To assess the level of nurse‐to‐nurse collaboration during the transfer of older people between hospital and primary health care and to evaluate the psychometric properties of the newly developed Nurse‐to‐Nurse Collaboration Between Sectors Instrument.
Nurse‐to‐nurse collaboration is required when older people transfer between hospital and primary health care to enhance the safety and continuity of care to patients. There is a lack of evidence about the nature and level of this collaboration.
A cross‐sectional survey design was used. This study adhered to the STROBE checklist.
A sample of 443 nurses (university hospital n = 240, primary health care n = 203) participated in the study from October 2017 to June 2018. Nurses completed the Nurse‐to‐Nurse Collaboration Between Sectors Instrument (86 items, 7–point Likert‐type scale), the Nurse‐Nurse Collaboration Scale and the Patient‐Centred Competency Scale.
Nurses rated the overall level of nurse‐to‐nurse collaboration moderately high (mean=4.49, standard deviation=0.83, maximum 7.00). Nurses considered collaboration an important and confidential process, gaining older people's trust in their care. Lower scores were given to the agreement of mutual objectives, policies and guidelines in collaboration, opportunities for job rotation and interacting and networking during the collaboration process. The internal consistency reliability of the newly developed instrument was acceptable.
Nurses collaborate with competence and confidentiality during the transfer of older people between care settings. However, there is a need for more opportunities to collaborate, to obtain mutual agreement about objectives, policies and practices, and better understand other nurse's roles and responsibilities in collaboration. The reliability and validity of the Nurse‐to‐Nurse Collaboration Between Sectors Instrument were acceptable though the number and wording of items will be reviewed and further tested.
Nurses need opportunities to collaborate, and there is a need to develop agreed objectives, practices, roles and responsibilities in this collaboration.
To explore the use and student outcomes of Team‐Based Learning in nursing education.
Team‐Based Learning is a highly structured, evidence‐based, student‐centred learning strategy that enhances student engagement and facilitates deep learning in a variety of disciplines including nursing. However, the breadth of Team‐Based Learning application in nursing education and relevant outcomes are not currently well understood.
A scoping review of international, peer‐reviewed research studies was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews.
The following databases were searched on 7 May 2020: Cumulative Index of Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO and Education Resources Information Center. Search terms related to nursing, education and Team‐Based Learning. Original research studies, published in English, and reporting on student outcomes from Team‐Based Learning in nursing education programmes were included.
Of the 1081 potentially relevant citations, 41 studies from undergraduate (n = 29), postgraduate (n = 4) and hospital (n = 8) settings were included. The most commonly reported student outcomes were knowledge or academic performance (n = 21); student experience, satisfaction or perceptions of Team‐Based Learning (n = 20); student engagement with behaviours or attitudes towards Team‐Based Learning (n = 12); and effect of Team‐Based Learning on teamwork, team performance or collective efficacy (n = 6). Only three studies reported clinical outcomes.
Over the last decade, there has been a growing body of knowledge related to the use of Team‐Based Learning in nursing education. The major gaps identified in this scoping review were the lack of randomised controlled trials and the dearth of studies of Team‐Based Learning in postgraduate and hospital contexts.
This scoping review provides a comprehensive understanding of the use and student outcomes of Team‐Based Learning in nursing education and highlights the breadth of application of Team‐Based Learning and variability in the outcomes reported.
To investigate the effect of reverse Trendelenburg position versus semi‐recumbent position on respiratory parameters of obese critically ill patients.
Reverse Trendelenburg position is recommended for obese patients; however, the effect among critically ill patients, especially those on mechanical ventilation, has limited study.
Randomised, controlled pretest, repeated post‐test trial with two parallel groups.
The study started from 13 January 2020–12 March 2020. Adult critically ill patients with a body mass index ≥30 were randomly assigned by computer‐generated randomisation to either reverse Trendelenburg position group (intervention) or semi‐recumbent position group (active comparator control). Outcome measures were ventilation parameters (dynamic compliance, partial pressure of arterial carbon dioxide and minute volume) and oxygenation parameters (hypoxaemic index and partial pressure of arterial oxygen). Measures were assessed immediately before positioning and after positioning in 10 minutes, 20 minutes and 30 minutes. CONSORT checklist was used to report the current study.
Four general intensive care units.
One hundred and ten patients (55 patients in each group) completed the study. The reverse Trendelenburg position group had a higher improvement than the semi‐recumbent position group as estimated by mean differences in their dynamic compliance, minute volume, partial pressure of carbon dioxide, partial pressure of oxygen and hypoxaemic index.
Reverse Trendelenburg position improves obese patients’ respiratory parameters more than semi‐recumbent position.
This study directs nurses to use the reverse Trendelenburg position, which is an important position for enhancing the parameters of ventilation and oxygenation of obese mechanically ventilated patients.
This study aimed to profile stress, exploring whether demographics and/or other factors uniquely contribute to stress for emergency departments nurses.
Nursing has been identified as a stressful profession with the potential to have negative impacts on nurses’ physical and mental health. Nurses working in emergency departments face unique daily stressors.
Cross‐sectional survey using a correlational design.
The survey was distributed in May 2019 to ED nurses working in New South Wales (NSW), Australia. A total of 242 nurses completed the survey, of which 190 cases were analysed. A standardised scale was used in the survey, the Expanded Nursing Stress Scale (ENSS). The sampling method for this research was non‐probability purposive sampling. STROBE checklist was used for this manuscript.
The results of this study indicated that emergency department nurses experience stress in their work settings. Stress is experienced predominantly because of problems in dealing with patients and their families, high workloads, and uncertainty concerning treatment.
The results of this study provide valuable insights into the work‐related stress experienced by emergency department nurses. This information can be used to inform the development of strategies to minimise stress for emergency nurses.
This study builds on existing, and contributes to new, knowledge about the current stressors for emergency department nurses. The results provide insights into how policies and procedures may need to be adjusted and interventions developed, that can help in reducing stress.
The objective of this study was to examine differences in personal characteristics, core practice competency and role stress according to levels of teaching efficacy among clinical nurse educators working in general hospitals.
In the clinical setting, successful adaptation to instruction among practicing clinical nurse educators is challenging.
Secondary analysis of data through a cross‐sectional study design was adopted.
Originally, 565 nurses were recruited from general hospitals; 364 were included in this study. Participants were nurses with more than 1 year of experience in various settings from 16 general hospitals wherein nursing students trained for clinical practicum in five cities in South Korea. Self‐reported data were collected via the Teaching Efficacy, Core Practice Competency and Perceived Stress Scales assessing clinical education‐related teaching efficacy, core practice competency and role stress. In the analyses, comparison between nurses with high and low teaching efficacy was conducted. We have followed through the EQUATOR (e.g. STROBE) research checklist for the preparation of this manuscript.
According to univariate analysis, levels of teaching efficacy were shown to be higher with age, longer clinical careers, in those undergoing a doctoral course or with a doctorate, previous experience in providing clinical education and enrolment in continuing education for clinical education. In the multivariate analysis, enrolment in continuing education for clinical education, assessment and intervention skills, critical thinking skills, teaching skills and role ambiguity were associated with level of teaching efficacy among nurse educators.
Based on the results of this study, we recommend that nursing administrators should foster the recognition of personal characteristics in potential clinical nurse educators or preceptors with high teaching efficacy.
Nurses should be supported by providing them with opportunities for professional development to enhance teaching efficacy.
To understand hospice palliative care nurses’ (HPCNs) perceptions towards spiritual care and their competence to provide spiritual care.
Previous research has shown that many nurses lack a clear understanding of the concept of spirituality and feel inadequately prepared to assess patients’ spiritual needs. Studies on competence in spiritual care are mostly descriptive, and the evidence for improving it is limited.
A mixed‐methods research design was used.
Quantitative data were collected from 282 nurses in forty hospice palliative care (HPC) institutions in South Korea and analysed using descriptive statistics, independent t‐test, one‐way ANOVA with Bonferroni test and multiple regression. Qualitative data collection involved two stages: first, an open‐ended question posed to 282 nurses, and second, focus group interviews conducted with six HPC experts. Both qualitative data sets were analysed separately using content analysis. This study followed the GRAMMS guidelines.
Of the six dimensions of spiritual care competence (SCC), the mean scores were highest in ‘attitude towards the patient's spirituality’ and ‘communication’, whereas the ‘assessment and implementation of spiritual care’ and ‘professionalisation and improving the quality of spiritual care’ had the lowest mean scores. Through content analysis, 4 themes regarding the meaning of spiritual care, 3 themes regarding requirements for spiritual care and 2 themes regarding preparedness for spiritual care were revealed. They perceived the needs of the understanding of spiritual care based on the attributes of spirituality, the education in systematic assessments and implementation for spiritual care with standardised terminology, and the opportunity to reflect on nurses’ own spirituality.
Practical SCC training for HPCNs and the subsequent development of clinical practice guidelines are of vital importance.
The results of this study provide a useful resource to develop educational programmes for strengthening the SCC of nurses and the entire HPC team.
Given the importance of doctoral training to the future of the discipline, we sought to gain insight into nurse doctoral supervisor's experiences of supervision training and preparation and their views on what quality training for doctoral supervisors in nursing would look like.
Doctorally prepared nurses have been found to contribute significantly to improvements in knowledge to inform patient care; yet there is little focus on the development of this aspect of the nursing workforce, and little evaluation of supervisor training, confidence and competence.
Qualitative storytelling, semi‐structured interviews were conducted via a videoconferencing programme, audio‐recorded and thematically analysed with twenty‐one experienced nurse doctoral supervisors. Findings are reported in line with the COREQ guidelines.
Thematic analysis revealed four themes: ‘I had a great mentor’: the importance of mentorship and role modelling; ‘Sometimes it's just trial and error’: learning through experience; ‘It's like tick a box’: strengths and limitations of formal supervisor training; and ‘The training should be more holistic’: what should be in supervisor training.
We recommend doctoral supervisors be encouraged to seek mentoring for supervision, formal mentoring and clinical supervision for the first five completions and the formation of discipline‐based supervisor learning groups in nursing as an adjunct to generic mandatory supervisor training.
Further development of clinical nursing is inextricably linked to quality nurse‐led research, and doctorally prepared nurses are essential to the continued development of nursing as an evidence‐informed practice discipline. Quality doctoral supervision for and by nurses is crucial and we argue that focus must be given to ensuring the development of a skilled doctoral supervision workforce in nursing.
To explore the association between perceived stress and quality of life (QoL) and the mediating role of general self‐efficacy and social support in this association.
Gestational diabetes mellitus (GDM) is one of the most common metabolic diseases suffered by pregnant women. Women with previous GDM may experience more medical‐related stress and have a lower QoL than those without it.
A multisite correlational study.
Four hundred sixty‐five women with previous GDM living in rural areas in China participated in this study from November 2017 to June 2019. The participants completed a set of self‐reported socio‐demographic questionnaires, the Perceived Stress Scale, the General Self‐Efficacy Scale, the Social Support Rating Scale and the World Health Organization QoL assessment (Brief version). STROBE checklist was used as the guideline for this study.
The mean QoL score was 13.97 (SD 2.07) for physical health, 13.75 (SD 1.98) for psychological health, 14.96 (SD 1.99) for social relations and 12.49 (SD 1.74) for environmental conditions. About 43.9% of women with previous GDM reported increased stress, which was negatively correlated with each of these QoL domains. Yet, the negative effect of perceived stress on QoL could be completely or partly mediated by better social support or general self‐efficacy among this population.
Nearly half of the women in the study living in rural China reported increased stress after delivery, and there is room to improve QoL in the environmental domain among women with previous GDM. Increasing general self‐efficacy or social support can help these women avoid the negative effects of perceived stress on their QoL.
These findings suggest that healthcare providers need to be cognizant of the importance of self‐efficacy and social support for women with previous GDM in both enhancing QoL and reducing the negative impact of perceived stress on QoL.
To examine transition shock in newly licensed nurses and the association of work environment and resilience with nurses' transition shock.
Although work environment is related to transition shock in newly licensed nurses, little is known about the factors of nursing work environment associated with transition shock. Furthermore, resilience is known to help nurses positively face workplace challenges; however, there is little evidence on the associations between resilience and transition shock in new nurses.
A cross‐sectional, descriptive study.
Data from 163 new nurses with <12 months of work experience in the current hospital since graduation were analysed. Participants' characteristics, work environment, nurse resilience and transition shock were self‐reported. Multivariable linear regressions were performed in three steps (following the STROBE checklist).
The highest mean score of transition shock was obtained for the item ‘I perceive the limitations of my professional knowledge in nursing care'. In the regression analysis adjusted for all variables, two factors of work environment—‘nurse staffing and resource adequacy’ and ‘collegial nurse‐physician relationships’—were associated with transition shock. Meanwhile, resilience was not related to transition shock.
The gap between newly licensed nurses' theoretical and practical knowledge continues to exist. Adequate nurse staffing and a positive relationship with physicians, rather than nurse resilience, were more likely to associate with new nurses' transition shock.
Hospitals need to provide ward‐based simulations and case‐based learning methods to enhance nurses' transition to professional practice. For nurses' transition, hospitals should make efforts to provide adequate nurse staffing and resources. Furthermore, hospitals should provide communication opportunities to build a positive collaborative culture between nurses and physicians. Unit nurse managers need to assess newly licensed nurses' perception of nurse–physician professional relationship and create an atmosphere of respect and understanding for each other.
To analyse nursing students’ perceptions of the clinical learning environment and supervision and the connection between their satisfaction and intention of staying in their placement hospitals.
Global nursing shortage necessitates strategies for the recruitment and retention of nurses. It is believed that nursing students’ clinical placement experiences can affect their learning outcomes, as well as influence their choice of future workplace.
Cross‐sectional, correlational study.
One hundred and eighty nursing students participated in the study. The data were collected in person using The Clinical Learning Environment, Supervision and Nurse Teacher scale tool. Students’ satisfaction with the clinical learning environment and learning process was measured using a 4‐point Likert scale developed by the researchers. The STROBE checklist was used in this paper.
Nursing students perceived a favourable clinical learning environment and supervision in the hospitals where they undertook clinical placements, recording high levels of satisfaction and high levels of intention to stay and work there. The clinical learning environment and supervision established positive correlations with student satisfaction.
This study promotes the development of knowledge and understanding of how student satisfaction and intention to stay and work in their placement hospitals relates to the quality of the clinical learning environment and supervision, which could be helpful to the management of healthcare facilities and faculties in improving nursing education and retention/recruitment strategies.
Nursing students represent the future of the nursing workforce, so managers of healthcare facilities and faculties should move towards promoting a clinical learning and supervisory environment where supervisors, tutors and staff are aware of their commitment to student education and promote optimal learning and positive experiences in order for students to feel satisfied and motivated to work in their placement hospitals.
This study aimed to examine the association between workload and patient safety culture (PSC) among intensive care unit (ICU) nurses.
ICU nurses play a vital role in promoting patient safety and are essential indicators in any healthcare system including ICUs. Research studies focusing on the relationship between nursing workload and PSC among ICU nurses are limited.
Descriptive correlational design.
The study participants involved 380 ICU nurses at two hospitals in Riyadh, Saudi Arabia. Data were collected between February 2019–April 2019 and were analysed using SPSS v.22 statistical software. This study was guided by the STROBE checklist.
The results showed that ICU nurses have high positive perceptions in the following PSC subscales: teamwork within units, organisational learning–continuous improvement, frequency of events reported, feedback and communication about error, management support for patient safety, teamwork across units, supervisor/manager expectations and actions promoting patient safety, handoffs and transitions, nonpunitive response to errors, staffing and overall perceptions of patient safety. However, the participants collectively considered the overall grade on patient safety as poor. The participants had high mean scores in physical demand, effort, mental demand and overall workload. A statistically significant variability existed in the mean scores of the PSC subscales and workload of ICU nurses. The overall workload was significantly and negatively associated with the PSC perceptions of ICU nurses.
The ICU nurses experienced high overall workload, physical demand, effort and mental demand which influenced the poor grade of their overall perceived PSC.
Identifying differences and associations with the perceptions of ICU nurses regarding workload and PSC is important because such perceptions may affect their delivery of nursing care. Hospital and nursing administrators must use the study results to find strategies that address workload issues and enhance patient safety.
To determine whether nurses respect or violate patient privacy by comparing nurses’ and patients’ opinions.
Although nurses want to respect patient privacy, they can sometimes violate patient privacy or not pay enough attention.
This comparative and cross‐sectional study was conducted with 357 patients and 305 nurses in 12 public hospitals in Trabzon, Turkey. Data were collected with an information form and the Patient Privacy Scale. Reporting is consistent with the STROBE checklist for cross‐sectional studies.
The total mean score of the patient privacy scale was 4.6 ± 0.39 for nurses and 4.5 ± 0.41 for patients, and no significant difference was found between their scores (U = 52999.0; p = .554). Further, the nurses (U = 14358.0; p = .000) and the patients (U = 13272.5; p = .006) in the public hospitals had statistically significantly higher overall privacy scores than those in the training and research hospitals. The overall privacy scale scores were higher and more statistically significant in the patients hospitalised in surgical clinics than those hospitalised in clinics for internal diseases (U = 8514.0; p = .005) and in single compared to married patients (U = 12364.5; p = .034).
Nurses respected patient privacy highly according to both nurses and patients, and there was no significant difference between their views. However, nurses working in training and research hospitals and internal diseases clinics need to improve their approaches to patient privacy.
The results of this study could be used to reduce patient privacy vulnerabilities in complex hospitals and clinics such as training and research hospitals and to improve institutional policies and activities regarding patient privacy. By comparing the results of patients and nurses, the study provided more consistent and accurate data about patient privacy.
This study examined nurses' intention to allow family presence during resuscitation (FPDR) by applying the theory of planned behaviour with an extended concept.
Medical institutions, including nurses and other medical professionals working in emergency and intensive care units, are reluctant to allow FPDR. However, this practice reduces the family's anxiety and stress while fostering well‐being and minimises their feelings of helplessness and distress by making them believe that they have helped the patient.
A cross‐sectional descriptive design was used in this study.
The participants were 252 nurses who had been working for at least 3 months in a general hospital in South Korea. Data were collected using self‐report questionnaires in April 2020 and were analysed using descriptive statistics, Pearson's correlation analysis and multiple regression analysis. The instruments were intention to allow FPDR (five constructs: intention to allow FPDR, positive attitude, negative attitude, subjective norm and perceived behavioural control), perception of FPDR and self‐confidence. The STROBE checklist was used for reporting this study.
The mean score for the intention to allow FPDR was 3.47 out of 5. The regression analysis results indicated that perception of FPDR, positive attitude and negative attitude predicted the intention to allow FPDR.
It is necessary to develop educational programmes to change the perceptions of and attitudes towards FPDR. Additionally, written policies and protocols for FPDR in South Korea are needed to develop systematic care for patients’ families during cardiopulmonary resuscitation.
The findings of this study provide baseline data for developing FPDR policies and guidelines that could minimise the family's distress and allow them to feel that they have helped the patient.
Approximately 80% of patients admitted to acute hospitals have at least one peripheral intravenous catheter inserted during their admission, for the administration of fluids and medicines, and/or diagnostic tests, so the failure rate is concerning. New technology may decrease these rates even when used by inexperienced inserters. The choice of insertion site for an intravenous catheter is a known predictor of catheter failure. Therefore, the objective for this study was to evaluate the utility of vessel locating devices for novice clinicians to select catheter insertion sites in the forearm.
An inter‐subject incomplete counterbalanced research design was employed with healthy volunteers. Novice clinicians used either a vessel locating device using light or sound waves or they used palpation to identify relatively superficial veins in the forearm. This was compared to site selection performed by an expert clinician using palpation method only. Measurements of differences were analysed from photos of chosen sites. Bland–Altman agreement analysis was used to plot novice expert agreement. The STROBE checklist was followed in reporting this study (Techniques to select site of insertion for a peripheral intravenous catheter with vessel locating devices (Appendix S1)).
A total of 32 novice clinicians used three vessel locating devices and a palpation technique. Novice clinicians did not choose more veins for optimum catheter placement when assisted with vessel locating devices compared to palpation techniques. All methods had a similar mean difference between novice and expert measurements and a similar percentage difference in distance from the expert choice. Bland–Altman agreement analysis did not identify any advantage for the novice with vessel locating devices over palpation.
Vessel locating devices do not enhance the ability of novice clinicians any greater than palpation when selecting suitable forearm veins. If vessel locating device approaches are to be adopted in clinical practice to support better insertion outcomes then current PIVC teaching techniques should include structured vessel locating devices theory and practice.
Successful insertion of a peripheral intravenous catheter (PIVC) on the first attempt is a challenging procedure for nurses. Careful consideration of the selected site of insertion could modify this risk factor for catheter failure. The choice of PIVC insertion site by a novice clinician compared to an expert does not necessarily improve with the use of vein locating technology. While there is a range of technological devices available to assist with locating vessels, there needs to be more emphasis from educators on how to select an appropriate insertion site for intravenous therapy.
This study aimed to (1) describe the development of integrated services between hospital‐based heart failure nursing services and municipally located home care nurses’ services and (2) identify the benefits of this collaboration for the development of home care nursing services.
Governments have called for better integration of healthcare services to respond to demographic ageing. Clinical pathways have been used to enhance integration and assure continuity between primary and secondary care. Competencies in addressing advanced health issues among home care nurses must be improved.
A longitudinal ethnographic study of the development of home care nursing services for persons living with heart failure.
Data were field notes from observations at meetings of the steering group designing the services, visits to patients’ homes and from educational sessions. Interviews were conducted with the home care nurses, heart failure nurses and focus group meetings with nurses working in home care nursing. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies checklist.
In a collaborative project, nurses from the two settings developed nursing services to address signs indicating exacerbation of heart failure and risk of hospital visits, involving advanced heart failure monitoring and treatment in patients’ homes. A clinical pathway was developed to assure effective assessment of patients’ condition. The home care nurses gained new knowledge and developed work practices that called for different competencies. Access to consultation from specialised heart failure nurses was instrumental in this transition.
The development of nursing services by integrating primary and secondary services facilitates translation of knowledge, competencies and understandings between nurses at different settings. Such integration can foster expertise in nursing services.
The transfer of specialised healthcare services to primary care facilitates collaboration and sharing of knowledge, understanding and work practices.
To investigate hospital, unit and staff variables as the correlates of missed nursing care (MNC) in Czech hospitals.
There is a considerable variability in patterns of MNC across different hospital, unit and staff characteristics.
A cross‐sectional study was conducted. The STROBE guidelines for reporting observational studies were followed for reporting of the research study.
A sample of 513 nurses working in nine acute care hospitals was recruited. MNC activities were measured with the MISSCARE Survey. Data were analysed using descriptive statistics and univariate logistic regression.
Type of unit was confirmed as a significant predictor of MNC. Staff characteristics (nurses’ work position, level of education and perceived adequacy of unit staff) and hospital variables did not contribute significantly to MNC.
The study replicated the patterns of MNC across different conceptual approaches. MNC was influenced by work environment characteristics rather than individual staff variables.
The results of this research showed that missed nursing care is influenced by work environment characteristics rather than individual staff variables.