Conectar
To explore registered nurses' thinking strategies during the drug administration process in nursing homes.
An exploratory qualitative design.
Eight registered nurses, one male and seven female, in five nursing home wards in Mid-Norway were observed during 15 drug dispensing rounds (175 drug dispensing episodes). Think Aloud sessions with follow-up individual interviews were conducted. The Think Aloud data were analysed using deductive qualitative content analysis based on Marsha Fonteyn's description of 17 thinking strategies. Interview data were used to clarify missing information and validate the content of Think Aloud data.
The registered nurses used all 17 thinking strategies described by Fonteyn, including several variants of each strategy. The three most frequent were ‘providing explanations’, ‘setting priorities’ and ‘drawing conclusions’. In addition, we found two novel thinking strategies that did not fit into Fonteyn's template, which were labelled ‘controlling’ and ‘interacting’. Among all strategies, ‘controlling’ was by far the most used, serving as a means for the registered nurses to stay on track and navigate through various interruptions, while also minimising errors during drug dispensing.
The study highlights the diverse thinking strategies employed by registered nurses in nursing homes during medication administration. The findings emphasise the multifaceted nature of medication administration and underscore the importance of skilled personnel in ensuring medication safety. Recognising the significance of these findings is crucial for maintaining patient well-being and upholding medication safety standards in healthcare settings.
Understanding the thinking strategies employed by registered nurses can inform training programmes and enhance the clinical judgements of health care professionals involved in medication administration, ultimately leading to improved patient outcomes and reduced medication errors in practice.
Patients were involved in this study as recipients of drugs which the nurses distributed during the observations. The patients were involved as a third party and consent to the observations was either given by the patients themselves or relatives in cases where the patient was not competent to consent. No personal information was collected about the patients.
The reporting of this study adhered to the COREQ checklist.
To explore the experiences of older adults (65+) living with acquired brain injury regarding their sense of well-being during physical rehabilitation within the Greek Healthcare System.
With the increasing ageing population and the life-changing effects of acquired brain injury, there is a need to focus on care for older people and their potential to live well. Rehabilitation systems deserve greater attention, especially in improving the well-being of those who are using them.
A qualitative study design with a hermeneutic phenomenological approach was used.
Fourteen older adults living with acquired brain injury and undergoing physical rehabilitation in Greece were purposively sampled. Semi-structured interviews were conducted to collect data and were thematically analysed using van Manen's and Clarke and Braun's methods. The COREQ checklist was followed.
Four themes emerged from the analysis: (1) Challenges of new life situation, (2) Seeking emotional and practical support through social interaction, (3) Identifying contextual processes of rehabilitation, (4) Realising the new self.
The subjective experiences, intersubjective relations and contextual conditions influence the sense of well-being among older adults living with acquired brain injury, thus impacting the realisation of their new self. The study makes the notion of well-being a more tangible concept by relating it to the degree of adaptation to the new situation and the potential for older adults to create a future whilst living with acquired brain injury.
Identifying the factors that impact older adults' sense of well-being during rehabilitation can guide healthcare professionals in enhancing the quality of care offered and providing more dignified and humanising care.
Older adults living with acquired brain injury were involved in the study as participants providing the research data.
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 explore and summarise the literature on the concept of ‘clinical deterioration’ as a nurse-sensitive indicator of quality of care in the out-of-hospital context.
The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review and the JBI best practice guidelines for scoping reviews.
Studies focusing on clinical deterioration, errors of omission, nurse sensitive indicators and the quality of nursing and midwifery care for all categories of registered, enrolled, or licensed practice nurses and midwives in the out-of-hospital context were included regardless of methodology. Text and opinion papers were also considered. Study protocols were excluded.
Data bases were searched from inception to June 2022 and included CINAHL, PsychINFO, MEDLINE, The Allied and Complementary Medicine Database, EmCare, Maternity and Infant Care Database, Australian Indigenous HealthInfoNet, Informit Health and Society Database, JSTOR, Nursing and Allied Health Database, RURAL, Cochrane Library and Joanna Briggs Institute.
Thirty-four studies were included. Workloads, education and training opportunities, access to technology, home visits, clinical assessments and use of screening tools or guidelines impacted the ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting.
Little is known about the work of nurses or midwives in out-of-hospital settings and their recognition, reaction to and relay of information about patient deterioration. The complex and subtle nature of non-acute deterioration creates challenges in defining and subsequently evaluating the role and impact of nurses in these settings.
Further research is needed to clarify outcome measures and nurse contribution to the care of the deteriorating patient in the out-of-hospital setting to reduce the rate of avoidable hospitalisation and articulate the contribution of nurses and midwives to patient care.
Factors that impact a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting are not examined to date.
A range of factors were identified that impacted a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting including workloads, education and training opportunities, access to technology, home visits, clinical assessments, use of screening tools or guidelines, and avoidable hospitalisation.
Where and on whom will the research have an impact?
Nurses and nursing management will benefit from understanding the factors that act as barriers and facilitators for effective recognition of, and responding to, a deteriorating patient in the out-of-hospital setting. This in turn will impact patient survival and satisfaction.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines guided this review. The PRISMA-Scr Checklist (Tricco et al., 2018) is included as (supplementary file 1).Data sharing is not applicable to this article as no new data were created or analysed in this study.”
Not required as the Scoping Review used publicly available information.
To explore the nature and extent of peer-reviewed literature related to the use of diagnostic imaging by nurse practitioners (NPs) to inform future practice and research.
Nurse practitioners undertake advanced assessment, diagnosis, and management of patients, including requesting and interpretation of diagnostic imaging. It is unclear what evidence exists related to the quality use of radiological investigations by NPs in recent years.
A scoping review based on the steps suggested by the Joanna Briggs Institute.
A structured review of the databases Medline, CINAHL and Embase was undertaken using the keywords and MESH terms ‘nurse practitioner’, ‘medical imaging’, ‘diagnostic imaging’, ‘scan’ and ‘radiography’. Only English language articles were included, and no date limit was applied. Database review was completed on 30 May 2021.
Eight themes were identified—country and clinical context, requesting diagnostic imaging, performing diagnostic imaging, image-guided interventions, interpreting diagnostic imaging, training education and knowledge, impact on resource usage and comparison with medical practitioners. There were more studies across a greater breadth of clinical specialties and imaging modalities in the United States than in other countries. Nurse practitioner practice is frequently benchmarked against that of medical colleagues. There is a paucity of studies focusing on educational preparation and the lack of relevant university curricula for NPs around diagnostic imaging.
There are significant gaps in the evidence outside of the United States across several of the identified themes. Further studies are needed to explore NP access to and use of diagnostic imaging and to understand the barriers and facilitators to this.
Studies from four countries were included in this review. The evidence suggests that, where studied, nurse practitioners (NPs) can safely and appropriately request and interpret plain x-rays in the emergency and minor injuries setting. Further research is needed to evaluate the educational needs of NPs in relation to diagnostic imaging and their use of advanced imaging techniques, particularly outside of the United States.
No patient or public contribution.
To discuss professionalism for pre-licensure nursing students and identify recommendations for inclusion in core values, didactic coursework and clinical training.
Professionalism is part of the nursing identity that encompasses integrity and honesty. This concept has been difficult to translate into formal education in nursing programs and clinical practice.
A discursive paper.
A search of national literature without date restrictions in PubMed, CINAHL, Google Scholar and frameworks for nursing education. We explored principles of professionalism in nursing education and practice.
Evidence-based literature supports the integration of core values of altruism, autonomy, human dignity, integrity, honesty and social justice into didactic curricula, and clinical training. Principles of professionalism can be incorporated intentionally in nursing education to maintain patient safety and trust.
The principles of professionalism, related to core values of the nursing profession, are abundantly described in the literature. However, these principles represent core values that have not been formally conceptualized. With the changing landscape of healthcare, there is a need for deliberate, measurable integration of professionalism into pre-licensure education.
There was no patient or public involvement in the design or drafting of this discursive paper.
To identify scales that assess parental stress in the paediatric clinical population and to analyse their psychometric properties.
Four electronic databases (PubMed, Web of Science, PsycINFO, and Scopus) and metasearch engines (Google Scholar and Open Grey) were searched with no time period limitations. Methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach modified by COSMIN. Finally, recommendations were made for the instruments with the highest quality of evidence.
A total of 38 studies reporting on 11 different instruments for assessing parental stress in the paediatric clinical setting were included. Six instruments were ‘A’ rated (recommended) in the final phase in line with COSMIN guidelines. The Paediatric Inventory for Parents was the instrument that evaluated the highest number of psychometric properties and obtained the highest methodological quality, global assessment, and quality of evidence for the different psychometric properties.
This systematic review provides an overview of the measurement properties of the parental stress instruments used in the paediatric clinical setting. The Paediatric Inventory for Parents stands out as being one of the most robust instruments for measuring stress in parents with a hospitalised or sick child. Evidence needs to be generated for all the parental stress scales used in the clinical setting.
Given that the psychometric properties of the existing parental stress scales used in paediatric health care settings have not been systematically assessed, the present review utilised comprehensive methods according to COSMIN.
PRISMA statement and COSMIN reporting guidelines for studies on measurement properties of patient-reported outcome measures.
Busyness as a construct within modern healthcare is complex and multidimensional. To date, few studies have sought to explore how busyness influences family-centred care. This study explored the influence of busyness on the delivery of family-centred care for nurses and parents.
Ethnography was selected as the research design. The study site was a metropolitan tertiary hospital inpatient paediatric unit in Sydney, Australia. Semi-structured interview and non-participant observation techniques were used for data collection. Ten paediatric nurses and 10 parents were interviewed and 40 h of non-participant observations were undertaken. The COREQ was used to report the study.
The findings are presented as three key themes: (i) ‘Supporting family-centred care’ in which participants detail beliefs about the nurse-parent relationships and how despite busyness nurses sought out moments to engage with parents; (ii) ‘Being present at the bedside’ identified the challenges in optimising safety and how parents adapted their way of being and interacting on the unit; and (iii) ‘The emotional cost of busyness’ and how this influenced nurse-parent interactions, care delivery and family-centred care.
The ethnography has given shape to social understandings of busyness, the complexities of paediatric nursing and family-centred care. The culture of care changed in moments of busyness and transformed parent and nursing roles, expectations and collaborative care that at time generated internal emotional conflict and tension.
Given the increasing work demands across health systems, new agile ways of working need to ensure maintenance of a family-centred approach. Strategies need to be developed during periods of busyness to better support collaborative connections and the well-being of paediatric nurses and parents. At an organisational level, fostering a positive workplace culture that shares a vision for family-centred care and collaboration is essential.
Parents of sick children admitted to an acute paediatric inpatient ward were invited to be a participant in a single interview. Parents were aware of the study through ward advertisement and informal discussions with the researchers or senior clinical staff. Engagement with parents was important as healthcare delivery in paediatrics is focused on the delivery of family-centred care. To minimise the risk of child distress and separation anxiety, children were present during the parent interview. Whist children and young people voices were not silenced during the interview process, for this study the parent's voice remained the focus. While important, due to limited resources, parents were not involved in the design analysis or interpretation of the data or in the preparation of this manuscript.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
To explore whether sleep deprivation contributes to medication errors in registered nurses (RNs).
Sleep deprivation is a potential issue for RNs, particularly those who work shifts. Sleep deprivation has been found to have a negative impact on numerous cognitive processes. Nurses administer several medications to patients a day, potentially while sleep deprived—anecdotal reports suggest that this could result in an increased risk of error occurring.
A scoping review was conducted using the Prisma-ScR extension framework to explore what is known about the effect of RNs' sleep deprivation on medication administration errors.
A search of databases generated 171 results. When inclusion and exclusion criteria were applied, 18 empirical studies were analysed. Studies included retrospective analysis of errors, surveys of perceptions of causes and observational studies.
Data indicated that RNs consider fatigue, which may be caused by sleep deprivation, to be a contributing factor to medication errors. The search only identified three observer studies, which provided conflicting results as to whether lack of sleep contributes to the error rate. Of the numerous tools used to measure sleep, the Pittsburgh Sleep Quality Index was the most frequently used.
Although RNs anecdotally consider a lack of sleep potentially contributes to medication errors, there is insufficient research to provide robust evidence to confirm this assumption.
Patient or public contributions were not required for this scoping review.
Sleep deprivation is a potential issue for nurses, especially those who work shifts. Poor sleep impacts cognitive processes that potentially could increase errors. Nurses should be aware of the impact sleep may have on patient safety.
To explore motivation, organisational climate, work engagement and related factors within the practice environment of nurse practitioners.
Motivation in the workplace, organisational climate and work engagement are important to motivate nurse practitioners and prevent early exit. However, little is known about related factors.
A cross-sectional design using a digital survey with multiple-choice and open-ended questions. Data were collected from 1 November 2019 to 30 March 2020.
The survey contained demographic and job-related data, instruments on motivation in the workplace, organisational climate and work engagement. Three open-ended questions were added to invite respondents to tell about their next career step, (dis)satisfaction with salary and additional comments. Quantitative data were not normally distributed (Kolmogorov–Smirnov test). Kruskal Wallis tests and Mann–Whitney U tests were used to test the relationship between independent and dependent variables. Answers on the open-ended questions were coded and categorised in themes. The STROBE checklist was followed.
In total 586 questionnaires were completed. The majority of the respondents were female (85%), and their mean age was 47 years (range 26–66 years). Aged 45 or over, more work experience, working in nursing homes, experiencing more autonomy, collaboration with other nurse practitioners, a firmly anchored position, satisfaction with salary and developmental opportunities contributed positively to the practice environment. Answers on the open-ended questions supported the quantitative results.
Work motivation, organisational climate and work engagement are positively related to a large variety of personal and work-related factors. Therefore, policymakers and professional organisations should be aware of the impact of these influencing factors to enhance an inspiring work environment.
Awareness of factors that influence nurse practitioners' practice environment can be used as a tool to screen and improve the present work environment.
Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well-being are often reported in patients on haemodialysis (HD).
We aimed to explore needs, barriers and facilitators—as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well-being.
This is an observational cross-sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal—aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well-being from the perspective of patients, their carers and HCPs.
In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private.
Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support.
To describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks.
Retrospective study.
The study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single-Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs.
Patients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care.
The inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes.
HL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge.
No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection.
To describe the contributing factors and types of reported medication incidents in home care related to the flow of information in different phases of the medication process, as reported by multi-professional healthcare groups.
This descriptive, qualitative study used retrospective data.
An incident-reporting database was used to collect 14,289 incident reports from 2017 to 2019 in a city in Finland. We used this data to select medication incidents (n = 1027) related to the flow of information in home care and between home care and hospitals. Data were divided into five groups based on the medication phase: (1) prescribing, (2) dispensing, (3) administration, (4) documentation and (5) self-administration. In addition, the types of medication-related incidents were described. The data were examined using abductive content analysis. The EQUATOR SRQR checklist was used in this report.
Four main categories were identified from the data: (1) issues related to information management, (2) cooperation issues between different actors, (3) work environment and lack of resources and (4) factors related to healthcare workers. Cooperation issues contributed to medication-related incidents during each phase. Incomplete communication was a contributing factor to medication incidents. This occurred between home care, remote care, hospital, the client and the client's relatives. Specifically, a lack of information-sharing occurred in repatriation situations, where care transitioned between different healthcare professionals.
Healthcare professionals, organisations, clients and their relatives should focus on the efficient and safe acquisition of medications. Specifically, the use of electronic communication systems, together with oral reports and checklists for discharge situations, and timely cooperation with pharmacists should be developed to manage information flows.
These findings demonstrate that healthcare professionals require uniform models and strategies to accurately and safely prescribe, dispense and administer medications in home care settings.
No patient or public contributions.
To explore how patients with Inflammatory bowel disease experienced encounters with healthcare professionals in two gastrointestinal outpatient clinics to demonstrate what matters in the communication between patients and healthcare professionals.
This fieldwork study is part of a larger study developing an application for patients with inflammatory bowel disease in a framework inspired by Participatory Design. Participatory design consists of three phases and this study focused on the first phase, needs assessment. A phenomenological hermeneutic approach and qualitative methods were applied to obtain an understanding of patients' needs.
Three weeks of participant observations and three focus groups with 14 subjects were conducted at two university hospitals in Denmark. Field notes and interview transcripts were analysed using condensation of meaning and interpreted based on interactional nursing practice theory. The reporting method adhered to the EQUATOR guideline: COREQ.
Four themes emerged: Easy and dependable access to healthcare professionals. Predictability of follow-up appointments. Importance of privacy during patient exams and Quality of time spent with healthcare professionals.
Easy, dependable access, privacy, presence and predictability of follow-up appointments were important to patients with Inflammatory Bowel Disease.
In communication with patients with inflammatory bowel disease, healthcare professionals must be aware of privacy and the importance of predictable follow-up agreements. They must be aware that presence and easy, reliable access positively affect patients' self-care skills.
This study is part of a larger project based on Participatory design involving patients and healthcare professionals in the development of technology to support communication.
Several studies have reported the prevalence of overweight and obesity in various countries but the global prevalence of nurses with overweight and obesity remains unclear. A consolidation of figures globally can help stakeholders worldwide improve workforce development and healthcare service delivery.
To investigate the global prevalence of overweight and obesity among nurses.
Systematic review with meta-analysis.
29 different countries across the WHO-classified geographical region.
Nurses.
Eight electronic databases were searched for articles published from inception to January 2023. Two independent reviewers performed the article screening, methodological appraisal and data extraction. Methodological appraisal was conducted using Newcastle-Ottawa Scale (NOS). Inter-rater agreement was measured using Cohen's Kappa. Meta-analyses were conducted to pool the effect sizes on overweight, obesity and waist circumference using random effects model and adjusted using generalised linear mixed models and Hartung–Knapp method. Logit transformation was employed to stabilise the prevalence variance. Subgroup analyses were performed based on methodological quality and geographical regions. Heterogeneity was assessed using the I 2 statistic.
Among 10,587 studies, 83 studies representing 158,775 nurses across 29 countries were included. Based on BMI, the global prevalence of overweight and obesity were 31.2% (n = 55, 95% CI: 29%–33.5%; p < .01) and 16.3% (n = 76, 95% CI: 13.7%–19.3%, p < .01), respectively. Subgroup analyses indicated that the highest prevalence of overweight was in Eastern Mediterranean (n = 9, 37.2%, 95% CI: 33.1%–41.4%) and that of obesity was in South-East Asia (n = 5, 26.4%, 95% CI: 5.3%–69.9%). NOS classification, NOS scores, sample size and the year of data collected were not significant moderators.
This review indicated the global prevalence of overweight and obesity among nurses along with the differences between regions. Healthcare organisations and policymakers should appreciate this increased risk and improve working conditions and environments for nurses to better maintain their metabolic health.
Not applicable as this is a systematic review.
PROSPERO (ref: CRD42023403785) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403785.
High prevalence of overweight and obesity among nurses worldwide.
To explore patients' and healthcare professionals' (HCPs) experiences of oral care during hospitalisation to identify needs and challenges.
Daily oral care is important to patients' health and well-being, to prevent diseases in the oral cavity, systemic infections and increased morbidity, which subsequently can lead to prolonged hospitalisation and, at worst, increased mortality. Despite this knowledge, oral care is a neglected part of nursing practice. Studies do not clearly identify barriers regarding oral care, as the existing knowledge is inadequate.
A qualitative study exploring participants' experiences to gain new in-depth knowledge of oral care among hospitalised patients.
A phenomenological-hermeneutic approach was applied. Participant observations were conducted on five hospital wards, combined with individual semi-structured interviews with 16 patients and 15 HCP. Data analysis was based on Ricoeur's theory of narrative and interpretation.
Four themes describing the challenges regarding oral care emerged: Oral care as a gut feeling; oral care fades into the background; even self-reliant patients need help with oral care; and the mouth reflects the life lived.
The identified challenges show there is a need for improvement in the health professional approach to oral care in nursing practice. Focus on increasing HCPs' knowledge, skills and competences can increase their nursing agency and support patients' self-care capacity.
Investigation of oral care during hospitalisation revealed four main challenges concerning both patients' and HCPs' lack of knowledge and awareness of oral care. Thus, patients and HCPs should be included in developing solutions to improve oral care in nursing practice.
The COREQ criteria for reporting qualitative research were adhered to.
A patient representative was involved in the discussion of the proposal, conduct and results of the study.
To explore collaborative practice and perceptions and attitudes of key stakeholders on collaboration in type 2 diabetes management in a tertiary care setting.
Understanding collaborative practice in diabetes care in developing countries helps to design and provide patient-centred and cost-effective care.
An exploratory qualitative study.
Interviews were undertaken with 30 patients and 18 health professionals and policymakers. Thematic data analysis was undertaken to explore collaborative practice and examine participant perspectives on collaboration in diabetes management. We compared the findings with D'Amour's Collaboration Framework to determine the level of collaboration.
Most participants reported a lack of collaborative practice in diabetes management, while they appreciated its importance in improving care. Perceptions varied with respect to what constituted collaborative practice. Three themes were identified: (1) perspectives of key stakeholders on current practice of collaboration; (2) impediments to collaborative practice; (3) strategies to improve collaborative practice. Analyses of the themes using D'Amour's Collaboration Framework indicated a low level of collaboration among physicians, nurses, pharmacists and policymakers, which was attributed to workload and time pressures on health professionals, power dynamics and lack of role clarity of all actors in collaborative action. Participants commented on the need to improve collaboration by establishing strong leadership and governance at different healthcare structure levels, which is committed to coordinating collaboration and developing collaborative frameworks and policies that guide collaborative undertaking.
Perceived shortcomings of collaboration were attributed to inadequate resources, power dynamics, a lack of strong team functioning and policies. Participants' positive perceptions provide an opportunity to improve collaborative practice through incorporation of collaborative frameworks and policies.
The findings in this study inform development of tailored and patient-centred diabetes care in tertiary care settings in sub-Saharan Africa.
The study was reported in accordance with the COREQ checklist.
Patients or the public were not involved in the design, analysis or interpretation of the data in this study. However, patients and healthcare providers participated in pilot interviews, which helped refine the interview guides. The summary of the findings of the study was also discussed with patients and healthcare providers, where they provided feedback.
The critical care nursing workforce is in crisis, with one-third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations.
Discursive/Position paper.
The discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer-reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports.
Critical care nurses have been disproportionately affected by the COVID-19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post-traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence-based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change.
We conclude that critical care nurses are in urgent need of preventative, evidence-based wellbeing interventions, and make suggestions for research and practice.
FreshRSS 