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MacKay LJ, Chang U, Kreiter E, Nickel E, Kamke J, Bahia R, Shantz S, Meyerhoff H. Exploration of trust between pediatric nurses and children with a medical diagnosis and their caregivers on inpatient care units: A scoping review. J Pediatr Nurs 2024:S0882-5963(24)00212-4. [PMID: 39085007 DOI: 10.1016/j.pedn.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/26/2024] [Accepted: 05/26/2024] [Indexed: 08/02/2024]
Abstract
PROBLEM Trust is central to the development of nurse-patient relationships. Pediatric nurses encounter difficulties developing trust with children and their caregivers. The purpose of this scoping review was to identify, examine, and summarize available evidence on the concept of trust among nurses and children/caregivers when admitted to hospital inpatient care units. ELIGIBILITY CRITERIA Using the Joanna Briggs Institute (JBI) methodology for conducing and reporting scoping reviews, CINAHL, MEDLINE, PsycINFO, Cochrane DSR, Cochrane Central, and JBI EBP were searched for qualitative, quantitative, mixed methods, and review studies with no time limits published in English. Included studies presented findings on the experiences of developing trust between pediatric nurses and children under 18 years of age and their caregivers within inpatient care units. RESULTS A total of 12,269 titles and abstracts were reviewed independently by two reviewers. 366 full-text articles were retrieved, a final of 81 studies were included in the review. CONCLUSIONS Trust was bi-directional between nurses and children/caregivers, developed over time during multiple interactions, and foundational to the development of relationships. Distinct facilitators and barriers to the development of trust between nurses and children/caregivers were identified. The development of trust was rewarding and enriching for both nurses and children/caregivers and was the fundamental to the provision of safe and high-quality nursing care. IMPLICATIONS Findings provide nurses with direction and strategies on how to develop and maintain trust with children/caregivers on inpatient care units. The development of training programs and interventions geared at equipping nurses with the skills to develop trust with children/caregivers is needed.
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Affiliation(s)
- Lyndsay Jerusha MacKay
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Una Chang
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Elizabeth Kreiter
- Norma Marion Alloway Library, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Emma Nickel
- Alberta Children's Hospital, 28 Oki Drive, Calgary, Alberta T3B 6A8, Canada.
| | - Janice Kamke
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Rubinder Bahia
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
| | - Sarah Shantz
- Alberta Children's Hospital, 28 Oki Drive, Calgary, Alberta T3B 6A8, Canada.
| | - Heather Meyerhoff
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1, Canada.
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Fang S, Zhao Y, Gao S, Sun J, Song D, Wu Y, Zhong Q, Sun J. 'Implicit rationing of nursing care processes'-Decision-making in ICU nurses' experiences: A qualitative study. Nurs Crit Care 2024. [PMID: 39011651 DOI: 10.1111/nicc.13127] [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: 02/18/2024] [Revised: 06/10/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Implicit rationing of nursing care is defined as the withholding of necessary nursing measures for patients because of a lack of nursing resources. However, no studies have explored the experience of decision-making about implicit rationing of nursing care in an intensive care unit (ICU). AIM To explore the process of ICU nurses' decisions and judgement based on the conceptual framework of implicit rationing of nursing care. STUDY DESIGN A qualitative study was undertaken between June 2020 and September 2020. The data collection methods were participative observation and interview. Eighteen ICU nurses participated in interviews. A thematic analysis was performed for the data analysis. RESULTS The following five themes emerged: assessment of the condition and nature of nursing and time taken; strategies for setting personal priorities; plan implementation under mitigation strategy; existing nursing in reality; evaluation of the implementation of implicit rationing care. Nurses choose different strategies during plan implementation. CONCLUSIONS In the absence of explicit guidelines on rationing nursing care, nurses often rely on intuitive and situational decision-making processes for setting priorities. Given the vulnerability of ICU patients and the absence of family caregivers, nurses bear a heightened ethical responsibility to provide care. Establishing a positive nursing culture is essential. It is both reasonable and effective to organize work by accurately quantifying workload, improving staffing levels and optimizing scheduling methods. These themes align with the decision-making process outlined in the conceptual framework and offer fresh perspectives. RELEVANCE TO CLINICAL PRACTICE Nurses have a greater responsibility to provide care in an ethical manner and to increase awareness of the importance of holistic nursing care for the patient, that is to raise awareness of the importance of care that is often missed. Nurses actively adopt strategies to reduce implicit rationing of nursing care, including teamwork, organized nursing, working overtime and ignoring quality. The findings highlight the importance of creating a positive nursing culture that encourages nurses to adopt positive strategies.
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Affiliation(s)
- Shuyan Fang
- School of Nursing, Jilin University, Changchun, China
| | - Yingnan Zhao
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shizheng Gao
- School of Nursing, Jilin University, Changchun, China
| | - Juanjuan Sun
- School of Nursing, Jilin University, Changchun, China
| | - Dongpo Song
- School of Nursing, Jilin University, Changchun, China
| | - Yifan Wu
- School of Nursing, Jilin University, Changchun, China
| | - Qiqing Zhong
- School of Nursing, Jilin University, Changchun, China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, China
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Peng M, Saito S, Mo W, Guan H. Why do nurses miss nursing care? A qualitative meta-synthesis. Jpn J Nurs Sci 2024; 21:e12578. [PMID: 37987226 DOI: 10.1111/jjns.12578] [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: 07/20/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
AIM The aim of this qualitative meta-synthesis was to discover the factors impacting on missed nursing care of nurses through systematic thinking. BACKGROUND Although nurses are responsible for high-quality care, missed nursing care is common, endangering patient safety. Understanding of the causes related to missed nursing care could help nursing managers improve the quality of nursing care. DESIGN A qualitative meta-synthesis guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). METHODS As a method designed to contribute to knowledge development, meta-synthesis allows for integration of qualitative study findings using thematic synthesis. Six databases were searched up to October 2021; nine studies met the inclusion and quality assessment criteria and meta-synthesis were conducted. RESULTS Three themes related to the causes why nurses missed nursing care were found. The themes included intrinsic resources (professional and ethical values, ambiguous nurse role, prioritization, education system, and knowledge), system structure (staff and resources shortage, heavy workload but limited time, and organizational management failure), and social environment (communication, working relationship and skill mix, and inappropriate ward layout). CONCLUSION The phenomenon of missed nursing care is a global tissue, with variations in its elements but also notable similarities. Meta-synthesis provides evidence of intrinsic and extrinsic factors that contribute to missed nursing care. RELEVANCE TO CLINICAL PRACTICE Recognizing and understanding the causes of missed nursing care is essential for nursing managers to ensure patient safety and the provision of high-quality care.
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Affiliation(s)
- Mengyun Peng
- School of Nursing, Soochow University, Suzhou, China
- Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Shinya Saito
- Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Wenping Mo
- Graduate School of Medicine, Division of Health Sciences, Osaka University, Osaka, Japan
| | - Hong Guan
- Department of Nursing, The Third Hospital of Dalian Medical University, Dalian, China
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Dasso N, Catania G, Zanini M, Rossi S, Aleo G, Signori A, Scelsi S, Petralia P, Watson R, Hayter M, Sasso L, Bagnasco A. Informal carers' experiences with their children's care during hospitalization in Italy: Child HCAHPS results from RN4CAST@IT-Ped cross-sectional study. J Pediatr Nurs 2024; 74:10-16. [PMID: 37980795 DOI: 10.1016/j.pedn.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE To examine informal carers' experiences during their child's hospitalization and evaluate the associations with care received and care context. DESIGN AND METHODS What is described in this article is only a part of the larger study, RN4CAST@IT-Ped, a multicenter cross-sectional study, with multi-level data collection through convenience sampling, the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to collect data from informal carers of pediatric patients, applying the "top box" approach. RESULTS Nine hospitals, 1472 nurses, and 635 children's parents were involved. A correlation was found between patient safety and satisfaction outcomes and nursing staff characteristics. Adequate workloads for nurses improved carers' assessment of their experience in the hospital. CONCLUSION Adequate staffing management could significantly improve informal carers' satisfaction with the care provided to their children during hospitalization. PRACTICE IMPLICATIONS Children's informal carers greatly value the care they receive in pediatric hospitals. Adequate workloads for nurses improve carers' overall evaluation of the care their children receive during hospitalization. Nursing management should consider improving these aspects to ensure high-quality care in children's hospitals.
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Affiliation(s)
- Nicoletta Dasso
- Health Professional Direction, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy.
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Silvia Rossi
- Health Professional Direction, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy.
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Via A. Pastore, 1, 16132 Genoa, Italy; Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland..
| | - Alessio Signori
- Department of Health Sciences, Biostatistics, Via A. Pastore 1, I-16132 Genoa, Italy.
| | - Silvia Scelsi
- Health Professional Direction, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy.
| | - Paolo Petralia
- Italian Association of Paediatric Hospitals (AOPI), General Director, ASL 4 S.S.R. Ligure, Via G. Gaslini 5, 16147 Genoa, Italy
| | | | - Mark Hayter
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom.
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
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Arıkan A, Esenay FI. Missed nursing care in pediatric emergency departments in Turkey: A cross-sectional study. Appl Nurs Res 2023; 72:151699. [PMID: 37423683 DOI: 10.1016/j.apnr.2023.151699] [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: 07/02/2022] [Revised: 05/15/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE A pediatric emergency department deals with a vast number of patients and a high load of emergent/high-priority healthcare practices. Therefore, at times, it is possible to experience missed nursing care in this department. This study aims to ascertain the types of and reasons for missed nursing care cases in pediatric emergency departments in Turkey. METHOD This is a cross-sectional survey study. Survey data were collected from 155 nurses using the "Introductory Information Form" and the "MISSCARE-Pediatric Emergency Department Survey." RESULTS Gastrostomy care, colostomy care, tracheotomy care, and teaching about hospital discharge were the care practices most often missed. The volume of patients, urgent patient situations, an inadequate number of nurses in charge, too many inexperienced nurses in the department, and assignment of work outside the scope of the job are the main reasons for missed care. CONCLUSION Pediatric emergency department patients experience missed nursing care and nurses should be supported more in order for them to provide efficient care to children.
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Affiliation(s)
- Aylin Arıkan
- Graduate Schools of Health Sciences at Ankara University, Ankara, Turkey.
| | - Figen Işık Esenay
- Department of Pediatric Nursing, Faculty of Nursing, Ankara University, Ankara, Turkey
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Rahmah NM, Hariyati RTS, Sekarsari R, Pakasi T. The Factor Associated with Missed Nursing Care in Hospital: A Systematic Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Patient safety is a major concern in the healthcare industry worldwide. Increasing patient safety is critical for avoiding negative outcomes in nursing care and achieving goals at the desired level of quality. One of the indicators of this quality care given to patient is known as missed care.
Aim: Aims of this study to explore the factors influencing missed care in order to improve the quality of nursing care.
Methods: This study is a systematic review that explores the factors influencing missed nursing care in hospitals. Meanwhile, the literature search was carried out in the CINAHL Pubmed, Ebsco, Science Direct, Proquest, Willey, Sage from 2017 to 2021.
Results: The results from six databases (n=3702) were sorted into 22 collected articles which include 18 quantitative, 2 qualitative, and 2 mixed methods. These findings highlighted three factors that influence missed nursing care: a lack of staffing, nurse competency, and the working environment.
Conclusion: The factors that contribute with missed nursing care in hospitals include lack of nurse staff, competency, and work environment. As a result, the nursing manager's critical role is to create adequate nursing staff, improve their competency, and foster a positive work environment.
Keywords: missed nursing care, lack of staffing, nurse competency, working environment
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Gawronski O, Biagioli V, Dall'oglio I, Cecchetti C, Ferro F, Tiozzo E, Raponi M. Attitudes and practices towards vital signs monitoring on paediatric wards: Cross-validation of the Ped-V scale. J Pediatr Nurs 2022; 65:98-107. [PMID: 35410733 DOI: 10.1016/j.pedn.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To develop and psychometrically test an instrument measuring the attitudes and practices towards vital signs (VS) monitoring in nurses caring for children on paediatric wards (Ped-V scale). DESIGN AND METHODS This is a multicentre cross-validation study with a cross-sectional design. The Ped-V scale was developed by adapting the V-scale to the paediatric context and administered to a convenience sample of clinical nurses working in paediatric wards from January to May 2020. The content validity of the Ped-V scale was evaluated by a group of 10 experts. The psychometric properties of the scale were tested through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). RESULTS Overall, 10 Italian hospitals participated in the study, and 640 questionnaires were completed (87% female). At EFA a 30-item version of the scale and four factors emerged. This solution was confirmed at CFA: F1) 'Inaccuracy of VS monitoring and workload'; F2) 'Clinical competence and communication'; F3) 'Standardization and protocol adherence'; F4) 'Misconceptions about key indicators'. Cronbach's alpha ranged between 0.63 and 0.85. CONCLUSIONS The Ped-V scale is valid and reliable for use in the paediatric context to identify barriers concerning nurses' self-efficacy, competences, and knowledge of clinical indicators of paediatric critical deterioration, attitudes towards accuracy, standardization, communication to senior team members and the appropriate use of technology in paediatric VS monitoring. PRACTICE IMPLICATIONS The Ped-V scale may assist in identifying gaps in nurses' attitudes and devising strategies to change nurses' beliefs, knowledge, skills and decreasing individual, local cultural or organizational barriers towards VS monitoring.
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Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Immacolata Dall'oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Critical Care, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Federico Ferro
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Laugesen B, Albrechtsen MT, Grønkjær M, Kusk KH, Nielsen MG, Jørgensen L, Pedersen B, Lerbæk B, Haslund-Thomsen H, Thorup CB, Jacobsen S, Bundgaard K, Voldbjerg SL. Nurses' Clinical Decision-Making in a Changed COVID-19 Work Environment: A Focus Group Study. Glob Qual Nurs Res 2022; 9:23333936221109876. [PMID: 35832604 PMCID: PMC9272177 DOI: 10.1177/23333936221109876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/07/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to explore how a changed COVID-19 work environment influences nurses’ clinical decision-making. Data were collected via three focus groups totaling 14 nurses working in COVID-19 pandemic wards at a Danish university hospital. The factors influencing decision-making are described in three themes; navigating in a COVID-19 dominated context, recognizing the importance of collegial fellowship, and the complexities of feeling competent. A strong joint commitment among the nurses to manage critical situations fostered a culture of knowledge-sharing and drawing on colleagues’ competencies in clinical decision-making. It is important for nurse leaders to consider multiple factors when preparing nurses not only to work in changing work environments, but also when nurses are asked to work in environments and specialties that deviate from their usual routines.
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Affiliation(s)
- Britt Laugesen
- Aalborg University, Denmark.,Aalborg University Hospital, Denmark
| | | | - Mette Grønkjær
- Aalborg University, Denmark.,Aalborg University Hospital, Denmark
| | | | | | - Lone Jørgensen
- Aalborg University, Denmark.,Aalborg University Hospital, Denmark
| | | | | | | | | | | | - Karin Bundgaard
- Aalborg University, Denmark.,Aalborg University Hospital, Denmark
| | - Siri Lygum Voldbjerg
- Aalborg University Hospital, Denmark.,University College North Denmark, Aalborg, Denmark
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Zontag D, Kuperman P, Honigman L, Treister R. Agreement between children's, nurses’ and parents’ pain intensity reports is stronger before than after analgesic consumption: results from a post-operative study. Int J Nurs Stud 2022; 130:104176. [DOI: 10.1016/j.ijnurstu.2022.104176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/14/2021] [Accepted: 01/08/2022] [Indexed: 01/11/2023]
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