Nurses' experiences of busyness in their daily work

Concept analysis of conscience-based nursing care: a hybrid approach of Schwartz-Barcott and Kim's hybrid model

BACKGROUND

The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care.

METHODS

This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived.

RESULTS

The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care.

CONCLUSION

Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.

Issues and Perspectives for the Study of Disruptive Clinician Behavior

This article discusses issues and perspectives related to the study of disruptive clinician behavior (DCB) to improve patient safety and healthcare professionals' work environments. Multiple terminologies and ambiguous definitions have resulted in conceptual confusion in studies on DCB. In addition, subjective classifications have led the attributes of DCB to overlap and fluctuate. Therefore, we share Rosenberg's definition of DCB as "any inappropriate behavior, confrontation, or conflict, ranging from verbal abuse to physical and sexual harassment." It is recommended that DCB be understood as a hierarchical structure identified through statistical analysis of field survey data. Furthermore, a recurring list of items is duplicated across existing studies on DCB triggers, contributing factors, and influences. These items can be organized into separate path models based on their mutual relationships. Given these assumed models, we believe that further studies on DCB can shift toward elucidating the mechanisms of occurrence and impact. Finally, based on the path models, we recommend improving healthcare professionals' psychological and social states through a policy shift from "zero-tolerance" to "to err is human" as a priority issue for DCB prevention and countermeasures.

Identifying communication difficulty and context-specific communication supports for patient-provider communication in a sub-acute setting: A prospective mixed methods study

PURPOSE

To identify the sub-acute rehabilitation inpatients who have communication difficulty and the range of communication supports that can facilitate communicative success.

METHOD

A prospective cohort mixed methods study was conducted on two inpatient sub-acute rehabilitation wards. Nurses screened all new admissions for communication difficulty using the Inpatient Functional Communication Interview, Screening Questionnaire (IFCI-SQ). Patients identified as having communication difficulty were interviewed by a speech-language pathologist (SLP) using the Inpatient Functional Communication Interview (IFCI). During the interview, the SLP trialled different communication supports. The number of patients who had communication difficulty on the IFCI-SQ was calculated. The number and type of communication supports that improved communication within the patient-SLP interview were calculated. Deductive-dominant qualitative content analysis was conducted on the communication supports used during the IFCI.

RESULT

Seventy patients were screened. Nurses reported communication difficulty in 45/70 (64%) of patients. A total of 15/45 patients were interviewed by an SLP using the IFCI. The provision of communication supports improved communication for all patients within the context of the patient-SLP interview.

CONCLUSION

Many sub-acute rehabilitation inpatients have communication difficulty in the hospital setting. A range of communication supports facilitated communication. These insights could inform future communication partner training (CPT) programs.

Parents' and nurses' perceptions and behaviours of family-centred care during periods of busyness

PURPOSE

Busyness as a construct within modern healthcare is complex and multidimensional. To date, few studies have sought to explore how busyness influences family-centred care. This study explored the influence of busyness on the delivery of family-centred care for nurses and parents.

DESIGN AND METHOD

Ethnography was selected as the research design. The study site was a metropolitan tertiary hospital inpatient paediatric unit in Sydney, Australia. Semi-structured interview and non-participant observation techniques were used for data collection. Ten paediatric nurses and 10 parents were interviewed and 40 h of non-participant observations were undertaken. The COREQ was used to report the study.

RESULTS

The findings are presented as three key themes: (i) 'Supporting family-centred care' in which participants detail beliefs about the nurse-parent relationships and how despite busyness nurses sought out moments to engage with parents; (ii) 'Being present at the bedside' identified the challenges in optimising safety and how parents adapted their way of being and interacting on the unit; and (iii) 'The emotional cost of busyness' and how this influenced nurse-parent interactions, care delivery and family-centred care.

CONCLUSIONS

The ethnography has given shape to social understandings of busyness, the complexities of paediatric nursing and family-centred care. The culture of care changed in moments of busyness and transformed parent and nursing roles, expectations and collaborative care that at time generated internal emotional conflict and tension.

PRACTICE IMPLICATIONS

Given the increasing work demands across health systems, new agile ways of working need to ensure maintenance of a family-centred approach. Strategies need to be developed during periods of busyness to better support collaborative connections and the well-being of paediatric nurses and parents. At an organisational level, fostering a positive workplace culture that shares a vision for family-centred care and collaboration is essential.

PATIENT OR PUBLIC CONTRIBUTION

Parents of sick children admitted to an acute paediatric inpatient ward were invited to be a participant in a single interview. Parents were aware of the study through ward advertisement and informal discussions with the researchers or senior clinical staff. Engagement with parents was important as healthcare delivery in paediatrics is focused on the delivery of family-centred care. To minimise the risk of child distress and separation anxiety, children were present during the parent interview. Whist children and young people voices were not silenced during the interview process, for this study the parent's voice remained the focus. While important, due to limited resources, parents were not involved in the design analysis or interpretation of the data or in the preparation of this manuscript.

DATA SHARING

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Work-related stress among nurses in the COVID-19 pandemic: What are the contributing factors?

OBJECTIVE

To analyze the contributing factors of work-related stress among nurses in the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted with 101 nurse practitioners from two hospitals in West Java, Indonesia. We distributed an online questionnaire to evaluate work-related stress and the data were analyzed using ordinal logistic regression.

RESULTS

More than half of the nurses experienced moderate work-related stress. The study revealed that nurses aged over 35 years old had a lower likelihood of experiencing work-related stress (AOR: 0.173; 95%CI: 0.038-0.782). Married nurses had a higher likelihood (AOR: 7.156; 95% CI: 1.456-35.163). Additionally, nurses with low and moderate workloads had a lower likelihood (AOR: 0.003; 95%CI: 0.000-0.051) and (AOR: 0.025; 95%CI: 0.005-0.116), respectively.

CONCLUSION

The consideration of age, marital status, and workload is essential in effectively addressing work-related stress among nurse practitioners.

Nurses' ways of talking about their experiences of (in)justice in healthcare organizations: Locating the use of language as a means of analysis

Nurses have their own ways of talking about their experiences of injustice in healthcare organizations. The aim of this article is to describe how nurses talk about their work-life experiences and discuss the discursive effects that arise from nurses' use of language regarding their political agency. To this end, we present the findings garnered from a study focused on exploring how nurses deploy their political agency to project their idea of social and political justice in public healthcare organizations and how they face the challenges and uncertainties of (re)thinking their institutional order when it does not resonate with their professional ethos. We then discuss the implications that nurses' use of language has in relation to their ability to deploy their political agency to oppose the forms of injustice they face in their daily practice. We conclude by stating that careful attention should be placed on understanding the discursive implications of nurses' use of language on their individual and collective emancipation in healthcare organizations.

Exploring the complex realities of nursing work in Kenya and how this shapes role enactment and practice-A qualitative study

AIM

We explore how nurses navigate competing work demands in resource-constrained settings and how this shapes the enactment of nursing roles.

DESIGN

An exploratory-descriptive qualitative study.

METHODS

Using individual in-depth interviews and small group interviews, we interviewed 47 purposively selected nurses and nurse managers. We also conducted 57 hours of non-participant structured observations of nursing work in three public hospitals.

RESULTS

Three major themes arose: (i) Rationalization of prioritization decisions, where nurses described prioritizing technical nursing tasks over routine bedside care, coming up with their own 'working standards' of care and nurses informally delegating tasks to cope with work demands. (ii) Bundling of tasks describes how nurses were sometimes engaged in tasks seen to be out of their scope of work or sometimes being used to fill for other professional shortages. (iii) Pursuit of professional ideals describes how the reality of how nursing was practised was seen to be in contrast with nurses' quest for professionalism.

[How do nurses describe timeliness in the delivery of nursing interventions? A qualitative study]

How do nurses describe timeliness in the delivery of nursing interventions? A qualitative study Abstract: Background: Timeliness of nursing interventions is fundamental to professional medical care. Although nurses have developed strategies to manage time resources, nursing interventions are often carried out too early or too late. Both can have a negative impact on the quality of care and safety. However, no publications are available describing nurses' views on the appropriateness of time to perform nursing interventions. Aim: The aim was to describe what registered nurses in the hospital understand by the timeliness to deliver care. Methods: For this qualitative study, eight registered nurses were interviewed individually. Data analysis was performed using content analysis according to Mayring. Results: For the participants, timeliness in performing care interventions can be described as relational and dynamically changing over time. For them it is not limited to a defined point in time and they explain it as a time frame. From their point of view, timely action can prevent harm and suffering and ensure patients safety and well-being. Environmental factors, nursing goals and the urgency of actions influence them whether they act in a timely manner. Conclusion: Among the participating nurses, there exists a shared, often implicit, understanding of timeliness. Results of this study may help to understand the implicit understanding and the related processes and contribute to quality assurance in nursing.

The Influence of Busyness on the Therapeutic Relationship, Nursing Activities and Teamwork: An Ethnography

To explore a notion of busyness within the context of pediatric acute care and how this influences the therapeutic relationship, nursing activities and teamwork between pediatric nurses and families. Ethnography was the research design. Semi-structured interviews and non-participant observation were used for data collection, which was undertaken in a level four pediatric inpatient unit in Sydney, New South Wales Australia. Brewer's (2000) ethnographic framework for analysis and interpretation was utilized and findings are presented as a realist tale. Interviews with 10 pediatric nurses and 10 parents, and 40 h of non-participant observations were conducted. Three themes are presented, which detail the cultural dimensions of busyness: i) the meaning of busyness; ii) relationships within the pediatric nursing team; and iii) shaping the therapeutic relationship. This ethnography identified how pediatric nurse and parental expectations and collaborative partnerships were re-shaped by busyness. Importantly, the ethnography has presented how busyness is perceived by pediatric nurses and parents, which require new negotiations and a rebalance of workload. Findings have implications for the healthcare workforce and organizational structure. Future research is required to explore how different ways of working better support the pediatric nurse and families during busyness.

Does Adding Training in Shared Decision Making for Home Care Teams to Providing Decision Guides Better Engage Frail Elders and Caregivers in Housing Decisions? :A Stepped-Wedge Cluster Randomized Trial

Background

Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams.

Objective

We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making.

Methods

We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis.

Results

A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI –5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults’ perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI −0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI −16.5% to 1.6%, P=.10).

Conclusions

Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making.

Trial Registration

ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525

Gender Equity and Impedes of Career Progression in the Nursing Profession in Khomas Region of Namibia

Introduction Women had for years endured impediments at the workplace in many aspects such as gender inequity and low pace of career advancement. The status quo is persistent despite the enactment of legal frameworks institutionalized to redress gender disparities in the workforce. Aim This study strives to explore gender equity, assess the magnitude of women in decision-making and to ascertain impediments that humper career progression in nursing. Method This study utilized secondary data collected from a thesis titled 'Gender equity and career progression in the Ministry of Health and Social Services in Khomas region of Namibia.The main study employed a mixed method approach to collect information through interviews. Tools Two separate semi-structured interview guides that comprised of both set of close-ended and open-ended questions were employed to gather information from selected respondents and the key informant. Results The conception that women in nursing are less successful in their careers in comparison to their male colleagues is contrary to the study findings as managerial positions at the studied institutions are held by women. Cultural factors are found to hold less significance in impeding career progression at Ministry of Health and Social Services as opposed to organizational hierarchical structure. Conclusion The feminization of the nursing career that led to the predominance of female in profession is still unopposed as the profession is not showing a sign of equilibrium of the two genders.