Revisiting the nursing metaparadigm: Acknowledging technology as foundational to progressing nursing knowledge

The meaning of being conscious during surgery with local or regional anesthesia-A phenomenological hermeneutic study

Background

With increasing prevalence of surgery under local or regional anesthesia, which allows patients to remain conscious during the intraoperative phase, there is a growing need to comprehend the lived experiences associated with this practice.

Objective

This study aimed to illuminate the lived experiences of individuals who remained conscious during surgical intervention under local or regional anesthesia.

Design

A qualitative design was chosen.

Settings

Participants in the present study were recruited from three surgical wards located in central Sweden using a purposive sampling strategy. The surgical disciplines included ear, gynecological, hernioplasty, orthopedic, and vessel surgeries.

Participants

Fourteen narrative interviews were conducted with individuals who had undergone elective surgery while conscious.

Methods

Verbatim transcribed text was analyzed using a phenomenological-hermeneutic method.

Results

The lived experience of being conscious during surgery was marked by feelings of hope alongside a sense of losing one's identity and experiencing destabilization. Structural analysis revealed two themes. The first theme, 'being in the hands of others', encompassed subthemes such as 'entering an unfamiliar environment and procedure,' 'losing foothold and a sense of self-identity,' and 'enduring unexpected or anticipated discomfort.' The second theme, 'managing the inevitable for future health concerns,' involved subthemes such as 'pursuing self-acceptance of the situation,' 'entrusting the professionals while seeking signs of a smooth procedure,' and 'Enhancing own resilience through continuous support.

Conclusions

Beyond the patient's physical well-being during surgery, the OR team should acknowledge the "person" component and focus on their emotional and social needs in this vulnerable situation. The four meta-paradigms of nursing-person, health, environment, and nursing-significantly influence the conscious patient's experience.

Patient or Public Contribution

No patient or public contribution.

Revisiting the philosophy of technology and nursing: Time to move beyond romancing resistance or resisting romance

Technology remains enmeshed in our daily lives and given its continuing presence in clinical practice and rapid technological proliferation; it becomes relevant for nurses to examine techno-onto-epistemology in relation to the discipline of nursing. This is critical considering the intersection of technology and nursing remains an area of ongoing discussion revealing a need for further philosophical reflection. To this end, this paper sought to examine the philosophy of technology from the engineering and humanities perspectives to contribute to the discussion regarding its intersection with the onto-epistemology of nursing. Although technology seems to be constantly present in nursing practice, two opposing perspectives reflecting a love-hate relationship is highlighted: technological optimism (promotes technology) and technological romanticism (dissuades technology). Based on Mitcham's interpretation of 'mutual relationship' and 'being-with', a potential way to break away from the binary perspectives is to view the intersection of/relationship between technology and nursing as being on a continuum rather than entirely monolithic entities. Caring is presented as multidimensional reflecting actions and attitudes. Arguably, some caring actions may intersect with the engineering perspective to suggest that technology can support nurses in their roles, that is, by imitating some of what nurses do, but not to replace them. From the humanities perspective, technology is presented as a way of being with humans exercising control over what technology has to offer. Put together, it is clearly time to break away from the love-hate relationship between nursing and technology. Although this emphasises a great need to build the technological competency of nurses, there is an even greater call for nurses to reflect on and voice the epistemological, ontological, axiological, and ethical issues that the application of technology raises for the discipline.

Exploring the role of communication in effective nurse leadership and patient care

Nurses have to be aware of their personal responsibility to demonstrate effective leadership and thereby contribute to safe and effective patient care. One of the primary skills that nurses can use to become effective leaders is communication. This article explores how communication is a vital tool in enabling nurse leaders to motivate their team members and advocate for patients. The author details some of the essential communication skills that nurses require if they are to promote person-centred care and explores the often-neglected areas of non-verbal and written communication. By possessing a full range of communication skills, nurses can empower themselves to lead clinical teams and advocate for patients.

Digital ethical reflection in home nursing care: Nurse leaders' and nurses' experiences

BACKGROUND

Nurse leaders increasingly need effective tools that facilitate the prioritisation of ethics and help staff navigate ethical challenges and prevent moral distress. This study examined experiences with a new digital tool for ethical reflection, tailored to improve the capabilities of both leaders and employees in the context of municipal long-term care.

AIM

The aim was to explore the experiences of nurse leaders and nurses in using Digital Ethical Reflection as a tool for ethics work in home nursing care.

RESEARCH DESIGN

The study employed a qualitative design, incorporating individual and focus group interviews for data collection. Qualitative content analysis was used to analyse the data.

PARTICIPANTS AND RESEARCH CONTEXT

The participants comprised six nurse leaders and 13 nurses, representing six home care zones across two Norwegian municipalities.

ETHICAL CONSIDERATIONS

The study involved informed, voluntary participation and was approved by the Norwegian Agency for Shared Services in Education and Research.

FINDINGS

Four themes were developed: a constant walk on the edge between engagement and discouragement and lost in translation describe the process, while tuning in to the ethical dimension and navigating ethical uncertainties illuminate the experienced significance of Digital Ethical Reflection.

CONCLUSION

Success with Digital Ethical Reflection in home nursing care depends on clear leadership planning, nurses' understanding of the tool's purpose, and active use of digital registrations. Support from ethically interested nurses enhances overall engagement. Further research is needed to explore the potential of Digital Ethical Reflection as an additional tool in long-term care ethics work.

When to err is inhuman: An examination of the influence of artificial intelligence-driven nursing care on patient safety

Artificial intelligence, as a nonhuman entity, is increasingly used to inform, direct, or supplant nursing care and clinical decision-making. The boundaries between human- and nonhuman-driven nursing care are blurred with the advent of sensors, wearables, camera devices, and humanoid robots at such an accelerated pace that the critical evaluation of its influence on patient safety has not been fully assessed. Since the pivotal release of To Err is Human, patient safety is being challenged by the dynamic healthcare environment like never before, with nursing at a critical juncture to steer the course of artificial intelligence integration in clinical decision-making. This paper presents an overview of artificial intelligence and its application in healthcare and highlights the implications which affect nursing as a profession, including perspectives on nursing education and training recommendations. The legal and policy challenges which emerge when artificial intelligence influences the risk of clinical errors and safety issues are discussed.

Integrating telemedicine in routine heart failure management: Experiences of healthcare professionals - A qualitative study

Objective

To describe the experiences of healthcare professionals with integrating telemedicine in routine heart failure (HF) care.

Methods

Semi-structured interviews were conducted with healthcare professionals (n = 19) in the Netherlands who were involved in decision-making, implementation or routine use of telemedicine in HF management. Using purposive sampling, nurses, cardiologists and managers were selected to be interviewed. Interviews were performed in-person, recorded and transcribed verbatim. Interview data were analysed using a reflexive thematic analysis.

Results

This study identified four themes: (1) Responsibility - the lack of a clear delineation of roles and responsibilities among healthcare professionals, patients and suppliers in telemedicine. (2) Confidence and safety - telemedicine is seen by healthcare professionals as capable of enhancing safety, yet also introduces the risk of fostering a false sense of security among patients. (3) Collaboration - actively involving end-users in the development and implementation of telemedicine promotes the adoption. (4) Processes and mutual agreements - rather than replacing traditional care, telemedicine is perceived as an adjunct to it. Structured care pathways support telemedicine implementation, and personalised telemedicine can empower patients in self-care.

Conclusions

Telemedicine is a promising intervention in the management of HF. However, existing systems and care pathways have resulted in limited adoption. Improvements in the collaboration and establishing clear agreements on responsibilities between professional, patient and supplier can lead to more confidence in adopting telemedicine. Structured care pathways can be supportive. A personalised telemedicine approach can ensure that telemedicine remains manageable for patient and professional.

A stepwise methodological approach to develop and validate the digital and technological self-efficacy scale for healthcare workers among nurses and nursing students

AIMS

To develop and validate the Digital and Technological Self-Efficacy Scale (Digitech-S) for healthcare workers among nurses and nursing students.

BACKGROUND

Digital and technological solutions (DTS) significantly impact working life in healthcare and educational settings. DTS-related self-efficacy might be defined the individual's confidence in proficiently performing digital and technological tasks, even when faced with challenges. Its assessment might guide educators in orienting focused interventions to enhance the self-efficacy of nurses and nursing students. Thus far, the assessment of DTS-related self-efficacy is currently undermined by the lack of valid and reliable measurements.

DESIGN

A stepwise methodological approach was employed in two main phases. Phase one focused on tasks guided by literature for generating items reflecting DTS. Phase two encompassed three steps: A content validity step, a first cross-sectional data collection for Mokken scaling analysis (MSA) performed to reduce the number of items toward a unidimensional structure and with a hierarchical approach, and a confirmatory factor analysis including the group (nurses vs. nursing students) as a covariate (MIMIC) to cross-validate the unidimensional structure and assess the measurement invariance using a second cross-sectional data collection round. A Multi-Group Confirmatory Factor Analysis (MG-CFA) was also conducted to test for configural, metric, scalar, and strict invariance across the two groups.

RESULTS

Phase one resulted in 36 items derived from a literature review, which was reduced to 33 after the content validity process. 660 responders (nurses = 388; nursing students = 272) were included in the sample analyzed with MSA, and 13 items were hierarchically selected for the subsequent data collection (Rho reliability = 0.95; Hs = 0.67; Hi ranging from 0.55 to 0.72). MIMIC models were performed on 421 responders (nurses = 268; nursing students = 153), and three items that caused non-invariance between nurses and nursing students were identified and removed from the final version (Cronbach's alpha = 0.928). The MG-CFA demonstrated configural and metric invariance, suggesting a consistent factor structure and factor loadings across both groups, but scalar and strict invariance were not fully achieved.

CONCLUSIONS

The Digitech-S is a 10-item scale showing a unidimensional and stable structure, which could be used for educational and research purposes.

Technology: A metaparadigm concept of nursing

Undoubtedly, technology continues to permeate the world at an unprecedented pace. The discipline of nursing is not alien to this phenomenon as nurses continue to employ various technological objects and applications in clinical practice, education, administration and research. Despite the centrality of technology in nursing, it has not been recognised as a metaparadigm domain of interest in the discipline of nursing. Thus, this paper sought to examine if technology truly reflected a metaparadigm domain using the four requirements posited by Fawcett. Using these requirements, we examined the onto-epistemology of technology in relation to nursing and conclude that technology potentially represents a distinct domain that intersects with nursing (particularly, from the humanities perspective). Also, technology encompasses some phenomena of interest to the discipline of nursing, demonstrates perspective-neutrality, and is international in scope and substance albeit with some nuances which do not fit well with nursing onto-epistemology. Put together, it is highlighted that technology intersects with the existing metaparadigm domains (person, health, environment and nursing) which positions it as a potential phenomenon of interest to the discipline of nursing requiring further work to articulate its position and role.

Experiência de uma capacitação virtual durante à COVID-19

Objetivo: relatar as experiências obtidas com a Capacitação Virtual em História da Enfermagem no período de distanciamento social da pandemia da COVID-19. Método: relato de experiência da construção e execução de uma Capacitação por meio de mídia virtual, desenvolvida no ano de 2020, em uma parceria entre ações extensionistas dos museus das Escolas de Enfermagem de Universidades Públicas Federais/Brasil, com apoio da Associação Brasileira de Enfermagem. As experiências foram discutidas nos campos da História da Enfermagem e da Educação. Resultados: com um total de 132 inscritos, a Capacitação foi realizada por meio de quatro transmissões ao vivo através do Instagram. A utilização de lives de acesso livre ao público possibilitou alcançar em média 358 pessoas. Os formulários elaborados e distribuídos aos inscritos subsidiaram a estruturação dos conteúdos abordados durante os encontros, a criação de metodologias ativas disponibilizadas aos participantes para apoiar o ensino de História da Enfermagem e também a avaliação final da Capacitação. Conclusão: a Capacitação permitiu contornar as dificuldades impostas pelo distanciamento social e contribuiu para dar protagonismo aos envolvidos, constituindo uma rede de apoio ao ensino de História da Enfermagem.