Showing papers in "Journal of Advanced Nursing in 2015"

A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education.

Abstract: Aim To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing. Background The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited. Design Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5. Data sources Computerized searches of five databases were undertaken for the period 1995–August 2013. Review methods Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results. Results Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies. Conclusion The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology.

An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice

Abstract: Aim To identify facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general (family) practice. Background Internationally, a shortage of doctors entering and remaining in general practice and an increasing burden of chronic disease has diversified the nurse's role in this setting. Despite a well-established general practice nursing workforce, little attention has been paid to the ways doctors and nurses collaborate in this setting. Design Integrative literature review. Data sources CINAHL, Scopus, Web of Life, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews and Trove (dissertation and theses) were searched for papers published between 2000 and May 2014. Review methods This review was informed by the approach of Whittemore and Knafl (2005). All included papers were assessed for methodological quality. Findings were extracted, critically examined and grouped into themes. Results Eleven papers met the inclusion criteria. Thematic analysis revealed three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities; (2) respect, trust and communication; and (3) hierarchy, education and liability. Conclusion This integrative review has provided insight into issues around role definition, communication and organizational constraints which influence the way nurses and general practitioners collaborate in a team environment. Future research should investigate in more detail the ways doctors and nurses work together in general practice and the impact of collaboration on nursing leadership and staff retention.

Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption

Abstract: Aims: To examine frontline staff acceptance of telehealth and identify barriers to and enablers of successful adoption of remote monitoring for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Background: The use of telehealth in the UK has not developed at the pace and scale anticipated by policy. Many existing studies report frontline staff acceptance as a key barrier, however data are limited and there is little evidence of the adoption of telehealth in routine practice. Design: Case studies of four community health services in England that use telehealth to monitor patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods: Thematic analysis of qualitative interviews with 84 nursing and other frontline staff; and 21 managers and key stakeholders; data collected May 2012-June 2013. Findings: Staff attitudes ranged from resistance to enthusiasm, with varied opinions about the motives for investing in telehealth and the potential impact on nursing roles. Having reliable and flexible technology and dedicated resources for telehealth work were identified as essential in helping to overcome early barriers to acceptance, along with appropriate staff training and a partnership approach to implementation. Early successes were also important, encouraging staff to use telehealth and facilitating clinical learning and increased adoption. Conclusions: The mainstreaming of telehealth hinges on clinical 'buy-in'. Where barriers to successful implementation exist, clinicians can lose faith in using technology to perform tasks traditionally delivered in person. Addressing barriers is therefore crucial if clinicians are to adopt telehealth into routine practice.

Understanding Compassion Fatigue: Understanding Compassion

Abstract: Aim A discussion of how the construct of compassion fatigue is understood in nursing. Background Compassion fatigue is a topic commonly found in nursing literature. Design Discussion paper. Data sources The literature from 1992–2012 on compassion fatigue was examined. The literature from 1998–2012 on compassion was examined. Implications for nursing There are multiple and diverse understandings and definitions of what compassion fatigue is. So much so, there are equally multiple, diverse and conflicting strategies to mitigate it. To understand better what compassion fatigue is, an examination of what compassion is was undertaken. Much is written that nurses are, or should be compassionate. Compassion is an archetype of nursing. However, there is little in the nursing literature defining what compassion is. Literature on compassion outside of nursing was then examined. There is a growing body of theory and research about compassion in other disciplines. None of the multiple definitions of nurse compassion fatigue match this understanding of compassion. The tools most often used to measure nurse compassion fatigue do not appear to measure the construct of compassion. Conclusion To understand what nurse compassion fatigue is, we must first understand what nurse compassion is.

The influence of authentic leadership and empowerment on nurses' relational social capital, mental health and job satisfaction over the first year of practice.

Abstract: Aims To examine a theoretical model testing the effects of authentic leadership, structural empowerment and relational social capital on the mental health and job satisfaction of new graduate nurses over the first year of practice. Background Relational social capital is an important interpersonal organizational resource that may foster new graduate nurses’ workplace well-being and promote retention. Evidence shows that authentic leadership and structural empowerment are key aspects of the work environment that support new graduate nurses; however, the mediating role of relational social capital has yet to be explored. Design A longitudinal survey design was used to test the hypothesized model. Methods One hundred ninety-one new graduate nurses in Ontario with <2 years of experience completed mail surveys in January–March 2010 and 1 year later in 2011. Path analysis using structural equation modelling was used to test the theoretical model. Results Participants were mostly female, working full time in medicine/surgery or critical care. All measures demonstrated acceptable reliability and validity. Path analysis results supported our hypothesized model; structural empowerment mediated the relationship between authentic leadership and nurses’ relational social capital, which in turn had a negative effect on mental health symptoms and a positive effect on job satisfaction. All indirect paths in the model were significant. Conclusion By creating structurally empowering work environments, authentic leaders foster relational social capital among new graduate nurses leading to positive health and retention outcomes.

An integrative review of promoting trust in the patient–primary care provider relationship

Abstract: Aim An integrative review of empirical studies on factors promoting trust in the patient–primary care provider relationship. Background Trust is essential to the patient–provider relationship. Patients with high trust in their healthcare providers have been found to have improved outcomes, including improved chronic disease management, increased use of preventative services and satisfaction with care. Breaches of trust in the healthcare system threaten trust. Exploring factors that promote trust in the patient–provider relationship is warranted. Design Integrative literature review. Data sources Electronic databases searched included CINAHL, MEDLINE and PsycARTICLES, using combinations of the key term ‘trust’ with: concept, practitioner, provider, physician, developing, creating, engendering, promoting and establishing. The results were limited to original publications in English, published between 1998–2013. Review methods A review of the literature was conducted by two independent reviewers based on the criteria established by Cooper; Whittemore and Knafl; and Polit and Beck. Methodological assessment tools were used to organize, evaluate the quality of and synthesize the data. Results A new conceptual definition of promoting trust is proposed that includes three core qualities: interpersonal and technical competence, moral comportment and vigilance. Gaps in the literature still exist related to rural, young adult, older adult and well patient populations. Conclusion The core qualities could serve as target areas for the development of interventions aimed at modifying provider behaviours so that trust can be established, maintained or improved. Future prospective longitudinal research studies are needed that enhance understanding of trust with multiple primary care provider types.

The effect of bullying on burnout in nurses: The moderating role of psychological detachment

Abstract: Aims The aim of the study was to examine the relationship between bullying and burnout and the potential buffering effect psychological detachment might have on this relationship. Background There is evidence to suggest that bullying is relatively widespread in the nursing profession, with previous studies indicating that bullying is associated with higher levels of burnout. There is, however, limited research focusing on potential moderators of the relationship between bullying and burnout. Design A cross-sectional quantitative study conducted with self-completed, anonymous questionnaires. Methods The study was conducted in 2011 with 762 Registered Nurses in Australia. Two hypotheses were tested with validated measures of bullying, psychological detachment and burnout. The hypotheses were tested using hierarchical regression. Results Bullying is positively associated with burnout. Psychological detachment does not significantly moderate the relationship between bullying and burnout. Conclusion The results indicate that bullying exacts a strong negative toll on nurses. Ensuring there are workplace policies and practices in place in healthcare organizations to reduce the instances of bullying and proactively address it when it does occur would therefore seem crucial. Individuals may also lower their risk of burning out by psychologically detaching from work.

The sustainability of healthcare innovations: a concept analysis.

Abstract: Aim To report on an analysis of the concept of the sustainability of healthcare innovations. Background While there have been significant empirical, theoretical and practical contributions made towards the development and implementation of healthcare innovations, there has been less attention paid to their sustainability. Yet many desired healthcare innovations are not sustained over the long term. There is a need to increase clarity around the concept of innovation sustainability to guide the advancement of knowledge on this topic. Design Concept analysis. Data sources We included literature reviews, theoretical and empirical articles, books and grey literature obtained through database searching (ABI/INFORM, Academic Search Complete, Business Source Complete, CINAHL, Embase, MEDLINE and Web of Science) from 1996–May 2014, reference harvesting and citation searching. Methods We examined sources according to terms and definitions, characteristics, preconditions, outcomes and boundaries to evaluate the maturity of the concept. Results This concept is partially mature. Healthcare innovation sustainability remains a multi-dimensional, multi-factorial notion that is used inconsistently or ambiguously and takes on different meanings at different times in different contexts. We propose a broad conceptualization that consists of three characteristics: benefits, routinization or institutionalization, and development. We also suggest that sustained innovations are influenced by a variety of preconditions or factors, which are innovation-, context-, leadership- and process-related. Conclusion Further conceptual development is essential to continue advancing our understanding of the sustainability of healthcare innovations, especially in nursing where this topic remains largely unexplored.

Participants' views of telephone interviews within a grounded theory study.

Abstract: Aim To offer a unique contribution to the evolving debate around the use of the telephone during semistructured interview by drawing on interviewees’ reflections on telephone interview during a grounded theory study. Background The accepted norm for qualitative interviews is to conduct them face-to-face. It is typical to consider collecting qualitative data via telephone only when face-to-face interview is not possible. During a grounded theory study, exploring users’ experiences with overnight mask ventilation for sleep apnoea, the authors selected the telephone to conduct interviews. This article reports participants’ views on semistructured interview by telephone. Design An inductive thematic analysis was conducted on data pertaining to the use of the telephone interview in a grounded theory study. Methods The data were collected during 4 months of 2011 and 6 months in 2014. The article presents an inductive thematic analysis of sixteen participants’ opinions about telephone interviewing and discusses these in relation to existing literature reporting the use of telephone interviews in grounded theory studies. Findings Overall, participants reported a positive experience of telephone interviewing. From each participants reports we identified four themes from the data: being ‘phone savvy; concentrating on voice instead of your face; easy rapport; and not being judged or feeling inhibited. Conclusion By drawing on these data, we argue that the telephone as a data collection tool in grounded theory research and other qualitative methodologies need not be relegated to second best status. Rather, researchers can consider telephone interview a valuable first choice option.

Being reflexive in qualitative grounded theory: discussion and application of a model of reflexivity

Abstract: Aim A discussion of the meaning of reflexivity in research with the presentation of examples of how a model of reflexivity was used in a grounded theory research project. Background Reflexivity requires the researcher to make transparent the decisions they make in the research process and is therefore important in developing quality in nursing research. The importance of being reflexive is highlighted in the literature in relation to nursing research, however, practical guidance as to how to go about doing research reflexively is not always clearly articulated. Design This is a discussion paper. Data sources The concept of reflexivity in research is explored using the Alvesson and Skoldberg model of reflexivity and practical examples of how a researcher developed reflexivity in a grounded theory project are presented. Implications for nursing Nurse researchers are encouraged to explore and apply the concept of reflexivity in their research practices to develop transparency in the research process and to increase robustness in their research. The Alvesson and Skoldberg model is of value in applying reflexivity in qualitative nursing research, particularly in grounded theory research. Conclusion Being reflexive requires the researcher to be completely open about decisions that are made in the research process. The Alvesson and Skolberg model of reflexivity is a useful model that can enhance reflexivity in the research process. It can be a useful practical tool to develop reflexivity in grounded theory research.

The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care

Abstract: Aims To understand the perspective of the homeless about their healthcare encounters and how their experiences of receiving healthcare influence their health-seeking behaviour. Background A phenomenological study was undertaken because of the increasing levels of homelessness in the United Kingdom. Most of the current literature is American or Canadian. Design An interpretive phenomenological inquiry. Method An opportunistic sample of fourteen single homeless adults was recruited from one male hostel and one non-residential day centre. Data collection was done in 2013. Semi-structured audio-recorded interviews were conducted one-to-one. Colaizzi's method for data analysis was used. Findings Three major themes were identified. Expressed Health Need, Healthcare Experiences and Attitudes to health care. Health problems are recognized by the homeless but the need for intervention is not always prioritised. Obstacles in access to health care in the UK are both perceived (attitudes towards the homeless; previous bad experience) and actual (difficulty in registering with a general practitioner, difficulty travelling to services, being forced to move to new area). Some homeless people feel that they are treated with prejudice and receive substandard care. Positive healthcare experiences were also reported. Conclusions Positive and negative healthcare encounters can profoundly affect the homeless. Recommendations: Address apparent inconsistency of care; promote greater interdisciplinary communication and referrals to homeless services from prisons and hospitals; increase the availability of intermediate services; reduce obligation of homeless to move area; research experiences of homeless families.

Organizational impact of nurse supply and workload on nurses continuing professional development opportunities: an integrative review.

Abstract: Aim To identify the best evidence on the impact of healthcare organizations' supply of nurses and nursing workload on the continuing professional development opportunities of Registered Nurses in the acute care hospital. Background To maintain registration and professional competence nurses are expected to participate in continuing professional development. One challenge of recruitment and retention is the Registered Nurse's ability to participate in continuing professional development opportunities. Design The integrative review method was used to present Registered Nurses perspectives on this area of professional concern. Data sources The review was conducted for the period of 2001–February 2015. Keywords were: nurs*, continuing professional development, continuing education, professional development, supply, shortage, staffing, workload, nurse: patient ratio, barrier and deterrent. Review methods The integrative review used a structured approach for literature search and data evaluation, analysis and presentation. Eleven international studies met the inclusion criteria. Results Nurses are reluctant or prevented from leaving clinical settings to attend continuing professional development due to lack of relief cover, obtaining paid or unpaid study leave, use of personal time to undertake mandatory training and organizational culture and leadership issues constraining the implementation of learning to benefit patients. Conclusion Culture, leadership and workload issues impact nurses' ability to attend continuing professional development. The consequences affect competence to practice, the provision of safe, quality patient care, maintenance of professional registration, job satisfaction, recruitment and retention. Organizational leadership plays an important role in supporting attendance at continuing professional development as an investment for the future.

An evaluation of the implementation of Advanced Nurse Practitioner (ANP) roles in an acute hospital setting

Abstract: Aim To evaluate the impact of implementing Advanced Nurse Practitioner roles on patients, staff members and organizational outcomes in an acute hospital. Background The worldwide development of advanced practice roles in nursing has been influenced by increasing demands and costs of health care. A key issue in the UK has been the reduction in hours junior doctors can work. While there is evidence these roles can have a positive impact in a variety of clinical specialties, little is known about the impact advanced nurses substituting for junior doctors can have on patients, staff members and organizational outcomes in general hospital care settings. Design Collective case study. Methods A collective case study in a district general hospital in England was undertaken in 2011–2012. Interviews with strategic stakeholders (n = 13) were followed by three individual case studies. Each case study represented the clinical area in which the roles had been introduced: medicine, surgery and orthopaedics and included interviews (n = 32) and non-participant observation of practice. Findings The ANPs had a positive impact on patient experience, outcomes and safety. They improved staff knowledge, skills and competence and enhanced quality of working life, distribution of workload and team-working. ANPs contributed to the achievement of organizational priorities and targets and development of policy. Conclusion ANPs undertaking duties traditionally performed by junior doctors in acute hospital settings can have a positive impact on a range of indicators relating to patients, staff members and organizational outcomes which are highly relevant to nursing.

Competency and an active learning program in undergraduate nursing education

Abstract: Aims To evaluate the effect of an active learning program on competency of senior students. Background Active learning strategies have been used to help students achieve desired nursing competency, but their effectiveness has not been systematically examined. Design A descriptive, cross-sectional comparative design was used. Two cohort group comparisons using t-test were made: one in an active learning group and the other in a traditional learning group. Methods A total of 147 senior nursing students near graduation participated in this study: 73 in 2010 and 74 in 2013. The active learning program incorporated high-fidelity simulation, situation-based case studies, standardized patients, audio-video playback, reflective activities and technology such as a SmartPad-based program. Results The overall scores of the nursing competency in the active group were significantly higher than those in the traditional group. Of five overall subdomains, the scores of the special and general clinical performance competency, critical thinking and human understanding were significantly higher in the active group than in the traditional group. Importance-performance analysis showed that all five subdomains of the active group clustered in the high importance and high performance quadrant, indicating significantly better achievements. In contrast, the students in the traditional group showed scattered patterns in three quadrants, excluding the low importance and low performance quadrants. This pattern indicates that the traditional learning method did not yield the high performance in most important areas. Conclusion The findings of this study suggest that an active learning strategy is useful for helping undergraduate students to gain competency.

Understanding patient‐to‐worker violence in hospitals: a qualitative analysis of documented incident reports

Abstract: Aim. To explore catalysts to, and circumstances surrounding, patient-to-worker violent incidents recorded by employees in a hospital system database. Background. Violence by patients towards health ...

Moral distress in critical care nurses: a phenomenological study

Abstract: Aim To explore and understand moral distress from the perspective of and as experienced by critical care nurses in Korea. Background The concept of moral distress among critical care nurses must be more broadly explored using a qualitative approach. Design Giorgi's phenomenological research approach was used. Methods A purposive sampling was used to select 14 critical care nurses. In-depth face-to-face interviews were performed in Korea from March 2012–December 2013. Findings Five main themes of moral distress emerged: (1) ambivalence towards treatment and care (notably prioritizing work tasks over human dignity, unnecessary medical treatments and the compulsory application of restraints); (2) suffering resulting from a lack of ethical sensitivity; (3) dilemmas resulting from nurses' limited autonomy in treatments; (4) conflicts with physicians; and (5) conflicts with institutional policy. Conclusion Staff shortages are aggravated by high staff turnover caused by ethical suffering. The resulting lack of staff can, in turn, give rise to added ethical conflicts as part of a vicious circle, leading to decreased patient satisfaction.

Systematic review of fall risk screening tools for older patients in acute hospitals.

Abstract: Aims To determine the most accurate fall risk screening tools for predicting falls among patients aged 65 years or older admitted to acute care hospitals. Background Falls represent a serious problem in older inpatients due to the potential physical, social, psychological and economic consequences. Older inpatients present with risk factors associated with age-related physiological and psychological changes as well as multiple morbidities. Thus, fall risk screening tools for older adults should include these specific risk factors. There are no published recommendations addressing what tools are appropriate for older hospitalized adults. Design Systematic review. Data sources MEDLINE, CINAHL and Cochrane electronic databases were searched between January 1981–April 2013. Only prospective validation studies reporting sensitivity and specificity values were included. Review methods Recommendations of the Cochrane Handbook of Diagnostic Test Accuracy Reviews have been followed. Results Three fall risk assessment tools were evaluated in seven articles. Due to the limited number of studies, meta-analysis was carried out only for the STRATIFY and Hendrich Fall Risk Model II. In the combined analysis, the Hendrich Fall Risk Model II demonstrated higher sensitivity than STRATIFY, while the STRATIFY showed higher specificity. In both tools, the Youden index showed low prognostic accuracy. Conclusion The identified tools do not demonstrate predictive values as high as needed for identifying older inpatients at risk for falls. For this reason, no tool can be recommended for fall detection. More research is needed to evaluate fall risk screening tools for older inpatients.

A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on self-efficacy, social support and postnatal depression among primiparas.

Abstract: AimTo examine the effectiveness of a postnatal psychoeducation programme in enhancing maternal self-efficacy and social support and reducing postnatal depression among primiparas.BackgroundPrimiparas experience various challenges during the early postnatal period with low self-efficacy, depression and lack of social support. Support in the form of postnatal educational programmes is needed to improve these outcomes of primiparas.DesignA randomized controlled two-group pre-test-post-test design was adopted.MethodsData were collected from June-December 2012 in a public hospital in Singapore from 122 primiparas, who were randomly assigned to the intervention (n=61) or control group (n=61). The intervention group received postnatal psychoeducation programme and routine care while the control group received routine care only. The Maternal Parental Self-Efficacy scale, Perinatal Infant Care Social Support scale and Edinburgh Postnatal Depression Scale were used to measure outcomes of maternal parental self-efficacy, social support and postnatal depression. The mean percentage changes of all three outcome variables from baseline to 6 and 12weeks postpartum between groups were used when performing repeated measures multivariate analysis of covariance.ResultsThe intervention group had significantly higher scores of maternal parental self-efficacy and social support and lower scores of postnatal depression at 6 and 12weeks postpartum when compared with the control group.ConclusionThe postnatal psychoeducation programme was effective in improving maternal outcomes and hence could be introduced as routine care with ongoing evaluation in the postnatal period. Future studies could focus on the effects of this programme on other populations. Trial registration no: ISRCTN15886353.

Professional ethics in nursing: an integrative review.

Abstract: Aim To conduct an integrative review and synthesize current primary studies of professional ethics in nursing. Background Professional ethics is a familiar concept in nursing and provides an ethical code for nursing practice. However, little is known about how professional ethics has been defined and studied in nursing science. Design and data sources Systematic literature searches from 1948–February 2013, using the CINAHL, PubMed and Scopus electronic databases to look at previously published peer-reviewed studies. Review method A modified version of Cooper's five-stage integrative review was used to review and synthesize current knowledge. Results Fourteen papers were included in this research. According to our synthesis, professional ethics is described as an intra-professional approach to care ethics and professionals commit to it voluntarily. Professional ethics consist of values, duties, rights and responsibilities, regulated by national legislation and international agreements and detailed in professional codes. Professional ethics is well established in nursing, but is constantly changing due to internal and external factors affecting the profession. Conclusion Despite the obvious importance of professional ethics, it has not been studied much in nursing science. Greater knowledge of professional ethics is needed to understand and support nurses’ moral decision-making and to respond to the challenges of current changes in health care and society.

Changes in caregiver burden and health-related quality of life of informal caregivers of older people with Dementia: evidence from the European RightTimePlaceCare prospective cohort study

Abstract: Aims. To describe differences in caregiver burden and health-related quality of life of informal caregivers of people with dementia in eight European countries and assess changes after transition from home to institutional long-term care. Background. Country differences in the experience of burden and health-related quality of life are rarely described. Design. Prospective cohort study. Methods. Data on burden and health-related quality of life were collected at baseline (conducted between November 2010–April 2012) and follow-up (after 3 months) using face-to-face interviews. Two groups of informal caregivers included those: (1) of people with dementia recently admitted to institutional long-term care facilities; and those (2) of people with dementia receiving home care. Statistical analyses focused on descriptive comparisons between groups and countries. Results. Informal caregivers of about 2014 were interviewed. Informal caregivers of people with dementia at home experienced more burden compared with informal caregivers of recently institutionalised people with dementia. Almost no differences in health-related quality of life were found between groups. Large differences between countries on outcomes were found. Informal caregivers of people with dementia who made the transition to an institutional long-term care facility experienced a statistically significant decrease in burden and psychological distress at follow-up. Conclusion. Cross-country differences may be related to differences in health and social care systems. Taking this into account, informal caregiver interventions need to be tailored to (country specific) contexts and (individual) needs. Findings highlight the positive impact of admission to institutional long-term care on informal caregiver well-being. (Less)

Qualitative systematic review: barriers and facilitators to smoking cessation experienced by women in pregnancy and following childbirth

Abstract: Aim To explore barriers and facilitators to smoking cessation experienced by women during pregnancy and postpartum by undertaking a synthesis of qualitative studies. Background The majority of pregnant women are aware that smoking in pregnancy compromises maternal and infant health. Despite this knowledge, quit rates among pregnant women remain low, particularly among women in disadvantaged circumstances; disadvantage also increases the chances of living with a partner who smokes and returning to smoking after birth. A deeper understanding of what hinders and what helps pregnant smokers to quit and remain ex-smokers postpartum is needed. Design A synthesis of qualitative research using meta-ethnography. Data sources Five electronic databases (January 1990–May 2013) were searched comprehensively, updating and extending the search for an earlier review to identify qualitative research related to the review's aims. Review methods Following appraisal, 38 studies reported in 42 papers were included and synthesized following the principles of meta-ethnography. Over 1100 pregnant women were represented, the majority drawn from disadvantaged groups. Results Four factors were identified that acted both as barriers and facilitators to women's ability to quit smoking in pregnancy and postpartum: psychological well-being, relationships with significant others, changing connections with her baby through and after pregnancy; appraisal of the risk of smoking. Conclusion The synthesis indicates that barriers and facilitators are not fixed and mutually exclusive categories; instead, they are factors with a latent capacity to help or hinder smoking cessation. For disadvantaged smokers, these factors are more often experienced as barriers than facilitators to quitting.

Nurses' views of patient participation in nursing care.

Abstract: AIMS: To explore nurses' views of patient participation in nursing care on medical wards. BACKGROUND: Nurses have frequent contact with patients, highlighting their potential role in enabling patient participation. However, some nurses' actions and attitudes act as barriers, failing to achieve core requirements of patient participation. Discovering nurses' views may assist in developing strategies to encourage patient participation in hospitals. DESIGN: Interpretive study. METHODS: Twenty nurses were recruited from four medical wards, located in two Australian hospitals. In-depth semi-structured interviews were conducted between November 2013-March 2014 and analysed using content analysis. FINDINGS: Five categories emerged from the nurses' views. The first category, acknowledging patients as partners, showed nurses respected patients as legitimate participants. In the second category, managing risk, nurses emphasized the need to monitor participation to ensure rules and patient safety were maintained. Enabling participation was the third category, which demonstrated nurses' strategies that enhanced patients' participation. The fourth category was hindering participation; encapsulating nurses' difficulty in engaging patients with certain characteristics. In the final category, realizing participation, nurses believed patients could be involved in physical activities or clinical communication. CONCLUSION: Nurses have a crucial role in promoting patient participation. Through acknowledging and enabling participation, nurses may facilitate patient participation in a range of nursing activities. The nurse's role in enacting participation is complex, having to accommodate each patient's risks and characteristics, highlighting the need for good assessment skills. Education, policy and research strategies are essential to foster nurses' pivotal role in patient participation.

Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention.

Abstract: Aims To investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings. Background The considerable research on turnover in long-term care has primarily focused on the impact of job satisfaction on turnover intention. Given the well-documented high turnover rate in nursing home staffing, dissatisfaction is expected to continue. Alternatives (e.g. reduction in work-to-family conflict) for reducing turnover under the circumstance of job dissatisfaction have not been investigated extensively. Design A cross-sectional mailed survey. Methods A convenience sample comprising 200 nurses from 25 private nursing homes in Central Taiwan was created. Data were collected from nurses about their level of turnover intention, job satisfaction and work-to-family conflict in 2012. A composite indicator structural equation model was used to examine the mediation model of this study. Results Overall, 186 nurses (93%) returned the completed questionnaires. Consistent with published research from other countries, turnover intention in our study was significantly and negatively associated with job satisfaction and significantly and positively associated with work-to-family conflict. In addition, job dissatisfaction indirectly influenced turnover intention through high work-to-family conflict. Conclusion Findings from this study indicate the importance of work-to-family conflict to nurse turnover. While work setting has a strong, well-documented influence on job satisfaction, limiting job satisfaction efforts to work setting improvements may not yield the hoped-for results unless work-to-family conflict is also considered and addressed.

A concept analysis of patient‐centred nursing in the intensive care unit

Abstract: Aim To report an analysis of the concept of patient-centred nursing in the context of intensive care. Background Clarification of patient-centred nursing in the intensive care unit is important because consensus definition of this concept is lacking. The severely compromised physiological state of these people and the sequelae of this differentiate patient-centred nursing in intensive care from that occurring in other hospital settings. While the broad concept has been analysed, it has not been examined in the context of intensive care. Design Concept analysis. Data sources CINAHL, PsycINFO, Medline and PubMed databases (2000–2014) were searched. Peer-reviewed papers were identified and reference lists of relevant articles searched. Methods Walker and Avant's eight-stage approach was used. Results Patient-centred nursing in the intensive care unit incorporates antecedents of a physiologically compromised patient requiring biomedical intervention, a professional and competent nurse and organizational support. The concept's defining attributes entail maintenance of patient identity by a compassionate and professional nurse exercising biomedical expertise. Consequences include patient satisfaction, positive patient experience, nurse job satisfaction and better nurse workforce retention. Conclusion Patient-centred nursing in intensive care is differentiated from other healthcare areas by the particular characteristics of critically ill patients, the critical care environment and the challenging bio-psycho-social demands made on intensive care nurses. Effective patient-centred nursing in this environment promotes beneficial outcomes for patients, nurses and healthcare service. Decision-makers and policymakers should support critical care nurses in this challenging role, to maintain delivery of patient-centred nursing and grow an effective nursing workforce.

Perceptions, experiences and needs of patients with idiopathic pulmonary fibrosis

Abstract: Aims To understand the perceptions, needs and experiences of patients with Idiopathic Pulmonary Fibrosis. Background Idiopathic pulmonary fibrosis is a progressive interstitial lung disease, with a mean life expectancy similar to some forms of cancer of 2–4 years from diagnosis. Unlike the cancer literature, which is rich with studies exploring the needs of their disease group, few publications exist on patient needs with this severe fibrotic lung disease. Design A Qualitative study which took place between 2007–2012. Methods Seventeen patients with a multidisciplinary team confirmed diagnosis of Idiopathic Pulmonary Fibrosis, with moderate to advanced disease severity and six of their informal carers were interviewed. An interview topic guide was developed by the researchers and service user group. The interviews were audio-recorded, semi-structured and took place at a regional respiratory and lung transplant centre in North West England. Interviews were transcribed verbatim and data analysed using Framework Analysis. Findings Three main themes were identified: ‘Struggling to get a diagnosis’; ‘Loss of the life I previously had’; and ‘Living with Idiopathic Pulmonary Fibrosis’. Patients reported struggling to get a diagnosis and coping with a life-limiting, rapidly progressive illness with no good treatment and few support structures. Conclusions There is an urgent need for a better understanding of the difficulties faced by people with Idiopathic Pulmonary Fibrosis and their carers. This can be used to develop better supportive care in the United Kingdom and ultimately improve the quality of life of these patients.

Recognizing and managing a deteriorating patient: a randomized controlled trial investigating the effectiveness of clinical simulation in improving clinical performance in undergraduate nursing students

Abstract: Aims. To report the results of a randomized controlled trial which explored the effectiveness of clinical simulation in improving the clinical performance of recognizing and managing an adult deteriorating patient in hospital. Background. There is evidence that final year undergraduate nurses may lack knowledge, clinical skills and situation awareness required to manage a deteriorating patient competently. The effectiveness of clinical simulation as a strategy to teach the skills required to recognize and manage the early signs of deterioration needs to be evaluated. Design. This study was a two centre phase II single, randomized, controlled trial with single blinded assessments. Method. Data were collected in July 2013. Ninety-eight first year nursing students were randomized either into a control group, where they received a traditional lecture, or an intervention group where they received simulation. Participants completed a pre- and postintervention objective structured clinical examination. General Perceived Self Efficacy and Self-Reported Competency scores were measured before and after the intervention. Student satisfaction with teaching was also surveyed. Results. The intervention group performed significantly better in the postobjective structured clinical examination. There was no significant difference in the postintervention General Perceived Self Efficacy and Self-Reported Competency scores between the control and intervention group. The intervention group was significantly more satisfied with their teaching method. Conclusion. Simulation-based education may be an effective educational strategy to teach nurses the skills to effectively recognize and manage a deteriorating patient. Keywords: clinical performance, critical illness, nursing education, patient deterioration, patient simulation, randomized controlled trial, self-efficacy

A descriptive study of nurse-reported missed care in neonatal intensive care units.

Abstract: Aims. The aims of this study are to describe: (1) the frequency of nurse-reportedmissed care in neonatal intensive care units; and (2) nurses’ reports of factorscontributing to missed care on their last shift worked.Background. Missed nursing care, or necessary care that is not delivered, isincreasingly cited as a contributor to adverse patient outcomes. Previous studieshighlight the frequency of missed nursing care in adult settings; the occurrence ofmissed nursing care in neonatal intensive care units is unknown.Design. A descriptive analysis of neonatal nurses’ self-reports of missed careusing data collected through a cross-sectional web-based survey.Methods. A random sample of certified neonatal intensive care nurses in sevenstates was invited to participate in the survey in April 2012. Data were collectedfrom nurses who provide direct patient care in a neonatal intensive care unit(n = 230). Descriptive statistics constituted the primary analytic approach.Results. Nurses reported missing a range of patient care activities on their lastshift worked. Nurses most frequently missed rounds, oral care for ventilatedinfants, educating and involving parents in care and oral feedings. Hand hygiene,safety and physical assessment and medication administration were missed leastoften. The most common reasons for missed care included frequent interruptions,urgent patient situations and an unexpected rise in patient volume and/or acuityon the unit.Conclusion. We find that basic nursing care in the neonatal intensive care unit ismissed and that system factors may contribute to missed care in this setting.Keywords: missed nursing care, neonatal intensive care, nursing, outcomes,quality, safety

Nursing students' understanding and enactment of resilience: a grounded theory study

Abstract: Aim The aim of this study was to explore nursing students' understanding and enactment of resilience. Background Stress is considered to be a major factor affecting the health, well-being and academic performance of nursing students. Resilience has been extensively researched as a process that allows individuals to successfully adapt to adversity and develop positive outcomes as a result. However, relatively little is known about the resilience of nursing students. Design A constructivist, grounded theory qualitative design was used for this study. Method In-depth individual interviews were conducted with 38 nursing students enrolled in a four-year, integrated baccalaureate nursing degree programme at a university in Ontario, Canada. Face-to-face interviews were conducted from January to April 2012 using a semi-structured interview guide. Findings The basic social process of ‘pushing through’ emerged as nursing students' understanding and enactment of resilience. Participants employed this process to withstand challenges in their academic lives. This process was comprised of three main phases: ‘stepping into’, ‘staying the course’ and ‘acknowledging’. ‘Pushing through’ also included a transient ‘disengaging’ process where students were temporarily unable to push through their adversities. The process of ‘pushing through’ was based on a progressive trajectory, which implied that nursing students enacted the process to make progress in their academic lives and to attain goals. Conclusion Study findings provide important evidence for understanding the phenomenon of resilience as a dynamic, contextual process that can be learnt and developed, rather than a static trait or personality characteristic.

A meta‐synthesis of factors influencing nursing home staff decisions to transfer residents to hospital

Abstract: Aim To report a meta-synthesis of qualitative research studies exploring the role of nursing home staff in decisions to transfer residents to hospital. Background Nurses and nurse assistants provide the majority of care to residents living in nursing homes and may be the only health workers present when a resident deteriorates. To inform future strategies, it is vital to understand the role of nursing home staff in decisions to transfer to hospital. Design and review methods A systematic review identified 17 studies to be included. The process of meta-synthesis was undertaken using the Joanna Briggs Institute's guidelines. Data sources Qualitative research papers published between January 1989–October 2012 were identified in key databases including Cinahl, Embase, Medline and PsycInfo. Results Nursing home staff members play a key role in decision-making at the time of a resident's deterioration. Multiple factors influence decisions to transfer to hospital including an unclear expectation of the nursing home role; limited staffing capacity; fear of working outside their scope of practice; poor access to multidisciplinary support and difficulties communicating with other decision-makers. Conclusions There is a lack of consensus regarding the role of the nursing home when a resident's health deteriorates. Nursing home staff would benefit from a clear prescription of their expected minimum clinical skill set; a staffing capacity that allows for the increased requirements to manage residents on-site, greater consistency in access to outside resources and further confidence and skills to optimize their role in resident advocacy.

'My mentor kicked a dying woman's bed…' analysing UK nursing students' 'most memorable' professionalism dilemmas.

Abstract: Aim To provide depth and breadth in the analysis of nursing students’ written narratives of ‘most memorable’ professionalism dilemmas. Background While nursing students are taught professionalism through formal curricula, they commonly experience workplace‐based professionalism dilemmas. Although non‐UK studies have begun to explore students’ lived experiences of dilemmas, they lack detail about when and where dilemmas occur, who is involved, what students do and why and how students feel. Design Online survey of healthcare students including 294 nursing students from 15 UK nursing schools. Method Nursing students provided a written narrative of their most memorable dilemma (December 2011–March 2012) as part of a survey examining the impact of professionalism dilemmas on moral distress. We conducted thematic and discourse analysis of all narratives and narrative analysis of one exemplar. Findings The most common themes were patient care dilemmas by healthcare personnel or students, student abuse and consent dilemmas. Of the dilemmas, 49·6% occurred over 6 months previously, 76·2% occurred in hospitals and 51·9% of perpetrators were nurses. 79·3% of students reported acting in the face of their dilemma. Of the narratives, 88·4% contained negative emotion talk and numerous significant relationships existed between types of emotion talk and dilemmas. Our narrative analysis demonstrates the impact of dilemma experiences through emotion talk and more subtle devices like metaphor. Conclusion Findings extend previous research with nursing and medical students. Nurse educators should help students construct emotionally coherent narratives to make sense of their experiences, actions and identities and to better prepare them for future professionalism dilemmas.