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To analyse existing knowledge on the psychometric properties of the Braden Scale when used within the acute care setting.
Systematic review and narrative synthesis.
A database search was conducted in June 2023 and updated in February 2024, seeking studies testing the psychometric properties of the Braden scale in the acute care setting. Data were sourced from five electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science). Study selection, data extraction and assessment of risk of bias were completed, with two reviewers independently conducting each stage and an independent reviewer arbitrating discrepancies. Data were extracted using a customised template and synthesised narratively. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.
Thirty-seven studies met the inclusion criteria. Internal consistency was reported between 0.64 and 0.78 (Cronbach's alpha). Inter-rater reliability was high, reported as ranging from 0.946 to 0.964 (intra-class correlations) or 0.86 to 0.949 (Pearson's correlation). Most validity studies tested predictive validity with wide variances reported.
The Braden Scale is reliable for assessing the risk of PI in acute care, but the validity of the scale is variable. Further research investigating validity beyond predictive validity is required.
Nurses working in acute care can use the Braden Scale with confidence of scale reliability. However, validity is variable and warrants a cautious approach. The true value resides in the capacity to trigger recognition of pressure injury risk.
Trial Registration: The protocol was registered a priori with the International Prospective Register of Systematic Reviews PROSPERO ref: CRD42023407545
To describe the cumulative incidence and characteristics of hospital-acquired pressure injury in acute palliative patients.
Secondary data analysis of hospital-acquired pressure injuries during 2019–2022.
The setting was a palliative care unit at a tertiary hospital in Queensland, Australia, including adult (≥ 18 years) acute-phase palliative inpatients. Retrospective data from four databases were used to identify and analyse hospital-acquired pressure injury cases from 2019 to 2022. Clinical characteristics of patients with and without hospital-acquired pressure injury were compared.
The incidence of hospital-acquired pressure injury in acute palliative care patients was 3.9% over the 4 years. These patients were predominantly male, with an average age of 74 years, with 66 of 78 cases developing in the deteriorating palliative care phase. Using the Waterlow Score, 51.3% of patients were assessed as at very high risk of pressure injury. Ninety-five hospital-acquired pressure injuries were reported in 78 patients; 16.8% were medical device-related, 40% were Stage 1 injuries, and the most common injury sites were the sacrum, heels and genitals. Patients with hospital-acquired pressure injury had significantly higher (worse) scores on both the palliative care Resource Utilisation Group-Activities of Daily Living and Problem Severity Scores. Regression analysis identified a high Problem Severity Score on admission as a significant predictor for hospital-acquired pressure injury development.
The incidence of hospital-acquired pressure injury in acute palliative patients is lower than in previous studies. However, many injuries occurred in those in the deteriorating phase, with higher scores for severity of symptoms. These findings suggest that acute palliative patients do require nursing care for pressure injury prevention, as well as for symptom management and activities-of-daily-living. Overall, this research contributes to a deeper understanding of pressure injury incidence and characteristics for acute palliative care patients. Future research should focus on population-specific pressure injury risk assessment to explore risk factors in greater detail.
Current pressure injury risk assessment tools, like the Waterlow Score, may not provide the comprehensive evaluation needed for the acute palliative care cohort. To better address the unique needs of this cohort, it may be necessary to refine existing tools or develop new instruments that integrate palliative-specific assessments, such as the Resource Utilisation Group-Activities-of-Daily-Living (RUG-ADL) and Problem (symptom) Severity Score (PSS). These adaptations could help improve pressure injury prevention care planning and enhance outcomes for patients in this setting.
This study separated acute palliative care patients from those at end-of-life and found a 3.9% cumulative incidence of pressure injuries. There were no significant differences in age, gender, or cancer diagnosis between patients with and without injuries. Patients without injuries were more likely to be in the deteriorating phase, while those with injuries had higher (worse) RUG-ADL scores. Regression analysis showed that each one-point increase in the PSS (symptom severity) made patients 1.2 times more likely to develop a pressure injury. The findings suggest that combining a validated risk assessment tool with the RUG-ADL and PSS tools could provide a more accurate risk assessment for hospitalised acute palliative care patients.
STROBE reporting guideline.
No patient or public contribution.
To explore the characteristics of oral healthcare education interventions for stroke clinicians and the effectiveness of these interventions in improving the oral health knowledge, attitudes, confidence, and practice among acute stroke clinicians.
Scoping review, guided by Arksey and O'Malley's (2005) framework.
Original full-text studies reporting educational oral healthcare interventions for stroke clinicians, including but not limited to nurses, were eligible for inclusion. Included studies were extracted and appraised using the Joanna Briggs Institute (JBI) Checklist aligned to the study methodology. Narrative synthesis was used to describe heterogeneous findings.
Key electronic bibliographic databases including CINAHL, Cochrane, MEDLINE (Ovid), ProQuest, Pubmed, and Scopus, in addition to grey literature, were searched for studies published between 1st January 2000 and 20th January 2024.
Five studies conducted in acute inpatient settings were included: two randomised controlled trials, two mixed-methods studies, and one quality improvement project. Most (n = 4) studies developed complex interventions that included education and other components (products, referral pathways, assessment tools), and were delivered either face-to-face or as an online program. Most studies reported positive changes in oral health knowledge, attitudes, and confidence. There was limited measurement of the acceptability and feasibility of the interventions, with only one study reporting positive feedback from clinicians. There was no evidence to support changes in clinical practice following any of the included interventions.
Existing evidence indicates interventions for stroke clinicians have some potential for building stroke clinicians' capacity to provide adequate oral healthcare. There is however no evidence linking these interventions to optimised patient outcomes. There is a need for research focused on the implementation and dissemination of tailored oral health educational interventions incorporating clinically meaningful outcomes.
Existing oral healthcare educational interventions appear to have a positive effect on stroke clinicians' oral health knowledge, confidence, and attitudes. Educational interventions in oral healthcare are perceived to be acceptable and feasible; however, further research is needed to design and test the effect of new interventions.
Integrated oral healthcare is particularly important for stroke survivors who are at greater risk of preventable aspiration pneumonia. This scoping review highlights the characteristics of existing educational programs for stroke clinicians, their effectiveness, and gaps in existing evidence. Review findings substantiate the need for future research to enhance existing oral healthcare interventions, to translate knowledge acquired from training into clinical practice, and to capture appropriate measures of effect.
The PRISMA-ScR Checklist.
This review was registered with the Open Science Framework registry (https://doi.org/10.17605/OSF.IO/4BWVF).
The aim of this umbrella review was to summarise the existing evidence on the effectiveness of nursing interventions targeted at adult patients in hospitals.
Existing systematic reviews were synthesised.
The literature search was conducted in PubMed, CINAHL Complete, and the Cochrane Library by two of the authors until June 6th 2024 without a time limit.
A total of 2652 records were identified. After screening the titles and abstracts, 2421 records were excluded. Then two records were excluded as they were not retrieved, and 125 records were excluded during full-text review as they did not meet the inclusion criteria. Finally, 11 reviews (141 original studies) were included in the quality assessment and were analysed narratively.
The most commonly used interventions were educational, followed by preventive, observative, or combinations of various interventions. All interventions were targeted at the care of somatic patients. The interventions lacked detailed descriptions of their content and duration. Nursing interventions were found to reduce anxiety, depression, disorder symptoms, pain intensity, length of hospital stay, serious adverse effects, mortality, infections and pressure ulcer prevalence.
There is limited high-quality evidence on the effectiveness of nursing interventions used by nurses at hospital settings. While nursing interventions can improve hospital patient outcomes, more high-quality systematic reviews and meta-analyses are needed. Only preventive interventions (such as pressure ulcer prevention and use of early warning scores) consistently showed positive effects and are relatively easy to implement in hospital nursing practice. Other interventions are not yet widely integrated into standard care in hospitals. It is necessary to study the cost-effectiveness of nursing interventions.
This umbrella review did not include any patient or public involvement.
This umbrella review of systematic reviews adheres to the PRISMA statement.
Registered nurses (RN)s account for the majority of the rural and remote health workforce and require different skills, knowledge and working practices compared to their metropolitan counterparts. Given the complexity and diversity of the rural and remote work environment, it is important to investigate the contemporary literature on the role and skill requirements of the RNs in these locations.
A scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. With the permission of the authors, this scoping review extends the work by Muirhead and Birks (2020) who explored the RN role in these locations in 2017. Database searches were conducted in the Cumulative Index for Allied Health and Nursing Literature (CINAHL), Cochrane, JBI, OVID (Emcare), Proquest, PubMed, Scopus and Rural and Remote Health Database. Studies published from November 2017 to June 2024 were included to reflect the current international roles of rural and remote RNs.
A total of 74 articles were included in the study. The overarching categories identified were clinical roles and non-clinical roles. Ongoing analysis established the subcategories of fundamental/foundational, specialist, management roles, support roles and ancillary roles. Four tensions within the rural and remote context were also identified; Generalist and specialist role; Poorly prepared or unprepared; Extended scope of practice; and Role uncertainty.
Registered Nurses in rural and remote locations conduct a wide variety of skills and tasks. Their role is expansive, context-dependant, and dynamic. Analysis of the literature found that globally, similarities exist for the role, including comparable challenges, barriers and opportunities Resource availability in a country impacts RN preparation, emphasising the need for systemic improvements to ensure equitable outcomes, especially in rural and remote areas.
The role of the rural and remote RN is broad and unique and requires different breadth and depth of skills and knowledge. The rural and remote RN role includes all levels of care for all patients across the lifespan, with varying resource and support levels. This scoping review provides valuable insight into the skills required to care for diverse communities. Understanding these requirements is essential, as it can inform the future focus on rural and remote nurse education and training and its subsequent impact on the quality of care for people living in rural and remote communities.
Workplace violence toward nurses is a significant global issue affecting their mental and physical health, job satisfaction and performance, and can ultimately lead to decisions to leave the profession. As the least experienced caregivers in the health workforce, nursing students are particularly vulnerable to experiencing workplace violence and are often powerless to deal with WPV incidents.
To examine clinical facilitators' insights into how to support nursing students following experiences of workplace violence during their clinical placement.
An exploratory, descriptive qualitative design.
Data were collected between September and November 2022 using semi-structured interviews with 11 clinical facilitators working in South Australia, each lasting about 1 h. The interviews were transcribed verbatim and analysed using thematic analysis.
Clinical facilitators identified that many students found support and solace from avenues outside of the CFs and university staff, including ward staff, family, friends and other students. However, students are limitedly prepared for the realities of clinical work, particularly concerning workplace violence, and that the university supports available were reactive to events in the clinical environment.
Addressing workplace violence requires systemic changes, better support for clinical facilitators and a steadfast commitment by all stakeholders to student safety.
Solid collaborations between universities and clinical facilities with clear guidelines and direct lines to address potential violence issues are essential. Zero-tolerance policies regarding workplace violence could provide a safer environment that promotes nursing student learning outcomes, safer placements, better student experiences and optimal healthcare provision.
COREQ guidelines were adhered to for reporting qualitative research.
This paper specifically explores the perspective of the clinical facilitator's experience of WPV in their role of supporting student learning during clinical placement.
To develop and validate a screening tool to identify patients with cardiovascular disease at risk of poor oral health and requiring referrals.
This study was part of a larger pilot study involving a cross-sectional survey and an oral health assessment conducted with patients with cardiovascular disease.
A four-item screening tool was developed by an expert panel and validated through a cross-sectional survey of patients with cardiovascular disease. The survey contained the tool and the oral health impact profile (OHIP-14) (first gold standard). Additionally, all survey participants were provided a clinical oral health assessment (second gold standard). Sensitivity and specificity analysis was undertaken comparing the tool to the two gold standards to assess patients with cardiovascular disease at risk of poor oral health.
Three hundred and twenty-one participants completed the cross-sectional survey and eighty nine undertook the oral health assessment. Results from both approaches showed that the tool had high sensitivities (OHIP-14 = 89%, Oral assessment = 88%) and low specificities (OHIP-14 = 33% and Oral assessment = 24%).
The four-item screening tool is a simple and valid tool to identify patients with cardiovascular disease at risk of poor oral health and requiring a dental referral. The tool could be incorporated into routine practice of nurses across various cardiac settings.
To understand, from a nursing perspective, factors affecting the use of prophylactic dressings to prevent pressure injuries in acute hospitalised adults.
Pressure injury causes harm to patients and incurs significant costs to health services. Significant emphasis is placed on their prevention. Relatively recently, prophylactic dressings have been promoted to reduce pressure injury development. However, in the acute care setting, information about the clinical use of these dressing is lacking.
Qualitative, descriptive.
Nineteen medical and surgical nurses participated. Semi-structured interviews were conducted and transcribed verbatim. Thematic analysis was performed using an inductive approach using NVivo software.
Three themes were identified, reflecting factors that influenced and perpetuated indiscriminate use of prophylactic dressings: False sense of security; Convenience and task prioritisation; and Navigating challenges in evidence-based pressure injury prevention.
The findings indicate inconsistent prevention practices, with prophylactic dressings often applied without justification or referral to research-based evidence to guide clinical decision-making. There was a prevailing attitude of ‘job done’ when a prophylactic dressing was applied.
This study has identified several factors that perpetuate the inappropriate use of prophylactic dressings for pressure injury prevention that may be amenable to organisational change. The findings indicate that nurses often rely on these dressings as a shortcut due to time constraints, which led to missed skin assessments and low-value care. The research can be used to inform the development of clear guidelines on dressings within hospital settings which encourage assessment-based selection for their use, and process-based guidance for their application, skin surveillance, dressing inspection and removal.
The Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline was followed.
Neither patients nor the public were directly involved in this study.
Aging populations require adapting healthcare systems for older adult's specific needs. Numerous initiatives to improve older-patient care have emerged, but the field lacks a unified framework. The current study aims to provide a systematic concept analysis of ‘age-friendly healthcare’, examining its characteristics, components and structure.
Rodger's evolutionary concept analysis.
Searches were conducted in ProQuest, CINAHL, PubMed and Scopus databases between November 2022 and October 2023, utilising the PRISMA 2020 reporting checklist.
A literature search using specific terms relevant to age-friendly healthcare retrieved 1407 articles. After screening for duplicates and relevance, 140 articles were examined for eligibility based on inclusion criteria for age-friendly care, language and full-text availability. Following full-text screening, 65 articles were included for data extraction by multiple researchers to synthesise theoretical, methodological and design elements.
Our findings highlight key attributes of age-friendly healthcare: Respect for older adults' autonomy and needs; leadership and organisational knowledge and support; Proactive policies and processes of care; holistic care environments; and communication and follow-up with awareness of challenges and barriers as well as prioritisation of continuity-of-care.
The concept of age-friendly healthcare is still developing, with much research focused on development and implementation rather than evaluation of real-world patient and health-system outcomes. Our analysis of the concept may help unify the field and clarify future research directions through identification of areas requiring further study and enable development of improved practices and policies for implementing age-friendly healthcare in a variety of settings.
This concept analysis did not include any patient or public involvement.
This study utilised the PRISMA reporting checklist.
To describe how clinicians provide culturally responsive care to culturally diverse people with kidney failure in haemodialysis centres.
Culturally diverse individuals receiving in-centre maintenance haemodialysis have unique cultural needs. Unmet cultural needs can impair and profoundly affect their experiences. Given culturally responsive care has the potential to enhance the experiences of culturally diverse people, it is vital to understand how clinicians provide culturally responsive care.
A scoping review was undertaken using Arksey and OMalleys framework. Five databases: Medline and CINAHL Complete (EBSCO), PsycINFO, Embase (OVID) and ProQuest Theses and Dissertation databases were searched for research literature published in English between 1990 and 2023. Narrative synthesis was used to synthesise the data.
From the 17,271 records screened, 17 papers reporting 14 studies met the inclusion criteria. Narrative synthesis revealed two themes: (i) communication enablers and barriers including linguistic differences, professional and lay interpreter use; and (ii) the importance of culture, which encompassed acknowledging cultural priorities, accommodating cultural food preferences and access to cultural training.
While competing priorities associated with haemodialysis may be a challenge for clinicians, recognising the significance of cultural care needs and accommodating them in care is important. Demonstrating respect towards cultural diversity and providing person-centred care by facilitating the unique cultural needs of people with kidney failure in haemodialysis is imperative.
Culturally responsive care is complex and multidimensional. Individuals' cultural care needs should be acknowledged, respected, and accommodated in care.
No patient or public contribution. The study protocol was registered in the Open Science Framework. https://osf.io/uv8g3.
To evaluate the incidence of skin-related complications attributable to incontinence-associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care.
Multicenter quality improvement study.
Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines.
Three hundred and eighty-one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown.
The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention.
Significant negative outcomes are associated with UI patients. External female urinary catheters are a non-invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD-related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown.
Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care.
Dysmenorrhea, or menstrual pain, is a subjective experience, and can only be assessed by patient-reported outcomes. These instruments should be reliable, valid and responsive.
To identify and critically appraise the available evidence for the measurement properties of specific patient-reported outcome measures used for dysmenorrhea.
The PRISMA statement was used to report this systematic review. Databases searched were PubMed, SCOPUS, CINAHL, Web of Science, ScienceDirect and Google Scholar (April 2021; updated on February 2023). Original studies with primary data collection, with no restriction on language and publication date that reported psychometric properties of one or more dysmenorrhea-related patient-reported outcome measure. The literature searches, selection of studies, data extraction and assessment of the risk of bias were performed independently by two reviewers and followed the COSMIN guidelines.
Thirty studies were analysed in this review, and 19 patient-reported outcome measures were evaluated. The instruments varied in relation to the measured construct and measurement properties (validity, reliability and responsiveness). The methodological quality of the studies and the quality of evidence of the patient-reported outcome measures were variable. Among the 13 studies that reported the development of patient-reported outcome measures, most had inadequate methodological quality, and the overall rating was insufficient or inconsistent.
The Dysmenorrhea Symptom Interference (DSI) scale was the only identified patient-reported outcome measure that has the potential to be recommended because of its sufficient rating combined with moderate quality of evidence for content validity. Future studies should further evaluate the measurement properties of the existing patient-reported outcome measures, or develop new patient-reported outcome measures following the COSMIN methodology.
Not applicable as this is a systematic review.
PROSPERO protocol: CRD42021244410. Registration on April 22, 2021.
To describe and interpret the sexual health experiences of men with IBD.
Interpretive qualitative study.
In-depth, semi-structured interviews were conducted with 22 men with a diagnosis of Inflammatory Bowel Disease. Interviews were digitally audio-recorded and transcribed verbatim. Data were analysed using constant comparative, thematic analysis.
Three themes were identified from interview data: (1) the disease shapes intimate connections, (2) the disease thwarts sexual experiences and (3) the disease disrupts male gender norms. Men reported that active disease lowered libido and could change pre-, inter- and post-coital sexual practices. All participants noted that health professionals did not initiate the discussion of sexual health and well-being needs in the outpatient hospital setting. Men who engaged in receptive anal sex reported a lack of disease-specific guidance and understanding from professionals.
Inflammatory bowel disease can negatively impact the sexual well-being, gender identity and activities of men. Further research is required to identify the care preferences of men with IBD and clarify the barriers and facilitators to sexual health assessment so that nurses may better support the health needs of this population.
This study highlights the need for sexual health and well-being support that is specific to disease and gender in IBD. There is a paucity of information and guidance for men with peri-anal disease and proctitis who engage in receptive anal sex, which requires urgent attention.
Reporting follows the COREQ checklist.
A patient and public involvement group informed the development of the study design. The group reviewed public facing documents and interview guides. One member of the group provided comments on the identified themes.
To investigate the feasibility and acceptability of the training process, procedures, measures and recruitment strategies necessary for a future investigation to test the reliability and validity of using positivity resonance measures in health care encounters.
Although the measurement of positivity resonance is promising, and non-participant observation is considered effective, their approaches to studying nurse–patient relationships have not been fully explored.
A mixed-methods observational study.
Video recordings of 30 nurse–patient dyads completing telehealth video visit encounters were edited and coded using behavioural indicators of positivity resonance. A post-visit survey gathered data on the participants' perceptions of positivity resonance and the study procedures. The research team completed memos and procedural logs to provide narrative data on the study's training, coding, recruitment and operational procedures. The study included 33 persons with cancer and 13 oncology nurses engaging in telehealth video visit encounters at an academic oncology ambulatory care center located in the southeastern United States.
Study procedures were found to be feasible and acceptable to participants. An adequate sample of participants (N = 46) were enrolled and retained in the study. Interrater reliability, as evidenced by Cohen's weighted kappa, ranged from .575 to .752 and interclass correlation coefficients >.8 were attainable within a reasonable amount of time and with adequate training. Behavioural indicators of positivity resonance were observed in all telehealth visits and reported by the participants in the perceived positivity resonance survey. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided reporting.
Designing research around the concept of positivity resonance is an innovative and feasible approach to exploring how rapport is cultivated within nurse–patient relationships.
Measuring positivity resonance may hold promise for exploring patient and nurse outcomes including trust, responsiveness, health-related behaviours, well-being, resilience and satisfaction.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided the reporting of results to ensure that adequate details of the study were provided to ensure an accurate and complete report.
Planning of the research design and study procedures was done in consultation with nurse clinicians with experience with telehealth and managers responsible within the practice setting where the study was conducted. This ensured the study procedures were ethical, safe, secure and did not create unnecessary burden to the study participants. The study included collecting data from nurse and patient participants about the acceptability of the study procedures.
To demonstrate how interoperable nursing care data can be used by nurses to create a more holistic understanding of the healthcare needs of multiple traumas patients with Impaired Physical Mobility. By proposing and validating linkages for the nursing diagnosis of Impaired Physical Mobility in multiple trauma patients by mapping to the Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC) equivalent terms using free-text nursing documentation.
A descriptive cross-sectional design, combining quantitative analysis of interoperable data sets and the Kappa's coefficient score with qualitative insights from cross-mapping methodology and nursing professionals' consensus.
Cross-mapping methodology was conducted in a Brazilian Level 1 Trauma Center using de-identified records of adult patients with a confirmed medical diagnosis of multiple traumas and Impaired Physical Mobility (a nursing diagnosis). The hospital nursing free-text records were mapped to NANDA-I, NIC, NOC and NNN linkages were identified. The data records were retrieved for admissions from September to October 2020 and involved medical and nursing records. Three expert nurses evaluated the cross-mapping and linkage results using a 4-point Likert-type scale and Kappa's coefficient.
The de-identified records of 44 patients were evaluated and then were mapped to three NOCs related to nurses care planning: (0001) Endurance; (0204) Immobility Consequences: Physiological, and (0208) Mobility and 13 interventions and 32 interrelated activities: (6486) Environmental Management: Safety; (0840) Positioning; (3200) Aspiration Precautions; (1400) Pain Management; (0940) Traction/Immobilization Care; (3540) Pressure Ulcer Prevention; (3584) Skincare: Topical Treatment; (1100) Nutrition Management; (3660) Wound Care; (1804) Self-Care Assistance: Toileting; (1801) Self-Care Assistance: Bathing/Hygiene; (4130) Fluid Monitoring; and (4200) Intravenous Therapy. The final version of the constructed NNN Linkages identified 37 NOCs and 41 NICs.
These valid NNN linkages for patients with multiple traumas can serve as a valuable resource that enables nurses, who face multiple time constraints, to make informed decisions efficiently. This approach of using evidence-based linkages like the one developed in this research holds high potential for improving patient's safety and outcomes.
In this study, there was no direct involvement of patients, service users, caregivers or public members in the design, conduct, analysis and interpretation of data or preparation of the manuscript. The study focused solely on analysing existing de-identified medical and nursing records to propose and validate linkages for nursing diagnoses.
To explore patients' experiences of shared decision-making, in nursing care during their stay in a healthcare institution.
This study employed a qualitative descriptive design.
Twenty participants were interviewed from two rehabilitation centres, a nephrology ward of a hospital, and a rehabilitation ward of a long-term care facility. A constant comparative method was used for the inductive analysis.
The main theme was ‘feeling seen and understood’, in the context of person-centred care, which served as the unifying thread across five themes. The five themes included the importance of a positive nurse–patient relationship as a foundation for shared decision-making. Next, patients experienced collaboration, and this was influenced by verbal and non-verbal communication. Another theme was that patients often felt overwhelmed during their stay, affecting shared decision-making. The fourth theme was that many decisions were not made through the shared decision-making process but were still perceived as satisfactory. The final theme highlighted patients' perspectives on their role in decision-making and influencing factors.
Patients describe how feeling seen and understood is a prerequisite for shared decision-making as a part of person-centred care. For nurses, this implies that they should focus on aspects such as building a good relationship and acknowledgement of patients' feelings and circumstances, next to empowering patients to feel knowledgeable and valued. This way patient's motivation to participate in shared decision-making will be enhanced.
Following the EQUATOR guidelines, reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Patients were involved in the study through interviews during the research process and member checks during analysis.
Before initiating shared decision-making processes, prioritise making the patient feel seen and understood. Be mindful that patients often feel overwhelmed during their stay. Use a person-centred approach to make patients feel knowledgeable—this empowers them for shared decision-making.
Research on patients' experiences of shared decision-making in nursing care is limited, yet crucial for understanding patients' needs in shared decision-making. This study highlights patients' perceptions that shared decision-making is best facilitated within the nurse–patient relationship by nurses who primarily focus on ensuring that patients feel acknowledged and understood.
To explore nurses' perceptions of using point-of-care ultrasound for assessment and guided cannulation in the haemodialysis setting.
Cannulation of arteriovenous fistulae is necessary to perform haemodialysis. Damage to the arteriovenous fistula is a frequent complication, resulting in poor patient outcomes and increased healthcare costs. Point-of-care ultrasound-guided cannulation can reduce the risk of such damage and mitigate further vessel deterioration. Understanding nurses' perceptions of using this adjunct tool will inform its future implementation into haemodialysis practice.
Descriptive qualitative study.
Registered nurses were recruited from one 16-chair regional Australian haemodialysis clinic. Eligible nurses were drawn from a larger study investigating the feasibility of implementing point-of-care ultrasound in haemodialysis. Participants attended a semistructured one-on-one interview where they were asked about their experiences with, and perceptions of, point-of-care ultrasound use in haemodialysis cannulation. Audio-recorded data were transcribed and inductively analysed.
Seven of nine nurses who completed the larger study participated in a semistructured interview. All participants were female with a median age of 54 years (and had postgraduate renal qualifications. Themes identified were as follows: (1) barriers to use of ultrasound; (2) deficit and benefit recognition; (3) cognitive and psychomotor development; and (4) practice makes perfect. Information identified within these themes were that nurses perceived that their experience with point-of-care ultrasound was beneficial but recommended against its use for every cannulation. The more practice nurses had with point-of-care ultrasound, the more their confidence, dexterity and time management improved.
Nurses perceived that using point-of-care ultrasound was a positive adjunct to their cannulation practice and provided beneficial outcomes for patients.
Haemodialysis clinics seeking to implement point-of-care ultrasound to help improve cannulation outcomes may draw on these findings when embarking on this practice change.
This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Patients were not directly involved in this part of the study; however, they were involved in the implementation study.
The larger study was registered with Australian New Zealand Clinical Trials Registry: ACTRN12617001569392 (21/11/2017) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373963&isReview=true
FreshRSS 