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To explore the phenomenon of nurse–patient's illness experience.
A multicentre phenomenological qualitative study was conducted in Italy.
A convenience sample of nurses with an acute illness experience, requiring at least one hospitalisation of ≥ 3 days, was enrolled. Semi-structured interviews were conducted. Data were transcribed verbatim and analysed according to Giorgi's descriptive method. Ethics committee approval was obtained for this study. The COnsolidated criteria for REporting Qualitative research checklist guided the study reporting.
Eleven interviews were conducted from August 2022 to July 2023. The essential structure ‘being on the other side of the fence’ and six common themes, ‘role reversal’, ‘expanded awareness’, ‘professional identity’, ‘emotional swing’, ‘having experienced it on their own skin’ and ‘reframing the healthcare context’, were identified. Nurses' awareness of the healthcare system and pathways related to their professional background at the onset of their illness experience turns into an expanded awareness of the illness experience in itself, having it ‘lived on their own skin’. When nurses return from the ‘other side of the fence’ to their professional role this new awareness triggers a more compassionate and cognizant relationship with patients and colleagues.
This study highlights the lived experience of nurses who became patients, showing characterising elements of ‘being on the other side of the fence’ and the potential of this experience for expanding nurses' awareness of other patients' experiences under their care.
Nurse–patients' illness experience may be instrumental to reinforce nurses' awareness, empathy and any positive attitude or practice devised to improve patient's illness experiences and patient centred care in hospitals.
Nurses participated as interview respondents.
To explore the role of nurse practitioners (NPs) in delivering models of acute and urgent care in local communities informing the development of NPs as a solution to providing sustainable and effective healthcare in these settings.
Descriptive qualitative multicase study.
The study population comprised NPs, clinic managers and general practitioners from NP-led acute and urgent care clinics across urban and rural Aotearoa New Zealand. Data were gathered from 20 semistructured interviews across seven sites. Data were thematically analysed to identify themes. Clinic-level operational data relating to the governance, team structures, and service delivery models were also collated and content from these data was integrated into the analysis and findings.
Five key themes were identified: meeting the needs of the community; development of NP-led acute care services; NPs as part of the healthcare team; training and support systems and supporting junior NPs and NP candidates.
Nurse practitioners have a valuable role to play in delivering acute and urgent care services to local communities. Increasing awareness of the NP role, the prioritisation of community needs and strengthening training and support structures at both a workforce and clinic level were key findings from this research.
Findings from this research guided the development of a set of recommendations which consider community, clinic and wider national perspectives and aim to support the future growth of NP-led community acute/urgent care.
This research has adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines.
The authors have nothing to report.
To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress.
Nested diary study.
Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model.
Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses.
The study highlights accountability's dual role—safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures.
Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff.
By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes.
The study has adhered to STROBE guidelines.
No patient or public contribution.
To describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks.
Retrospective study.
The study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single-Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs.
Patients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care.
The inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes.
HL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge.
No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection.
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