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Anteayer Journal of Advanced Nursing

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.

The impact of COVID‐19 on nursing students' lives and online learning: A cross‐sectional survey

Abstract

Aims

To explore the impact of COVID-19 on students' lives and their online learning experience.

Design

A cross-sectional survey design was used in this study.

Methods

A total of 44 nursing students who were enrolled in an undergraduate programme at a Canadian University participated in the study. The students were asked to fill out a 35-item survey that was developed by the European Students' Union and that was circulated across Europe in April 2020.

Results

The COVID-19 pandemic and subsequent lockdown affected students mentally, and emotionally. Findings also revealed that whilst most students had the privilege to study from home, many students did not have a desk, or a quiet place to study in their home and some had problems with Internet connectivity. Online lectures were delivered according to students' preferences; however, students were dissatisfied with the way their practice was organized.

Conclusion

The similarities between this study and the European study provide common grounds for academics around the world to connect, collaborate and work on the challenges in providing nurse education in emergencies such as national disasters or pandemics to ensure preparedness for such future events.

Patient or Public Contribution

No Patient or Public Contribution.

Impact

The commonalities experienced in nursing education across the globe should act as an impetus for globalized nursing action. Educators need to prepare and reinvent a role for students in the clinical area in the event of future disasters/pandemics. Policy makers and administrators need to ensure when switching to online education no student is underprivileged or marginalized in the process.

Supporting older nurses and midwives in the Australian healthcare workplace—A qualitative descriptive study

Abstract

Aim

To explore support strategies for older nurses and midwives in Australian healthcare workplaces.

Design

A qualitative descriptive study.

Method

Participants were 50 older nurses and midwives and 20 healthcare managers recruited from a broad range of Australian healthcare settings. Data were collected using semi-structured interviews from November 2018 to April 2021. The interviews were recorded, transcribed and thematically analysed.

Results

The limited number of identified sedentary roles and inequitable distribution of workload responsibilities were identified as constraints that impact the provision of workplace support for older nurses and midwives in healthcare settings. Three major themes were identified: Workplace support, Personal support and Doing more. A small number of participants reported support was available at work, but most said there was not. Of the reported strategies some were offered exclusively to a cohort that met an age criterion, while others were open to all staff regardless of age. Personal support strategies were employed outside of the workplace while others used strategies during working hours. Doing more related to suggestions about how organizations could do more to support older nurses and midwives at work.

Conclusion

Support mechanisms like adjustments in workload, employment fraction, practice location, upskilling and wellness programs in workplaces are limited. To facilitate retention and support older nurses and midwives in the workforce, health workplaces should consider implementing support mechanisms that can be tailored to the individual needs of the nurse or midwife over the life course of their career.

Impact

The findings of this study highlight the lack of support for many older nurses and midwives in Australian healthcare workplaces, emphasizing the need for further research into innovative practices on how to better support healthcare staff as they age.

Reporting Method

This study adhered to the COREQ reporting method.

Patient or Public Contribution

No patient or public contribution.

Between delivering chronic care and answering patients' burdens: Understanding HIV specialist nurses' experiences in the age of treatment

Abstract

Aim(s)

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.

Design

An interpretative phenomenological study was conducted using in-depth interviews.

Methods

Twenty-one interviews with nurses were conducted between November 2021 and March 2022. A thematic analysis was performed.

Results

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.

Conclusion

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.

Implications for the Profession and/or Patient Care

A potential re-evaluation of the role of nurses in providing chronic HIV care.

Impact

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.

Report Method

The COREQ guideline was used.

Patient or Public Contribution

Amsterdam UMC (AMC) staff, the national organization of HIV Nurses and patient organizations contributed to the study design.

Low‐value home‐based nursing care: A national survey study

Abstract

Aims

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.

Design

A quantitative, cross-sectional design.

Methods

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.

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.

Conclusion

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.

Reporting Method

STROBE checklist for cross-sectional studies.

Patient or Public Contribution

No Patient or Public Contribution.

Implications for the Profession and/or Patient Care

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.

Exploring men's struggles with infertility: A qualitative content analysis

Abstract

Aim

To investigate the experiences of men struggling with infertility.

Design

This is a qualitative study, and the report follows the COREQ checklist.

Methods

A team of nurse researchers conducted this research in Iran to examine the experiences of 11 men with primary infertility. The participants were selected through targeted sampling and underwent in-depth semi-structured interviews. The data collected was analysed using the conventional content analysis method outlined by Krippendorff. To ensure the study's accuracy, it followed the criteria proposed by Lincoln and Guba.

Results

The central theme, “the threat to masculinity,” was identified upon analysis. It comprises six categories: psychological pressure of confronting reality, frustration, discomfort with others, holding out against ridicule, tolerating unwanted opinions and advice and concealment of infertility and therapy.

Conclusion

This study brings attention to the challenge to masculinity that men with primary infertility face as their central struggle. It highlights the importance of culturally sensitive care from healthcare professionals, emotional support, counselling services and public awareness to reduce the stigma surrounding male infertility. It can be valuable to evaluate and enhance infertility care in various settings.

Implications for the Profession and Patient Care

To provide the best possible care for infertile men, it would be beneficial for nurses to pay more attention to sociocultural factors. Fertility care should be respectful of patients' beliefs and backgrounds.

Impact

What problem did the study address?

Infertility care has been the subject of recent research, focusing on the impact of sociocultural factors. Male-factor infertility is often overlooked in clinical care literature. There is a correlation between cultural background and men's acceptance of reproductive healthcare.

What were the main findings?

Male infertility is often avoided in discussions due to its perceived threat to masculinity. Multiple factors, including societal norms, cultural expectations and personal experiences, influence the nature of men's struggles with infertility. Providing emotional support and counselling services is crucial so that men can openly discuss their fertility challenges and seek treatment without feeling ashamed or judged.

Where and on whom will the research have an impact?

Raising public awareness and providing education about male infertility is crucial. Nurses must exhibit cultural sensitivity while caring for men experiencing infertility. Policymakers need to implement strategies to reduce the stigma surrounding male infertility.

Reporting Method

The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Patient or Public Contribution

No public or patient involvement.

Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence‐based practice into routine care: An interpretative phenomenological analysis

Abstract

Aim

To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care.

Design

A qualitative interpretative phenomenological analysis.

Methods

A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis.

Results

Six superordinate themes emerged: Understanding of advanced practice; ‘Treated as an equal and as a “nurse”’; Nursing management support; ‘A voice to implement anything new’; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice.

Conclusion

There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care.

Impact and Implications

The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients.

Contribution to the Wider Global Clinical Community

As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice.

Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care.

Reporting Method

Consolidated criteria for reporting qualitative research (COREQ).

Patient or Public Contribution

No patient or public contribution.

Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review

Abstract

Aim

To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies.

Design

Realist review according to the Realist and Meta-narrative Evidence Syntheses—Evolving Standards (RAMESES).

Data Sources

PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022.

Review Methods

Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group.

Results

Multiple context–mechanism–outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only.

Conclusions

A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies.

Impact

Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated.

No Patient or Public Contribution

Prospero ID CRD42021292290.

Understanding ‘value’ in the context of community‐based interventions for people affected by dementia: A concept analysis

Abstract

Aim

This study aimed to conduct a concept analysis of value in the context of community-based interventions for people affected by dementia.

Background

Concepts of value play a critical role in shaping the delivery and distribution of community-based health interventions through related concepts. However, the use and meaning of ‘value’ is rarely clarified limiting the term's utility in practice and research. Increasing need for community healthcare and scarce public resources means developing understanding of value in community-based interventions for people affected by dementia is timely, and may support more informed approaches to exploring, explaining and delivering value.

Design

Evolutionary Concept Analysis was used to systematically determine the characteristics of value.

Data Sources

Peer-reviewed and grey literature databases were searched between April and July 2021, with 32 pieces of literature from different disciplines included in the final sample. No limits were set for the years of literature retrieved.

Methods

Literature was thematically analysed for information on the antecedents, attributes and consequences of value.

Results and Discussion

The analysis uncovered a need and/or desire to understand the experience of people affected by or that affect interventions; and to demonstrate, prove/disprove the (best) quality and nature of results of interventions as antecedents of value. Attributes of value were stakeholder/person centred, measurable, time and context dependent and multidimensional. Consequences of the concept included shared decision-making, valuation of interventions and internal/external investment and development of interventions.

Conclusion

Through concept analysis value can now be better understood and applied. The development of a conceptual model to illustrate the constituent elements and relationships of the concept adds transparency to where, why and how concepts of value are enabled that supports future concept development.

Patient and Public Contribution

No patient or public contribution.

Insight into the experiences of caregivers of older adults in long‐term care homes: A photovoice study

Abstract

Aims

To explore the lived experiences of caregivers of people living in long-term care (LTC) homes during the initial phases of the COVID-19 pandemic and potential supports and resources needed to improve caregivers' quality of life.

Background

Carers (or care partners) of adults in LTC contribute substantially to the health and well-being of their loved ones by providing physical care, emotional support and companionship. Despite their critical role, little is known about how caregivers have been impacted by the pandemic.

Design

An interpretive descriptive approach that incorporated the photovoice method was used.

Methods

Using a purposive sampling strategy, six family carers in Ontario, Canada were recruited between September and December 2021. Over a 4-week period, caregivers took pictures depicting their experience of the pandemic that were shared in a virtual focus group. Visual and text data were analysed using thematic analysis with an inductive approach.

Findings

Caregivers expressed feelings of frustration, confusion and joy. Emerging themes included: (i) feeling like a ‘criminal’ amidst visitor restrictions and rules; (ii) experiencing uncertainty and disappointment in the quality of care of long-term care homes; (iii) going through burnout; and (iv) focusing on small joys and cherished memories.

Conclusions

The combination of visual and textual methods provided unique insight into the mental distress, isolation and intense emotional burdens experienced by caregivers during the pandemic.

Impact

Our findings underscore the need for LTC organizations to work in unison with caregivers to optimize the care of residents and support the mental health of caregivers.

Reporting Method

This work adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist.

Public Contributions

The caregivers included in the study were involved in the co-creative process as active contributors informing the design and validation of the codes and themes.

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