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.
(a) To describe trigger terms that can be used to identify reports of inadequate staffing contributing to medication administration errors, (b) to identify such reports, (c) to compare the degree of harm within incidents with and without those triggers, and (d) to examine the association between the most commonly reported inadequate staffing trigger terms and the incidence of omission errors and “no harm” terms.
This was a retrospective study using descriptive statistical analysis, text mining, and manual analysis of free text descriptions of medication administration–related incident reports (N = 72,390) reported to the National Reporting and Learning System for England and Wales in 2016.
Analysis included identifying terms indicating inadequate staffing (manual analysis), followed by text parsing, filtering, and concept linking (SAS Text Miner tool). IBM SPSS was used to describe the data, compare degree of harm for incidents with and without triggers, and to compare incidence of “omission errors” and “no harm” among the inadequate staffing trigger terms.
The most effective trigger terms for identifying inadequate staffing were “short staffing” (n = 81), “workload” (n = 80), and “extremely busy” (n = 51). There was significant variation in omission errors across inadequate staffing trigger terms (Fisher’s exact test = 44.11, p < .001), with those related to “workload” most likely to accompany a report of an omission, followed by terms that mention “staffing” and being “busy.” Prevalence of “no harm” did not vary statistically between the trigger terms (Fisher’s exact test = 11.45, p = 0.49), but the triggers “workload,” “staffing level,” “busy night,” and “busy unit” identified incidents with lower levels of “no harm” than for incidents overall.
Inadequate staffing levels, workload, and working in haste may increase the risk for omissions and other types of error, as well as for patient harm.
This work lays the groundwork for creating automated text‐analytical systems that could analyze incident reports in real time and flag or monitor staffing levels and related medication administration errors.
To compare the effects of integrating mother’s breast milk (BM) with three different combinations of sensory stimuli on preterm infant pain during peripheral venipuncture procedures.
A prospective, repeated‐measures randomized controlled trial.
Preterm infants (gestational age between 28 and 37 weeks, and in stable condition) needing venipuncture were recruited by convenience sampling (N = 140) and randomly assigned to four treatment conditions: (a) routine care (condition 1); (b) BM odor or taste (condition 2); (c) BM odor or taste + heartbeat sounds (HBs; condition 3), and (d) BM odor or taste + HBs + non‐nutritive sucking (NNS; condition 4). Pain scores were assessed based on the Premature Infant Pain Profile‐Revised (PIPP‐R) over nine phases: baseline (phase 0, 5 min without stimuli before venipuncture), disinfecting (phase 1), during venipuncture (phase 2), and a 10‐min recovery (phases 3–8).
Infants who received BM odor or taste + HBs + NNS had significantly lower increases in pain scores from baseline compared with controls across phases 1 through 8. Infants treated with either condition 2 or 3 demonstrated significant reductions in mild pain during disinfecting and recovery phases, as compared with the controls. When condition 2 was used as the reference, there were no significant differences in pain scores between the infants receiving condition 3 across the nine phases, suggesting mothers’ HBs have only mild analgesic effects on venipuncture pain.
Integration of mother’s BM odor or taste, HBs, and tactile NNS should be considered as an intervention for alleviation of procedural pain for preterm infants.
Clinicians should incorporate the integrated sensory intervention into caregiving support for preterm infants undergoing short painful procedures.
This study aimed to examine the associations among emotional labor strategies, stress from emotional labor, and burnout in nurses.
We employed a descriptive cross‐sectional design. Data were collected from May to November 2018 in South Korea using structured questionnaires. Participants were 303 nurses from 27 hospitals, who were recruited by convenience sampling.
Emotional labor strategies (surface acting, deep acting, and expression of naturally felt emotions), stress, and burnout were self‐reported. A path analysis using structural equation modeling was performed to examine the associations among the study variables.
Bivariate analyses revealed that surface acting was positively correlated with stress and burnout, deep acting was negatively correlated with burnout, and naturally felt emotions were negatively correlated with stress and burnout. The path analysis revealed that surface acting was positively associated with stress, naturally felt emotions were negatively associated with burnout, and the stress from emotional labor was positively associated with burnout. Although surface acting was not directly associated with burnout, it was indirectly associated through stress.
Surface acting involves regulation and suppression of one’s felt emotions. The findings of this study suggest that hospitals need to reduce expectations for surface acting to reduce nurses’ stress and burnout. Organizational efforts to provide interventions that improve nurses’ ability to manage their emotions in interactions with patients might effectively foster nurses’ well‐being.
Surface acting might contribute to nurses’ burnout, and naturally felt emotions might reduce nurses’ burnout. Nurse managers should thus provide opportunities to discuss the utilized emotional labor strategies and encourage appropriate responses depending on the patient context. Programs that promote emotional competence may reduce the adverse effects associated with nurses’ emotional labor and foster effective coping strategies.
To explore the prevalence of hepatitis C virus (HCV) infection as well as the levels of liver health literacy and association with the health status of people with HCV through the nurse‐led community health development goal of global elimination.
A community‐based, cross‐sectional study was conducted between July 2018 and June 2019 in coastal Western Yunlin County, Taiwan. This study was conducted at five townships, and serum HCV antibody (anti‐HCV) screening was used for the identification of potentially infected people by a collaborating local hospital.
Of the 1,963 adults from rural areas enrolled in this study, 321 (16.4%) were anti‐HCV positive, 237 (73.8%) reported that they were unaware of their HCV positivity, and none of them were provided information on direct‐acting antiviral agent therapy. The levels of anti‐HCV positivity were higher among female patients (p < .05), elderly people (p < .001), those with a low education level (p < .001), and those from the Sihu Township within Yunlin County (p < .001). Participants with anti‐HCV positivity tended to have lower intakes of vegetables (p < .01) and fruit (p < .05), a greater number of comorbidities (p < .05), as well as a greater incidence of abnormal liver (p < .001) and renal function (p < .001) compared to those with anti‐HCV negativity. Multivariable linear regression analysis showed that the presence of HCV infection and a greater number of metabolic syndrome components were associated with poor liver and renal function.
These findings showed a high prevalence of HCV infection among adults living in rural areas, who had low literacy levels on hepatitis, unhealthy lifestyles, and abnormal liver and renal function.
Clinicians and primary healthcare providers should initiate efforts to increase the levels of liver health literacy by increasing the accessibility to infection confirmation tests and reducing the number of barriers to the reception of antiviral treatment.
The aim of this integrative review was to synthesize findings of the published studies on barriers to prostate cancer screening by men in sub‐Saharan Africa.
Five‐step Cooper integrative methodology guided this review. Electronic databases, including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EBSCOHOST, MEDLINE, ProQuest, and PsycINFO, were searched using specific search terms in combinations to identify relevant articles for the review. Through this process, 83 articles were retrieved and evaluated for duplications and relevance of titles, abstracts, and content. Seventeen articles met the inclusion criteria and were judged to be methodologically adequate. These articles were published between 2008 and 2018.
Studies that met the inclusion criteria were from seven sub‐Saharan countries, including Burkina Faso (n = 1), Ghana (n = 1), Kenya (n = 2), Namibia (n = 1), Nigeria (n = 8), South Africa (n = 3), and Uganda (n = 1). The most common barrier was lack of knowledge, followed by perceptions, attitudes, and beliefs that hindered screening and testing for prostate cancer.
The findings from the integrative review suggest that individuals with low levels of education tend to lack knowledge, cannot comprehend information, and are mistrustful about prostate cancer screening. Low socio‐economic status was also associated with poor prostate screening and testing uptake.
Evidence from this review demonstrates that lack of knowledge is a major barrier for prostate screening among men in many parts of sub‐Saharan Africa.
Implementation science research seeks to understand ways to best ensure uptake of research‐based initiatives to health care; however, there is little research done on how to sustain such efforts. Sustainability is the degree to which an initiative continues to be used in practice after efforts of implementation have ended. Sustainability research is a growing field of implementation science that needs further research to understand how to predict and measure the long‐term use of effective initiatives to improve health care. The question of what influences the sustainability of research‐based initiatives to improve health care remains unknown.
The purpose of this article was to present a refined program theory on the contextual factors and mechanisms that influence the sustainability of one large‐scale quality management initiative (Lean) in pediatric health care.
We conducted a multiphase realist investigation to explain under what contexts, for whom, how, and why Lean efforts are sustained or not sustained in pediatric health care through the generation of an explanatory program theory.
This article presents the theoretical triangulation of our multiphase realist investigation, resulting in a refined program theory. We integrated the initial program theories (IPTs) from each research phase to form a refined program theory. It involved going back and forth from the initial IPT to the findings from each phase and our middle‐range theories and examining the most substantiated IPTs on the contextual factors and mechanisms that influenced the sustainability of Lean efforts.
The refined program theory depicts the complex nature to sustaining Lean efforts and that sustainability as a small, often unrepresentative portion of something much larger or more complex that cannot yet be seen or understood. The approach and nature of implementation is critical to shaping contexts for sustainability. Outcomes from implementation become facilitating or hindering contexts for sustainability. Customization to context is an important contextual factor for sustainability. Sense making, value congruency, and staff engagement are critical aspects from early implementation that enable or hinder processes of sustainment. Such mechanisms can trigger staff empowerment that can lead to a greater likelihood of sustainability.
These findings have important implications for sustainability research, in understanding the determinants of sustainability of research‐based initiatives in health care.
It is important to understand and explain determinants of sustainability through theory‐driven evaluative research in order to assist key stakeholders in sustaining the effective research‐based initiatives made to improve healthcare services, patient care, and outcomes.
Nurse scientists play an indispensable role in developing new knowledge to advance the health of patients, families, and communities. Yet PhD nurse enrollment has significantly dropped, and many later career nurse scientists are nearing retirement. The purpose of this article is to outline potential strategies to enhance the PhD nurse pipeline. Potential strategies are identified at three distinct time points along the PhD trajectory: (a) prior to a PhD program (increasing the pipeline), (b) during a PhD program (enhancing graduation rates and transitioning into research‐focused careers), and (c) in the postdoctoral or early career period (establishing scholarly independence and an active program of research). Talented students should be approached early on in their education to ascertain interest in a scientific research‐based career, and all students could be engaged in research opportunities while in undergraduate programs. During a PhD program, supportive mentors are a key component for student success and may provide assistance in obtaining ongoing funding and scholarship support. Throughout doctoral study and into early career, less structured opportunities can be influential, including conference support, online and face‐to‐face training, and ongoing funding and scholarship support for postdoctoral study or fellowships. At each career stage, there should be a focus on designing scientifically sound nursing research that will impact outcomes in measurable and sustainable ways. We must not focus our attention only on student recruitment. Public messaging efforts are needed to raise awareness of the role of nurse researchers. In addition, several stakeholders play a role in increasing the PhD pipeline and producing independent nurse scientists, and they should be acknowledged in these efforts. The strategies described may be beneficial for any nurse contemplating a research career as well as for those who may serve as mentors to these individuals. More broadly, these strategies may be employed by colleges and universities, funding bodies, professional nursing societies, and healthcare organizations in the United States and abroad. Increasing the PhD pipeline, and fostering a more robust field of independent nurse scientists, will translate into improved patient outcomes.
This study aimed to examine the quality of family‐centered care perceived by primary family caregivers and its influencing factors in mental healthcare practice.
A cross‐sectional, correlational study.
A convenience sample of 121 mental health nurses and 164 primary family caregivers of patients with schizophrenia was recruited from acute psychiatric wards and chronic psychiatric rehabilitation wards in three psychiatric hospitals in Taiwan. Structured questionnaires for mental health nurses were designed to examine nurses’ attitudes toward schizophrenia and the importance of families in nursing care. Primary family caregivers were assessed to determine their perceptions of quality of family‐centered care. At least one primary family caregiver of patients was matched to a nurse who took major responsibility for the patient during the hospitalization. Data were analyzed with descriptive statistics, Pearson’s product‐moment correlations, independent t‐test, one‐way analysis of variance, and stepwise regression analyses.
Quality of family‐centered care perceived by primary family caregivers regarding the provision of general and specific information, as compared to enabling and partnership, coordinated and comprehensive care, and respectful and supportive care, was relatively inadequate. Younger and more educated primary family caregivers, having relatives with schizophrenia in acute wards, less supportive nurses’ attitudes toward schizophrenia, and the importance of family in nursing care were correlated with poor primary family caregivers’ perceptions of quality of family‐centered care. Nurses’ supportive attitudes toward schizophrenia and chronic psychiatric rehabilitation wards where patients received care were key factors in determining better quality of family‐centered care.
Findings provide a platform for the development of effective continuing education and training programs to equip mental health nurses with supportive attitudes toward mental illness and an integration of the family in nursing care, which will ultimately improve mental health care for families experiencing mental health problems.
Efforts in professional training to address stigma and encourage a family‐centered approach into recovery‐oriented practice for practicing mental healthcare providers, including mental health nurses, are recommended.
The purpose of this study was twofold: (a) to assess predictors of the turnover intention, burnout, and perceived quality of care among nurses working in Oman, and (b) to examine the potential moderating role of job satisfaction on the relationship between work environment and nurse turnover intention.
A cross‐sectional design was used to collect data from a sample of 207 nurses working in a public hospital in Muscat, Oman.
An electronic survey was used to assess nurses’ perceptions of work environment, burnout, job satisfaction, turnover intention, and quality of care.
Participation in hospital affairs, a foundation for quality of care, and staffing adequacy were predictors of burnout among nurses and perceived quality of care. Logistic regression analysis revealed that working in a favorable environment was associated with less turnover intention, but only when job satisfaction was high.
Improving nurse job satisfaction is a mechanism through which future interventions could enhance working conditions and promote better nurse retention.
Organizational strategies are needed to increase nurse job satisfaction by empowering nurses to take more active roles in hospital affairs as a strategy to reduce turnover intention and enhance the quality of patient care.