In an editorial concerned with radicalism, it is perhaps appropriate to start with Karl Marx. To paraphrase this greatest of political philosophers, we must learn the lessons of history. So, I wish to consider the idea of nursing radicalism, with recourse to a selective consideration of the past, contemplation of the present, and, most crucially, to inspire a critical imagination of what could be the future. Latterly, the very vocabulary of ‘radical’ has been demeaned, denigrated and demonised. I wish to reclaim an appreciation of nursing radicals as a wholesome and positive force for good, with huge potential for making a difference at various degrees of scale; from the global to the everyday. Indeed, I contend no change of any worth can neglect attention to the everyday human relationships bound up in making the change happen.
To systematically identify, appraise and synthesise patients’, residents’, and nurses’ experiences of fundamental nursing care for nutrition, elimination, mobility, and hygiene.
The evidence base for effective nursing behaviours to assist people with their fundamental care needs is sparse, hampering the development of effective interventions. Synthesising data on patients’ and nurses’ experiences of fundamentals of nursing care could contribute to the development of such an intervention.
Systematic review and synthesis of qualitative data from qualitative studies on patients’ and nurses’ experiences of fundamental nursing care behaviours addressing peoples’ nutrition, elimination, mobility, and hygiene needs. We appraised study quality and relevance and used a narrative approach to data synthesis, fulfilling PRISMA criteria (Supplementary file 1).
We identified 22,374 papers, 47 met our inclusion criteria. Most papers were of low quality. Sixteen papers met our quality and relevance criteria and were included for synthesis. Papers were about nutrition (2) elimination (2), mobility (5), hygiene (5) and multiple care areas (2). We found nurses and patients report that fundamental nursing care practices involve strong leadership, collaborative partnerships with patients and cohesive organisational practices aligned to nursing care objectives and actions.
To improve fundamental care and interventions suitable for testing may require attention to leadership, patient‐nurse relationships and organisational coherence plus the fundamentals of care nursing interventions themselves.
More rigorous mixed methods research about fundamental nursing care is needed to inform nursing practice and improve patient’s experience. Nursing interventions should include effective nurse leadership and nurse patient collaboration and a focus on fundamental care by the host organisation.
The purpose of this scoping review is to synthesize and map the literature on the psychological outcomes reported following debriefing of healthcare providers who experience expected and unexpected patient death in either clinical practice or simulation setting.
Patient death occurs in both the clinical and simulation environments and can result in psychological stress in healthcare providers and students. While debriefing following patient death has demonstrated the ability to promote positive psychological outcomes, addressing the psychological or emotional stress of the event is inconsistently addressed.
A scoping review was conducted using the Arksey and O’Malley framework.
The Cochrane Library, MEDLINE, CINAHL, PsycINFO, JBI, and Scopus databases were searched with English language constraints and no limit on publication date. The Scoping Reviews (PRISMA‐ScR) Checklist was used (Tricco et al., 2018) (see Supplementary File 1).
Eighteen articles (16 research papers, 2 review papers) met the inclusion criteria. Of the 16 research papers, 9 reported on debriefing models in the simulation environment and 7 in the clinical setting. The types of debriefing models found in the simulation setting tended to focus on healthcare providers’ learning, while those in the clinical setting typically focused on healthcare providers’ emotional reactions and resulted in positive psychological effects. Conclusion: Debriefing has the potential to positively affect psychological outcomes of healthcare providers who experience patient death. The type of debriefing that is selected is a key component to achieving these positive outcomes.
To clarify beliefs linked with depression among older adults with depression in Japan.
As a result of global population aging, caring for older adults with depression has become an important issue worldwide. In this paper, the concept of “beliefs” pertains to phenomena that lead to distress about disease and can be alleviated through talk therapy. While previous studies focused on illness beliefs in people with mental illness and depression, no studies have yet focused on such beliefs among older adults with depression.
Qualitative, narrative‐research–based method.
Observation and 1–5 narrative interviews lasting 60–90 min were conducted with each of 19 older adults with depression in a Japanese psychiatric ward. The resulting narratives were thematically analyzed to derive relevant themes and subthemes. Reporting of this research adheres to COREQ guidelines.
Four themes and twelve subthemes were revealed. Depression‐linked beliefs among older adults with depression were (1) “guilt and regret,” (2) “pessimism,” (3) “futility of treatment,” and (4) “desire to be needed by loved ones and society.”
Depression‐linked beliefs among older adults with depression constituted spiritual pain reflecting character tendencies, including experiences of loss and developmental challenges related to aging as well as subjects’ natural diligence and consideration for others.
(1) Helping nurses better understand distress experienced by older adults with depression, who are prone to feel guilt and regret when reflecting on the past, and to alleviate distress through dialogue and providing positive affirmation for patients. (2) To understand and assuage distress over experiences of loss in old age. (3) To help older adults with depression form a more relaxed attitude toward life, so that even if they have experienced loss as a result of old age, they can maintain their self‐esteem and existential sense of self‐worth.
My interest in research ethics began more than 20 years ago when I was a doctoral student seeking research ethics approval for my Grounded Theory study exploring what it was like to live with Normal Pressure Hydrocephalus. To cut a long story short, my application was rejected on two occasions primarily because the Research Ethics Committee (REC) didn't understand what I trying to do or how I was going to do it. This experience motivated me to get more involved in the ethical review of research and now, more than 20 years later, I spend considerable amounts of my time thinking about research ethics and the ethical conduct of research, as a researcher, as a research ethicist and as the Chair of an NHS REC.
The aim of this study was to understand why Western Australian (WA) midwives choose to remain in the profession.
Midwifery shortages and the inability to retain midwives in the midwifery profession is a global problem. The need for effective midwifery staff retention strategies to be implemented is therefore urgent, as is the need for evidence to inform those strategies.
Glaserian Grounded Theory (GT) methodology was used with constant comparative analysis.
Fourteen midwives currently working clinically area were interviewed about why they remain in the profession. The GT process of constant comparative analysis resulted in an overarching core category emerging. The study is reported in accordance with Tong and associates’ (2007) consolidates criteria for reporting qualitative research (COREQ).
The core category derived from the data was labelled ‐ ‘I love being a midwife; it's who I am’. The three major categories that underpin the core category are labelled: ‘The people I work with make all the difference’; ‘I want to be ‘with woman’ so I can make a difference’ and ‘I feel a responsibility to pass on my skills, knowledge and wisdom to the next generation’.
It emerged from the data that midwives’ ability to be ‘with woman’ and the difference they feel they make to them, the people they work with, and the opportunity to ‘grow’ the next generation together underpin a compelling new middle range theory of the phenomenon of interest.
The theory that emerged and the insights it provides will be of interest to healthcare leaders, who may wish to use it to help develop midwifery workforce policy and practice, and by extension to optimise midwives’ job satisfaction, and facilitate the retention of midwives both locally and across Australia.
In the case of life threatening conditions such as respiratory or cardiac arrest, or the clinical deterioration of the patient, a Code Blue activation may be instigated. A Code Blue activation involves a team of advanced trained clinicians attending the emergency needs of the patient.
The aim of the study was to explore the number of cases of Code Blue activations, looking at the timing, clinical ward, diagnosis, and activation criteria while noting cases where escalation from a Medical Emergency Team (MET) call occurs in one Regional Healthcare Service in Victoria, Australia over a six year period.
A quantitative retrospective descriptive study of Code Blue emergencies over a six year period from June 2010 to June 2016 was conducted. Data collected from the RISKMAN™ program operating at a single site was imported into SPSS (V 22) for descriptive statistical analysis. A STROBE Equator checklist was used for this study (see Supplementary File 1).
The majority of Code Blue activations were male (59%, n=127) and aged between 70‐89 years of age (43%, n=93). A Code Blue activation was more likely to occur at 0800 hrs, 1400 hrs or 2200 hrs, corresponding to the nurses’ change of shift, with the majority of Code Blues (27.8%, n=60) occurring in the emergency department. Cardiac arrest was the main activation criteria with 54.6% (n=118) cases followed by respiratory arrest (14%, n=32). Interestingly 20%, (n=45) of the Code Blue activations were upgraded from a Medical Emergency Team (MET) call.
This project has produced several interesting findings surrounding Code Blue activations at one regional Healthcare service that are not present in existing literature and is worthwhile of further investigation.
To examine qualitative studies which reported on patients' challenges of living with and managing Inflammatory Bowel Disease (IBD).
There is a growing body of qualitative research focusing on the subjective experiences of patients with IBD. This research points to the daily challenges that patients experience which can relate to their physical and psychological health, as well as their social wellbeing, and may impact negatively on their lives. To date, there has been little attempt to synthesise these studies, and little is known about how patients manage the challenges they experience.
A meta‐synthesis was conducted, based on guidelines developed by Sandelowski and Barroso (2007) and PRISMA (Moher et al. 2009).
Searches were conducted within the CINAHL, MEDLINE, PsycINFO, Psychology and Behavioural Sciences Collection and SocINDEX databases to locate qualitative and mixed methodology studies. The retrieved articles were screened against pre‐determined inclusion criteria. Quality appraisal was assessed using the Joanna Briggs Institute critical appraisal tool for qualitative research (Lockwood et al. 2015).
Thematic analysis resulted in three themes: the unpredictability of living with IBD, the emotional turmoil of living with IBD and striving to maintain a normal life in managing IBD.
The greatest challenges for patients identified in this meta‐synthesis were the physical symptoms associated with IBD. These impacted negatively on their psychological and social wellbeing and reduced their quality of life. There is a notable gap in research on patient experiences of managing the challenges identified in everyday life and to what extent they receive support from healthcare professionals.
The results of this meta‐synthesis offer insights into how the physical challenges of living with IBD, particularly in relation to symptoms, impact adversely on patients' psychological and social wellbeing. These insights are clinically relevant to healthcare professionals as a basis for supporting patients to manage their challenges.
To explore how managers describe leading towards person‐centred care in Swedish nursing homes.
Although a growing body of research knowledge exists highlighting the importance of leadership to promote person‐centred care, studies focused on nursing home managers' own descriptions of leading their staff towards providing person‐centred care is lacking.
Descriptive interview study. COREQ guidelines have been applied.
The study consisted of semi‐structured interviews with 12 nursing home managers within 11 highly person‐centred nursing homes purposively selected from a nationwide survey of nursing homes in Sweden. Data collection was performed in April 2017, and the data were analysed using content analysis.
Leading towards person‐centred care involved a main category; embodying person‐centred being and doing, with four related categories: operationalising person‐centred objectives; promoting a person‐centred atmosphere; maximising person‐centred team potential; and optimising person‐centred support structures.
The findings revealed that leading towards person‐centred care was described as having a personal understanding of the PCC concept and how to translate it into practice, and maximising the potential of and providing support to care staff, within a trustful and innovative work place. The findings also describe how managers co‐ordinate several aspects of care simultaneously, such as facilitating, evaluating and refining the translation of person‐centred philosophy into synchronised care actions.
The findings can be used to inspire nursing home leaders' practices and may serve as a framework for implementing person‐centred care within facilities. A reasonable implication of these findings is that if organisations are committed to person‐centred care provision, care may need to be organised in a way that enables managers to be present on the units, to enact these strategies and lead person‐centred care.
The purpose of this study was to explore how undergraduate students perceive and make decisions regarding mental health nursing as a career following completion of an inpatient mental health practicum.
Among nursing students, mental health is consistently perceived as the least desirable nursing career path. However, evidence to explain why this is the case remains limited, with a lack of research exploring students' experiences of mental health settings and how these experiences influence their perceptions of a mental health nursing career. This knowledge gap limits strategies to support nurses' selection of mental health nursing as a career path, contributing to a global shortage of mental health nurses.
This study used a qualitative narrative inquiry design.
In‐depth interviews (N = 15) were conducted with undergraduate nursing students to explore their experiences of mental health practicums. Participants had all completed a 6‐week practicum in inpatient mental health settings in urban hospitals. Reporting follows COREQ guidelines.
Nursing students' decisions to not choose a career in mental health nursing were influenced by negative practicum experiences, including the institutional environments of the inpatient mental health settings and witnessing of harmful nursing practices. These factors were identified as barriers to pursuing a career in mental health nursing. However, students expressed desire to continue to work with clients with mental health challenges and aimed to pursue nursing careers that preserve this opportunity in different healthcare settings.
These findings expand upon existing literature that frequently positions nursing students as “uninterested” in mental health nursing and offers insights that can contribute to addressing global mental health nursing shortages.
This study highlights the need for mental health nurses, nursing leaders, and educators to recognise and respond to students' difficult experiences in the inpatient mental health setting during practicums.
To explore the experiences of the families of young adults with intellectual disabilities at the point of transition from child to adult health services.
The population of people with intellectual disabilities is changing rapidly, with young people with increasingly complex needs surviving into adulthood and requiring transition from child to adult health services.
An interpretative qualitative design.
Semi‐structured interviews were held with ten family carers of young adults with intellectual disabilities and complex care needs, who were in the process of or had recently completed a transition from child to adult health services in Scotland. Data were analysed using thematic analysis. The COREQ checklist was used.
Transition emerged as a highly emotional and challenging period for family carers. Their experiences were captured in five main themes: “a deep sense of loss,” “an overwhelming process,” “parents making transitions happen,” “a shock to the adult healthcare system” and “the unbearable pressure.” Nurses were often seen as instrumental to counteracting some of these challenges.
There is an urgent need to respond to the challenges experienced by carers at the point of transition and beyond, by ensuring early and coordinated planning, effective information sharing and communication and clear transition processes and guidelines. A person‐centred and family‐centred approach is required to minimise negative impact on the health and well‐being of the young adult with intellectual disabilities and their carers.
Registered nurses have a key role in providing information and support, along with coordinating care at the time of transition from child to adult health services for young adults with complex intellectual disabilities. It is vital that their input is person‐centred and responds effectively to the expert knowledge of family carers, while at the same time ensuring their needs for information and support are also addressed.
To describe the prescribing behaviours and practices of registered nurse and midwife prescribers and to explore experiences of enablers and barriers to prescribing practices.
The extension of prescriptive authority to nurses and midwives internationally has created new opportunities for them to expand their scope of practice and is of significant benefit to effective and efficient health service provision.
Cross‐sectional national survey of registered nurse and midwife prescribers.
Data were collected through an online survey between April and July 2018. A total of 84 nurse and midwife prescribers participated. The STROBE checklist was applied as the reporting guideline for this study.
Respondents estimated that two‐fifths of their consultations involved an episode of prescribing. Nurse and midwife prescribers engaged in similar prescribing behaviours spanning the range of activities from initiating new medications to ceasing medicines. The most frequently selected criteria for prescribing was clinical effectiveness. Prescribing was viewed as essential to respondents’ clinical practice, allowing them to provide a complete episode of care and leading to a reduction in medication errors and reduced delays and waiting times for patients. Enablers of prescribing included knowledge, experience, education and access to continuous professional development, as well as support from colleagues and organisations.
Little is known about the prescribing behaviours and practices of registered nurse and midwife prescribers. While prescribing authority enables nurse and midwife practitioners to deliver holistic care, there remains significant barriers and challenges including increased workloads, lack of continuous professional development, lack of support and overly restrictive rules and policies governing prescribing.
Addressing the barriers identified in this study could enable more nurse and midwife prescribers to work to their full scope of practice, enabling populations to fully capitalise on the contributions of registered nurse and midwife prescribing services.
To explore newly graduated nurses' strategies for, and experiences of, sleep problems and fatigue when starting shiftwork. A more comprehensive insight into nurses' strategies, sleep problems, fatigue experiences and contributing factors is needed to understand what support should be provided.
For graduate nurses, the first years of practice are often stressful, with many reporting high levels of burnout symptoms. Usually, starting working as a nurse also means an introduction to shiftwork, which is related to sleep problems. Sleep problems may impair stress management and, at the same time, stress may cause sleep problems. Previously, sleep problems and fatigue have been associated with burnout, poor health and increased accident risk.
Semi‐structured interviews were conducted with nurses (N = 11) from four different Swedish hospitals, and qualitative inductive content analysis was used. The study was approved by the Regional Ethical Review Board in Stockholm. The COREQ checklist was followed.
Many nurses lacked effective strategies for managing sleep and fatigue in relation to shiftwork. Various strategies were used, of which some might interfere with factors regulating and promoting sleep such as the homeostatic drive. Sleep problems were common during quick returns, often due to difficulties unwinding before sleep, and high workloads exacerbated the problems. The described consequences of fatigue in a clinical work context indicated impaired executive and nonexecutive cognitive function.
The findings indicate that supporting strategies and behaviours for sleep and fatigue in an intervention for newly graduated nurses starting shiftwork may be of importance to improve well‐being among nurses and increase patient safety.
This study highlights the importance of addressing sleep and fatigue issues in nursing education and work introduction programmes to increase patient safety and improve well‐being among nurses.
To explore palliative care nurses’ work experiences caring for patients at the end of life in private homes.
The home continues to be a desired place for care and dying; however, professional competence is needed and specialist palliative care nurses play a crucial role, often highly valued by patients and their family members. The private home as a physical work environment for nurses is explored, with both positive and negative aspects being described. To ensure future high‐quality end‐of‐life care, there is a need to describe how palliative care nurses work in private homes.
Participant‐generated photographs were used in conjunction with follow‐up interviews with ten palliative home care nurses. Interpretive description was used for analysis. This study follows the COREQ checklist.
The analysis process resulted in four constructed themes, presented here as strategies used by palliative care nurses: adjusting interactions and actions depending on the environment when entering each unique private home; supporting patients and family members in finding a balance between self‐care, independence and safe care; guiding patients and family members towards and through environmental changes supporting end‐of‐life care at home; and using transitions between homes to reflect, recuperate and prepare.
Working as a palliative care nurse in private homes clearly requires a variety of skills and competences, here operationalised in different strategies used to promote high‐quality care.
Palliative care nurses’ considerations, insights and competence when performing end‐of‐life care in the diverse environments of private homes can contribute to the development of clinical practice. Knowledge about strategies can be used in nursing practice during everyday work, in nursing education and in the organisation of care, and can inform policy to ensure future high‐quality palliative home care.
To explore the impact of cultural beliefs of dementia as witchcraft in sub‐Saharan Africa.
The population of sub‐Saharan Africa is ageing, which increases the number of those at risk of dementia. Mental health and physical diseases that affect behaviour have often been associated with witchcraft. Accusations of witchcraft leave individuals vulnerable and at risk.
A systematic review, which followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and completed a PRISMA checklist. CINAHL, PsycINFO, Web of Knowledge, PubMed and Science Direct databases were searched for relevant studies published from their inception to 31 May 2019 by applying appropriate Medical Subject Headings. Data analysis adhered to Thomas and Harding's thematic synthesis.
The review identified limited literature on this topic, with only five papers meeting the inclusion and exclusion criteria. Studies explored health provision, and knowledge and beliefs of dementia in Tanzania and South Africa. Three themes emerged as follows: (a) poor knowledge of dementia, including the belief of dementia as witchcraft; (b) challenges of supporting a family member with dementia in the community; and (c) health‐seeking behaviours of and for people with dementia.
There remains a need for dementia awareness and education across sub‐Saharan Africa communities, including faith and traditional healers, and healthcare professionals to support pluralistic healthcare provision. Nurses are the best‐placed healthcare professionals to support these initiatives and the development and implementation of low‐resource nonpharmacological interventions to support people with dementia and their families living in the community.
Nurses working in sub‐Saharan Africa and those caring for patients from sub‐Saharan Africa can only provide person‐centred care and support for a person with dementia and their family if they understand their cultural beliefs, one of which may include witchcraft.
This research was conducted to explore the effectiveness of employing the healthcare failure mode and effect analysis method in the management of trial of labour after caesarean, with the aims of increasing vaginal birth after caesarean section rate and reducing potential risks that might cause severe complications.
Previously high caesarean section rate in China and the “two children” policy leads to the situation where multiparas are faced with the choice of another caesarean or trial of labour after caesarean. Despite evidences showing the benefits of vaginal birth after caesarean, obstetricians and midwives in China tend to be conservative due to limited experience and insufficient clinical routines. Thus, its management needs further optimisation in order to make the practice safe and sound.
A prospective quality improvement programme using the healthcare failure mode and effect analysis.
With the structured methodology of healthcare failure mode and effect analysis, we determined core processes of antepartum and intrapartum management, conducted risk priority numbers and devised remedial protocols for failure modes with high risks. The programme was then implemented as a clinical routine under the agreement of the institutional review board and vaginal birth after caesarean success rates were compared before and after the quality improvement programme, both descriptively and statistically. Standards for Quality Improvement Reporting Excellence 2.0 checklist was chosen on reporting the study process.
Seventy failure modes in seven core processes were identified in the management process, with 14 redressed for actions. The 1‐year follow‐up trial of labour after caesarean and vaginal birth after caesarean rate was increased compared with the previous 3 years, with a vaginal birth after caesarean rate of 86.36%, whereas the incidence of uterine rupture was not compromised.
The application of healthcare failure mode and effect analysis can not only promote trial of labour after caesarean and vaginal birth after caesarean rate, but also maintaining a low risk of uterine rupture.
This modified vaginal birth after caesarean management protocol has been shown effective in increasing its successful rate, which can be continued for further comparison of severe complications to the previous practice.
To develop and evaluate the psychometric properties of a self‐report instrument measuring 6‐ to 12‐year‐old children's own experiences of participation in health care.
Validated measures to evaluate children's participation in health care can play a critical role in strategic work towards supporting children's participation at an individual level and in working towards quality improvements at an organisational level. There are, however, no available instruments to achieve this.
An instrument development design was used, together with the TRIPOD checklist. Item construction was based on research about children's perspectives on participation in health care and Shier's model for participation. The face and content validity was evaluated by 14 healthy children, 9 paediatric nurses and 8 children with different diseases. The construct validity, internal consistency and stability reliability were evaluated based on data from 138 children visiting a paediatric clinic.
The testing of the face and content validity resulted in an instrument with child‐friendly language, additional instructions and visual attractive presentation. The principle component analysis resulted in the four‐factor solution: “To be included,” “To trust professionals,” “To take control,” and “To understand information.” Internal consistency and intraclass correlation coefficients were acceptable.
We conclude that the child participation in health care (ChiPaC) instrument has adequate reliability and validity when used to evaluate children's participation in health care. The involvement of children in the development of ChiPaC resulted in a brief, colourful and user‐friendly instrument for use in paediatric health care.
This new questionnaire, ChiPaC, is adapted for children between 6–12 years measuring participation in health care from a child perspective. ChiPaC can be used in the practical work of supporting individual children's participation in health care as well as in the strategical work towards quality improvements on an organisational level.
To explore how nursing students perceive and use the conceptual Fundamentals of Care framework in case‐based work in nursing education and furthermore to describe influencing factors on perceptions and use of the framework.
The Fundamentals of Care framework has been integrated in core courses in two Schools of Nursing in Region North Denmark in response to studies reporting that nursing students and newly graduated nurses lack the knowledge, skills and competencies to meet the challenges of delivering fundamental care in clinical practice. An integration of the framework in case‐based work in nursing education has not previously been studied.
The study design was focused ethnography. Data were collected using participant observations, focus group interviews and individual interviews. Four groups of four to five nursing students participating in case‐based work sessions and three faculty members from two Schools of Nursing were included. The study adhered to COREQ.
The results show an uncertainty among the students about how to understand and use the conceptual framework in case‐based work. The uncertainties derive from diversities in faculty members’ perceptions and curricular planning among others. However, the framework appears to support the students’ learning about what nursing is and requires.
The study indicates that integrating Fundamentals of Care framework in case‐based work may be one way of teaching nursing students the complexities of integrated fundamental nursing care. However, there is a need to consider how to support students in articulating Fundamentals of Care, and to draw attention to the influence of role models and curricular planning.
The study provides knowledge relevant when customising future educational interventions regarding the integration of Fundamentals of Care in nursing education and may provide valuable knowledge of evaluation strategies.