A concept development of 'being sensitive' in nursing

Improvements in practising nurses' knowledge, skills, self-efficacy, confidence, and satisfaction after a simulated clinical experience of caring for a patient undergoing chemotherapy: a quasi-experimental study

BACKGROUND

The beneficial effect of simulation experience on nursing students is well established in the literature. However, an accurate simulation modality to help professional nurses enhance their clinical competence and expertise remains unexplored. The current study evaluated and contrasted the impact of two simulation modalities on nurses' knowledge, abilities, self-efficacy, confidence, and satisfaction following a simulated clinical experience caring for chemotherapy patients.

METHODS

A quasi-experimental research design was employed in this study. The participants were divided into group A, comprising nurses exposed to the high-fidelity simulation, and group B, comprising nurses exposed to the virtual simulation.

RESULTS

The study found that nurses exposed to high-fidelity simulation and virtual simulation gained a high standard of knowledge and skills. The nurses' post-test and post-objective structured clinical examination (OSCE) scores drastically increased after simulation exposure compared to their pre-test and pre-OSCE scores. For the group exposed to high-fidelity simulation, the mean differences were - 19.65 (pre- and post-test) and 23.85 (pre- and post-OSCE), while for the group exposed to virtual simulation, the mean differences were - 22.42 (pre- and post-test) and 20.63 (pre- and post-OSCE). All p-values indicated significant differences < 0.001. Moreover, both groups exhibited high self-efficacy, confidence, and satisfaction levels after the simulation experience. The outcomes of both simulation modalities regarding self-efficacy, confidence, and satisfaction levels indicate no significant difference, as supported by p-values of > 0.05.

CONCLUSION

High-fidelity simulation and virtual simulation training effectively and efficiently advance nurses' professional competence. The nurses exposed to high-fidelity simulation and virtual simulation gained high levels of knowledge and skills. Additionally, it increased their sense of happiness, self-worth, and self-efficacy. The simulation approach will be a potent instrument for improving nurses' competency and fully developing their sense of expertise. Therefore, developing policies adopting simulation as part of their professional development will ensure patient safety and improve health outcomes.

Nurses' perspectives on the application of humanistic anatomical knowledge in clinical practice

Knowledge of human anatomy is vital for nurses. Medical educators use a variety of educational pedagogies, including the use of cadavers, to cultivate nursing students into competent and professional care providers and to help them gain authentic experience and knowledge before entering the workplace. Studies have provided numerous examples of students with positive learning experiences in human-centric (humanistic) anatomy courses; however, whether these positive experiences translate into effective clinical practice remains largely unknown. This study explored nurses' perspectives on the effects of a humanistic anatomy program on their nursing practice. Focus groups with semi-structured interview guidelines were conducted to collect data. Twenty-one nurses working in hospitals in Taiwan participated and divided themselves into four groups on the basis of willingness to participate and availability. The interviews were recorded using smartphones, and the recordings were transcribed using a computer. The transcriptions were then checked word by word artificially and analyzed by hand. Three main themes emerged during the analysis: adapting to the professional journey, managing time when providing humanistic care, and cultivating professionalism. The results demonstrate educators' expectations that humanistic anatomy education for nursing students expands students' professional knowledge and helps them develop humanistic competencies as professional nurses.

The relationship between nurses' ethical reasoning with the quality of nursing care

Context

A high quality of nursing care is an important priority of nursing profession and directly associated with increased patient satisfaction. Evidence shows that ethical professional issues are challenging with significant influences on the quality of nursing care.

Aims

The aim of this study was to determine how quality of patient care relates to the nurses’ ethical reasoning as viewed by patients in medical wards.

Settings and Design

This study used a descriptive correlational design.

Subjects and Methods

Data collection tools included a Nursing Dilemma Test and Quality Patient Care Scale. In total, 180 hospitalized patients and 180 nurses who worked in medical wards of Hospitals in 2017 were enrolled. Sample selection was done by the census method.

Statistical Analysis Used

Data were analyzed by the SPSS software version 22.

Results

The means score for nurses’ quality care was 91.71 ± 14.81. Furthermore, the mean score for ethical reasoning among nurses was at an average level of 45.07 ± 6.12. There was no significant relationship between the quality of care and nurse’s ethical reasoning (P > 0.05).

Conclusions:

The results revealed that factors other than ethical reasoning of nurses are related to quality of care. Furthermore, nurses showed an average ability in ethical reasoning. So to improve this situation, healthcare system administrators can offer professional training programs to increase ethical sensitivity and reasoning among the nurses who face daily ethical issues.

Nurses' experiences of providing "sensitive nursing care" for terminally-ill individuals with cancer: A qualitative study

PURPOSE

To explore the sensitive nursing care provided by nurses who care for terminally-ill individuals with cancer.

METHODS

In-depth interviews were conducted using Colaizzi's phenomenological approach. Participants were 16 hospice specialists and four non-specialist nurses with experience in caring for terminal cancer patients in hospice specialized institutions in South Korea.

RESULTS

Eight theme clusters were drawn from the data and these clusters had two dimensions consisting of sensitive attitudes and sensitive nursing behaviors. The sensitive attitudes included reflecting on past experiences, developing an accepting attitude toward death, using intuition to address critical situations, and having an open mind regarding collaborating with colleagues. The sensitive nursing behaviors contained listening to patients' needs, responding to patients in a manner suitable to their conditions, quickly responding to patients' problem, and providing a moment saying farewell.

CONCLUSIONS

Teamwork and role models can help hospice specialists and non-specialist nurses caring for terminally-ill individuals with cancer to improve the sensitive nursing care. The sensitive attitudes and behaviors can be used as basic data for training programs designed to enhance nurses' sensitivity.

Nurses respond to patients' psychosocial needs by dealing, ducking, diverting and deferring: an observational study of a hospice ward

BACKGROUND

Psychosocial support is considered a central component of nursing care but it remains unclear as to exactly how this is implemented in practice. The aim of this study was to provide a descriptive exploration of how psychosocial needs (PNs) of patients in a hospice ward are expressed and met, in order to develop an understanding of the provision of psychosocial support in practice.

METHODS

An embedded mixed-methods study was conducted in one hospice ward. Data collection included observations of patients' expressions of PNs and nurses' responses to those expressed PNs, shift hand-overs and multi-disciplinary meetings. Interviews about the observed care were conducted with the patients and nurses and nursing documentation pertaining to psychosocial care was collated. Descriptive statistical techniques were applied to quantitative data in order to explore and support the qualitative observational, interview and documentary data.

RESULTS

During the 8-month period of observation, 227 encounters within 38 episodes of care were observed among 38 nurses and 47 patients. Within these encounters, 330 PNs were expressed. Nurses were observed immediately responding to expressed PNs in one of four ways: dealing (44.2 %), deferring (14.8 %), diverting (10.3 %) and ducking (30.7 %). However, it is rare that one type of PN was clearly expressed on its own: many were expressed at the same time and usually while the patient was interacting with the nurse for another reason, thus making the provision of psychosocial support challenging. The nurses' response patterns varied little according to type of need.

CONCLUSIONS

The provision of psychosocial support is very complex and PNs are not always easily recognised. This study has allowed an exploration of the actual PNs of patients in a hospice setting, the way in which they were expressed, and how nurses responded to them. The nurses faced the challenge of responding to PNs whilst carrying out the other duties of their shift, and the fact that nurses can provide psychosocial support as an inherent component of practice was verified. The data included in this paper, and the discussions around the observed care, provides nurses everywhere with an example against which to compare their own practice.

Nurses' views of shortcomings in patent care encounters in one hospital in Sweden

AIM AND OBJECTIVE

To describe nurses' views of shortcomings in patient care encounters in one hospital in Sweden.

BACKGROUND

Shortcomings in encounters in healthcare have increased during recent years. Dissatisfaction with encounters in healthcare can affect patients' experiences of dignity, health and well-being.

DESIGN

A qualitative design was used in the study.

METHODS

Three focus group discussions with 15 nurses were conducted. The nurses worked in five different wards. The focus group discussions were subjected to a thematic content analysis.

RESULTS

The results are presented in two themes. The first theme, 'Disregard for the patient's unique nursing needs', describes that information without consideration of the patient's needs, and nurses not being completely present in the meeting with the patient affected healthcare encounters and experiences of quality of care. In the second theme, 'Difficulty managing obstacles', nurses described care situations over which they could not always prevail due to lack of time and/or lack of awareness of the patient's vulnerability.

CONCLUSION

The findings illustrate the importance of nurses and their approaches to patients. The nurse's attitude is important for the patient's experiences of participation, security, dignity, and well-being. The findings also illustrate the importance of routines in the healthcare organisation that support and facilitate positive encounters between patients, their close relatives and the healthcare staff.

RELEVANCE TO CLINICAL PRACTICE

Nurses require understanding, presence and commitment in their relationships to every unique patient, and their goal should be to adopt interventions with regard to positive healthcare encounters based on each patient's experiences of good nursing care.

Letting go: How newly graduated registered nurses in Western Canada decide to exit the nursing profession

BACKGROUND

The Canadian Nurses Association (CNA) estimates a nursing shortage in Canada will rise to 60,000 registered nurses by 2022. Further compounding this crisis is the approximate 14-61% of new nursing graduates who will change nursing roles or exit the profession.

AIM

To explore the factors and basic psychosocial process involved in the decisions of newly graduated registered nurses in Western Canada who permanently exit the nursing profession within five years.

DESIGN

Data was collected through unstructured and semi-structured interviews using the Glaserian grounded theory method.

FINDINGS

Participants were found to be in a process of letting go of nursing that commenced as students and continued as they entered practice as registered nurses. Four major themes were identified. 1) Navigating constraints of the healthcare system and workplace: participants encountered difficulties adjusting to shiftwork and workload. 2) Negotiating social relationships, hierarchies, and troublesome behaviors; specifically hierarchal and horizontal violence. 3) Facing fears, traumas and challenges. 4) Weighing competing rewards and tensions which resulted in leaving the nursing profession.

CONCLUSION

Students and subsequently new nursing graduates require a variety of supports to establish a nursing identity and remain in the profession. These supports include a manageable workload; meaningful orientation; interprofessional teamwork; and engagement within transformational and authentic leadership constructs. New nurses require a sense of being welcomed, valued, respected and accepted into the workplace environment, as well as constructive feedback, emotional support and debriefing to face workplace challenges.

The importance of time in ethical decision making

Departing from a contemporary novel about a boy who is going to die from leukaemia, this article shows how the dimension of time can be seen as a morally relevant category that bridges both 'dramatic' issues, which constitute the dominant focus of bioethical decision making, and 'undramatic' issues, which characterize the lived experience of patients, relatives and health care workers. The moral task of comparing the various time dimensions of a given situation is explained as an act of 'synchronizing' the clocks. Ethical sensitivity and competence are presented as core skills that allow a continuity of care in situations where dramatic issues seem to be resolved, but undramatic ones are still not addressed. A nine-step model of shared decision making is proposed as an approach to identifying critical junctures within an illness trajectory and synchronizing the clocks of the involved actors.