence each aspect (noticing, interpreting, and responding) should be a key consideration in organizational efforts to improve the overall response to patient deterioration. Research is needed to enhance understanding of the contextual factors that impact nurses' clinical judgment to inform interventions to support timely recognition and response.
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Allande-Cussó R, Fernández-García E, Porcel-Gálvez AM. Defining and characterising the nurse-patient relationship: A concept analysis. Nurs Ethics 2021; 29:462-484. [PMID: 34879785 DOI: 10.1177/09697330211046651] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The nurse-patient relationship involves complex attitudes and behaviours with ethical and deontological implications. It has been linked to improvements in patient health outcomes, although there is still no consensus in the scientific literature as to the definition and characterisation of the concept. This article aim to define the concept of the nurse-patient relationship. A concept analysis was conducted using the Walker and Avant method to identify the attributes defining the nurse-patient relationship. An integrative review of the literature was conducted using the PubMed, Web of Science, Scopus, and Cumulative Index to Nursing & Allied Health Literature databases. A review of the grey literature and other minor non-indexed publications on the topic was also conducted. A total of 36 articles were included in the review. A model case, a contrary case, a related case, and empirical references were produced to clarify the concept and identify its essential attributes. The concept is defined as a helping relationship involving interaction between different players. It is the basis of nursing care and is intended to meet the healthcare needs of the individual receiving this care. It is also viewed as an intervention in itself, requiring a specific training process just like any other nursing skill. The essential attributes of the relationship are empathy, presence, contact, authenticity, trust, and reciprocity. In conclusion, the nurse-patient relationship is a helping relationship established with the patient and/or their family based on interaction, communication, respect for ethical values, acceptance, and empathy in order to encourage introspection and behavioural change. Key components include communication, active listening, and respect. Bioethical values and confidentiality must also be present to ensure that the relationship is built on equality and intimacy.
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Øfsti R, Devik SA, Enmarker I, Olsen RM. "Looking for Deviations": Nurses' Observations of Older Patients With COPD in Home Nursing Care. Glob Qual Nurs Res 2020; 7:2333393620946331. [PMID: 32875007 PMCID: PMC7436839 DOI: 10.1177/2333393620946331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022] Open
Abstract
Nurses working in home care play a significant role in observing and identifying changes in the health status of patient with chronic obstructive pulmonary disease (COPD). The aim of this study was to explore and describe nurses’ observations of older patients with COPD when providing home nursing care. In this qualitative explorative study, data were collected through observations of 17 home care visits using the think-aloud technique, followed up with individual interviews with the nurses. Qualitative content analysis was used to analyze the data. The findings showed that the nurses’ observations (focus, methods, and interpretation) were characterized by their search for deviations from what they judged to be the patient’s habitual state. The nurses did not use any tool or guidelines, nor did they follow a standard procedure. Instead, when observing and interpreting, they performed a complex process guided by their experience and knowledge of the patient, and the patient’s individual and contextual circumstances. This knowledge contributes to warranted reflection on nurses’ practice in this context to secure COPD patients’ safety and quality of life.
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Delaney KR, McIntosh D. Exploring the thinking, reasoning and clinical approach of expert child psychiatric nurses. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 34:41-49. [PMID: 32697417 DOI: 10.1111/jcap.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Expert nurses are characterized by their deep knowledge of patient situations and understanding of patients in the context of their total situation. We know of no studies that have focused on the expert practice of child/adolescent (C/A) psychiatric mental health (PMH) advanced practice nurse. OBJECTIVE The purpose of this study was to gather information on how expert C/A advanced practice psychiatric nurses (APPNs) view their role and assess/treat children and adolescents with complex mental health issues. METHOD Expert C/A APPNs were interviewed by one of the two investigators using a semi-structured interview guide. All interviews were audiotaped and transcribed. This was a qualitative descriptive study and in line with that method, interview content was open-coded and examined for themes that were collapsed into categories. RESULTS Fifteen C/A PMH APPNs were interviewed. Initial categories that were distilled included descriptions of their commitment to the population, development of families as partners, an expanded approach to medication management, and how they demonstrate expertise. CONCLUSION Expert nurses adopt an invaluable approach to children and families-inherently patient and family-centered. They view the child/teen in terms of the multiple contexts of their lives.
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Affiliation(s)
- Kathleen R Delaney
- Department of Community, Systems and Mental Health, Rush College of Nursing, Chicago, Illinois, USA
| | - Diana McIntosh
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, USA
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Lavoie P, Clarke SP, Clausen C, Purden M, Emed J, Cosencova L, Frunchak V. Nursing handoffs and clinical judgments regarding patient risk of deterioration: A mixed-methods study. J Clin Nurs 2020; 29:3790-3801. [PMID: 32644241 DOI: 10.1111/jocn.15409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/09/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore how change-of-shift handoffs relate to nurses' clinical judgments regarding patient risk of deterioration. BACKGROUND The transfer of responsibility for patients' care comes with an exchange of information about their condition during change-of-shift handoff. However, it is unclear how this exchange affects nurses' clinical judgments regarding patient risk of deterioration. DESIGN A sequential explanatory mixed-methods study reported according to the STROBE and COREQ guidelines. METHODS Over four months, 62 nurses from one surgical and two medical units at a single Canadian hospital recorded their handoffs at change of shift. After each handoff, the two nurses involved each rated the patient's risk of experiencing cardiac arrest or being transferred to an intensive care unit in the next 24 hr separately. The information shared in handoffs was subjected to content analysis; code frequencies were contrasted per nurses' ratings of patient risk to identify characteristics of information that facilitated or hindered nurses' agreement. RESULTS Out of 444 recorded handoffs, there were 125 in which at least one nurse judged that a patient was at risk of deterioration; nurses agreed in 32 cases (25.6%) and disagreed in 93 (74.4%). These handoffs generally included information on abnormal vital signs, breathing problems, chest pain, alteration of mental status or neurological symptoms. However, the quantity and seriousness of clinical cues, recent transfers from intensive care units, pain without a clear cause, signs of delirium and nurses' knowledge of patient were found to affect nurses' agreement. CONCLUSIONS Nurses exchanged more information regarding known indicators of deterioration in handoffs when they judged that patients were at risk. Disagreements most often involved incoming nurses rating patient risk as higher. RELEVANCE TO CLINICAL PRACTICE This study suggests a need to sensitise nurses to the impact of certain cues at report on their colleagues' subsequent clinical judgments. Low levels of agreement between nurses underscore the importance of exchanging impressions regarding the likely evolution of a patient's situation to promote continuity of care.
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Affiliation(s)
- Patrick Lavoie
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Montreal Heart Institute Research Center, Montreal, QC, Canada
| | - Sean P Clarke
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Christina Clausen
- Center for Nursing Research, Jewish General Hospital, Montreal, QC, Canada.,Ingram School of Nursing, McGill University, Montreal, QC, Canada.,Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Margaret Purden
- Center for Nursing Research, Jewish General Hospital, Montreal, QC, Canada.,Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Jessica Emed
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Lidia Cosencova
- Center for Nursing Research, Jewish General Hospital, Montreal, QC, Canada
| | - Valerie Frunchak
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
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Tonkikh O, Zisberg A, Shadmi E. Association between continuity of nursing care and older adults' hospitalization outcomes: A retrospective observational study. J Nurs Manag 2020; 28:1062-1069. [PMID: 32285500 DOI: 10.1111/jonm.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
AIM To assess the relationship between continuity in nursing assignment in older adults' acute hospitalization and patient experience and functional decline. BACKGROUND In-hospital functional decline affects up to 40% of hospitalized older adults. Nurses are responsible for performing functioning-preserving interventions. Whether continuity of nursing care contributes to patients' functional outcomes is unclear. METHOD A retrospective observational study of 609 patients aged ≥70 admitted to internal medicine units. Patients were surveyed on their functional (cognitive and physical) status and satisfaction with the hospital care experience. Dispersion and sequence of nursing assignment were measured by the Continuity of Care Index and Sequential Continuity Index. Multivariate logistic regressions were modelled for each continuity score and outcome. RESULTS Achieving 25% of the maximum Continuity of Care Index was associated with lower odds of cognitive decline (OR = 0.64, 95% CI = 0.43-0.94) and higher odds of satisfaction (OR = 1.52, 95% CI = 1.06-2.17). Achieving 25% of the maximum Sequential Continuity Index was associated only with higher odds of satisfaction (OR = 1.43, 95% CI = 1.01-2.02). Continuity scores were not associated with physical functioning decline. CONCLUSION Continuity in nursing assignment is related to a positive patient experience and cognitive functioning of hospitalized older adults. IMPLICATIONS FOR NURSING MANAGEMENT Continuity should be prioritized in scheduling and assignment algorithms.
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Affiliation(s)
- Orly Tonkikh
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
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Vandermorris A, Sampson L, Korenblum C. Promoting adherence in adolescents and young adults with cancer to optimize outcomes: A developmentally oriented narrative review. Pediatr Blood Cancer 2020; 67:e28128. [PMID: 31886630 DOI: 10.1002/pbc.28128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/10/2019] [Accepted: 11/25/2019] [Indexed: 01/03/2023]
Abstract
Adherence is a critical consideration in ongoing efforts to improve outcomes among adolescents and young adults (AYAs) with cancer. In this narrative review, we embed existing conceptualizations of adherence within a developmental context to provide a novel vantage point from which to examine this important issue. Applying this developmentally oriented framework, we summarize the most current literature on strategies to enhance adherence in the AYA population. A developmentally informed approach to working with AYAs can elucidate unique strengths and vulnerabilities of this population and offer a new perspective on opportunities to respond to biopsychosocial barriers to adherence in a strengths-based, collaborative manner.
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Affiliation(s)
- Ashley Vandermorris
- Division of Adolescent Medicine, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
| | - Lorna Sampson
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Chana Korenblum
- Princess Margaret Cancer Centre, University Health Network, Division of Adolescent Medicine, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
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Albanesi B, Marchetti A, D'Angelo D, Capuzzo MT, Mastroianni C, Artico M, Lusignani M, Piredda M, De Marinis MG. Exploring Nurses’ Involvement in Artificial Nutrition and Hydration at the End of Life: A Scoping Review. JPEN J Parenter Enteral Nutr 2020; 44:1220-1233. [DOI: 10.1002/jpen.1772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/10/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Beatrice Albanesi
- Department of Biomedicine and Prevention University of Rome “Tor Vergata Rome Italy
| | - Anna Marchetti
- Department of Biomedicine and Prevention University of Rome “Tor Vergata Rome Italy
| | - Daniela D'Angelo
- CNEC Center for Clinical Excellence and Quality of Care Istituto Superiore di Sanità Rome Italy
| | | | | | - Marco Artico
- Palliative Care and Pain Therapy Unit Azienda ULSS 4 Veneto Orientale San Donà di Piave Italy
| | - Maura Lusignani
- Biomedical Sciences for Health University of Milan Milan Italy
| | - Michela Piredda
- Research Unit Nursing Science Campus Bio‐Medico di Roma University Rome Italy
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Hernández Zambrano SM, Carrillo Algarra AJ, Estupiñan Avellaneda YJ, González Rodríguez ÁC, Martínez Herrera E, Enciso Olivera CO, Gómez Duque M. Privilegiar la dignidad durante la muerte en unidades de cuidados intensivos. Perspectivas del personal de salud. REPERTORIO DE MEDICINA Y CIRUGÍA 2020. [DOI: 10.31260/repertmedcir.01217273.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Los pacientes que ingresan a las Unidades de Cuidados Intensivos (UCI) no siempre evolucionan hacia la recuperación, lo que implica que el personal de la UCI tenga una visión holística para favorecer una “buena muerte” centrada en el acompañamiento familiar y la mitigación del sufrimiento. Objetivo: comprender el sentido otorgado por los profesionales de la salud de la UCI respecto a los cuidados del paciente al final de la vida y el apoyo a sus familiares. Metodología: estudio cualitativo descriptivo en dos UCI de Bogotá. La información se obtuvo con la técnica de grupos focales y se analizó siguiendo la propuesta de Taylor y Bogdan, adaptada por Amezcua y Hueso. Resultados: emergieron cuatro categorías: sentidos y significados del equipo interdisciplinario respecto a la muerte, comunicación al final de vida en la UCI, percepciones sobre muerte digna en la UCI y dilemas éticos respecto al manejo terapéutico al final de vida. Conclusiones: Para la atención del paciente crítico al final de la vida se debe garantizar comodidad, ausencia de dolor, acompañamiento familiar, bienestar espiritual, respeto por la voluntad del paciente y una buena comunicación que facilite la inclusión de los familiares en la toma de decisiones. Para mitigar la sobrecarga y el sufrimiento del personal de salud generado por la muerte y la toma de decisiones al final de vida, se sugiere formación y diseño de protocolos multidisciplinarios.
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Delaney KR. Child psychiatric nursing: Shaping a future vision of our work with children. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:5-6. [DOI: 10.1111/jcap.12264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kathleen R. Delaney
- Department of Community Systems and Mental Health NursingRush College of Nursing Chicago Illinois
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Avery J, Schreier A, Swanson M. A complex population: Nurse's professional preparedness to care for medical-surgical patients with mental illness. Appl Nurs Res 2020; 52:151232. [PMID: 31937475 DOI: 10.1016/j.apnr.2020.151232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
Globally, patients with the co-morbidity of physical and mental illness experience greater health complexities than the general population. Yet nurses caring for medical-surgical patients with a secondary diagnosis of mental illness are often unprepared for these complexities. This paper focuses on professional experiences from a more extensive parent study that evaluated components of nursing preparedness (nursing care self-efficacy and mental health care competency) to provide care for medical-surgical patients who also have mental illness. The parent study explored characteristics of variables (personal, educational and professional) more frequently associated with and more predictive of nursing preparedness. Discussed will be the findings from characteristics of professional experiences that best indicated nurse preparedness to care for medical-surgical patients with mental illness. A descriptive correlational design was used with a convenience sample of RNs (N = 260) from a tertiary health system in the south-eastern United States. Findings significantly indicated three characteristics of professional experiences - mentoring, frequency of care and continuing education - best prepare a registered nurse to care for this complex population. Further research is necessary to locate, grow and develop mentors and to construct accessible, affordable continuing education regarding care of this population for a prepared nursing workforce and work environment.
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Affiliation(s)
- Jeanette Avery
- East Carolina University College of Nursing, Greenville, NC 27858, USA.
| | - Ann Schreier
- East Carolina University College of Nursing, Greenville, NC 27858, USA
| | - Melvin Swanson
- East Carolina University College of Nursing, Greenville, NC 27858, USA
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Bennett E, Stutzman SE, Hicks AD, Olson DM. Exploring Provider Cultural Competence and Patient Mood in an Outpatient Apheresis Unit. J Transcult Nurs 2020; 31:22-27. [PMID: 30924719 DOI: 10.1177/1043659619838026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Health care and culture are important to patient care. Theoretical frameworks, service delivery, and self-awareness are important to the provider/patient. Provider care varies, and studies are needed to understand the current interactions between providers, patients, and culture. Methodology: This was a prospective, descriptive correlational pilot study. Providers and patients completed a baseline assessment of culture, as well as a Brief Mood Introspection Scale at each visit at the patient's standard of care visit (i.e., visit as part of clinical procedures). Results: The providers and baseline assessment of culture showed higher than average cultural awareness. All four mood subscales show no statistically significant differences in patient or providers' mood. There were no significant differences in mood when considering differences and similarities between gender, race, and ethnicity. Discussion: There was no difference in patient or provider mood in this study when based on the differences or similarities in gender, race, and ethnicity.
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Affiliation(s)
- Emelita Bennett
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sonja E Stutzman
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amber D Hicks
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - DaiWai M Olson
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Radwin LE, Cabral H, Bokhour BG, Seibert MN, Stolzmann K, Annis A, Mohr DC. A scale to measure nurses' and providers' patient centered care in primary care settings. PATIENT EDUCATION AND COUNSELING 2019; 102:2302-2309. [PMID: 31351786 DOI: 10.1016/j.pec.2019.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/26/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES 1) Refine pilot scale measuring patients' experiences of outpatient nurses' and providers' care; 2) Determine variance explained by (a) pilot scale items and (b) "Survey of Health Experiences of Patients" (SHEP)/"Consumer Assessment of Health Care Providers and Systems" (CAHPS) scale items. METHODS Randomly selected Veteran patients with recent visits with primary care outpatient nurses and providers (n = 1192) completed scales: pilot "PCC in Primary Care: Nurses and Providers Scale" and SHEP/CAHPS scale items. Factor analyses conducted using structural equation modeling (SEM), variance measurement using regression strategies. RESULTS SEM generated scale comprised 17 items in 3 factors; 2 operationalized nurses' care; 1 providers' care. Fit statistics were acceptable. Variance explained for total PCC: nurses = 42%, providers = 56%. Combined pilot and SHEP/CAHPS item analyses yielded similarly structured scale. 70% of provider care variance explained by single item. CONCLUSION Appraisal of team, value-based care requires accrediting care to the appropriate clinician. The "PCC in Primary Care: Nurses and Providers Scale (PC2:NaPS)" provides a psychometrically sound measure for this purpose. PRACTICE IMPLICATIONS PC2:NaPS use would improve primary care leaders' and clinicians' analyses of patient centered care and associated outcomes in their settings, and thus enhance success of quality improvement and organizational projects.
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Affiliation(s)
- Laurel E Radwin
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Howard Cabral
- Boston University School of Public Health, Boston, MA, USA.
| | - Barbara G Bokhour
- Boston University School of Public Health, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, Bedford, MA, USA.
| | - Marjory Nealon Seibert
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Kelly Stolzmann
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Ann Annis
- Michigan State University, East Lansing, MI, USA.
| | - David C Mohr
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA.
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Johansson B, Mårtensson LB. Ways of strategies to knowing the patient described by nursing students. Nurse Educ Pract 2019; 38:120-125. [PMID: 31260879 DOI: 10.1016/j.nepr.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/14/2019] [Accepted: 06/03/2019] [Indexed: 11/24/2022]
Abstract
Knowing the patient has been identified in research as important in nursing practice. It's a central phenomenon used by nurses in decision-making to provide good and safe qualitative individualized care. The aim of this study was to describe what strategies nursing students' use to 'know the patient'. Interviews with ten nursing students were analysed using a qualitative content analysis. Four themes emerge: Prepare oneself before the first meeting; Creating relationship; Dare to be open and near; Doing the best for the patient, with a main theme: To engage with and care for the unique person. The results show that the nursing students prepare themselves by reading journals, asking staff members for information and research current diseases and medications before the first meeting with the patient. They also think through how to behave and to be present in the encounter and to create a good relationship with the patient which can only be done by spending time together. They are open-minded while listening to the patient to get to know the unique person behind the façade of the patient. This study indicates that knowing the patient is important to nursing students, or else they cannot provide good quality of care for the patients nor be satisfied in their work as nurses. The students also emphasize that if they are not able to get to know the patient, it's better for someone else to take over the responsibility of care for the patient.
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Affiliation(s)
| | - Lena B Mårtensson
- School of Health Sciences, University of Skövde, Box 408, SE-541 28, Skövde, Sweden.
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Orique SB, Despins L, Wakefield BJ, Erdelez S, Vogelsmeier A. Perception of clinical deterioration cues among medical-surgical nurses. J Adv Nurs 2019; 75:2627-2637. [PMID: 31012138 DOI: 10.1111/jan.14038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/12/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Abstract
AIM To examine medical-surgical nurses' capacity and tendency to perceive cues indicating clinical deterioration and nursing characteristics influencing deterioration cue perception. DESIGN Cross-sectional, explorative study design. METHODS Data were collected over 10 weeks between September-November 2017. Medical-surgical nurses completed an online survey consisting of a demographic questionnaire, the Occupational Fatigue, Exhaustion Recovery scale and 50 detection trials. Descriptive statistics and statistical tests were used to describe and interpret data. FINDINGS A significant association was found between nurses' capacity and tendency to perceive deterioration cues. As nurses' capacity to perceive deterioration cues increased, nurses were more likely to classify patient cues as indicators of deterioration. Fatigue, education, and certification were not identified as characteristics associated with deterioration cue perception. However, experience was observed to significantly influence nurses' capacity to perceive deterioration cues based on levels of skills acquisition. CONCLUSION Study findings imply that future research should be directed at determining whether other individual factors and organizational system dynamics influence deterioration cue perception. IMPACT To better understand how nurses perceive deterioration cues, this study integrated concepts from the Situation Awareness model and Signal Detection Theory. Novice, advanced beginner and competent nurses were found to have a lower capacity to perceive deterioration cues compared with proficient and expert nurses. With simulation increasingly being used as a primary teaching modality in nursing, the development of a simulation-based signal detection training intervention may be beneficial in enhancing deterioration cue perception.
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Affiliation(s)
- Sabrina B Orique
- Advanced Nursing Practice Department, Kaweah Delta Health Care District, Visalia, California
| | - Laurel Despins
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | | | - Sanda Erdelez
- School of Library and Information Science, Simmons College, Boston, Massachusetts
| | - Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
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Cheruiyot JC, Brysiewicz P. Nurses’ perceptions of caring and uncaring nursing encounters in inpatient rehabilitation settings in South Africa: A qualitative descriptive study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Bahr SJ, Weiss ME. Clarifying model for continuity of care: A concept analysis. Int J Nurs Pract 2018; 25:e12704. [DOI: 10.1111/ijn.12704] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah J. Bahr
- College of NursingMarquette University Milwaukee Wisconsin USA
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24
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Kelly M, Ellaway RH, Reid H, Ganshorn H, Yardley S, Bennett D, Dornan T. Considering axiological integrity: a methodological analysis of qualitative evidence syntheses, and its implications for health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:833-851. [PMID: 29761255 DOI: 10.1007/s10459-018-9829-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
Qualitative evidence synthesis (QES) is a suite of methodologies that combine qualitative techniques with the synthesis of qualitative knowledge. They are particularly suited to medical education as these approaches pool findings from original qualitative studies, whilst paying attention to context and theoretical development. Although increasingly sophisticated use is being made of qualitative primary research methodologies in health professions education (HPE) the use of secondary qualitative reviews in HPE remains underdeveloped. This study examined QES methods applied to clinical humanism in healthcare as a way of advancing thinking around the use of QES in HPE in general. A systematic search strategy identified 49 reviews that fulfilled the inclusion criteria. Meta-study was used to develop an analytic summary of methodological characteristics, the role of theory, and the synthetic processes used in QES reviews. Fifteen reviews used a defined methodology, and 17 clearly explained the processes that led from data extraction to synthesis. Eight reviews adopted a specific theoretical perspective. Authors rarely described their reflexive relationship with their data. Epistemological positions tended to be implied rather than explicit. Twenty-five reviews included some form of quality appraisal, although it was often unclear how authors acted on its results. Reviewers under-reported qualitative approaches in their review methodologies, and tended to focus on elements such as systematicity and checklist quality appraisal that were more germane to quantitative evidence synthesis. A core concern was that the axiological (value) dimensions of the source materials were rarely considered let alone accommodated in the synthesis techniques used. QES can be used in HPE research but only with careful attention to maintaining axiological integrity.
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Affiliation(s)
- Martina Kelly
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada.
| | - Rachel H Ellaway
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
| | - Helen Reid
- Queen's University, Belfast, Northern Ireland, UK
| | - Heather Ganshorn
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
- Engineering and Science, University of Calgary, Calgary, Canada
| | - Sarah Yardley
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Tim Dornan
- Queen's University, Belfast, Northern Ireland, UK
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Abstract
Providing nursing care for an individual who is terminally ill is a complex endeavor. Understanding the different ways nurses who work in hospice agencies use knowing about and caring for persons receiving services becomes important because the actions of nurses are influenced by the nurses' perceptions. Hearing the narrative of nurses providing end-of-life care through phenomenological research can inform nursing education and institutions' methods to support the development of skills and characteristics to improve palliative and end-of-life nursing care. The purpose of this research was to question nurses who work in hospice agencies concerning their lived experiences related to knowing about and caring for individuals who were receiving hospice services. Four themes were identified related to the concepts of knowing and caring. These are difficult-to-measure concepts but add value to the profession and document how nurses contribute to patient care. In addition, the concepts are meaningful to patients and families receiving hospice services. The research provided a method of making the work of these nurses visible and gave more knowledge about nurses who provide end-of-life care.
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Debout C. [Advanced practice nurse in France: first outline]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2018; 63:59-65. [PMID: 29680143 DOI: 10.1016/j.soin.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After several years of discussions and debate, regulations should soon be applied in France allowing for the deployment of advanced practice nurses as provided for by law no. 2016-41 of January 2016 relating to the modernisation of the French health system. The profile of this new category of nurse, whose scope of practice will be extended, will combine clinical practice carried out with patients with stabilised chronic diseases and activities aimed at promoting the continuing development of the nursing teams' skills and at supporting change processes.
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Affiliation(s)
- Christophe Debout
- c/o Soins, Elsevier Masson SAS, 65, rue Camille-Desmoulins, 92442 Issy-les-Moulineaux, France.
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Abstract
There is wide agreement that nursing practice is a combination of art and science. While the science is easily found in nursing education, research, and practice, the art is overshadowed. Philosophical and theoretical discussions on the art of nursing are plentiful, but research demonstrating its importance to nursing practice is lacking. In this article, the nature of nursing is explored separate from science, and a comprehensive exploration of the literature on the art of nursing is presented. Three themes concerning the art of nursing are identified and discussed, including implications for research, practice, and education.
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Affiliation(s)
- Deborah Henry
- 1 Nursing Instructor, Blue Ridge Community College, Hendersonville, NC, USA
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Collins SA, Rozenblum R, Leung WY, Morrison CR, Stade DL, McNally K, Bourie PQ, Massaro A, Bokser S, Dwyer C, Greysen RS, Agarwal P, Thornton K, Dalal AK. Acute care patient portals: a qualitative study of stakeholder perspectives on current practices. J Am Med Inform Assoc 2018; 24:e9-e17. [PMID: 27357830 DOI: 10.1093/jamia/ocw081] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/22/2016] [Indexed: 01/24/2023] Open
Abstract
Objective To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. Materials and Methods Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. Results Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. Discussion Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. Conclusion Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a "road map" for future work related to acute care patient portals.
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Affiliation(s)
- Sarah A Collins
- Partners Healthcare System, Wellesley, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ronen Rozenblum
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Anthony Massaro
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Cindy Dwyer
- Johns Hopkins Medical Center, Baltimore, Maryland
| | | | | | | | - Anuj K Dalal
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Critical care nurses’ experiences of withdrawal of treatment: A systematic review of qualitative evidence. Int J Nurs Stud 2018; 77:15-26. [DOI: 10.1016/j.ijnurstu.2017.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE Oral medicines are frequently modified (eg, tablets crushed) for older adults. However, these modifications can have clinical, legal and/or ethical implications. Nurses bear responsibility for medicine administration and hence, perform these modifications. The aim of this study was to investigate the knowledge, attitudes and beliefs of nurses about oral medicine modification for older adults. DESIGN A qualitative study was conducted using semi-structured, face-to-face interviews with nurses providing care to older adults in acute and long-term care settings. Interviews were audio-recorded, transcribed verbatim and analysed thematically. SETTINGS Sixteen purposively selected care settings; 4 acute-care and 12 long-term care settings were included. Nurses were recruited by convenience sampling at these sites. PARTICIPANTS Eighteen nurses participated (83% female, 67% long-term care, 33% acute-care, median age (IQR) 38 years (32.5-52.0)). RESULTS Three major themes: modifying-a necessary evil, nurses' role as patient advocate and modifying-we are working very much as a team and two minor themes: fractional dosing, and covert administration emerged from the data. Nurses viewed oral medicine modifications as being a routine and necessary occurrence in geriatric patient care due to limitations of available formulations and the presence of age-related challenges in drug administration. Nurses' knowledge of residents' requirements ensured that they advocate for those with individualised formulation needs, however, nurses rely on pharmacists for information about modifications. Nurses expressed a desire for supports including increased education and ward-specific, pharmacist-developed recommendations on common modifications. CONCLUSIONS This study has provided useful insights into the views of nurses regarding oral medicine modification for older adults. The unique and varied formulation requirements of older adults must be acknowledged. Increased engagement by healthcare professionals, the pharmaceutical industry, regulatory agencies and policy-makers is required to facilitate the development of age-appropriate formulations. In the interim, practical interventions, informed by the findings of this study, are required.
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Affiliation(s)
- Aoife Mc Gillicuddy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork National University of Ireland, Cork, Republic of Ireland
| | - Abina M Crean
- Synthesis and Solid State Pharmaceutical Centre, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Maria Kelly
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork National University of Ireland, Cork, Republic of Ireland
| | - Laura Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork National University of Ireland, Cork, Republic of Ireland
- Pharmacy Department, Mercy University Hospital, Cork, Republic of Ireland
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LeBlanc A, Bourbonnais FF, Harrison D, Tousignant K. The experience of intensive care nurses caring for patients with delirium: A phenomenological study. Intensive Crit Care Nurs 2017; 44:92-98. [PMID: 28993046 DOI: 10.1016/j.iccn.2017.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this research was to seek to understand the lived experience of intensive care nurses caring for patients with delirium. The objectives of this inquiry were: 1) To examine intensive care nurses' experiences of caring for adult patients with delirium; 2) To identify factors that facilitate or hinder intensive care nurses caring for these patients. RESEARCH METHODOLOGY This study utilised an interpretive phenomenological approach as described by van Manen. SETTING Individual conversational interviews were conducted with eight intensive care nurses working in a tertiary level, university-affiliated hospital in Canada. FINDINGS The essence of the experience of nurses caring for patients with delirium in intensive care was revealed to be finding a way to help them come through it. Six main themes emerged: It's Exhausting; Making a Picture of the Patient's Mental Status; Keeping Patients Safe: It's aReally Big Job; Everyone Is Unique; Riding It Out With Families and Taking Every Experience With You. CONCLUSION The findings contribute to an understanding of how intensive care nurses help patients and their families through this complex and distressing experience.
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Affiliation(s)
- Allana LeBlanc
- University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada.
| | | | - Denise Harrison
- University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada
| | - Kelly Tousignant
- University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada
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Kahn JM, Athale UH, Clavell LA, Cole PD, Leclerc JM, Laverdiere C, Michon B, Schorin MA, Welch JJG, Sallan SE, Silverman LB, Kelly KM. How Variable Is Our Delivery of Information? Approaches to Patient Education About Oral Chemotherapy in the Pediatric Oncology Clinic. J Pediatr Health Care 2017; 31:e1-e6. [PMID: 27461368 PMCID: PMC5154954 DOI: 10.1016/j.pedhc.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/29/2022]
Abstract
In pediatric patients with acute lymphoblastic leukemia, adherence to oral chemotherapy relies largely on a parent's comprehension of the drug's indication and administration guidelines. We assessed how pediatric oncology providers educate families about oral chemotherapy. We conducted a cross-sectional survey of 68 physicians and nurses from 9 institutions in the Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium. The inter-individual approach to patient education is variable and may consist of handouts, treatment calendars, and discussions. The extent of teaching often varies depending on a provider's subjective assessment of a family's needs. Twenty-five percent of providers suggested standardizing patient teaching. When developing educational models, care teams should consider approaches that (a) objectively identify families in need of extensive teaching, (b) designate allotted teaching time by nursing staff during clinic visits, and (c) maintain the variation and dynamism that informs a successful provider-patient relationship.
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Faculty Descriptions of Simulation Debriefing in Traditional Baccalaureate Nursing Programs. Nurs Educ Perspect 2016; 37:262-268. [PMID: 27740557 DOI: 10.1097/01.nep.0000000000000065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM A study was conducted to describe simulation debriefing practices of faculty in accredited, traditional, baccalaureate nursing programs in the United States. BACKGROUND Best debriefing practices include debriefing by a competent facilitator in a safe environment using a structured framework. Yet, structured frameworks and evaluation of debriefing are lacking in nursing education. METHOD This article reports the interview findings from the qualitative component of a large-scale mixed-methods study. RESULTS Twenty-three full-time faculty members with an average of 6 years of simulation debriefing experience participated in interviews. Three themes emerged with subthemes: a) having the student's best interest at heart, b) getting over the emotional hurdle, and c) intentional debriefing evolves into learning. Gaps were found in faculty development, use of a structured framework, and evaluation. CONCLUSION Research is warranted on use of video, postdebriefing assignments, cofacilitation, and debriefing effectiveness.
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Kvande M, Delmar C, Lykkeslet E, Storli SL. Assessing changes in a patient's condition - perspectives of intensive care nurses. Nurs Crit Care 2016; 22:99-104. [PMID: 27651301 DOI: 10.1111/nicc.12258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/13/2016] [Accepted: 08/09/2016] [Indexed: 12/28/2022]
Abstract
AIM To explore the phenomenon of assessing changes in patients' conditions in intensive care units from the perspectives of experienced intensive care nurses. BACKGROUND Providing safe care for patients in intensive care units requires an awareness and perception of the signs that indicate changes in a patient's condition. Nurses in intensive care units play an essential role in preventing the deterioration of a patient's condition and in improving patient outcomes. DESIGN AND METHODS This hermeneutic phenomenological study conducted close observations and in-depth interviews with 11 intensive care nurses. The nurses' experience ranged from 7 to 28 years in the intensive care unit. Data were collected at two intensive care units in two Norwegian university hospitals. The analysis was performed using the reflective methods of van Manen. FINDINGS An overarching theme of 'sensitive situational attention' was identified, in which the nurses were sensitive in relation to a patient and understood the significance of a given situation. This theme was further unfolded in four subthemes: (1) being sensitive and emotionally present, (2) being systematic and concentrating, (3) being physically close to the bedside and (4) being trained and familiar with the routines. CONCLUSIONS Nurses understand each patient's situation and foresee clinical eventualities through a sensitive and attentive way of thinking and working. This requires nurses to be present at the bedside with both their senses (sight, hearing, smell and touch) and emotions and to work in a concentrated and systematic manner. Knowledge about the unique patient exists in interplay with past experiences and medical knowledge, which are essential for nurses to understand the situation. RELEVANCE TO CLINICAL PRACTICE Clinical practice should develop routines that enable nurses to be present at the bedside and to work in a concentrated and systematic manner. Furthermore, providing safe care requires nurses to be sensitive and attentive to each patient's unique situation.
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Affiliation(s)
- Monica Kvande
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Charlotte Delmar
- Section for Nursing, Department of Public Health, Health Faculty Aarhus University, DK & Faculty of Health Science, Aalborg University, DK & University College Diakonova, Oslo, Norway
| | - Else Lykkeslet
- Faculty of Health and Social Care, Molde University College, Molde, Norway
| | - Sissel Lisa Storli
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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Dewar B, Kennedy C. Strategies for Enhancing “Person Knowledge” in an Older People Care Setting. West J Nurs Res 2016; 38:1469-1488. [DOI: 10.1177/0193945916641939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article presents findings from a study about compassionate care—the development of person knowledge in a medical ward caring for older people. Appreciative inquiry, an approach to research that focuses on discovering what works well and implementing strategies to help these aspects happen most of the time, was used. Staff, patients, and families participated in this study, which used a range of methods to generate data including interviews and observations. Immersion/crystallization was used to analyze these data using a reflexive and continuous approach to extracting and validating data. Findings uncovered that knowledge of the person and ways of promoting this were key dimensions of compassionate caring. The attributes of “caring conversations” emerged through the analysis process, which we suggest are crucial to developing person knowledge. The political and public focus on compassionate care makes it opportune to raise discussion around this form of knowledge in academic and practice debates.
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Voltelen B, Konradsen H, Østergaard B. Family Nursing Therapeutic Conversations in Heart Failure Outpatient Clinics in Denmark: Nurses' Experiences. JOURNAL OF FAMILY NURSING 2016; 22:172-98. [PMID: 27165753 DOI: 10.1177/1074840716643879] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
As part of the Heart Failure Family Trial presently being conducted in Denmark, this qualitative process evaluation explored the perceptions of seven practicing cardiac nurses who offered family nursing therapeutic conversations (FNTC) to families in three heart failure outpatient clinics. FNTC were guided by the Calgary Family Assessment and Intervention Models. Data consisted of 34 case reports written by the nurses which documented the use of FNTC, including family responses to the FNTC. A focus group interview with the six of the nurses about their experience of offering FNTC was also conducted. Content analysis was performed using a combined deductive and inductive process. Nurses reported developing a distinct, closer, and more constructive relationship with the patients and their families and reported FNTC increased family bonding and strengthened family relationships. The nurses considered FNTC to be feasible interventions in the routine care provided in heart failure outpatient clinics.
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Affiliation(s)
- Barbara Voltelen
- University of Southern Denmark, Odense, Denmark University College Lillebaelt, Vejle, Denmark
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Costello M. Nurses' Self-Identified Characteristics and Behaviors Contributing to Patients' Positive Perceptions of Their Nursing Care. J Holist Nurs 2016; 35:62-66. [PMID: 27093903 DOI: 10.1177/0898010116643835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study was designed to uncover the characteristics and behaviors of nurses identified by patients as providing exceptional nursing care. "Being present" and "Knowing the patient" were the major themes that captured the nurses' experience. Four subthemes were identified: looking for commonalities, sharing personal experiences, use of humor, and caring for the spiritual needs of patients.
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Spruill CT, Heaton A. The Challenge of Continuity of Care: Evolution of a Nursing Care Model in NICU. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.nainr.2015.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ramvi E. I am only a nurse: a biographical narrative study of a nurse's self-understanding and its implication for practice. BMC Nurs 2015; 14:23. [PMID: 25931986 PMCID: PMC4415295 DOI: 10.1186/s12912-015-0073-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 04/23/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The personal is a vital part of professional nursing practice. From a psycho-social perspective, nurses produce and reproduce conceptions of the Self through experience. A literature search on nurses' self-understanding in a psycho-social perspective yields no results. Hence, the aim of this study was to investigate personal and professional experiences that may have formed the self-understanding of a nurse, and how this self-understanding may have influenced her professional practice. METHODS Using a single case approach, I conducted a Biographical Narrative Interview with a 50-year-old experienced Norwegian nurse. I asked the nurse to tell me the story of her life and how her work has affected her and possibly changed the way she saw herself. The overall aim of the interpretation was to understand the historically situated subjectivity in terms of the nurse's personal, social and professional constraints and chosen options. RESULTS The nurse's narrative of her life story made it possible to trace a common theme throughout her experiences, the experience of being "only a nurse". The nurse experienced a low status, as well as a downgrade in the competence needed to deliver quality care in professional relationships. She felt it difficult to identify with the experience of being on the bottom of the social ladder and to identify with the female, mothering ideal connected to nursing. She desired a better position, and wanted to identify with strong women. In contrast to reality, her self-understanding influenced her relationship with her patients, her professional pride and her further professional development. CONCLUSIONS This study shows that the professional practice of a nurse was informed by her self-understanding. This study suggests that the individual nurse must be given the opportunity to explore her professional vulnerability based on the assumption that it is both personally and socially constituted. This study indicates that the exploration of a nurse's self-understanding is one way to contribute to professional development.
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Affiliation(s)
- Ellen Ramvi
- Department of Health Studies, The University of Stavanger, Faculty of Social Sciences, Stavanger, N-4036 Norway
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Knowing the patient: A qualitative study on care-taking and the clinical pharmacist-patient relationship. Res Social Adm Pharm 2015; 12:78-90. [PMID: 26004019 DOI: 10.1016/j.sapharm.2015.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/17/2015] [Accepted: 04/17/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous studies have found clinical pharmacists (CPs) and clinical pharmacy specialists (CPSs) in direct patient care have positive effects across various patient outcomes. However, there are also other kinds of care-taking occurring in pharmacy-run clinic appointments that produce value for patients. OBJECTIVE To identify and characterize how CPs/CPSs in direct care clinics develop and practice care-taking behaviors which advance the pharmacist-patient relationship. METHODS Semi-structured CP/CPS interviews were conducted once per year for two years (46 year 1, 50 year 2) along with direct observations of clinical pharmacy work as part of an anticoagulation improvement intervention. Participants were from Veterans Health Administration (VHA) medical centers and VHA community-based outpatient clinics in the Northeastern U.S. Interviews were transcribed verbatim and thematically analyzed using NVIVO 10 software. RESULTS It was found that CPs/CPSs practice "knowing the patient" in ways related to, but distinct from this practice in the nursing literature. For CPs/CPSs, knowing the patient occurred over time, and it produced familiarity and trust between CPs/CPs and patients. A reciprocal relationship developed in which patients came to rely on CP/CPSs for other types of assistance. Patterns of knowing the patient and being known by the patient manifested in three distinct ways: 1) identifying the patient's unmet needs, 2) explaining other medications, and 3) helping the patient navigate the system. CONCLUSION This research identifies an action, knowing the patient, whereby CPs use their knowledge of the patient to deliver individualized care. This study contributes to the developing literature on pharmacist-patient relationships and pharmacist-patient communication.
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Shimizu F, Suzuki M. Role development of nurses for technology-dependent children attending mainstream schools in Japan. J SPEC PEDIATR NURS 2015; 20:87-97. [PMID: 25623262 DOI: 10.1111/jspn.12105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the role development of nurses caring for medical technology-dependent children attending Japanese mainstream schools. DESIGN AND METHODS Semi-structured interviews with 21 nurses caring for technology-dependent children were conducted and analyzed using the modified grounded theory approach. RESULTS Nurses developed roles centered on maintaining technology-dependent children's physical health to support children's learning with each other, through building relationships, learning how to interact with children, understanding the children and the school community, and realizing the meaning of supporting technology-dependent children. PRACTICE IMPLICATIONS These findings support nurses to build relationships of mutual trust with teachers and children, and learn on the job in mainstream schools.
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Affiliation(s)
- Fumie Shimizu
- Department of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Theophilos T, Green R, Cashin A. Nurse Practitioner Mental Health Care in the Primary Context: A Californian Case Study. Healthcare (Basel) 2015; 3:162-71. [PMID: 27417754 PMCID: PMC4934530 DOI: 10.3390/healthcare3010162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/10/2015] [Indexed: 11/22/2022] Open
Abstract
In America, mental health needs surpass the availability of specialized providers. This vulnerable population also has other obstacles for comprehensive care including gaps in medical coverage, stigma, economic barriers, and a geographical mal-distribution of qualified mental health professionals. A wide availability of primary care providers, including primary care and family nurse practitioners, are well-positioned to deliver integrated mental and physical health care. A case study from a Southern California Coachella Valley primary care clinic with integrated services is used to demonstrate the much-needed approach of care to address health disparities that face low-income immigrants, migrant workers, and others without access to specialized care centers and providers. It is argued that mental health care should be part of all holistic treatment provided by primary care and family nurse practitioners. This has implications for curricula and practice development.
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Affiliation(s)
- Theane Theophilos
- School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia.
| | - Roger Green
- College of Health, Human Services, and Nursing, California State University Dominguez Hills, 1000 East Victoria Street, Carson, CA 90747, USA.
| | - Andrew Cashin
- School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia.
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Cho SH, Kim YS, Yeon KN, You SJ, Lee ID. Effects of increasing nurse staffing on missed nursing care. Int Nurs Rev 2015; 62:267-74. [PMID: 25762430 DOI: 10.1111/inr.12173] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inadequate nurse staffing has been reported to lead nurses to omit required nursing care. In South Korea, to reduce informal caregiving by patient families and sitters and to improve the quality of nursing care, a public hospital operated by the Seoul Metropolitan Government has implemented a policy of increasing nurse staffing from 17 patients per registered nurse to 7 patients per registered nurse in 4 out of 13 general nursing units since January 2013. AIM The study aims to compare missed nursing care (omission of required care) in high-staffing (7 patients per nurse) units vs. low-staffing (17 patients per nurse) units to examine the effects of nurse staffing on missed care. METHODS A nurse survey conducted in July 2013 targeted all staff nurses in all four high-staffing and all nine low-staffing units; 115 nurses in the high-staffing units (response rate = 94.3%) and 117 nurses in the low-staffing units (response rate = 88.6%) participated. Missed nursing care was measured using the MISSCARE survey that included 24 nursing care elements. Nurses were asked how frequently they had missed each element on a 4-point scale from 'rarely' to 'always'. RESULTS Overall, nurses working in high-staffing units had a significantly lower mean score of missed care than those in low-staffing units. Seven out of 24 nursing care elements were missed significantly less often in high-staffing (vs. low-staffing) units: turning, mouth care, bathing/skin care, patient assessments in each shift, assistance with toileting, feeding and setting up meals. CONCLUSION The findings suggest that increasing nurse staffing is associated with a decrease in missed care. Less omission of required nursing care is expected to improve nursing surveillance and patient outcomes, such as patient falls, pressure ulcers and pneumonia. IMPLICATIONS FOR NURSING AND HEALTH POLICY Adequate nurse staffing should be ensured to reduce unmet nursing needs and improve patient outcomes.
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Affiliation(s)
- S-H Cho
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Y-S Kim
- Public Health Policy Institute, Seoul Metropolitan Government, Seoul, South Korea
| | - K N Yeon
- Public Health Policy Institute, Seoul Metropolitan Government, Seoul, South Korea
| | - S-J You
- Department of Nursing, Mokpo National University, Mokpo, South Korea
| | - I D Lee
- Department of Nursing, Seoul Medical Center, Seoul, South Korea
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Laerkner E, Egerod I, Hansen HP. Nurses' experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit: a qualitative study. Intensive Crit Care Nurs 2015; 31:196-204. [PMID: 25743598 DOI: 10.1016/j.iccn.2015.01.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation. DESIGN AND SETTING The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where a protocol of no sedation is implemented. Data were generated during participant observation in practice and by interviews with 16 nurses. Data were analysed using thematic interpretive description. FINDINGS An overall theme emerged: "Demanding, yet rewarding". The demanding aspects of caring for more awake intubated patients included unpredictability, ambiguous needs and complex actions, while the rewarding aspects included personal interaction. Three sub-themes were identified: (i) caring for and with the patient, (ii) negotiating relational and instrumental care and (iii) managing physical and emotional closeness. CONCLUSION Despite the complexity of care, nurses preferred to care for more awake rather than sedated patients and appreciated caring for just one patient at a time. The importance of close collaboration between nurses and doctors to ensure patient comfort during mechanical ventilation was valued. Caring for more awake non-sedated patients required the nurses to act at the interface between ambiguous possibilities and needs, which was perceived as both demanding and rewarding.
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Affiliation(s)
- Eva Laerkner
- Faculty of Health, Department of Public Health, University of Southern Denmark, Denmark; Dept. of Anesthesiology and Intensive Care, Odense University Hospital, Denmark.
| | - Ingrid Egerod
- University of Copenhagen, Copenhagen University Hospital Rigshospitalet, Trauma Centre, Denmark
| | - Helle Ploug Hansen
- Faculty of Health, Department of Public Health, University of Southern Denmark, Denmark
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Rodgers C, Wills-Bagnato P, Sloane R, Hockenberry M. Health-Related Quality of Life among Children and Adolescents during Hematopoietic Stem Cell Transplant Recovery. J Pediatr Oncol Nurs 2015; 32:329-36. [PMID: 25592668 DOI: 10.1177/1043454214563413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Health-related quality of life (HRQoL) has been noted to fluctuate among children during hematopoietic stem cell transplant (HSCT) recovery; however, the specific timing and associations of these changes are poorly understood. This repeated-measures study aimed to describe HRQoL changes among children and adolescents during the first 6 months of HSCT recovery and estimate the associations of demographic factors, diagnosis, transplant information, and symptoms with HRQoL. Twenty-three children and adolescents who received an allogeneic HSCT were recruited from a pediatric teaching institution in the southern United States. Demographic, diagnosis, and transplant information was obtained from the medical record. The Memorial Symptom Assessment questionnaire and the Peds Quality of Life Cancer Module (PedsQL CM) were completed at 1 month post-HSCT and then once monthly for 5 additional months. Mean HRQoL scores fluctuated during the study with the lowest mean HRQoL noted at 1 month post-HSCT and the highest mean HRQoL noted at 4 months post-HSCT. No significant differences in HRQoL scores were noted among demographic, diagnosis, or transplant factors. Feeling tired, sad, or worried or having insomnia at 1 month post-HSCT was negatively correlated to HRQoL. Nurses have opportunities to explore important issues with patients and need to be aware of fluctuations with HRQoL and factors associated with lower HRQoL during HSCT recovery.
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Affiliation(s)
| | | | - Richard Sloane
- Duke University, Center for the Study of Aging and Human Development, Durham, NC, USA
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