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Smith CM, Horne CE, Wei H. Nursing practice in modern healthcare environments: A systematic review of attributes, characteristics, and demonstrations. J Adv Nurs 2024; 80:3481-3498. [PMID: 38308427 DOI: 10.1111/jan.16088] [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: 07/13/2023] [Revised: 01/04/2024] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
AIM To identify Attributes, Characteristics and Demonstrations of nursing practice from both nurses' and people perspectives in today's healthcare environments. A secondary aim was to identify relevant differences between female and male nurses in the context of ACDs. DESIGN This systematic review was informed by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews. METHODS The search included articles ranging from the years 2000 to 2023 across 10 electronic databases and multiple grey literature outlets. McMaster critical review forms and the Mixed Methods Appraisal Tool were used to appraise article quality. The Convergent Integrated Approach to Mixed Study Systematic Reviews was used to guide data synthesis. RESULTS Twenty articles were included in this review, 13 qualitative, five quantitative and two mixed-methods studies. Three themes emerged, including knowledge, practice skills and interpersonal relationships. Differences in Attributes, Characteristics and Demonstrations of professional practice between women and men in nursing were also explored. CONCLUSION Findings suggest that evolving healthcare environments challenge nurses to remain focused on patient-centred and compassionate care. The review also supports nurses caring in a manner that empowers people, increases well-being, and reduces suffering. IMPACT Identified characteristics and attributes of nursing practice, including emphasis on continuous learning, interpersonal relationships and compassion, have a profound impact on nursing. Nurses should remain adaptable, compassionate and patient-focused in an ever-evolving healthcare environment. These foundational care principles are necessary for improving patient outcomes, enhancing trust between people and healthcare providers, and increasing inclusivity and diversity in the nursing workforce. WIDER GLOBAL COMMUNITY Nurses worldwide should strive to embody these attributes to provide high-quality, patient-centred care in an inclusive environment in today's demanding healthcare environment. Gender-specific differences in the perception and expression of professional Attributes, Characteristics and Demonstrations can inform inclusion and diversity efforts in the workplace. REPORTING METHOD This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
| | - Carolyn E Horne
- UNC Charlotte College of Health and Human Services, School of Nursing, Charlotte, North Carolina, USA
| | - Holly Wei
- Texas Tech University Health Sciences Center, School of Nursing, Lubbock, Texas, USA
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Edmonds SW, Cullen L, DeBerg J. The Problem with the Pyramid for Grading Evidence: The Evidence Funnel Solution. J Perianesth Nurs 2024; 39:484-488. [PMID: 38823963 DOI: 10.1016/j.jopan.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/28/2023] [Indexed: 06/03/2024]
Affiliation(s)
- Stephanie W Edmonds
- Nurse Scientist, Nursing Administration, Abbott Northwestern Hospital, part of Allina Health, Minneapolis, MN
| | - Laura Cullen
- Evidence-Based Practice Scientist, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics.
| | - Jennifer DeBerg
- User Services Librarian, Hardin Library for Health Sciences, University of Iowa, Iowa City, IA
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Molendijk-van Nieuwenhuyzen K, Belt-van Opstal R, Hakvoort L, Dikken J. Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study. BMC Geriatr 2024; 24:476. [PMID: 38816688 PMCID: PMC11140891 DOI: 10.1186/s12877-024-05023-z] [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: 11/17/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization. METHODS This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed. RESULTS The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit. CONCLUSION Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.
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Affiliation(s)
| | | | | | - Jeroen Dikken
- De Haagse Hogeschool, Faculteit Gezondheid, Voeding & Sport, Johanna Westerdijkplein 75, 2521 EN, The Hague, The Netherlands
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Kanda K, Blythe S, Grace R, Elcombe E, Rodgers K, Kemp L. 'Everything's adaptable': A qualitative study of how nurses make decisions in sustained home-visiting care with mothers and children experiencing adversity. J Adv Nurs 2023; 79:4568-4579. [PMID: 37314007 DOI: 10.1111/jan.15736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
AIMS To explore nurse decision-making processes in the delivery of sustained home-visiting care for mothers of young children who are experiencing adversity. DESIGN Qualitative descriptive research design using focus group interviews. METHODS Thirty-two home-visiting nurses participated in four focus group interviews exploring their decision-making in the care they provide to families. The data were analysed using a reflexive thematic analysis approach. RESULTS Four steps of a recurring stepwise decision-making process were identified: (1) information gathering; (2) exploring; (3) implementing; (4) checking. The facilitators and barriers to effective decision-making processes were also identified and included elements relating to good relationship skills, a good attitude, high quality training and mentoring and resources. CONCLUSION The findings indicate that a recurring stepwise process of decision-making requires both analytical and intuitive approaches. The intuition required by home-visiting nurses is to sense unvoiced client needs and identify the right time and way to intervene. The nurses were engaged in adapting the care in response to the client's unique needs while ensuring the fidelity of the programme scope and standards. We recommend creating an enabling working environment with cross-disciplinary team members and having well-developed structures, particularly the feedback systems such as clinical supervision and case reviews. Enhanced skills to establish trusting relationships with clients can help home-visiting nurses make effective decisions with mothers and families, particularly in the face of significant risk. IMPACT This study explored nurse decision-making processes in the context of sustained home-visiting care, which has been largely unexplored in the research literature. Understanding the effective decision-making processes, particularly when nurses customize or individualize the care in response to the client's unique needs, assists with the development of strategies for precision home-visiting care. The identification of facilitators and barriers informs approaches designed to support nurses in effective decision-making.
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Affiliation(s)
- Kie Kanda
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Rebekah Grace
- Transforming early Education and Child Health, Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Emma Elcombe
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Kim Rodgers
- Acting Nurse Manager, Child and Family Health Nursing, Primary and Community Health, South Western Sydney Local Health District, NSW Health, Liverpool, New South Wales, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Litchfield I, Calvert MJ, Kinsella F, Sungum N, Aiyegbusi OL. "I just wanted to speak to someone- and there was no one…": using Burden of Treatment Theory to understand the impact of a novel ATMP on early recipients. Orphanet J Rare Dis 2023; 18:86. [PMID: 37069697 PMCID: PMC10111696 DOI: 10.1186/s13023-023-02680-y] [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: 06/22/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Advanced therapy medicinal products such as Chimeric antigen receptor T-cell therapy offer ground-breaking opportunities for the treatment of various cancers, inherited diseases, and chronic conditions. With development of these novel therapies continuing to increase it's important to learn from the experiences of patients who were among the first recipients of ATMPs. In this way we can improve the clinical and psychosocial support offered to early patient recipients in the future to support the successful completion of treatments and trials. STUDY DESIGN We conducted a qualitative investigation informed by the principles of the key informant technique to capture the experience of some of the first patients to experience CAR-T therapy in the UK. A directed content analysis was used to populate a theoretical framework informed by Burden of Treatment Theory to determine the lessons that can be learnt in supporting their care, support, and ongoing self-management. RESULTS A total of five key informants were interviewed. Their experiences were described within the three domains of the burden of treatment framework; (1) The health care tasks delegated to patients, Participants described the frequency of follow-up and the resources involved, the esoteric nature of the information provided by clinicians; (2) Exacerbating factors of the treatment, which notably included the lack of understanding of the clinical impacts of the treatment in the broader health service, and the lack of a peer network to support patient understanding; (3) Consequences of the treatment, in which they described the anxiety induced by the process surrounding their selection for treatment, and the feeling of loneliness and isolation at being amongst the very first recipients. CONCLUSIONS If ATMPs are to be successfully introduced at the rates forecast, then it is important that the burden placed on early recipients is minimised. We have discovered how they can feel emotionally isolated, clinically vulnerable, and structurally unsupported by a disparate and pressured health service. We recommend that where possible, structured peer support be put in place alongside signposting to additional information that includes the planned pattern of follow-up, and the management of discharged patients would ideally accommodate individual circumstances and preferences to minimize the burden of treatment.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Applied Research Collaboration (ARC) - West Midlands, Birmingham, UK
- Birmingham Health Partners (BHP) Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Francesca Kinsella
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nisha Sungum
- Midlands and Wales Advanced Therapy Treatment Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Applied Research Collaboration (ARC) - West Midlands, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Birmingham Health Partners (BHP) Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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Li H, Zhang W, Lu Q, Wang J, Zhi Y, Zhang L, Zhou L. Which Frequency of Ankle Pump Exercise Should Be Chosen for the Prophylaxis of Deep Vein Thrombosis? INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221105989. [PMID: 35658650 PMCID: PMC9168852 DOI: 10.1177/00469580221105989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Ankle pump exercise (APE) is an effective method to prevent deep vein
thrombosis (DVT) in the lower extremities. However, traditional APE at a
frequency of 3 times/min applied in the clinic lacked high compliance, and
individuals were found to prefer an APE of 30 times/min. This study aimed to
compare the effects of APEs with the above two different frequencies on the
venous hemodynamics and fatigue of lower extremities. Methods The study applied a randomized cross-over design, and 307 healthy adults were
randomly assigned into two groups, whose left feet performed 5 minutes of
traditional APE (3 times/min, after 10 minutes of rest) and 5 minutes of
selected APE (30 times/min, after 10 minutes of rest) in different orders.
The diameters and blood flow velocities of the external iliac vein, femoral
vein, and popliteal vein of the left extremities were recorded with the
color doppler ultrasound when participants were at rest and after 5 minutes
of traditional or selected APE. The fatigue of lower extremities was
assessed with the Rating of Perceived Exertion (RPE) after the participants
performed 5 minutes of different APEs. Results After both traditional APE and selected APE, the diameters and blood flow
(peak systolic) velocities of the external iliac vein, femoral vein, and
popliteal vein increased significantly in the participants (P<.01), and
the effects of the two APEs on venous hemodynamics of the lower extremities
had no significant difference (P>.05). However, participants reported
that traditional APE caused higher fatigue, and 252 (82.1%) participants
preferred APE at 30 times/min. Conclusion Both traditional and selected APE could increase venous blood flow in the
lower extremity. Despite the equivalent effects, the selected APE of 30
times/min may cause less fatigue than the traditional one of 3
times/min.
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Affiliation(s)
- Haiyan Li
- Department of Vascular Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Wei Zhang
- Department of Clinical Nursing, Nursing School, Naval Medical University, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Jinping Wang
- Department of Vascular Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Yanru Zhi
- Department of Vascular Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Lingjuan Zhang
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Lanshu Zhou
- Department of Clinical Nursing, Nursing School, Naval Medical University, Shanghai, China
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