Supporting and Empowering Direct-Care Nurses to Promote EBP: An Example of Evidence-Based Policy Development, Education, and Practice Change

'Why doesn't anyone ask me'? Patients' experiences of receiving, performing and practices of oral care in an acute Orthopaedic Department

AIMS AND OBJECTIVES

Oral care is an integrated part of everyday life. Within nursing, barriers related to providing oral care often lead to unmet caring needs. Poor oral care is associated with a risk of respiratory and cardiovascular complications during hospitalisation. Knowledge on patients' perspectives of maintaining or receiving oral care during admissions are limited. Following the Fundamentals of Care (FOC) framework, this study uses a person-centred approach to explore patients' perceptions and experiences of receiving or performing oral care, including the nursing staff's clinical practices.

METHODOLOGICAL DESIGN AND JUSTIFICATION

A focussed ethnographic approach was used to explore patients' perspectives and clinical practices during acute admissions in an Orthopaedic Department.

ETHICS ISSUES AND APPROVAL

The local Data Protection Agency and the Ethics Committee approved the study.

RESEARCH METHODS, RESULTS AND CONCLUSIONS

Data were collected in an Orthopaedic ward at a Copenhagen University hospital, Hvidovre, and consisted of 14 days of field observations of clinical practices and 15 patient interviews. Data were analysed inductively using qualitative content analysis. Two themes were identified. The first, 'The purpose of oral care is defined by the eye of the beholder', describes the social implications for the patients and how patients reject the assumption of oral care being a transgressive act. The second, 'The unspoken need', focus on the lack of dialogue, including the limited provision of oral care and how the nursing staff assesses patients' ability to perform oral care (in)dependently without including the patients.

CONCLUSION

Oral care is related to the patient's psychological and physical well-being and affects social appearance. When oral care is provided respectfully, patients do not experience oral care as a transgressive act. Nursing staff's self-assessments of the patients' (in)dependency to perform oral care risk leading to incorrect care. Developing and implementing interventions applicable to the clinical practice is needed.

The influence of empowered work environments on the psychological experiences of nursing assistants during COVID-19: a qualitative study

Background

Nursing Assistants (NA) who feel empowered tend to perform their duties better, have higher morale and job satisfaction, and are less likely to leave their jobs. Organizational empowerment practices in hospitals likely shape the psychological experiences of empowerment among these personnel; however, little is known about this relationship.

Objective

We used qualitative inquiry to explore the relationship between organizational empowerment structural components and feelings of psychological empowerment among hospital frontline workers during a public health emergency.

Methods

Kanter’s Theory of Structural Empowerment and Spreitzer’s Psychological Empowerment in the Workplace Framework were applied to identify the conceptual influences of organizational practices on psychological experiences of empowerment. In-depth interviews were conducted with a convenience sample of NAs, caring for hospitalized COVID-19 patients. Directed content analysis was performed to generate a data matrix consisting of the psychological experiences of meaning, competence, self-determination, and impact embedded under the organizational structural components of information, resources, support, and opportunity.

Results

Thirteen NAs (mean age = 42 years, 92% female) completed interviews. Information, or lack thereof, provided to the NAs influenced feelings of fear, preparation, and autonomy. Resources (e.g., protocols, equipment, and person-power) made it easier to cope with overwhelming emotions, affected the NAs’ abilities to do their jobs, and when limited, drove NAs to take on new roles. NAs noted that support was mostly provided by nurses and made the NAs feel appreciated, desiring to contribute more. While NAs felt they could consult leadership when needed, several felt leadership showed little appreciation for their roles and contributions. Similar to support, the opportunity to take care of COVID-19 patients yielded a diverse array of emotions, exposed advances and gaps in NA preparation, and challenged NAs to autonomously develop new care practices and processes.

Conclusion

Management and empowerment of healthcare workers are critical to hospital performance and success. We found many ways in which the NAs’ psychological experiences of empowerment were shaped by the healthcare system’s empowerment-related structural conditions during a public health emergency. To further develop an empowered and committed critical workforce, hospitals must acknowledge the organizational practice influence on the psychological experiences of empowerment among NAs.