Conectar
The aim of this paper is to present the evidence on the effectiveness of non-surgical interventions to improve health and well-being in women living with Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome.
Systematic review guided by Preferred Reporting Items for Systematic Reviews checklist.
The search was conducted between June and September 2022 across the following databases: CINAHL, EMBASE, Medline, PsycINFO and Cochrane. Trial registries (clinicaltrials. gov, World Health Organization International Clinical Trials Registry Platform (ICTRP), Cochrane Controlled Trials Register-CCTR), Google scholar, dissertations, conference proceedings and reference lists of included studies were also searched. Corresponding authors, formal and informal MRKH groups were contacted to obtain any significant studies or reviews.
Eligible were only English-language empirical studies of any time period. The review followed narrative synthesis.
Twenty-three studies were identified that fit the inclusion criteria which included 1540 MRKH syndrome affected women. Four studies were on psychological interventions (n = 85) and 19 studies (vaginal dilation therapy n = 897, coital dilation n = 57) focused on non-surgical vaginal dilation as a measure to vaginal agenesis in MRKH syndrome.
Clearly, vaginal dilation is a viable initial treatment option for women with MRKH syndrome. There is limited evidence that ‘coital dilation’ is an effective method of dilation for vaginal agenesis. The literature, however, supports the need for psychological intervention to improve health and well-being.
Women with MRKH syndrome who require dilation can receive guidance and support from their healthcare providers, particularly sexual and reproductive health nurses, clinical nurse specialists and gynaecologists. From the point of diagnosis, clinical psychologists should be involved. As much as feasible, family and partner support can be encouraged.
No patient or public contribution.
To outline the theoretical, philosophical, and major assumptions associated with phenomenography and then address the application of a phenomenographical approach within the context of midwifery research.
Phenemonography is a little-known qualitative research approach amongst the main design traditions of phenomenology, grounded theory, case study, and ethnography more typically used within midwifery research. Phenomenography aims to describe the qualitatively different ways that people perceive, conceptualize, or experience a phenomenon. Phenemonography has a distinctly different approach from other qualitative methods as it places emphasis on the ‘collective’ meaning over individual experience.
Phenomenography, as an approach, rests within the interpretivist paradigm recognizing that there are multiple interpretations of reality. Phenomenography emphasizes the various ways that people experience the same phenomenon, including both the similarities and differences. The second-order perspective embraced by phenomenography suggests that the researcher directs themselves towards people's understanding of the world; essentially the world is described as it is understood rather than as it is. It is the reporting about how these different realities appear at a collective level that is the output of phenomenographic research.
A framework for conducting phenomenographic research is illustrated by outlining the steps within the methodological approach required to undertake a research study using phenemonography.
Phenomenography is a qualitative research approach that can usefully be applied in many midwifery contexts where a collective understanding of a phenomena is required. Using a phenomenographic approach can provide the midwifery profession with knowledge about variations in how women and midwives think, and how aspects of different phenomena are experienced in within a midwifery setting.
To explore nurses' and doctors' experiences of providing care to people brought in by police (BIBP) to the emergency department (ED).
A qualitative interpretive study using in-depth individual interviews.
Semi-structured interviews were conducted with nurses and doctors who worked in various EDs in one Australian state and were involved in the care of people BIBP. Interviews were undertaken between May and October 2022 and focused on the structures (i.e., what), processes (i.e., how) and outcomes of care for people BIBP. Data were analysed using deductive and then inductive content analysis.
Nine nurses and eight doctors were interviewed. Structures described by participants included human structures (staff) and organizational structures (areas for assessment, involuntary assessment orders, investigations, chemical/physical restraints). For processes, participants described practices including risk/mental health assessments, legal considerations, and increased/decreased levels of care compared to other presentations. Communication processes were largely between police and health care staff. Service outcomes pertained to discharge location (custody, community, hospital admission) and length of stay.
The current care delivery for people BIBP to the ED is unique and complex, often occurring in high traffic, resource-intensive areas. There is a need to strengthen structures and processes, to improve service outcomes.
Understanding the care requirements for people brought into ED by police enables the delivery of targeted care alongside appropriate resource allocation.
This study provides a comprehensive understanding of the health care requirements for people BIBP to EDs. Interventions delivered in the ED to support health care delivery for people BIBP and foster clinician and police relationships are required to optimize patient and health service outcomes.
This study adheres to the COREQ checklist (Table S1) of the EQUATOR guidelines.
This study focused on ED staff experiences.
Organizational culture has been studied for over four decades among nurses, across countries and contexts. However, wide variation exists in how the concept has been defined and at what level of the organization it is measured. The aim of this study was to use a dimensional analysis to conduct a conceptual synthesis of unit culture from a nursing perspective.
Dimensional analysis, rooted in grounded theory methodology, was used to describe unit culture from a nursing perspective.
A literature search was conducted in April 2022. Inclusion criteria were (1) peer review publications, (2) used the term ‘unit culture’ or ‘ward culture’, (3) references nurses' role in unit culture, (4) published in the last 20 years and (5) written in English. One hundred fifteen articles met inclusion criteria, but dimensional saturation was researched after coding 24 articles.
Findings were synthesized into four core dimensions and 10 subdimensions. Dimensions of unit culture included customs (practice norms, communication and prioritization), shared beliefs (assumptions, values and attitudes), hierarchy (social and informational) and atmosphere (emotional climate and collaboration). Conditions that shape unit culture include individual nurse characteristics, working conditions, unit policies/procedures and leadership. Unit culture impacts nurse work experiences and decision-making processes, which can affect outcomes including nurse wellbeing, practice behaviours and adherence to unit policies.
Identifying the dimensions of unit culture helps to bring clarity to a concept that is not well defined in existing literature.
This model of unit culture can be used to guide development of new instruments to measure unit culture or guide researchers in utilizing existing measures. Developing measures specific to unit culture are warranted to strengthen researchers' ability to assess how changing conditions of a unit (e.g. leadership, workload) changes unit culture and its related outcomes.
No Patient or Public Contribution.
To evaluate and summarize the evidence for prevention and management of enteral feeding intolerance in critically ill patients and provide reference for clinical practice.
This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing.
Current literatures were systematically searched for the best evidence for prevention and management of enteral feeding intolerance in critically ill patients. Literature types included clinical guidelines, best practice information sheets, expert consensuses, systematic reviews, evidence summaries and cohort studies.
UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Sinomed, Web of Science, Yi Maitong Guidelines Network, DynaMed, MEDLINE, CNKI, WanFang database, Chinese Medical Journal Full-text Database, European Society for Clinical Nutrition and Metabolism website, the American Society for Parenteral and Enteral Nutrition website were searched from January 2012 to April 2023.
We finally identified 18 articles that had high-quality results. We summarized the 24 pieces of best evidence from these articles, covering five aspects: screening and assessment of the risk of enteral nutritional tolerance; formulation of enteral nutrition preparations; enteral nutritional feeding implementation; feeding intolerance symptom prevention and management; and multidisciplinary management. Of these pieces of evidence, 19 were ‘strong’ and 5 were ‘weak’, 7 pieces of evidence were recommended in level one and 4 pieces of evidence were recommended in level two.
The following 24 pieces of evidence for prevention and management of enteral feeding intolerance in critically ill patients were finally recommended. However, as these evidences came from different countries, relevant factors such as the clinical environment should be evaluated before application. Future studies should focus on more specific symptoms of feeding intolerance and more targeted prevention design applications.
The clinical medical staffs are recommended to take evidence-based recommendations for the implementation of standardized enteral nutrition to improve patient outcomes and decrease gastrointestinal intolerance in critically ill patients.
The management of enteral nutrition feeding intolerance has always been a challenge and difficulty in critically ill patients. This study summarizes 24 pieces of the best evidence for prevention and management of enteral nutrition feeding intolerance in critically ill patients. Following and implementing these 24 pieces of evidence is beneficial to the prevention and management of feeding intolerance in clinical practice. The 24 pieces of evidence include five aspects, including screening and assessment of the risk of enteral nutritional tolerance, formulation of enteral nutrition preparations, enteral nutritional feeding implementation, feeding intolerance symptom prevention and management and multidisciplinary management. These five aspects constitute a good implementation process. Screening and assessment of enteral nutritional tolerance throughout intervention are important guarantees for developing a feasible nutrition program in critically ill patients. This study will be benefit to global medical workers in the nutritional management of critically ill patients.
This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute (JBI). The reporting specifications include problem establishment, literature retrieval, literature screening, literature evaluation, the summary and grading of evidence and the formation of practical suggestions. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is ‘Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients’, the registration number is ‘ES20231823’.
To construct key quality indicators for aged care facilities in China.
Evaluating the care quality in aged care facilities is problematic. Evaluation of nursing care quality is important for improving nursing and self-supervision in aged care facilities. However, a few regulations and studies regarding care quality evaluation have been implemented in China.
This two-tier Delphi study aimed to achieve consensus on key quality indicators for aged care facilities in China. The entry pool was determined by literature review and research team discussion, followed by a discussion by a panel of experts to establish the items of the Delphi study. Finally, key care quality indicators were established through a two-round Delphi study. This study followed the SQUIRE 2.0 guidelines.
The initial 16 quality indicators of the entry pool was developed based on a literature review and a group discussion. Sixteen quality indicators were reduced to eight after the expert discussion. After two rounds of expert consultation, the eight quality indicators became nine, which were then evaluated for importance, formula rationality, and operability using Kendall's harmony coefficients (first round: 0.150, 0.143 and 0.169, respectively; second round: 0.209, 0.159 and 0.173, respectively).
Key quality indicators provide quantifiable evidence for evaluating the care quality in aged care facilities, but their applicability needs continuous improvement.
Nine key quality indicators were selected from numerous indicators for measuring the care quality in aged care facilities, supporting the evaluation of the care quality and self-supervision for aged care facilities.
No elderly or public contribution.
To identify latent profiles of competence and perceptions of spiritual care among clinical nurses and explore the possible influencing factors.
Understanding nurses' level of spiritual care competence and their perceptions and acceptance of such care is important, which could help devise nurse training programmes to address such competence in clinical nurses. However, research addressing interindividual variability in competence and perceptions among Chinese nurses is lacking.
Multicentre cross-sectional study.
Nurses working in departments with critically ill patients from 12 community, 5 secondary and 10 tertiary hospitals in Shanghai completed a demographic information questionnaire and the Chinese versions of the Spiritual Care Competence Scale, Spiritual Care-Giving Scale and Spiritual Perspectives Scale. The data were analysed using IBM SPSS v26.0 and Mplus version 8.3. Latent profile analysis identified subgroups with different levels of spiritual care competence.
In total, 1277 Chinese nurses were recruited. Four profiles of competence and perceptions of spiritual care were revealed: Low ability (23.8%), High ability (6.4%), High acceptance (34.9%) and Moderate (34.9%). The level of job position, spiritual care-related education, hospital grade and nurses' perceptions and perspectives of spiritual care predicted the probability of profile memberships in their competence.
There was heterogeneity in the characteristics of spiritual care competence. Nursing managers can implement individualised interventions, including relevant training, according to the influencing factors of different competence profiles to improve the level of such competence among nurses.
The results provide a new and expanded view of improving nurses' spiritual care competence. Interprofessional collaboration with clinicians, administrators, educators and spiritual leaders can contribute to the development of related education and training.
EQUATOR guidelines, STROBE checklist: cross-sectional studies.
All participants were clinical nurses. Participants were informed they could withdraw from the study at any time.
Hospital-acquired pressure injuries (HAPIs) are a global high-stakes patient safety issue. Key stakeholder perspectives regarding their role and experiences with pressure injuries is critical as part of the solution to minimizing HAPI occurrence and attain sustainability.
A qualitative, descriptive approach provided multiple perspectives of key stakeholders to support the complexity of HAPI care. The qualitative data are a part of a mixed method convergent research study examining pressure injury prevention and management practices.
Nursing system theory, mixed method convergent design, and participatory action research methodologies were chosen to address both the gap analysis development and results, achieve collaborative comprehensiveness, and enable key stakeholder involvement throughout this HAPI prevention and management initiative. Participants were recruited and enrolled from a large Level I trauma hospital and the key stakeholders. Demographic information were collected prior to the individual interview. Focused interviews were conducted virtually using zoom technology. Qualitative data were analyzed using NVivo software and thematic analysis was confirmed across the co-investigators for congruence and applicability to the research questions.
Qualitative interviews with 26 key stakeholders provided data to support and integrate a link with gap analysis results on the complex health issue of HAPIs. Specific barrier and recommendation themes identified interventions that could be prioritized. The 52 barrier and 52 recommendation themes/sub-theme(s) respectively were organized by Donabedian (structure, process, and outcome) with structure elements the majority. The top three structure barrier themes involved equipment and standards for use, staff prevention education, and specialized health professionals. The top three structure recommendation themes involved specialized health professionals, equipment and standards for use, and an educational plan for those at risk or with HAPIs.
The article provides findings from the qualitative portion of a mixed method study related to HAPIs. The qualitative findings associated with the gap analysis quantitative results, achieved the goal of the participatory action research key stakeholders' input into HAPI care and can be replicated internationally.
The benefit of key stakeholder's involvement in solving a clinical problem is sustainability. A quantitative approach and integrating qualitative stakeholders' perspectives provide an in-depth solution that will advance nursing capacity toward health care delivery and HAPI nursing science and policy development on a global level.
To use co-design principles to design a nationwide maternity experiences survey and to distribute the survey through social media.
A co-designed, cross sectional, and national online survey.
Using co-design principles from study design and throughout the research process a cross-sectional, online, national survey of Australian women's experiences of maternity care was designed. Four validated survey instruments were included in the survey design.
An extensive social media strategy was utilized, which included paid advertising, resulting in 8804 surveys for analysis and 54,896 comments responding to open text questions.
The inclusion of co-design principles contributed to a well-designed survey and consumer involvement in distribution and support of the online survey. The social media distribution strategy contributed to high participation rates with overall low marketing costs.
Maternity services should be designed to provide woman-centered, individualized care. This survey was co-designed with maternity users and maternity organizations to explore women's recent experiences of maternity care in Australia. The outcomes of this study will highlight the factors that contribute to positive and negative experiences in maternity services.
As a co-designed study, there was consumer engagement from the design of the study, throughout the research process.
Missed nursing care (MNC) significantly affects patient safety and quality of care. It is a widely used concept that has been studied in different settings, but research in paediatric care is quite limited. Therefore, this descriptive cross-sectional study aimed to report the prevalence, patterns, correlates, factors and predictors of MNC in paediatric care units in two central European countries.
A cross-sectional comparative study.
Data collection was carried out between June and November 2021 using the MISSCARE Survey-Pediatric. The study included 441 registered nurses working in paediatric care units in the Czech Republic and Slovakia. Data were analysed using descriptive and inferential statistics in the SPSS 25.0 statistical program.
Almost all nurses, 92.7% of nurses missed at least one nursing activity during the last shift. The most missed care activity in both countries was the promotion of neuroevolutionary development, and the most prominent reasons were labour resources. MNC was weakly but significantly correlated with nurse experience in the current position and was predicted by the country, nurse education and overtime hours (p ≤ .05). Differences in prevalence of MNC and reasons for MNC were identified based on several variables (p ≤ .05).
The assessment of MNC in paediatric settings is often a neglected area, although the prevalence in this study was moderate.
Nurse staff shortages, as a global problem, have many impacts on patient outcomes in the delivery of nursing care. However, there are also many factors that can reduce the prevalence of MNC. More research should focus on a closer examination of these factors that involve hospital and nurse variables.
The study was carried out according to the STROBE checklist and the RANCARE guideline.
No patient or public contribution.
Gynaecological cancer illness and treatment have a significant impact on women's sexual health and concerns regarding sexual health are known to be an unmet need in survivors. The digital support programme Gynea was designed to enhance women's health, including sexual health, after gynaecological cancer treatment. This study aimed to explore how cancer survivors experienced participation in Gynea.
This is a phenomenological hermeneutic study. Individual, in-depth semi-structured interviews were conducted to explore lived experiences. Twenty women were interviewed after completing the Gynea programme. The transcripts were analysed using Lindseth and Norberg's phenomenological hermeneutic method.
Three main themes (with subthemes) emerged from the analysis: (1) A silent existential trauma; (2) Redefining sexual health; (3) Communicating with a partner about sexuality. The women redefined sexual health rather than just being sexual intercourse, being a rediscovery of the body. The women's increased awareness and understanding of their own sexual health empowered their communication about their sexuality with their partners. This was important for regaining sexual health and intimacy in their relationships.
Participation in Gynea helped to strengthen the women's sexual integrity. Knowledge and support empowered them to take care of their sexual needs and communicate these with their partners.
Healthcare services and nurses need to be aware that sexual health is an existential state of being, in which good sexual health does not necessarily equate to sexual function, but rather to sexual empowerment. Digital support with nurse guidance can support women in caring for their sexual health after cancer illness by thematizing sexual health with a holistic approach and should be part of the medical treatment.
Twenty gynaecological cancer survivors contributed by sharing their experiences from the sexual health module in Gynea.
To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID-19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health-related quality of life and cost-effectiveness.
Parallel two-arm, cluster-level randomized controlled trial.
Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID-19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient-reported co-primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention-to-treat analyses.
We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570–572 (98.1%–98.5%) patient participants in 14 clusters. We found no evidence of between-group differences on any patient, nurse or economic outcomes. We found between-group differences over time, in favour of the intervention, for three of our five co-primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the ‘other’ ethnicity subgroup.
We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non-white British patients' experience of care.
We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required.
Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non-white British patients' experience of care.
CONSORT and CONSERVE.
Patients with experience of hospitalization with COVID-19 were involved in guideline development and writing, trial management and interpretation of findings.
To understand the experiences of HIV nurses in the context of ambivalence between biomedical treatment advancements and the continuing burden for people living with HIV and negative representations of HIV.
An interpretative phenomenological study was conducted using in-depth interviews.
Twenty-one interviews with nurses were conducted between November 2021 and March 2022. A thematic analysis was performed.
Six themes related to the nurses' experiences emerged. Despite effective treatment for most people with HIV, nurses identify patient populations that require additional care. Nurses are flexible in making extra appointments to accommodate complex issues in these patients. Nurses develop a unique relationship with their patients based on trust and empathy, linked to patient's experiences with stigma and discrimination for people with HIV. Nurses perceive their tasks as becoming increasingly complex. There is explicit awareness about the changes in HIV care from acute to chronic care and how this affects nurses' tasks. Nurses continue to differentiate HIV from other chronic conditions.
Biomedical advancements change the organization of HIV care while public health concerns remain and patient population has particular needs due to negative social representations of HIV. Nurses navigate these issues in their everyday care.
A potential re-evaluation of the role of nurses in providing chronic HIV care.
Our study addresses the roles of HIV nurses as care is shifting towards chronic care models. The unique relationship between nurses and patients is key in understanding the importance of nurses in the care trajectory. These findings impact the institutional role of nurses in HIV treatment centres and the institutional organization of HIV care.
The COREQ guideline was used.
Amsterdam UMC (AMC) staff, the national organization of HIV Nurses and patient organizations contributed to the study design.
Dying well at home usually requires the help and assistance of an informal caregiver. This role is usually unpaid, wide-ranging and oftentimes demanding. From diagnosis to death of a loved one, informal caregivers can experience one and frequently numerous transitions, however, little is known about this process. The purpose of this scoping review is to chart, explore and understand caregivers' experiences of transitioning when providing end-of-life care. A preliminary search of the literature indicated a paucity of research highlighting a notable absence of caregiver's perspectives and acknowledgements of the support they need to ensure successful transitions during this time. Consequently, this review has the potential to make a valuable contribution to the literature.
Arksey and O'Malley's (2005) framework, further enhanced by Levac et al. (2010) and Peters et al. (2020) was used to conduct this scoping review. The Extension for Scoping Reviews (PRISMA-ScR) guided reporting. A systematic search of the databases PUBMED, PsychINFO, CINAHL, EMBASE, and Web of Science and a selection of grey literature was undertaken from the year 1990 to date by two researchers. Titles and abstracts of the literature identified were screened and finally, a narrative synthesis of 11 articles was undertaken to answer the following research question: What is known from the literature about informal caregivers' transitions when caring for a dying person in the home?
Current knowledge on this topic is limited; however, from this review, two main themes were identified: ‘Challenges arising during transitioning’ with subthemes of burden of care and fading away. The second theme ‘Coping strategies’ comprised subthemes of meaning-making, seeking normality and hope. This evidence may support the development of transitional care interventions in the future and improve patient and caregiver outcome measures and experiences to inform a larger research study exploring this phenomenon.
N/A as this is a Scoping Review.
An understanding of the experiences of transitioning when caring for a loved one dying at home could help mitigate challenges informal caregivers face when providing end-of-life care in the home. While informal caregivers are crucial to support people who want to die at home, the role is often invisible and family carers need support and recognition to reduce the burden of care and challenges they experience as they transition in their role.
To explore potential areas of low-value home-based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home-based nursing care.
A quantitative, cross-sectional design.
An online survey with questions containing scaled frequencies on five-point Likert scales and open questions on possible related influencing factors of low-value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results.
A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low-value care practices reported were: (1) ‘washing the client with water and soap by default’, (2) ‘application of zinc cream, powders or pastes when treating intertrigo’, (3) ‘washing the client from head to toe daily’, (4) ‘re-use of a urinary catheter bag after removal/disconnection’ and (5) ‘bladder irrigation to prevent clogging of urinary tract catheter’. The top five related influencing factors reported were: (1) ‘a (general) practitioner advices/prescribes it’, (2) ‘written in the client's care plan’, (3) ‘client asks for it’, (4) ‘wanting to offer the client something’ and (5) ‘it is always done like this in the team’. Higher educational levels and an age above 40 years were associated with a lower provision of low-value care.
According to registered nurses and certified nursing assistants, a number of low-value nursing practices occurred frequently in home-based nursing care and they experienced multiple factors that influence the provision of low-value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de-implementation strategy.
STROBE checklist for cross-sectional studies.
No Patient or Public Contribution.
Nursing care is increasingly shifting towards the home environment. Not all nursing care that is provided is effective or efficient and this type of care can therefore be considered of low-value. Reducing low-value care and increasing appropriate care will free up time, improve quality of care, work satisfaction, patient safety and contribute to a more sustainable healthcare system.
To develop a nurse-led model of analgesia to manage post-operative pain in the surgical neonate.
A four-round e-Delphi study was conducted from March to December 2022.
An e-Delphi method was used seeking a consensus of 70% or greater. Fifty-one experts were invited to join the panel. Members consisted of multi-disciplinary healthcare professionals who work in areas associated with neonatal care. In round 1, 49 statements relative to neonatal pain assessment and management were distributed to the panel. Panel members were asked to rate their level of agreeance on a Likert scale from 1 to 5 (1 = strongly disagree to 5 = strongly agree). Ratings equal to or greater than 4 represented agreement, 3 indicated uncertainty and 2 or less disagreement with the proposed statement. An opportunity for free-text responses after each statement was provided. This iterative process continued for three rounds. In the fourth and final round, the completed model of neonatal nurse-controlled analgesia was presented along with a further opportunity to provide feedback on the final version.
Four rounds of statements and voting were required to reach consensus on a model of neonatal nurse-controlled analgesia. The model consists of criteria for use, over-arching guidelines and three separate pathways based on an individual baby's pain assessment scores, need for pain relieving interventions and time-lapsed post-surgical procedure.
A comprehensive model of neonatal nurse-controlled analgesia, applicable to the Australasian context, was developed in collaboration with a group of neonatal experts.
This study provides a multi-modal family-integrated model to manage neonatal post-operative pain. By providing nurses with increased autonomy to assess and manage acute pain, this model has the potential to not only provide a more responsive and individualized approach to alleviate discomfort, but highlights the integral role of parent partnerships in the neonatal intensive care.
This study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies.
No patient or public contribution was utilized for this study.
To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care.
A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines.
An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity.
Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete post-intervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced.
The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care.
Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care.
This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, The intervention reduced time spent on clinical documentation and increased time for direct patient care, This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care.
The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines.
The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript.
Work-related violence is a significant problem in healthcare settings and emergency departments are one of the highest at-risk locations. There have been significant challenges in identifying successful risk-mitigation strategies to reduce the incidence and impact of work-related violence in this setting. This research explores the perspectives of clinical staff who routinely use violence risk assessment to provide recommendations for improvements.
This qualitative research used interviews of staff who routinely use of the Bröset Violence Checklist in an emergency department. The study was conducted in April 2022.
Interview transcripts were subjected to Thematic Analysis to explore participants' clinical experiences and judgements about the utility of the Bröset Violence Checklist.
Eleven staff participated in semi-structured interviews. Participants described themes about the benefits of routine violence risk assessment and the influence of the subjective opinion of the scorer with respect to the emergency department patient cohort. Four categories of violence risk factors were identified: historical, clinical, behavioural and situational. Situational risks were considered important for tailoring the tool for context-specificity. Limitations of the BVC were identified, with recommendations for context-specific indicators.
Routine violence risk assessment using the Bröset Violence Checklist was deemed useful for emergency departments, however, it has limitations.
This study's findings offer potential solutions to reduce violence affecting front-line workers and practical processes that organizations can apply to increase staff safety.
The findings produced recommendations for future research and development to enhance utility of the Bröset Violence Checklist.
EQUATOR guidelines were adhered to and COREQ was used.
No patient or public contribution was involved in this study.
To identify what is currently known about how women experience online antenatal education.
Integrative literature review.
This integrative review applied the five-stage methodological framework outlined by Whittemore and Knafl (2005), supporting rigour in problem identification, selection and critical appraisal of quality literature, data analysis and synthesis of findings.
A literature search was conducted in May/June 2022, utilizing databases including OVID Embase, CINAHL, Joanna Briggs Institute EBP database, Nursing and Allied Health database, Wiley Online Library, Google scholar search engine and related reference lists. The search was limited to English language and primary research articles published in the last 10-year period (2012–2022).
12 articles met inclusion criteria. Three primary themes were identified: Comprehensibility: Looking back – understanding women's needs and preferences; Manageability: In the moment – flexibility versus social connection; and Meaningfulness & sustainability: Looking forward – the future of digital maternity education.
Findings identified a marked digital divide for women accessing online antenatal education, placing vulnerable women at risk of continuing inequity. E-health literacy frameworks need to be implemented to create genuine accessibility, comprehensibility and cultural responsiveness to best meet the needs of users.
As digital health is an emerging field, there is strong evidence that online antenatal education requires further evaluation to better meet the needs of pregnant women and their support people. Enhancing digital health literacy for health professionals will also promote a greater understanding for how to uphold and support the socio-technical dimensions of online service delivery.
There were no patient or public contributions as part of this integrative review of the literature.
To describe nurses’ and specialist nurses’ experiences of moral distress and how it affects daily work in surgical care.
A qualitative descriptive study design was used.
A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis.
Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care.
The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk.
Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive.
There was no patient or public contribution.
FreshRSS 