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AnteayerInternacionales

Caring for the carers in a public health district: A well‐being initiative to support healthcare professionals

Abstract

Aims and Objectives

To assess the impact of the proactive organisational resource allocation in terms of a 6‐week well‐being initiative to support public healthcare professionals' workplace engagement, well‐being and job satisfaction.

Background

Burnout of healthcare professionals can be a major cost to the Australian economy and public healthcare sector. According to the social exchange theory, when healthcare professionals perceive that their organisation proactively allocates resources to caring for its employees, then they are more likely to reciprocate and become more engaged in their work roles.

Design

The study used a pre‐ and postsurvey of healthcare professionals who participated in the well‐being initiative.

Methods

Between February–June 2019, 172 healthcare professionals were surveyed before and after a well‐being initiative. The survey included questions on workplace engagement, workplace well‐being and job satisfaction. Paired t tests were used to determine whether the difference between before and after averages was significant. The TREND statement was used to ensure the quality reporting of this study.

Results

The well‐being initiative had a positive impact on the healthcare professionals involved in the initiative. Nursing staff benefitted the most from the well‐being initiative, while the full‐time staff members and highly experienced demonstrated an increase in engagement.

Conclusion

Well‐being initiatives can be a targeted strategy to help alleviate burnout amongst healthcare professionals and build a mutually beneficial relationship between management and employees.

Relevance to clinical practice

This study shows how implementing a staff well‐being initiative increases workplace engagement, which benefits both the individual and the organisation.

Information concerning ICU patients’ families in the handover – the clinicians’ «game of whispers»: a qualitative study

Abstract

Aims and objectives

To explore how information concerning ICU patients´ families is included in the ICU clinicians’ daily handover.

Background

Handover refers to the transfer of information and care responsibility between clinicians. An effective and precise handover is of great importance to ensure quality of care. Although improvements in handovers have received increasing attention in recent decades, little is known about how information about ICU patients’ family members is included in handovers.

Design

A qualitative study using Charmaz’ constructivist grounded theory approach.

Methods

Data were gathered through participant observation, focus groups, dyadic and individual interviews of physicians and nurses from four ICUs in different Norwegian hospitals. The data consists of 270 observation hours, seven focus groups, three dyadic interviews and two individual interviews. Field notes and transcribed interview data were analysed using constructivist grounded theory approach. COREQ checklist was applied as reporting guideline for this study.

Findings

“A game of whispers” emerged as the core category, representing missing information about the patient’s family during the handover. Together with three subcategories: “documentation dilemmas”, “being updated” and “talking together”, the core category explains how transfer of family‐related information between clinicians is continually processed and resolved.

Conclusions

This study indicates challenges related to appropriate and high‐quality handover concerning ICU patients´ families. Oral handovers are essential in terms of clinicians’ need to elaborate on written information and update each other. However, oral transmission involves a high risk of information loss during the handover. Written documentation about the family seems to be inadequate and poorly structured.

Relevance to clinical practice

The study findings suggest a need for increased awareness in practice and research of the importance of transferring appropriate and reliable information about patients’ families between ICU clinicians. User‐friendly handover tools and patient records that include information on patients’ family members should be developed.

Self‐management programs for cirrhosis: a systematic review

Abstract

Background and aims

Liver cirrhosis severely decreases patients' quality of life. Since self‐management programs have improved quality of life and reduce hospital admissions in other chronic diseases, they have been suggested to decrease liver cirrhosis burden.

Methods

We performed a systematic review and meta‐analysis to evaluate the clinical impact of self‐management programs in patients with liver cirrhosis, which followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Primary outcomes include health‐related quality of life (HRQOL) and hospitalization. We searched MEDLINE, CENTRAL, EMBASE, CINAHL, PsycINFO and two trial registers to July 2017.

Results

We identified four randomized trials (299 patients) all rated at a high risk of bias. No difference was demonstrated for HRQOL (Standardized Mean Difference ‐0.01, 95% CI: ‐0.48 to 0.46) and hospitalization days (Incidence Rate Ratio 1.6, 95% CI: 0.5 to 4.8). For secondary outcomes, one study found a statistically significant improvement in patient knowledge (Mean Difference (MD) 3.68, 95% CI: 2.11 to 5.25) while another study found an increase in Model for End‐Stage Liver Disease scores (MD 2.8, 95% CI: 0.6 to 4.9) in the self‐management group. No statistical difference was found for the other secondary outcomes (self‐efficacy, psychological health outcomes, healthcare utilization, mortality). Overall, the quality of the evidence was low. The content of self‐management programs varied across studies with little overlap.

Conclusions

The current literature indicates that there is no evidence of a benefit of self‐management programs for people with cirrhosis.

Relevance to clinical practice

Practitioners should use self‐management programs with caution when delivering care to patients living with cirrhosis. Further research is required to determine what are the key features in a complex intervention like self‐management. This review offers a preliminary framework for clinicians to develop a new self‐management program with key features of effective self‐management interventions from established models.

Nurses’ knowledge of the routine care and maintenance of adult vascular access devices: a scoping review

Abstract

Background

Vascular access devices(VAD), centrally CVAD) or peripherally(PIV) located, are common in the nursing profession. A high proportion of admitted patients require a VAD to enable administration of intravenous treatments or diagnostic modalities. As the primary caregivers for these patients, nurses are responsible for ongoing care and maintenance of these devices.

Objective

This scoping review examines the current state of practicing nurses knowledge around routine care and maintenance of adult VADs.

Methods

In the fall of 2018, the following databases were searched: Medline‐Ovid 1946 to current, Embase‐Ovid 1947 to current, Ebsco CINAHL Plus with full text, and ProQuest Nursing & Allied Health database and articles were selected according to the PRISMA‐ScR checklist. Inclusion criteria: original research published in peer‐reviewed journals; in English or French; focused on practising nurses’ knowledge about the routine care and maintenance of adult VADs.

Results

Of the 4099 abstracts identified, 36 full‐text articles were included. Study characteristics are reported in addition to themes found in the literature: the relationship between demographic data and CVAD/PIV knowledge, the state of nurses’ CVAD/PIV knowledge, and nurses’ CVAD/PIV knowledge scores. Overall, significant gaps in nurses’ knowledge on the care and maintenance of VADs are noted.

Conclusion

The variability in nurses’ knowledge around both CVAD and PIV led the authors to conclude that there is room for improvement in the educational preparation of nurses and a need for workplace training.

Relevance to Clinical Practice

This scoping review intends to highlight the knowledge gap of nurses with regards to best practices for VAD routine care and maintenance and demonstrate the need for education, both in educational and healthcare institutions, to ensure high quality care and improved patient outcomes related to VADs.

"The challenge of joining all the pieces together"‐Nurses’ experience of palliative care for older people with advanced dementia living in residential aged care units

Abstract

Aims and objectives

To describe nurses’ experiences of palliative care for older people with advanced dementia living in residential aged care units.

Background

Dementia is a global health problem and the number of older people with dementia who need palliative care is increasing. Previous research has revealed that care for older people with dementia in the final stage of life is usually complex. However, little is known about how nurses experience palliative care for older people with advanced dementia living in residential aged care units.

Method

Nine individual, semi‐structured face‐to‐face interviews with nurses working in residential aged care units for older people with advanced dementia in palliative care in western Sweden were analysed using qualitative inductive content analysis. The COREQ checklist was followed.

Results

The nurses considered that palliative care for older people with advanced dementia is a complex and challenging form of care. In particular, they identified three challenges that must be met: developing specialised knowledge and skills, developing teamwork as a working method, and creating a caring relationship.

Conclusions

The results of our analysis indicate that if nurses are aware of and understand that the challenges are essential for ‘joining all the pieces together’, the palliative care for older people with advanced dementia may become a positive experience for nurses and may increase their sense of satisfaction and security in their professional role.

Relevance to clinical practice

For the palliative care to be successful the nurses need to ‘join all the pieces together’, i.e. succeed in developing specialised knowledge and skills, developing teamwork as a working method, and creating a caring relationship to establish a person‐centred care with the older person with advanced dementia and with his or her relatives.

Parents' experiences of transition from hospital to home of a child with complex health needs: A systematic literature review

Abstract

Aims and objectives

To critically appraise primary research on the views and experiences of parents of children with complex health needs during the transition from hospital to home.

Background

Children with complex health needs frequently transition across and within healthcare systems, due to their age, care needs and ongoing health conditions. Repeated and unplanned admissions are significantly higher for children with complex health needs. Yet parents, as the primary providers of care, report being unsupported and unprepared during the transition from hospital back to home due to poor communication, inadequate discharge planning and education, resulting in stress and anxiety within the home environment.

Design

Systematic review following PRISMA guidelines.

Methods

A systematic search was completed of the databases CINAHL, MEDLINE, PsycINFO, EMBASE and the Cochrane Library Review between January 2009 and September 2019. Data were extracted, categorised and analysed using a thematic analysis approach. An adapted CASP qualitative assessment tool was utilised for quality assessment. All included articles were marked for validity and relevance to current research with an overall score from 0–20.

Results

A total of 13 studies of mixed quality were identified. CASP quality scores ranged from 13–18. Four themes emerged highlighting parents' experiences of the emotional processes, communication, coordination and support and resources when transitioning from hospital to home.

Conclusions

Hospital discharge and transition from hospital to home is a complicated and at times frustrating process for parents of children with complex health needs. Parents report being exhausted and stressed during this often‐challenging period of adjustment which was perceived as a difficult and emotional process. There is a clear lack of support available for parents both from hospital and community services.

The impact of inflammatory bowel disease on sexual health in men: A scoping review

Abstract

Aims and objectives

To review the literature on the impact of inflammatory bowel disease on the sexual health of men, and make recommendations for nursing practice and research.

Background

Inflammatory bowel disease is a chronic condition of the gastrointestinal tract, causing symptoms that may impact upon sexual health. Specialist nurses are well positioned to assess and manage sexual health, but there is a lack of clinical guidance, especially in relation to men.

Design

A systematic scoping review following the Arksey and O’Malley (2005) framework reported in line with the PRISMA‐ScR checklist (Tricco et al. 2018).

Methods

OVID MEDLINE ALL [R], OVID EMBASE [R], OVID PsychINFO, EBSCO CINAHL Complete, The Cochrane Library and ProQuest were searched. Inclusion and exclusion criteria were applied independently by two reviewers. Data was extracted, charted and summarised from eligible studies.

Results

Thirty‐one studies met the inclusion criteria. These were synthesised under three categories: mediators, moderators, and descriptors of sexual health. Depression, disease activity and surgery were the most commonly cited disease‐related factors to affect sexual health in men. The most commonly used assessment tool was The International Index of Erectile Function. Descriptors of function included; frequency of intercourse, libido and the ability to maintain a desired sexual role.

Conclusions

The effect of inflammatory bowel disease on sexual health in men involves a complex interaction of physical and psychosocial factors. Researchers must explore areas outside of erectile function to understand how the disease impacts sexuality, sexual well‐being and masculinity. This can be achieved through qualitative exploration of patient, partner and health professional experiences.

Relevance to clinical practice

A holistic nursing assessment of men with inflammatory bowel disease should include sexual health. Developing understanding of how the disease influences sexual interaction and expression will facilitate support that is relevant, accessible and of value to men living with the disease.

Cover Images

Cover Images

The cover image © Shriners Hospitals for Children‐Canada is based on the Original Article The day‐to‐day experiences of caring for children with Osteogenesis Imperfecta : A qualitative descriptive study by Aimee Castro, Argerie Tsimicalis et al.,https://doi.org/10.1111/jocn.15310..


Issue Information

Journal of Clinical Nursing, Volume 29, Issue 15-16, Page 2731-2732, August 2020.

Dyadic teams and nursing care: a critical incident study of nurses in the emergency medical service

Abstract

Aim and objectives

The aim of the study was to describe EMS nurses’ experiences of and coping with critical incidents, when providing nursing care as a member of a dyadic team.

Background

Nursing care in EMS is a complex task, taking into account the physical, psychological as well as existential dimensions of the patient’s suffering. In this, EMS nurses are dependent on the dyadic team. Teams in EMS are described as essential for providing safe medical care. However, nursing care also comprises relationships with patients as a means of reducing patient suffering.

Design

The study has an inductive descriptive qualitative design, in adherence to the COREQ‐checklist.

Methods

A critical incident technique was used. Thirty‐five EMS nurses were interviewed individually, with a focus on dyadic teams providing nursing care. The interviews were analysed with the aim of defining main areas, categories and sub‐categories.

Results

The experiences of critical incidents emerged to form two main areas; ‘Functional co‐operation’ and ‘Dysfunctional co‐operation’, comprising seven categories and sixteen sub‐categories. Their coping with critical incidents encompassed two main areas; ‘Adapting oneself’ and ‘Adapting nursing care and the colleague’, comprising four categories and nine sub‐categories.

Conclusions

Reflection as part of the daily practice emerges as important for the development of nursing care both in relation to individual team‐members and also the dyadic team as a unit. In addition, the results highlight consensus within dyadic teams regarding the objectives of nursing care, as well as the importance of defined roles.

Relevance to clinical practice

This study underlines the importance of strengthening the dyadic EMS team’s ability to co‐operate using common goals and knowledge within clinical nursing care. The individual team members’ different roles have to be explicit. In addition, clinical care has to be organised to generate preconditions for mutual performance monitoring through collegial feedback and reflection.

Spiritual care provision to end of life patients: A systematic literature review

Abstract

Aim

To develop an understanding of how nurses provide spiritual care to terminally ill patients in order to develop best practice.

Background

Patients approaching the end of life (EoL) can experience suffering physically, emotionally, socially and spiritually. Nurses are responsible for assessing these needs and providing holistic care, yet are given little implementable, evidence‐based guidance regarding spiritual care. Nurses internationally continue to express inadequacy in assessing and addressing the spiritual domain, resulting in spiritual care being neglected or relegated to the pastoral team.

Design

Systematic literature review, following PRISMA guidelines.

Methods

Nineteen electronic databases were systematically searched and papers screened. Quality was appraised using the Critical Appraisal Skills Programme qualitative checklist, and deductive thematic analysis, with a priori themes, was conducted.

Results

Eleven studies provided a tripartite understanding of spiritual caregiving within the a priori themes: Nursing Spirit (a spiritual holistic ethos); the Soul of Care (the nurse‐patient relationship) and the Body of Care (nurse care delivery) . Ten of the studies involved palliative care nurses.

Conclusion

Nurses who provide spiritual care operate from an integrated holistic worldview, which develops from personal spirituality, life experience and professional practice of working with the dying. This worldview, when combined with advanced communication skills, shapes a relational way of spiritual caregiving that extends warmth, love and acceptance, thus enabling a patient’s spiritual needs to surface and be resolved.

Relevance to clinical practice

Quality spiritual caregiving requires time for nurses to develop: the personal, spiritual and professional skills that enable spiritual needs to be identified and redressed; nurse‐patient relationships that allow patients to disclose and co‐process these needs. Supportive work environments underpin such care. Further research is required to define spiritual care across all settings, outside of hospice, and to develop guidance for those involved in EoL care delivery.

Relationships between the National Early Warning Score 2, clinical worry, and patient outcome at discharge: Retrospective observational study

Abstract

Aims and objectives

To examine the performance of the National Early Warning Score 2 and composite score for clinical worry in identifying patients at risk of clinical deterioration, and to determine relationships between National Early Warning Score 2, clinical worry score, and patient outcome at discharge.

Background

The efficacy of early warning systems depends on patient population and care settings. Based on a theoretical framework on factors affecting clinical deterioration and patient outcomes, studies exploring the relationship between early warning systems and patient outcomes at discharge are sparse.

Design

Retrospective observational study.

Methods

A random sample of 732 medical records were reviewed. The area under the receiver‐operating‐characteristic curve was calculated to evaluate predictive abilities regarding the events of unanticipated in‐hospital mortality, unplanned intensive care unit/ higher‐dependency bed admission, and cardiac arrest. Multiple logistic regression analyses were performed to determine relationships between National Early Warning Score 2, clinical worry score, and patient outcome. Reporting followed the STROBE checklist.

Results

National Early Warning Score 2 and clinical worry score significantly predicted the events within 24 hours of the assessment. After controlling for other patient, treatment, and organizational characteristics, National Early Warning Score 2 was a significant factor associated with patient outcome, but clinical worry score was not. Specifically, patients at high risk based on National Early Warning Score 2 were less likely to have improved outcome.

Conclusions

National Early Warning Score 2 and clinical worry score performed well for predicting deteriorating condition of patients. National Early Warning Score 2 was significantly associated with patient outcome. It can be used for efficient patient management for safe, quality care.

Relevance to clinical practice

National Early Warning Score 2 can be used for early assessment of not only clinical deterioration but also patient outcome and provide timely intervention, when coupled with clinical worry score.

Bedside handover at the change of nursing shift: a mixed methods study

Abstract

Aim

To describe the structures, processes and content of bedside handover at the change of nursing shift in an acute care context.

Background

The handover of patient information and care at the change of nursing shift is an essential, albeit risk laden, time consuming activity in clinical practice.

Design

A convergent parallel mixed methods design was used.

Methods

Thirty episodes of bedside handover were concurrently audio recorded and observed using a researcher developed tool modelled on the five domains of the British Medical Association’s Safe Handover–Safe Patients framework. The audio recordings were analysed using content analysis. Quantitative and qualitative data generated, were then triangulated to develop a more complete interpretation of the structure, process and content of information transferred at the patient’s bedside during the change of nursing shift. This study followed Good Reporting of a Mixed Methods Study guidelines.

Results

Bedside handover was observed to be mainly conducted at a fast pace. However, within this timeframe large volumes of complex information was shared and important nurse–patient interactions occurred. Analysis of the audio recordings provided evidence that the dialogue during handover was nurse dominated and the outgoing nurse appeared to influence the degree of patient participation.

Conclusion

Bedside handover at the change of nursing shift involves three key stakeholders: outgoing nurse, incoming nurse and the patient. A combination of intricate communication skills both verbal and non‐verbal facilitate the rapid sharing of large volumes of complex information which is necessary for the continuity and safety of patient care across nursing shifts.

Relevance to clinical practice

The comprehensive description of the complexities of bedside handover in this study provides an insight into this frequently occurring, important nursing practice and can be used to support nurse education and practice development.

Parental Readiness for Hospital Discharge as a Mediator between Quality of Discharge Teaching and Parental Self‐Efficacy in Parents of Preterm Infants

Abstract

Aims and Objectives

To examine the extent to which parental readiness for hospital discharge mediates the relationship between quality of discharge teaching and parental self‐efficacy in parents of preterm infants.

Background

Parental readiness for hospital discharge and self‐efficacy should be considered to establish if preterm infants and their families are prepared for the discharge. High‐quality discharge teaching could facilitate a smooth discharge transition. However, little is known about how quality of discharge teaching influences parental readiness for hospital discharge and self‐efficacy.

Design

This was a descriptive cross‐sectional study of 202 parents with preterm infants in a tertiary hospital in Eastern China.

Methods

The key variables of interest were measured using the Chinese versions of the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale‐Parent Form, and Preterm Parenting and Self‐Efficacy Checklist. Path analyses were conducted to test the mediation models. STROBE checklist was used to compile the study’s report.

Results

Parental readiness for discharge (overall and knowledge dimension) partially mediated the relationship between the quality of discharge teaching and parental self‐efficacy. The two dimensions (content received and delivery) of quality of discharge teaching positively influenced parental self‐efficacy by improving parental readiness for discharge.

Conclusions

Parental readiness for hospital discharge, especially the knowledge dimension, was an important factor in quality of discharge teaching’s association with self‐efficacy in parents of preterm infants. Improving the quality of discharge teaching could increase parental readiness for discharge, and thus promote parental self‐efficacy.

Relevance to Clinical Practice

Improving discharge instructions is essential to help parents of preterm infants prepare for the transition to home care. Assessing readiness and confidence at an early stage and continuing to do so throughout the hospital stay may provide additional ways for nurses to identify parents’ knowledge gaps and to provide tailored interventions at more opportune times before hospital discharge.

Family members’ lived experiences when a loved one undergoes an interhospital intensive care unit‐to‐unit transfer: a phenomenological hermeneutical study

Abstract

Aims and objectives

The aim of the study was to reveal meanings of family members’ lived experiences when a loved one undergoes an interhospital intensive care unit‐to‐unit transfer.

Background

Interhospital intensive care unit‐to‐unit transfers take place between different hospitals and their respective intensive care units. These types of transfers are an increasing phenomenon but are sparsely studied from the family members’ perspective. Indeed, the patient’s critical illness and care can have a major impact on family members. During the transfer process, there is a demand for the involved intensive care health personnel to make family members feel safe and cared for.

Design

A qualitative design based on phenomenological hermeneutics.

Methods

The study was conducted at two Swedish general intensive care units. Data were generated through individual in‐depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The COREQ principles were applied in the conduct and reporting of this study.

Results

Four themes that reveal meanings of family members’ lived experiences were developed: losing your safe haven, dealing with uncertainty, carrying your own and others’ burdens and a wish to be close.

Conclusions

The study reveals that an interhospital intensive care unit‐to‐unit transfer affects the whole family and is characterised by family members experiencing many negative feelings. The findings also illustrate that being a family member when a loved one is transferred means being exposed to the core existential elements of being human, such as loneliness and searching for meaning.

Relevance to clinical practice

The study highlights the importance of maintaining a family‐centred approach during the transfer process. Our findings can provide deeper knowledge for intensive care health personnel, better preparing them for the delicate task of providing family‐centred care during the interhospital intensive care unit‐to‐unit transfer process.

Relationships of Illness Representation and Quality of Life in Patients with End‐stage Renal Disease Receiving Hemodialysis

Abstract

Aim and Objectives

To examine the relationship between illness representations and quality of life, and to test whether illness representations can predict quality of life, in patients with hemodialysis.

Background

Illness representations are interpretations of and actions taken by individuals when faced with threats to their health. Exploring relationship of illness representations and quality of life in patients with hemodialysis may help patients self‐manage their illness and improve their quality of life.

Methods

A cross‐sectional correlation design was used (the checklist STROBE was chosen for this study). The study setting was a hemodialysis center in a teaching hospital. A total of 172 surveys were completed. The inventory comprised demographic data, illness data, the Brief Illness Perception Questionnaire, and the World Health Organization Quality of Life.

Results

The illness representations of the surveyed patients fell in the middle range of being not too optimistic or pessimistic. Overall quality of life of patients is moderate. The predictors of quality of life included living status, source of income, and two illness representation elements.

Conclusions

This study revealed an association between illness representations and quality of life in patients with hemodialysis. New knowledge provided by this study can assist healthcare professionals caring for patients with a Chinese cultural background.

Relevance to clinical practice

Illness representation assessment could be added to clinical care standards, and patients living with family or without family could be given different interventions.

Nursing handoffs and clinical judgments regarding patient risk of deterioration: A mixed‐methods study

Abstract

Aims and objectives

To explore how change‐of‐shift handoffs relate to nurses’ clinical judgments regarding patient risk of deterioration.

Background

The transfer of responsibility for patients’ care comes with an exchange of information about their condition during change‐of‐shift handoff. However, it is unclear how this exchange affects nurses’ clinical judgments regarding patient risk of deterioration.

Design

A sequential explanatory mixed‐methods study reported according to the STROBE and COREQ guidelines.

Methods

Over four months, 62 nurses from one surgical and two medical units at a single Canadian hospital recorded their handoffs at change‐of‐shift. After each handoff, the two nurses involved each rated the patient’s risk of experiencing cardiac arrest or being transferred to an intensive care unit in the next 24 hours separately. The information shared in handoffs was subjected to content analysis; code frequencies were contrasted per nurses’ ratings of patient risk to identify characteristics of information that facilitated or hindered nurses’ agreement.

Results

Out of 444 recorded handoffs, there were 125 in which at least one nurse judged that a patient was at risk of deterioration; nurses agreed in 32 cases (25.6%) and disagreed in 93 (74.4%). These handoffs generally included information on abnormal vital signs, breathing problems, chest pain, alteration of mental status, or neurological symptoms. However, the quantity and seriousness of clinical cues, recent transfers from intensive care units, pain without a clear cause, signs of delirium, and nurses’ knowledge of patient were found to affect nurses’ agreement.

Conclusions

Nurses exchanged more information regarding known indicators of deterioration in handoffs when they judged that patients were at risk. Disagreements most often involved incoming nurses rating patient risk as higher.

Relevance to clinical practice

This study suggests a need to sensitize nurses to the impact of certain cues at report on their colleagues’ subsequent clinical judgments. Low levels of agreement between nurses underscore the importance of exchanging impressions regarding the likely evolution of a patient’s situation to promote continuity of care.

Nursing teamwork in general ward settings: A mixed‐methods exploratory study among enrolled and registered nurses

Abstract

Aim

This study aimed to examine the perceived level of nursing teamwork and factors influencing teamwork among enrolled nurses (ENs) and registered nurses (RNs) in general ward settings.

Background

The nursing care delivery model includes RNs, ENs and others who work as a team to deliver patient care. The potential impact of teamwork on nursing care highlights the need to explore the work of nursing teams.

Design

A mixed‐methods exploratory study.

Method

Quantitative and qualitative data were collected concurrently from ENs and RNs in 2018. Two hundred and forty‐eight (n = 248) nurses completed the Nursing Teamwork Survey. Sixteen nurses participated in focus group discussions. Qualitative data were reported following COREQ guidelines, while quantitative data followed the STROBE guidelines.

Results

Both ENs and RNs scored highest for the shared mental model subscale but lowest for the team orientation subscale. Factors including qualification level, years of working experience, perceived job staffing adequacy and job satisfaction were found to influence teamwork. Three themes emerged from the qualitative findings: expectations of each other’s role, delegation practices, and interpersonal relationships. ENs and RNs differed in their expectations of their role in basic patient care activities and faced power struggles related to delegation practices. Open and structured communication was deemed essential in building interpersonal relationships.

Conclusion

The ENs and RNs have clear understanding of their personal roles and responsibilities towards achieving a common goal. However, teamwork may be improved with a shared mental model in performing basic nursing care tasks, mutual support for workload management, better delegation practices, effective communication, enhanced interpersonal relationships, and better team orientation.

Relevance to clinical practice

Nurse managers and educators need to work collaboratively to foster positive delegation practices in clinical practice supported by applicable team training that enhances mutual trust, backup behaviors, and collective orientation in nursing teams.

Modelling of self‐management in schizophrenia: The role of neurocognition, self‐efficacy, and motivation

ABSTRACT

Aims and objectives

This study aimed to address the interrelationships among neurocognition, self‐efficacy, motivation, and self‐management in individuals with schizophrenia.

Background

Self‐management performance of individuals with schizophrenia is relatively poor. The effect of neurocognitive impairment on self‐management in schizophrenia remains inconsistent, which may be attributed to the neglect of possible mediating factors. Little attention has been given to the role of motivation and self‐efficacy for linking neurocognition to self‐management.

Design

A cross‐sectional study.

Methods

Three hundred and twenty patients were recruited with convenience sampling in this study. Patients’ neurocognitive function, self‐efficacy, motivation, and self‐management behaviors were measured. Pearson or Spearman correlation analysis and path analysis were performed to examine the interrelationships. This study followed STROBE checklist for cross‐sectional studies (see Appendix S1).

Results

The final model, with good fit indices, revealed that (1) neurocognition, self‐efficacy, and motivation were directly associated with self‐management, (2) self‐efficacy and motivation partly mediated the impact of neurocognition on self‐management, and (3) motivation additionally mediated the association of self‐efficacy and self‐management.

Conclusions

Our study extends the current findings, indicating that self‐efficacy and motivation may act as mediators in the relationship between neurocognition and self‐management in schizophrenia.

Relevance to clinical practice

Mental health professionals should pay attention to interventions targeting both cognitive and psychosocial components to enhance self‐management in individuals with schizophrenia.

An exploration of the factors influencing career choice in mental health

Abstract

Aims and objectives

To identify the factors that are associated with considering a career in mental health.

Background

The mental health specialty is facing a recruitment crisis in the United Kingdom but there is limited evidence about which factors encourage and discourage people to consider a career in mental health

Design

Quantitative, observational, online survey using a multiple ordinal logistic regression model to identify if there were any significant predictors of the extent to which participants would consider a career in mental health. The design and write up of the study were guided by the STROBE checklist.

Method

We gathered the views of 231 participants (female = 188, 81.7%) aged between 16 and 65 (mean = 22.7, SD = 8.9), using an online survey, the majority of whom were studying on, or graduates of, psychology/social studies degrees. Information was gathered about the extent to which a range of factors influenced consideration of a career in mental health.

Results

The majority (71.2%) of participants reported that they would definitely or probably consider undertaking a career in mental health, and over half (51.4%) would consider a career as a mental health nurse. The ability to help others and receiving appropriate training required for the role were important career choice factors. Being female, having a mental health condition, and greater knowledge of mental health, were associated with a significantly greater likelihood of considering a career in mental health, while having had experience of working with people with mental health difficulties was significantly negatively associated.

Conclusions

Students and graduates of psychology and social studies degrees appear to be a large, untapped recruitment pool for mental health services.

Relevance to clinical practice

The results can inform more targeted recruitment strategies and development of suitable career pathways for those interested in a career in mental health.

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