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Anteayer Journal of Advanced Nursing

Characteristics and effectiveness of mentoring programmes for specialized and advanced practice nurses: A systematic review

Abstract

Aims

(1) To identify, evaluate and summarize evidence about the objectives and characteristics of mentoring programmes for specialized nurses (SNs) or nurse navigators (NNs) and advanced practice nurses (APNs) and (2) to identify the effectiveness of these programmes.

Design

A systematic review based on PRISMA guidelines.

Data Sources

From November 2022 until 7 December 2022, four databases were searched: PubMed, EMBASE, CINAHL and The Cochrane Library.

Review Methods

Study selection was performed independently by two researchers. Disagreements were discussed until consensus was reached. Data extraction was undertaken for included studies. Data synthesis was conducted using narrative analysis. Quality appraisal was performed using the Critical Appraisal Skill Programme (CASP) and Mixed Methods Appraisal Tool (MMAT).

Results

Twelve articles were included, all of which focused on mentoring programmes for APNs. Different forms of mentorship (e.g. (in)formal mentorship, work shadowing, workshops) were reported. Studies reported positive outcomes on job retention (n = 5), job satisfaction (n = 6), skills improvement (n = 7), satisfaction with the programme (n = 7) and confidence improvement (n = 4) among participants of mentoring programmes.

Conclusion

There is a lack of uniformity and consistency in various elements of mentoring programmes. Further research is needed to develop mentoring programmes for both APNs and SNs/NNs in a systematic and theoretically underpinned manner. It is necessary to establish a thorough evaluation methodology, preferably using a mixed methods design that includes both a qualitative process evaluation and a comprehensive outcome evaluation using validated questionnaires, taking into account the NN/APN, the interprofessional team and organizational level.

Impact

The synthesis of evidence may be useful to organizations developing and implementing mentoring programmes for both SN/NN and APN. The development of a mentoring programme for nursing experts should be considered a complex intervention that requires theoretical frameworks and contextual considerations.

No Patient or Public Contribution

Not applicable, as no patients or public were involved.

Barriers and facilitators to opioid deprescribing among Advanced Nurse Practitioners: A qualitative interview study

Abstract

Aim

To explore the experiences primary care Advanced Nurse Practitioners have had in relation to deprescribing opioids in chronic non-malignant pain.

Design

A qualitative interview study.

Methods

Primary care Advanced Nurse Practitioners were recruited from across the Northern Ireland GP Federations. Data collection for this study took place between April and June 2022. In total, 10 semi-structured online interviews were conducted. Interviews were audio and visually recorded, transcribed verbatim and interpreted using a thematic analysis framework. The COREQ criteria were used to guide the reporting of this study.

Results

The Advanced Nurse Practitioners experienced several challenges associated with opioid deprescribing and the implementation of current chronic pain guidelines. The main barriers identified were difficulties engaging patients in deprescribing discussions, a lack of availability of supportive therapies and poor access to secondary care services. The barriers identified directly impacted on their ability to deliver best practice which resulted in a sense of professional powerlessness.

Conclusion

The experiences of the Advanced Nurse Practitioners demonstrate that opioid deprescribing in patients with chronic pain is challenging, and implementation of current chronic pain guidelines is difficult.

Impact

This study contributes to existing literature on the topic of reducing opioid prescribing and as far as the authors are aware, is the first study to examine the experiences of primary care advanced nurse practitioners in this context. These findings will be of interest to other primary care practitioners, and prescribers involved in the management of chronic non-malignant pain.

Patient or Public Contribution

No patient or public contribution.

Re‐imagining of an undergraduate, second‐degree entry, accelerated nursing program's curriculum utilizing a postmodern, learner‐centred lens and a concept‐based framework

Abstract

Introduction

It is necessary to re-imagine nursing curriculums utilizing a postmodern approach, as outdated teacher-centred methods of nursing education with emphasis on memorization versus critical thinking no longer meet the needs of the contemporary learner and the current challenges of the healthcare environment. There is an explicit need to redesign nursing curriculums that are future-oriented, adaptive and flexible and serve the learners' best interests.

Background

Distilled from a decade of teaching experience in an undergraduate, second-degree entry, accelerated nursing program, this paper describes the construction of a learner-centred, postmodern, concept-based nursing curriculum that aims to foster learners' inquiry skills, critical thinking, problem-solving, and experiential learning—all which develop learners' autonomy, self-direction, and lifelong learning. The objective is to foster learners' transformational and emancipatory learning and metacognition.

Discussion

An extensive review of the current trends, contemporary nursing knowledge for the past decade (2013–2023), and seminal literature on theories and frameworks paralleled with the review of current and future trends in Canadian and global health care, including the socio-economic, politico and environmental contexts, led to the formulation of a concept-based curriculum. Grounded in the constructivist paradigm, the curriculum applies interperetivist, critical, feminist, and indigenous lenses. The Strength-Based Nursing framework was selected as the core guiding framework. The curriculum's four curricular themes and foundational pillars were adopted directly from the framework to provide a starting point for concept development. These initial themes were then juxtaposed with relevant nursing, and social theories, policies, and frameworks, ensuring a robust coverage of modern nursing knowledge and allowing for the core concepts of the curriculum to emerge. A total of 21 concepts and 192 sub-concepts were developed.

Conclusion

Implications for future practice require nursing educators to receive support and professional development opportunities in developing skills and confidence in entering a classroom as co-learners and facilitators.

Interventions to support nurses as second victims of patient safety incidents: A qualitative study of nurse managers' perceptions

Abstract

Aims

To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them.

Design

A qualitative study using interviews.

Methods

A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis.

Results

The study identified three main categories: (1) Management of second victim support, which contained three sub-categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub-categories developing practices and developing an open and non-blaming patient safety culture.

Conclusion

Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon.

Implications for the Profession and Patient Care

Mitigating the harmful effects of patient safety incidents can improve nurses' well-being, reduce burden and attrition risks and positively impact patient safety.

Impact

Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work.

Reporting Method

COREQ checklist was used.

What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support. Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work.

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study

Abstract

Aims

To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings.

Design

A qualitative descriptive study. Data were collected via semi-structured interviews.

Methods

In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized.

Results

Six themes and 20 sub-themes were identified. Non-validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed.

Conclusion

Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness.

Impacts

The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post-cardiac event counselling.

Reporting Method

Adherence to COREQ guidelines was maintained.

Patient or Public Contribution

No Patient or Public Contribution as this study explored health professionals' experiences only.

A multi‐facetted patient safety resource—A qualitative interview study on hospital managers' perception of the nurse‐led Rapid Response Team

Abstract

Aim

To explore hospital managers' perceptions of the Rapid Response Team.

Design

An explorative qualitative study using semi-structured individual interviews.

Methods

In September 2019, a qualitative interview study including nineteen hospital managers at three managerial levels in acute care hospitals was conducted. Interview transcripts were analysed with an inductive content analysis approach, involving researcher triangulation in data collection and analysis processes.

Findings

One theme, ‘A resource with untapped potential, enhancing patient safety, high-quality nursing, and organisational cohesion’ was identified and underpinned by six categories and 30 sub-categories.

Conclusion

The Rapid Response Team has an influence on the organization that goes beyond the team's original purpose. It strengthens the organization's dynamic cohesion by providing clinical support to nurses and facilitating learning, communication and collaboration across the hospital. Managers lack engagement in the team, including local key data to guide future quality improvement processes.

Implications

For organizations, nursing, and patients to benefit from the team to its full potential, managerial engagement seems crucial.

Impact

This study addressed possible challenges to using the Rapid Response Team optimally and found that hospital managers perceived this complex healthcare intervention as beneficial to patient safety and nursing quality, but lacked factual insight into the team's deliverances. The research impacts patient safety pointing at the need to re-organize managerial involvement in the function and development of the Rapid Response Team and System.

Reporting Method

We have adhered to the COREQ checklist when reporting this study.

“No Patient or Public Contribution”

Roles, mutual expectations and needs for improvement in the care of residents with (a risk of) dehydration: A qualitative study

Abstract

Aim

Examining the perspectives of formal and informal caregivers and residents on roles, mutual expectations and needs for improvement in the care for residents with (a risk of) dehydration.

Design

Qualitative study.

Methods

Semi-structured interviews with 16 care professionals, three residents and three informal caregivers were conducted between October and November 2021. A thematic analysis was performed on the interviews.

Results

Three topic summaries contributed to a comprehensive view on the care for residents with (a risk of) dehydration: role content, mutual expectations and needs for improvement. Many overlapping activities were found among care professionals, informal caregivers and allied care staff. While nursing staff and informal caregivers are essential in observing changes in the health status of residents, and medical staff in diagnosing and treating dehydration, the role of residents remains limited. Conflicting expectations emerged regarding, for example, the level of involvement of the resident and communication. Barriers to multidisciplinary collaboration were highlighted, including little structural involvement of allied care staff, limited insight into each other's expertise and poor communication between formal and informal caregivers. Seven areas for improvement emerged: awareness, resident profile, knowledge and expertise, treatment, monitoring and tools, working conditions and multidisciplinary working.

Conclusion

In general, many formal and informal caregivers are involved in the care of residents with (a risk of) dehydration. They depend on each other's observations, information and expertise which requires an interprofessional approach with specific attention to adequate prevention. For this, educational interventions focused on hydration care should be a core element in professional development programs of nursing homes and vocational training of future care professionals.

Impact

The care for residents with (a risk of) dehydration has multiple points for improvement. To be able to adequately address dehydration, it is essential for formal and informal caregivers and residents to address these barriers in clinical practice.

Reporting Method

In writing this manuscript, the EQUATOR guidelines (reporting method SRQR) have been adhered to.

Patient or Public Contribution

No patient or public contribution.

Long‐term care facilities' response to the COVID‐19 pandemic: An international, cross‐sectional survey

Abstract

Aims

To (i) assess the adherence of long-term care (LTC) facilities to the COVID-19 prevention and control recommendations, (ii) identify predictors of this adherence and (iii) examine the association between the adherence level and the impact of the pandemic on selected unfavourable conditions.

Design

Cross-sectional survey.

Methods

Managers (n = 212) and staff (n = 2143) of LTC facilities (n = 223) in 13 countries/regions (Brazil, Egypt, England, Hong Kong, Indonesia, Japan, Norway, Portugal, Saudi Arabia, South Korea, Spain, Thailand and Turkey) evaluated the adherence of LTC facilities to COVID-19 prevention and control recommendations and the impact of the pandemic on unfavourable conditions related to staff, residents and residents' families. The characteristics of participants and LTC facilities were also gathered. Data were collected from April to October 2021. The study was reported following the STROBE guidelines.

Results

The adherence was significantly higher among facilities with more pre-pandemic in-service education on infection control and easier access to information early in the pandemic. Residents' feelings of loneliness and feeling down were the most affected conditions by the pandemic. More psychological support to residents was associated with fewer residents' aggressive behaviours, and more psychological support to staff was associated with less work–life imbalance.

Conclusions

Pre-pandemic preparedness significantly shaped LTC facilities' response to the pandemic. Adequate psychological support to residents and staff might help mitigate the negative impacts of infection outbreaks.

Impact

This is the first study to comprehensively examine the adherence of LTC facilities to COVID-19 prevention and control recommendations. The results demonstrated that the adherence level was significantly related to pre-pandemic preparedness and that adequate psychological support to staff and residents was significantly associated with less negative impacts of the pandemic on LTC facilities' staff and residents. The results would help LTC facilities prepare for and respond to future infection outbreaks.

Patient or public contribution

No Patient or Public Contribution.

Advanced practice nursing in Europe—Results from a pan‐European survey of 35 countries

Abstract

Aim

To report the results of a mapping exercise by the European Federation of Nurses on current advanced practice nursing frameworks and developments across Europe.

Design

Online, cross-sectional, questionnaire study.

Methods

An online questionnaire was distributed among 35 national nurses' associations across Europe in March 2021. The questionnaire solicited input on 60 items concerning key features of advanced practice nursing, intending to map existing developments and better understand the current state of advanced practice nursing in Europe. Data analysis used descriptive statistics, including counts and percentages, tabulation; open-text responses were handled with thematic synthesis techniques.

Results

The definition, sense-making and operationalization of advanced practice nursing vary across Europe. Important variations were noted in the definition and requirements of advanced practice nursing, resulting in different views on the competencies and scope of practice associated with this role. Importantly, the level of education and training required to qualify and practice as an advanced practice nurse varies across European countries. Furthermore, only 11 countries reported the existence of a national legislation establishing minimum educational requirements.

Conclusion

Significant variation exists in how countries define advanced practice nursing and how it is regulated at academic and practice levels. More research is needed to clarify whether this variation results from designing models of advanced practice nursing that work in different contexts; and what impact a standardized regulatory framework could have to grow the volume of advanced practice nurses across Europe.

Impact

The current paper exposes the lack of clarity on the development and implementation of advanced practice nursing across Europe. We found significant variation in the definition, recognition, regulation and education of advanced practice nurses. Our data are essential to policymakers, professional associations and employers to ensure a coordinated and systematic effort in the consistency and ongoing development of advanced practice nurses across Europe.

Patient or Public Contribution

No patient or public contribution applied; the participants were national nurses' associations.

Using a novel ambulatory monitoring system to support patient safety on an acute infectious disease ward during an unfolding pandemic

Abstract

Aim

To gain staff feedback on the implementation and impact of a novel ambulatory monitoring system to support coronavirus patient management on an isolation ward.

Design

Qualitative service evaluation.

Methods

Semi-structured interviews were conducted with 15 multidisciplinary isolation ward staff in the United Kingdom between July 2020 and May 2021. Interviews were audio-recorded, transcribed and analysed using thematic analysis.

Findings

Adopting Innovation to Assist Patient Safety was identified as the overriding theme. Three interlinked sub-themes represent facets of how the system supported patient safety. Patient Selection was developed throughout the pandemic, as clinical staff became more confident in choosing which patients would benefit most. Trust In the System described how nurses coped with discrepancies between the ambulatory system and ward observation machines. Finally, Resource Management examined how, once trust was built, staff perceived the ambulatory system assisted with caseload management. This supported efficient personal protective equipment resource use by reducing the number of isolation room entries. Despite these reported benefits, face-to-face contact was still highly valued, despite the risk of coronavirus exposure.

Conclusion

Hospital wards should consider using ambulatory monitoring systems to support caseload management and patient safety. Patients in isolation rooms or at high risk of deterioration may particularly benefit from this additional monitoring. However, these systems should be seen as an adjunct to nursing care, not a replacement.

Implications for the Profession and/or Patient Care

Nurses valued ambulatory monitoring as a means of ensuring the safety of patients at risk of deterioration and prioritizing their workload.

Impact

The findings of this research will be useful to all those developing or considering implementation of ambulatory monitoring systems in hospital wards.

Reporting Method

This manuscript follows the Consolidated criteria for Reporting Qualitative Research (COREQ) guidelines with inclusion of relevant SQUIRE guidelines for reporting quality improvement.

Patient or Public Contribution

No Patient or Public Contribution.

Patients involvement in the discharge process from hospital to home: A patient's journey

Abstract

Aims

The aims of the study were to gain insight in the transfer process from hospital to homecare or rehabilitation centre from a patient's perspectives and to describe the experienced involvement, information provision and information needs patients.

Design

A multiple case study with a phenomenological approach.

Methods

Observations and interviews were employed, between May 2019 and August 2019, to capture the patient's perspectives and experiences on involvement, information provision and needs. Observations were executed during the discharge process from hospital to homecare (n = 6) or revalidation centre (n = 1) and during admission interviews with community nurses (n = 6). Interviews were conducted at the patient's home and the revalidation centre.

Results

Eight themes were identified within three phases of the transfer process. The Sign-up phase contained two themes: ‘organizing follow-up care’ and ‘planning the moment of discharge from the hospital’. The two themes in the Transfer phase were, ‘verbal information provision’ and ‘written information provision’. Four themes were identified in the End phase: ‘nursing supplies’, ‘medication’, ‘the electronic patient portal’ and ‘continuation of (para)medical care’.

Conclusions

Patient participation in the transition process from the hospital to follow-up care can be improved. This study indicates that unsafe situations could be prevented by patient involvement and clear perceptions of the role and responsibilities of patients, family and healthcare professionals.

Implications to Patient Care

Patient and family involvement has the potential to improve transition of care and techniques for shared decision-making can be applied to a greater extent.

Impact

This paper highlights that patients and families should be acknowledged as key figures in the transfer process and gives direction to healthcare professionals on how to increase involvement in the transfer process by actively inviting patients to participate in the transfer process.

Reporting Method

COREQ guidelines for qualitative reporting.

No patient or public contribution.

Contribution to Global Clinical Community

This paper gives insights in patients’ and families’ perspectives on transition of nursing care and their involvement during the whole transfer process. This paper gives direction how to improve patient participation during the discharge process from hospital to follow-up care.

The meaning of preparedness for informal caregivers of older adults: A concept analysis

Abstract

Aim

To examine the concept of preparedness over time in research with informal caregivers of older adults.

Design

Concept analysis.

Methods

Rodgers' evolutionary method of concept analysis was used to guide this theoretical paper due to the dynamic nature of preparedness, which is influenced by both context and time. Using Rodgers' inductive approach, concept elements were derived from a content analysis of included studies. In the final step, to generate hypotheses and implications regarding the concept, the conceptual structure of preparedness of informal caregivers of older adults was connected to a theoretical problem in the nursing discipline using the Caregiving Stress Process Framework.

Data Sources

Four databases (EBSCO CINAHL, Ovid MEDLINE, Ovid PsycINFO and Scopus) were searched in November 2022 and updated in September 2023. No date limits were set for searching, as the intent was to analyse possible variations of the concept over time.

Results

The attributes of preparedness include self-confidence, having knowledge, skills and abilities to perform daily tasks, handling emotions and developed over time. These attributes can be compared with the stressors outlined in the Caregiving Stress Process Framework (i.e., the moment the caregiver identifies some ‘stressor’; something that prevents them from feeling confident in their preparedness).

Conclusion

The concept of preparedness of informal caregivers of older adults is defined as caregiver's self-confidence about their current competence related to the knowledge, skills and abilities to perform daily tasks, and to handle emotions over time. To link the concept to a theoretical perspective, we propose adaptations to a well-known theory, the Caregiving Stress Process Framework. Future research on caregiving preparedness needs to avoid circular definitions and work with the attributes of preparedness to support caregivers.

Implications for the Profession and/or Patient Care

This paper contributes to the development of interventions that focus on the health and preparedness of informal caregivers of older adults. Clarifying the concept of preparedness helps nurses to support caregivers since it is then known which aspects are included in the preparedness of caregivers (e.g., daily tasks and handling emotions). A more fulsome understanding of preparedness supports us to see beyond stressors of caregiving.

Impact

This study addresses informal caregivers of older adults' preparedness to provide care. We synthesized existing definitions that have been used in research with this population to propose a robust conceptualization of the concept of preparedness, which contributes to better understanding of how preparedness can be supported.

Reporting Method

We were unable to locate a reporting method related to this kind of work (concept analysis).

Patient or Public Contribution

Not applicable as no new data generated.

Researcher‐initiated role play, stimulated recall interview, storycrafting, painting and drawing as research methods to reach children's perspectives in health sciences

Abstract

Aim

To describe the application of selected creative and participatory research methods in nursing science.

Design

Research methodology paper.

Methods

Researcher-initiated role play, stimulated recall interviews, the Storycrafting method, painting and drawing. Altogether, 11 children (5–7 years old) and 12 parents participated in the research.

Results

Each small group (n = 3) acted differently during the data collection. Not every child wanted to play, draw or tell stories, but they all expressed their views through some method. Although the same themes emerged from children's narratives, they could not have been verified by just one method.

Conclusions

Using creative and participatory methods and the principles of studies of child perspectives are applicable ways of conducting research in nursing science. Children must be treated as individuals during the research process, and they must have opportunities to use several communication methods to express their views.

Implications for the profession and patient care

Understanding different ways to interact with children and hear children's views will help nurses to encounter children.

Impact

In this article, we present a valid way of conducting research with children. By following our protocol, nursing research from a child perspective can be implemented.

Reporting Method

Consolidated criteria for reporting qualitative research (COREQ).

Patient Contribution

The child participants were involved in choosing physical places for data collection and the usage and order of the selected methods. Both the children and the adult participants took part in interpreting the research data.

Understanding the needs and preferences for cancer care among First Nations people: An integrative review

Abstract

Aim

This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people.

Design

Integrative review.

Data Sources

An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted.

Results

Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs.

Conclusion

Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs.

Patient or Public Contribution

Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work.

Implications for Nursing Practice

Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.

Safety culture in maternity hospital: Perception of nurse‐midwives

Abstract

Aim

To explore nurse-midwives' perceptions of safety culture in maternity hospitals.

Design

A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research.

Methods

Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis.

Findings

Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication.

Conclusion

The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential.

Impact

Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care.

Patient or Public Contribution

There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves.

Patients' experiences with early rehabilitation in intensive care units: A qualitative study about aspects that influence their participation

Abstract

Aim

To explore patients' experiences with early rehabilitation in the intensive care unit and what they perceive to influence their participation.

Design

A qualitative design anchored in phenomenological and hermeneutical traditions utilizing in-depth interviews.

Methods

Thirteen patients were interviewed from 5 to 29 weeks following discharge from three units, in January–December 2022. Analysed using systematic text condensation and the pattern theory of self. Reporting adhered to consolidated criteria for reporting qualitative research.

Results

Interviews described four main categories: (1) A foreign body, how the participants experienced their dysfunctional and different looking bodies. (2) From crisis to reorientation, the transformation the participants experienced from a state of crisis to acceptance and the ability to look forwards, indicating how bodily dysfunctions are interlinked to breakdowns of the patients' selves and the reorganization process. (3) Diverse expectations regarding activity: ambiguous expectations communicated by the nurses. (4) Nurse–patient: a powerful interaction, highlighting the essential significance of positive expectations and tailored bodily and verbal interaction for rebuilding the patient's outwards orientation.

Conclusion

Outwards orientation and reorganization of the self through a reduction in bodily dysfunctions, strengthening the patients' acceptance of the situation, providing tailored expectations and hands-on and verbal interaction appear to be fundamental aspects of patient participation in early rehabilitation.

Implications

Insights into patients' perceptions show how dysfunctional bodies cloud individuals' perceptual fields, causing inwards orientation and negative thoughts concerning themselves, their capabilities, environment and future. This knowledge can improve nurses' ability to tailor care to promote optimal recovery for patients.

Patient or Public Contribution

User representative contributed to the design of the study.

Nursing students' and educators' perspectives on sustainability and climate change: An integrative review

Abstract

Aim

To identify and synthesize research on the awareness, attitudes and action related to sustainability and climate change from the perspective of nursing students and educators globally.

Design

Integrative review.

Methods

The review was guided by Whittemore and Knafl. Included studies were appraised using the Mixed Methods Appraisal Tool. A deductive content analysis based on Elo and Kyngäs' methodology was employed.

Data Sources

CINAHL, MEDLINE, EMBASE, Web of Science, British Education Index, GreenFILE and Scopus were searched up to the 8th November 2022.

Results

Thirty-two studies were included in the review. Two studies included nursing educators in their samples, the rest focused solely on students. Findings suggest that whilst some students were aware of sustainability issues and felt that nurses have a responsibility to mitigate climate change, others showed limited awareness and believed that nurses have more important priorities. A global interest was seen among students for increased curricular content related to sustainability and climate change. Waste management and education of others were suggested actions students can take; however, barriers included lack of confidence and limited power.

Conclusion

There is a need for sustainability education within nursing curricula, accompanied by student support.

Implications for the Profession

The review acts as a starting point to make sustainable healthcare and climate change mitigation integral aspects of nursing.

Impact

Sustainability education within nursing curricula can positively impact on sustainable healthcare and climate change mitigation. More research is needed on the perspectives of nursing educators.

Reporting Method

The review is reported according to the PRISMA guidelines.

Patient or Public Contribution

No Patient or Public Contribution.

‘Hearing silences’: Exploring culturally safe transitional care: A qualitative study among Turkish‐speaking migrant frail older adults

Abstract

Aims

This study aimed to investigate the experiences and transitional care needs of Turkish frail older adults living in the UK and determine how this information can be utilized to improve the provision of culturally sensitive care during the transitional period.

Design

Qualitative descriptive research with semi-structured individual interviews.

Methods

“The ‘Silences’ Framework guided the research design, from conceptualizing the research question to structuring the report of final outputs. For this study, semi-structured, in-depth interviews were conducted with sixteen older adults living with frailty and five family caregivers between January and May of 2023 in the United Kingdom.

Results

Major themes that were identified included: (i) information and communication, (ii) care and support, (iii) the role of culture and (iv) trust and satisfaction. Further analysis, through discussion and immersion in the data, revealed that care transition periods were presented alongside three phases of transitional care: pre-transition (during hospitalization), early-transition (the period between discharge and the 7th day after discharge) and late transition (the period between the 8th day and 12th month after discharge).

Conclusions

Our study revealed that the communication and informational needs of frail older individuals change during the transition period. While Turkish older adults and family caregivers expressed satisfaction with healthcare services in the UK, many struggled due to a lack of knowledge on how to access them.

Impact

The support of family caregivers is a crucial component in facilitating transitional care for frail older patients, as they help in accessing healthcare services and using technological devices or platforms. It should be noted that family caregivers often hold the same level of authority as their elderly Turkish counterparts.

Patient or Public Contribution

No patient or public contribution.

Care call requests and inpatient beds modernization: Is there any link? A prospective observational study in the oncological setting

Abstract

Aim

The study aims to analyse the principal causes of patients' care calls and compare differences before and after inpatient beds' technological modernization in a surgical breast oncological ward.

Design

A prospective observational study was conducted under the STROBE guidelines. Data were collected from June to September 2022.

Methods

Statistical analyses were performed to compare each reason for care calls, by shifts and pre and post-inpatient bed modernization.

Results

Two thousand five hundred and fifty-nine care request calls were analysed during the 202 observed shifts. The most frequent reason was related to the requests for positions.

Conclusion

Technological modernization of the beds has not led to effective—positive—changes; on the contrary, it seems at first glance to show an upward trend in calls above all in the short period after the changes.

Implications for the profession and/or patient care

What problem did the study address? By analysing the principal causes of care calls and comparing the differences before and after inpatient beds' technological modernization, this study evaluates if inpatient gear or device modernization can impact care call requests. What were the main findings? The results show that the most frequent reasons for care calls were position, possession and other. These findings seem not superimposable; the hypothesis supported by the international literature in which the causes relating to potty and pain were found among the main reasons. Where and on whom will the research have an impact? These results could impact the care organizational area in nursing care and could improve care quality, patient satisfaction and safety.

Reporting Method

This prospective observational study was conducted following STROBE guidelines.

Patient or Public Contribution

After adequate information (presentation, design methods and objectives), all unit healthcare staff agreed to collaborate in the study.

Firearms and post‐separation abuse: Providing context behind the data on firearms and intimate partner violence

Abstract

Aim

The aim of this study is to provide insight from maternal survivors of intimate partner violence (IPV) describing their experiences with their ex-partners' firearm ownership, access, storage and behaviours in the context of co-parenting and separation.

Design

We conducted a qualitative descriptive study informed by the IPV and Coparenting Model.

Methods

The analytic sample consists of self-identified maternal survivors (n = 14) who completed semi-structured qualitative interviews between January and May 2023 describing experiences of post-separation abuse. Participants were recruited through social media and domestic violence advocacy and legal aid organizations. In the interview guide, participants were asked one item about firearm exposure: Have you or your children had any experiences with guns and your ex-partner that made you or your children feel scared? Interviews were audio-recorded and transcribed. Interview transcripts were managed and coded in ATLAS.ti using a codebook. Codes were applied using descriptive content analysis, discrepancies reconciled and themes related to firearm exposure in the context of post-separation abuse identified.

Results

Six themes emerged related to firearm experiences and post-separation abuse: (1) gun ownership (2) gun access; (3) unsafe storage; (4) direct and symbolic threats; (5) involving the children; (6) survivors' protective actions.

Conclusion

This manuscript provides context on how abusive ex-partners' firearm ownership, access and threats cause terror and pervasive fear for mothers and children following separation. Analysis of qualitative data provides important insights into opportunities to address firearm injury prevention.

Impact

Findings add to the contextual understanding of how survivors of IPV experience non-fatal firearm abuse. Existing quantitative data may not capture the full extent of fear caused by perpetrators' gun ownership access and symbolic threats. Data from this study can help inform firearm injury prevention efforts.

Patient or Public Contribution

The authors would like to acknowledge and thank the individuals who helped in cognitive testing of the interview guide prior to conducting interviews with participants, including (3) survivors of post-separation abuse. The authors would also like to acknowledge domestic violence advocates and those individuals who helped with recruitment and connected us with participants. Importantly, with deep gratitude, the authors would like to thank the participants who generously shared their time and stories with us.

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