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To evaluate registered nurses' perceptions of whether the mandated use of the early warning system vital signs tool impacts the development of nurses' higher-order thinking skills.
A concurrent mixed methods study design.
Using an online survey, registered nurses' perceptions were elucidated on whether early warning system algorithmic tools affected the development of their higher-order thinking. Likert-type matrix questions with additional qualitative fields were used to obtain information on nurse's perceptions of the tool's usefulness, clinical confidence in using the tool, compliance with escalation protocols, work environment and perceived compliance barriers.
Most of the 305 (91%) participants included in the analysis had more than 5 years of nursing experience. Most nurses supported the early warning tool and were happy to comply with escalation protocols if the early warning score concurred with their assessment of the patient (63.6%). When the score and the nurse's higher-order thinking did not align, some had the confidence to override the escalation protocol (40.0%), while others omitted (69.4%) or inaccurately documented vital signs (63.3%) to achieve the desired score. Very few nurses (3.6%) believe using early warning tools did not impede the development of higher-order thinking.
Although experienced nurses appreciate the support of early warning tools, most value patient safety above the tools and rely on their higher-order thinking. The sustained development and use of nurses' higher-order thinking should be encouraged, possibly by adding a critical thinking criterion to existing algorithmic tools.
The study has implications for all nurses who utilize algorithmic tools, such as early warning systems, in their practice. Relying heavily on algorithmic tools risks impeding the development of higher-order thinking. Most experienced nurses prioritize their higher-order thinking in decision-making but believe early warning tools can impede higher-order thinking.
Registered nurses participated as survey respondents.
To compare student nurses' expectations and newly qualified nurses' experiences regarding clinical practice in Switzerland 1 year after graduation.
A secondary explorative analysis of a cross-sectional survey.
The data were sourced from the Swiss National Graduate Survey of Health Professionals covering six universities of applied sciences between 2016 and 2019, with information on three cohorts of bachelor student nurses, with a 1-year follow-up between each year. The participants were 533 bachelor-prepared nursing graduates.
The student nurses' overall expectations included the following top two prioritized aspects: ‘contributing to something important’ and ‘adequate time to spend with patients’. Newly graduated nurses' clinical practice experiences demonstrated that not all expectations were met 1 year after graduation. The largest gaps were found in ‘adequate time to spend with patients’, ‘work–life balance’ and experiencing ‘good management’.
The most crucial expectation gaps are related to having sufficient time to spend with patients and a good work–life balance. The most important result is whether there is a shortage of places for nurses to work rather than the oft-cited shortage of nurses.
The expectations of Swiss newly qualified nurses can be better met by an assessment in the first year about which individual perceptions of workplace characteristics cause them to make choices to change something about their work, affect their job satisfaction or influence their intention to stay.
Few of the student nurses' expectations were met 1 year after graduation, therefore Swiss healthcare institutions should improve needs assessments to strengthen the nurse workforce starting early in employment. The results underscore the importance of a constructive management culture, such as that in magnet hospitals in the United States which underpins the philosophy of changing in nursing. The results can be used internationally as a benchmark and as a basis for introducing potential interventions for nurse retention.
This study was reported following the Standardized Reporting of Secondary Data Analyses Checklist.
There were no patient or public contributions.
This study has not been registered.
To develop a trigger tool for parents and lay caregivers of children with medical complexity (CMC) at home and to validate its content.
This was a multi-method study, using qualitative data, a Delphi method and a concept mapping approach.
A three-round electronic Delphi was performed from December 2021 to April 2022 with a panel of 23 expert parents and 30 healthcare providers, supplemented by a preliminary qualitative exploration of children's signs of deterioration and three consensus meetings to develop the PArents' Trigger Tool for Children with Medical Complexity (PAT-CMC). Cognitive interviews with parents were performed to assess the comprehensiveness and comprehensibility of the tool. The COREQ checklist, the COSMIN guidelines and the CREDES guidelines guided the reporting respectively of the qualitative study, the development and content validity of the trigger tool and the Delphi study.
The PAT-CMC was developed and its content validated to recognize clinical deterioration at home. The tool consists of 7 main clusters of items: Breathing, Heart, Devices, Behaviour, Neuro-Muscular, Nutrition/Hydration and Other Concerns. A total of 23 triggers of deterioration were included and related to two recommendations for escalation of care, using a traffic light coding system.
Priority indicators of clinical deterioration of CMC were identified and integrated into a validated trigger tool designed for parents or other lay caregivers at home, to recognize signs of acute severe illness and initiate healthcare interventions.
The PAT-CMC was developed to guide families in recognizing signs of deterioration in CMC and has potential for initiating an early escalation of care. This tool may also be useful to support education provided by healthcare providers to families before hospital discharge.
Parents of CMC were directly involved in the selection of relevant indicators of children's clinical deterioration and the development of the trigger tool. They were not involved in the design, conducting, reporting or dissemination plans of this research.
To highlight the value of utilizing the Listening Guide methodology for nursing research and provide an exemplar applying this methodology to explore a novel concept in an underrepresented group—inner strength in persons newly diagnosed with mild cognitive impairment along with their care partners.
Methodology discussion paper.
The exemplar study used the Listening Guide methods for data elicitation and analysis. Methods included adaptations for the study population and novice qualitative researchers.
The Listening Guide methodology with adaptations enabled the research team to centre the voices of persons living with mild cognitive impairment, highlight an abstract phenomenon and attend to the influences of the sociopolitical context. Further, this methodology helped address common challenges emerging qualitative researchers encounter, including understanding methods of application, engaging reflexively and immersing in the data.
The Listening Guide is a voice-centred qualitative methodology that is well suited to foreground the experiences of groups underrepresented in research and explore emerging phenomena.
Nurses are central to striving for health equity. The Listening Guide methodology offers a valuable and accessible research tool to understand the experiences and needs of underrepresented groups and shape healthcare in response.
The Listening Guide methodology can be broadly applied to research with persons with mild cognitive impairment, and other underrepresented groups, to explore other phenomena beyond inner strength and move the science forward in representing the perspectives of groups underrepresented by research.
Persons living with cognitive impairment and their care partners participated in study conceptualization, interview guide development, methods development and dissemination plans.
To explore the feasibility of development and implementation of an educational intervention addressing sexual and gender minority healthcare issues; examine recruitment processes and instrument appropriateness.
Non-randomized feasibility study.
The educational intervention was developed and implemented in family nurse practitioner courses with data collection from August through December 2022. Clinical preparedness, attitudinal awareness and basic knowledge were measured using the lesbian, gay, bisexual and transgender Development of Clinical Skills Scale.
Development and implementation of the intervention was feasible but will require amendment before progressing to the pilot study. Clinical preparedness and basic knowledge increased post-intervention, but attitudinal awareness did not improve. Recruitment did not achieve the desired sample size. Instrument internal consistency reliability was confirmed.
Feasibility was established but will require amendment prior to the pilot study.
To prepare nurses and nurse practitioners to care for sexual and gender minority patients.
This study addressed the feasibility of developing and implementing a sexual and gender minority healthcare education using an e-Learning platform. Findings confirm that the intervention was feasible but will require amendment. The intervention increased knowledge and clinical preparedness in caring for this population, but recruitment was challenging. This research will impact nurses, nurse practitioners and nurse educators.
The authors adhered to the relevant EQUATOR guidelines. The Consolidated Standards of Reporting Trials guideline extension for reporting randomized and feasibility guidelines were used.
Sexual and gender minority community members contributed to the intervention development.
The feasibility of using interactive e-learning educational resources to provide sexual and gender minority healthcare curriculum. Evidence to support the use of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale to measure learning outcomes.
This study was not prospectively registered because it was an educational intervention involving graduate student nurses and did not assess clinical outcomes of patients.
(1) To identify, evaluate and summarize evidence about the objectives and characteristics of mentoring programmes for specialized nurses (SNs) or nurse navigators (NNs) and advanced practice nurses (APNs) and (2) to identify the effectiveness of these programmes.
A systematic review based on PRISMA guidelines.
From November 2022 until 7 December 2022, four databases were searched: PubMed, EMBASE, CINAHL and The Cochrane Library.
Study selection was performed independently by two researchers. Disagreements were discussed until consensus was reached. Data extraction was undertaken for included studies. Data synthesis was conducted using narrative analysis. Quality appraisal was performed using the Critical Appraisal Skill Programme (CASP) and Mixed Methods Appraisal Tool (MMAT).
Twelve articles were included, all of which focused on mentoring programmes for APNs. Different forms of mentorship (e.g. (in)formal mentorship, work shadowing, workshops) were reported. Studies reported positive outcomes on job retention (n = 5), job satisfaction (n = 6), skills improvement (n = 7), satisfaction with the programme (n = 7) and confidence improvement (n = 4) among participants of mentoring programmes.
There is a lack of uniformity and consistency in various elements of mentoring programmes. Further research is needed to develop mentoring programmes for both APNs and SNs/NNs in a systematic and theoretically underpinned manner. It is necessary to establish a thorough evaluation methodology, preferably using a mixed methods design that includes both a qualitative process evaluation and a comprehensive outcome evaluation using validated questionnaires, taking into account the NN/APN, the interprofessional team and organizational level.
The synthesis of evidence may be useful to organizations developing and implementing mentoring programmes for both SN/NN and APN. The development of a mentoring programme for nursing experts should be considered a complex intervention that requires theoretical frameworks and contextual considerations.
Not applicable, as no patients or public were involved.
Identification and synthesis of research data related to the roles and competencies of physicians and nurses that are prerequisites for careful shared decision-making with patients potentially undergoing cardiac surgery.
A scoping review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews and the PRISMA Extension for Scoping Reviews.
PubMed, EMBASE and CINAHL were searched from inception dates up to March 2022, to identify primary studies published in a peer-reviewed journal. Study selection, assessment of the methodological quality and data extracting of the included studies were done by at least two independent researchers. To describe the findings of the studies, an emergent synthesis approach was used to visualize a descriptive representation of professional roles and competencies in shared decision-making, in an overview.
The systematic search revealed 10,055 potential papers, 8873 articles were screened on title and abstract and 76 full texts were retrieved. Eight articles were included for final evaluation. For nurses and physicians, 26 different skills were identified in the literature to practice shared decision-making in cardiac surgery. The skills that emerged were divided into five professional roles: moderator; health educator; data collector; psychological supporter and translator.
This review specifies the professional roles and required competencies related to shared decision-making in cardiac surgery. Further research is needed to compare our findings with other clinical areas and from there to arrive at a professional division of roles between the different clinical disciplines involved.
The visualization of generic shared decision-making competencies and roles should establish the professional division of positions between various clinical physician and nurse disciplines in order to create a treatment plan based on evidence, values, preferences and the patient's personal situation.
No patient or public contribution.
Health professionals witness pain and suffering when they care for sick people and their families. Compassion is a necessary quality in their work as it combines the will to help, alleviate suffering and promote the well-being of both the people they are attending and the professionals themselves. The aim of the study was to design and evaluate the psychometric properties of the Capacity for Compassion Scale (CCS).
A quantitative, descriptive and cross-sectional study was carried out to evaluate the psychometric properties of the scale (reliability, temporal stability, content validity, criterion validity and construct validity).
The study was carried out in two phases: pilot study and final validation. The data were collected between April and May 2022. The sample was selected by convenience sampling and was made up of a total of 264 participants, 59 in the pilot phase and 205 in the final validation.
The Capacity for Compassion Scale has been shown to have good psychometric properties in relation to reliability, temporal stability, and content, criterion, and construct validity. Factor analysis showed that there were four subdimensions of the scale: motivation/commitment, presence, shared humanity and self-compassion. The results also indicate that compassionate ability is significantly correlated with age and work experience.
The Capacity for Compassion Scale shows adequate psychometric properties. This instrument measures the compassion capacity of health professionals, which is a valuable discovery for new lines of research in this field.
Through this scale, low levels of capacity for compassion can be detected that negatively influence the quality of care provided by health professionals. The Capacity for Compassion Scale can therefore contribute to the identification of needs and promote training around compassion for health professionals.
No patient or public contribution.
Compassion in health professionals has positive effects on improving the quality of care, the satisfaction of professionals and the work environment. There are compassion cultivation programmes whose validity has been proven for the development of the dimensions of compassion. There is no specific instrument that measures capacity for compassion in healthcare professionals.
A scale is designed to measure capacity for compassion in health professionals. This is the only such scale available up until now. The scale measures four dimensions of compassion: motivation/commitment, presence, shared humanity and self-compassion.
The development of specific programmes that can increase the compassion of health professionals with all the benefits that this can bring to health care is encouraged. It will be possible to analyse the effects of training programmes on the cultivation of compassion.
To explore the prevalence of social isolation among Japanese community-dwelling older adults before and during the COVID-19 pandemic as well as determine how family and friend connections before and during the pandemic affected frail older adults during the pandemic.
A cross-sectional study.
A total of 852 community-dwelling older adults in Hokkaido and Tokyo, Japan were surveyed conducted between April and November 2021 using convenience sampling. The Lubben social network scale-6, frailty screening index, and geriatric depression scale were used to assess social isolation, frailty and depression, respectively. A path analysis was conducted to evaluate the effect of social isolation on frailty.
Participants had a mean age of 76.8 ± 6.6 years. Overall, 46% and 59% of participants were socially isolated before and during the COVID-19 pandemic, respectively. Frailty was found in 19% of participants during the pandemic. Friends and family connectedness before the pandemic had no direct relationship with frailty; only friend connectedness affected frailty indirectly via depression. Family connectedness during the pandemic had a significant, negative and direct relationship with frailty.
The findings show that connectedness with family and friends is critical for older people's physical and mental health.
Nurses in the community should consider these findings to reduce mental health problems and physical decline among older adults. It is important to identify older adults who are socially isolated from their families or friends and provide resources to help them build relationships within their communities.
Community centre staff and community volunteers assisted in data collection. The public was not involved in data analysis, interpretation or manuscript preparation.
To obtain consensus on barriers and facilitators to nurse prescribing following its recent introduction in Spain.
A three round online Delphi survey and focus group.
An exploratory method was used with three consecutive rounds of questionnaires based on anonymity and feedback, and a focus group. The study was carried out with primary care, specialized care, socio-health care and manager nurses.
On the basis of the Delphi study that was conducted, a list of 15 barriers and 18 facilitators of nurse prescribing was obtained. However, no general consensus was found with respect to the prioritization of these barriers/facilitators. The analysis of the results of the focus group confirmed the information obtained from the Delphi study. The main barriers highlighted were dependence on the figure of the physician, insufficient training in pharmacology, a lack of institutional support and the limited list of products that could be prescribed. The key facilitators were academic knowledge and ongoing training and education, independence in the functions and responsibilities of the nursing profession, adaptation to new roles and autonomy in the case of chronic care processes.
Nurses were generally positive about the introduction of nurse prescribing. The commitment of nurses to training and their accreditation as prescribers (internal forces) and health policy and nursing management (external forces) play a fundamental role in supporting the basis of nurse prescribing and ensuring that it is developed with the identified support resources, such as staff training and the provision of the materials necessary for its proper implementation, all with the aim of guaranteeing quality healthcare.
Strong models of nurse prescribing are being considered globally to address population needs. The results can help the future implementation of non-medical independent prescribing and provide guidance to the government and society on the interventions that can be used to consolidate it.
What problem did the study address? By 2027, the world's population will receive more than 4.5 trillion doses of medicine each year. However, the WHO estimates a projected shortfall of 10 million health workers by 2030. Inadequacies with traditional physician-led care systems mean that new approaches are imperative to maintain patient access to prescription medicines, with NP being a key element in this regard. In Catalonia (Spain), the accreditation process for nurses as prescribers was implemented in 2021. It is therefore of vital importance to question and consult the nurses themselves, the main promoters of the process, to find out their perceptions and thus be able to take them into consideration in the implementation process. What were the main findings? A total of 15 barriers and 17 facilitators were identified. The main perceived barriers are dependence on the figure of the physician, insufficient training in pharmacology during undergraduate studies and a lack of institutional support. The main perceived facilitators are academic knowledge and ongoing education and training, independence in nursing functions and responsibilities, and adaptation to new roles and tasks. Where and on whom will the research have an impact? These results can contribute to improving NP implementation in Spain and serve as a reference for other countries, especially where NP education and training have only recently been instigated or are in the planning process.
Standards for reporting qualitative research: a synthesis of recommendations. SRQR.
No patient or public contribution.
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