Japan is now a super‐aged society, and the older population is estimated to reach 39.9% in 2060 (Cabinet Office, 2016). Long‐term care insurance was launched in 2000 to support the older population in community‐settings. Presently, many parents in their 80s who are receiving pensions are supporting their single children in their 50s who have experienced social withdrawal and been unemployed since their youth. This situation, commonly called the ‘8050 issue’, is increasing in Japan (Ministry of Health, Labour, and Welfare, 2019).
To explore newly employed nurses’ socialisation in the process of introduction into an oncological clinic from the perspectives of unit managers and newly employed nurses.
There are managerial challenges in retaining nurses at workplaces. The way in which nurses are socialised into their work is important for their job satisfaction and retainment.
Qualitative, semi‐structured interviews with seven nurses and two unit managers, and written introductory material. Thematic analyses were made, inspired by Goffman’s concepts of social interaction, back stage, front stage and roles. SRQR checklist was used.
Unit managers created the framework for socialising newly employed nurses through written introductory guidelines and assignments of supervisors as mainstream role models. Newly employed nurses were socialised gradually through mirroring their supervisors in their role as nurse. Front stage, patients often functioned as objects for newly employed nurses’ training. Back stage, patients often functioned as communication objects for all professionals. Newly employed nurses, who also demand roles such as transformer, boss, coordinator, prompter and friend, were socialised into the role of assistant to the doctor. Medical rounds functioned as a socialisator in this process.
The allocated supervisors were role models in socialising newly employed nurses into an oncological clinic and its culture. Nurses were socialised into an understanding of care as a biomedical orientation, in which medicine had a higher value than care in the existing knowledge hierarchy at the oncological clinic. This might have implications for who applies for and stays in the job.
Increased awareness of the importance of socialisation of nurses into the clinic during the introduction process. Re‐thinking nurses’ independent functions and patient perspectives in introduction of newly employed nurses to maintain and develop nursing as an independent profession.
To explore nursing students’ subjective experience of emotions during first‐year clinical placements, strategies used to manage their emotions, and socialisation to emotion management.
Emotion regulation is a key source of stress for early career and student nurses. Clinical placement experiences can elicit strong emotions in nursing students; however, they may be unprepared for the challenge of regulating their emotions in real‐world practice. How nursing students learn to manage their emotions in the clinical setting, whether they receive support for this, and how they are socialised to manage their emotions during placements, are not well known.
An exploratory qualitative study.
Semi‐structured interviews (n=19) were conducted with first year nursing students, exploring their experiences of emotion management during clinical placement. Interview transcripts were analysed using conventional qualitative content analysis. Reporting adheres to the COREQ Checklist.
Interactions with patients and staff often elicited negative feelings. Structured guidance for emotion management by supervising staff was scarce. Students used informal self‐reflection and interpretation to guide emotion management.
In the absence of strategic socialisation and formal support for effective emotion management, students used emotional labour strategies that can negatively impact on well‐being. A focus on adequately preparing nursing students for emotion work is a necessary component of classroom and clinical learning environments. Structured debriefing during clinical placements may provide a relevant context to discuss emotions arising during clinical work, and to learn emotion management strategies.
Emotional competence, a fundamental ability for registered nurses and students, supports personal health maintenance and strengthens professional practice. Students are exposed to clinical environments and interpersonal encounters that evoke strong emotions. They need situated learning strategies and formal support to develop knowledge and strengthen capability for emotion management, as this is essential for promoting professional development and patient care.
Internationally, health authorities and governments are warning older people that they are at a higher risk of more serious and possible fatal illness associated with COVID‐19. Mortality data from Oxford COVID‐19 Evidence Service (25/3/20) indicates a risk of mortality of 3.6% for people in their 60s, which increases to 8.0% and 14.8% for people in their 70s and over 80s. Therefore, the global recommendation for older populations includes social isolation, which involves staying at home and avoiding contact with other people, possibly for an extended period of time, currently estimated to be between three and four months. Older populations in this current context, refers to people over 70 years, and 50 years in some particularly vulnerable Indigenous populations.
What use are words at a time like this? I am writing this on 27th March as the world is plunging further into the coronavirus crisis. Like many worldwide, I am in virtual ‘lockdown’ in Australia while the exponential spread of the virus continues. At a follow‐up tele‐consult with my medical consultant recently, he said that he was apprehensive about the ‘calm before the storm’ that our health services face. He was deadly serious.
Personal resilience has been conceptualised in many different ways; however, a common definition is that resilience is the ability to cope successfully despite adverse circumstances (Henshall, 2020). Historically, the term ‘resilience’ encompasses both physiological and psychological aspects and the latter is personal to individuals, with some people having more developed strategies for personal resilience than others. Understandings of resilience vary between populations, contexts and cultures (McDonald et al., 2012), with resilience being viewed in some cases as an inherent personality trait and in others as a dynamic process existing on a continuum between resilience and vulnerability.
Clinicians’ knowledge and skills for evidence‐based practice (EBP) and organizational climate are important for science‐based care. There is scant literature regarding aligning organizational culture with EBP implementation and even less for unit and organizational culture. The Nursing EBP Survey examines individual, unit, and organizational factors to better understand registered nurses’ (RN) self‐reported EBP.
Establish and confirm factor loading, reliability, and discriminant validity for the untested Nursing EBP Survey.
The study employed a descriptive cross‐sectional survey design and was targeted for RNs. The setting included 14 hospitals and 680 medical offices in Southern California. The 1999 instrument consisted of 22 items; 7 items were added in 2005 for 29 items. The questionnaire used a 5 point, Likert‐type scale. The survey website opened in November 2016 and closed after 23 weeks. Psychometric testing and factor determination used parallel analysis, exploratory factor analysis, confirmatory factor analysis (CFA), and ANOVA post hoc comparisons.
One thousand one hundred and eighty‐one RNs completed the survey. All factor loadings in the CFA model were positive and significant (p < .001). All standardized loadings ranged from .70 to .94. The covariance estimate between Factor 1 and Factor 2 was marginally significant (p = .07). All other covariances and error variances were significant (p < .001). Final factor names were Practice Climate (Factor 1), Data Collection (Factor 2), Evidence Appraisal (Factor 3), Implementation (Factor 4), and Access to Evidence (Factor 5). Four of 5 factors showed significant differences between education levels (p < .05 level). All factors showed significant differences (p < .05) between inpatient and ambulatory staff, with higher scores for inpatient settings.
Nurses’ knowledge, attitudes, and skills for EBP vary. The 2019 Nursing EBP survey offers RNs direction to plan and support improvement in evidence‐based outcomes and tailors future EBP initiatives.
Anecdotal reports from across the country highlight the fact that nurses are facing major challenges in moving new evidence‐based practice (EBP) initiatives into the electronic health record (EHR).
The purpose of this study was to: (a) learn current processes for embedding EBP into EHRs, (b) uncover facilitators and barriers associated with rapid movement of new evidence‐based nursing practices into the EHR and (c) identify strategies and processes that have been successfully implemented in healthcare organizations across the nation.
A qualitative study design was utilized. Purposive sampling was used to recruit nurses from across the country (N = 29). Nine focus group sessions were conducted. Semistructured interview questions were developed. Focus groups were conducted by video and audio conferencing. Using an inductive approach, each transcript was read and initial codes were generated resulting in major themes and subthemes.
Five major themes were identified: (a) barriers to advancing EBP secondary to the EHR, (b) organizational structure and governing processes of the EHR, (c) current processes for prioritization of EHR changes, (d) impact on ability of clinicians to implement EBP and (e) wait times and delays.
Delays in moving new EBP practice changes into the EHR are significant. These delays are sources of frustration and job dissatisfaction. Our results underscore the importance of a priori planning for anticipated changes and building expected delays into the timeline for EBP projects. Moreover, nurse executives must advocate for greater representation of nursing within informatics technology governance structures and additional resources to hire nurse informaticians.
To develop knowledge about homecare professionals’ observational competence in early recognition of deterioration in frail older patients.
The number of frail older patients in homecare has been rising, and these patients are at higher risk of deterioration and mortality. However, studies are scarce on homecare professionals’ recognition and response to clinical deterioration in homecare.
This study applies an explorative, qualitative, mixed‐methods design.
The data were collected in two homecare districts in 2018 during 62 hours of participant observation, as well as from six focus group interviews. The data were subjected to qualitative content analyses. The Standards for Reporting Qualitative Research (SRQR) checklist was used to report the results.
The data analyses revealed two main themes and five sub‐themes related to homecare professionals’ observational practices. The first main theme entailed patient‐situated assessment of changes in patients’ clinical condition, i.e., the homecare professionals’ recognised changes in patients’ physical and mental conditions. The second theme was the organisational environment, in which planned, practical tasks and collaboration and collegial support were emphasised.
The homecare professionals in the two districts varied in their ability to recognise signs of patient deterioration. Their routines are described in detailed work plans, which seemed to affect assessment of their patients’ decline.
The results can inform homecare services on how homecare professionals’ observational competence and an appropriate organisational system are essential in ensuring early detection of deterioration in frail older patients.
To explore the gendered nature of the nursing working force To consider current initiatives and programmes to encourage men to enter the nursing profession. To understand some of the barriers to recruiting men into the nursing profession.
To identify training strategies and determine how registered health and social care practitioners change their practice post Mental Capacity Act training.
Narrative literature review
Seventeen databases were searched up to December 2019; CINAHL, Social Care Online, PubMed, Social Policy and Practice, Discover, Medline, Science Direct, Ovid, PsycINFO, ASSIA, Social Services Abstracts, Science Direct, Academic Search Premier, Web of Science, British Nursing Index, DH‐Data, King’s Fund Library Catalogue.
Empirical studies of any design investigating Mental Capacity Act training were searched and screened. Data were extracted to a bespoke spreadsheet and quality assessed. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, (PRISMA).
Of 162 papers identified, 16 were included comprising qualitative, quantitative and mixed methods studies. Trainees valued interactive training with close alignment to practice. Training did not lead to demonstrable practice change. Barriers in the context and cultures of care environments were identified.
To facilitate application of Mental Capacity Act legislation, identified barriers should be addressed. Future training should be interactive, scenario‐based and relevant to trainees’ practice.
The Mental Capacity Act is widely misunderstood and implementation poor. Training is proposed as a solution, but the nature of training that will positively affect practice remains unknown. This review aims to address this gap in the evidence base. Interactive training, using scenarios that reflect practice complexities, has the most positive impact. Cultural norms in care environments may impede application of this legislation.
The review has international relevance as there is a global imperative to adhere to the United Nations Convention on the Rights of Persons with Disabilities. The review will inform training design and delivery to ensure that people with impaired capacity to make decisions are given the best opportunity to act autonomously.
To describe mother’s experiences of feeding their extremely preterm infant.
When an infant is born extremely preterm, there is a long rocky road for the mother if she wants to breastfeed. Some manage to reach their goals, others do not. Studies of feeding extremely preterm infants in the neonatal intensive care unit (NICU) are scarce.
A qualitative method with an inductive approach.
Nine mothers giving birth to extremely preterm infants were interviewed by telephone after discharge from the NICU. The interviews were transcribed verbatim and analysed with qualitative content analysis. The COREQ checklist was followed.
The overall theme was “you can’t flight, you need to fight”. The theme reflects the mothers will to do the best for their infants even if the struggle with milk expression and breastfeeding practice evoked feelings of helplessness, exposure, worry, and disappointment. The categories forming the theme were: The wish to provide own breastmilk; For the infant’s best; Loss of control; Help to reach the goals.
The mothers had a strong will to provide breastmilk to their infants but requested more support in order to be successful.
There is a need for evidence based support programs for mothers of extremely preterm infants to encourage them to persevere with milk expression and breastfeeding over time.
To analyze, hierarchically, factors associated with hospital readmissions for acute coronary syndrome.
Hospital readmissions have risen, especially in patients with multiple comorbidities, which are most often chronic. The leading causes of hospital readmission include acute coronary syndrome, which is costly and often preventable. Determining clinical and non‐clinical variables that increase the chances of readmission is important to assess and evaluate patients hospitalized for coronary heart diseases.
A case‐control study whose dependent variable was hospital readmission for acute coronary syndrome.
The study included 277 inpatients, of whom 132 were in their first hospitalization and 145 had already been hospitalized for acute coronary syndrome. The independent variables for this hierarchical model were sociodemographic conditions, life habits, access to health services, and physical health measures. Data were obtained by interviews, anthropometric measurements, and patient records. Logistic regression analysis was performed using the stepwise technique, with Microsoft Excel and R version 3.2.3. The research was reported via the Reporting of Observational Studies in Epidemiology (STROBE).
In the final hierarchical logistic model, the following risk factors were associated with readmission for acute coronary syndrome: inadequate drug therapy adherence, stress, history of smoking for 30 years or more, and the lack of use of primary care health services.
Clinical and non‐clinical variables are related to hospital readmission for acute coronary syndrome and can increase the chance of readmission by up to six times.
The predictive model can be used to avoid readmission for acute coronary syndrome, and it represents an advance in the prediction of the occurrence of the outcome. This implies the need for a reorientation of the network for post‐discharge care in the first hospitalization for acute coronary syndrome.
To investigate the relationship between symptom burden, medication adherence, and spiritual well‐being in patients with chronic obstructive pulmonary disease (COPD).
The relationship between spirituality and medication adherence has been investigated in different chronic conditions. However, the relationship between symptom burden, medication adherence, and spiritual well‐being in patients with COPD has not been explored.
A descriptive correlational study design was adopted.
A total of 112 patients with COPD were included in the study. Data were collected using the COPD Assessment Test (CAT), the Adherence to Refills and Medications Scale‐7 (ARMS‐7), and the Functional Assessment of Chronic Illness Therapy‐Spiritual Well‐Being Scale (FACIT‐Sp). The data were analyzed using descriptive and correlational statistics. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) Checklist was used.
The CAT score was significantly higher in patients on long‐term oxygen therapy and those who had more than three comorbid conditions (p < 0.05). The mean score of ARMS‐7 was significantly associated with age (p < 0.05). Current smokers had higher ARMS‐7 and lower FACIT‐Sp scores (p < 0.001). The FACIT‐Sp score was negatively and moderately associated with the CAT and ARMS‐7 scores (p < 0.001).
This study concluded that individuals with higher spiritual well‐being had lower symptom burden and higher medication adherence. The need for long‐term oxygen therapy and a high number of comorbid conditions were associated with increased symptom burden. Current smokers had lower spiritual well‐being and medication adherence.
Spiritual well‐being should be evaluated when assessing symptom burden and medication adherence in clinical practice. In addition, further studies examining the causal relationship between symptom burden, spiritual well‐being, and medication adherence in different populations are warranted.
The aim of this study was to examine the knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses.
Pain is the most commonly reported symptom in patients presenting to the emergency department, with over half rating their pain as moderate to severe. Patients unable to communicate, such as critically ill intubated patients, are at greater risk of inadequate pain management.
This cross‐sectional exploratory study used survey methodology to explore knowledge, perceptions and factors influencing pain management practices among Australian emergency nurses.
Australian emergency nurses were invited to complete an online survey comprising 91‐items. The response rate was 450 of 1,488 (30.2%). STROBE guidelines were used in reporting this study.
Variations in level of acute pain management knowledge, especially in older, cognitively impaired or mechanically ventilated patients were identified. Poor interprofessional communication, workload and staffing negatively impacted on nurses’ intention to administer analgesia. For intubated patients, validated observation pain assessment instruments were rarely used, although respondents recognised the importance of pain management in critically ill patients.
Emergency nurses recognise the importance of pain relief. The ability to nurse‐initiate analgesia, education and training in pain management education is variable. Little education is provided on assessing and managing acute pain in elderly, cognitively impaired or mechanically ventilated patients. Use of validated pain assessment instruments to assess pain in critically ill patients is poor.
While pain management is the responsibility of all healthcare professionals, in the emergency department, it is a core role of emergency nursing. This study highlights the variation in ability to nurse‐initiate analgesia, level of acute pain knowledge, education and training, and use of validated pain assessment instruments to guide pain management in critically ill intubated patients.
This study explores nonverbal communication behaviours between general practice nurses and patients during chronic disease consultations.
Nonverbal communication is an important aspect of nurse‐patient lifestyle risk reduction conversations. Despite the growing role of general practice nurses in lifestyle risk modification when managing chronic disease, few studies have investigated how this communication occurs.
Observational study within a concurrent mixed methods project.
Thirty‐six consultations by 14 general practice nurses were video recorded between August 2017 and March 2018. Video analysis used the Nonverbal Accommodation Analysis System. A STROBE checklist was used to guide this paper.
Joint convergence of nurse‐patient behaviours such as laughing, smiling and eye contact were most common (44%; n=157). Patient‐nurse eye contact time decreased significantly across the consultation, while nurse gesturing increased significantly. No significant relationship between consultation length and convergent to divergent behaviour categorisation or nurse‐computer use across the consultation was found.
The high levels of convergent behaviours are promising for person‐centred care. However, scope exists to enhance nonverbal interactions around lifestyle risk reduction. Supporting nurses with skills and improved environments for lifestyle risk communication has potential to improve therapeutic relationships and patient outcomes.
These results indicate that nurses support patients through nonverbal interactions during conversations of lifestyle risk reduction. However, there are opportunities to improve this practice for future interventions.