Voices that care: licensed practical nurses and the emotional labour underpinning their collaborative interactions with registered nurses

Professional voice use in health and nursing care - Time for reconsideration? A scoping review

BACKGROUND

Communication is a key tool in the nursing profession. It is known that listeners are sensitive to the speaker's voice and interpret the speaker's intentions primarily from the non-verbal signal conveyed.

AIM

To map and discuss the current state of knowledge and research evidence on professional voice use in health and nursing care.

DESIGN AND METHOD

A scoping review adherent to the EQUATOR guidelines PRISMA-ScR.

DATA SOURCES

Searches in the EBSCO, CINAHL, Medline, PubMed, PsychInfo and PsycArticles databases were conducted between 1 and 28 February 2023.

RESULTS

According to the data (n =  23), health professionals use voice as a vital aspect of caring communication and caring relationships, and in leadership as well as inter-professional collaboration, to facilitate information exchange and understanding and promote shared decision-making. The data showed that there is also a rising tendency to explore vocal demands and problems among health professionals. No studies were found on the use of voice in digital health and nursing care services or by social robots. Most of the reviewed studies were cross-sectional, rather small, and focused primarily on the perspectives of healthcare professionals.

CONCLUSION

The use of voice should be explored as a vital aspect of caring communication and caring relationships from the patients' perspective, and the effects of voice use on listeners' emotions and actions should be examined in different contexts with modern, voice-specific data collection methods. Studies focusing on voice use in digital health care and by social robots are also needed. By integrating training programmes, education and technological innovations, health care can leverage the full potential of voice-based communication to promote a more coordinated and patient-centred care environment, true inter-professional collaboration and effective leadership.

IMPACT

Professional voice use is an essential part of all health and nursing care and an impressive method that should be used consciously. Therefore, the meaning and methods of voice use, including speech accommodation, should be systematically introduced into health and nursing care and included in nursing education.

Healthcare professionals' views of a new second-level nursing associate role: A qualitative study exploring early implementation in an acute setting

AIM

The study aimed to establish the views of a range of stakeholders about their experiences of the newly implemented nursing associate role in England and its potential to contribute to patient care.

BACKGROUND

Second-level nursing roles are increasingly used internationally within the healthcare workforce. In response to registered nurse workforce deficits, a new nursing associate role has been introduced in England to augment care provided by registered nurses and enable career progression of support workers.

DESIGN

Qualitative descriptive design.

METHODS

Semi-structured interviews and a focus group were conducted with a range of healthcare professionals in a large inner city acute secondary care healthcare organisation in England. Interviews were guided by the Consolidated Framework for Implementation Research and analysed using Framework Analysis. The study was reported according to COREQ guidelines.

RESULTS

33 healthcare professionals were interviewed-directors of nursing, ward managers, nursing associates and multidisciplinary team members. Participants perceived the role was broadly adaptable to different healthcare settings and provided a positive professional development mechanism for healthcare support workers. Managers felt training commitments made implementing the role complex and costly. Participants argued the role had limitations, particularly with intravenous medicine management. Implementation was impeded by rapid pace and consequent lack of clear communication and planning.

CONCLUSIONS

The nursing associate role was perceived as an inclusive pathway into nursing but with limitations when working with high-acuity patients. Further evaluation is needed to investigate how the role has embedded over time.

RELEVANCE TO CLINICAL PRACTICE

The role should be seen as both a stepping stone into registered nursing positions and valued as part of the nursing workforce. Consideration must be given to how the role can be safely implemented in different settings. Findings have relevance to healthcare leaders internationally, who continue to work in a climate of economic pressure and staffing shortages.

The role of teamwork in the implicit rationing of nursing care: A systematic mixed-methods review

AIM

To systematically evaluate the role of teamwork in implicit rationing care and how to improve teamwork.

BACKGROUND

The implicit rationing of nursing leads to adverse effects for both patients and nurses. Therefore, how to reduce it has attracted increasing research attention. How teamwork may be an important factor in reducing implicit rationing care has become a focus of research.

METHODS

Data between May 2000 and May 2020 were collected from five databases. The study was guided by the framework of a mixed studies review.

RESULTS

Seventeen studies were chosen for review regarding efficient teamwork to reduce implicit rationing care. The following seven subthemes with positive effects that improve teamwork and reduce implicit rationing care were formed: (a) improving knowledge and skills; (b) promoting effective communication; (c) building mutual trust; (d) reducing turnover intention; (e) reasonable staffing; (f) division of responsibilities; and (g) cultivating team consciousness.

CONCLUSIONS

Teamwork can decrease implicit care and is influenced by many factors, but the intervention is singular. In the future, teamwork can be further improved to reduce implicit care.

IMPLICATIONS FOR NURSING MANAGEMENT

With more intervention research in the future, leadership and team-oriented roles can be used to complete all the care needed.

Collaboration among Registered Nurses and Licensed Practical Nurses: A Scoping Review of Practice Guidelines

Professional associations, nurse scholars, and practicing nurses suggest that intraprofessional collaboration between nurses is essential for the provision of quality patient care. However, there is a paucity of evidence describing collaboration among nurses, including the outcomes of collaboration to support these claims. The aim of this scoping review was to examine nursing practice guidelines that inform the registered nurse (RN) and registered/licensed practical nurse (R/LPN) collaborative practice in acute care, summarize and disseminate the findings, and identify gaps in the literature. Ten practice guidelines, all published in Canada, were included in the final scoping review. The findings indicate that many of the guidelines were not evidence informed, which was a major gap. Although the guidelines discussed the structures needed to support intraprofessional collaboration, and most of the guidelines mention that quality patient care is the desired outcome of intraprofessional collaboration, outcome indicators for measuring successful collaborative practice were missing in many of the guidelines. Conflict resolution is an important process component of collaborative practice; yet, it was only mentioned in a few of the guidelines. Future guidelines should be evidence informed and provide outcome indicators in order to measure if the collaborative practice is occurring in the practice setting.

Acute care nursing team members' perceptions of roles: Their own and each other's

AIM

To examine registered nurses', licensed practical nurses' and health care aides' perceptions of their and each other's roles.

BACKGROUND

Nursing team members' perceptions about their own and each other's roles affect how they understand their contributions to patient care and their work relationships and social status within health care organisations. There is a paucity of literature on how nursing team members perceive their roles and those of their colleagues.

DESIGN

Secondary analysis of qualitative data using qualitative description. The parent study used grounded theory to examine nursing care for hospitalized older adults.

METHOD

Conventional content analysis of interview transcripts and field notes from the original study.

RESULTS

All nursing team members reported satisfaction from providing direct care. Registered nurses were uniquely responsible for leadership. Scope-of-practice changes contributed to role confusion and tension among team members.

CONCLUSIONS

More research is needed to better understand how to support nursing teams learning about one another.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers could facilitate clarification about nursing roles and support effective role deployment.

Collaboration among registered nurses and practical nurses in acute care hospitals: A scoping review

AIM

This study examined the extent, range, and nature of registered nurse (RN) and practical nurse (PN) collaboration in acute care hospitals and identified research gaps in the existing literature.

BACKGROUND

Optimal patient care requires collaboration between RNs and PNs. A lack of unity and unresolved tension among different types of nurses influences collaboration and has significant implications on practice and the organizations where nurses work.

METHODS

Using Arksey and O'Malley's (2005) framework, a scoping review was undertaken to answer the research question: what is known from the existing literature about the structures, processes, and outcomes of RN-PN collaboration in hospitals?

RESULTS

Twenty-nine studies were included with the majority coming from North America. Donabedian's model assisted with the identification of three themes: scope of practice, interpersonal skills, and nurse and patient-related outcomes.

CONCLUSION

The findings demonstrate there is a paucity of research specific to RN-PN collaboration. Nurse administrators/managers play an important role in addressing the interpersonal skills of nurses and providing an ongoing education on collaboration in the practice setting. Additional studies should focus on the development of nursing collaborative practice models of patient care, the examination of interventions to improve RN-PN collaborative practice, and the assessment of outcomes relating to collaboration among nurses.

Nursing care providers' perceptions on their role contributions in patient care: An integrative review

AIMS AND OBJECTIVES

To explore registered nurses', licensed practical nurses' and healthcare aides' perceptions of their own and each other's role contributions.

BACKGROUND

In response to contemporary economic and political pressures, healthcare institutions across the world have endeavoured to download job duties to less educated healthcare providers. As a result, nursing care is usually delivered by a team of nursing staff that have different roles. This means that there are fewer registered nurses and more licensed practical nurses and healthcare aides on nursing teams, despite evidence that increased numbers of registered nurses improve patient safety and care outcomes.

DESIGN

This study was an integrative review using Whittemore and Knafl's stages for ensuring rigour. These stages include problem identification, literature searching, data evaluation, data analysis and presentation.

METHODS

Four electronic databases were searched according to previously designed search strategies. The 14 retrieved articles were appraised using MMATs for quality. Data were extracted and analysed thematically.

RESULTS

The findings of the integrative review revealed that registered nurses, licensed practical nurses and healthcare aides had little understanding about the roles of their fellow nursing team members and had difficulties describing their own roles. However, no studies concurrently examined registered nurses', licensed practical nurses' and healthcare aides' perceptions on their own or each other's roles and little were written about licensed practical nurses.

CONCLUSION

More research is needed to examine the entire nursing team's perceptions about the various nursing roles.