FreshRSS

🔒
☐ ☆ ✇ Journal of Clinical Nursing

Leading care close to the patient in community home care for older persons: A lifeworld hermeneutic study from nurses' perspectives

Por: Maria Claesson · Cecilia Ljungblad · Elisabeth Lindberg — Junio 18th 2024 at 07:03

Abstract

Aim

To explain and understand leading care close to older persons in community home care from the perspective of registered nurses (RNs).

Background

Leading care close to older persons in home care is an overlooked and not well-described phenomenon. In home care, specific demands are placed on the registered nurse, as responsible for leading care guided by the older person's expectations and desires.

Design

A reflective lifeworld hermeneutic approach grounded in the philosophy of phenomenology and hermeneutics. The study followed the COREQ checklist.

Methods

Individual interviews were conducted with nine RNs working in community home care in a community in western Sweden. The data were analysed with a lifeworld hermeneutic approach.

Results

The findings present four partially interpreted themes: leading with respect in a shared space, leadership that involves existential questions of life, balancing responsibility enables preservation of autonomy and challenges in maintaining a patient perspective. The partially interpreted themes conclude in a main interpretation: The patient perspective as an anchor when balancing responsibility for another person in an existential vulnerability of life.

Conclusion

Leading care means being both close to the patient and at a distance when caring is performed through the hands of others. Ethical demands are placed on RNs as they encounter the vulnerability of the older person.

Relevance to Clinical Practice

The findings can contribute to a greater understanding of the meaning of RNs as leaders and may have an impact for decision makers and policies to create conditions for leadership that contributes to dignified care for older persons in community home care.

Patient of Public Contribution

Registered nurses working in community home care participated in data collection.

☐ ☆ ✇ Journal of Clinical Nursing

Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study

Por: Carol Crevacore · Linda Coventry · Christine Duffield · Elisabeth Jacob — Abril 1st 2024 at 07:22

Abstract

Aims

To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses.

Design

Mixed method explanatory sequential design.

Methods

A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena.

Results

Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not.

Conclusions

Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety.

Implications for the profession and/or patient care

Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety.

Impact

Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff.

Reporting method

Complied with the APA Style JARS-MIXED reporting criteria for mixed method research.

Patient or public contribution

No patient or public contribution.

☐ ☆ ✇ Journal of Clinical Nursing

Children's and parents' experiences of home care provided by hospital staff: A scoping review

Abstract

Aims

To describe what is known from existing scientific literature on children's and parents’ experiences of hospital-based home care and to identify future research areas.

Design

The scoping review design used adheres to the methodological framework of Arksey and O'Malley, and to the PRISMA-ScR checklist.

Review Methods

A systematic search was conducted, and peer-reviewed scientific papers were screened through the application of Rayyan software. Data were extracted and presented in table and synthesised thematically as narrative text.

Data Sources

Searches were carried out November 2021 and updated November 2022 in the CINAHL, MEDLINE, Embase, Cochrane, Scopus, Web of Science, Academic Search Elite, and Amed databases and Google Scholar.

Results

A total of 1950 studies were screened and assessed for eligibility. Eight studies met the inclusion criteria by reporting on parents' experiences, whereas five out of these eight studies also reported on the experiences of children. Parents of children with cancer and preterm children reported feeling more in control, being empowered, and being more connected to their children's care team when their children were receiving hospital-based home care. The family's own resources were activated, and they felt more involved in their children's care compared to being in an inpatient setting.

Children with cancer, acute infection, chronic disease, and/or a syndrome reported feeling safer and more comfortable in their home environment and experienced better interaction with their care providers. Some aspects of the children's health-related quality of life (HRQOL) were improved.

Conclusion

The identified studies indicate that hospital-based home care is a valued alternative to traditional inpatient care by both parents and children. The mode of care has no crucial negative effects. Future studies should encompass the experiences of children with different diagnoses and syndromes and compare patients treated in a traditional hospital setting with those in a hospital-based home-care programme.

Relevance to Clinical Practice

Children's and parents’ experiences of HBHC indicate that it offers a good solution if parents are well prepared and feel in control. In addition, certain structural conditions must be in place before this type of care can be established: there must be a certain number of patients and the hospital must not be too far away. In the field of neonatal home care, professionals should be more responsive to fathers’ needs and tailor support by focusing on their individual experiences and needs. Our findings may guide and inform best practice for present and future providers of HBHC.

Implications for the Profession and/or Patient Care

Hospital-based home care can offer families a greater degree of autonomy, more flexible care options, improved family functioning, improved communication with care providers, and more control over the child's care. When certain structural conditions are met, such as a certain number of patients, the hospital not being too far away, and parents being well prepared and feeling in control, then hospital-based home care is valued as an alternative to traditional inpatient care. Specific aspects of children's HRQOL may improve, and the psychosocial burden on the family does not increase.

Impact

HBHC provides a valued alternative to traditional inpatient care and allows families to receive care in the comfort of their own home. Our findings may guide and inform best practice for present and future providers of hospital-based home care.

Reporting Method

In this scoping review, we have adhered to the Preferred Reporting Items for Systematic reviews and Meta Analyses Extension for Scoping Reviews checklist.

Patient or Public Contribution

There has been no direct patient or public contribution to the review.

Trial and Protocol Registration

Not required.

☐ ☆ ✇ Journal of Clinical Nursing

Patients' and Nurses' experiences of caring in nursing: An integrative literature review across clinical practices

Abstract

Aim

To summarise, interpret and synthesize research findings on patients' and nurses' experiences of caring in nursing across clinical practices.

Background

Caring is a universal element of nursing; however, economic restrictions often negatively impact health services, and time shortages and limited numbers of staff may characterize care encounters. It is unclear how these contextual conditions affect patients' and nurses' experiences of caring.

Design and Methods

This integrative literature review covers papers published between 2000 and 2022. Four databases—PubMed, PsycINFO (via Ovid), MEDLINE (via Ovid) and CINAHL (via EBSCO)—were systematically searched for eligible papers in May 2022. The included studies were critically appraised. Content analysis was performed to interpret and synthesize the findings. In accordance with the EQUATOR guidelines, the PRISMA 2020 and PRISMA-S checklists were used. An Integrative review methodology guided the process.

Findings

In total, 33 studies were included in the review. Three themes captured the experiences of caring in nursing: (1) the complexity of the nursing care context, (2) the professionalism of the nurse, and (3) the trusting patient–nurse relationship.

Conclusion

The experience of caring in nursing depended on nurses' competence and discretion in the personal encounter framed by the nursing context. The caring relationship was based on reciprocity, but it remains asymmetrical, as the nurse had the power and responsibility to empower the patient. Barriers, such as increased demands for efficiency and resource scarcity, may hinder the experience of caring in nursing.

Implications for the profession and patient care

By promoting an ongoing discussion of caring in nursing, nurse management can systematically support nurses in reflecting on their practice in diverse and complex clinical contexts.

Patient or public contribution

No patient or public contribution was made due to the study design.

☐ ☆ ✇ Journal of Clinical Nursing

Exploring the terminological validity of ‘chronic pain’ nursing diagnosis: A retrospective descriptive study using nursing diaries

Por: Nicola Ramacciati · Elisabetta Metlichin · Gian Domenico Giusti — Septiembre 5th 2023 at 13:51

Abstract

Aim

The aim of this study is to generate empirical evidence, drawing from clinical records, with the goal of elevating the level of evidence supporting the nursing diagnosis (ND) of ‘chronic pain’.

Background

Chronic pain is a prevalent condition that affects all age groups. Patients often feel disbelieved about their pain perception, leading to adverse psychological effects, difficulty accessing healthcare and poor rehabilitation outcomes.

Design

Retrospective descriptive study. Standards for Reporting Diagnostic Accuracy Studies guidelines were followed in this study.

Methods

Data were extracted from Electronic Health Records (EHR) of patients admitted to the University Hospital of Perugia, Italy, between March 2016 and December 2022. The study sample comprised individuals without a specific medical diagnosis or high-risk population. Out of 1,048,565 EHR, 43,341 clinical-nursing diaries with the keyword ‘pain’ were identified, from which 283 clinical-nursing notes were selected based on a keyword-based retrieval technique and diagnostic definition for further analysis.

Results

Our study findings support the diagnostic descriptors of the ‘chronic pain’ ND in clinical-nursing diaries. We observed the presence of 9 out of 11 defining characteristics, 7 out of 10 related factors, 4 out of 8 at-risk populations and 11 out of 17 associated conditions.

Conclusions

The study validated diagnostic criteria for chronic pain and proposed ‘haematological pathology’ as a new associated condition. The findings were presented to the Diagnosis Development Committee of NANDA-International for further review. However, limitations of the study prompted the need for further analysis using natural language processing and artificial neural network techniques. As a result, a new research direction using artificial intelligence (AI) tools was initiated.

Relevance to Clinical Practice

The study validates diagnostic descriptors for chronic pain and proposes future directions in semantic analysis and AI tools, aiming to enhance clinical practice and decision-making in nursing care.

Patient or Public Contribution

No patient or public contribution.

❌