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To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic.
A descriptive, qualitative study.
Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis.
First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines.
A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice.
Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation.
During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future.
This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR).
No Patient or Public Contribution.
To examine the positive motivational paths from perceived autonomy-supportive leadership, and the negative motivational paths from perceived controlling leadership to satisfaction and frustration of basic psychological needs, work motivation, work performance, work engagement and somatic symptom burden among nurses using Self-Determination Theory.
The study used a cross-sectional design mapping nurses' perceptions of the various study variables through a survey.
Nurses working in the municipal healthcare in Norway were recruited through an electronic questionnaire sent out via a link to their emails between 29th of August and 29th of September 2020. Of them, 219 nurses completed the questionnaire. Study hypotheses were tested using structural equation modelling.
Higher levels of perceived autonomy-supportive leadership were associated with reduced levels of somatic symptom burden and increased levels of work performance and work engagement through the satisfaction of basic psychological needs and autonomous motivation, specifically identified regulation and intrinsic motivation. Perceptions of controlling leadership were associated with heightened levels of somatic symptom burden through basic psychological need frustration, amotivation and introjected motivation, along with lower levels of work engagement through need frustration and amotivation.
This study underscores the positive motivational paths of perceived autonomy-supportive leadership on nurses' work performance and wellbeing through the facilitation of basic psychological need satisfaction and autonomous motivation. Conversely, the study highlights negative motivational paths of perceived controlling leadership on reduced work engagement and heightened ill-being through the basic psychological need frustration, controlled motivation and amotivation.
This study provides insights and actionable recommendations for nurses and their leaders, emphasizing the significance of understanding the adverse impact associated with perceived controlling leadership. The findings underscore the importance of addressing these issues to mitigate detrimental effects on motivation and overall work functioning.
No patient or public contribution.
To analyze toxic positivity and its relevance to nursing.
Concept analysis using Schatzman's dimensional analysis approach.
Two searches were conducted using Google Scholar, JSTOR, ProQuest and CINAHL (1990–2023). Keywords included “toxic positivity” (Phase 1) and “emotional suppression,” “unrealistic optimism”; “disingenuous happiness,” “forced gratitude” and “logical fallacy” (Phase 2). Retained sources (1) were in English (Phases 1 and 2); (2) used ‘toxic positivity’ as a construct reflecting the purpose of analysis (Phase 1); and (3) demonstrated relevance towards analytical findings (Phase 2). Total analytic sources were 35.
The analytic phase, identification, elucidated conceptual dimensions and contexts. The analytic phase, logistics, examined relationships among dimensions and contexts through an iterative process resulting in a dimensional matrix/conceptual model.
Salient dimension is Emotional Suppression with two sub-dimensions, Logical Fallacy and Forced Gratitude. Other dimensions include Unrealistic Optimism and Disingenuous Happiness. Contexts include intra- and post-paradigmatic societal shifts and intra- and post-traumatic experiences. Analysis reveals toxic positivity as an exchange between a giver and receiver with the receiver experiencing negative outcomes.
The concept appears consistent in its application and use across contexts and is emerging in nursing literature.
Acknowledging toxic positivity in nursing may inform theoretical and future research related to improving nursing burnout, bolstering retention, and enhancing well-being. Nurses across work environments may encounter toxic positivity. Leaders should consider policy adoption and inclusion of trauma-informed practices.
Nursing workforce issues require deeper examination of potential contributing factors. Findings suggest toxic positivity may be encountered in work environments impacting nursing at individual and system levels.
No patient or public contribution.
The increase in the number of people with chronic obstructive pulmonary disease (COPD) and the disease burden, has prompted concerted efforts to improve healthcare, particularly outpatient services. In line with these attempts the Partnership-Based Nursing Practice Theoretical Framework for People with COPD was developed to guide outpatient nursing care. The principal approach of the framework is a ‘Dialogue’ with the patients, which has four components: ‘Establishing family involvement’, ‘Assisting living with symptoms’ and ‘Facilitating access to healthcare’, with the primary goal being ‘Enhancement of the health experience’. With new knowledge, research on the framework, and extensive experience in using it, a need arose to modify the framework to maximize its clinical utility.
Discursive paper.
A narrative review and critical reflection was conducted to revise the nursing practice framework via selected literature search from 2012 to 2022, research on the framework, and the authors' reflections on the clinical experience of using the framework.
The nursing practice framework highlights capacities and possibilities that lie in the nurse–patient relationship. The overarching dialogue in the revised framework includes both patients and families. The action-related component ‘Assisting living with the disease’ was added to the framework to underscore the significance of attempting to understand what may lie ahead for patients and families. The other action-related components are as follows: ‘Assisting living with symptoms’ and ‘Facilitating access to healthcare’. The primary goal remains unchanged: enhancing the ‘Health experience’.
Using the revised nursing practice framework in outpatient care may help to enhance the lives of people with COPD and their families, particularly at advanced stages of the disease. It may have transferability to other groups of people living with progressive diseases dealing with complicated health problems, and to reduce the usage of costly healthcare resources such as hospital care.
The partnership-based nursing practice framework assumes an extension of conventional specialized respiratory service and embraces a comprehensive account for that which may influence the patient's health problems. This guidance, which holistically attends to patient-family needs of living with complicated and progressive health predicaments, is fundamental. It contributes to strengthening the disciplinary focus of nursing, interdisciplinary collaboration, person-family-centred quality nursing care and inspires research initiatives. Critical reflections and updates on nursing practice frameworks, such as this revision, are essential to advance nursing and healthcare.
There is no direct patient- or public contribution.
To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury.
Exploratory.
Scoping review.
Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021).
Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3).
Quality of evidence was low for the interventional studies and best practice recommendations.
Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations.
This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment.
We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews.
No patient or public contribution.
Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people.
Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).
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