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Anteayer Journal of Advanced Nursing

Low‐value home‐based nursing care: A national survey study

Abstract

Aims

To explore potential areas of low-value home-based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home-based nursing care.

Design

A quantitative, cross-sectional design.

Methods

An online survey with questions containing scaled frequencies on five-point Likert scales and open questions on possible related influencing factors of low-value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results.

Results

A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low-value care practices reported were: (1) ‘washing the client with water and soap by default’, (2) ‘application of zinc cream, powders or pastes when treating intertrigo’, (3) ‘washing the client from head to toe daily’, (4) ‘re-use of a urinary catheter bag after removal/disconnection’ and (5) ‘bladder irrigation to prevent clogging of urinary tract catheter’. The top five related influencing factors reported were: (1) ‘a (general) practitioner advices/prescribes it’, (2) ‘written in the client's care plan’, (3) ‘client asks for it’, (4) ‘wanting to offer the client something’ and (5) ‘it is always done like this in the team’. Higher educational levels and an age above 40 years were associated with a lower provision of low-value care.

Conclusion

According to registered nurses and certified nursing assistants, a number of low-value nursing practices occurred frequently in home-based nursing care and they experienced multiple factors that influence the provision of low-value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de-implementation strategy.

Reporting Method

STROBE checklist for cross-sectional studies.

Patient or Public Contribution

No Patient or Public Contribution.

Implications for the Profession and/or Patient Care

Nursing care is increasingly shifting towards the home environment. Not all nursing care that is provided is effective or efficient and this type of care can therefore be considered of low-value. Reducing low-value care and increasing appropriate care will free up time, improve quality of care, work satisfaction, patient safety and contribute to a more sustainable healthcare system.

Decision‐making experiences related to mastectomy: A descriptive qualitative study

Abstract

Aim

To obtain an in-depth understanding of women's decision-making experiences related to mastectomy.

Design

A descriptive qualitative interview study.

Methods

Individual semi-structured interviews were conducted face-to-face with 27 Chinese women with breast cancer who underwent mastectomy at two tertiary hospitals in mainland China between September 2020 and December 2021 after obtaining the appropriate ethical approvals. Interviews were conducted in Mandarin. Data were analysed using inductive content analysis.

Results

Mean age of participants was 48 years (range 31–70). Most participants had low education, low monthly family income, had a partner and health insurance, had been diagnosed with early breast cancer, and had not undergone reconstructive surgery. Six categories related to decision-making experiences emerged: (1) Emotions affecting decision-making, (2) Information seeking for decision-making, (3) Beliefs about mastectomy and the breast, (4) Participation in decision-making, (5) People who influence decision-making, and (6) Post-decision reflection. Participants did not mention the role of nurses in their decision-making process for mastectomy.

Conclusions

This study adds valuable insights into the limited evidence on women's experience with decision-making about mastectomy from a Chinese perspective, which is important given the continuing high prevalence of mastectomy in many regions. Future studies from other countries and ethnic groups are recommended to gain diverse knowledge.

Impact

The findings of this study are useful for nurses and other healthcare professionals in the multidisciplinary team to better support women with breast cancer in their decision-making process regarding mastectomy. The findings could inform future interventions to support treatment decision-making and may be relevant to women living in similar socio-medical contexts to those in mainland China.

Reporting Method

The study was reported following the Standards for Reporting Qualitative Research checklist.

Patient or Public Contribution

No patient or public contribution.

Unmet care needs of women who have undergone breast cancer surgery: A scoping review

Abstract

Aim

To summarize the evidence regarding the unmet care needs of women who have undergone breast cancer surgery and identify research gaps.

Design

A scoping review.

Data Sources

This review entailed a systematic search in EMBASE, Medline via PubMed, CINAHL Complete, APA PsycINFO, Cochrane Library, Web of Science and Scopus (up until 30 July 2023).

Review Methods

This review was guided by Arksey and O'Malley's Framework (2005) and the Preferred Reporting Items for Systematic Reviews and Meta-analysis-Scoping Review extension (PRISMA-ScR).

Results

Twenty-five studies that included 4914 participants were retrieved. Fourteen studies employed quantitative designs, eight used qualitative methods, two were mixed-methods studies and one used a qualitative meta-synthesis. Women who have undergone breast cancer surgery experience a wide range of complex and multifaceted unmet care needs. The informational/educational and psychological/emotional domains were the most frequently reported among the identified domains. Meanwhile, the sexual and spiritual/religious beliefs domains remained relatively underexplored. Furthermore, none of the assessment tools used in these studies captured the entirety of the possible domains of unmet care needs.

Conclusion

Needs assessment should be integrated into the routine care of women who have undergone breast cancer surgery. Interventions should be developed to address the unmet informational/educational and psychological/emotional needs of women. Future studies should employ high-quality mixed-methods approaches to explore women's sexual and spiritual/religious concerns.

Impact

This review provides a comprehensive overview of the unmet care needs of women who have undergone the breast cancer surgery. These findings will contribute to the development of tailored interventions. This review also informs future studies to explore distinct domains of unmet care needs.

Patient or Public Contribution

No patient or public contribution.

Optimization of solid oral dosage form administration to patients with swallowing difficulties: An integrative review

Abstract

Aim

To appraise and synthesize research investigating optimizing the administration of solid oral dosage forms (SODFs) to adults with swallowing difficulties.

Design

An integrative review.

Methods

An electronic search was conducted on Medical Literature Analysis and Retrieval System Online (Public Medline interface), Elsevier SciVerse Scopus and Scientific Electronic Library Online (updated February 2023). Restriction regarding the publication date was not considered for the inclusion of records. Studies addressing risks, general aspects, recommendations about patient postural adjustments, swallowing techniques, swallowing aids and aspects of concealment of SODFs were included.

Results

Fifty-three records published between 2002 and 2021 were included. The main administration risks were aspiration, asphyxia and solid oral dosage form-induced oral/oesophageal mucosal lesions. The most frequent general aspect reported was administering one oral dosage form at a time. The sitting position was the most patient postural adjustment mentioned. The most frequently reported solid oral dosage form swallowing technique was the lean-forward method for capsules. Solid oral dosage form swallowing aids cited: tongue and throat lubricant and solid oral dosage form coating device, swallowing cup and swallowing straw.

Conclusion

The literature data on administering SODFs for adults with swallowing difficulties were appraised and synthesized. Some aspects, for example, not administering SODFs simultaneously, can make swallowing safer. Postural adjustments and solid oral dosage form swallowing aids are important to avoid administration risks. Swallowing SODFs can be easier if learned by techniques. Liquid and food are helpful as vehicles, and several of these have been listed.

Implications for the Profession and/or Patient Care

By optimizing the contributing factors of administering oral pharmacotherapy, the nurse can use appropriate practices to improve patient safety. Additionally, knowing and establishing the administration aspects are reasonable steps for standardizing care for patients with swallowing oral dosage form difficulties.

Impact

This study addressed administering SODFs to adult patients with swallowing difficulties. The administration of SODFs to adult patients with swallowing difficulties can be optimized if only one oral dosage form at a time is administrated and if patient postural adjustments, swallowing techniques and swallowing aids are used. This investigation will impact the care of patients with swallowing difficulties.

Reporting Method

The authors declare they adhered to the relevant EQUATOR guidelines and report following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement.

Patient or Public Contribution

No patient or public contribution.

Experience of rehabilitation specialist nurses in providing bowel care for stroke patients: A qualitative study

Abstract

Aims

This study aims to explore the experiences of rehabilitation specialist nurses in providing bowel care to stroke patients and to identify the factors that either facilitate or hinder their practice.

Design

This was a descriptive qualitative design study.

Methods

Between May 2022 and October 2022, we conducted in-depth and semi-structured interviews with 12 rehabilitation specialist nurses from two tertiary hospitals in Changsha, China. Thematic analysis was employed to analyse the interview transcripts.

Findings

Three key themes were revealed from our analysis: (1) acceptance of bowel care as a process, (2) high level of recognition improves the experience and (3) challenges stemming from limited knowledge and rights. Acceptance of bowel care as a dynamic process, coupled with a high level of recognition, enabled nurses to prioritize the health and safety of patients over personal feelings and achieve professional accomplishments. However, they encountered challenges in terms of professional development and restricted prescribing rights for bowel care.

Conclusion

The experiences of rehabilitation specialist nurses in providing bowel care are dynamic. These findings have important implications for healthcare improvement, including the need for collaboration with healthcare professionals and nurturing nurses' self-identity, comprehensive training plans, innovative programs and expanding the scope of rehabilitation specialist nurses' rights.

Impact

This study enhances our understanding of the challenges faced by rehabilitation specialist nurses caring for stroke patients with neurogenic bowel dysfunction. The findings provide insights into how to enhance bowel care experience and develop further in this field.

Reporting Method

This study adhered to the EQUATOR guideline and utilized the COREQ checklist.

Patient or Public Contributions

This study involved participants who were registered nurses, and there were no contributions from patients or public.

Shattered childhood: Experiences of polio survivors in Finland 1950s and 1960s

Abstract

Aim

To describe the childhood experiences of patients with polio from the acute phase of the disease during post-war Finland in the 1950s and 1960s.

Design

Qualitative empirical study based on self-reported history of nursing rooted in the past, a history of experiences.

Methodology

Interview materials were gathered in the form of themes (45) and written interviews (4) (29 September 2018 to 30 June 2019). Data were analysed by reflexive thematic analysis to highlight hidden and latent experiences. This approach generated the study's main theme, themes and subthemes.

Results

The main theme, ‘shattered childhood’, generated from the study results and was then divided into two themes, both of which were influenced in part by the loss of a familiar childhood, the changed environment, the breakdown of the body and the absence of control. Through their childhood memories, polio survivors described their broken childhoods using the following themes: ‘betrayal by their bodies’ and ‘isolation’. In the narratives, the theme ‘betrayal by one's own body’ was generated by the following subthemes: ‘suddenness of the affliction’, ‘paralysis’ and ‘being moved to the hospital’. The ‘isolation’ theme developed from the subthemes ‘isolation from the body and surroundings’ and ‘emotional and social loneliness’.

Conclusion

Polio survivors' experiences during the acute stage of the disease were traumatic and demonstrated children's inferior nursing position in Finland in the 1950s and 1960s.

Impact

The study increases our understanding of the history of caring for children and families who were affected and disabled by polio and the importance of their experiences in society and healthcare settings.

Patient or Public Contribution

The authors collaborated with the Finnish Polio Association to recruit study participants and plan the study. Patients with polio during childhood underwent interviews, and their experiences formulated the data, which were analysed and the basis of the results.

Reporting Method

Consolidated criteria for reporting qualitative research (COREQ), a 32-item checklist for interviews and focus groups, have been used as a reporting and checklist tool. All authors have agreed on the final version and the use of the COREQ criteria, relationship with participants, theoretical framework, setting, data collection and data analysis and report.

Violence against nurses by patients and visitors in the emergency department: An integrative review

Abstract

Aim

This integrative review explored violence against emergency nurses by patients/visitors, examining its nature, contributing factors and consequences.

Design

Integrative review.

Data Sources

Articles were obtained from PubMed, CINAHL, EMBASE, Web of Science and PsycInfo databases, up until December 2021.

Review Methods

26 articles were reviewed, evaluating study quality with the Crowe Critical Appraisal Tool and synthesizing conclusions through theme development and coding.

Results

This review delves into the issue of violence perpetrated against emergency nurses by patients and visitors. It elucidates three overarching themes: the nature of violence, the contributing factors and the consequences of such acts.

Conclusion

The findings inform healthcare policy for the development of prevention approaches while identifying research gaps and emphasizing the need for alternative study designs and methodologies.

Impact

This review has implications for nursing practice, policymaking and research, emphasizing the need for stakeholder engagement and tailored interventions for at-risk emergency nurses.

No Patient or Public Contribution

This project was an integrative review of the literature therefore no patient or public contribution was necessary.

What Already is Known

Violence by patients and visitors in healthcare settings, especially in emergency departments, has garnered considerable attention.

What this Paper Adds

This review specifically examines violence-targeting emergency department nurses from patients and visitors, assessing its characteristics, contributing factors and consequences.

Implications for Practice/Policy

The findings will guide stakeholder engagement in developing interventions to support vulnerable emergency nurses.

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