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Anteayer Journal of Advanced Nursing

“I don't feel like I'm a person”: Nursing knowledge of transgender care through the lens of transgender people

Abstract

Aims

One aim of this study was to discover and understand the perceptions of healthcare delivery for transgender people who have had interactions with nurses while receiving care. An additional purpose of this study was to identify if these perceptions of nursing knowledge have an influence on transgender individuals seeking future healthcare.

Design

Qualitative, interpretive description.

Methods

Recruitment of participants and interviews took place between September and November 2020. Confidentiality and protection of human participants was prioritized, and data analysis concluded in early 2021.

Results

Ten participant interviews were completed until data saturation were determined. One overarching theme and five supporting themes were constructed from data. Based on participant experiences, these themes reflect transgender peoples' perceptions of nursing knowledge of transgender care and how these perceptions impact seeking future healthcare.

Conclusion

Experiences that shaped transgender peoples' perceptions of nursing knowledge of transgender care varied depending on the locations of these services and the experience and understanding of registered nurses. These findings highlight the perceptions that transgender people have of registered nurses' knowledge of transgender care and the influence that those perceptions have on them seeking future healthcare.

General Practice Nurses' experiences of changing care delivery during COVID‐19. Implications for future practice: Qualitative study protocol

Abstract

Aim

To explore how General Practice Nurses experience implementing change at pace and scale in delivering care during consecutive waves of the COVID-19 pandemic. To evaluate the impact of changes to general practice nurses' working practices on professional wellbeing.

Background

In response to the COVID-19 pandemic, general practice rapidly and extensively changed care delivery. There has been little exploration of the experiences of General Practice Nurses and care delivery, job satisfaction, workload, stress and professional support.

Design

A qualitative case study design of three to five general practice case sites will explore General Practice Nurses' experiences during the Covid-19 pandemic. The study was funded and approved by the General Nursing Council Trust in June 2021. University ethics approval was gained in July 2021. Health Research Authority approval has been obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834].

Methods

Data will consist of focus groups and/or semi-structured interviews with General Practice Nurses, primary healthcare team members and other key informants. Business/strategy and nurse team meetings relating to workforce planning/review will be observed. Documents will be analysed and routinely collected general practice data will provide descriptive contextualisation at each site. The study will be theoretically underpinned by the Non-adoption, Abandonment, Scale-up, Spread and Sustainability Framework and data analysed using framework analysis.

Discussion

General Practice Nurses have a unique sphere of knowledge and undertake specific work in primary care. This workforce is challenged by recruitment, retention and retirement issues, leading to the loss of highly experienced and knowledgeable professionals. It is important to explore how working practices brought about by Covid-19 affect General Practice Nurses.

Impact

This study will explore working practices brought about by the Covid-19 pandemic to inform care delivery, patient care and support General Practice Nursing workforce wellbeing and will highlight and mitigate negative aspects of novel and changing care delivery. Key factors in implementing and supporting future practice and change implementation will be developed.

Trial registration: CPMS: 51834.

REducing delay through edUcation on eXacerbations for people with chronic lung disease: Study protocol of a single‐arm pre‐post study

Abstract

Aim

This study protocol aims to examine the effectiveness and preconditions of a self-management program—named REducing Delay through edUcation on eXacerbations (REDUX)—in China.

Background

The high disease burden in people with chronic lung disease is mainly due to exacerbations. There is a need for effective exacerbation-management interventions. A nurse-led program, REDUX, helped patients self-manage exacerbations.

Design

A single-arm pre-post study.

Methods

Fifty-four patients and 24 healthcare professionals (HCPs) in Chinese primary care will be included. The core element of the program is a personalized action plan. HCPs will receive training in using the action plan to help patients manage exacerbations. The intervention will start when a patient is referred to the nurse for a post-exacerbation consultation and ends when the patient presents for the second post-exacerbation consultation. During the first post-exacerbation consultation, the patient and nurse will create the action plan. The primary outcomes in patients will include the delays between the onset of exacerbation and recognition, between exacerbation recognition and action, between exacerbation recognition and consultation with a doctor, and when the patients feel better after receiving medical help from HCPs. The secondary outcomes will include preconditions of the program. The ethics approval was obtained in September 2021.

Discussion

This study will discuss a culturally adapted nurse-led self-management intervention for people with chronic lung disease in China. The intervention could help Chinese HCPs provide efficient care and reduce their workload. Furthermore, it will inform future research on tailoring nurse-led self-management interventions in different contexts.

Impact

The study will contribute to the evidence on the effectiveness and preconditions of REDUX in China. If effective, the result will assist the nursing of people with chronic lung disease.

Trial registration: Registered in the Chinese clinical trial registry (ID: 2100051782).

Post‐separation abuse: A concept analysis

Abstract

Aim

To report an analysis of the concept of post-separation abuse and its impact on the health of children and adult survivors.

Design

Concept analysis.

Data Sources

A literature search was conducted via PubMed, Cochrane and Embase and identified articles published from 1987 to 2021.

Methods

Walker and Avant's (2019) eight stage methodology was used for this concept analysis, including identifying the concept, determining the purpose of analysis, identifying uses of the concept, defining attributes, identifying a model case and contrary case, antecedents and consequences and defining empirical referents.

Results

Post-separation abuse can be defined as the ongoing, willful pattern of intimidation of a former intimate partner including legal abuse, economic abuse, threats and endangerment to children, isolation and discrediting and harassment and stalking. An analysis of literature identified essential attributes including fear and intimidation; domination, power and control; intrusion and entrapment; omnipresence; and manipulation of systems. Antecedents to post-separation abuse include patriarchal norms, physical separation, children, spatiality and availability, pre-separation IPV and coercive control and perpetrator characteristics. Consequences include lethality, adverse health consequences, institutional violence and betrayal, such as loss of child custody and economic deprivation.

Conclusion

This concept analysis provides a significant contribution to the literature because it advances the science for understanding the phenomenon of post-separation abuse. It will aid in developing risk assessment tools and interventions to improve standards of care for adult and children survivors following separation from an abusive partner.

Impact

This concept analysis of post-separation abuse provides a comprehensive insight into the phenomenon and a theoretical foundation to inform instrument development, future research and intervention. Post-separation abuse is a complex, multi-faceted phenomenon that requires differential social, legal and healthcare systems responses to support the health and well-being of survivors and their children.

Exclusive breastfeeding in African American women: A concept analysis

Abstract

Aim

To report an analysis of the concept of exclusive breastfeeding (EBF) in African American women.

Background

EBF is the gold standard for infant nutrition from birth until 6 months. The rate of EBF in United States is low—26%, with African American women having the lowest rates. The low rates of EBF in this population are strongly attributed to bias, racism and generational trauma. Therefore, clarifying the concept of EBF with respect to these factors is important for promoting EBF rates of this population.

Design

Concept analysis.

Data sources

Search was conducted in four databases (CINAHL, PubMed, PsycINFO and Scopus) for articles published between 2001 and 2021. A total of 30 articles (20 quantitative, seven qualitative and three mixed methods) clarified the concept. Relevant literature emanated from diverse disciplines examining historical and present maternal and infant health.

Methods

Concept analysis using Rodger's evolutionary method.

Results

An operational definition of the concept of EBF in African American women was developed from the identified antecedents (modifiable and non-modifiable), defining attributes and consequences of the concept. Access to breastfeeding resources, maternal (prenatal intention to breastfeed, smoking status, attitude towards breastfeeding), infant (skin-to-skin care, successful latching and weight) and contextual factors (socioeconomic, occupational and cultural) predict EBF. The primary attributes of EBF were physiological, physical, psychological and relational. Consequences of EBF were positive health outcomes for, and increased bonding between, mother and infant.

Conclusion

This concept analysis is the first identifying modifiable and non-modifiable antecedents of EBF. The analysis provides an operational definition for EBF in African American women which is useful to promote understanding of breastfeeding. This new concept examines the historic societal trauma associated with wet nursing and reframes breastfeeding as a positive maternal and infant health behaviour.

A theory‐driven exercise intervention among community‐dwelling (pre)frail older adults: Protocol for a stepped‐wedge cluster‐randomized trial

Abstract

Aim

This study is aimed to evaluate the effectiveness of a theory-driven exercise intervention for Chinese community-dwelling (pre)frail older adults, and to clarify the underlying mechanisms of the exercise intervention in this population.

Design

A stepped-wedge cluster-randomized trial.

Methods

A stepped-wedge cluster-randomized trial will be conducted among (pre)frail older adults at six communities in a county of central China. A 12-week multicomponent exercise intervention based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) will be implemented to all participants during the study period. The primary outcomes are frailty, muscle mass, muscle strength and physical performance. Secondary outcomes include beliefs in exercise, exercise behaviours and other physical, mental and social functioning. Assessments will be conducted at baseline and at week 12, 24 and 36. A multilevel regression model will be used to evaluate the effectiveness of exercise interventions. A multilevel mediation model will be used to clarify the underlying mechanisms of this exercise intervention.

Discussion

This study is expected to provide an effective and practical mode for exercise interventions among Chinese community-dwelling (pre)frail older adults, and contribute to the existing evidence in this field.

Trial registration

Chinese Clinical Trial Registry ChiCTR2100041981.

Exploring the context, role and impact of public health nursing during COVID‐19: A multiple case study protocol

Abstract

Aim

The purpose of this study is to: (a) describe public health nursing roles over the course of the COVID-19 pandemic in Ontario, Canada; (b) describe the contextual factors that influence public health nursing role implementation; and (c) describe nurses' perceived impact of their roles on client outcomes and professional/personal nursing practice.

Design

Descriptive multiple case study.

Methods

Recruitment of public health nurses (PHNs), working in direct service or administrative leadership positions, in an Ontario public health unit will be conducted through purposive and snowball sampling. Nursing roles will be compared and contrasted across three cases differentiated by geographic setting: urban, urban–rural, northern. In each geographic case, a priori estimates of sample size will include 10 PHNs providing direct care and at least five nurses in an administrative leadership role; with an overall estimated study sample size of 45 individuals. Demographic data will be collected using an online anonymous survey. Individual semi-structured interviews with PHNs, and focus groups with nursing administrators will be conducted via telephone and audio-recorded. Individual interviews and focus groups will be transcribed verbatim. Reflexive thematic analysis will be used to generate emergent themes in each case and cross-case synthesis will be used to compare and contrast patterns across geographic cases.

Discussion

Expected findings will provide an in-depth analysis of the rapidly evolving roles and functions of PHNs throughout the COVID-19 pandemic and their impact on individuals, families and communities. As well, findings will provide a new understanding about the contextual barriers and facilitators of PHN role implementation in their working environments.

Impact

Study findings can support decision-making in relation to funding, resource allocation and supportive work structures and processes at a public health system and/or individual public health organization level.

Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta‐analysis

Abstract

Aims

To examine the patient-related factors that have been linked to glycaemic control in people living with type 2 diabetes mellitus in Middle Eastern countries.

Design

A systematic review and meta-analysis.

Data Sources

A computerized search was conducted using the databases MEDLINE (via PubMed and Ovid), EMBASE, Scopus and CINAHL to identify peer-reviewed articles published in English between 1 January 2010 and 21 May 2020. On 28 June 2021, the search was updated with the same keywords and databases; however, no further relevant studies were identified.

Review Methods

Extracted data were analysed using Review Manager 5.4.

Results

The final sample consisted of 54 articles with a total of 41,079 participants. Pooled data showed an increased risk of inadequate glycaemic control in smokers [OR = 1.26, 95% confidence interval (CI): 1.05, 1.52; p = .010], obese patients (OR = 1.30, 95% CI: 1.10, 1.54; p = .002), patients with elevated waist to hip ratio (OR = 1.62, 95% CI: 1.16, 2.26; p = .004) and longer disease duration (OR = 2.01, 95% CI: 1.64, 2.48; p < .001). A lower risk of inadequate control was associated with physical activity (OR = 0.40, 95% CI: 0.24, 0.67; p < .001) and self-management (OR = 0.49, 95% CI: 0.29, 0.82; p = .006).

Conclusion

These findings highlight the opportunity to address factors to improve glycaemic control. Further longitudinal studies are required to better understand these variations, to assess all predictors of glycaemic control in participants with type 2 diabetes, and to provide a strong basis for future measures to optimize glycaemic control.

Pandemic perspectives from the frontline—The nursing stories

Abstract

Aim

To describe the experiences of registered nurses working in a US healthcare system during the COVID-19 pandemic.

Design

This qualitative thematic analysis study is a secondary analysis of stories submitted by nurses to a repository established by the parent study.

Methods

Registered nurses working in various roles in a healthcare system submitted stories (N = 45) to open-ended prompts via an online repository between June 2020 and February 2021. A team of three nurse scientists coded the stories using Dedoose software. Initial codes were then reviewed by the team to synthesize initial coding into themes. The COREQ checklist was used to ensure research reporting guidelines were met.

Results

Thematic analysis revealed three themes in a global theme of COVID-19 pandemic-related personal and professional evolution: (1) The art and science of pandemic nursing, (2) Persisting despite challenges; and (3) Learning as we went. Each of the three organizing themes were supported by basic themes.

Conclusions

Identified themes affirm some of nursing's long-standing core values, such as the central role of human connectedness in restoring health, but findings also reflect new evolutionary processes of moral identity formation that occurred among nurses and the nursing profession during the COVID-19 pandemic.

Impact

Findings from this study describe the processes by which nurses' moral identity evolved during a segment of the COVID-19 pandemic. Collectively, these evolutions represent important shifts in the nursing profession. Using findings from this study, nurse educators, nurse managers and healthcare administrators will be able to implement effective, sustainable policies and processes that meet the needs of both the community and the workforce.

No Patient or Public Contribution

This study was designed to capture the experiences of nurses employed by one healthcare organization. However, it was not conducted using input or suggestions from the public or the patient population served by the organization.

Building a community‐academic partnership to improve screening for intimate partner violence: Integrating advocates in healthcare clinic settings

Abstract

Aims

To develop an innovative community-academic partnership to advance, test and promote intimate partner violence screening and referral protocols by comparing the effect of integrating intimate partner violence advocates versus enhancing medical training in medical clinic settings serving women from vulnerable populations. Detecting intimate partner violence in healthcare settings allows for survivors to connect to safety and referral resources prior to violence escalating. Screening for intimate partner violence and connecting patients to referral resources requires creating a safe and trusting relationship between healthcare providers and patients. Developing screening and referral protocols responsive to survivors' needs requires involvement of clinic staff, survivors and community agencies that support survivors.

Design

Three phases of the project include Discovery, Implementation and Dissemination. Mixed-methodology will help in understanding current practices and effects of interventions.

Methods

Actions included in each phase: Discovery: 1) nurse-led focus groups of clinic staff, providers and survivors to understand current clinic practices; 2) retrospective chart review of the number of screens performed, positive screens detected and interventions performed. Implementation: 1) randomization of patients to be interviewed by a trained advocate or by healthcare provider with enhanced training; and 2) assess the number of screenings and referrals performed in each arm and 3) evaluate outcomes of intervention. Dissemination through: presentations, manuscripts and policy recommendations at the institutional and regional level. This IRB-approved proposal was funded in July 2021 by an Advancing a Healthier Wisconsin grant.

Discussion

The partnership has improved channels of communication and understanding between diverse clinical care providers, survivors and community agency staff as they navigate the complex challenges to the development and integration of screening and referral protocols.

Impact

This project will provide evidence of the most effective intimate partner violence screening and referral methodology that can be utilized in a wide variety of medical settings.

The prognostic impact of symptom clusters in patients with heart failure: A systematic review and meta‐analysis

Abstract

Aim

To determine the impact of symptom clusters on clinical outcomes among heart failure patients.

Design

Systematic review and meta-analysis.

Data sources

Peer-reviewed articles were searched from 12 English and Chinese language databases from inception to August 2021.

Review Methods

Narrative syntheses were first conducted to integrate symptom clusters reported in the identified studies. This was followed by meta-analysis to synthesize the evidence on the association or predictive effects of symptom clusters on clinical outcomes.

Results

Twelve studies were identified. Among studies which identified highly correlated symptoms as in a cluster, meta-analysis indicated that severe congestive (r = .45, 95% CI = 0.38–0.52), weary (r = .41, 95% CI = 0.33–0.50), ischaemic (r = .29, 95% CI = 0.04–0.51) and stress-related (r = .62, 95% CI = 0.31–0.81) symptom clusters were correlated with a poorer health-related quality of life. As for studies used latent class to identified patient cohorts of similar symptom pattern, high symptom cohorts (hazard ratio = 1.86, 95% CI = 1.39–2.48) and incongruent physical and psycho-cognitive symptom cohorts was associated with a significantly higher risk (hazard ratio = 2.10, 95% CI = 1.44–3.07) of combined event rate relative to low symptom presentation.

Conclusions

This review has identified the impact of symptom clusters on clinical outcomes in heart failure patients. In addition to the classical physical symptoms highlighted in the clinical management guidelines, our findings suggested the important predictive role of psycho-cognitive and weary symptoms in determining the clinical outcomes of HF patients.

Impact

This review concluded the promising prospect of symptom clusters in shaping clinical outcomes of heart failure. The findings highlighted the importance of integrating care to minimize the disease impact on psycho-cognitive function and weary symptoms among this clinical cohort. The review also inform the direction on how to advance the knowledge on symptom clusters among this clinical cohort.

Nurse manager intentional rounding and outcomes: Findings of a systematic review

Abstract

Aim

To summarize the evidence available on Nurse Manager Intentional Rounding (NMIR) describing the main characteristics and methodological quality of studies available, the features of rounding and the outcomes as measured to date.

Design

A systematic review.

Data Sources

Electronic databases, including MEDLINE-EBSCHOST, PubMed, CINAHL, Scopus, Cochrane, Clinicalkey, ScienceDirect, OVID, Sage Journals and Web of Science, were searched up to June 2021.

Review Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline was used to summarize methods and report findings. The Joanna Briggs Institute Critical Appraisal tools were used to evaluate the methodology quality of the studies included.

Results

Seven studies were included with pre-post-test (n = 3), longitudinal, two-group post-tests, quasi-experimental, and retrospective study designs (n = 1, respectively). In five studies, the nurse managers were trained to conduct the rounding, which was shaped according to three main features: a structured (n = 4), a semi-structured (n = 1) and an unstructured rounding (n = 2) delivered from high (twice a day 7/7) to low intensity (once a day, 5/7). Two main outcomes have been measured to date, the patient satisfaction and some aspects related to the care quality. Five studies reported that the satisfaction scores of patients who received rounding were significantly higher than that perceived by patients not receiving rounding. About the other aspects of the quality of care, two studies documented significant improvements as a consequence of the NMIR (e.g. information accessibility, discharge instructions, coordination of care after discharge).

Conclusion

Studies available report in general a low methodological quality, mainly due to their pragmatic nature as quality improvement projects. Therefore, transforming this field of research by establishing a methodological rigour and a theoretical foundation in both interventions and outcomes and by designing experimental approaches, might expand the evidence available on the effects of nurse managers intentional rounding.

Short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish‐language: Instrument development and psychometric evaluation

Abstract

Aims

To develop and psychometrically test the short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish-language to detect violence perpetrated and suffered in dating relationships.

Design

A psychometric instrument development and validation study.

Methods

A two-phase approach was used: Phase (1) the items of the original instrument were revised and new items related to online violence and sexual violence were incorporated. Content validation by a Delphi panel with 25 psychometric and dating violence experts were performed. Next, a face validity was performed in 32 students followed by a pilot study in another 74 participants. Phase (2) Psychometric validation, the instrument was tested in a sample of 1091 university students, analysing the psychometric properties based on construct validity and internal consistency. The study was conducted from September to November 2020 in the context of the Andalusian Public University System.

Results

In phase (1) 42 items for each subscale (perpetration, victimization) were accepted by the Delphi panel, and acceptable values were obtained for the criteria of clarity, coherence, and relevance. In phase (2) the MSDV 2.0 showed acceptable psychometric properties. Confirmatory factor analysis showed a five-dimensional structure with 18 items for each subscale with excellent fit rates. Reliability analysis indicated adequate internal consistency (α = .879–.802) and correlations with the Depression, Anxiety, and Stress Scale (ρ = .418–.225) and the self-perceived health item (ρ = .380–.179), providing evidence of its convergent validity. Cut-off points were also calculated for each dimension, with their corresponding sensitivity and specificity, indicating to be a good instrument for detecting possible cases of dating violence.

Conclusion

The MSDV 2.0 is the only short instrument published to date that measures the dating violence suffered and perpetrated taking into account all its dimensions. Its use would serve as support in prevention programs and design of public policies.

Impact

The short version of the MSDV 2.0 could be a comprehensive enough instrument to enable a detection and evaluation of dating violence in the educational setting.

Integrative review of the needs and challenges of indigenous palliative care in rural and remote settings

Abstract

Aims

To appraise and synthesize the empirical literature on the needs and challenges of Indigenous peoples' accessibility to palliative care in rural and remote settings.

Design

Whittemore and Knafl’s updated approach to integrative reviews, PRISMA guidelines and CASP (2020) checklists for narrative analysis were followed.

Data Sources

A systematic search of the published empirical literature from 1 January 2015 to 31 December 2021 was undertaken in five databases.

Review Methods

Twenty-four studies met the research question and the inclusion criteria.

Results

Four themes describe the findings: Respect of Indigenous cultural beliefs on death and dying, connection to the land, needs for culturally responsive care and presence of institutional and systemic barriers. These themes indicate a pressing need to increase the accessibility and utilization of palliative care. Most of the studies were qualitative and conducted by teams of Indigenous and non-Indigenous researchers.

Conclusion

Integrating Indigenous knowledge and providing culturally responsive palliative care are steps towards achieving the decolonization of palliative care and responding to Indigenous people's needs of palliative care services. Institutional and systemic racism affect Indigenous peoples' access and delivery of palliative services in Canada and globally.

Impact

The review highlights the need for establishing partnerships and building local capacity with Indigenous communities to develop and implement culturally responsive palliative care programmes in remote locations.

‘Barriers to overcoming the barriers': A scoping review exploring 30 years of clinical supervision literature

Abstract

Aims/Questions

To explore the barriers and facilitators to nurses accessing clinical supervision; explore the barriers and facilitators to organizations implementing clinical supervision and capture what skills nurses require to facilitate clinical supervision.

Design

Scoping review of peer-reviewed research and grey literature.

Data sources

CINAHL, Medline, PsychINFO and Scopus were searched for relevant papers published between 1990 and 2020. Google, Google Scholar, OpenGrey & EThOS were used to search for grey literature.

Review Methods

PRISMA-ScR guidelines were used during the literature review process. Eighty-seven papers were included, and data were extracted from each paper using a standardized form. Data synthesis was undertaken using Seidel's analytical framework.

Results

Five themes were identified: Definitions and Models, (Mis) Trust and the Language of Supervision, Alternative Parallel Forums and Support Mechanisms, Time and Cost and Skills required.

Conclusion

Since its inception in the 1990s, clinical supervision has long been regarded as a supportive platform for nurses to reflect on and develop their practice. However, this review highlights that despite an awareness of the skills required for nurses to undertake clinical supervision, and the facilitators for nurses to access and organizations to implement clinical supervision, there have been persistent barriers to implementation. This review identifies these persistent factors as ‘barriers to overcoming the barriers' in the clinical supervision landscape. These require critical consideration to contribute towards moving clinical supervision forward in the spirit of its original intentions.

Impact

This review progresses the debate on clinical supervision through critically analysing the barriers to overcoming the barriers. To this end, the review is designed to stimulate critical discussions amongst nurses in different clinical spaces and key stakeholders such as policy makers and regulatory bodies for the nursing profession.

The intellectual capital supporting nurse practice in a post‐emergency state: A case study

Abstract

Aim

To explore the resources supporting current nurse practice in the post-emergency country of Liberia, using the nursing intellectual capital framework, as nurses work to meet the targets set by Government of Liberia's Essential Package of Health Services.

Design

Case study.

Methods

Data were collected in Liberia February–June 2019. Direct observation, semi-structured interviews and photographs were used to investigate how nurse practice is supported. Field notes, transcripts and photographs were coded using both directed and conventional content analysis. Reports were then generated by code to triangulate the data.

Results

Thirty-seven nurses at 12 health facilities participated. The intellectual capital supporting inpatient and outpatient nurse practice differs in important ways. Inpatient nurse practice is more likely to be supported by facility-based protocols and trainings, whereas outpatient nurse practice is more likely to be supported by external protocols and trainings, often developed by the Liberian government or non-governmental organizations. This can lead to uneven provision of inpatient protocols and trainings, often favouring private facilities. Similarly, inpatient nurses rely primarily on other nurses at their facilities for clinical support while outpatient nurses often have external professional relationships that provided them with clinical guidance.

Conclusion

Much has been accomplished to enable outpatient nurses to provide the primary- and secondary-care target services in the Essential Package of Health Services. However, as the Liberian government and its partners continue to work towards providing certain tertiary care services, developing analogous protocols, trainings and clinical mentorship networks for inpatient nurses will likely be fruitful, and will decrease the burden on individual facilities.

Impact

Nurses are often expected to meet new service provision targets in post-emergency states. Further research into how best to support nurses as they work to meet those targets has the potential to strengthen health systems.

A systematic review: Unfinished nursing care and the impact on the nurse outcomes of job satisfaction, burnout, intention‐to‐leave and turnover

Abstract

Aim

To investigate the association of unfinished nursing care on nurse outcomes.

Design

Systematic review in line with National Institute for Health and Care Excellence guideline.

Data sources

CINAHL, the Cochrane Library, Embase, Medline, ProQuest and Scopus databases were searched up until April 2020.

Review Methods

Two independent reviewers conducted each stage of the review process: screening eligibility, quality appraisal using Mixed Methods Appraisal Tool; and data extraction. Narrative synthesis compared measurements and outcomes.

Results

Nine hospital studies were included, and all but one were cross-sectional multicentre studies with a variety of sampling sizes (136–4169 nurses). Studies had low internal validity implying a high risk of bias. There was also a high potential for bias due to non-response. Only one study explicitly sought to examine nurse outcomes as a primary dependent variable, as most included nurse outcomes as mediating variables. Of the available data, unfinished nursing care was associated with: reduced job satisfaction (5/7 studies); burnout (1/3); and intention-to-leave (2/2). No association was found with turnover (2/2).

Conclusion

Unfinished nursing care remains a plausible mediator of negative nurse outcomes, but research is limited to single-country studies and self-reported outcome measures. Given challenges in the sector for nurse satisfaction, recruitment and retention, future research needs to focus on nurse outcomes as a specific aim of inquiry in relation to unfinished nursing care.

Impact

Unfinished nursing care has previously been demonstrated to be associated with staffing, education and work environments, with negative associations with patient outcomes (patient satisfaction, medication errors, infections, incidents and readmissions). This study offers new evidence that the impact of unfinished nursing care on nurses is under investigated. Policymakers can prioritize the funding of robust observational studies and quasi-experimental studies with a primary aim to understand the impact of unfinished nursing care on nurse outcomes to better inform health workforce sustainability.

Corrigendum

Journal of Advanced Nursing, Volume 78, Issue 6, Page 1848-1848, June 2022.

Theory‐based capacity building intervention for intersectoral action for health at local governments: An exploratory pilot study

Abstract

Aim

To design, implement and evaluate a nurse-led capacity building intervention (PromoGOB) for intersectoral action for health at local governments.

Design

The programme was based on theories of the policy process and organizational change and facilitated by a nurse developing a health broker role. A complex intervention perspective was adopted in carrying out the study. The intervention was evaluated using a mixed method embedded design.

Methods

Quantitative component relied on a specific questionnaire. This tool, designed and piloted ad hoc, measured the capacity in terms of knowledge, awareness, resources, skills, and commitment, both at sectoral and government levels. For the qualitative component, semi-structured interviews were conducted. These explored the perceived capacity and feasibility and acceptability issues. The programme was initiated at the end of October 2019, and it lasted a total of 5 weeks. Nineteen individuals representing various sectors at a local government in northern Spain participated in the study. The data analysis was concluded by the end of March 2020.

Findings

PromoGOB positively influenced participants' capacity for addressing health promotion. Awareness component, intersectoral work and the nurse as health broker were essential in the programme. The necessity of political participation was identified as an issue to be prioritized in future studies.

Conclusion

This study highlights the relevance of capacity building at local governments and the role that nurses can play in it. Further work should be undertaken to continue developing Health in All Policies approach at local level.

Impact

This study offers a starting point for nurses to get involved in the policy process of health promotion, performing a specific role as health brokers, building capacity at local governments for addressing social determinants of health, and delving into theories and concepts of the Health in All Policies field.

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