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AnteayerInternacionales

Impact of authentic leadership on nurses' well‐being and quality of care in the acute care settings

Abstract

Introduction

Both nurses' well-being and quality of care are top priorities of the healthcare system. Yet, there is still a gap in understanding the extent and how authentic leadership influences them. This information is needed to inform the development of effective interventions, organizational practices, and policies. Thus, this study aimed to test the mechanism by which nurses' perception of their managers' authentic leadership impacts nurses' well-being and perception of quality of care, given the role of the nursing practice environment and nurses' psychological capital.

Design

A cross-sectional design was used.

Methods

This study recruited a random sample of 680 nurses from six hospitals in Saudi Arabia. A final sample of 415 completed the surveys, with a response rate of 61%. Structural equation modeling was performed to test the hypothesized model.

Results

The study showed that nurses' perceptions of authentic leadership in their managers positively and directly affect their perceptions of quality of care but do not directly affect nurses' well-being. Both the nursing practice environment and psychological capital fully mediated the relationship between authentic leadership and nurses' well-being. However, the nursing practice environment partially mediated the relationship between authentic leadership and perceptions of quality of care.

Conclusion

The findings contribute to understanding the crucial role of authentic leaders' style in nurses' well-being and quality of care through its positive impact on the nursing practice environment and psychological capital.

Clinical Relevance

Designing interventions and policies that specifically target nursing managers' authentic leadership style has implications for enhancing nurses' well-being and the quality of patient care. Institutional measures are needed to help leaders practice an authentic leadership style to create a positive nursing practice environment and cultivate nurses' psychological capital, both of which contribute to nurses' well-being and attaining a better quality of care. Further work is required to highlight the outcomes of implementing an authentic leadership style relevant to other leadership styles.

Promoting resident thriving in nursing homes: A qualitative study

Abstract

Aim

To explore how staff promote resident thriving in an Australian nursing home.

Design

Qualitative research design using content analysis.

Methods

Interviews were held with 14 nursing staff working in an Australian nursing home in March/April 2018. Data were analysed using qualitative content analysis.

Results

Four themes were revealed: promoting personalized care; promoting opportunities for autonomy; promoting connection and meaning; and promoting a curated environment.

Conclusions

Staff promoted resident thriving in relation to everyday care, activities, capabilities, relationships and the lived environment. Interventions that were perceived to promote thriving were described relative to the nurse, the resident, the care team and the wider nursing home context.

Implications for the Profession and/or Patient Care

The findings provide novel insight into the understanding and application of the concept of thriving in long-term care from nursing staffs' perspective.

Impact

What Problem did the Study Address?

Nursing home staff are uniquely positioned to support resident thriving through person-centred care, yet little is known about how staff support promotion of thriving for nursing home residents in their everyday practice.

What were the Main Findings?

Nursing home staff perceived that they promoted thriving by personalizing care and supporting autonomy, connection, meaning and pleasure for residents.

Where and on Whom will the Research have an Impact?

These findings are of interest for the clinicians, educators and researchers who develop, implement and evaluate interventions to improve place-related well-being in nursing homes.

Reporting Method

CORE-Q checklist.

Patient or Public Contribution

No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience.

Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study

Abstract

Aims

To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses.

Design

Mixed method explanatory sequential design.

Methods

A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena.

Results

Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not.

Conclusions

Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety.

Implications for the profession and/or patient care

Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety.

Impact

Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff.

Reporting method

Complied with the APA Style JARS-MIXED reporting criteria for mixed method research.

Patient or public contribution

No patient or public contribution.

Mapping health promotion practices across key sectors and its intersectoral approach at the local level: Study protocol

Abstract

Aims

This study outlines a protocol aimed at identifying and mapping health promotion practices in need of development from the perspectives of key sectors responsible for it at the local level and from an intersectoral perspective across four Spanish regions.

Design

A complementary multi-method study combining survey methods and qualitative interviews will be adopted.

Methods

Purposive snowball sampling will be employed to select potentially rich informants from city councils, primary care centres, primary and secondary schools, and public health and civil society organizations in 12 municipalities sensitive to local health. Data on the degree of execution of health promotion activities, the level of intersectorality in their implementation, and their origins will be collected using PromoACTIVA questionnaires, an intersectoral typology model and an interview protocol. A parallel mixed analysis encompassing descriptive statistics and a ‘framework analysis’ will be performed.

Discussion

This study is expected to yield thorough and reliable insights into health promotion practices and omissions at the local level by focusing on key stakeholders, both individually and collaboratively. This information can enhance health promotion planning and improve its effectiveness, efficiency and contextual relevance. The development and testing of a methodology for the integration and interpretation of these data will ensure sustainable capacity building.

Impact

Managers and practitioners interested in health promotion planning in the researched settings can benefit from a comprehensive map of the current state of their practices and insights into the starting points of collaboration. In addition, planners from other local settings will gain access to tools and methodologies to replicate and expand these maps to their own contexts.

Stakeholder Engagement

Engaging key stakeholders with experience working in or with primary care centres, public health organizations, primary and secondary schools, civil society organizations, and city councils was vital to ensure the study's relevance and feasibility.

Depression and anxiety among nurses during the COVID‐19 pandemic: Longitudinal results over 2 years from the multicentre VOICE–EgePan study

Abstract

Aims

To examine symptoms of depression and generalised anxiety among nurses over 2 years during the pandemic and compare them to the general population.

Background

The COVID-19 pandemic has led to a significant increase in mental stress among the population worldwide. Nursing staff have been identified as being under remarkable strain.

Design

A multicentre prospective longitudinal study.

Methods

Symptoms of depression and generalised anxiety in 507 nurses were examined at four different time points (T1: April–July 2020, T2: November 2020–January 2021, T3: May–July 2021, T4: February–May 2022). Results were compared with values of the German general population, presence of gender-specific differences was analysed and frequencies of clinically relevant levels of depression and anxiety were determined.

Results

Throughout the study (T1–T4), a significant increase in depressive and anxiety symptoms was observed. At all four measurement time points, nurses showed significantly higher prevalence for depression and anxiety compared to the German general population. No significant gender differences were found. Frequencies for probable depression and generalised anxiety disorder among nurses were: 21.6% and 18.5% (T1), 31.4% and 29.2% (T2), 29.5% and 26.2% (T3), 33.7% and 26.4% (T4).

Conclusion

During the pandemic, symptoms of depression and generalised anxiety among nurses increased significantly and remained elevated. Their symptom levels were permanently higher than in the general population. These findings strongly suggest that the circumstances of the pandemic severely affected nurses´ mental health.

Relevance to Clinical Practice

The COVID-19 pandemic caused a great mental strain on caregivers. This study was able to demonstrate the significant increase in depression and anxiety among nurses during the pandemic. It highlights the urgent need for prevention, screening and support systems in hospitals.

Implications for the Profession

Supportive programmes and preventive services should be developed, not least to prevent the growing shortage of nurses in the health care systems.

Reporting Method

The study adhered to relevant EQUATOR guidelines. The STROBE checklist for cohort study was used as the reporting method.

Patient Contribution

Five hundred and seven nurses completed the questionnaire and provided data for analysis.

Trial and Protocol Registration

The study was registered with the German Clinical Trials Register (https://drks.de/search/en) under the following ID: DRKS00021268.

Sustainable employability of long‐term care staff in self‐managing teams: A qualitative study

Abstract

Aim

To discover what long-term care (LTC) staff working in self-managing teams consider necessary to remain sustainably employable.

Design

Qualitative study with semi-structured interviews.

Methods

In 2020, semi-structured interviews were conducted one-on-one with 25 LTC workers from a medium-large Dutch organization providing long-term care. All interviews were audio-recorded, anonymously transcribed verbatim and analysed with thematic content analysis in the software program Atlas.ti.

Results

LTC workers indicated a need for autonomy. They wanted their control and involvement in decisions to be strengthened. Furthermore, LTC workers indicated a need for relatedness, by experiencing support, a feeling of togetherness and more time to have attention for the residents. Lastly, LTC workers expressed a need for (assistance in) further developing their competence.

Conclusion

In order to remain willing and able to work, LTC workers in self-managing teams want their needs for autonomy, relatedness and competence to be addressed. Working conditions are important to these LTC workers' sustainable employability since they can hinder or promote the satisfaction of their needs.

Implications

It is important that management in LTC is aware of the importance of LTC workers' needs for sustainable employability. We recommend that management critically reflect on and invest in addressing these needs by enhancing indicators and limiting inhibitors of the needs.

Impact

A robust LTC workforce is necessary to provide care to the aging population. In the context of the increasing implementation of self-managing teams in LTC organizations, understanding what workers in self-managing teams need in order to remain sustainably employable is crucial. For sustainable employability (i.e. to remain willing and able to work), interviewees indicated a need for autonomy, relatedness, and competence. Nearly all participants stressed the importance of belonging and feeling connected. Working conditions seemed to relate not only directly to the sustainable employability of LTC staff but also indirectly through their lack of contribution to the satisfaction of workers' psychological needs. The outcomes of this study primarily impact workers and management within LTC organizations with self-managing teams. They benefit from recognizing the significance of addressing workers' needs to ensure their essential and sustainable employability in the sector.

Reporting Method

The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative (COREQ) research were used.

Patient or Public Contribution

Two LTC workers provided advice and feedback regarding the materials and set up of the interviews. These two ambassadors additionally helped in reaching our population, by disseminating information about the study.

Children's and parents' experiences of home care provided by hospital staff: A scoping review

Abstract

Aims

To describe what is known from existing scientific literature on children's and parents’ experiences of hospital-based home care and to identify future research areas.

Design

The scoping review design used adheres to the methodological framework of Arksey and O'Malley, and to the PRISMA-ScR checklist.

Review Methods

A systematic search was conducted, and peer-reviewed scientific papers were screened through the application of Rayyan software. Data were extracted and presented in table and synthesised thematically as narrative text.

Data Sources

Searches were carried out November 2021 and updated November 2022 in the CINAHL, MEDLINE, Embase, Cochrane, Scopus, Web of Science, Academic Search Elite, and Amed databases and Google Scholar.

Results

A total of 1950 studies were screened and assessed for eligibility. Eight studies met the inclusion criteria by reporting on parents' experiences, whereas five out of these eight studies also reported on the experiences of children. Parents of children with cancer and preterm children reported feeling more in control, being empowered, and being more connected to their children's care team when their children were receiving hospital-based home care. The family's own resources were activated, and they felt more involved in their children's care compared to being in an inpatient setting.

Children with cancer, acute infection, chronic disease, and/or a syndrome reported feeling safer and more comfortable in their home environment and experienced better interaction with their care providers. Some aspects of the children's health-related quality of life (HRQOL) were improved.

Conclusion

The identified studies indicate that hospital-based home care is a valued alternative to traditional inpatient care by both parents and children. The mode of care has no crucial negative effects. Future studies should encompass the experiences of children with different diagnoses and syndromes and compare patients treated in a traditional hospital setting with those in a hospital-based home-care programme.

Relevance to Clinical Practice

Children's and parents’ experiences of HBHC indicate that it offers a good solution if parents are well prepared and feel in control. In addition, certain structural conditions must be in place before this type of care can be established: there must be a certain number of patients and the hospital must not be too far away. In the field of neonatal home care, professionals should be more responsive to fathers’ needs and tailor support by focusing on their individual experiences and needs. Our findings may guide and inform best practice for present and future providers of HBHC.

Implications for the Profession and/or Patient Care

Hospital-based home care can offer families a greater degree of autonomy, more flexible care options, improved family functioning, improved communication with care providers, and more control over the child's care. When certain structural conditions are met, such as a certain number of patients, the hospital not being too far away, and parents being well prepared and feeling in control, then hospital-based home care is valued as an alternative to traditional inpatient care. Specific aspects of children's HRQOL may improve, and the psychosocial burden on the family does not increase.

Impact

HBHC provides a valued alternative to traditional inpatient care and allows families to receive care in the comfort of their own home. Our findings may guide and inform best practice for present and future providers of hospital-based home care.

Reporting Method

In this scoping review, we have adhered to the Preferred Reporting Items for Systematic reviews and Meta Analyses Extension for Scoping Reviews checklist.

Patient or Public Contribution

There has been no direct patient or public contribution to the review.

Trial and Protocol Registration

Not required.

Enhancing blood pressure management protocol implementation in patients with acute intracerebral haemorrhage through a nursing‐led approach: A retrospective cohort study

Abstract

Aim

To evaluate the impact of nurse care changes in implementing a blood pressure management protocol on achieving rapid, intensive and sustained blood pressure reduction in acute intracerebral haemorrhage patients.

Design

Retrospective cohort study of prospectively collected data over 6 years.

Methods

Intracerebral haemorrhage patients within 6 h and systolic blood pressure ≥ 150 mmHg followed a rapid (starting treatment at computed tomography suite with a target achievement goal of ≤60 min), intensive (target systolic blood pressure < 140 mmHg) and sustained (maintaining target stability for 24 h) blood pressure management plan. We differentiated six periods: P1, stroke nurse at computed tomography suite (baseline period); P2, antihypertensive titration by stroke nurse; P3, retraining by neurologists; P4, integration of a stroke advanced practice nurse; P5, after COVID-19 impact; and P6, retraining by stroke advanced practice nurse. Outcomes included first-hour target achievement (primary outcome), tomography-to-treatment and treatment-to-target times, first-hour maximum dose of antihypertensive treatment and 6-h and 24-h systolic blood pressure variability.

Results

Compared to P1, antihypertensive titration by stroke nurses (P2) reduced treatment-to-target time and increased the rate of first-hour target achievement, retraining of stroke nurses by neurologists (P3) maintained a higher rate of first-hour target achievement and the integration of a stroke advanced practice nurse (P4) reduced both 6-h and 24-h systolic blood pressure variability. However, 6-h systolic blood pressure variability increased from P4 to P5 following the impact of the COVID-19 pandemic. Finally, compared to P1, retraining of stroke nurses by stroke advanced practice nurse (P6) reduced tomography-to-treatment time and increased the first-hour maximum dose of antihypertensive treatment.

Conclusion

Changes in nursing care and continuous education can significantly enhance the time metrics and blood pressure outcomes in acute intracerebral haemorrhage patients.

Reporting Method

STROBE guidelines.

Patient and Public Contribution

No Patient or Public Contribution.

Optimising wound monitoring: Can digital tools improve healing outcomes and clinic efficiency

Abstract

Background

Chronic wounds present significant challenges for patients and nursing care teams worldwide. Digital health tools offer potential for more standardised and efficient nursing care pathways but require further rigorous evaluation.

Objective

This retrospective matched cohort study aimed to compare the impacts of a digital tracking application for wound documentation versus traditional manual nursing assessments.

Methods

Data from 5236 patients with various wound types were analysed. Propensity score matching balanced groups, and bivariate tests, correlation analyses, linear regression, and Hayes' Process Macro Model 15 were utilised for a mediation-moderation model.

Results

Digital wound tracking was associated with significantly shorter healing durations (15 vs. 35 days) and fewer clinic nursing visits (3 vs. 5.8 visits) compared to standard nursing monitoring. Digital tracking demonstrated improved wound size reduction over time. Laboratory values tested did not consistently predict healing outcomes. Digital tracking exhibited moderate negative correlations with the total number of nursing visits. Regression analysis identified wound complexity, hospitalizations, and initial wound size as clinical predictors for more nursing visits in patients with diabetes mellitus (p < .01). Digital tracking significantly reduced the number of associated nursing visits for patients with peripheral vascular disease.

Conclusion

These findings suggest that digital wound management may streamline nursing care and provide advantages, particularly for comorbid populations facing treatment burdens.

Reporting Method

This study adhered to STROBE guidelines in reporting this observational research.

Relevance to Clinical Practice

By streamlining documentation and potentially shortening healing times, digital wound tracking could help optimise nursing resources, enhance wound care standards, and improve patient experiences. This supports further exploration of digital health innovations to advance evidence-based nursing practice.

Patient or public contribution

This study involved retrospective analysis of existing patient records and did not directly include patients or the public in the design, conduct, or reporting of the research.

A comparative vignette study: Evaluating the potential role of a generative AI model in enhancing clinical decision‐making in nursing

Abstract

Aim

This study explores the potential of a generative artificial intelligence tool (ChatGPT) as clinical support for nurses. Specifically, we aim to assess whether ChatGPT can demonstrate clinical decision-making equivalent to that of expert nurses and novice nursing students. This will be evaluated by comparing ChatGPT responses to clinical scenarios to those of nurses on different levels of experience.

Design

This is a cross-sectional study.

Methods

Emergency room registered nurses (i.e. experts; n = 30) and nursing students (i.e. novices; n = 38) were recruited during March–April 2023. Clinical decision-making was measured using three validated clinical scenarios involving an initial assessment and reevaluation. Clinical decision-making aspects assessed were the accuracy of initial assessments, the appropriateness of recommended tests and resource use and the capacity to reevaluate decisions. Performance was also compared by timing response generations and word counts. Expert nurses and novice students completed online questionnaires (via Qualtrics), while ChatGPT responses were obtained from OpenAI.

Results

Concerning aspects of clinical decision-making and compared to novices and experts: (1) ChatGPT exhibited indecisiveness in initial assessments; (2) ChatGPT tended to suggest unnecessary diagnostic tests; (3) When new information required re-evaluation, ChatGPT responses demonstrated inaccurate understanding and inappropriate modifications. In terms of performance, the mean number of words utilized in ChatGPT answers was 27–41 times greater than that utilized by both experts and novices; and responses were provided approximately 4 times faster than those of novices and twice faster than expert nurses. ChatGPT responses maintained logical structure and clarity.

Conclusions

A generative AI tool demonstrated indecisiveness and a tendency towards over-triage compared to human clinicians.

Impact

The study shows that it is important to approach the implementation of ChatGPT as a nurse's digital assistant with caution. More study is needed to optimize the model's training and algorithms to provide accurate healthcare support that aids clinical decision-making.

Reporting method

This study adhered to relevant EQUATOR guidelines for reporting observational studies.

Patient or public contribution

Patients were not directly involved in the conduct of this study.

The role of leadership in nurses' wellbeing and performance: A cross‐sectional survey using a dual motivational pathway model

Abstract

Aim

To examine the positive motivational paths from perceived autonomy-supportive leadership, and the negative motivational paths from perceived controlling leadership to satisfaction and frustration of basic psychological needs, work motivation, work performance, work engagement and somatic symptom burden among nurses using Self-Determination Theory.

Design

The study used a cross-sectional design mapping nurses' perceptions of the various study variables through a survey.

Methods

Nurses working in the municipal healthcare in Norway were recruited through an electronic questionnaire sent out via a link to their emails between 29th of August and 29th of September 2020. Of them, 219 nurses completed the questionnaire. Study hypotheses were tested using structural equation modelling.

Results

Higher levels of perceived autonomy-supportive leadership were associated with reduced levels of somatic symptom burden and increased levels of work performance and work engagement through the satisfaction of basic psychological needs and autonomous motivation, specifically identified regulation and intrinsic motivation. Perceptions of controlling leadership were associated with heightened levels of somatic symptom burden through basic psychological need frustration, amotivation and introjected motivation, along with lower levels of work engagement through need frustration and amotivation.

Conclusion

This study underscores the positive motivational paths of perceived autonomy-supportive leadership on nurses' work performance and wellbeing through the facilitation of basic psychological need satisfaction and autonomous motivation. Conversely, the study highlights negative motivational paths of perceived controlling leadership on reduced work engagement and heightened ill-being through the basic psychological need frustration, controlled motivation and amotivation.

Impact

This study provides insights and actionable recommendations for nurses and their leaders, emphasizing the significance of understanding the adverse impact associated with perceived controlling leadership. The findings underscore the importance of addressing these issues to mitigate detrimental effects on motivation and overall work functioning.

Patient or Public Contribution

No patient or public contribution.

A meta‐synthesis of the experience of paediatric nurses in communication with children

Abstract

Aim

This study aimed to conduct a meta-synthesis to explore the experiences of paediatric nurses in communication with children.

Method

We conducted a meta-synthesis review, following the outline proposed by Sandelowski, Barrosso & Voils. Our search encompassed six electronic databases, namely PubMed, Scopus, EBSCO (MEDLINE), Web of Science, SAGE, and Wiley. The Primary keywords used were “nurse”, “child”, “communication”, and “qualitative”. We included qualitative articles in English within the field of paediatric nursing between 1990 and 2023. Initially, 1980 records were identified which reduced to 1339 references after removing duplicates. Subsequently, we assessed 112 full-text articles for eligibility and 14 relevant studies were ultimately included in our review. Quality appraisal was conducted using the Critical Appraisal Skill Programme checklist with no study being excluded based on quality criteria. Data were synthesized using the qualitative thematic analysis method.

Results

The data analysis yielded three themes and seven sub-themes. These themes include swinging between triadic and dyadic communication, applying a hybrid of communication methods, and influential factor in communication.

Conclusions

This study highlighted the significance of establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse–parent–child) in paediatric care. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Additionally, identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments.

Implications

Understanding the communication process and the factors that influence it can be instrumental in equipping paediatric nurses with enhanced communication skills in their practice.

Impact

Establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse–parent–child) in paediatric care is crucial. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments.

Exploring intensive care nurses' perception of simulation‐based learning: A systematic review and meta‐synthesis

Abstract

Aim(s)

To explore intensive care nurses' (ICN) perceptions of simulation-based learning (SBL).

Design

A systematic review and meta-synthesis.

Methods

The review followed the PRISMA guidelines for reporting a systematic review. A systematic search strategy was developed using a modified PICo framework. A comprehensive search was conducted in July 2023 in CINAHL, OVID Embase, Medline complete, Web of Science, ERIC and Scopus databases for articles published in English between 2013 and 2023. Data were extracted using the Joanna Briggs Institute QARI Data Extraction, with data synthesis guided by Braun and Clark's thematic analysis approach. Quality appraisal was assessed using the CASP tool.

Results

Eleven studies providing qualitative data were included for analysis. Analysis and meta-synthesis led to the construction of two themes: The learning experience and professional growth through collaboration.

Conclusion

The review highlights the balance needed in finding the appropriate simulation approach, with the right level of fidelity, conducted at appropriately regular intervals, incorporating the correct makeup of professional team members, conducted in the right environment and facilitated by a skilled facilitator, to ensure best outcomes and return on investment for ICN's education.

Implications for Practice

These findings are a valuable resource for educators and organisations considering simulation-based learning initiatives in the intensive care setting.

No Patient or Public Contribution

This review involved analysis of existing literature and as such no unique patient or public involvement occurred.

Reporting Method

The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines.

Exploring older people's experiences of the interpersonal care relationship between nurses and patients during hospitalization in the pandemic period: A qualitative study

Abstract

Aim

This article presents the findings of a qualitative study focusing on the experiences of people aged over 70 years in the interpersonal nurse–patient care relationship in hospital settings during and after the COVID-19 pandemic. The aim was to analyse different aspects of this relationship, including nurses' behaviour and caring attitudes, the person-centred model of care, patients' involvement in their own care and communication in the hospital context.

Design

An exploratory qualitative study was conducted on the basis of an interpretative framework.

Methods

Six focus groups were conducted. A total of 34 participants were purposively recruited from three nursing homes in Spain, Italy and Portugal. Specific inclusion criteria were used to select participants.

Results

Five main categories were identified. Analysis revealed the importance of empathy and sensitivity in caring relationships, as well as the need for personalized and patient-centred care. The importance of effective communication and recognition of ageist behaviour by professionals was highlighted. In addition, independent of the pandemic, situational factors in the hospital environment were identified that influence the interpersonal care relationship.

Conclusions

The study highlights the need to promote a person-centred model of care that takes into account the specific preferences and needs of older people. This is achieved by identifying elements of the interpersonal nurse–patient relationship. In addition to highlighting the disparity of opinion regarding an active or passive role in self-care and decision making, the importance of addressing ageism and improving communication is emphasized.

What problem did the study address?

The importance of the patient–nurse relationship in hospital care has been highlighted in previous studies. Critical elements of the patient care experience have been identified as empathy and effective communication. Ageism in healthcare has been recognized as a potential barrier to patient-centred care.

What were the key findings?

The main findings highlight the importance of empathy and personalized care, emphasize the importance of effective communication and address ageist behaviours in the nurse–patient relationship.

Where and who will the research impact?

By highlighting the need for person-centred care and improved communication strategies, particularly in the context of caring for older patients during and after the COVID-19 pandemic, this research will have an impact on healthcare professionals, policy makers and carers.

Reporting Method

The COREQ guideline was used.

Patient or public contribution

This study adopted a collaborative approach to ensure that patient perspectives were integrated into the research process. We organized regular focus groups. Patients were actively involved in shaping the research questions, refining the study design and interpreting the emerging findings. Their valuable input helped us to understand the nuances of their experience and to prioritize the aspects that were critical to their well-being. In addition, their insights guided the development of practical recommendations aimed at improving the interpersonal care relationship between nurses and patients in hospital settings, ensuring that their voices were heard and reflected in the proposed interventions. This patient-centred approach fostered a sense of empowerment among the participants. It reinforced the notion that their experiences and opinions are integral to shaping healthcare practice.

Introduction of a Registered Undergraduate Student of Nursing workforce: A qualitative study of student and registered nurses

Abstract

Aim

To explore the benefits and challenges of a recently introduced Registered Undergraduate Student of Nursing workforce from the perspective of Nurses and Registered Undergraduate Students of Nursing, in a major metropolitan hospital in Australia in 2020.

Design

A qualitative descriptive study was undertaken using individual interviews and focus groups.

Methods

Purposively selected employed Registered Undergraduate Students of Nursing and nurses who worked with them were interviewed, using a semi-structured format. Recordings were transcribed and coded using NVivo software. Reflexive thematic analysis using an inductive approach was undertaken.

Results

Four major themes were revealed: (i) Navigating the programme, (ii) Belonging and integration; (iii) Patient care; and (iv) Continuing Development. Initial challenges were common, often related to clarifying the scope of practice for the new role. Ongoing issues were associated with gaps in understanding the role and lack of integration into the team. Mostly, nurses and Registered Undergraduate Students of Nursing built positive, professional relationships. Nurses valued the Registered Undergraduate Student of Nursing knowledge and skill level, reporting improved workload and work experiences when the Registered Undergraduate Student of Nursing was on shift. Nurses believed that the Registered Undergraduate Students of Nursing enhanced patient care. Registered Undergraduate Students of Nursing described positive, therapeutic relationships with patients. Registered Undergraduate Student of Nursing employment provided opportunities for new learning, leading to increased efficiency and confidence on clinical placement.

Conclusions

This employment model benefited the Registered Undergraduate Students of Nursing and nurses who worked with them. In the absence of adequate training and support, challenges remained unresolved and negatively impacted the experience for nurses. In addition to university-level education and clinical placement, the employment model can create a third space for student learning via on-the-job training. The study supports the ongoing employment of student nurses through the Registered Undergraduate Student of Nursing model.

Implications for the Profession and/or Patient Care

Impact

This study contributes to the very small body of literature investigating Registered Undergraduate Student of Nursing workforces in Australian hospitals. It is the first to explore the experiences of both nurses and students working together in a major metropolitan setting and also the first in the context of the COVID-19 pandemic. This study reflected a mostly positive experience for Registered Undergraduate Student of Nursing and the nurses who worked with them and highlighted the importance of adequate oversight and support in the implementation and maintenance of a Registered Undergraduate Student of Nursing workforce. Employed Registered Undergraduate Students of Nursing reported improved confidence, skills, and felt like they started clinical placement at an advantage, ready to step up and learn the Registered Nurse scope of practice. In addition to university-level education and clinical placement, this employment model creates a third space for learning via on-the-job training.

Reporting Method

COREQ guidelines were followed in the reporting of this study.

Patient or Public Contribution

No patient or public contribution.

Patients' and Nurses' experiences of caring in nursing: An integrative literature review across clinical practices

Abstract

Aim

To summarise, interpret and synthesize research findings on patients' and nurses' experiences of caring in nursing across clinical practices.

Background

Caring is a universal element of nursing; however, economic restrictions often negatively impact health services, and time shortages and limited numbers of staff may characterize care encounters. It is unclear how these contextual conditions affect patients' and nurses' experiences of caring.

Design and Methods

This integrative literature review covers papers published between 2000 and 2022. Four databases—PubMed, PsycINFO (via Ovid), MEDLINE (via Ovid) and CINAHL (via EBSCO)—were systematically searched for eligible papers in May 2022. The included studies were critically appraised. Content analysis was performed to interpret and synthesize the findings. In accordance with the EQUATOR guidelines, the PRISMA 2020 and PRISMA-S checklists were used. An Integrative review methodology guided the process.

Findings

In total, 33 studies were included in the review. Three themes captured the experiences of caring in nursing: (1) the complexity of the nursing care context, (2) the professionalism of the nurse, and (3) the trusting patient–nurse relationship.

Conclusion

The experience of caring in nursing depended on nurses' competence and discretion in the personal encounter framed by the nursing context. The caring relationship was based on reciprocity, but it remains asymmetrical, as the nurse had the power and responsibility to empower the patient. Barriers, such as increased demands for efficiency and resource scarcity, may hinder the experience of caring in nursing.

Implications for the profession and patient care

By promoting an ongoing discussion of caring in nursing, nurse management can systematically support nurses in reflecting on their practice in diverse and complex clinical contexts.

Patient or public contribution

No patient or public contribution was made due to the study design.

Characteristics and effectiveness of mentoring programmes for specialized and advanced practice nurses: A systematic review

Abstract

Aims

(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.

Design

A systematic review based on PRISMA guidelines.

Data Sources

From November 2022 until 7 December 2022, four databases were searched: PubMed, EMBASE, CINAHL and The Cochrane Library.

Review Methods

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).

Results

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.

Conclusion

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.

Impact

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.

No Patient or Public Contribution

Not applicable, as no patients or public were involved.

Development, Validation, and Usability of the Chatbot ESTOMABOT to Promote Self-care of People With Intestinal Ostomy

imageThis study aimed to describe the process of construction, validation, and usability of the chatbot ESTOMABOT to assist in the self-care of patients with intestinal ostomies. Methodological research was conducted in three phases: construction, validation, and usability. The first stage corresponded to the elaboration of a script through a literature review, and the second stage corresponded to face and content validation through a panel of enterostomal therapy nurses. In the third phase, the usability of ESTOMABOT was assessed with the participation of surgical clinic nurses, patients with intestinal elimination ostomies, and information technology professionals, using the System Usability Scale. The ESTOMABOT content reached excellent criteria of adequacy, with percentages of agreement equal to or greater than 90%, which were considered adequate, relevant, and representative. The evaluation of the content validity of the script using the scale content validity index/average proportion method reached a result above 0.90, and the Fleiss κ was excellent (P

Content Validation of a Questionnaire to Measure Digital Competence of Nurses in Clinical Practice

imageClinical practice nurses need adequate digital competence to use technologies appropriately at work. Questionnaires measuring clinical practice nurses' digital competence lack content validity because attitude is not included as a measure of digital competence. The aim of the current study was to identify items for an item pool of a questionnaire to measure clinical practice nurses' digital competence and to evaluate the content validity. A normative Delphi study was conducted, and the content validity index on item and scale levels was calculated. In each round, 21 to 24 panelists (medical informatics specialists, nurse informatics specialists, digital managers, and researchers) were asked to rate the items on a 4-point Likert scale ranging from “not relevant” to “very relevant.” Within three rounds, the panelists reached high consensus and rated 26 items of the initial 37 items as relevant. The average content validity index of 0.95 (SD, 0.07) demonstrates that the item pool showed high content validity. The final item pool included items to measure knowledge, skills, and attitude. The items included represent the international recommendations of core competences for clinical nursing. Future research should conduct psychometric testing for construct validity and internal consistency of the generated item pool.

A meta‐synthesis exploring nurses' experiences of assisted dying and participation decision‐making

Abstract

Aims and Objectives

To explore nurses' experiences of assisted dying and understand how their perspectives inform their participation decision-making.

Background

Assisted dying is a complex and contentious issue with the potential to create moral unrest for nurses. The nursing role in assisted dying varies between jurisdictions.

Design

Systematic review. A meta-synthesis using thematic analysis.

Methods

Three electronic databases were searched for primary qualitative studies published in English, from New Zealand, Australia or Canada, up to October 2022. Seven articles were included; themes were analysed and key themes were established. Reporting adhered to PRISMA.

Results

The findings highlight the complexity of nurses' decision-making about participation or non-participation in assisted dying and the moral, philosophical and social influences that impact on their decision-making. This is presented as a spectrum of influence which persuades or dissuades nurses to participate in assisted dying. The 12 themes have been categorised into four key themes: personal persuaders, personal dissuaders, professional persuaders and professional dissuaders.

Conclusions

The findings suggest that nurses should be involved in policy and procedure guideline development and be offered education and training programmes to ensure safe, confident and informed practice. The need for mentorship programmes was also prevalent in the research.

Relevance to Clinical Practice

It is crucial that nurses be offered education and training in assisted dying. Clear policy and procedure guidelines are essential, and nurses should be involved in the development of these.

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