Showing papers in "Journal of Clinical Nursing in 2013"

Efficacy of person-centred care as an intervention in controlled trials - a systematic review.

Abstract: Aims and objectives To identify person-centred care as an intervention in controlled trials, where patients had been involved as a partner, and to describe the outcomes of these studies. Background The notion of person-centred care asserts that patients are persons and partners in care and should not be reduced to their disease alone. Design A systematic literature review. Method Searches were undertaken in the databases PUBMED and CINAHL. The inclusion criteria were that person-centred care as an intervention was described as a partnership between the caregiver and the patient, and that the studies were randomised controlled trials or quasi-experimental designs. The studies were analysed based on methodology, context and type of intervention, outcomes and effects of the interventions. Eleven trials fulfilled the inclusion criteria. Results The studies were carried out in a variety of contexts with diverse outcomes. Person-centred care as an intervention was shown to be successful in eight of the studies. The internal and external validity in the studies were generally good. However, as regards the precision of the studies there was a wide variation. Conclusions The value and efficacy of person-centred care as an intervention have only been studied to a limited extent. Methodological problems in trial design and execution could account for the general lack of research on person-centred care. Evidence that person-centred care is effective is insufficient, more stringent studies are needed. Relevance to clinical practice The results suggest that person-centred care may lead to significant improvements, but the implementation and relevant effects needs to be assessed in more studies.

The attitudes of undergraduate nursing students towards mental health nursing: a systematic review.

Abstract: Aims and objectives To present the findings of a systematic review on (1) the attitudes of undergraduate nursing students towards mental health nursing and (2) the influence of undergraduate nursing education on the attitudes of undergraduate nursing students towards mental health nursing. Background Recruitment and retention of mental health nurses is challenging. Undergraduate nursing students' attitudes towards mental health nursing may influence whether they choose to practice in this specialty upon graduation. Design A systematic review. Method Searches of the CINAHL, MEDLINE and PsycINFO electronic databases returned 1400 records, of which 17 met the inclusion criteria for this review. A further four papers were obtained through scanning the reference lists of those articles included from the initial literature search. Results Research on the attitudes of undergraduate nursing students towards mental health nursing has consistently shown that mental health is one of the least preferred areas of nursing for a potential career. With respect to the influence of undergraduate nursing education on the attitudes of students towards mental health nursing, quasi-experimental studies have generally demonstrated that students tended to have more favourable attitudes towards mental health nursing when they had received more hours of theoretical preparation and undertaken longer clinical placements. Conclusion Many nursing students regard mental health nursing as the least preferred career option. Education, via classroom teaching and clinical placements, seems to engender more positive attitudes towards mental health nursing. There is no evidence, however, that changing student attitudes results in more graduates beginning careers in mental health nursing. Reference to clinical practice The constancy of negative attitudes to mental health nursing over time suggests the focus of research should shift. Clinicians have the capacity to promote a more positive view of mental health nursing. This requires further exploration.

Work engagement and occupational stress in nurses and other healthcare workers: the role of organisational and personal factors

Abstract: Aims and objectives The aims of this study were to: (1) identify the role of organisational and personal factors in predicting work engagement in healthcare workers and (2) compare work engagement and occupational stress perceptions of healthcare professional categories. Background Healthcare professionals, with particular regard to nurses, are exposed to several job stressors that can adversely affect both their mental and physical health and also decrease work engagement. Work engagement can be considered as the positive opposite of burnout, and it is characterised by energy, involvement and professional efficacy. Design A cross-sectional survey research was conducted with self-report questionnaires. Methods The Maslach Burnout Inventory–General Survey, the Areas of Worklife Scale and four scales from the Occupational Stress Indicator were administered to a sample of 198 hospital staff (registered nurses, nurse aides, physicians and physiotherapists), of which 110 participated in the study. Results The most significant predictors of energy were workload, mental health and job satisfaction; the best predictors of involvement were community, workload, mental health and job satisfaction; professional efficacy was best predicted by values and job satisfaction. In relation to the second aim, physiotherapists had the highest levels of occupational stress and disengagement from their work, while nurse aides were the most work-engaged and job-satisfied professional category, with positive perceptions of the work environment. Conclusions Both organisational and personal factors were found to be significantly associated with work engagement. In this study, physiotherapists were the category with the highest risk of work-related psychological problems, whereas nurse aides had the lowest risk. Relevance to clinical practice Interventions aimed at improving clinical practice and psychological health of nurses and hospital staff should focus on workload, workers' personal expectations and job satisfaction.

Effect of spiritual intelligence, emotional intelligence, psychological ownership and burnout on caring behaviour of nurses: a cross-sectional study

Abstract: Aims and objectives. To propose a model of prediction of caring behaviour among nurses that includes spiritual intelligence, emotional intelligence, psychological ownership and burnout. Background. Caring behaviour of nurses contributes to the patients’ satisfaction, well-being and subsequently to the performance of the healthcare organisations. This behaviour is influenced by physiological, psychological, sociocultural, developmental and spiritual factors. Design. A cross-sectional survey was used, and data were analysed using descriptive statistics and structural equation modelling. Methods. Data were collected between July–August 2011. A sample of 550 nurses in practice from seven public hospitals in and around Kuala Lumpur (Malaysia) completed the questionnaire that captured five constructs. Besides nurses, 348 patients from seven hospitals participated in the study and recorded their overall satisfaction with the hospital and the services provided by the nurses. Data were analysed using structural equation modelling (SEM). Results. The key findings are: (1) spiritual intelligence influences emotional intelligence and psychological ownership, (2) emotional intelligence influences psychological ownership, burnout and caring behaviour of nurses, (3) psychological ownership influences burnout and caring behaviour of nurses, (4) burnout influences caring behaviour of nurses, (5) psychological ownership mediates the relationship between spiritual intelligence and caring behaviour and between emotional intelligence and caring behaviour of nurses and (6) burnout mediates the relationship between spiritual intelligence and caring behaviour and between psychological ownership and caring behaviour of nurses. Conclusions. Identifying the factors that affect caring behaviour of nurses is critical to improving the quality of patient care. Spiritual intelligence, emotional intelligence, psychological ownership and burnout of nurses play a significant role in effecting caring behaviour of nurses. Relevance to clinical practice. Healthcare providers must consider the relationships between these factors in their continuing care and incorporation of these in the nursing curricula and training.

Predicting exercise adherence in cancer patients and survivors: a systematic review and meta‐analysis of motivational and behavioural factors

Abstract: Aims and objectives To examine research findings regarding predictors of adherence to exercise programmes in cancer populations. Background Cancer patients are advised to participate in daily exercise. Whether they comply with the recommendations for physical activity or not remains unclear. Design A systematic review and meta-analysis. Methods Empirical articles published in English between 1995 and 2011 were searched in electronic databases and in reference lists, using the search terms ‘adherence’, ‘predictors’, ‘exercise’, and ‘cancer’ in varying combinations. Twelve of 541 screened abstracts met the inclusion criteria. The included studies' eligibility considering predictors of exercise adherence were reviewed. A quality assessment process evaluating the studies methodological quality was performed. Eight of the reviewed studies were considered eligible for a meta-analysis involving Pearson's r correlations. Results Exercise stage of change, derived from the transtheoretical model of behaviour change (TTM) was found to be statistically significant and a strong predictor of exercise adherence. In addition, the theory of planned behaviour (TPB) construct; intention to engage in a health-changing behaviour and perceived behavioural control, demonstrated significant correlations with exercise adherence. Conclusions The review identified that both the TPB and the TTM frameworks include aspects that predicts exercise adherence in cancer patients, and thus contributes to the understanding of motivational factors of change in exercise behaviour in cancer populations. However, the strengths of predictions were relatively weak. More research is needed to identify predictors of greater importance. Relevance to clinical practice Surveying the patients' readiness and intention to initiate and maintain exercise levels, as well as tailoring exercise programmes to individual needs may be important for nurses in order to help patients meet exercise guidelines and stay active.

Family needs and involvement in the intensive care unit: a literature review

Abstract: Aims and objectives To understand the needs of critically ill patient families', seeking to meet those needs and explore the process and patterns of involving family members during routine care and resuscitation and other invasive procedures. Methods A structured literature review using Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest, Google scholar, Meditext database and a hand search of critical care journals via identified search terms for relevant articles published between 2000 and 2010. Results Thirty studies were included in the review either undertaken in the Intensive Care Unit or conducted with critical care staff using different methods of inquiry. The studies were related to family needs; family involvement in routine care; and family involvement during resuscitation and other invasive procedures. The studies revealed that family members ranked both the need for assurance and the need for information as the most important. They also perceived their important needs as being unmet, and identified the nurses as the best staff to meet these needs, followed by the doctors. The studies demonstrate that both family members and healthcare providers have positive attitudes towards family involvement in routine care. However, family members and healthcare providers had significantly different views of family involvement during resuscitation and other invasive procedures. Conclusion Meeting Intensive Care Unit family needs can be achieved by supporting and involving families in the care of the critically ill family member. More emphasis should be placed on identifying the family needs in relation to the influence of cultural values and religion held by the family members and the organisational climate and culture of the working area in the Intensive Care Unit.

Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk

Abstract: Aims and objective. To verify association between PU development with nursing workload and illness severity and to verify whether nursing workload and illness severity are related with Braden Scale scores. Background. Critically ill patients are more susceptible to treatment complications because of the severity of their clinical condition. Design. Prospective descriptive study. Methods. Patients consecutively admitted to three intensive care units (ICUs) of a public university hospital located in Sao Paulo, Brazil and without pressure ulcer (PU) at admission and a minimum stay of 24 hours were included in the sample. Prospective data collection included demographic, clinical and hospitalisation data, Nursing Activities Score (NAS), Simplified Acute Physiology Score (SAPSII) and Braden Scale. Multivariate linear regression analysis was applied to verify whether nursing workload and illness severity are related with Braden Scale scores. Multivariate logistic regression analysis was used to verify whether nursing workload and illness severity were risk factors associated with PU development. Results. The study sample included 160 patients. The mean Braden score was 12·0 and PU incidence was 34·4%. Multivariate linear regression analysis identified as factors related to variation of Braden scores: illness severity (SAPSII), nursing workload (NAS) and age. Multivariate logistic regression showed a model with risk factors associated with PU development: sex, length of ICU stay, illness severity and nursing workload. Conclusion. Nursing workload, severity of illness, sex and length of ICU stay were identified as risk factors associated with PU development. However, nursing workload acted as a protective factor. Illness severity, nursing workload and age were related to Braden scores. Relevance to clinical practice. Accurate identification of risk factors and the use of clinical judgment in skin assessment are prerequisites for determining appropriate strategies to prevent pressure ulcers, to improve quality of care for patient safety and to reduce length of ICU and hospital stay and costs.

Musical intervention for patients with dementia: a meta‐analysis

Abstract: Aims and objectives To provide a meta-analysis of the effects of music interventions on patients with dementia, separating, for the first time, between different types of interventions and different outcome measures, namely affective, behavioural, cognitive and physiological. Background Music therapy is an attractive form of intervention for the growing number of demented patients, for whom pharmacological interventions are not always effective and may lead to undesired side effects. While music is more frequently applied in clinical settings for each year, no meta-analysis has considered effects of music interventions on affective, behavioural, cognitive and physiological outcomes separately. Design A standard meta-analysis approach was applied. Methods We include all original studies found for the key words music and dementia. Mean effect sizes and confidence intervals are computed from study effect sizes according to standard methods, and these are considered for various common types of music interventions separately. Results Nineteen studies with a total of 478 dementia patients exhibit effect sizes ranging from 0·04–4·56 (M = 1·04). Many of these indicate large positive effects on behavioural, cognitive and physiological outcome measures, and medium effects on affective measures. Conclusions Music interventions seem to be effective and have the potential of increasing the quality of life for patients with dementia. Many studies in this area suffer from poor methodological quality, which limits the reach of meta-analysis and the strength and generalisability of these conclusions. Relevance to clinical practice Being inexpensive and largely without adverse side effects, current knowledge seems to indicate that music interventions can be recommended for patients in all stages of dementia.

Fathers’ perceptions of the barriers and facilitators to their involvement with their newborn hospitalised in the neonatal intensive care unit

Abstract: Aims and objectives. To explore what fathers perceive to be facilitators or barriers to their involvement with their infants. Background. Fathers make unique and important contributions to the development of their infants. Fathers of infants in the neonatal intensive care unit often feel that they have a limited role to play in their infant’s care, and surveys suggest that they are not typically involved in infant caregiving. Paradoxically, qualitative studies have found that fathers do want to be involved, and their lack of involvement is an important source of stress. Design. Qualitative descriptive. Methods. Eighteen fathers of infants, in the neonatal intensive care unit for at least one week, were interviewed and asked to describe what they perceived to be the barriers and facilitators to their involvement. Interviews were audio taped and transcribed, and the data was content analysed. Results. Three major categories of barriers/facilitators were identified: (1) infant factors (size and health status, twin birth and infant feedback), (2) interpersonal factors (the rewards of and attitudes and beliefs regarding fatherhood; family management; previous experiences) and (3) neonatal intensive care unit environmental factors (physical and social). These factors could often be a barrier or facilitator to involvement depending on the context. Conclusions. This study provides insights into what factors influence involvement, and how nursing staff can support involvement and best meet fathers’ needs. Relevance to clinical practice. Nurses should explore the forms of involvement that a father desires, as well as the demands on their time, and determine what might be done to promote involvement. Fathers should be assisted to maximise the time that they do have with the infant. Nurses must provide clear and consistent information about whether and when caregiving is advisable, and they can explain and demonstrate how fathers can care for their infant.

Students' experiences of implementing clinical skills in the real world of practice.

Abstract: Aims and objectives To examine the factors that impact on students' implementation of clinical skills in the practice setting. This was a part of a larger exploration into the role of the Clinical Skills Laboratory in preparing student nurses for clinical practice. Background It is already known that students can experience reality shock on clinical placement and that staff support is crucial for their adaptation to the environment. This process is similar to socialisation theory whereby the newcomer adapts to the workplace. Design A multiple case study design ( n = 5) was used. Methods Data were collected using semi-structured interviews ( n = 43) and non-participant observation of students implementing skills in clinical practice. Results Findings revealed the factors that could facilitate students' implementation of clinical skills were as follows: provision of learning opportunities, staff support and supervision, and students' confidence. Factors that hindered students were reality shock, 'the gap' in how skills were taught in the higher education institutions and the clinical setting, and missed learning opportunities. Support from peers in the clinical area and having previous experience of working as a health care assistant, or similar, were the factors that could either positively or negatively impact on students. Conclusions Students need to be adequately prepared for the real-life clinical environment. Understanding, through socialisation theory, how students adapt to the workplace can facilitate this process. Facilitating students' learning includes supporting them, developing their confidence and ensuring that they have prior exposure to undertaking clinical skills. Relevance to practice Staff working with students in clinical practice can help facilitate students' learning and implementing of clinical skills through an understanding of how students adapt and 'fit in' to their working environment. [ABSTRACT FROM AUTHOR]; Copyright of Journal of Clinical Nursing is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The qualitative findings from an online survey investigating nurses' perceptions of spirituality and spiritual care

Abstract: Aims and objectives To provide an opportunity for members to express their understandings of spirituality and spiritual care. Background The role and place of spirituality within nursing have been contested by academics and wider society. One argument posited is supporting patients with their spiritual needs is not the responsibility of nurses. This is despite a clear professional requirement for nurses to achieve competence in the delivery of spiritual care. Design The Royal College of Nursing (RCN) conducted an online survey of its membership to ascertain their perceptions of spirituality and spiritual care identifying current practice. Methods This article presents the findings from the final part of the survey that asked respondents to use a free-text facility to add comments on the subjects of spirituality and spiritual care. Results Overall, 4054 RCN members responded, of these 2327 provided additional comments. These comments were analysed using keyword and content/thematic analysis. Five broad themes emerged: (1) theoretical and conceptual understanding of spirituality, (2) fundamental aspects of nursing, (3) notion of integration and integrated care, (4) education and professional development and (5) religious belief and professional practice. Findings suggest that nurses have diverse understandings of spirituality and the majority consider spirituality to be an integral and fundamental element of the nurses' role. Conclusion Generally, nurses had a broad, inclusive understanding of spirituality considering this to be ‘universal’. There was some uncertainty and fear surrounding the boundaries between personal belief and professional practice. Respondents advocated formal integration of spirituality within programmes of nurse education. Relevance to clinical nursing The concept of spirituality and the provision of spiritual care are now recognised as fundamental aspects of the nurse's role. There is a need for greater clarity between personal and professional boundaries to enable nurses to feel more confident and competent in delivering spiritual care.

Moral distress: levels, coping and preferred interventions in critical care and transitional care nurses

Abstract: Aims and objectives To examine the level and frequency of moral distress in staff nurses working in two types of units in an acute care hospital and to gather information for future interventions addressing moral distress. Background In 2008, the American Association of Critical Care Nurses published a Position Statement on Moral Distress. Nurses working in units where critically ill patients are admitted may encounter distressing situations. Moral distress is the painful feelings and/or psychological disequilibrium that may occur when taking care of patients. Design An exploratory, descriptive design study was used to identify the type and frequency of moral distress experienced by nurses. The setting was an acute care hospital in which the subjects were sampled from two groups of nurses based on their unit assignment. Methods A descriptive, questionnaire study was used. Nurses completed the 38-item moral distress scale, a coping questionnaire, and indicated their preferred methods for institutional support in managing distressing situations. A convenience sample of staff nurses was approached to complete the moral distress questionnaire. Results Overall, the nurses reported low levels of moral distress. Situations creating the highest levels of moral distress were those related to futile care. A significance between group differences was found in the physician practice dimension. Specific resources were identified to help guide future interventions to recognise and manage moral distress. Conclusion Nurses reported lower levels and frequency of moral distress in these units but their open-ended responses appeared to indicate moral distress. Nurses identified specific resources that they would find helpful to alleviate moral distress. Relevance to clinical practice There are numerous studies that identify the situations and the impact of moral distress, but not many studies explore treatments and interventions for moral distress. This study attempted to identify nurse preferences for lessening the impact of moral distress.

The role of aggressions suffered by healthcare workers as predictors of burnout

Abstract: Aims and objectives. To examine the prevalence of aggression against healthcare professionals and to determine the possible impact that violent episodes have on healthcare professionals in terms of loss of enthusiasm and involvement towards work. The objective was to analyse the percentage of occupational assault against professionals' aggression in different types of healthcare services, differentiating between physical and verbal aggression as a possible variable in detecting burnout in doctors and nursing professionals. Background. Leiter and Maslach have explored a double process model of burnout not only based on exhaustion by overload, but also based on personal and organisational value conflicts (community, rewards or values). Moreover, Whittington has obtained conclusive results about the possible relationship between violence and burnout in mental health nurses. Design. A retrospective study was performed in three hospitals and 22 primary care centres in Spain (n = 1·826). Methods. Through different questionnaires, we have explored the relationship between aggression suffered by healthcare workers and burnout. Results. Eleven percent of respondents had been physically assaulted on at least one occasion, whilst 34·4% had suffered threats and intimidation on at least one occasion and 36·6% had been subjected to insults. Both forms of violence, physical and non-physical aggression, showed significant correlations with symptoms of burnout (emotional exhaustion, depersonalisation and inefficacy). Conclusions. The survey showed evidence of a double process: (1) by which excess workload helps predict burnout, and (2) by which a mismatch in the congruence of values, or interpersonal conflict, contributes in a meaningful way to each of the dimensions of burnout, adding overhead to the process of exhaustion-cynicism-lack of realisation. Relevance to clinical practice. Studies indicate that health professionals are some of the most exposed to disorders steaming from psychosocial risks and a high comorbidity: anxiety, depression, etc. There is a clear need for accurate instruments of evaluation to detect not only the burnout but also the areas that cause it. Professional exhaustion caused by aggression or other factors can reflect a deterioration in the healthcare relationship. Language: en

The relationship between job satisfaction and intention to leave current employment among registered nurses in a teaching hospital.

Abstract: Aims and objectives: To assess Malaysian nurses' perceived job satisfaction and to determine whether any association exists between job satisfaction and intention to leave current employment. Background: There is currently a shortage of qualified nurses, and healthcare organisations often face challenges in retaining trained nurses. Job satisfaction has been identified as a factor that influences nurse turnover. However, this has not been widely explored in Malaysia. Design: Cross-sectional survey. Methods: Registered nurses in a teaching hospital in Malaysia completed a self-administered questionnaire. Of the 150 questionnaires distributed, 141 were returned (response rate = 94%). Results: Overall, nurses had a moderate level of job satisfaction, with higher satisfaction for motivational factors. Significant effects were observed between job satisfaction and demographic variables. About 40% of the nurses intended to leave their current employment. Furthermore, age, work experience and nursing education had significant associations with intention to leave. Logistic regression analysis revealed that job satisfaction was a significant and independent predictor of nurses' intention to leave after controlling for demographic variables. Conclusion: The results suggest that there is a significant association between job satisfaction and nurses' intention to leave their current employment. It adds to the existing literature on the relationship between nurses' job satisfaction and intention to leave. Relevance to clinical practice: Methods for enhancing nurses' job satisfaction are vital to promote the long-term retention of nurses within organisations. Attention must be paid to the needs of younger nurses, as they represent the majority of the nursing workforce and often have lower satisfaction and greater intention to leave than older nurses do. Strategies to nurture younger nurses, such as providing opportunities for further education, greater management decision-making capabilities and flexible working environment, are essential.

Quality of life and mental health among parents of children with cerebral palsy: the influence of self‐efficacy and coping strategies

Abstract: Aims and objectives To explore the quality of life and mental health of caregivers of children with cerebral palsy and to examine the impact of self-efficacy and coping strategies on these outcomes. Background Few studies analyse the impact of caring for a child with cerebral palsy on the caregivers' quality of life besides mental health. Also, less attention has been paid to the influence of caregiver's personal resources like self-efficacy or coping strategies on how they adjust to the child's illness and the care situation. Design Cross-section correlational design. Methods Sixty two parents of children with cerebral palsy completed measures to assess the quality of life (i.e. physical, environmental and social relationships), mental health (i.e. general mental health, depression and anxiety), self-efficacy and coping strategies. Results Parents of children with cerebral palsy had, in general terms, low levels of quality of life and mental health. Self-efficacy was related to most of the outcomes, whereas any of the coping strategies assessed was significantly related to the outcomes. Conclusions Quality of life and mental health can be affected in caregivers of children with CP. Personal resources like self-efficacy also need attention as they can help in the understanding of the differences in these outcomes and the design of effective interventions. Relevance of clinical practice Self-efficacy should be a key element in interventions addressed to parents of children with CP to elicit a process of empowerment that can improve the well-being of the family as a whole.

Pain, fatigue, disturbed sleep and distress comprised a symptom cluster that related to quality of life and functional status of lung cancer surgery patients.

Abstract: Aims and objectives To explore the common symptom cluster in lung cancer patients with surgical treatment and to evaluate the relationships between symptom cluster and patients’ disease outcomes, including functional status and quality of life. Background Lung cancer is one of the leading causes of cancer-related death for both men and women, and its incidence is increasing in China. Growing number of researches confirmed that symptoms in lung cancer patients with chemotherapy and radiotherapy occurred as ‘symptom cluster’ across the disease trajectory and influenced disease outcomes. However, few studies focused on the symptom cluster and its effects on quality of life and functional status of lung cancer surgery patients. Design This is a descriptive, cross-sectional design. Methods Symptoms in lung cancer surgery were assessed by M.D. Anderson Symptom Inventory, Karnofsky Performance Scale and Quality of Life Instruments for Cancer Patients – Lung Cancer. One hundred and forty-five individuals were involved in the survey. Results The top four common and most severe symptoms were pain, fatigue, disturbed sleep and distress for lung cancer surgery patients. 4·8% (n = 7) and 17·2% (n = 25) of patients reported co-occurrence of two or three symptoms of pain, fatigue, disturbed sleep and distress. About 76·6% (n = 111) of patients reported co-occurrence of all the four symptoms. There were strong negative relationships between the top four symptoms and Karnofsky Performance Scale and Quality of Life Instruments for Cancer Patients – Lung Cancer scores. Conclusion Pain, fatigue, disturbed sleep and distress constituted the common symptom cluster during the disease trajectory in patients with lung cancer who got surgical treatment and negatively affected their quality of life and functional status. Relevance to clinical practice Symptoms in lung cancer surgery patients often occurred as cluster during the trajectory of disease. To improve the well-being of patients, attentions need to be focused on developing symptom cluster management strategies.

The importance of preoperative information for patient participation in colorectal surgery care

Abstract: Aims and objectivesTo identify and describe patients' experiences of a preoperative information session with a nurse, as part of the enhanced recovery after surgery (ERAS) concept, and its impact o ...

Care and compassion: the experiences of newly qualified staff nurses

Abstract: Aims and objectives To explore newly qualified staff nurses' perceptions of compassionate care and factors that facilitate and inhibit its delivery. Background It is known that the transition from student to staff nurse is challenging due to a variety of factors including increased expectations of competence, inadequate staffing levels and eclectic support. Methods A qualitative approach was taken. Data from newly qualified staff nurses (within first year post registration) were collected by focus groups (n = 6, total participants = 42), using a flexible agenda to guide discussion. Data were analysed to locate codes and themes. Results Support for newly qualified staff was eclectic rather than systematic. Participants felt they were ‘flung in at the deep end’ and ‘left to sink or swim’. Some staff were perceived as ‘ingrained in the woodwork’ and resistant to change of even a minor nature, creating an environment of ‘institutionalised negativity’. Clinical supervision was considered a support when available. Compassionate care was a tautology for most participants, that is, care would not be care in the absence of compassion. Compassion as a concept was described frequently with reference to situations in which it was absent. Nursing was ‘more than just a job’, but an occupation in which ‘emotional engagement’ is not only desirable but a prerequisite for provision of high-quality care. Conclusion Findings indicated a tension between ‘agency’ (the ability of individuals to act) and ‘structure’ (physical, social, managerial and cultural environments within which care takes place). Supportive environments facilitate provision of compassionate care although individuals remain accountable for their own practice. This study adds depth to existing literature about newly qualified staff nurses, with specific reference to compassionate care. Relevance to clinical practice Undergraduate nursing programmes should prepare students for the reality of delivering compassionate care despite competing commitments. Managers of care settings should ensure that a formalised supportive framework is in place for registered nurses throughout their first year of practice

Developing complex interventions for nursing: a critical review of key guidelines

Abstract: Aims and objectives To identify the most comprehensive approach to developing complex interventions for nursing research and practice. Background The majority of research in nursing is descriptive and exploratory in nature. There is an increasing professional and political demand for nurses to develop and provide evidence to support their practices. Nurses need to explore current practice and develop and test interventions to provide the evidence required for safe practice. Design A literature review using a systematic approach. Methods The review was carried out using four databases: CINAHL, PubMed, PsycINFO and BNI (2000–2011), and the search was limited to ‘brief interventions’ and complex intervention development (January 2000–September 2011). Included papers reported on guidelines for intervention development or ‘how’ an intervention was developed. Results Six papers reported on guidelines for developing interventions. There are many similarities between the guidelines with a similar pattern of guideline development in Europe and the USA. The only guideline reported to have been used in the development of interventions is the Medical Research Council framework (MRC) (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000), with 9 of 14 papers that describe the development of an intervention reporting the use of this guideline. The other five papers did not mention the use of any guideline or framework. Conclusions The MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework appears to be the most widely used guideline reported for developing complex interventions. Although the updated MRC (Developing and Evaluating Complex Interventions, 2008) framework adds considerably to the original MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework, other guidelines contribute additional guidance which can inform the development of nursing interventions. These additional guidelines are presented in a model for developing complex interventions for nursing. Relevance to clinical practice The model will help nurses planning to develop nursing interventions as it provides additional and nursing-specific guidance to the MRC (Developing and Evaluating Complex Interventions, 2008) framework for the development of complex interventions for nursing practice.

Medication administration errors by nurses: adherence to guidelines

Abstract: Aims & objectives Medication administration errors represent one of the major concerns in patient safety. We aimed to study the rate using more robust methods for the correct results. Backgrounds Very few studies have been carried out on medication administration error frequency. Previous studies of medication error frequency have used mainly surveys of clinical nurses, which may result in substantial undercounts. Design & Methods We developed a checklist using basic medication guidelines including the Five Rights, infection recommendations and medication recording rules. After validity and reliability were confirmed, we performed direct observation using a checklist to evaluate the medication activities of clinical nurses. Results We observed total 293 cases of medication activities, collected data and calculated adherence ratios per item. Only 45·6% of nurses verified the amount of medication indicated on the vial at least once for at least one-second. In addition, only 6·5% read the name of the patient from the wristband. Administering the medication at the correct time guideline was observed 41·0% of the time. The guideline regarding hand washing before external and oral medications was followed only 4·5% of the time, although this figure was much higher for intravenous medications at 96·6%. Overall, among 31 categories regarding drug administration, 17·2 (± 3·6) items per person were followed, whereas 5·7 (± 1·2) items per person were violated. Conclusion Thus, the results overall showed low rates of adherence to guidelines, suggesting that many medication administration guidelines are not strictly followed. We found key instances in which nurses did not follow the guidelines, including many from the Five Rights. About one in four elements were violated overall. Relevance to clinical practice The results of this study could be adopted to make guidelines of medication administration more practical for the clinical nurses to adhere.

Qualitative exploration of nurses' decisions to activate rapid response teams.

Abstract: Aims and objectives To identify barriers and facilitators to nurses' decisions regarding activation of rapid response teams (RRTs) in hospitals. Background Hospitalised patients in the United States who experience cardiopulmonary arrest seldom recover. Most of these patients show signs of clinical deterioration prior to cardiopulmonary arrest. RRTs have been shown to decrease the incidence of cardiopulmonary arrest by bringing needed resources to unstable patients. Despite the evidence in support of the activation of RRTs, nurses do not always use this resource. Nurses' decisions to activate or not to activate the RRT are not clearly understood. Design We used a qualitative design for this study. Methods A purposive sample of 15 medical/surgical nurses was recruited from a small medical centre in the Midwest. Researchers used semistructured, open-ended questions to elicit subject responses regarding facilitators and barriers to activating RRTs. Results Themes emerged and were categorised as facilitators and barriers to calling the RRT. Facilitators and barriers were then subdivided into distinct subthemes: RRT characteristics and unit culture. The expertise of the RRT members and support and encouragement from nursing unit colleagues and leaders emerged as two potential facilitators. Communication of the RRT members and calling the physician first emerged as two potential barriers. We also identified educational factors that were not clearly facilitators or barriers to calling the RRT. Conclusions Further study is needed using quantitative designs with larger sample sizes. Relevance to clinical practice Nurses can build upon knowledge of facilitators and barriers related to RRT characteristics and nursing unit culture.

The experience of food, eating and meals following radiotherapy for head and neck cancer: a qualitative study

Abstract: Aims and objectives. To describe the experience of food, eating and meals following radiotherapy in patients with head and neck cancer.Background. Eating problems are common in patients with head a ...

Staff engagement as a target for managing work environments in psychiatric hospitals: implications for workforce stability and quality of care.

Abstract: Aims and objectives To examine relationships between practice environment ratings, workload, work engagement, job outcomes and assessments of quality of care in nursing personnel in psychiatric hospitals. Design Cross-sectional survey. Background A broad base of research studies in health care reveals important links between work environment factors, staff burnout and organisational outcomes that merit examination in inpatient mental healthcare settings. Work engagement, a positively framed parallel construct for burnout, may offer an additional insight into the impacts of work on staff. Methods A sample of 357 registered nurses (65·5%), licensed practical nurses (23·5%) and non-registered caregiver (10·6%) of two Belgian psychiatric hospitals were surveyed. A causal model was tested using structural equation modelling, whereby it was proposed that work engagement would be influenced by work environment factors and itself impact perceived quality of care and staff job outcomes such as job satisfaction and turnover intentions. Results An adjusted model was confirmed. Practice environment features influenced staff vigour and dedication and demonstrated positive effects on job satisfaction, turnover intentions and perceived quality of care through their effects on absorption. Conclusion The findings of this study suggest that work engagement is a likely direct consequence of practice environments that may ultimately have impacts on both staff and patient outcomes. Relevance to clinical practice Leaders, nurse managers, clinicians as well as nurses themselves should be aware of the importance of work environments in mental healthcare facilities that favour engagement. Future efforts should focus on developing and sustaining practice environments that engage mental healthcare workers within interdisciplinary teams with the goal of creating a stable workforce possessing optimal possible knowledge, skills and abilities for delivering care.

Identifying challenges of living with type 1 diabetes: child and youth perspectives.

Abstract: Aims and objectives To identify challenges children and youth with type 1 diabetes encounter from their own perspectives. Background Type 1 diabetes requires lifestyle changes involving diet modification, monitoring blood glucose, counting carbohydrates and administering insulin. Learning self-care and developing positive attitudes can improve glucose management and promote long-term benefits. Therefore, understanding challenges of youth living with type 1 diabetes from their own perspective is an important first step in improving diabetes outcomes for this age group. Design Qualitative descriptive design using focus groups to identify the experiences and challenges of children and youth living with type 1 diabetes. Methods Six focus groups were held over a four-month period in 2010; each participant attended one focus group. A total of 16 children and youth with type 1 diabetes participated. The focus group discussions were audio recorded, transcribed verbatim and analysed for common themes according to qualitative methodology. To assure trustworthiness, investigators independently coded interviews and themes were refined and adjusted until consensus was reached. Results Three themes emerged after analysing transcripts from the focus groups that embody challenges children and youth with type 1 diabetes faced: (1) low blood glucose; (2) self-care activities; and (3) feeling different and/or alone. Conclusions Data indicated type 1 diabetes is challenging for this age group. These challenges must be addressed to assist youth in learning to manage their disease and promote healthy outcomes. Relevance to clinical practice It is important for nurses to discuss challenges, understand perspectives of this age group, listen to their concerns, work with them to develop strategies promoting health, minimise complications, reduce or eliminate feeling different or alone and assist parents' efforts to be supportive.

Nurse practitioner job satisfaction: looking for successful outcomes

Abstract: Aims and objectives To examine overall job satisfaction and its association with extrinsic and intrinsic characteristics of job satisfaction among nurse practitioners at the chosen practice site. The objectives were to identify relevant retention and recruitment strategies, from the nurse practitioners perspective, by examining (1) what role aspects are most satisfying, and (2) approaches for successful, professional development and integration in the role. Background Supportive professional practice environments are particularly important to nurses’ satisfaction with their work and the quality of patient care provided. Hence, research that examines nurse practitioners practice implications and barriers in today's healthcare system is essential. Design/Methods A descriptive-correlational design using survey methodology. A nonprobability sample of convenience was used. The outcome measures were: The Misener Nurse Practitioner Job Satisfaction Scale and two investigator-developed surveys. Results Participants expressed dissatisfaction with professional and monetary recognition, assertive influence, administrative support and collegial relationships. Conclusions Interaction of subscale factors on overall job satisfaction and demographic survey findings has important implications for health administrators and nurse practitioners in similar organisations. Relevance to clinical practice Stakeholders in healthcare milieus need to be fully engaged in the redesign of the American healthcare system heeding the recommendations of the Institute of Medicine to provide safer health systems to the public. By doing this, issues related to frustration by nurse practitioners related to job satisfaction will be addressed. The need for cooperation, participation, collaboration and instrumental communication are essential in the delivery of safe, quality patient care. A better understanding of intrinsic professional rewards needs to be learned by nurse practitioners who want to seek professional satisfaction and engage in the survival and growth of the profession. Nurse practitioners armed with this translational information have viable agenda items that can be negotiated into extrinsic rewards.

A systematic review on the effectiveness of prewarming to prevent perioperative hypothermia.

Abstract: Aims and objectives To analyse available research on the effectiveness of prewarming to prevent perioperative hypothermia and identify knowledge gaps for future research. Background Perioperative hypothermia is common and causes complications, such as coagulation and platelet function abnormalities; increased cardiac morbidity, surgical site infection, and pressure ulcer incidence levels. In this context, several methods have been investigated to prevent perioperative hypothermia, including prewarming. Prewarming is defined as the warming of peripheral tissues or the skin surface before anaesthetic induction and may consist of an active cutaneous warming system or the preoperative administration of vasodilation drugs. Design Systematic review. Methods We searched CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline (January 1990–November 2011) for randomised controlled trials on the effectiveness of prewarming for prevention of perioperative hypothermia, published in English, Spanish and Portuguese, and involving elective surgery patients aged 18 years or older. Results Of 730 identified studies, only 13 met the inclusion criteria. After hand-searching the reference lists of included studies, an additional study was identified for a total sample of 14 studies. The results suggest that forced-air warming system is effective to reduce hypothermia when applied for the prewarming of surgical patients. Conclusion Prewarming patients with the forced-air warming system might be effective to reduce perioperative hypothermia, and new studies are needed to examine the use of carbon fibre technology. Relevance to clinical practice Nurses can use this review to inform decision-making on a prewarming programme in the perioperative period. They can also develop research on strategies to put in practice prewarming in the surgical context.

Family members' perceptions of the nursing bedside handover

Abstract: Aims and objectives. To explore families’ perceptions of shift-to-shift bedside handover. Background. The potential role families can play in bedside handover is unknown. Understanding family members’ perceptions can provide a foundation for nurses to tailor their bedside handover to family members’ perceptions, encouraging their involvement and potentially improving patient care. Design. Qualitative study, using case study methodology. Methods. The study was conducted with eight family members in one rehabilitation ward in Queensland, Australia, in 2009. Data included observations of bedside handover, field notes and in-depth interviews. Thematic analysis of data was conducted to identify unique and common themes indicative of family perceptions. Results. Three major themes emerged. The first, understanding the situation, consisted of three subthemes: feeling informed, understanding the patient’s condition and understanding patient’s treatment. The second theme was interacting with nursing staff, with five subthemes, including sharing information, clarifying information, assisting in care, asking questions and interpreting for the patient. The final subtheme was finding value, which contained five subthemes: feeling at ease, feeling included, valuing individualisation, preparing for the future and maintaining patient privacy. Conclusions. Bedside handover provides an opportunity to involve family members in patient care and promote family-centred care core concepts. Family members value the chance to participate and can ultimately improve the accuracy of handover communication. Relevance to clinical practice. Bedside handover is beneficial for nurses, patients and family members and embodies patient and family-centred care. Managers should consider its implementation in hospitals, developing strategies such as standard operating protocols for a more family inclusive approach to communication. Nurses may require further training to best undertake bedside handover and involve family members in care. The study suggests expansion of research into this important area of family-centred care.

Motivational interviewing and exercise programme for community-dwelling older persons with chronic pain: a randomised controlled study.

Abstract: Aims and objectives To examine the effectiveness of an integrated motivational interviewing and physical exercise programme on pain, physical and psychological function, quality of life, self-efficacy, and compliance with exercise for community-dwelling older persons with chronic pain. Background Chronic pain is common among older persons. Indeed, motivation for managing pain is poor, and may cause negative consequences. Motivational interviewing maybe effective in treating chronic pain. Design Single-blinded randomised control study. Methods Older persons with chronic pain (n = 56) were recruited from two elderly community centres. They were blinded from the group allocation. The programme was conducted by an motivational interviewing-trained physiotherapist and registered nurses. Participants in the experimental group received an 8-week integrated motivational interviewing and physical exercise programme, while the control group received regular activities in the centre. Motivational interviewing used open-ended questions to encourage participants to express and recognise their pain and behaviours and professional feedback was given accordingly. Pain intensity, pain self-efficacy, anxiety, happiness, depression, mobility and quality of life were measured before and after the motivational interviewing and physical exercise programme. Attendance and compliance rate of the programme was calculated in the experimental group. Results Significant improvements in pain intensity, pain self-efficacy, anxiety, happiness and mobility after the motivational interviewing and physical exercise programme (all p < 0·05) for experimental group, while no significant improvement in control group except on the happiness scale. Regarding group differences in the outcome measures, the change scores on pain intensity, state anxiety and depression were significantly better in the experimental group. Conclusion Motivational interviewing and physical exercise programme is effective in improving pain, physical mobility, psychological well-being and self-efficacy for community-dwelling older persons with chronic pain. Relevance to clinical practice Motivational interviewing is a feasible counselling technique whose content can be modified based on target group to change maladaptive behaviours, elicit ambivalences and enhance self-efficacy for making changes. Thus, promoting motivational interviewing and physical exercise programme to older persons with pain is effective and important.

Children's and parents' perceptions of postoperative pain management: a mixed methods study.

Abstract: AIMS AND OBJECTIVES: To explore children's and parents' perceptions about the quality of postoperative pain management. BACKGROUND: Children continue to experience moderate to severe pain postoperatively. Unrelieved pain has short- and long-term undesirable consequences. Thus, it is important to ensure pain is managed effectively. Little research has explored children's and parents' perceptions of pain management. DESIGN: Exploratory study. METHODS: Children (n = 8) were interviewed about their perceptions of pain care using the draw-and-write technique or a semi-structured format and asked to rate the worst pain experienced postoperatively on a numerical scale. Parents (n = 10) were asked to complete the Information About Pain questionnaire. Data were collected in 2011. RESULTS: Most children experienced moderate to severe pain postoperatively. Children reported being asked about their pain, receiving pain medication and using non-pharmacological methods of pain relief. A lack of preoperative preparation was evident for some children. Most parents indicated they had received information on their child's pain management. Generally, participants were satisfied with care. CONCLUSION: Participants appeared satisfied with the care provided despite experiencing moderate to severe pain. This may be attributable to beliefs that nurses would do everything they could to relieve pain and that some pain is to be expected postsurgery. RELEVANCE TO CLINICAL PRACTICE: Children are still experiencing moderate to severe pain postoperatively. Given the possible short- and long-term consequences of unrelieved pain, this is of concern. Knowledge translation models may support the use of evidence in practice, and setting a pain goal with parents and children may help improve care.

Professional competence of practising nurses

Abstract: Aims and objectives To compare nurse competence in terms of its quality and frequency of action in medical, surgical, paediatric/obstetric/gynaecological and psychiatric clinical fields. Background One challenge of current health care is to target practising nurses' competencies to optimal use. Therefore, a systematic assessment of nurse competence is justified. Studies using the Nurse Competence Scale have found that nurses' competence is on a good or very good level and it increases with age and work experience. Design A cross-sectional comparative survey using the Nurse Competence Scale. Methods A purposive sample of 2083 nurses in a major University Hospital in Finland participated in this study in 2007–2008. Descriptive statistics and inferential statistics' anova with Bonferroni correction, and Pearson/Spearman correlation coefficients were used to analyse the data. Results The overall level of competence of nurses was good, and the quality of action correlated positively with the frequency of action. Nurses in the psychiatric field reached somewhat higher overall mean scores than nurses in other clinical fields. On item level, nurses seemed to be the most competent in actions related to immediate individualised patient care, the maintenance of their own professional competence and commitment to nursing ethics. Age and particularly work experience were positively correlated with the competence. Conclusion Findings from this large data corroborate previous study results on the category level assessment of nurse competence using the Nurse Competence Scale indicating a good level of competence. On item level, findings revealed more detailed themes of nurse competence, which complements earlier knowledge retrieved from the category level analysis and could be used to target nurses' competencies to even more optimal use. Relevance to clinical practice Competence assessment and targeted interventions are recommended as tools for the management for planning nurses' career development and continuing education to ensure competent and motivated work force and high-quality care.