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Anteayer Journal of Advanced Nursing

Pre‐hospital symptom clusters and symptom network analysis in decompensated cirrhotic patients: A cross‐sectional study

Abstract

Aims

To generate pre-hospital symptom networks, explore core, bridge and sentinel symptoms, identify pre-hospital symptom clusters and analyse relationship between influencing factors and symptom clusters in decompensated cirrhosis patients.

Design

A cross-sectional study design using the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

Methods

Demographical, physiological, psychological and sociological characteristics and the pre-hospital symptoms of 292 decompensated cirrhotic patients were collected from October 2021 to March 2023 in China. Frequencies, percentages, means, standard deviations, independent samples t-tests, one-way analysis of variance, exploratory factor analysis, multiple stepwise regression analysis and network analysis were used for data analysis.

Results

‘I don't look like myself’ and itching were core and bridge symptoms, while bloating and lack of energy were sentinel symptoms in decompensated cirrhotic patients. Monthly family income, anxiety, depression, social support and disease duration influenced the neuropsychological symptom cluster, with worrying as the strongest predictor symptom. Influential factors for cirrhosis-specific symptom cluster included Child-Pugh class, monthly family income, disease duration, anxiety and depression, with itching being the strongest predictor symptom. Monthly family income, disease duration and depression were influential factors for gastrointestinal symptom cluster, with loss of appetite as the strongest predictor symptom.

Conclusions

Neuropsychological, cirrhosis-specific and gastrointestinal symptom clusters were formed in decompensated cirrhotic patients. Through network analysis, direct connections between symptoms, symptom clusters and their influencing factors were revealed, thereby offering clinicians a foundation for effectively managing patients' pre-hospital symptoms.

Impact

Decompensated cirrhosis patients commonly have multiple symptoms, while the management of pre-hospital symptoms is often suboptimal. This study identified neuropsychological, cirrhosis-specific, gastrointestinal symptom clusters and recognized core, bridge and sentinel symptoms in these patients. It also revealed the most prominent symptoms within each cluster. This provides insight into the hierarchy of symptoms, improving symptom management in decompensated cirrhosis.

Patient and Public Involvement

There was no patient or public involvement.

Uncertainty in surrogate decision‐making about end‐of‐life care for people with dementia: An integrative review

Abstract

Aim

To describe uncertainty in surrogate decision-making regarding end-of-life care for people with dementia using Mishel's reconceptualized uncertainty in illness theory.

Design

Integrative literature review using Whittemore and Knafl's approach.

Data Sources

PubMed, CINAHL, EMBASE, Scopus and Web of Science were searched using terms such as uncertainty/unpredictability, decision-making/advance care planning/end-of-life care planning, surrogate/family/caregiver/proxy and dementia. The search was initially conducted on 28 September 2021 and updated on 31 July 2023.

Review Methods

Through systematic screening, 20 research articles were included in the analysis. Content related to uncertainty in surrogate decision-making regarding end-of-life care was extracted and analysed, focusing on the reconceptualized uncertainty in illness theory.

Results

First, surrogate uncertainty exists in various areas of surrogate decision-making regarding end-of-life care. Second, antecedents of surrogate uncertainty include numerous intrinsic and extrinsic factors. Third, surrogates exhibited some negative psychological responses to uncertainty but continually processed and structured their uncertainty through certain approaches, leading them to grow as decision-makers. Finally, research-based evidence on surrogates' processing of uncertainty and shifts to new life perspectives remains limited.

Conclusion

Surrogates' uncertainty in decision-making regarding end-of-life care for people with dementia is well characterized using the reconceptualized uncertainty in illness theory. Healthcare providers should help surrogates manage their uncertainty in surrogate decision-making more constructively throughout the dementia trajectory.

Implications for the Profession and/or Patient Care

The findings highlight the importance of assessing how surrogates process uncertainty and gauging how to help them process uncertainty and transition to new life perspectives.

Impact

This review contributes to healthcare professionals' understanding of surrogates' uncertainty in end-of-life care planning for people with dementia, especially what they are uncertain about, what influences their uncertainty and how they process it.

Reporting Method

This study adheres to the PRISMA reporting guidelines.

Patient or Public Contribution

No patient or public contribution.

Living with multimorbidity: A qualitative exploration of shared experiences of patients, family caregivers, and healthcare professionals in managing symptoms in the United States

Abstract

Aims

To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit.

Design

Experience-based co-design.

Methods

Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis.

Results

Twenty-three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow-up care.

Conclusion

Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes.

Implications for the Profession and/or Patient Care and Impact

This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life.

Reporting Method

We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting.

Patient or Public Contribution

This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience-based co-design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co-design events, to support symptom management for people with multimorbidity.

Nurse managers' perceptions of the prospective acceptability of an implementation leadership training programme: A qualitative descriptive study

Abstract

Aim

To explore the prospective acceptability of an implementation leadership training programme prototype for nurse managers in China to implement evidence-based practices, from the perspectives of potential programme participants and deliverers.

Design

A qualitative descriptive study was conducted in Spring 2022 at three tertiary hospitals in Hunan, China.

Methods

We conducted individual semi-structured interviews with unit-level nurse managers (n = 14), including 12 potential participants, and two potential deliverers that have been involved in developing the programme prototype. Interview questions and thematic analysis were guided by the Theoretical Framework of Acceptability.

Results

After reviewing the programme content, potential participants and deliverers reported that unit nurse managers would benefit from engaging in the programme, acknowledging that the programme fit with professional nursing values for implementing research evidence. They expressed positive views about being involved in producing academic papers through the training process, and interactive multi-modal training activities such as group work, experience-sharing and coaching. Seven participants were not very confident about being fully engaged in the training, as they could not navigate the English research literature. Both participants and deliverers highlighted factors that would influence their participation, including time constraints, the impact of the COVID-19 pandemic, and support from senior organizational leadership.

Conclusions

The training programme prototype was perceived to be useful and acceptable. The multimodal training activities were considered a strength and managers expressed an interest in writing academic papers about their implementation processes. Support from senior hospital leaders and programme deliverers was identified as critical to the training programme's success.

Impact

The study helps understand nurse managers' perceptions and concerns of participating in an implementation leadership training programme and could inform the development and refinement of similar programmes in various nursing contexts globally.

Living in a multicultural context: Health and integration from the perspective of undocumented Mediterranean migrants, residents, and stakeholders in Italy. A qualitative‐multimethod study

Abstract

Aim

To catch a representative view of a multicultural population's needs.

Design

Qualitative study.

Methods

Semi-structured interviews were conducted from July 2022 to January 2023 with the project's stakeholders, migrants, and residents. Data analysis was performed using a multimethod textual analysis technique.

Findings

Territorial barriers, lack of social network, and specific professionals' training emerged as healthcare delivery obstacles. For migrants, language improvement emerged as a health priority. A deep relationship with migrants emerged as a deficiency for residents.

Conclusion

A welcoming project equipped with solid leadership and the right resources can be fundamental in mediating health promotion and integration. In this process, the involvement of the resident population is essential.

Implications for the Profession and/or Patient Care

Analysing the migrants' needs and the strengths and limitations of a reception system could help identify the challenges for professionals in delivering culturally competent care. In this context, the nurse's role becomes relevant, being responsible for taking charge and caring for the population and the link between professionals and the population.

What Problem Did the Study Address?

The study addressed the problem of improving the overall health of migrants, refugees, and asylum seekers, mainly focusing on reception and integration into a new society process.

What Were the Main Findings?

Worse health was identified with adaptation, integration, and family problems. Territorial barriers emerged, hindering good health.

Where and on Whom Will the Research Have An Impact?

These research findings can be valuable for health professionals who want to improve the reception process and enhance a care model integrated with residents.

Patient or Public Contribution

No patient or public contribution.

Reporting Method

To describe the research report, we referred to the COREQ checklist (Tong et al., 2007).

The parent perspective on paediatric delirium and an associated care bundle: A qualitative study

Abstract

Aims

To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle.

Design

We conducted a qualitative exploratory descriptive study using semi-structured individual or dyad interviews.

Methods

Twelve semi-structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis.

Findings

We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long-term consequences, (4) adding insight to the bundle, and (5) family engagement.

Conclusion

The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium.

Impact

This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit.

Reporting Method

The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting.

Patient or Public Contribution

No patient or public contribution to the research design.

What does this Paper Contribute to the Wider Global Community?

- It increases awareness of the parent's perspective on PD in critically ill children. - It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage. - It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child.

Exploring NICU nurses' views of a novel genetic point‐of‐care test identifying neonates at risk of antibiotic‐induced ototoxicity: A qualitative study

Abstract

Aim

To explore the views of neonatal intensive care nursing staff on the deliverability of a novel genetic point-of-care test detecting a genetic variant associated with antibiotic-induced ototoxicity.

Design

An interpretive, descriptive, qualitative interview study.

Methods

Data were collected using semi-structured interviews undertaken between January and November 2020. Participants were neonatal intensive care nursing staff taking part in the Pharmacogenetics to Avoid Loss of Hearing trial.

Results

Thematic analysis resulted in four themes: perceived clinical utility; the golden hour; point-of-care device; training and support. Recommendations were made to streamline the protocol and ongoing training and support were considered key to incorporating the test into routine care.

Conclusion

Exploring the views of nurses involved in the delivery of the point-of-care test was essential in its implementation. By the study endpoint, all participants could see the value of routine clinical introduction of the point-of care test.

Implications for the Profession and/or Patient Care

Nurses are in a key position to support the delivery of point-of-care genetic testing into mainstream settings. This study has implications for the successful integration of other genetic point-of-care tests in acute healthcare settings.

Impact

The study will help to tailor the training and support required for routine deployment of the genetic point-of-care test. The study has relevance for nurses involved in the development and delivery of genetic point-of-care tests in other acute hospital settings.

Reporting Method

This qualitative study adheres to the Standards for Reporting Qualitative Research EQUATOR guidelines and utilizes COREQ and SRQR checklists.

Patient or Public Contribution

All staff working on the participating neonatal intensive care units were trained to use the genetic point-of-care test. All inpatients on the participating units were eligible to have testing via the point-of-care test. The Pharmacogenetics to Avoid Loss of Hearing Patient and Public Involvement and Engagement group provided valuable feedback.

Trial and Protocol Registration

Registered within the University of Manchester. Ethics approval reference numbers: IRAS: 253102 REC reference: 19/NW/0400. Also registered with the ISRCTN ref: ISRCTN13704894.

The role of healthcare leaders in implementing equitable clinical academic pathways for nurses: An integrative review

Abstract

Aim

To identify and synthesize empirical evidence on the role of healthcare leaders in the development of equitable clinical academic pathways for nurses.

Design

Integrative literature review.

Data Sources

Literature was searched using CINAHL, PubMed, ProQuest and Google Scholar databases.

Review Methods

A total of 114 eligible articles published between 2010 and2022 were screened, 16 papers were selected.

Results

Results highlighted the need for consistent national, regional, and organizational policy approaches to developing clinical academic careers for nurses. Government health departments and National Health boards must focus on increasing engagement in research and evidence-based nursing practice for high-quality patient care. Discriminatory practices and attitudes were identified as barriers. Discrimination due to gender was evident, while the impact of race, ethnicity, and other social categories of identity are under-researched. Educational leaders must unravel misconceptions about research, highlighting its relevance to patient care and bedside nurses' work. Academic leaders together with executive nurses, research funders and professional nursing bodies must create appropriately remunerated career structures. Transformative approaches are required to develop the clinical academic nurse role and understand its value in clinical practice.

Conclusion

Multiple elements exist within complex systems that healthcare leaders can navigate collaboratively to develop and implement clinical nurse academic roles. This requires vision, acknowledgement of the value of nursing research and the importance of evidence-based research infrastructures.

Impact

Findings highlight the collaborative role of healthcare leaders as critical to the success of critical academic careers for nurses. This review can inform those still to formalize this innovative role for nurses.

Reporting Method

The review complies with the PRISMA guidelines for reporting systematic reviews. This paper contributes evidence about the healthcare leader's role in developing clinical academic pathways for nurses to the wider global clinical community.

Patient or Public Contribution

No patient or public contribution was included in this review.

Development and implementation of sexual and gender minority curriculum for advanced practice nursing: A feasibility study

Abstract

Aim

To explore the feasibility of development and implementation of an educational intervention addressing sexual and gender minority healthcare issues; examine recruitment processes and instrument appropriateness.

Design

Non-randomized feasibility study.

Methods

The educational intervention was developed and implemented in family nurse practitioner courses with data collection from August through December 2022. Clinical preparedness, attitudinal awareness and basic knowledge were measured using the lesbian, gay, bisexual and transgender Development of Clinical Skills Scale.

Results

Development and implementation of the intervention was feasible but will require amendment before progressing to the pilot study. Clinical preparedness and basic knowledge increased post-intervention, but attitudinal awareness did not improve. Recruitment did not achieve the desired sample size. Instrument internal consistency reliability was confirmed.

Conclusion

Feasibility was established but will require amendment prior to the pilot study.

Implications for the Profession and/or Patient Care

To prepare nurses and nurse practitioners to care for sexual and gender minority patients.

Impact

This study addressed the feasibility of developing and implementing a sexual and gender minority healthcare education using an e-Learning platform. Findings confirm that the intervention was feasible but will require amendment. The intervention increased knowledge and clinical preparedness in caring for this population, but recruitment was challenging. This research will impact nurses, nurse practitioners and nurse educators.

Reporting Method

The authors adhered to the relevant EQUATOR guidelines. The Consolidated Standards of Reporting Trials guideline extension for reporting randomized and feasibility guidelines were used.

Public Contribution

Sexual and gender minority community members contributed to the intervention development.

What Does this Paper Contribute to the Wider Global Clinical Community?

The feasibility of using interactive e-learning educational resources to provide sexual and gender minority healthcare curriculum. Evidence to support the use of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale to measure learning outcomes.

Trial Registration

This study was not prospectively registered because it was an educational intervention involving graduate student nurses and did not assess clinical outcomes of patients.

Remote area nurses' experiences of workplace safety in very remote primary health clinics: A qualitative study

Abstract

Aim

To explore Remote Area Nurses' experiences of the implementation of workplace health and safety policies and risk mitigation strategies in Australian very remote primary health clinics.

Design

This qualitative study used online semi-structured interviews, with participants purposively sampled to maximize variation in work location and service type. Data were analysed using a reflexive thematic analysis approach. Coding was carried out inductively, with NVivo 12 aiding data management.

Setting

The interviews were conducted from 24 Februrary 2021 to 06 March 2021 with Remote Area Nurses from very remote primary health clinics in Australia.

Participants

Fifteen Remote Area Nurses participated in the study.

Results

Thematic analysis revealed varied approaches to workplace safety among the different health services and regions. While the spread of ‘never alone’ policies in many clinics addressed one of the significant risks faced by Remote Area Nurses, gaps remained even for hazards specifically highlighted in existing work health and safety legislation. Meaningful collaboration with staff and the community, local orientation, preparation for the role and providing quality care were protective factors for staff safety. Understaffing, unsafe infrastructure and inadequate equipment were common concerns among Remote Area Nurses.

Conclusion

Health services need to prioritize workplace safety and take a continuous quality improvement approach to its implementation. This will include ensuring safety strategies are appropriate for the local context, improving infrastructure maintenance, and establishing sustainable second responder systems such as a pool of drivers with local knowledge.

Implications for the Profession

Poor personal safety contributes to burnout and high turnover of staff. Nurses' insights into the barriers and enablers of current workplace safety strategies will aid policymakers and employers in future improvements.

Reporting Method

COREQ reporting guidelines were followed.

PIPE Statement

A panel of six Remote Area Nurses collaborated in the development of this project.

Self‐supporting wound care mobile applications for nurses: A scoping review

Abstract

Aim

This study provides an overview of the literature to identify and map the types of available evidence on self-supporting mobile applications used by nurses in wound care regarding their development, evaluation and outcomes for patients, nurses and the healthcare system.

Design

Scoping review.

Review Method

Joanna Briggs Institute scoping review methodology was used.

Data Sources

A search was performed using MEDLINE, Embase, CINAHL (via EBSCO), Web of Science, LiSSa (Littérature Scientifique en Santé), Cochrane Wounds, Érudit and grey literature, between April and October 2022, updated in April 2023, to identify literature published in English and French.

Results

Eleven studies from 14 publications met the inclusion criteria. Mostly descriptive, the included studies presented mobile applications that nurses used, among other things, to assess wounds and support clinical decision-making. The results described how nurses were iteratively involved in the process of developing and evaluating mobile applications using various methods such as pilot tests. The three outcomes most frequently reported by nurses were as follows: facilitating care, documentation on file and access to evidence-based data.

Conclusion

The potential of mobile applications in wound care is within reach. Nurses are an indispensable player in the successful development of these tools.

Implications for the Profession and Patient Care

If properly developed and evaluated, mobile applications for wound care could enhance nursing practices and improve patient care. The development of ethical digital competence must be ensured during initial training and continued throughout the professional journey.

Impact

We identified a dearth of studies investigating applications that work without Internet access. More research is needed on the development of mobile applications in wound care and their possible impact on nursing practice in rural areas and the next generation of nurses.

Reporting Method

The Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Review guidelines were used.

Patient or Public Contribution

No patient or public contribution.

Patient positioning on the operating table and patient safety: A systematic review and meta‐analysis

Abstract

Aim

To identify occurrence of harmful incidents related to patient positioning on operating table.

Design

Systematic review and meta-analysis.

Data Sources

Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram depicting the flow information.

Review Methods

The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta-analysis.

Results

Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross-sectional design, and 12 were register-based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta-analysis of the two RCTs showed higher risk of chemosis with head-down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]).

Conclusions

Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously.

Impact

This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high-quality, well-designed studies that focus on harmful incidents and prevention of harm related to patient positioning.

Patient or Public Contribution

No patient or public contribution, as this is a review of previous research.

Decisional needs in people with kidney failure, their relatives and health professionals about end‐of‐life care options: A qualitative interview study

Abstract

Aim

To investigate the decisional needs in Denmark of people with kidney failure, relatives, and health professionals when planning end-of-life care.

Design

A qualitative interview study.

Methods

Individual semi-structured interviews were carried out with people with kidney failure, relatives and health professionals from November 2021 to June 2022. Malterud's systematic text condensation was used to analyse transcripts.

Results

A total of 13 patients, 10 relatives, and 12 health professionals were interviewed. Overall, four concepts were agreed on: (1) Talking about end of life is difficult, (2) Patients and relatives need more knowledge and information, (3) Health professionals need more tools and training, and (4) Experiencing busyness as a barrier to conversations about end of life.

Conclusion

People with kidney failure, relatives, and health professionals shared certain decisional needs while also having some different decisional needs about end-of-life care. To meet these various needs, end-of-life conversations should be systematic and organized according to the patients' needs and wishes.

Impact

Non-systematic end-of-life care decision-making processes limit patients' involvement. Patients and relatives need more knowledge about end-of-life care, and health professionals need more competences and time to discuss decisional needs. A shared decision-making intervention for people with kidney failure when making end-of-life care decisions will be developed.

Reporting Method

This empirical qualitative research is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Patient or Public Contribution

Patients, relatives, and health professionals have been involved throughout the research process as part of the research team and advisory board. The patients are people with kidney failure and the relatives are relatives of a person with kidney failure. For this study, the advisory board has particularly contributed to the validation of the invitation letter for participation, the interview guides and the preparation of the manuscript.

Introduction of a Registered Undergraduate Student of Nursing workforce: A qualitative study of student and registered nurses

Abstract

Aim

To explore the benefits and challenges of a recently introduced Registered Undergraduate Student of Nursing workforce from the perspective of Nurses and Registered Undergraduate Students of Nursing, in a major metropolitan hospital in Australia in 2020.

Design

A qualitative descriptive study was undertaken using individual interviews and focus groups.

Methods

Purposively selected employed Registered Undergraduate Students of Nursing and nurses who worked with them were interviewed, using a semi-structured format. Recordings were transcribed and coded using NVivo software. Reflexive thematic analysis using an inductive approach was undertaken.

Results

Four major themes were revealed: (i) Navigating the programme, (ii) Belonging and integration; (iii) Patient care; and (iv) Continuing Development. Initial challenges were common, often related to clarifying the scope of practice for the new role. Ongoing issues were associated with gaps in understanding the role and lack of integration into the team. Mostly, nurses and Registered Undergraduate Students of Nursing built positive, professional relationships. Nurses valued the Registered Undergraduate Student of Nursing knowledge and skill level, reporting improved workload and work experiences when the Registered Undergraduate Student of Nursing was on shift. Nurses believed that the Registered Undergraduate Students of Nursing enhanced patient care. Registered Undergraduate Students of Nursing described positive, therapeutic relationships with patients. Registered Undergraduate Student of Nursing employment provided opportunities for new learning, leading to increased efficiency and confidence on clinical placement.

Conclusions

This employment model benefited the Registered Undergraduate Students of Nursing and nurses who worked with them. In the absence of adequate training and support, challenges remained unresolved and negatively impacted the experience for nurses. In addition to university-level education and clinical placement, the employment model can create a third space for student learning via on-the-job training. The study supports the ongoing employment of student nurses through the Registered Undergraduate Student of Nursing model.

Implications for the Profession and/or Patient Care

Impact

This study contributes to the very small body of literature investigating Registered Undergraduate Student of Nursing workforces in Australian hospitals. It is the first to explore the experiences of both nurses and students working together in a major metropolitan setting and also the first in the context of the COVID-19 pandemic. This study reflected a mostly positive experience for Registered Undergraduate Student of Nursing and the nurses who worked with them and highlighted the importance of adequate oversight and support in the implementation and maintenance of a Registered Undergraduate Student of Nursing workforce. Employed Registered Undergraduate Students of Nursing reported improved confidence, skills, and felt like they started clinical placement at an advantage, ready to step up and learn the Registered Nurse scope of practice. In addition to university-level education and clinical placement, this employment model creates a third space for learning via on-the-job training.

Reporting Method

COREQ guidelines were followed in the reporting of this study.

Patient or Public Contribution

No patient or public contribution.

Research on the relationship between nurses' compliance with standard precautions, servant leadership and emotional exhaustion: A cross‐sectional survey

Abstract

Aim

This study aimed to analyse the effects of servant leadership on nurses' emotional failure and compliance with standard precautions and to explore the moderating effect of individual resilience.

Design

A cross-sectional survey.

Methods

This descriptive cross-sectional study was conducted from October 9 to November 1, 2022. The convenience sampling method was used to collect questionnaire data from 924 clinical nurses in a third-class general hospital in Chongqing, China.

Results

The emotional exhaustion and compliance with standard precautions were at the general level. Servant leadership mediated by emotional exhaustion had a significant positive predictive effect on compliance with standard precautions. Personal resilience played a negative moderating role in the relationship between servant leadership and emotional exhaustion. For nurses with low resilience, servant leadership had a greater impact on emotional exhaustion.

Conclusion

The current compliance with standard precautions for clinical nurses is not high due to emotional exhaustion. The level of servant leadership can alleviate nurses' emotional exhaustion and improve compliance with standard precautions. Especially for nurses with low personal resilience, the care and support of department leaders are needed.

Impact

We found that the compliance with standard precautions is not high, and the link between emotional exhaustion, servant leadership and compliance with standard precautions provides a basis for further patient care.

No Patient or Public Contribution

There was no patient or public involvement.

Impact Statement

Nurses are the key population for hospital infection prevention and control, and their level of compliance with standard precautions is of great significance for hospital infection prevention and control. However, in practice, nurses' compliance with standard precautions is generally low. Most of the previous studies on nurses' compliance with standard precautions were conducted from the perspective of individual nurses, based on the staff's ‘knowledge, belief, and action’ to study the current status of compliance with standard precautions and the factors affecting adherence, with less attention paid to the influence of psychological, environmental, and organizational factors. Therefore, the study focuses on the impact of servant leadership and emotional exhaustion on standard precautionary adherence, which is of great significance for good care management at the organizational level. It also explored how the impact of servant leadership on emotional exhaustion varies across levels of resilience, which is important for accurately identifying different types of nursing staff and targeting assistance.

Satisfaction with maternity triage following implementation of the Birmingham Symptom‐Specific Obstetric Triage System (BSOTS): Perspectives of women and staff

Abstract

Aim

To explore the satisfaction and experiences of women and staff with the BSOTS in an Australian hospital.

Design

Cross-sectional descriptive survey.

Methods

Surveys were distributed to women and staff between February and May 2022. Survey questions reflected satisfaction with triage and provision of care under the BSOTS system (for women) and confidence in using the BSOTS system and its impact on triage-related care (for staff). Survey data were summarized using descriptive statistics, and qualitative responses were analysed using content analysis.

Results

There were 50 women and 40 staff (midwives and doctors) survey respondents. Most women were satisfied with triage wait times, the verbal information they received and the time it took for them to receive care. Nearly all midwife participants indicated they had high knowledge and confidence in using the BSOTS. Most staff indicated that the BSOTS supported the accurate assessment of women and had benefits for women, staff and the hospital.

Conclusion

The findings showed that women and staff were satisfied with receiving and providing care in a maternity triage setting under the BSOTS system.

Implications for the Profession and/or Patient Care

Implementing standardized maternity triage approaches such as the BSOTS in health settings delivering care to pregnant women is recommended for improving flow of care and perceptions of care quality by women.

Impact

Quality of maternity triage processes is likely to impact the satisfaction of women attending services and the staff providing care. The BSOTS was shown to improve maternity triage processes and was associated with satisfaction of women and staff. Maternity settings can benefit from implementing triage approaches such as the BSOTS as it standardizes and justifies the care provided to women. This is likely to result in satisfaction of women and staff engaged in maternity triage and improve the birth outcomes of women and babies.

Reporting Method

The reporting of this paper has followed SQUIRE guidelines.

Patient or Public Contribution

Women engaged with maternity services were participants in the study but did not contribute to the design, conduct or publication of the study.

Long‐term care planning and the influencing factors among sexual minority older women: A qualitative study

Abstract

Aims

The aim of the study was to explore plans, considerations and factors influencing long-term care among older sexual minority (SM) women.

Design

Qualitative interview study.

Methods

Semi-structured in-depth interviews were conducted with 37 older Taiwanese SM women between May and September 2019. This study analysed interview data using a socio-ecological model and constant comparative analysis.

Results

The most frequently reported long-term care plans were housing and institutions, private medical or long-term care insurance, financial planning and medical decisions. Factors associated with women's long-term care plans were categorized using the socio-ecological model level: (1) intrapersonal factors: current physical and mental health status, ageing signs and women's attitudes towards ageing; (2) interpersonal-level factors: receiving support from partners, child(ren), siblings or significant others, concerns about being a caregiver for parents and worries regarding social isolation; (3) community-level factors: receiving support from lesbian, gay, bisexual and transgender (LGBT) organizations; private lesbian online groups; or religious groups; (4) societal-level factors: concerns about negative social environments, concerns about the healthcare system and healthcare providers, inappropriate policies and insufficient resources.

Conclusion

This study identified multi-level factors related to long-term care plans and concerns among older Taiwanese SM women. Recommendations for nurses, managers of long-term care and healthcare settings, policymakers, and governments have been provided to diminish health disparities and reduce anxiety among older SM women.

Impact

This study assists nurses in understanding older SM women's long-term care concerns and worries when accessing long-term care and healthcare services and helps nurses provide SM-sensitive services and care for women.

Patient or Public Contribution

SM older women were recruited from LGBT organizations, LGBT-friendly bookstores, restaurants, coffee shops and LGBT online chatrooms using purposive and snowball sampling.

Issue Information

Journal of Advanced Nursing, Volume 80, Issue 2, February 2024.

Factors associated with dietary behaviour change support in patients: A qualitative study among community nurses

Abstract

Aim

To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes.

Background

Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long-term complications from chronic lifestyle-related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential.

Design

A qualitative descriptive study.

Methods

Data were collected in the Netherlands in 2018–2019 via semi-structured face-to-face interviews with 18 nurses. Interview guide themes were informed by the COM-B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis.

Results

Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse–patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context.

Conclusion

It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet.

Impact

The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self-management. Well-fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients.

Patient or Public Contribution

A nurse provided feedback on the interview guide.

Work‐related stress, stress reactions and coping strategies in ambulance nurses: A qualitative interview study

Abstract

Aim

To describe experiences of work-related stress, stress reactions and coping strategies among registered nurses (RNs) in the ambulance service (AS).

Design

A descriptive and qualitative design.

Methods

Participants were recruited from eight different ambulance stations from different geographical locations in central Sweden. Data were collected from 14 RNs during the period from January 2022 to May 2022 using a semi-structured interview guide. Qualitative content analysis was used to analyse data using an abductive approach.

Results

Three categories describe the RNs' experiences; (1) Situations that cause work-related stress, (2) Reactions and feelings that occur and (3) Management of work-related stress. These three main categories included a total of 12 subcategories. Work-related stress was experienced when participants were a part of traumatic events or experienced insufficient cooperation or a disturbing event in the work environment. The different causes lead to different kinds of reactions with feelings of frustration, fear and loneliness being prominent. To manage the work-related stress, RNs used different kinds of strategies and support from colleagues or lack thereof seemed to have a major impact.

Conclusions

Findings revealed the importance of having competent colleagues in the AS. Working with a competent colleague can reduce experiences of stress and prevent feelings of loneliness. It is important for the AS to provide stress-reduction support, to promote cooperation and to maintain and develop RNs' professional competence to ensure quality care and patient safety in the AS.

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