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AnteayerInternacionales

Factors influencing management of agitation in aged care facilities: a qualitative study of staff perceptions

Abstract

Background

Agitation in older people is commonly associated with cognitive decline, complex medical diagnoses and polypharmacy. Impaired communication and comprehension within a dementia trajectory adds complexity to assessment and management. Despite high prevalence, agitated behaviours remain challenging to manage in residential aged care settings.

Aim

To explore staff perceptions of agitation in residents of aged care facilities, including the influence of dementia, when selecting management strategies to reduce agitated behaviour.

Design

Qualitative descriptive.

Methods

Semi‐structured interviews with 11 aged care staff were conducted at two aged care sites. Transcripts were examined using content analysis to identify common issues and categories. The study complied with COREQ guidelines. (see. Supplementary file)

Results

Participants reported managing resident agitation at least once per shift; most frequently manifesting as wandering, restlessness, or aggression. Management strategies included distraction, providing space, knowing the resident, identifying causative factors, spending individual time, and if necessary medication administration. Agitation management was more challenging for residents with dementia due to impaired communication or comprehension of instruction.

Conclusions

While participants strived to deliver individualised person‐centred care, this was difficult given time and resource constraints. Contemporary management of agitation therefore remains variable in everyday practice, with resident preference used when causative factors were known. Conversely, for residents with impaired communication and/or comprehension, distraction and chemical restraint were commonly used. Nuanced education for assessment and management is recommended to better address this unmet need for some residents.

Relevance to clinical practice

For optimal care, appropriate allocation of time and resources is necessary to identify causative and contextual factors for individual residents. Recommendations are for additional staff training in communication and attitude, and collaborating with frontline staff to develop a practical guide for management of agitation in aged care. These simple initiatives may help to improve consistency of care delivery and resident outcomes.

Recovery Experiences of Younger Stroke Survivors Who Are Parents: A Qualitative Content Analysis

Abstract

Aims and objectives

To explore the experience of parenting for younger stroke survivors (aged 18 to 64 years at the time of the stroke).

Background

Stroke among younger adults increased 43% between 2000 and 2010. The social, emotional, and physical functioning of younger adults affects multiple aspects of their lives including parenting. There is limited research on the experience of parenting after stroke.

Design

This is a qualitative descriptive study.

Methods

We conducted individual semi‐structured interviews with 10 younger adults who were actively parenting children under the age of 18 years at the time of the stroke. Conventional content analysis was used to analyze the data. We report the methods and results using the COREQ checklist.

Results

Impairments from stroke disrupted participants’ identity, relationships, and roles as a parent. The degree to which parenting abilities and behaviors were affected by stroke was contingent upon the type and severity of impairments as well as the children's age. Participants also observed emotional and behavioral changes in their children in response to their stroke. Support from family, friends, healthcare providers, and children's school/daycare was crucial to participants throughout their stroke recovery. Two major themes emerged: 1) finding a new normal and 2) support for parenting post‐stroke.

Conclusions

Findings enable a deeper understanding of the distinct parenting challenges younger stroke survivors face and can inform future research on this population.

Relevance for clinical practice

Study findings highlight the need for continual and tailored follow‐up by nurses and other allied healthcare professionals to decrease the difficulty stroke survivors experience when trying to resume their role as parents.

Nurses’ experiences of compassionate care in the palliative pathway

Abstract

Aims and objectives

The aim was to explore how nurses experience compassionate care for patients with cancer and family caregivers in different phases of the palliative pathway.

Background

Compassion is fundamental to palliative care and viewed as a cornerstone of high‐quality care provision. Healthcare authorities emphasize that patients should have the opportunity to stay at home for as long as possible. There are, however, care deficiencies in the palliative pathway.

Design

This study employed a qualitative design using focus groups and a hermeneutic approach.

Methods

Four focus groups with three to seven female nurses in each group were conducted in Mid‐Norway in 2018. Nurses’ ages ranged from 28‐60 years (mean age =45 years), and they were recruited through purposive sampling (N = 21). Compassionate care was chosen as the theoretical framework. Reporting followed the COREQ guidelines.

Results

Three themes expressing compassionate care related to different phases of the pathway were identified: (a) information and dialogue, (b) the creation of a space for dying, and (c) family caregivers’ acceptance of death.

Conclusions

This study showed that it was crucial to create a space for dying, characterized by trust, collaboration, good relationships, empathy, attention, silence, caution, slowness, symptom relief, and the absence of noise and conflict.

Relevance to clinical practice

The quality of compassion possessed by individual practitioners, as well as the overall design of the healthcare system, must be considered when creating compassionate care for patients and their family caregivers. Nursing educators and health authorities should pay attention to the development of compassion in education and practice. Further research should highlight patients’ and family caregivers’ experiences of compassionate care and determine how healthcare systems can support compassionate care.

Impact

What does this paper contribute to the wider global clinical community? It provides insight into nurses’ role in compassionate care in different phases of the palliative pathway. It highlights the importance of early engagement with family caregivers, as a key element of compassionate care. Nurses play a crucial role in creating a space for dying, which is important for patients’ and their family members’ preparation for death.

Factors associated with family cohesion and adaptability among Chinese registered nurses

Abstract

Aim

To identify determinants of family cohesion and adaptability among Chinese registered nurses.

Background

In China, the shortage of registered nurses imposes a higher physical and emotional workload, which will aggravate their work‐family conflicts. Therefore, it is easy for nurses to ignore the importance of family, which is undeniably detrimental to healthy self‐development and providing better care to patients.

Design

ith a cross‐sectional and observational study design (See the STROBE checklist and Supplementary File 1).

Methods

The Family Cohesion and Adaptability Scale was administered to registered nurses (N = 825) from 10 hospitals throughout China. Multiple linear regression was used to analyze the related factors for family cohesion and adaptability.

Results

The multiple regression analysis revealed that inharmonious relationship with spouse’s parents, discordant nurse‐patient relationship, parents live in countryside, poor leadership were found to be important risk predictors of family cohesion, and inharmonious relationship with spouse’s parents, discordant nurse‐patient relationship, high education, feel overworked, poor leadership were found to be important risk predictors of family adaptability.

Conclusion

Hospital managers need to pay attention to the risk factors that affect nurses’ family cohesion and adaptability. To achieve this, they should employ targeted measures to enhance these aspects in time, which will help improve nurses’ family life and promote their participation and role in family decision‐making. This will not only help them create a better external environment for their healthy self‐development but also allow them to maintain a better mood and energy to take care of patients.

Relevance to clinical practice

Family cohesion and adaptability are important for nurses, as they may affect nurses’ healthy self‐development and quality of service provided to patients. Hospital managers should pay attention to the risk factors of nurses’ family cohesion and adaptability, such as poor nurse‐patient relationship, and consider employing corresponding measures to help them.

Patient‐centred communication for women with breast cancer: Relation to body image perception

Abstract

Aims and objectives

This study aimed to determine the predictive values of patient‐centred communication (PCC) and patient's characteristics on the body image (BI) perception in postmastectomy patients.

Background

Patient‐centred communication has been touted as a means of addressing BI issues, especially for postmastectomy patients.

Design and Methods

This predictive correlational study was conducted on 275 surgically treated breast cancer patients admitted to the Oncology Departments of two hospitals in Tabriz, Iran. These patients were selected using a convenience sampling method. The Body Image after Breast Cancer Questionnaire (BIBCQ) and patient‐centred communication questionnaire (PCCQ) were used for collecting the data. Descriptive and inferential statistics were applied to the data. Reporting was in accordance with the STROBE guideline.

Results

A multivariable model significantly predicted BI perception in participants using surgery type and time elapsed following surgery. Participants’ limitations were significantly affected by surgery type and participants’ perception of the nurses’ PCC skills. Arm concern was significantly affected by surgery type and nurses’ PCC skills.

Conclusion

Patient‐centred skills in nurse–patient communication are critical for resolving BI difficulties such as arm concerns and limitations regarding the disease and its treatment.

Relevance to clinical practice

Patient‐centred communication skills can be taught nurses in the clinical setting to help alleviate patients’ BI problems.

Ageing simulation in health and social care education: A mixed methods systematic review

Abstract

Aim

To identify, evaluate and summarize evidence from qualitative, quantitative and mixed method studies conducted using age suits or other age simulation equipment, with health and social care students.

Design

Convergent segregated mixed method review design as outlined by the Johanna Briggs Institute.

Data Sources

CINAHL (+ with Full Text), MEDLINE, PsycINFO, PubMed, SocINDEX, Web of Science, Cochrane Library, Emerald Insight, Proquest nursing, Science Direct, Wiley Online and BioMed Central (January 2000–January 2020).

Review methods

Convergent segregated synthesis was used to synthesize evidence from the studies and the MERSQI checklist used to appraise quality.

Results

A total of 23 studies were reviewed: one randomized control, two post‐test only randomized control, three quasi‐experimental, 15 one‐group pre/post studies and two qualitative studies. Of the seventeen studies carrying out inferential statistics on attitude scores post intervention, 11 reported an improvement, three indicated no significant change and three reported worsening scores. Key themes included use of appropriate scales, type of equipment used, location and length of interactions, debriefing and contextualization of interventions in broader teaching.

Conclusion

The impact of ageing simulation interventions on health and social care student's attitudes to older people was predominantly positive. However, further high‐quality research is warranted to understand the optimal use of such interventions in the context of health care for a growing ageing population.

Impact

It is important health and social care staff have appropriate knowledge and training to enable them to provide high‐quality care to older people and challenge potential ageism in the system. This review adds to the body of work around the use of simulation and experiential learning to educate health and social care students about ageing and ageism. It also offers recommendations for using ageing simulations effectively to inform attitudes of prospective professionals who will influence future health and social care.

Educational needs and disaster response readiness: A cross‐sectional study of clinical nurses

Abstract

Aim

To analyse clinical nurses’ educational needs and disaster response readiness and the factors influencing their disaster response readiness.

Design

This was a cross‐sectional study.

Methods

A convenience sample comprising 260 nurses with more than a year of working experience at a hospital in Korea was selected from 1‐31 August 2019. Data on nurses’ educational needs and disaster response readiness were collected from participants. A multiple regression model was used to examine the factors influencing disaster response readiness among nurses.

Results

Factors influencing personal readiness were number of years of clinical experience, being female, working in a medical ward, and educational needs for disaster response. Factors influencing self‐protection were working in a medical ward and working in the emergency room. Factors influencing the emergency response were working in a medical ward and working in the emergency room. Factors influencing clinical management were a graduate‐level education or higher, working in a medical ward, working in the emergency room, working in the paediatric ward, experience receiving disaster‐related education, and educational needs for disaster response.

Conclusion

It is essential to be aware of the educational needs and disaster readiness of hospital clinical nurses, to develop their capacity to respond such situations. In addition, to improve the disaster competency of nurses, it is necessary to develop an education programme that considers the factors influencing disaster response readiness in this study.

Impact

Nurses must have the knowledge and skills to respond to a disaster. Nurse educators should help nurses strengthen their disaster‐related knowledge, skills, and judgment. Hospital administrators should encourage nurse educators to provide disaster‐related training and simulation‐based education to increase nurses’ disaster competency to act during disasters.

Exploring patient experiences of participating in a telephone‐based self‐management support intervention: Proactive Health Support (PaHS)

Abstract

Aim

Proactive Health Support is a telephone‐based self‐management intervention that is carried out in Denmark by Registered Nurses who provide self‐management support to people at risk of hospital admission. We aimed to explore participants’ experiences of Proactive Health Support and to identify what the participants find important and meaningful during the intervention process.

Design

Qualitative design involving semi‐structured interview.

Methods

Using a phenomenological–hermeneutical framework, we conducted semi‐structured interviews with 62 participants in their own homes (32 women, 30 men; aged 20–81 years) in spring and fall 2018.

Results

The participants felt confident that they could discuss every matter with the nurses. Participants benefitted from accessibility to the nurses’ professional and medical competences and they felt relief that the nurses contacted them via the telephone due to their multiple health conditions. The participants felt that the nurses were available and helped them to navigate the healthcare system.

Conclusion

The participants valued the intervention because they benefitted from the nurses’ holistic approach. They described the nurses’ knowledge and professionalism in relation to their symptoms, treatments, and medicine as important and meaningful. Accordingly, the intervention seemed to promote feelings of independence and self‐management among the participants.

Impact

From a nursing perspective, the study highlights that it is possible to establish a close relationship and behavioural change among participants through regular telephone contact.

Prioritisation of diabetes‐related footcare amongst primary care healthcare professionals

Abstract

Aims and objectives

To assess primary healthcare professionals’ priority for managing diabetic foot disease (DFD) over the progressive course of the condition compared to other aspects of diabetes care.

Background

DFD affects up to 60 million people globally. Evidence suggests that comprehensive preventative footcare may reduce serious complications of DFD, such as amputation.

Design

A cross‐sectional quantitative study reported according to STROBE statement.

Methods

General Practitioners (GPs) and Credentialled Diabetes Educators (CDEs) working within Australian primary care were invited to complete an online survey, to obtain information about preventative and early intervention footcare priorities and practices. Ten GPs and 84 CDEs completed the survey.

Results

On diagnosis of type 2 diabetes, haemoglobin A1c (HbA1c) review was identified to be one of the top three priorities of care by 57 (61%) of participants whilst at 20‐year history of diabetes 73 (78%) participants indicated its priority. Foot assessments became a priority for 78% (n = 73) of participants and podiatry referrals a priority for 53% (n = 50) of participants only when a “foot concern” was raised. Referrals to specialist high‐risk foot podiatrists or services were a first priority for 56% (n = 53), when the person had significant amputation risk factors.

Conclusion

Diabetes‐related preventative footcare assessments and management remain a low priority amongst primary healthcare professionals. Preventative care for asymptomatic complications, such as DFD, may be overlooked in favour of monitoring HbA1c or medication management. Limited prioritisation of footcare in primary care is concerning given the risks for amputation associated with DFD.

Relevance to clinical practice

This study reveals the need for primary healthcare decision makers and clinicians to ensure preventative footcare is a focused priority earlier in the diabetes care continuum. Collaborative and widespread promotion of the importance of proactive rather than reactive footcare practices is required to support prevention of foot ulcers and amputation.

Using metaphor method to interpret and understand meanings of international operating room nurses' experiences in organ procurement surgery

Abstract

Aims

To demonstrate how metaphor method can be employed in health care research, through a rainbow metaphor to conceptualise lived experiences, and represent a sense of verisimilitude, in a phenomenological study of international nurses' experiences of organ procurement procedures.

Background

International operating room nurses are likely to form unique attitudes towards multi‐organ procurement. Phenomenology is used to focus on discovering human experiences and the meanings of certain phenomena. Phenomenological writing can mediate people's reflections and actions, measure people's thoughtfulness and help people to see and show lived experiences from their lifeworlds.

Design

Metaphor was used to interpret meanings of international operating room nurses' experiences in organ procurement surgery. The meanings were identified through a phenomenological approach informed by the work of van Manen.

Methods

A metaphor method was used to interpret and understand the lived experiences of eighteen international OR nurses recruited from nine different countries. Thematic data analysis was used to portray their lived experiences in organ procurement procedure.

Results

Using a rainbow as metaphor, a vivid picture was portrayed reflecting international OR nurses' experiences and organ procurement journey in Australia as challenging, with mixed feelings. According to the relationship between certain colours and emotions, four essential themes evolved into the concept of a four‐colour rainbow to signify the meanings of international OR nurses' experiences in organ procurement procedures. The essential themes represented by these four colours were as follows: Orange—“The surreality of experiencing death,” Red—“Personal and professional challenges,” Green—“Becoming stronger” and Purple—“My beliefs, my wishes.”

Conclusion

Interpreting the meanings of their organ procurement experiences using metaphor method provided valuable insights about what personal and professional challenges these nurses faced, how they coped and managed their challenges, what support and care they required from others, and suggestions for future practice.

Relevance to clinical practice

Operating room nurses in practice needed a range of workplace supports and the rainbow metaphor provides a suitable approach for reflection and understanding of their experiences in organ procurement, with a focus on international, newly graduated and less experienced nurses.

Practice improvement is a likely outcome when nurses have a better understanding of their experiences and the experiences of others in their team and this will assist in identifying their knowledge and professional support needs. The method demonstrates how metaphor can be applied to understand clinical nursing situations.

Effectiveness of blood glucose control protocol for open heart surgery patients

Abstract

Aims

To evaluate the effectiveness of a tailored blood glucose control protocol for postoperative cardiac surgery patients treated in intensive care.

Design

Retrospective study.

Methods

Data for the control group (non‐tailored protocol) were collected from medical records at a tertiary hospital in Seoul, Korea between April–July 2015. Data for the experimental group (tailored protocol) were obtained from medical records between April–July 2016. After adjusting the target blood glucose range, eliminating single‐dose insulin administration and extending the blood glucose measurement time interval, data for blood glucose measurements, time for reaching and maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments for the experimental group were collected.

Results

In the experimental group (where the target blood glucose rate was increased) the hypoglycaemia rate and the variation in blood glucose decreased significantly compared with the control group. In particular, the experimental group maintained relatively stable blood glucose levels by retaining a small variation range in glucose, regardless of the presence of diabetes. Time required for maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments per patient decreased.

Conclusion

The tailored protocol contributes to the safe and effective control of blood glucose in critical care patients after cardiac surgery and to the efficiency of nurses administering it.

Impact

This study has two significant impacts. The application of the tailored protocol has a positive impact on patients’ blood glucose management, a critical component of treatment for postoperative cardiac patients in intensive care units. It also has a positive impact on the efficiency of nurses applying it. The results of this study are thus expected to facilitate successful implementation of clinical protocols for critical care after heart surgery.

Systematic review: What is the impact of self‐scheduling on the patient, nurse and organization?

Abstract

Aim

To systematically review and evaluate the literature on the impact of self‐scheduling on patient, nurse and organization‐related outcomes.

Design

A systematic review.

Data sources

PubMed, Embase, Web of Science, Cinahl, Scopus, Google Scholar, ERIC and Cochrane Library were screened until October 2019 (week 40) for peer‐reviewed, empirical articles, written in English, Dutch or French.

Review methods

Two reviewers screened title and abstract using predetermined eligibility criteria and one reviewer screened the full texts of relevant hits. Quality was assessed with the Mixed Methods Appraisal Tool.

Results

Studies (N = 23) were retained and classified into explanatory and descriptive studies. The articles reported on a range of outcomes: patient‐ and nurse‐reported quality of care, job satisfaction, satisfaction with scheduling, work/life balance, planning involvement, interaction with colleagues, health and well‐being, psychosocial factors, professional development, nurse manager's scheduling time, general working conditions, turnover, temporary employment agency use and absenteeism, recruitment and retention.

Conclusion

The evidence base is limited. Several studies confirmed the positive impact of self‐scheduling on the nurse and the organization. However, other studies found negative outcomes or no change. These outcomes should be interpreted in the light of contextual factors and the implementation process, which was often not without difficulties. Future research should use a multimethod longitudinal design, bear in mind the possibilities of quantitative research (e.g. for studying psychosocial factors) and employ a theoretical framework.

Impact

This review informs about the inconsistent evidence on the association between self‐scheduling and patient, nurse and organization‐related outcomes and includes enablers and barriers to a successful implementation. These outcomes are influenced by the implementation process and the sustainability of the self‐scheduling system, which are still major challenges for healthcare management. This demonstrates the urgent need for further research.

Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis

Abstract

Aims

The aim of this systematic review and meta‐analysis was to summarize and quantify peripheral intravenous catheter‐related complications.

Design

This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta‐analysis of Observation Studies in Epidemiology for cohort studies.

Data sources

The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 ‐April 2019.

Review Methods

Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman–Tukey double arcsine transformation using random‐effects meta‐analysis; estimates of heterogeneity were taken from inverse‐variance fixed‐effect models.

Results

Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter‐related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department‐inserted catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies.

Conclusion

Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi‐specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced.

Impact

Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters.

Formal caregivers’ perceptions and experiences of using pet robots for persons living with dementia in long‐term care: A meta‐ethnography

Abstract

Aim

To explore the formal caregivers’ perceptions and experiences of using pet robots for persons living with dementia residing in long‐term care settings and the factors influencing their perceptions by evaluating, integrating, and synthesizing findings from relevant international research articles using a meta‐ethnography.

Design

Noblit and Hare's interpretative meta‐ethnography.

Data sources

Eight articles, published between 2013–2018, were identified following a systematic search of four databases (Scopus, ProQuest Central, EBSCO, and Google Scholar) between June 2019–February 2020.

Review methods

Two researchers independently appraised the selected articles. Noblit and Hare's seven steps and a meta‐ethnography reporting guidance were used. Reciprocal translation was used to obtain a line of argument synthesis.

Results

Three overarching themes were identified: a beneficial tool but not for everybody, a tool that has limitations but could be overcome, and a positive experience if appropriately introduced and sustained.

Conclusion

This meta‐ethnography contributes to the understanding of current potential benefits and limitations of pet robots for persons living with dementia residing in long‐term settings. It also identifies several factors, as perceived by caregivers, that may influence their acceptability, adoption, and routine use in practice.

Impact

Although for the past two decades pet robots have been used as a psychosocial intervention for persons living with dementia in long‐term care settings, there is a dearth of literature on the perception of formal caregivers and their experience of such interventions. While pet robots can have emotional, social, behavioural, and practical benefits, there are several technological, organizational, and contextual challenges and limitations that constrain their routine use. The solutions synthesized in this review can be of benefit to robot designers, facility managers, policy makers, and other health care professionals interested in introducing pet robots in long‐term care settings.

Nursing discharge teaching for hospitalized older people: A rapid realist review

Abstract

Aim

To develop, refine and put forward a programme theory that describes configurations between context, hidden mechanisms and outcomes of nursing discharge teaching.

Design

Rapid realist review guided by Pawson's recommendations and using the Realist and Meta‐narrative Evidence Syntheses: Evolving Standards.

Data Sources

We performed searches in MEDLINE, Embase, CINAHL Full text, Google Scholarand supplementary searches in Google. We included all study designs and grey literature published between 1998‐2019.

Review Methods

We followed Pawson's recommended steps: initial programme theory development; literature search; document selection and appraisal; data extraction; analysis and synthesis process; presentation and dissemination of the revised programme theory.

Results

We included nine studies and a book to contribute to the synthesis. We developed 10 context–mechanisms–outcome configurations which cumulatively refined the initial programme theory. These configurations between context, mechanisms and outcome are classified in four categories as follows: relevancy of teaching content; patients’ readiness to engage in the teaching–learning process; nurses’ teaching skills and healthcare team approach to discharge teaching delivery. We also found that some of the same contexts generated similar outcomes, but through different mechanisms, highlighting interdependencies between context–mechanisms–outcome configurations.

Conclusion

This rapid realist review resulted in an explanatory synthesis of how discharge teaching works to improve patient‐centred outcomes. The proposed programme theory has direct implications for clinical practice by giving meaning to the ‘hidden’ mechanisms used by nurses when they prepare patients to be discharged home and can inform curricula for nursing education.

Impact

The essential components, process mechanisms, contexts and impacts of the nursing discharge teaching are not consistently or clearly described, explained or evaluated for effectiveness. This review uncovers underlying contexts and mechanisms in the teaching/learning process between patients and nurses. The resulting programme theory can guide nurse clinicians and managers towards improvements in conducting discharge teaching.

Nursing students' engagement with social media as an extracurricular activity: An integrative review

Abstract

Objective

To explore primary research evidence reporting the reason for undergraduate nursing students' engagement with social media as an extracurricular activity.

Background

The formal integration of social media into nursing education has been discussed extensively in previous research. The influence of social media on nursing students' learning and class engagement has also been explored. However, despite the growing volume of literature examining the formal use of social media by undergraduate nursing students, a broader perspective on how and why nursing students engage with social media as an extracurricular activity has not yet been explored.

Design

An integrative review.

Methods

A systematic search was performed to find articles published between 2007–2019 using Ovid MEDLINE, Embase, Ovid Emcare and CINAHL Plus databases and the Google Scholar search engine. The review process is reported according to PRISMA.

Results

Twelve papers met the inclusion criteria, revealing that undergraduate nursing students engaged with social media for many reasons external to their formal curricula. They engaged with social media to keep in touch with others and to entertain themselves, promote learning, find social support, develop a professional nursing identity, share their experiences as nursing students and locate job opportunities.

Conclusion

Undergraduate nursing students engaged with social media for numerous reasons. It supported students in their academic and personal lives by keeping them in touch with people around them. The students used social media to identify with the nursing profession; however, its influence on their professional identity development is yet to be fully explored.

Relevance to clinical practice

Nursing schools should consider the myriad of reasons students engage with social media in order to optimise their professional development. Understanding how nursing students' professional identity develops via social media may be used to help sustain nursing students and support their transition into practice.

Predictive factors of a prolonged length of stay in a community Nursing‐Led unit: A retrospective cohort study

Abstract

Aims and objectives

To describe the care provided to patients admitted into a community Nursing‐Led inpatient unit and to identify factors predicting a length of stay exceeding an established threshold.

Background

Few studies have been conducted to describe the care provided in a Nursing‐Led unit. No studies have investigated factors affecting length of stay in these services.

Design

Retrospective cohort study.

Methods

Consecutive patients admitted to a community Nursing‐Led unit between 2009–2015 were enrolled. Sociodemographic, medical and nursing care (diagnoses and activities) variables were collected from electronic health records. Descriptive analysis and a backward stepwise logistic regression model were applied. The study followed the STROBE guidelines.

Results

The study enrolled 904 patients (mean age: 77.7 years). The most frequent nursing diagnoses were bathing self‐care deficit and impaired physical mobility. The nursing activities most provided were enteral medication administration and vital signs measurement. Approximately 37% of the patients had a length of stay longer than the established threshold. Nine covariates, including being discharged to home, having an impaired memory nursing diagnosis or being treated for advanced wound care, were found to be independent predictors of prolonged length of stay. Variables related to medical conditions did not affect the length‐of‐stay threshold.

Conclusions

The length of stay in the community Nursing‐Led unit was mainly predicted by conditions related to sociodemographic factors, nursing complexity and functional status. This result confirms that the medical and nursing needs of a community Nursing‐Led unit population substantively differ from those of hospitalised acute patients.

Relevance to clinical practice

The nursing complexity and related nursing care to be provided may be adopted as a criterion to establish the appropriate length of stay in the community Nursing‐Led unit for each individual patient.

Perceptions of managers regarding prerequisites for the development of professional competence of newly graduated nurses: A qualitative study

Abstract

Aim and objectives

To describe perceptions of managers regarding prerequisites for professional competence development of newly graduated nurses following a 1‐year residency program.

Background

In general, managers are unsatisfied with the professional competence of newly graduated nurses. Therefore, they have been involved in residency programs to support the nurses’ transition from being nursing students to professional nurses. However, perceptions of managers regarding the professional competence development of nurses have been sparingly studied.

Design/Methods

Qualitative, descriptive study with a data‐driven inductive approach with content analysis to obtain an understanding of the perceptions of nine managers through interviews. EQUATOR checklist COREQ is used.(see Supplementary file‐1)

Results

Three themes emerged: 1) The nurses´ relationships with their teams and patients, 2) expectations regarding the development of practical skills and leadership skills, and 3) prerequisites for continuing learning by supportive structures and a mutual responsibility between the manager and the nurse. Reflection was perceived by the managers as a cornerstone in the learning and development of professional competence. Learning theory was important, but learning practical clinical skills was essential for the nurses to develop competence and be able to perform their work, including being a leader of the team. Some structures discouraged continued learning in the development of professional competence, indicating a gap between the health care settings and the basic nursing program.

Conclusions

There is a gap between the university and the health care settings in maintaining a structure for continued learning, which requires cooperation. This gap and tension can be a driving force for the learning process of competence development. Relationships with team members and patients are considered fundamental for developing professional competence.

Relevance to clinical practice

To overcome the gap between the university and the health care settings, the managers can facilitate nurses’ continued learning by creating structures for reflection.

Promotion of professional quality of life through reducing fears of compassion and compassion fatigue: Application of the Compassionate Mind Model to Specialist Community Public Health Nurses (Health Visiting) training

Abstract

Aims and Objectives

To identify if a Compassionate Mind Model‐based curriculum reduces students’ perceived fears of compassion and improves their professional well‐being.

Background

Enabling compassion is mandatory within nurse education but evidencing it is challenging. Research suggests that application of the Compassionate Mind Model might reduce students’ fears of compassion and also decrease compassion fatigue. This study reports outcomes of a post‐registration curriculum based on that model for training Specialist Community Public Health Nurses (Health Visiting).

Design

A quantitative, prospective evaluation of a 12‐month training course for Health Visiting students. Reporting was guided by the STROBE checklist for observational studies.

Methods

Fears of Compassion Scales were applied at course start (time 1), mid‐point (time 2; +6months), and end (time 3; +12months) to evaluate fears of compassion of 26 post‐registration student Health Visitors (81% of course cohort) who provided data at all three points. The Professional Quality of Life tool was administered simultaneously to evaluate compassion satisfaction and burnout/secondary traumatic stress (compassion fatigue).

Results

Between time 1 and time 3 mean Fears of compassion scores decreased by 16.6‐48.5% (Repeated Measures Analysis of Variance); mid‐point scores were intermediary. At time 3, Compassion satisfaction had increased slightly (+4.1%), negatively correlated with Fears of compassion for self (r= ‐0.602; p=0.001;n=26) and Fears of receiving compassion from others (r= ‐0.568; p=0.002;n=26). Burnout score decreased by 18.7%, correlated positively with Fear of compassion for self (r=0.493; p=0.011;n=26) and Fear of receiving compassion from others (r=0.615; p=0.001;n=26). Secondary traumatic stress score decreased by 16.5% but was not correlated with any fear of compassion.

Conclusion

Findings suggest that application of the Compassionate Mind Model might reduce practitioners’ fears of compassion linked to a decrease in risk of compassion fatigue.

Relevance to clinical practice

The Compassionate Mind Model could provide an effective vehicle to promote compassion and nurse well‐being.

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