Conectar
To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability.
A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation.
Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs.
Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies.
Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap.
Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce.
We have adhered to COREQ reporting guidelines (See supplemental file).
This study did not include patient or public involvement in its design, conduct, or reporting.
Administering supplemental oxygen to prevent hypoxaemia is a fundamental treatment for patients hospitalised with acute injury or illness. However, the amount of oxygen administered frequently exceeds that needed to maintain normoxaemia, causing patients to experience hyperoxaemia and wasting supplemental oxygen. Closed-loop, autonomous oxygen titration systems are designed to optimise oxygen delivery by administering the lowest possible oxygen flow that maintains peripheral oxygen saturation (SpO2) within a predefined range. For adults hospitalised with an acute injury or illness, it remains uncertain whether the use of a closed-loop, autonomous oxygen titration system safely increases the proportion of time spent in normoxaemia (SpO2 90%–96%) compared with usual care.
The Strategy to Avoid Excessive Oxygen using Autonomous Oxygen Titration Intervention trial is a multicentre, unblinded, parallel-group, randomised trial being conducted at four level 1 trauma centres in the USA. The trial compares an autonomous oxygen titration system versus usual care among 300 adults hospitalised for major trauma, burn, acute care surgery or acute respiratory illness. The primary outcome is the proportion of patient-time spent within the targeted normoxaemia range (SpO2 90%–96%) as measured by continuous non-invasive pulse oximetry, during the first 72 hours after randomisation. Secondary outcomes include the amount of supplemental oxygen administered and the proportion of time spent in hypoxaemia (SpO22 >96%). Specifying the protocol and statistical analysis plan before the conclusion of enrolment increases the rigour, reproducibility and interpretability of the trial. Enrolment began on 6 May 2024.
The trial protocol was approved by the single institutional review board at the University of Colorado School of Medicine and the Office of Human Research Oversight at the Department of Defense. We will present the results at scientific conferences and submit them for publication in a peer-reviewed journal.
In this commentary, I consider the disparity between the care we see as a necessity for cancer patients and the lack of care we afford to many persons with chronic disease.
I ground my arguments in my own clinical practice and research experiences over a 50-year period augmented by reference to available literature sources.
In tracing developments within the fields of cancer and chronic illness care, I draw on my own research and that of others.
Although chronic illness has long been recognised as causing the majority of the burden on our health care systems and as a significant source of suffering in our society, it has not attracted the level of enthusiasm from researchers, policy makers, and health care systems that we have seen in the context of other diseases such as cancer. Nurses have an intimate knowledge of the suffering occasioned by chronic illness; however, it has been difficult for nursing to mobilise coordinated action in prioritising a re-balance of health systems to better serve those with chronic conditions.
The advent of medical assistance in dying in Canada has shed a spotlight on the implications of the discrepancy between our prioritising patient need in the care and support of patients with conditions such as cancer, in contrast with the supports and services we make available to those with chronic conditions.
Although nursing intimately engages with the burden of chronic illness, it has not mobilized coherent advocacy toward strengthening our societal commitment to this aspect of our care systems.
There is an opportunity for nursing to make a meaningful difference in a fundamental health care system inequity if we can come to understand that chronic illness is as deserving of our collective research, practice change, and policy attention as is cancer.
No patient or public contribution.
by Sally Lindsay, Janice Phonepraseuth, Van Slothouber, Jaden Lo, Jennifer N. Stinson, Sharon Smile
BackgroundRacially minoritized youth with disabilities often encounter more extensive forms of discrimination. However, little is known about youth perspectives for addressing disability-related and other forms of discrimination, which is important for enhancing the participation and inclusion of youth with disabilities. This study explored the recommendations of youth with disabilities for addressing barriers and multiple forms of discrimination.
MethodsThis study involved in-depth interviews with a purposive sample of 20 youth with disabilities. We applied an inductive thematic analysis to the transcripts.
ResultsOur findings highlighted the following key themes: (1) addressing barriers in healthcare, education, employment and the legal system; (2) community, social supports and resources; (3) advocacy; and (4) inclusive policies and youth involvement.
ConclusionsThere is a critical need for more inclusive services and support for youth with disabilities, especially those with multiple minoritized identities, to foster safe environments and quality of life.
This discussion paper explores the group experience of a cohort of eight nurses completing our university's first professional nursing doctorate programme.
This paper aims to make sense of our shared experience and to contribute to what is known about doctoral study by sharing our insights.
Discursive paper.
Through individual and group reflections on our experience, we address the questions ‘why did we stay’? and ‘how do we make sense of the fact that we all, as a group, successfully completed the programme’? We drew on principles of collaborative and collective auto-ethnography to guide our group reflexivity in response to these questions.
The main reasons we gave for staying were: (i) commitment, which had three strands - ‘proving’, ‘obligation’ and ‘self-determination’ - and (ii) shared-identity and common humanity. The two further elements that helped us make sense of our cohort's completion were (i) the joy of learning together and (ii) professional friendship and Socratic inquiry.
As the first programme cohort for the nursing doctorate in our area, we became a close and supportive group, which we argue contributed to our success. We ascribed this to our characteristics as doctoral students and the creation of a sisterhood reminiscent of a community of practice. We also acknowledged the importance of the WhatsApp platform in facilitating group cohesion, and the sense of reflexive closure brought by the process of reflection at the end of our programme.
We recommend that doctoral cohorts, supervisors, and teaching teams systematically plan opportunities into programmes for organic relationship development and consider how the literature on communities of practice and academic persistence might support academic development. Academic staff could also encourage students to set up an online communication channel such as WhatsApp or similar at an early stage in their programmes and give particular consideration to closure and transition to post-doctoral practice on completion of professional doctorates.
To explore oncology nursing advance care planning practices and understand how to better support nurses in conducting advance care planning with patients and their families.
Qualitative interpretive descriptive methodology.
Semi-structured, individual telephone or Zoom interviews with 19 oncology nurses in a Western province of Canada between May and August 2022. Interviews were audio-recorded, transcribed, de-identified, and analysed using inductive, thematic, and constant comparative techniques.
Oncology nurses highlighted several factors affecting their ability to engage in advance care planning, including (1) uncertainties related to the nursing role in advance care planning, such as how and when a nurse ought to engage; (2) the educational, experiential, and training environment; and (3) structural barriers, such as a lack of time, space, and privacy; models of care that inhibit nurses from developing longitudinal relationships with their patients; and team dynamics that affect advance care planning interdisciplinary collaboration.
To create environments that support oncology nurses to conduct advance care planning, the findings suggest uncertainties be addressed through a clear and cohesive organisational approach to advance care planning and ongoing, integrated educational opportunities. Further, service delivery models may need to be restructured such that nurses have dedicated time and space for nurse-led advance care planning and opportunities to develop trusting relationships with both patients and their interdisciplinary colleagues.
Oncology nurses recognised the value of advance care planning in supporting patient-centred care and shared decision making, yet they reported limited engagement in advance care planning in their practice. To support oncology nurses in conducting advance care planning, healthcare leaders may address (1) advance care planning-related uncertainties and (2) structural barriers that prevent nurses from engaging in advance care planning with patients and their families. Findings may guide modifications to care models, enhancing support for oncology nurses in conducting advance care planning.
We selected and adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) as the most applicable guideline.
No patient or public contribution.
FreshRSS