The study examined self-reported job-related stressors induced by the COVID-19 pandemic and psychological distress among hospital nurses and physicians. In addition, we explored the role of negative affect (NA) and background variables in relation to COVID-19-related job stressors and psychological distress.
During COVID-19 pandemic, hospital nurses and physicians were exposed to highly enduring occupational stress, that stem from subjective appraisal of inadequate job resources (i.e., personal protection equipment, information on how to manage safely in the ongoing work and organizational attention to the needs arising from the ongoing work).
Between May and July 2020, 172 nurses and physicians working at a medical centre in Israel filled in self-report questionnaires about sociodemographic data, COVID-19-related job stressors, psychological distress and NA.
Our results confirmed the positive direct link between perceived COVID-19-related job stressors and psychological distress among hospital nurses and physicians. NA was found to serve as a mediator in this association (indirect link). Furthermore, nurses and physicians' seniority was related positively to psychological distress and also played a moderator role in the indirect link.
We recommend to monitor the mental health of hospital nurses and physicians and to provide a platform to address their job stressor concerns related to COVID-19, and share helpful coping strategies.
During the abrupt COVID-19 outbreak, hospital nurses and physicians face challenges that might raise NA and psychological distress. Our study revealed that among hospital nurses and physicians, COVID-19-related perceived job stressors and psychological distress were positively linked, and NA plays a mediating role in this association. Among nurses and physicians with moderate or high years of seniority (>11 years), higher COVID-19-related perceived job stressors associated with higher NA, which in turn was associated with greater psychological distress. Policymakers would be wise to provide a platform to address hospital nurses and physicians' mental health.
To develop a conceptual framework of the core qualities and competencies of the intensive and critical care nurse based on the experiences of intensive care patients, their relatives and the intensive and critical care nurses.
A comprehensive, systematic search in seven databases supplemented with hand, citation and reference search. Sources published from 2007 to 2019 were included.
Noblit and Hare's understanding of meta-ethnography and the work of the eMERGE project have directed the synthesis.
Nineteen studies were included and synthesized into a conceptual framework. Overarching theme: ‘feeling safe and being safe’, subtheme: ‘creating confidence and motivation’ and conceptual categories (CCs): ‘technical skills and biophysical knowledge’; ‘inter/intra professional teamwork skills’; ‘communication skills (with patients and their relatives)’; ‘constant and attentive bedside presence’; ‘creating participative care’; ‘creating confidence through daily care’; ‘creating a good atmosphere and having a supportive and encouraging attitude’; and ‘building relationship to maintain self-esteem’.
By including the perspectives of intensive care patients, their relatives and intensive and critical care nurses, the core qualities and competencies comprise elements of both patient safety and the feeling of safety. The framework outlines concepts necessary to ensure person-centred and safe intensive care. Further research should involve each perspective to validate and strengthen the findings.
The development of standards and competence guidelines expressing the learning outcomes and qualification of intensive and critical care nurses should be based on input from intensive care patients, their relatives and intensive and critical care nurses. A variety of core qualities and competencies are necessary to create confidence and motivation, and to make the patient feel safe and be safe. This conceptual framework might form a basis for development of a program or assessment tool to facilitate excellence in education and practice in intensive care.
To explore the experiences of informal caregivers of people with dementia with the hospitalization of their relative concerning patient care, interactions with nurses, caregivers’ situation and the acute hospital environment.
The data were collected using an online questionnaire among a panel of caregivers (n = 129), together with a focus group and individual interviews from February to November 2019. The data were triangulated and analysed using a conceptual framework.
Almost half of the respondents were satisfied with the extent to which nurses considered the patient's dementia. Activities to prevent challenging behaviours and provide person-centred care were rarely seen by the caregivers. Caregivers experienced strain, intensified by a perceived lack of adequate communication and did not feel like partners in care; they also expressed concern about environmental safety. A key suggestion of caregivers was to create a special department for people with dementia, with specialized nurses.
Positive experiences of caregivers are reported in relation to how nurses take dementia into account, involvement in care and shared decision making. Adverse experiences are described in relation to disease-oriented care, ineffective communication and an unfamiliar environment. Caregivers expressed increased involvement when included in decisions and care when care was performed as described by the triangle of care model. Caregivers reported better care when a person-centred approach was observed. Outcomes can be used in training to help nurses reflect and look for improvements.
This study confirms that caregivers perceive that when they are more involved in care, this can contribute to improving the care of patients with dementia. The study is relevant for nurses to reflect on their own experiences and become aware of patients’ caregivers’ perspectives. It also provides insights to improve nurses’ training and for organizations to make the care and environment more dementia-friendly.
To establish how the Manchester Triage System can correctly prioritize patients admitted to the emergency department for transitory loss of consciousness in relation to their risk of presenting severe acute disease.
A observational retrospective study.
A total of 2291 patients who required a triage evaluation for a transitory loss of consciousness at the emergency department of Merano Hospital between 1 January 2017 and 30 June 2019 were considered. Transitory loss of consciousness was classified according to European Society of Cardiology guidelines. The baseline characteristics of the patients were collected and divided according to the priority level assigned at triage into two different study groups: high priority (red/orange) and low priority (blue/green/yellow). The composite outcome of the study was defined as the diagnosis of a severe acute disease.
Of the patients enrolled, 17% (390/2291) had a high-priority code and 83% (1901/2291) received a low-priority code. Overall, a severe acute disease was present in 16.9% of patients (387/2291). The Manchester Triage System had a sensitivity of 42.4%, a specificity of 88.1% and an accuracy of 80.4% for predicting severe acute disease. The discriminatory ability had an area under the receiver operating characteristic curve of 0.651 (CI 95%: 0.618–0.685).
Despite the good specificity, the low sensitivity does not currently allow the Manchester Triage System to completely exclude patients with a severe acute disease who presented in the emergency department for a transitory loss of consciousness. Therefore, it is important to develop precise nursing tools or assessments that can improve triage performance.
The assessment of a complex symptom can create difficulties in the stratification of patients in triage, assigning low-priority codes to patients with a severe disease. Additional tools are needed to allow the correct triage assessment of patients presenting with transitory loss of consciousness.
To synthesize evidence on the ability of specialist care home support services to prevent hospital admission of older care home residents, including at end of life.
Systematic review, without meta-analysis, with vote counting based on direction of effect.
Fourteen electronic databases were searched from January 2010 to January 2019. Reference lists of identified reviews, study protocols and included documents were scrutinized for further studies.
Papers on the provision of specialist care home support that addressed older, long-term care home residents’ physical health needs and provided comparative data on hospital admissions were included. Two reviewers undertook study selection and quality appraisal independently. Vote counting by direction of effect and binomial tests determined service effectiveness.
Electronic searches identified 79 relevant references. Combined with 19 citations from an earlier review, this gave 98 individual references relating to 92 studies. Most were from the UK (22), USA (22) and Australia (19). Twenty studies were randomized controlled trials and six clinical controlled trials. The review suggested interventions addressing residents’ general health needs (p < .001), assessment and management services (p < .0001) and non-training initiatives involving medical staff (p < .0001) can reduce hospital admissions, while there was also promising evidence for services targeting residents at imminent risk of hospital entry or post-hospital discharge and training-only initiatives. End-of-life care services may enable residents to remain in the home at end of life (p < .001), but the high number of weak-rated studies undermined confidence in this result.
This review suggests specialist care home support services can reduce hospital admissions. More robust studies of services for residents at end of life are urgently needed.
The review addressed the policy imperative to reduce the avoidable hospital admission of older care home residents and provides important evidence to inform service design. The findings are of relevance to commissioners, providers and residents.
To provide a timely analysis around the concept of stigma among transgender and gender-diverse people accessing healthcare.
While research on stigma has been prolific in other disciplines, the literature on stigma—especially among transgender and gender-diverse people—have been limited in nursing. A clear definition of stigma among transgender/gender-diverse people is also lacking in the nursing literature.
Walker and Avant's method of concept analysis.
PubMed and CINAHL databases were used to retrieve English language records from February 2016 to February 2021. Influential literature from sociology and psychology and an online dictionary and thesaurus were also used to clarify the concept.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to search the scientific literature to clarify and describe the antecedents, defining attributes, consequences and empirical referents of stigma among transgender/gender-diverse people accessing healthcare.
A clear definition of stigma was identified. The defining attributes of stigma—labelling, stereotype, separation, status loss and discrimination—reflect its definition. Without asymmetrical power relationships, stigma will not exist. The consequences of stigma include negative and positive outcomes.
While this concept analysis provides clarification of stigma, further exploration of the concept is needed. Furthermore, this concept analysis illustrates how nurses are strategically positioned to disrupt the power structures that allow stigma to operate. Understanding the concept of stigma also enables nurses to create equitable and multifaceted inventions to improve healthcare access among transgender and gender-diverse people.
Incidence of atrial fibrillation is considerably high after open heart surgery, which may prolong hospitalization and increase mortality. The aim of the present study is to investigate the perioperative risk factors for the occurrence of new-onset atrial fibrillation following isolated coronary artery bypass grafting.
A retrospective study.
A total of 327 Korean patients recorded to have undergone first-time isolated coronary artery bypass grafting and no preoperative history of atrial fibrillation were included. The data were obtained from electronic health record from January 2010 to December 2019 at a tertiary care hospital. Predictors of new-onset atrial fibrillation after the surgery were identified by multivariate logistic regression analysis.
The incidence rate of new-onset atrial fibrillation after coronary artery bypass grafting was approximately 28.4%, and the highest occurrence rate was 44.1% on postoperative day 2. Our main finding showed that advanced age was the strongest predictor of atrial fibrillation after coronary artery bypass grafting. In addition, history of stroke and depression, chronic obstructive pulmonary disease and intraoperative use of intra-aortic balloon pump were shown to be the risk factors.
Our findings showed that approximately 28% patients had new-onset atrial fibrillation after the surgery. Healthcare professionals should proactively assess risk factors for postoperative atrial fibrillation and focus more on older adults with pre-existing comorbidities, such as stroke, depression and chronic obstructive pulmonary disease.
Older adults with history of stroke, depression and comorbid chronic obstructive pulmonary disease should be carefully monitored closely during perioperative period. The study highlights that early assessment of new-onset postoperative atrial fibrillation can contribute to promote the quality of nursing care and frontline nurses may be a vital role in timely detection of atrial fibrillation after surgery. Prospective studies are required to identify the mechanisms connecting perioperative risk factors for atrial fibrillation after cardiac surgery.
To assess the prognostic accuracy of comorbidity-adjusted National Early Warning Score in suspected Coronavirus disease 2019 patients transferred from nursing homes by the Emergency Department.
Multicentre retrospective cohort study.
Patients transferred by high-priority ambulances from nursing homes to Emergency Departments with suspected severe acute respiratory syndrome coronavirus 2 infection, from March 12 to July 31 2020, were considered. Included variables were: clinical covariates (respiratory rate, oxygen saturation, systolic blood pressure, heart rate, temperature, level of consciousness and supplemental oxygen use), the presence of comorbidities and confirmatory analytical diagnosis of severe acute respiratory syndrome coronavirus 2 infection. The primary outcome was a 2-day mortality rate. The discriminatory capability of the National Early Warning Score was assessed by the area under the receiver operating characteristic curve in two different cohorts, the validation and the revalidation, which were randomly selected from the main cohort.
A total of 337 nursing homes, 10 advanced life support units, 51 basic life support units and 8 hospitals in Spain entailing 1,324 patients (median age 87 years) was involved in this study. Two-day mortality was 11.5% (152 cases), with a positivity rate of severe acute respiratory syndrome coronavirus 2 of 51.2%, 77.7% of hospitalization from whom 1% was of intensive care unit admission. The National Early Warning Score results for the revalidation cohort presented an AUC of 0.771, and of 0.885, 0.778 and 0.730 for the low-, medium- and high-level groups of comorbidities.
The comorbidity-adjusted National Early Warning Score provides a good short-term prognostic criterion, information that can help in the decision-making process to guide the best strategy for each older adult, under the current pandemic.
What problem did the study address?
Under the current coronavirus disease 2019 pandemic, targeting older adults at high risk of deterioration in nursing homes remains challenging. What were the main findings?
Comorbidity-adjusted National Early Warning Score helps to forecast the risk of clinical deterioration more accurately. Where and on whom will the research have impact?
A high NEWS, with a low level of comorbidity is associated with optimal predictive performance, making these older adults likely to benefit from continued follow up and potentially hospital referral under the current coronavirus disease 2019 pandemic.
To investigate research hotspots and trends in nursing education from 2014 to 2020, and provide references for researchers to understand the research status and developing trends in this field.
A co-word analysis based on keywords.
Data were obtained from nursing education-related academic research articles that were retrieved through a literature search using PubMed during the period of 2014–2020. Keywords included in the analysis of literature were considered as the research objects. Bibliographic Item Co-occurrence Matrix Builder (BICOMB) was employed to extract high-frequency keywords and generate co-occurrence matrix, graphical clustering toolkit (gCLUTO) was used to perform cluster analysis, and SPSS 25.0 was used to perform strategic diagram analysis.
Overall, 7857 articles were retrieved, from which 2679 keywords were obtained and 64 high-frequency keywords extracted. The results revealed seven hotspots in nursing education during the period of 2014–2020, which included research on: (i) continuing education in nursing, (ii) application and influence of the internet in nursing education, (iii) postgraduate nursing education, (iv) undergraduate nursing education and clinical quality training, (v) current development status and tendency of nursing education, (vi) nursing teaching methods and (vii) organization and management in nursing education.
The seven research hotspots could reflect the publication trends in nursing education. By providing a co-word analysis—including cluster and strategic diagram analysis—an overall command of the latest hotspots can be depicted, and researchers conducting research in nursing education can have some hints.
This study allows the development of future research on nursing education. Future researchers should explore the application of new network technologies in the process of nursing teaching, quality of postgraduate nursing education, innovative teaching methods as well as teaching strategies of improving students’ clinical ability, current situation of economics and leadership in nursing education and ability of organization and management in undergraduate nursing education.
To verify a hypothesized model of the relationships between compassion fatigue, burnout and compassion satisfaction, as well as their influencing factors and consequences, among emergency nurses.
A descriptive, cross-sectional design.
A hypothesized model was proposed on the basis of the current literature. A convenience sample was conducted of nurses working in the emergency departments of six hospitals in Shanghai, China, from July to September 2020. A total of 445 valid data points were collected using various self-designed and well-validated instruments. Descriptive statistics and correlations were computed, and a path analysis was used to assess model fitness and to investigate direct and indirect effects.
The final model reported a desirable fit with significant paths. Compassion satisfaction and compassion fatigue directly and inversely affected burnout, and compassion satisfaction positively influenced compassion fatigue. Perceived social support directly improved compassion satisfaction and protected against compassion fatigue. Compassion satisfaction and compassion fatigue directly affected mental health, and burnout directly influenced physical health. Compassion fatigue, burnout and compassion satisfaction had complicated effects on turnover intention.
Emergency nurses’ compassion satisfaction and compassion fatigue may be two coexisting constructs, and both affect burnout. Perceived social support acts as a protector of the three dimensions, and their effects on health status and turnover intention can be significant and complicated.
Emergency nurses may experience high levels of compassion satisfaction and compassion fatigue simultaneously, which can help to explain why compassion fatigue did not directly increase emergency nurses’ turnover intention. The direct effects of compassion fatigue and burnout on emergency nurses’ health status and working engagement were significantly different. Support from significant others, professional psychological intervention and emergency nursing system reforms are required to tackle emergency nurses’ compassion fatigue and burnout and improve their compassion satisfaction.
The purpose of this study was to investigate which factors are associated with the quality of dementia care in acute care hospitals.
The number of people with dementia who are admitted to acute care hospitals is increasing. Improving the quality of dementia care in acute care hospitals is an important issue. Prior studies have demonstrated that not only knowledge and nursing experience, but also psychological factors and the nursing practice environment are related to high-quality care on general wards.
Cross-sectional hypothesis-testing design.
Participants were nurses providing care to people with dementia at acute care hospitals. Questionnaires were distributed to 300 acute care hospitals in Japan, 10 copies each and 773 valid responses were received. Based on the hypothesis model, variables were tested using multiple regression analysis. The model described the relationship between quality of care, personal attributes and the nursing practice environment. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.
Almost 90% of the study sample was female, the mean age was 37.4 ± 9.3 years, and the mean nursing experience was 14.0 ± 8.7 years. The results showed that nursing foundations for quality of care, staffing and resource adequacy, specialist consultation, promoting systematic recreation and exchange, knowledge, and feelings towards people with dementia were associated with the quality of dementia care in acute care hospitals. The adjusted coefficient of determination was 0.367.
This study identified factors associated with the quality of dementia care in acute care hospitals. Knowledge and feelings towards people with dementia are important, and the nursing practice environment plays an important role in improving the quality of dementia care.
Not only improving nurse's practical ability but also a supportive nursing practice environment enhances the quality of dementia care in acute care hospitals.
The aims of this study were to (1) explore the barriers and challenges of sex trafficking identification and (2) understand how sex trafficking indicators are perceived (i.e. relevance and utility) by healthcare providers at five sites of a large sexual health care organization in a Midwestern state within the United States.
A qualitative, collective case study was conducted.
In-depth, semi-structured interviews were conducted with 23 healthcare staff (e.g. medical assistants, nurse practitioners) who provided sexual and reproductive healthcare between fall 2018 and spring 2020.
Findings suggest that providers perceived behavioural and verbal sex trafficking indicators (e.g. patients appearing nervous or being unable to answer questions) as relevant, particularly with a female patient accompanied by a ‘controlling’ male. Medical and physical indicators (e.g. repeat STIs, bruises and tattoos) were perceived as generally lacking clinical utility or irrelevant. Some indicators were only perceived as relevant when combined or only later, upon reflection (e.g. older, female adult accompanying one or more female patients).
Healthcare providers may be aware of sex trafficking indicators conducive to identifying female patients, in relationships with older men, who are at risk of sex trafficking. Our study finds that healthcare providers may not be aware of all recommended sex trafficking indicators and the nuances of how patients present.
Provider trainings on sex trafficking dynamics and nuanced clinical presentations should include observing ST indicators in simulated interviews, assessing and safety planning (including using harm reduction strategies) with seemingly ambiguous cases. In addition, we recommend that trainings emphasize the relationship between the continuum of agency and victimization in sex trafficking and patient presentations.
To examine the distribution of dyadic care types in multiple chronic conditions, compare self-care and caregiver contributions to patients' self-care in each care type and identify the patient and caregiver characteristics associated with each care type.
Secondary analysis of a multicentre, cross-sectional study.
Patient-caregiver dyads were enrolled from outpatient clinics and community settings. The Dyadic Symptom Management Type Scale was used to categorize dyads by type. Self-care, self-efficacy, comorbidities and cognitive impairment were measured in patients, whereas caregiver contributions to patient self-care, self-efficacy, caregiver burden and hours of caregiving were measured in caregivers. Sociodemographic characteristics perceived social support and mutuality were measured in both patients and caregivers. Univariate and multivariate analyses were performed.
A sample of 541 patient-caregiver dyads was examined. The most frequent dyadic care type was the collaborative-oriented (63%). In the patient-oriented type, patients scored higher on self-care compared with caregivers; in the caregiver-oriented and collaborative types, caregivers scored higher than patients supporting the typology. The patient-oriented type was associated with younger, healthier male patients with better cognitive status, who scored higher for mutuality and whose caregivers scored lower for burden. The caregiver-oriented type was associated with older, less educated patients, with caregivers experiencing higher burden and unemployment. The collaborative type was associated with sicker patients, with the caregiver more probably to be female and employed, with higher perceived social support, mutuality and burden. The incongruent dyadic care type was associated with lower caregiver mutuality.
In the context of multiple chronic conditions, clinicians should consider targeting any educational interventions aimed at improving patient self-care and caregiver contributions to self-care by dyadic care types.
Hypertensive disorders of pregnancy increase a woman’s risk for developing cardiovascular disease, with risk factors manifested as early as one year postpartum. Researchers are examining how physical activity may help to mitigate cardiovascular risk factors in this population.
Review the existing scientific literature on the impact of physical activity in women with a history of hypertensive disorders of pregnancy related to physical activity and cardiovascular risk factor outcomes.
This integrative review examined research studies addressing physical activity in women with a history of preeclampsia or other hypertensive disorders of pregnancy. Using four databases, the search strategy included published studies through December 31, 2019. Identified studies were assessed using Joanna Briggs Institute critical appraisal tools.
The initial search identified 1,166 publications. Seven studies including two observational, four quasi-experimental, and one experimental study were included in the review. Although the studies had limitations, none of these limitations were deemed significant enough to eliminate a study from the review. Studies were conducted in four countries, and participants were predominantly White. Physical activity interventions primarily consisted of delivery of educational content, and data were primarily obtained by self-report. Of the five studies utilizing intervention strategies, three reported positive findings including increased physical activity, enhanced physiologic adaptations, and decreased physical inactivity. One study reported mixed findings of improved physical fitness in both groups, while another reported no change in intent to change exercise behavior associated with the intervention.
Physical activity promotion among women with a history of hypertensive disorders of pregnancy has been studied by a small group of researchers. Current literature on the topic is characterized by limited sample diversity, lack of exercise-based interventions, and over reliance on self-report to measure physical activity. It is imperative that further research be conducted to facilitate improved cardiovascular outcomes.
Postoperative delirium is the most common complication of surgery particularly in older patients.
The current study aimed to summarize the commonly used delirium assessment tools in assessing postoperative delirium (POD) and to estimate the incidence rates of POD.
A systematic review that included empirical cohort studies reporting the use of delirium assessment tools in assessing POD between 2000 and 2019. Five core databases were searched for eligible studies. The methodological quality assessment of the included studies was undertaken using the Joanna Briggs Institute (JBI) critical appraisal checklist to examine the risk of bias. Pooled incidence estimates were calculated using a random effects model.
Nineteen studies with a total of 3,533 postsurgery older patients were included in this review. The confusion assessment method (CAM) and CAM-ICU were the most commonly used tools to assess POD among older postoperative patients. The pooled incidence rate of POD was 24% (95% CI [0.20, 0.29]). The pooled incidence estimates for mixed (noncardiac) surgery, orthopedic surgery, and tumor surgery were 23% (95% CI [0.15, 0.31]), 27% (95% CI [0.20, 0.33]), and 19% (95% CI [0.15, 0.22]), respectively. More than 50% of included studies used CAM to assess POD in different types of postoperative patients. Using CAM to assess delirium is less time-consuming and it was suggested as the most efficient tool for POD detection.
We identified that CAM could be implemented in different settings for assessing POD. The incidence and risk factors for POD introduced can be used for future research to target these potential indicators. The incidence rate, risk factors, and predictors of POD explored can provide robust evidence for clinical practitioners in their daily practice.
Many organizations struggle to systematically integrate EBP into practice. EBP mentors address organizational barriers and promote the translation of evidence into clinical practice at the bedside.
To evaluate research findings related to EBP mentor development programs, to identify effective practices, and to assess the outcomes associated with EBP mentor development programs.
A comprehensive review of the literature was conducted to retrieve studies from CINAHL, PubMed, and Scopus, using keywords and subject headers related to EBP mentorship and quality and safety outcomes. Studies were appraised and reviewed to compare mentor program composition and examine clinician, organizational, and patient outcomes.
Fifteen studies met inclusion criteria: one randomized control trial (RCT), one literature review, eleven descriptive studies, and two case reviews. Most programs included didactic content, an EBP project with coaching, and resources to support learning. The studies found that these programs led to improvements in clinicians’ EBP beliefs, practices, and abilities, the organization’s readiness for EBP, and patient safety.
There is solid justification for healthcare organizations to invest in an EBP mentor development program.
Nurse leaders play a unique role in seeking ways to promote a strong nurse workforce and positive work attitudes and behaviors among nurses to assist in their success. The leadership practice of nurse managers could be an important factor in promoting nurses’ organizational resilience and job involvement.
To determine the relationship between transformational leadership practices of first-line nurse managers and nurses’ organizational resilience and job involvement.
A descriptive correlational research design was conducted at a Saudi university hospital. The study consisted of 60 nurse managers and 211 nurses. Measures included Leadership Practices Inventory, organizational resilience, and job involvement questionnaires. Results were analyzed using inferential statistics and Structural Equation Modeling.
In addition to the positive significant correlation found among the studied variables, First-Line Nurse Managers’ Leadership practices accounted for 43% and 40% of the variance of nurses’ organizational resilience and job involvement.
Nurse leaders perform a crucial role in embracing and executing effective strategies through their transformational leadership and managerial caring to support nurses’ resilience and job involvement. Shared governance and a respectful working atmosphere that conveys gratitude to nurses are popular strategies that enhance the efficacy of nursing leadership and promote positive work attitudes among nurses.
At least 40% of maternal deaths are attributable to failure to rescue (FTR) events. Nurses are positioned to prevent FTR events, but there is minimal understanding of systems-level factors affecting obstetric nurses when patients require rescue.
To identify the nurse-specific contexts, mechanisms, and outcomes underlying obstetric FTR and the interventions designed to prevent these events.
A realist review was conducted to meet the aims. This review included literature from 1999 to 2020 to understand the systems-level factors affecting obstetric nurses during FTR events using a human factors framework designed by the Systems Engineering Initiative for Patient Safety.
Existing interventions addressed the prevention of maternal death through education of clinicians, improved protocols for care and maternal transfer, and an emphasis on communication and teamwork.
Few researchers addressed task overload or connected employee and organizational outcomes with patient outcomes, and the physical environment was minimally considered. Future research is needed to understand how systems-level factors affect nurses during FTR events.
To explore the barriers to healthy eating among nurses working in hospitals.
Published and unpublished papers were identified through electronic searches on PubMed, CINAHL, PsycINFO, Embase, Scopus, COCHRANE Library, Food Science and Technology Abstract, ProQuest Dissertations and Theses and OpenGrey from inception until 6 September 2020. English-language primary qualitative or mixed-method studies on barriers to healthy eating among hospital nurses were included. Mixed-method studies were eligible if their qualitative data were distinguishable. Studies on nursing assistants, enrolled nurses, nursing students, and patient-care assistants were excluded, as well as studies without full-texts, correlational studies, quantitative surveys, exploratory studies, conference abstracts and reviews.
The studies were appraised using Critical Appraisal Skills Programme checklist. Qualitative data were extracted using Joanna Briggs Institute Qualitative Data Extraction Tool. Data synthesis followed two stages, meta-summary and meta-synthesis, proposed by Sandelowski & Barroso.
Twelve studies published from 2008 to 2020 involving 618 hospital nurses were included. The meta-summary generated 10 themes, which were meta-synthesized into three interrelated themes: personal barriers (e.g. nonchalance towards unhealthy eating), interprofessional and patient-related barriers (e.g. sharing unhealthy food), and organizational barriers (e.g. overwhelming work demands).
Insufficient self-control and self-confidence, nonchalance and negligence towards healthy eating and cultural beliefs that oppose the practice of healthy eating (personal barriers), exposure of unhealthy food practices in wards (interprofessional and patient-related barriers) and hospital cafeterias, overwhelming work exigencies and institutional constraints (organizational barriers) hindered nurses to achieve wholesome healthy eating.
Many hospital nurses’ encountered challenges in healthy eating, thereby potentially jeopardizing their health and work performance. The findings emphasized the need of a joint effort by hospital nurses, families and colleagues, and hospital institutions to overcome the barriers to healthy eating faced by the hospital nurses.
To explore evidence reporting facilitators and barriers to implementation of nurse prescribing and provide practical recommendations for evidence-informed implementation and adoption of nurse prescribing under a supervision model.
As demand for access to quality health care services increases, health professional roles are expanding to meet population needs. Nurse prescribing has been effective in some countries and is being considered globally to address growing health care demand. Successful implementation of health service models requires careful planning and consideration. No existing reviews have examined implementation factors in the literature.
CINAHL, MEDLINE, PubMed and EMBASE databases were searched from inception to 15 April 2020.
This integrative review is guided by Whittemore and Knafl and adheres to PRISMA reporting guidelines. The sustainability of innovation framework was used to synthesize data concerning implementation and sustainability factors (i.e. innovation, organizational, political, workforce and financial) for nurse prescribing.
A total of 39 articles were reviewed with literature predominantly reporting findings related to non-medical and nurse prescribing under various models. Variable evidence was found to inform nurse prescribing across five implementation and sustainability factors identifying several areas that require in-depth consideration. Very little evidence is available on nurse prescribing under supervision.
Introduction of service reform is often costly. This review highlights gaps in the literature and raises areas for consideration prior to implementation of this new service delivery model. The introduction of nurse prescribing must be planned and informed by available evidence to support effective adoption, practice and patient outcomes.
There are significant gaps in evidence related to nurse prescribing under a supervision model. Based on the evidence synthesized in this review, this paper provides practical recommendations for health service providers, managers, clinicians, educators and researchers to support implementation and adoption of nurse prescribing.