Hospital Processes and the Nurse-Patient Interaction in Breast Cancer Care. Findings from a Cross-Sectional Study

The impact of digital technology use on nurses' professional identity and relations of power: a literature review

AIM

This study seeks to review how the use of digital technologies in clinical nursing affects nurses' professional identity and the relations of power within clinical environments.

DESIGN

Literature review.

DATA SOURCES

PubMed and CINAHL databases were searched in April 2023.

METHODS

We screened 874 studies in English and German, of which 15 were included in our final synthesis reflecting the scientific discourse from 1992 until 2023.

RESULTS

Our review revealed relevant effects of digital technologies on nurses' professional identity and power relations. Few studies cover outcomes relating to identity, such as moral agency or nurses' autonomy. Most studies describe negative impacts of technology on professional identity, for example, creating a barrier between nurses and patients leading to decreased empathetic interaction. Regarding power relations, technologically skilled nurses can yield power over colleagues and patients, while depending on technology. The investigation of these effects is underrepresented.

CONCLUSION

Our review presents insights into the relation between technology and nurses' professional identity and prevalent power relations. For future studies, dedicated and critical investigations of digital technologies' impact on the formation of professional identity in nursing are required.

IMPLICATIONS FOR THE PROFESSION

Nurses' professional identity may be altered by digital technologies used in clinical care. Nurses, who are aware of the potential effects of digitized work environments, can reflect on the relationship of technology and the nursing profession.

IMPACT

The use of digital technology might lead to a decrease in nurses' moral agency and competence to shape patient-centred care. Digital technologies seem to become an essential measure for nurses to wield power over patients and colleagues, whilst being a control mechanism. Our work encourages nurses to actively shape digital care.

REPORTING METHOD

We adhere to the JBI Manual for Evidence Synthesis where applicable. EQUATOR reporting guidelines were not applicable for this type of review.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Nurse-to-patient ratios and readiness for hospital discharge: A moderated mediation model

AIM

To explore whether and to what extent, nurse-patient assessment differences mediate the association between nurse-to-patient ratios and readiness for hospital discharge, and examine whether nurse-patient characteristics moderate the indirect and/or direct effect of mediation model.

DESIGN

A cross-sectional study was carried out from March 2021 to December 2022.

METHODS

A total of 523 pairs of gastrointestinal cancer patients with PICC and their nurses were recruited. All the participants were invited to complete the general information questionnaire and the Readiness for Hospital Discharge Scale. Outcome measure was patient-reported readiness for hospital discharge. This study was reported according to the STROBE checklist.

RESULTS

The patients reported a low level of readiness for hospital discharge. Nurse-patient assessment differences were positively associated with nurse-to-patient ratios but negatively associated with readiness for hospital discharge. Furthermore, nurse-patient assessment differences fully mediated the effect of nurse-to-patient ratios on readiness for hospital discharge, and age and gender of patients only moderated the indirect path of mediation model.

Investigation of social support as a mediator of the relationship between physical and psychological health among hospitalised patients

AIM

To investigate the self-reported levels of social support from friends and family and from nurses as mediators of the relationship between self-rated physical and psychological condition in hospitalised patients.

DESIGN

Cross-sectional study of adult inpatients at a large tertiary-care hospital in the northeast United States.

METHODS

Multiple mediation analysis of survey data.

RESULTS

In surveys received from 324 inpatients, one fourth of the variation in patients' self-rated psychological condition was explained by self-rated physical condition. Social support from family and friends mediated a significant proportion (11.0%) of the relationship between self-rated physical and psychological condition, however social support from nurses did not.

CONCLUSION

Social support from family and friends can positively influence the psychological health of inpatients, but nurses are not an adequate replacement for the social support provided by family and friends.

IMPLICATIONS FOR NURSING

Although nurses cannot replace the social support provided by family and friends, the assessment of social isolation and care planning of interventions to support patients is a fundamental nursing role. Technology to connect patients with friends and family should be used to mitigate isolation for hospitalised patients unable to receive in-person visits from loved ones.

IMPACT

The influence of social support from family and friends and nurses was addressed. The study found social support from family and friends, but not nurses, to influence the relationship between physical and psychological ratings. This finding has implications for the role of nurses in the hospital setting.

REPORTING METHOD

Strengthening the Reporting of Observational Studies in Epidemiology guidelines were followed.

Validation of a patient-reported measure of social support provided by nurses in breast cancer care (SuPP-N): based on a cross-sectional patient survey in 83 German hospitals

OBJECTIVES

To validate the patient-reported measure of Social Support Perceived by Patients Scale-Nurses (SuPP-N).

DESIGN/SETTING

A secondary data analysis based on a cross-sectional breast cancer patient survey in 83 German hospitals. Patients were asked to give written informed consent before they were discharged. If they agreed to participate, the questionnaire was sent via mail to their home address after discharge.

PARTICIPANTS

Of 5583 eligible patients, 4841 consented to participate in the study and 4217 returned completed questionnaires (response rate: 75.5 %). For the data analysis n=3954 respondents were included. On average, participants were 60 years old and mostly in cancer stages I and II.

PRIMARY AND SECONDARY OUTCOME MEASURES

Perceived social support was assessed with a three-item patient-reported scale (SuPP-N). Convergent validity and criterion-related validity were tested using the following constructs: trust in nurses, trust in the treatment team (Wake Forest Physician Trust Scale, adapted), quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), processes organisation, availability of nurses.

RESULTS

The structural equation model (SEM) assuming a one-dimensional structure of the instrument showed acceptable goodness of fit (root mean square error of approximation=0.04, Comparative Fit Index=0.96 and Tucker-Lewis Index=0.96; factor loadings ≥0.83). Hypothesis-consistent correlations with trust in nurses (beta=0.615; p<0.01) and trust in the treatment team (beta=0.264; p<0.01) proved convergent validity. Criterion-related validity was proved by its association with patients' quality of life (beta=-0.138; p<0.01), processes organisation (beta=-0.107; p<0.01) and the availability of nurses (beta=0.654; p<0.01).

CONCLUSION

The results of the SEM identify potential important factors to foster social support by nurses in cancer care. In patient surveys, the SuPP-N can be used efficiently to measure patient-reported social support provided by nurses. The use of the scale can contribute to gain a better understanding of the relevance of social support provided by nurses for patients and to detect possible deficits and derive measures with the aim of improving the patient-nurse interaction.

Organizational Health Literacy in a Hospital-Insights on the Patients' Perspective

Health literacy-sensitive communication has been found to be an important dimension of organizational health literacy measured from the patients' perspective. Little is known about the role of health literacy-sensitive communication in complex care structures. Therefore, our aim was to assess which hospital characteristics (in terms of process organization) and patient characteristics (e.g., age, chronic illness, etc.) contribute to better perceptions of health literacy-sensitive communication, as well as whether better health literacy-sensitive communication is associated with better patient reported experiences. Data were derived from a patient survey conducted in 2020 in four clinical departments of a university hospital in Germany. Health literacy-sensitive communication was measured with the HL-COM scale. Data from 209 patients (response rate 24.2%) were analyzed with a structural equation model (SEM). Results revealed that no patient characteristics were associated with HL-COM scores. Better process organization as perceived by patients was associated with significantly better HL-COM scores, and, in turn, better HL-COM scores were associated with more patient-reported social support provided by physicians and nurses as well as fewer unmet information needs. Investing into good process organization might improve health literacy-sensitive communication, which in turn has the potential to foster the patient-provider relationship as well as to reduce unmet information needs of patients.