To explore newly employed nurses’ socialisation in the process of introduction into an oncological clinic from the perspectives of unit managers and newly employed nurses.
There are managerial challenges in retaining nurses at workplaces. The way in which nurses are socialised into their work is important for their job satisfaction and retainment.
Qualitative, semi‐structured interviews with seven nurses and two unit managers, and written introductory material. Thematic analyses were made, inspired by Goffman’s concepts of social interaction, back stage, front stage and roles. SRQR checklist was used.
Unit managers created the framework for socialising newly employed nurses through written introductory guidelines and assignments of supervisors as mainstream role models. Newly employed nurses were socialised gradually through mirroring their supervisors in their role as nurse. Front stage, patients often functioned as objects for newly employed nurses’ training. Back stage, patients often functioned as communication objects for all professionals. Newly employed nurses, who also demand roles such as transformer, boss, coordinator, prompter and friend, were socialised into the role of assistant to the doctor. Medical rounds functioned as a socialisator in this process.
The allocated supervisors were role models in socialising newly employed nurses into an oncological clinic and its culture. Nurses were socialised into an understanding of care as a biomedical orientation, in which medicine had a higher value than care in the existing knowledge hierarchy at the oncological clinic. This might have implications for who applies for and stays in the job.
Increased awareness of the importance of socialisation of nurses into the clinic during the introduction process. Re‐thinking nurses’ independent functions and patient perspectives in introduction of newly employed nurses to maintain and develop nursing as an independent profession.
To explore nursing students’ subjective experience of emotions during first‐year clinical placements, strategies used to manage their emotions, and socialisation to emotion management.
Emotion regulation is a key source of stress for early career and student nurses. Clinical placement experiences can elicit strong emotions in nursing students; however, they may be unprepared for the challenge of regulating their emotions in real‐world practice. How nursing students learn to manage their emotions in the clinical setting, whether they receive support for this, and how they are socialised to manage their emotions during placements, are not well known.
An exploratory qualitative study.
Semi‐structured interviews (n=19) were conducted with first year nursing students, exploring their experiences of emotion management during clinical placement. Interview transcripts were analysed using conventional qualitative content analysis. Reporting adheres to the COREQ Checklist.
Interactions with patients and staff often elicited negative feelings. Structured guidance for emotion management by supervising staff was scarce. Students used informal self‐reflection and interpretation to guide emotion management.
In the absence of strategic socialisation and formal support for effective emotion management, students used emotional labour strategies that can negatively impact on well‐being. A focus on adequately preparing nursing students for emotion work is a necessary component of classroom and clinical learning environments. Structured debriefing during clinical placements may provide a relevant context to discuss emotions arising during clinical work, and to learn emotion management strategies.
Emotional competence, a fundamental ability for registered nurses and students, supports personal health maintenance and strengthens professional practice. Students are exposed to clinical environments and interpersonal encounters that evoke strong emotions. They need situated learning strategies and formal support to develop knowledge and strengthen capability for emotion management, as this is essential for promoting professional development and patient care.
Internationally, health authorities and governments are warning older people that they are at a higher risk of more serious and possible fatal illness associated with COVID‐19. Mortality data from Oxford COVID‐19 Evidence Service (25/3/20) indicates a risk of mortality of 3.6% for people in their 60s, which increases to 8.0% and 14.8% for people in their 70s and over 80s. Therefore, the global recommendation for older populations includes social isolation, which involves staying at home and avoiding contact with other people, possibly for an extended period of time, currently estimated to be between three and four months. Older populations in this current context, refers to people over 70 years, and 50 years in some particularly vulnerable Indigenous populations.
What use are words at a time like this? I am writing this on 27th March as the world is plunging further into the coronavirus crisis. Like many worldwide, I am in virtual ‘lockdown’ in Australia while the exponential spread of the virus continues. At a follow‐up tele‐consult with my medical consultant recently, he said that he was apprehensive about the ‘calm before the storm’ that our health services face. He was deadly serious.
Personal resilience has been conceptualised in many different ways; however, a common definition is that resilience is the ability to cope successfully despite adverse circumstances (Henshall, 2020). Historically, the term ‘resilience’ encompasses both physiological and psychological aspects and the latter is personal to individuals, with some people having more developed strategies for personal resilience than others. Understandings of resilience vary between populations, contexts and cultures (McDonald et al., 2012), with resilience being viewed in some cases as an inherent personality trait and in others as a dynamic process existing on a continuum between resilience and vulnerability.
To develop knowledge about homecare professionals’ observational competence in early recognition of deterioration in frail older patients.
The number of frail older patients in homecare has been rising, and these patients are at higher risk of deterioration and mortality. However, studies are scarce on homecare professionals’ recognition and response to clinical deterioration in homecare.
This study applies an explorative, qualitative, mixed‐methods design.
The data were collected in two homecare districts in 2018 during 62 hours of participant observation, as well as from six focus group interviews. The data were subjected to qualitative content analyses. The Standards for Reporting Qualitative Research (SRQR) checklist was used to report the results.
The data analyses revealed two main themes and five sub‐themes related to homecare professionals’ observational practices. The first main theme entailed patient‐situated assessment of changes in patients’ clinical condition, i.e., the homecare professionals’ recognised changes in patients’ physical and mental conditions. The second theme was the organisational environment, in which planned, practical tasks and collaboration and collegial support were emphasised.
The homecare professionals in the two districts varied in their ability to recognise signs of patient deterioration. Their routines are described in detailed work plans, which seemed to affect assessment of their patients’ decline.
The results can inform homecare services on how homecare professionals’ observational competence and an appropriate organisational system are essential in ensuring early detection of deterioration in frail older patients.
To identify training strategies and determine how registered health and social care practitioners change their practice post Mental Capacity Act training.
Narrative literature review
Seventeen databases were searched up to December 2019; CINAHL, Social Care Online, PubMed, Social Policy and Practice, Discover, Medline, Science Direct, Ovid, PsycINFO, ASSIA, Social Services Abstracts, Science Direct, Academic Search Premier, Web of Science, British Nursing Index, DH‐Data, King’s Fund Library Catalogue.
Empirical studies of any design investigating Mental Capacity Act training were searched and screened. Data were extracted to a bespoke spreadsheet and quality assessed. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, (PRISMA).
Of 162 papers identified, 16 were included comprising qualitative, quantitative and mixed methods studies. Trainees valued interactive training with close alignment to practice. Training did not lead to demonstrable practice change. Barriers in the context and cultures of care environments were identified.
To facilitate application of Mental Capacity Act legislation, identified barriers should be addressed. Future training should be interactive, scenario‐based and relevant to trainees’ practice.
The Mental Capacity Act is widely misunderstood and implementation poor. Training is proposed as a solution, but the nature of training that will positively affect practice remains unknown. This review aims to address this gap in the evidence base. Interactive training, using scenarios that reflect practice complexities, has the most positive impact. Cultural norms in care environments may impede application of this legislation.
The review has international relevance as there is a global imperative to adhere to the United Nations Convention on the Rights of Persons with Disabilities. The review will inform training design and delivery to ensure that people with impaired capacity to make decisions are given the best opportunity to act autonomously.
To describe mother’s experiences of feeding their extremely preterm infant.
When an infant is born extremely preterm, there is a long rocky road for the mother if she wants to breastfeed. Some manage to reach their goals, others do not. Studies of feeding extremely preterm infants in the neonatal intensive care unit (NICU) are scarce.
A qualitative method with an inductive approach.
Nine mothers giving birth to extremely preterm infants were interviewed by telephone after discharge from the NICU. The interviews were transcribed verbatim and analysed with qualitative content analysis. The COREQ checklist was followed.
The overall theme was “you can’t flight, you need to fight”. The theme reflects the mothers will to do the best for their infants even if the struggle with milk expression and breastfeeding practice evoked feelings of helplessness, exposure, worry, and disappointment. The categories forming the theme were: The wish to provide own breastmilk; For the infant’s best; Loss of control; Help to reach the goals.
The mothers had a strong will to provide breastmilk to their infants but requested more support in order to be successful.
There is a need for evidence based support programs for mothers of extremely preterm infants to encourage them to persevere with milk expression and breastfeeding over time.
To analyze, hierarchically, factors associated with hospital readmissions for acute coronary syndrome.
Hospital readmissions have risen, especially in patients with multiple comorbidities, which are most often chronic. The leading causes of hospital readmission include acute coronary syndrome, which is costly and often preventable. Determining clinical and non‐clinical variables that increase the chances of readmission is important to assess and evaluate patients hospitalized for coronary heart diseases.
A case‐control study whose dependent variable was hospital readmission for acute coronary syndrome.
The study included 277 inpatients, of whom 132 were in their first hospitalization and 145 had already been hospitalized for acute coronary syndrome. The independent variables for this hierarchical model were sociodemographic conditions, life habits, access to health services, and physical health measures. Data were obtained by interviews, anthropometric measurements, and patient records. Logistic regression analysis was performed using the stepwise technique, with Microsoft Excel and R version 3.2.3. The research was reported via the Reporting of Observational Studies in Epidemiology (STROBE).
In the final hierarchical logistic model, the following risk factors were associated with readmission for acute coronary syndrome: inadequate drug therapy adherence, stress, history of smoking for 30 years or more, and the lack of use of primary care health services.
Clinical and non‐clinical variables are related to hospital readmission for acute coronary syndrome and can increase the chance of readmission by up to six times.
The predictive model can be used to avoid readmission for acute coronary syndrome, and it represents an advance in the prediction of the occurrence of the outcome. This implies the need for a reorientation of the network for post‐discharge care in the first hospitalization for acute coronary syndrome.
To investigate the relationship between symptom burden, medication adherence, and spiritual well‐being in patients with chronic obstructive pulmonary disease (COPD).
The relationship between spirituality and medication adherence has been investigated in different chronic conditions. However, the relationship between symptom burden, medication adherence, and spiritual well‐being in patients with COPD has not been explored.
A descriptive correlational study design was adopted.
A total of 112 patients with COPD were included in the study. Data were collected using the COPD Assessment Test (CAT), the Adherence to Refills and Medications Scale‐7 (ARMS‐7), and the Functional Assessment of Chronic Illness Therapy‐Spiritual Well‐Being Scale (FACIT‐Sp). The data were analyzed using descriptive and correlational statistics. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) Checklist was used.
The CAT score was significantly higher in patients on long‐term oxygen therapy and those who had more than three comorbid conditions (p < 0.05). The mean score of ARMS‐7 was significantly associated with age (p < 0.05). Current smokers had higher ARMS‐7 and lower FACIT‐Sp scores (p < 0.001). The FACIT‐Sp score was negatively and moderately associated with the CAT and ARMS‐7 scores (p < 0.001).
This study concluded that individuals with higher spiritual well‐being had lower symptom burden and higher medication adherence. The need for long‐term oxygen therapy and a high number of comorbid conditions were associated with increased symptom burden. Current smokers had lower spiritual well‐being and medication adherence.
Spiritual well‐being should be evaluated when assessing symptom burden and medication adherence in clinical practice. In addition, further studies examining the causal relationship between symptom burden, spiritual well‐being, and medication adherence in different populations are warranted.
The aim of this study was to examine the knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses.
Pain is the most commonly reported symptom in patients presenting to the emergency department, with over half rating their pain as moderate to severe. Patients unable to communicate, such as critically ill intubated patients, are at greater risk of inadequate pain management.
This cross‐sectional exploratory study used survey methodology to explore knowledge, perceptions and factors influencing pain management practices among Australian emergency nurses.
Australian emergency nurses were invited to complete an online survey comprising 91‐items. The response rate was 450 of 1,488 (30.2%). STROBE guidelines were used in reporting this study.
Variations in level of acute pain management knowledge, especially in older, cognitively impaired or mechanically ventilated patients were identified. Poor interprofessional communication, workload and staffing negatively impacted on nurses’ intention to administer analgesia. For intubated patients, validated observation pain assessment instruments were rarely used, although respondents recognised the importance of pain management in critically ill patients.
Emergency nurses recognise the importance of pain relief. The ability to nurse‐initiate analgesia, education and training in pain management education is variable. Little education is provided on assessing and managing acute pain in elderly, cognitively impaired or mechanically ventilated patients. Use of validated pain assessment instruments to assess pain in critically ill patients is poor.
While pain management is the responsibility of all healthcare professionals, in the emergency department, it is a core role of emergency nursing. This study highlights the variation in ability to nurse‐initiate analgesia, level of acute pain knowledge, education and training, and use of validated pain assessment instruments to guide pain management in critically ill intubated patients.
This study explores nonverbal communication behaviours between general practice nurses and patients during chronic disease consultations.
Nonverbal communication is an important aspect of nurse‐patient lifestyle risk reduction conversations. Despite the growing role of general practice nurses in lifestyle risk modification when managing chronic disease, few studies have investigated how this communication occurs.
Observational study within a concurrent mixed methods project.
Thirty‐six consultations by 14 general practice nurses were video recorded between August 2017 and March 2018. Video analysis used the Nonverbal Accommodation Analysis System. A STROBE checklist was used to guide this paper.
Joint convergence of nurse‐patient behaviours such as laughing, smiling and eye contact were most common (44%; n=157). Patient‐nurse eye contact time decreased significantly across the consultation, while nurse gesturing increased significantly. No significant relationship between consultation length and convergent to divergent behaviour categorisation or nurse‐computer use across the consultation was found.
The high levels of convergent behaviours are promising for person‐centred care. However, scope exists to enhance nonverbal interactions around lifestyle risk reduction. Supporting nurses with skills and improved environments for lifestyle risk communication has potential to improve therapeutic relationships and patient outcomes.
These results indicate that nurses support patients through nonverbal interactions during conversations of lifestyle risk reduction. However, there are opportunities to improve this practice for future interventions.
To identify opportunities for gamification in the elective primary fast‐track total hip and knee arthroplasty journey in order to support patients’ health‐related behavior.
Gamification provides an opportunity to increase engagement in a given health behavior and, eventually, the possibility of reaching improved outcomes through continued or consistent behavior.
A secondary analysis.
Semi‐structured interviews were conducted with 20 healthcare professionals in a single joint‐replacement center in Finland during autumn 2018. NVivo software was used for deductive and inductive coding. The open codes were also calculated. The consolidated criteria for reporting qualitative research was followed.
Gamification opportunities were identified related to six dimensions: accomplishment, challenge, competition, guided, playfulness, and social experience. Based on the frequencies of the coded content, most opportunities for gamification can be identified in the context of personalized counselling, monitoring, and social support.
Several opportunities for gamification were identified and quantified. While various needs and limitations need to be considered when developing digital gamified solutions and more research into the effectiveness of such solutions will be required, the current study opens possible future avenues for exploring the use of gamification in lower limb joint replacement journey and other specialisms.
This study provides an important insight into healthcare professionals’ views of the current state of the total hip and knee arthroplasty journey and the potential for its development. In addition, it pinpoints the biggest opportunities for gamified services in the context of personalized counselling, monitoring, and social support. Despite the focus of this secondary analysis being on the arthroplasty journey, the findings can also be generalized in other surgical journeys.
To explore the health care professional experience of providing care coordination to people living with multimorbidity.
There is increasing interest in improving care of people living with multimorbidity who need care coordination to help manage their health. Little is known about the experiences of health care professionals working with people living with multimorbidity.
Phenomenological approach to understanding the experiences of health care professionals.
We interviewed 18 health care professionals, including 11 registered nurses, working in care coordination in Melbourne, Australia. We used interpretative phenomenological analysis to identify themes from descriptions of providing care, identifying and responding to a person’s needs, and the barriers and facilitators to providing person‐centred care.
We identified four themes: (1) Challenge of focusing on the person; (2) ‘Hear their story’, listening to and giving time to clients to tell their story; (3) Strategies for engagement in the program; and, (4) ‘See the bigger picture’, looking beyond the disease to the needs of a person. Our results are reported using COREQ.
The health care professionals experienced challenges to a traditional approach to care when focusing on the person. They described providing care that was person‐centred, and acknowledged that optimal, guideline‐oriented care might not be achieved. They took the necessary time to hear the story and see the context of the person’s life, to help the person manage their health.
For registered nurses in care coordination programs, focusing on the client may challenge traditional approaches to care. Providing care involves developing a relationship with the client to optimise health outcomes. Experienced registered nurses appear to use skills in reflective practice, and accept the parameters of care to improve the client’s health and wellbeing.
To synthesize and review literature related to instruments that measure psychosocial aspects of fundamental care in acute hospital care settings.
Psychosocial aspects of care often receive less priority in terms of care provision in acute care environments. At the same time if these elements are overlooked there may be consequences. Despite the availability of many instruments designed to measure specific aspects of care these concepts are often not studied within the broader context of fundamentals of care, but rather coexist as isolated explorations of specific sub elements.
A scoping review was conducted, based on Arksey & O’Malley’s (2005) methodological framework and following the PRISMA checklist.
Using the five recommended steps ‐identifying the research question; identifying relevant studies; study selection; charting the data; summarizing and reporting the results – three databases were searched: MEDLINE/Pubmed, CINHAL, and EMBASE in February 2019.
Following independent screening by two of the authors, 48 papers were included. From these 48 papers, 33 instruments were identified. Only five of these tools thoroughly assessed psychosocial aspects elements of care (dignity, respect, privacy and patients’ choice) through dedicated items.
This review provides nurses with a synthesis of 33 instruments that assess the psychosocial aspects of care. This provides an important resource to guide measurement of dignity, respect, privacy and patients’ choice. The findings also provide guidance to future research in this field.
This paper reviews and synthesizes these instruments to provide a resource to nurses to inform their decisions and practice around measurement and evaluation of these key aspects of care. This provides a useful guide to measure and monitor the improvement of fundamental care delivery in practice, and points to strengths and weaknesses of the instruments concerned.
To investigate the effects on the quality of care of the Patient Report Informing Self‐Management Support (PRISMS) form compared with usual care among patients with Chronic Obstructive Pulmonary Disease (COPD) consulting a COPD nurse in primary health care.
Patients with COPD experience symptoms affecting their everyday lives and there is a need for interventions in self‐management support. The delivery of chronic care in an organized, structured, and planned manner can lead to more productive relationships between professionals and patients.
A multicentre randomised controlled trial with a post‐test design, according to the CONSORT checklist, in one intervention group (n=94) and one control group (n=108).
In addition to usual care, the intervention group (n=94) completed the PRISMS form to indicate areas where they wanted self‐management support before the consultation with the COPD nurse. This form comprises 17 items that patients with COPD commonly experience as problems. The control group received usual care (n=108). The primary outcome was patients’ satisfaction with quality of care, assessed using the Quality from the Patient’s Perspective (QPP) questionnaire. Means and (SD) are presented where applicable. Differences between the intervention and control group were analysed with Student’s t‐test for independent groups for interval data, and the Mann‐Whitney U‐test for ordinal data.
Participants in the intervention group were more satisfied with the QPP domains “personal attention”, regarding both “Perceived reality” (p=0.021) and “Subjective Importance” (p=0.012). The PRISMS form revealed “Shortness of breath” as the most commonly experienced problem and the issue most desired to discuss.
The PRISMS form improved patient satisfaction with quality of care regarding personal attention, which is an important factor in patient participation and improving relationships and communication.
The PRISMS form can be a useful tool in improving person‐centred care when delivering self‐management support.
To explore older inpatients’ experiences and perceptions of delirium and non‐pharmacological delirium prevention strategies (NDPS).
Delirium is a distressing and serious complication in hospitalised older adults. NDPS (supporting nutrition, mobility and cognitive participation) have strong supporting evidence. Few studies have explored older inpatients’ perspectives of these strategies. This information may assist staff to better support patient participation in NDPS.
Qualitative study using an interpretive descriptive (ID) methodological approach to explore older patient’s experience of delirium and NDPS.
Structured interviews of inpatients aged over 65 years across 6 medical and surgical wards explored patients’ experiences and perceptions of delirium and prevention activities related to nutrition, mobility and cognition; and barriers and enablers to participation. Reporting used COREQ.
Twenty‐three participants were included (12 male, 11 reported delirium experience). Participants reported a range of physiological, emotional and psychological responses to delirium, hearing about delirium was different to experiencing it. Most participants were aware of the benefits of maintaining nutrition and hydration, physical activity and cognitive engagement in hospital. Barriers included poor symptom control, inflexible routines and inconsistent communication, while enablers included access to equipment, family involvement, staff encouragement and individual goals. These were organised into themes: outlook, feeling well enough, hospital environment, feeling informed and listened to, and support networks.
A more patient centred approach to delirium prevention requires consideration of older people’s values, needs, preferences and fit within the hospital environment and routines. Feeling informed, listened to and receiving support from staff and family carers can improve older inpatients’ engagement in NPDS to prevent delirium in hospital.
Nurses are ideally placed to improve patient participation in NDPS through holistic assessment and care, addressing symptoms, providing clear information about delirium and delirium prevention, and facilitating family carer support and patient interactions.
This study aimed to develop a grounded theory of the patients’ experiences with patient‐controlled admission
Research indicates a potential for involving patients in mental health care, but there is a need to develop and investigate new approaches in health services. Patient‐controlled admission is an option for patients with severe mental disorders to refer themselves for a brief hospital admission when needed and thus avoid the usual admission procedure
Classic grounded theory with generation of a theory based on the constant comparative method for data collection and analysis.
Field observations and interviews with 26 mental health patients. The COREQ checklist was followed.
We found that patient‐controlled admission induced safety by providing faster access to help and thus preventing further deterioration of symptoms. Being self‐determined, achieving calmness, and receiving care with support and guidance from professionals during admission contributed to the sense of safety. The familiarity with the mental health professionals in their related units supported the patients in managing their situation. On the other hand, feelings of being overlooked by the professionals and experiencing uncertainty could undermine patients’ feeling of safety.
We demonstrate that safety is a focal point for patients when receiving help and support in mental health care. Patient‐controlled admission can induce a feeling of safety both at the hospital and at home. Patients’ self‐determination is strengthened, and brief admissions give them an opportunity to handle what they are currently struggling with. Professionals can support patients in this, but their actions can also reduce patients’ feeling of safety.
Patient involvement can be introduced in psychiatry, and even severely ill patients seem to be able to assess their own condition. Feasibility may, however, be associated with the attitude and behavior of the professionals in clinical practice.
In the unparalleled and extraordinary public health emergency in which we find ourselves, across the world nurses stand as we always do – at the front line. Nurses everywhere are staffing our clinics, hospital wards and units – in some situations, literally working until they drop, and in some regions, they are doing so while dealing with a lack of essential items. Indeed, we see reports that nurses in many parts of the world are grappling with shortages of much needed supplies including personal protective equipment such as masks, gloves and gowns, yet are actively embracing the challenges presented by COVID‐19.
To explore how working‐age adults experience patient participation in hospital haemodialysis.
End‐stage kidney disease is a progressive, chronic condition imposing patients with high treatment burdens and low health‐related quality of life. Patients face multiple medical decisions related to living with kidney failure. Given their frequent interaction with health services, patient participation may be of special value.
Qualitative design with a narrative approach.
In 2018, eleven patients aged 35–64 years undergoing hospital haemodialysis participated in individual interviews. All interviews were analysed using a narrative approach. Reporting followed the Consolidated criteria for Reporting Qualitative Research guidelines.
The patients’ narratives of participation comprised three themes following their healthcare trajectory: Informed, but not involved in treatment choices; Duality of care and control; and Frail trust reflecting collaborative deficiencies. The patients received good information about dialysis, but were not involved in choice of treatment modality. Professional work, as well as the nature of treatment, contributed to restricted patient autonomy. Patients’ trust suffered from collaborative deficiency generating delays in their treatment trajectories, and patients extended their responsibility into the coordination of transitions as a way of coping with these issues.
The study identified challenges related to patient involvement and interdisciplinary collaboration. Involving patients through dialogue and acknowledging their experiences, preferences and lifestyles may strengthen the mutual patient–professional understanding of treatment. Despite increased focus on seamless trajectories, patients face obstacles regarding interdisciplinary collaboration and coordination of health services.
The findings indicate a want of individually customised care for people requiring dialysis. Patients need to be involved in the choice of treatment modality as well as decisions related to the current treatment. Information must include potential consequences of the different treatment modalities. Health services need to strengthen collaboration in order to secure treatment continuity and patient involvement.