To explore the attitude of nursing professionals towards death.
Systematic qualitative review methods were used.
A search was conducted in the PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and CUIDEN databases. This study included 17 articles.
Thirteen categories emerged, which were grouped into three themes: meanings and feelings during the dying process; coping strategies in the face of death; and the importance of training, experience, and providing a dignified death. In the different accounts of the participants, it was found that death had a large negative emotional impact on them, that the participants complained about the lack of previous training in the care of dying patients, and that avoiding these complex situations was one of the strategies most commonly used by professionals to face the death of a patient.
The lack of training in the basic care of terminally ill patients, as well as today’s preconceived negative idea about death, both cause health professionals to experience situations of great stress and frustration resulting, on many occasions, in resorting to avoidance of these situations, thus preventing dying with dignity.
In this article, we explore the consequences of this process for nursing professionals, common coping strategies, and possible areas for improvement, such as the need for the training of nursing professionals in the care of terminally ill patients and their families.
Workplace violence against nurses is a widespread phenomenon that has been associated with many unfavorable individual and organizational outcomes. The aim of this study was to analyze the relationship between violence and work functioning in a sample of Italian nurses.
Cross‐sectional, with retrospective analysis of exposure.
All nurses from a local hospital were invited to complete a questionnaire assessing violent experiences that occurred in the previous 12 months. The questionnaire also measured job strain (with the Demand‐Control‐Support questionnaire), organizational justice (with Colquitt’s Questionnaire), and work impairment (with the Nurses Work Functioning Questionnaire). The associations were examined with logistic regression analyses.
Of the 302 nurses who were invited, 275 (91.1%) agreed to participate. The total work impairment score was significantly higher among the nurses exposed to violence compared with the nonexposed nurses (42.2 ± 27.8 vs. 31.9 ± 31.6, respectively; p < .001). Exposed nurses also reported significantly higher levels of job strain (0.96 ± 0.25 vs. 0.8 ± 0.21; p = .003) and lower levels of perceived organizational justice (56.6 ± 12.6 vs. 62.5 ± 14.8; p = .001) than nonexposed nurses. Nurses who had experienced violence had a significantly higher risk for impairment of work functioning than their colleagues (crude odds ratio [OR] = 2.33; 95% confidence interval [CI 95%] = 1.42–3.83). The association between violence and impairment remained significant after adjusting for demographic variables, occupational stress, and perceived organizational justice (OR = 1.83; 95% CI 95% = 1.06–3.17).
Workplace violence is associated with impaired work function in nurses. Job strain and perceived organizational injustice are associated with impairment.
Violence prevention programs in healthcare activities should include training for violent behavior identification and de‐escalation techniques, structural and administrative measures for violence control (such as alarms, surveillance, staff increase), and measures to reduce occupational stress, which can include wellness courses, spirituality, organizational improvements, and staffing methodologies.
The nursing workforce in Australian general practice has increased exponentially in size over recent years to meet the growing demand for health care. Nurses are more likely to remain working if they are satisfied with their jobs. Satisfaction is impacted by a complex range of factors, including the environment, workplace relationships, and the nurses’ role. Therefore, satisfaction data cannot be generalized across disparate clinical settings. This study sought to investigate the job satisfaction and turnover intentions of nurses working in Australian general practice.
A cross‐sectional online survey of nurses employed in general practices across Australia was conducted using convenience and snowball sampling techniques. The survey tool contained a 29‐item job satisfaction scale and 8 items around turnover intention.
786 responses were included in the analysis. Respondents were most satisfied with the work nature aspects of their job and least satisfied with the pay items. While most participants intended to stay in nursing (86%) and general practice (77%) employment, a substantial group were undecided about their future (16%). Those who were dissatisfied with their job or neutral in their satisfaction were more likely to be intending to leave than those who were satisfied with their job.
This is the first study of job satisfaction and turnover intention reported about nurses working in Australian general practice. It has highlighted that a substantial proportion of the workforce is undecided about their future. Therefore, strategies need to be developed to address the issues raised around job satisfaction to reduce the potential loss of these skilled nurses.
Those intending to leave general practice nursing are more likely to be dissatisfied in their jobs. Understanding the factors that impact job satisfaction is important to inform strategies that will facilitate retention of nurses in general practice employment.
Intimate partner violence against women is a priority global health issue. It has had serious negative consequences on women’s health and has led to huge burdens on the community. Numerous interventions have been demonstrated to have positive effects, and the majority of them have been developed using a top‐down approach. However, the specific needs of abused Chinese women have not been fully addressed; incorporating women’s input seems to be an essential element for the success of any intervention. This article describes the experiences and success in using a community‐based participatory approach (CBPA) to develop a culturally appropriate intervention for abused Chinese women in order to address their multifaceted needs.
A CBPA was adopted in this study to develop a culturally appropriate intervention in order to address the multifaceted needs of abused Chinese women.
A core group of six participants (three abused Chinese women, one researcher, and two social workers who provided community services for abused Chinese women) was formed in a local community center in Hong Kong. The three Chinese women were recruited from the local community center, and according to the Abuse Assessment Screen they had been in an intimate relationship in the preceding 12 months and had been abused by an intimate partner.
Three core group meetings were conducted over 6 weeks for intervention development. An integrated multicomponent intervention was developed, comprising a four‐part, women‐centered program called “Women‐centred, we are with you.” The program was implemented and completed over 4 months (October 2015 to January 2016). Eighteen abused Chinese women participated in the intervention.
A CBPA provides actual empowerment spirit for abused Chinese women. This approach was well accepted by the women and enabled them to develop more culturally appropriate interventions in fulfilling their specify needs.
Researchers can consider using a CBPA to develop and tailor a culturally appropriate intervention for groups such as abused Chinese women in order to improve their health and eliminate disparities by addressing their specific and multifaceted needs.
Heart failure (HF) causes high rates of hospital admissions. It is known that disease progression impacts the health‐related quality of life (HRQoL) of both patients and caregivers, yet to date, this finding is based on cross‐sectional studies with limited samples.
The study aim is to analyze the relationship between HF patients’ use of hospital services (a proxy for disease progression) and the HRQoL of their family caregivers.
This work is a multicenter nested case‐control study on a population of patients admitted to hospitals in southern Spain due to heart failure. The sample comprised 530 patient‐caregiver dyads. Hospital admission data were retrospectively collected for the 5 years prior to inclusion in the study. Bivariate analyses and multivariate logistic regression were used to determine associations between patient deterioration and caregivers’ quality of life.
Patients’ use of hospital services was associated with worsened quality of life for family caregivers, with an overall OR of 1.48 (95% CI: 1.23‐1.79). A positive correlation was found between patients’ perceptions of their physical health and the perceived mental health of caregivers (r = 0.127, p = 0.004) and between the perceived mental health of both (r = 0.291; p <0.0001).
Greater use of hospital services by patients with HF is an independent predictor of deterioration of family caregivers’ HRQoL. The physical and mental components of patients’ and their family caregivers’ HRQoL interact and influence each other. Additional factors, such as the nature and intensity of care provided, also determine the worsening of a family caregiver’s HRQoL.
These results can be used to identify family caregivers of people with heart failure at risk of suffering a deterioration in their health‐related quality of life. Increased use of hospital services is an independent predictor of the deterioration of the family caregivers’ health‐related quality of life. Since clinical nurses are the main provider who gives support and education to family caregivers, they should be alert to this situation and individualize interventions to prevent this deterioration.
This study aimed to evaluate what types and forms of support nursing staff need in providing palliative care for persons with dementia. Another aim was to compare the needs of nursing staff with different educational levels and working in home care or in nursing homes.
A cross‐sectional, descriptive survey design was used.
A questionnaire was administered to a convenience sample of Dutch nursing staff working in the home care or nursing home setting. Data were collected from July through October 2018. Quantitative survey data were analyzed using descriptive statistics. Data from two open‐ended survey questions were investigated using content analysis.
The sample comprised 416 respondents. Nursing staff with different educational levels and working in different settings indicated largely similar needs. The highest‐ranking needs for support were in dealing with family disagreement in end‐of‐life decision making (58%), dealing with challenging behaviors (41%), and recognizing and managing pain (38%). The highest‐ranking form of support was peer‐to‐peer learning (51%). If respondents would have more time to do their work, devoting personal attention would be a priority.
Nursing staff with different educational levels and working in home care or in nursing homes endorsed similar needs in providing palliative care for persons with dementia and their loved ones.
It is critical to understand the specific needs of nursing staff in order to develop tailored strategies. Interventions aimed at increasing the competence of nursing staff in providing palliative care for persons with dementia may target similar areas to support a heterogeneous group of nurses and nurse assistants, working in home care or in a nursing home.
The views of butch‐ and femme‐identified lesbians toward their own breasts, breast cancer, breast cancer screenings, and their behavior and intentions toward breast health care were examined and compared in this study.
A total of 208 Taiwanese lesbians (134 butch‐identified lesbians and 78 femme‐identified lesbians) completed an online survey.
Butch‐identified lesbians were more likely to hold negative views regarding their own breasts, which were found to be significantly and negatively associated with their actions in performing breast self‐examinations when compared with femme‐identified lesbians.
Healthcare providers should be aware of and provide culturally competent care to lesbians with different identities.
The results can be employed as evidence for promoting lesbians’ breast health, particularly butch‐identified lesbians. Healthcare providers should provide a supportive environment in order to promote a positive body image and improve breast health among lesbians.
To establish a website to advance nursing research and education involving omics technologies and methodologies through facilitating collaborations, use of existing data and samples, mentoring, and access to training opportunities.
The Omics Nursing Science & Education Network (ONSEN) website was established following identification of gaps in omics nursing infrastructure and resources that could be addressed via a concerted, collaborative effort. ONSEN content was created using input from a workgroup of experts in genomics and other omics, education, practice, and nursing research. Alpha testing was conducted with workgroup members, followed by website refinements and enhancements, and subsequent beta testing by potential end users. ONSEN was launched in August 2018.
ONSEN has three main sections. The Education and Training section provides information on mentoring and pre‐ or postdoctoral opportunities in addition to a knowledge matrix to advance education and skills in genomic nursing science. The Research Collaborations section promotes awareness of ongoing omics nursing research in order to foster collaborations and sharing of samples or data among investigators with programs in omics nursing research or an interest in developing such programs. The Common Data Elements (CDE) section provides information on the benefits of incorporating CDEs into nursing science as well as links to National Institutes of Health resources to facilitate use of CDEs.
ONSEN provides opportunities for nurse scientists and trainees to leverage samples and datasets, locate mentors and pre‐ or postdoctoral positions, further the use of CDEs, and enhance education and skills for integrating omics into nursing science.
Advancing omics nursing science via ONSEN resources will accelerate the elucidation of the molecular underpinnings of disease and associated symptoms as well as inform the development of rapidly translatable, personalized intervention strategies, grounded in biological mechanisms, for improved health outcomes across populations and the lifespan.
To determine whether illness perceptions, coping strategies, and sociodemographic and clinical variables are related to the quality of life (QoL) in adults with multiple chronic conditions (MCCs) living in China.
By employing a cross‐sectional design based on the transactional stress and coping theory, a convenience sample of adults with MCCs were recruited from a university‐affiliated hospital between November 2017 and May 2018 in Northern Anhui, China.
A self‐reported questionnaire, including the Brief Illness Perceptions Questionnaire, the Brief Coping Orientation to Problems Experienced inventory, and the Short Form Survey version 2, was administered. Sociodemographic and clinical data regarding MCCs were also collected. Descriptive statistics including frequencies, means, standard deviations, and correlation coefficients were calculated to examine the relationship between illness perceptions, coping, and QoL. Hierarchical multiple regression models were used to identify variables associated with physical and mental QoL.
A total of 351 participants (50% male) were recruited, with a mean age of 58.9 years (SD = 14.6). Of the participants, 83% had two chronic conditions. Participants reported impaired physical and mental QoL when compared with the general population in China. Poorer QoL was correlated with stronger illness perceptions of consequences and timeline and increased use of denial and disengagement and self‐blame. Increasing age and more chronic conditions were associated with worse QoL. A higher education level was significantly associated with better physical and mental QoL.
This study found that adults with MCCs living in China experienced impaired QoL. The strong relationship found between the participants’ perceptions of MCCs, coping strategies, and QoL suggested that healthcare professionals should recognize the physical and psychological impacts of MCCs and address the significance of adaptations to MCCs in future treatment programs. The findings will help healthcare professionals design more specific interventions to modify illness perceptions and enhance certain coping strategies to improve the QoL of people with MCCs. Healthcare professionals can mobilize available resources from healthcare and social systems to enhance people’s coping and adaptation to MCCs.
With an understanding of the illness perceptions of people with MCCs, healthcare professionals could offer information related to consequences, timeline, and personal control to enable better alignment between people’s expectations and their actual situations. By knowing people’s coping strategies, healthcare professionals can offer additional support to people who prefer strategies of denial and disengagement and self‐blame.
To explore the behavior of parents, with and without health training, seeking care from emergency services due to their child’s fever.
A qualitative study based on Grounded Theory using a triangulated sample (theoretical sampling and snowball sampling) of parents of children 0 to 12 years old who received care for fever in the emergency primary care services of two Spanish municipalities.
Data saturation was achieved after eight focus groups segmented by gender, place of residence, and education (57 participants). Data analysis followed the constant comparative method and coding process.
The parents attended the emergency department when fever was high or persistent and to determine the cause. The reasons for avoiding the emergency department differed; whereas the health professional parents avoided consulting other colleagues as they felt questioned, for parents who were not healthcare professionals, there was a fear of acquiring an infection.
Parents’ search for healthcare differs according to their background and education.
These results provide key information for the design of care plans to improve health care and patient satisfaction.
To analyze the effect of different diabetes education methods on metabolic control, body mass index (BMI), and blood pressure.
A systematic review was carried out.
PubMed, Medline, Embase, Cochrane, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), CUIDEN, Ibecs, and Scopus databases were consulted. The search was done in May 2018. Studies included controlled clinical trials on diabetes education in primary care that were published in English and Spanish during the years 2011 to 2018.
The post‐intervention results were as follows: glycosylated hemoglobin concentration (HbA1c) ranged between ‐1.6% (individual education [IE]) and + 0.05% (mixed education [ME]). The values of BMI varied from ‐0.7% (group education [GE]) to ‐0.3% (GE). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) fluctuated. SBP varied from ‐8.5 mmHg (GE) to +2.9 mmHg (GE); DBP varied from ‐3.1 mmHg (GE) to ‐0.9 mmHg (GE). Total cholesterol ranged from ‐15.9/dL (GE) to +2 mg/dL (GE). LDL cholesterol ranged from ‐18.3 mg/dL (GE) to ‐7 mg/dL (ME). HDL cholesterol ranged from +0.8 mg/dL (IE) to +8.12 mg/dL (GE). Triglycerides varied from ‐21.1 mg/dL (GE) to +11.0 (GE).
The most profound decrease in HbA1c was achieved using individual education. However, to decrease BMI, SBP, DBP, total cholesterol, LDL cholesterol, and triglycerides, group education was the most effective intervention.
To obtain good metabolic control, it is necessary to address both clinical and psychological aspects, including modifying nutritional and dietary habits, monitoring medication, increasing knowledge of diabetes, and combining theoretical content with physical exercise programs. Reinforcement strategies are very important to achieve the objectives of educational programs.
As part of a contextual analysis, this study aimed to generate a comprehensive understanding of barriers and facilitators to pain management in nursing homes to identify potential leverage points for future implementation studies.
An explanatory sequential mixed‐methods study embedded in a cross‐sectional study in 20 Swiss nursing homes (data collection: July–December 2016).
Quantitative data were collected via care worker questionnaire surveys comprising 20 items assessing perceptions of barriers to pain management. Descriptive statistics were computed. In the subsequent qualitative strand we conducted four focus group discussions with care workers (registered nurses, licensed practical nurses, and nursing aides) using a knowledge‐mapping approach. Findings of both strands were merged and mapped onto domains of the Capability, Opportunity, and Motivation determine Behavior (COM‐B) system, a model for behavior, to identify determinants for behavior change.
Data from 343 completed care worker surveys (response rate 67.3%) and four focus groups with care workers were analyzed. Items rated most problematic were as follows: lack of availability of nonpharmacological treatment (60.9%), lack of application of nonpharmacological treatment (53.6%), reluctance of residents to report pain (51.1%), and lack of time for a comprehensive pain assessment (50.5%). Focus groups partly corroborated quantitative findings and complemented them with facilitators, such as close collaboration with physicians and further barriers (e.g., organizational factors such as high turnover and a lack of established routines in pain management).
Our approach using a behavioral model highlighted a need for implementation strategies that improve pain management knowledge and focus on motivational aspects to establish new routines and habits related to pain management among care workers.
Our findings suggest that future approaches to improve pain management in nursing homes should go beyond provision of education and training. To establish new practices or adapt existing ones, a more complex approach (e.g., introduction of external or internal facilitators) is necessary to influence motivation and ultimately change behavior.
The purpose of this study was to describe the level of moral distress experienced by nurses, situations that most often caused moral distress, and the intentions of the nurses to leave the profession.
A descriptive, cross‐sectional, correlational design was applied in this study. Registered nurses were recruited from five large, urban Lithuanian municipal hospitals representing the five administrative regions in Lithuania. Among the 2,560 registered nurses, from all unit types and specialities (surgical, therapeutic, and intensive care), working in the five participating hospitals, 900 were randomly selected to be recruited for the study. Of the 900 surveys distributed, 612 questionnaires were completed, for a response rate of 68%. Depending on the hospital, the response rate ranged from 61% to 81%. Moral distress was measured using the Moral Distress Scale–Revised (MDS‐R). The MDS‐R is designed to measure nurses’ experiences of moral distress in 21 clinical situations. Each of the 21 items is scored using a Likert scale (0–4) in two dimensions: how often the situation arises (frequency) and how disturbing the situation is when it occurs (intensity). On the Likert scale, 0 correlates to situations that have never been experienced, and 4 correlates to situations that have occurred very often.
Among the 612 participants, 206 (32.3%) nurses reported a low level of moral distress (mean score 1.09); 208 (33.9%) a moderate level of distress (mean score 2.53), and 207 (33.8%) a high level of distress (mean score 3.0). The most commonly experienced situations that resulted in moral distress were as follows: “Carrying out physician’s orders for what I consider to be unnecessary tests and treatments” (mean score 1.66); “Follow the family’s wishes to continue life support even though I believe it is not in the best interest of the patient” (mean score 1.31); and “Follow the physician’s request not to discuss the patient’s prognosis with the patient or family” (mean score 1.26). Nurses who had a high moral distress level were three times more likely to consider leaving their position compared with respondents who had a medium or low moral distress level (8.7% and 2.9%, respectively; p < .05).
Our findings provide evidence on the association between moral distress and intention to leave the profession. Situations that may lead health professionals to be in moral distress seem to be mainly related to the unethical work environment.
The findings of this study reported that moral distress plays a role in both personal and organizational consequences, including negative emotional impacts upon employees.
To explore the association between the levels of temporary nurse staffing and patient mortality. Achieving adequate nurse staffing levels plays a vital role in keeping patients safe from harm. The evidence around deploying temporary staffing to maintain safe staffing levels is mixed, with some studies reporting no adverse effects on patient mortality.
A retrospective longitudinal observational study using routinely collected data on 138,133 patients admitted to a large hospital in the south of England. Data were collected between April 2012 and April 2015.
We used multilevel survival models to explore the association between in‐hospital deaths and daily variation in registered nurse (RN) and nursing assistant (NA) temporary staffing, measured as hours per patient per day. Analyses controlled for unit and patient risk.
Use of temporary staffing was common, with only 24% (n = 7,529) of the 30,980 unit‐days having no temporary RN staff and 13% (n = 3,951) having no temporary NAs. The hazard of death was increased by 12% for every day a patient experienced high levels (1.5 hr or more per day) of RN temporary staffing (adjusted hazard ratio [aHR] 1.12, 95% confidence interval [CI] 1.03–1.21). The hazard of death was increased on days when NA temporary staffing was more than 0.5 hr per patient (aHR 1.06; 95% CI 1.03–1.08).
Days with more than 1.5 hr per patient of temporary RNs and days with more than 0.5 hr of temporary NAs were associated with increased hazard of death.
Heavy reliance on temporary staff is associated with higher risk for patients dying. There is no evidence of harm associated with modest use of temporary RNs so that required staffing levels can be maintained.
This article aims to provide perspectives on the establishment of a consortium for nurse scientists with similar career trajectories interested in cancer‐related symptoms (CRS) research. Hereby, we describe the development of and recent outcomes from the CRS consortium, the lessons learned in establishing the consortium, and future directions to advance the science of CRS.
New and innovative strategies are needed to address the complexity of CRS research. A CRS consortium was created to allow a mechanism for oncology nurse scientists with varying expertise to collaborate to advance CRS research. The National Institutes of Health (NIH) Symptom Science Model (SSM) guides the research of the CRS Consortium.
A need for improved CRS assessment and management has been identified. The CRS consortium was created as a collaborative think tank to begin to address this need. Guided by the NIH SSM, CRS consortium members have worked to define symptom phenotypes, enhance understanding of the biologic mechanisms that can contribute to symptom phenotypes, and develop tailored interventions to improve symptom management. Dissemination of the CRS consortium efforts involve publications and presentations.
Nurse scientists interested in symptom science and biobehavorial research face many challenges on how to initiate and sustain independent programs of research. Through the formation of a CRS consortium, oncology nurse scientists can work together to address identified issues in symptom measurement and management.