Pub Date : 2024-07-17DOI: 10.1016/j.ijnsa.2024.100222
Background
Followership is defined as the role individuals play in supporting, contributing to, and realizing the vision and directives set by their leaders. Such a role is indispensable in healthcare, facilitating effective team dynamics and healthcare delivery. Within the nursing field, it encompasses nurses' active engagement and participation in healthcare delivery, ensuring safety, fostering teamwork, and enhancing patient outcomes. Despite its significance, the exploration of followership within the nursing context of Saudi Arabia remains limited.
Objective
This study aims to explore how followership is perceived and practiced by nurses in this unique cultural and professional setting, and its implications for healthcare delivery.
Methods
We conducted a qualitative inquiry involving seven registered nurses working in hospitals affiliated with the Saudi Arabian Ministry of Health. Semi-structured interviews were conducted, and a thematic analysis was utilized to extract key findings.
Results
Our thematic analysis identified four main themes and several sub-themes that encapsulate the participants' perspectives on followership. The themes include: (1) Understanding of followership, where a predominant lack of clarity about the concept was observed, often conflating it with teamwork; (2) Followers' involvement in decision-making, highlighting the limited participation of nurses in decision-making processes due to hierarchical and autocratic leadership structures; (3) Barriers to followership, which encompassed issues such as poor leadership, the undervaluation of the follower role, lack of training and development opportunities, challenges in collaboration, and language barriers; and (4) Facilitators of followership, identified as effective leadership, followership training, communication skills, positive relationships, respect, collaboration, understanding of roles, commitment, and flexibility. These findings elucidate the complex landscape of followership within the nursing profession in Saudi Arabia, revealing both the challenges and pathways to fostering effective followership in healthcare settings.
Conclusion and Implications
This study reveals a widespread lack of awareness about followership among nurses in Saudi Arabia, highlighting significant challenges related to hierarchy and the undervaluation of the follower role in nursing practice and education. It underscores the need for educational and training interventions that redefine and elevate the role of followership in clinical settings to enhance collaboration, assertiveness, and decision-making skills. Moreover, the study advocates for the re-evaluation of leadership practices to better acknowledge and value followership, promoting a more flattened hierarchy that encourages active participation in patient care and organizational development. Implementing these chang
{"title":"Perceptions of followership among nurses: A qualitative study","authors":"","doi":"10.1016/j.ijnsa.2024.100222","DOIUrl":"10.1016/j.ijnsa.2024.100222","url":null,"abstract":"<div><h3>Background</h3><p>Followership is defined as the role individuals play in supporting, contributing to, and realizing the vision and directives set by their leaders. Such a role is indispensable in healthcare, facilitating effective team dynamics and healthcare delivery. Within the nursing field, it encompasses nurses' active engagement and participation in healthcare delivery, ensuring safety, fostering teamwork, and enhancing patient outcomes. Despite its significance, the exploration of followership within the nursing context of Saudi Arabia remains limited.</p></div><div><h3>Objective</h3><p>This study aims to explore how followership is perceived and practiced by nurses in this unique cultural and professional setting, and its implications for healthcare delivery.</p></div><div><h3>Methods</h3><p>We conducted a qualitative inquiry involving seven registered nurses working in hospitals affiliated with the Saudi Arabian Ministry of Health. Semi-structured interviews were conducted, and a thematic analysis was utilized to extract key findings.</p></div><div><h3>Results</h3><p>Our thematic analysis identified four main themes and several sub-themes that encapsulate the participants' perspectives on followership. The themes include: (1) Understanding of followership, where a predominant lack of clarity about the concept was observed, often conflating it with teamwork; (2) Followers' involvement in decision-making, highlighting the limited participation of nurses in decision-making processes due to hierarchical and autocratic leadership structures; (3) Barriers to followership, which encompassed issues such as poor leadership, the undervaluation of the follower role, lack of training and development opportunities, challenges in collaboration, and language barriers; and (4) Facilitators of followership, identified as effective leadership, followership training, communication skills, positive relationships, respect, collaboration, understanding of roles, commitment, and flexibility. These findings elucidate the complex landscape of followership within the nursing profession in Saudi Arabia, revealing both the challenges and pathways to fostering effective followership in healthcare settings.</p></div><div><h3>Conclusion and Implications</h3><p>This study reveals a widespread lack of awareness about followership among nurses in Saudi Arabia, highlighting significant challenges related to hierarchy and the undervaluation of the follower role in nursing practice and education. It underscores the need for educational and training interventions that redefine and elevate the role of followership in clinical settings to enhance collaboration, assertiveness, and decision-making skills. Moreover, the study advocates for the re-evaluation of leadership practices to better acknowledge and value followership, promoting a more flattened hierarchy that encourages active participation in patient care and organizational development. Implementing these chang","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000493/pdfft?md5=1d6c077f908ae8879883781eaefde420&pid=1-s2.0-S2666142X24000493-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141638065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.1016/j.ijnsa.2024.100226
Background
The coronavirus (COVID-19) pandemic presented unprecedented challenges to healthcare systems worldwide, with intensive care unit (ICU) nurses at the forefront of patient care. To date, there is limited evidence into ICU nurses'experiences of the pandemic in Kuwait.
Research question/aims/objectives
To elucidate the challenges faced by ICU nurses in Kuwait during the pandemic, by considering two research questions: “What contributed to intensified pressure for the ICU nurses?” and “How were the nurses affected?”.
Research design
This was a qualitative study which utilised semi-structured interviews. Interviews were conducted between January 2021 and June 2022 with ICU nurses who worked during the COVID-19 pandemic. The data were analysed using Charmaz's grounded theory methodology.
Participants and research context
25 nurses from three ICUs in Kuwait.
Ethical considerations
The study was approved by the University Ethics Committee and by the Ministry of Health in Kuwait.
Findings/Results
The analysis identified two themes (the factors contributing to intensified pressure in the ICU, and the impact on the nurses) and seven sub-themes. The pressure in the ICU intensified due to the rise in the number of patients, staff shortages, and the requirement to adhere to unrealistic new procedures for infection control. Restricted and cancelled leave, as well as impaired autonomy at work, impeded the nurses’ ability to recover from stress. The heightened stress also contributed to a worsening in interpersonal relationships between the nurses and their colleagues. The nurses’ care was compromised by these challenges, leading to moral distress and a range of mental health symptoms (e.g., stress, anxiety, emotional exhaustion).
Conclusions
The study accords with other research conducted during the pandemic in revealing a significant mental health toll among healthcare workers during the pandemic. The stressors were similar to those which have been reported in other studies, although there were also context-specific effects relating to the environment of the ICU and the Kuwaiti context.
{"title":"The Challenges Experienced by ICU Nurses in Kuwait during the COVID-19 Pandemic","authors":"","doi":"10.1016/j.ijnsa.2024.100226","DOIUrl":"10.1016/j.ijnsa.2024.100226","url":null,"abstract":"<div><h3>Background</h3><p>The coronavirus (COVID-19) pandemic presented unprecedented challenges to healthcare systems worldwide, with intensive care unit (ICU) nurses at the forefront of patient care. To date, there is limited evidence into ICU nurses'experiences of the pandemic in Kuwait.</p></div><div><h3>Research question/aims/objectives</h3><p>To elucidate the challenges faced by ICU nurses in Kuwait during the pandemic, by considering two research questions: “What contributed to intensified pressure for the ICU nurses?” and “How were the nurses affected?”.</p></div><div><h3>Research design</h3><p>This was a qualitative study which utilised semi-structured interviews. Interviews were conducted between January 2021 and June 2022 with ICU nurses who worked during the COVID-19 pandemic. The data were analysed using Charmaz's grounded theory methodology.</p></div><div><h3>Participants and research context</h3><p>25 nurses from three ICUs in Kuwait.</p></div><div><h3>Ethical considerations</h3><p>The study was approved by the University Ethics Committee and by the Ministry of Health in Kuwait.</p></div><div><h3>Findings/Results</h3><p>The analysis identified two themes (the factors contributing to intensified pressure in the ICU, and the impact on the nurses) and seven sub-themes. The pressure in the ICU intensified due to the rise in the number of patients, staff shortages, and the requirement to adhere to unrealistic new procedures for infection control. Restricted and cancelled leave, as well as impaired autonomy at work, impeded the nurses’ ability to recover from stress. The heightened stress also contributed to a worsening in interpersonal relationships between the nurses and their colleagues. The nurses’ care was compromised by these challenges, leading to moral distress and a range of mental health symptoms (e.g., stress, anxiety, emotional exhaustion).</p></div><div><h3>Conclusions</h3><p>The study accords with other research conducted during the pandemic in revealing a significant mental health toll among healthcare workers during the pandemic. The stressors were similar to those which have been reported in other studies, although there were also context-specific effects relating to the environment of the ICU and the Kuwaiti context.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000535/pdfft?md5=fd1940e7a3a9a2eb30caa61fab766b9f&pid=1-s2.0-S2666142X24000535-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.1016/j.ijnsa.2024.100225
Background
The COVID-19 pandemic contributed to increased pressure on healthcare systems. During periods when the demands exceed the capacity of healthcare organizations, adaptive strategies are used to meet these demands. During the COVID-19 pandemic, working hours for nursing staff were reorganized and extended. This has posed challenges for recovery, which may be a key factor for maintaining health and safety under such conditions.
Objectives
The aim of the study was to bring insights into how nursing staff perceived their working hours and recovery during the COVID-19 pandemic, and if they experienced any changes in their sleep and well-being.
Design
A qualitative descriptive design was chosen, as it is suitable for gaining insight into perceptions and experiences.
Methods
Qualitative semi-structured interviews were conducted using an interview guide. The interviews were analyzed using thematic analysis. Sixteen registered nurses and six certified nursing assistants from four Swedish hospitals participated in the study.
Results
The organization of working hours during the COVID-19 pandemic was considered suboptimal and resulted in more demanding working hours and poor recovery. Nursing staff experienced loss of control as they lost influence over working hours, working hours became more unpredictable and the boundaries between work and leisure became blurred. Nursing staff also experienced a decline in their health and well-being, including extreme fatigue, impaired sleep and physical/mental changes.
Conclusion
The strategies used by healthcare organizations to meet increasing demands during the COVID-19 pandemic contributed to impaired recovery and well-being of nursing staff, which could generate negative feedback loops contributing to depletion of resources at the organizational level.
{"title":"Under pressure - Nursing staff's perspectives on working hours and recovery during the COVID-19 pandemic: A qualitative study","authors":"","doi":"10.1016/j.ijnsa.2024.100225","DOIUrl":"10.1016/j.ijnsa.2024.100225","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic contributed to increased pressure on healthcare systems. During periods when the demands exceed the capacity of healthcare organizations, adaptive strategies are used to meet these demands. During the COVID-19 pandemic, working hours for nursing staff were reorganized and extended. This has posed challenges for recovery, which may be a key factor for maintaining health and safety under such conditions.</p></div><div><h3>Objectives</h3><p>The aim of the study was to bring insights into how nursing staff perceived their working hours and recovery during the COVID-19 pandemic, and if they experienced any changes in their sleep and well-being.</p></div><div><h3>Design</h3><p>A qualitative descriptive design was chosen, as it is suitable for gaining insight into perceptions and experiences.</p></div><div><h3>Methods</h3><p>Qualitative semi-structured interviews were conducted using an interview guide. The interviews were analyzed using thematic analysis. Sixteen registered nurses and six certified nursing assistants from four Swedish hospitals participated in the study.</p></div><div><h3>Results</h3><p>The organization of working hours during the COVID-19 pandemic was considered suboptimal and resulted in more demanding working hours and poor recovery. Nursing staff experienced loss of control as they lost influence over working hours, working hours became more unpredictable and the boundaries between work and leisure became blurred. Nursing staff also experienced a decline in their health and well-being, including extreme fatigue, impaired sleep and physical/mental changes.</p></div><div><h3>Conclusion</h3><p>The strategies used by healthcare organizations to meet increasing demands during the COVID-19 pandemic contributed to impaired recovery and well-being of nursing staff, which could generate negative feedback loops contributing to depletion of resources at the organizational level.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000523/pdfft?md5=38f2269f592a7545ecbacdc44412d364&pid=1-s2.0-S2666142X24000523-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-08DOI: 10.1016/j.ijnsa.2024.100223
Background
Children's Health Ireland (CHI), who govern and operate acute paediatric services for the greater Dublin area, are also the client for the new children's hospital project which will be Ireland's first fully digital hospital. Design, development and implementation of digital solutions has been prioritised by the National Strategy for Children's Nursing to transform and accelerate nurse-led services.
Aim
The aim of this phase of a larger study was to explore the perspectives and opinions of key stakeholders on the requirements, benefits, and challenges for a bespoke patient portal, with a specific focus on the ANP-led Neurosurgical Service and children and young people with hydrocephalus.
Methods
Interviews and focus groups were held online, and data were recorded and transcribed verbatim. Twenty-three participants across eight sites were interviewed including parents, healthcare professionals, experts and management/administrators. Data were analysed using Braun and Clarke's (2006) framework.
Results
Four key findings and considerations were identified in relation to patient portals in general and their interoperability with Electronic Health Records, as well as a bespoke patient portal for children and young people with hydrocephalus
Conclusions
The availability of a patient portal for children and young people with hydrocephalus would be hugely advantageous to their parents, the ANP led nursing service, and healthcare professionals in both the neurosurgical service at CHI and at regional healthcare organisations as well as for administration, research, and reports. More timely access to health data as well as a consistent log of information and communications between patients and healthcare professionals, would be more efficient and effective than current practices.The augmented ANP-led Neurosurgical Nursing Service at CHI will act as a pilot project from which other nurse-led digital patient services can learn from.
Study Registration
This study was conducted between September 2022 and June 2023. It was registered in Trinity College Dublin, Ireland
Twitter Abstract
A study exploring requirements, benefits, & challenges for an interoperable patient portal in an ANP led Service for children with hydrocephalus
背景爱尔兰儿童健康组织（CHI）负责管理和运营大都柏林地区的儿科急诊服务，同时也是新儿童医院项目的客户，该医院将成为爱尔兰首家全数字化医院。数字解决方案的设计、开发和实施已被国家儿童护理战略（National Strategy for Children's Nursing）列为优先事项，以转变和加速由护士主导的服务。这项大型研究的这一阶段旨在探讨主要利益相关者对定制患者门户网站的要求、益处和挑战的观点和看法，重点关注由助理护士主导的神经外科服务以及患有脑积水的儿童和青少年。八个地点的 23 名参与者接受了访谈，其中包括家长、医护人员、专家和管理/行政人员。结论为患有脑积水的儿童和青少年提供患者门户网站对他们的父母、ANP 领导的护理服务、CHI 神经外科服务和地区医疗机构的医护人员以及管理、研究和报告都非常有利。与目前的做法相比，更及时地访问健康数据以及一致的信息记录和患者与医护人员之间的沟通将更加高效和有效。在 CHI，由 ANP 领导的增强型神经外科护理服务将作为一个试点项目，其他由护士领导的数字化患者服务可以从中学习。本研究于2022年9月至2023年6月期间进行，在爱尔兰都柏林圣三一学院注册Twitter AbstractA study exploring requirements, benefits, & challenges for an interoperable patient portal in an ANP led Service for children with hydrocephalus
{"title":"Designing an interoperable patient portal to augment an Advanced Nurse Practitioner service for Children with hydrocephalus","authors":"","doi":"10.1016/j.ijnsa.2024.100223","DOIUrl":"10.1016/j.ijnsa.2024.100223","url":null,"abstract":"<div><h3>Background</h3><p>Children's Health Ireland (CHI), who govern and operate acute paediatric services for the greater Dublin area, are also the client for the new children's hospital project which will be Ireland's first fully digital hospital. Design, development and implementation of digital solutions has been prioritised by the National Strategy for Children's Nursing to transform and accelerate nurse-led services.</p></div><div><h3>Aim</h3><p>The aim of this phase of a larger study was to explore the perspectives and opinions of key stakeholders on the requirements, benefits, and challenges for a bespoke patient portal, with a specific focus on the ANP-led Neurosurgical Service and children and young people with hydrocephalus.</p></div><div><h3>Methods</h3><p>Interviews and focus groups were held online, and data were recorded and transcribed verbatim. Twenty-three participants across eight sites were interviewed including parents, healthcare professionals, experts and management/administrators. Data were analysed using <span><span>Braun and Clarke's (2006)</span></span> framework.</p></div><div><h3>Results</h3><p>Four key findings and considerations were identified in relation to patient portals in general and their interoperability with Electronic Health Records, as well as a bespoke patient portal for children and young people with hydrocephalus</p></div><div><h3>Conclusions</h3><p>The availability of a patient portal for children and young people with hydrocephalus would be hugely advantageous to their parents, the ANP led nursing service, and healthcare professionals in both the neurosurgical service at CHI and at regional healthcare organisations as well as for administration, research, and reports. More timely access to health data as well as a consistent log of information and communications between patients and healthcare professionals, would be more efficient and effective than current practices.The augmented ANP-led Neurosurgical Nursing Service at CHI will act as a pilot project from which other nurse-led digital patient services can learn from.</p></div><div><h3>Study Registration</h3><p>This study was conducted between September 2022 and June 2023. It was registered in Trinity College Dublin, Ireland</p></div><div><h3>Twitter Abstract</h3><p>A study exploring requirements, benefits, & challenges for an interoperable patient portal in an ANP led Service for children with hydrocephalus</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X2400050X/pdfft?md5=a26ee14e9b9c66d2c0e8380ceb0de30f&pid=1-s2.0-S2666142X2400050X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nurses are tasked with addressing the health impacts of climate change. Eco-nursing competencies, covering knowledge, attitudes, and skills related to climate change, equip nurses to actively mitigate and adapt to its effects on health and the environment.
Objective
To synthesize existing literature on eco-nursing roles and competencies for nurses.
Methods
A scoping review of published papers examined nurses' roles and eco-nursing competencies. Databases searched included Academic Search Complete, CINAHL Plus, MEDLINE (PubMed), and Google Scholar. Search terms encompassed climate change and nursing synonyms, limited to English articles up to April 15, 2023. Thematic analysis was used to synthesize findings, delineating roles, and eco-nursing competencies. Results were tabulated.
Results
Out of 445 papers identified, 31 underwent data analysis. These papers highlighted nurses' roles in climate change (42%), along with climate change knowledge and skills (64.5%), and attitudes (13%). Roles encompassed research, education, advocacy, leadership, and clinical practice, with corresponding competencies embedded within existing core competencies for general nurses, nurse specialists, and nurse managers.
Conclusion
The review demonstrates that nurses' roles in climate change necessitate relevant knowledge, attitudes, and skills. Future research should contextualize these roles and eco-nursing competencies based on geographical locations, considering the distinct disease burden in each area.
Registration
The study protocol was registered in the Open Science Framework on 5 March 2023 before conducting the full study https://doi.org/10.17605/OSF.IO/9GC4N
Tweetable abstract
Amidst growing concerns about climate change, nurses are increasingly tasked with preparing to mitigate its health impacts through the delineation of eco-nursing competencies. These competencies will equip nurses to effectively tackle the health and environmental ramifications of climate change, building upon existing core competencies tailored to various geographic contexts.
{"title":"Eco-nursing competencies for nurses: A scoping review","authors":"Thandazile Sibindi, Jennifer-Anne Chipps, Talitha Crowley","doi":"10.1016/j.ijnsa.2024.100221","DOIUrl":"https://doi.org/10.1016/j.ijnsa.2024.100221","url":null,"abstract":"<div><h3>Background</h3><p>Nurses are tasked with addressing the health impacts of climate change. Eco-nursing competencies, covering knowledge, attitudes, and skills related to climate change, equip nurses to actively mitigate and adapt to its effects on health and the environment.</p></div><div><h3>Objective</h3><p>To synthesize existing literature on eco-nursing roles and competencies for nurses.</p></div><div><h3>Methods</h3><p>A scoping review of published papers examined nurses' roles and eco-nursing competencies. Databases searched included Academic Search Complete, CINAHL Plus, MEDLINE (PubMed), and Google Scholar. Search terms encompassed climate change and nursing synonyms, limited to English articles up to April 15, 2023. Thematic analysis was used to synthesize findings, delineating roles, and eco-nursing competencies. Results were tabulated.</p></div><div><h3>Results</h3><p>Out of 445 papers identified, 31 underwent data analysis. These papers highlighted nurses' roles in climate change (42%), along with climate change knowledge and skills (64.5%), and attitudes (13%). Roles encompassed research, education, advocacy, leadership, and clinical practice, with corresponding competencies embedded within existing core competencies for general nurses, nurse specialists, and nurse managers.</p></div><div><h3>Conclusion</h3><p>The review demonstrates that nurses' roles in climate change necessitate relevant knowledge, attitudes, and skills. Future research should contextualize these roles and eco-nursing competencies based on geographical locations, considering the distinct disease burden in each area.</p></div><div><h3>Registration</h3><p>The study protocol was registered in the Open Science Framework on 5 March 2023 before conducting the full study <span>https://doi.org/10.17605/OSF.IO/9GC4N</span><svg><path></path></svg></p></div><div><h3>Tweetable abstract</h3><p>Amidst growing concerns about climate change, nurses are increasingly tasked with preparing to mitigate its health impacts through the delineation of eco-nursing competencies. These competencies will equip nurses to effectively tackle the health and environmental ramifications of climate change, building upon existing core competencies tailored to various geographic contexts.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000481/pdfft?md5=d9d13a865167e55e534c9c334d0af0e0&pid=1-s2.0-S2666142X24000481-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141595196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1016/j.ijnsa.2024.100224
Background
With increasing prevalence of surgery under local or regional anesthesia, which allows patients to remain conscious during the intraoperative phase, there is a growing need to comprehend the lived experiences associated with this practice.
Objective
This study aimed to illuminate the lived experiences of individuals who remained conscious during surgical intervention under local or regional anesthesia.
Design
A qualitative design was chosen.
Setting(s)
Participants in the present study were recruited from three surgical wards located in central Sweden using a purposive sampling strategy. The surgical disciplines included ear, gynecological, hernioplasty, orthopedic, and vessel surgeries.
Participants
Fourteen narrative interviews were conducted with individuals who had undergone elective surgery while conscious.
Methods
Verbatim transcribed text was analyzed using a phenomenological-hermeneutic method.
Results
The lived experience of being conscious during surgery was marked by feelings of hope alongside a sense of losing one's identity and experiencing destabilization. Structural analysis revealed two themes. The first theme, 'being in the hands of others', encompassed subthemes such as 'entering an unfamiliar environment and procedure,' 'losing foothold and a sense of self-identity,' and 'enduring unexpected or anticipated discomfort.' The second theme, 'managing the inevitable for future health concerns,' involved subthemes such as 'pursuing self-acceptance of the situation,' 'entrusting the professionals while seeking signs of a smooth procedure,' and 'Enhancing own resilience through continuous support.
Conclusions
Beyond the patient's physical well-being during surgery, the OR team should acknowledge the "person" component and focus on their emotional and social needs in this vulnerable situation. The four meta-paradigms of nursing—person, health, environment, and nursing—significantly influence the conscious patient's experience.
{"title":"The meaning of being conscious during surgery with local or regional anesthesia–A phenomenological hermeneutic study","authors":"","doi":"10.1016/j.ijnsa.2024.100224","DOIUrl":"10.1016/j.ijnsa.2024.100224","url":null,"abstract":"<div><h3>Background</h3><p>With increasing prevalence of surgery under local or regional anesthesia, which allows patients to remain conscious during the intraoperative phase, there is a growing need to comprehend the lived experiences associated with this practice.</p></div><div><h3>Objective</h3><p>This study aimed to illuminate the lived experiences of individuals who remained conscious during surgical intervention under local or regional anesthesia.</p></div><div><h3>Design</h3><p>A qualitative design was chosen.</p></div><div><h3>Setting(s)</h3><p>Participants in the present study were recruited from three surgical wards located in central Sweden using a purposive sampling strategy. The surgical disciplines included ear, gynecological, hernioplasty, orthopedic, and vessel surgeries.</p></div><div><h3>Participants</h3><p>Fourteen narrative interviews were conducted with individuals who had undergone elective surgery while conscious<strong>.</strong></p></div><div><h3>Methods</h3><p>Verbatim transcribed text was analyzed using a phenomenological-hermeneutic method.</p></div><div><h3>Results</h3><p>The lived experience of being conscious during surgery was marked by feelings of hope alongside a sense of losing one's identity and experiencing destabilization. Structural analysis revealed two themes. The first theme, 'being in the hands of others', encompassed subthemes such as 'entering an unfamiliar environment and procedure,' 'losing foothold and a sense of self-identity,' and 'enduring unexpected or anticipated discomfort.' The second theme, 'managing the inevitable for future health concerns,' involved subthemes such as 'pursuing self-acceptance of the situation,' 'entrusting the professionals while seeking signs of a smooth procedure,' and 'Enhancing own resilience through continuous support.</p></div><div><h3>Conclusions</h3><p>Beyond the patient's physical well-being during surgery, the OR team should acknowledge the \"person\" component and focus on their emotional and social needs in this vulnerable situation. The four meta-paradigms of nursing—person, health, environment, and nursing—significantly influence the conscious patient's experience.</p></div><div><h3>Patient or Public Contribution</h3><p>No patient or public contribution</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000511/pdfft?md5=e4305818fa5bbde754e9fbbdc5f5fcea&pid=1-s2.0-S2666142X24000511-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141638920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Falls amongst the elderly represent a global public health challenge because of their potential to cause illness, death, and reduce the autonomy of this group. They also impact the emotional, family, social and economic well-being of those involved. Various strategies to prevent falls have been reported in the literature, focusing mainly on addressing individual risk factors, and on the continuous assessment of the risk of falls in older people.
Objective
This study evaluated user satisfaction and acceptability of a comprehensive model, implemented in the community, to prevent falls amongst independent older adults aged 65 years and above. It sought to capture both the perceptions of the individuals who received the intervention and of the interventionists who implemented it. The study protocol was registered at ClinicalTrials.gov in November 2020 (ID: NCT04313062).
Design
Qualitative, exploratory study using a case study design. The evaluation of the intervention followed the recommendations proposed by the Medical Research Council for complex interventions. Methods and participants: In the period between April 2021 to April 2022, 11 semi-structured interviews were conducted with independent older adults between 65 and 80 years of age who participated in the implementation of the comprehensive model in Santiago, Chile. Data were also collected with eight interventionists through: three semi-structured interviews at the beginning of the intervention; and two focus groups with seven interventionists at the end of the implementation of the model. The team members undertook a content analysis of the data collected.
Results
Three themes emerged to account for the satisfaction and acceptability of the intervention with the model on the part of the participants and interventionists: (1) Previous experience of older persons and interventionists; (2) The older person-interventionist encounter and its context; and (3) Identification of facilitators, strengths and challenges for the implementation of the model. The results show a positive assessment of the model, highlighting the value of the social contact derived from the intervention by both participants and interventionists. Although the model involved an individual intervention, the participants’ accounts indicate that it reached out to others, including family members and other elderly acquaintances. Moreover, the interventionists helped identify challenges in implementation and made recommendations to strengthen the model.
Conclusion
The evaluation of satisfaction and feasibility of implementing the model showed positive results that will nurture the next phase of development of this model, which involves scaling up the intervention.
{"title":"Acceptability and feasibility of a comprehensive fall prevention model for independent older adults: A qualitative evaluation","authors":"Francisca Marquez-Doren, Camila Lucchini-Raies, Claudia Alcayaga, Claudia Bustamante, Marcela González-Agüero","doi":"10.1016/j.ijnsa.2024.100220","DOIUrl":"https://doi.org/10.1016/j.ijnsa.2024.100220","url":null,"abstract":"<div><h3>Background</h3><p>Falls amongst the elderly represent a global public health challenge because of their potential to cause illness, death, and reduce the autonomy of this group. They also impact the emotional, family, social and economic well-being of those involved. Various strategies to prevent falls have been reported in the literature, focusing mainly on addressing individual risk factors, and on the continuous assessment of the risk of falls in older people.</p></div><div><h3>Objective</h3><p>This study evaluated user satisfaction and acceptability of a comprehensive model, implemented in the community, to prevent falls amongst independent older adults aged 65 years and above. It sought to capture both the perceptions of the individuals who received the intervention and of the interventionists who implemented it. The study protocol was registered at ClinicalTrials.gov in November 2020 (ID: NCT04313062).</p></div><div><h3>Design</h3><p>Qualitative, exploratory study using a case study design. The evaluation of the intervention followed the recommendations proposed by the Medical Research Council for complex interventions. Methods and participants: In the period between April 2021 to April 2022, 11 semi-structured interviews were conducted with independent older adults between 65 and 80 years of age who participated in the implementation of the comprehensive model in Santiago, Chile. Data were also collected with eight interventionists through: three semi-structured interviews at the beginning of the intervention; and two focus groups with seven interventionists at the end of the implementation of the model. The team members undertook a content analysis of the data collected.</p></div><div><h3>Results</h3><p>Three themes emerged to account for the satisfaction and acceptability of the intervention with the model on the part of the participants and interventionists: (1) Previous experience of older persons and interventionists; (2) The older person-interventionist encounter and its context; and (3) Identification of facilitators, strengths and challenges for the implementation of the model. The results show a positive assessment of the model, highlighting the value of the social contact derived from the intervention by both participants and interventionists. Although the model involved an individual intervention, the participants’ accounts indicate that it reached out to others, including family members and other elderly acquaintances. Moreover, the interventionists helped identify challenges in implementation and made recommendations to strengthen the model.</p></div><div><h3>Conclusion</h3><p>The evaluation of satisfaction and feasibility of implementing the model showed positive results that will nurture the next phase of development of this model, which involves scaling up the intervention.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X2400047X/pdfft?md5=3a39869b57bc154f5bb630c2f37c1c2d&pid=1-s2.0-S2666142X2400047X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141483790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Learning basic mental health care competence is often challenging for the bachelor of science student nurses, and many lack basic mental health care competence to ensure safe and confident mental health care practice. Mental health assessment is an integrated part of this competence.
Objective
The objective of this study was to explore and describe in depth how student nurses experience learning and achieving basic mental health competence while on mental health placement with the support of a learning tool.
Design
An explorative and descriptive qualitative design was conducted to gain insight on how student nurses experienced learning basic mental health competence when on placement.
Setting
A diversity of mental health placement settings in which student nurses were involved with patient care or welfare were approached; general psychiatric wards (n = 2), psychiatric ward for elderly people (n = 1), community mental health in-patient facilities (n = 2) and unconventional placements in the community (n = 9). Unconventional placements are a diversity of non-clinical service contexts.
Participants
The participants comprised student nurses in their 3rd and final year while on mental health placement. Potential participants received information from course coordinators, the online learning platform, and from teachers in plenary. Using purposive sampling, 14 student nurses were recruited.
Methods
Individual semi-structured interviews were conducted online and in person at two campuses of one university in Norway between August 2020 and December 2021. The interviews were transcribed and thematically analysed as described by Braun and Clarke.
Results
Students expressed insecurity in a new clinical context. They engaged in new learning situations and realized the diversity of nursing practice. Unconventional placements were described as challenging contexts for learning basic mental health care competence.
Conclusions
This qualitative study provided insight into how student nurses experience learning mental health assessment, and gaining relational, communicative, and ethical competence while on placement. Students revealed their insecurities and challenges in learning in a new context. Awareness of clinical learning opportunities on placement when preparing student nurses to learn basic mental health competence may help improve their confidence.
{"title":"Learning and achieving basic mental health competence in placement studies with the support of a tool: A qualitative study of student nurses’ experiences","authors":"Siv Camilla Marriott , Ellen Karine Grov , Marianne Thorsen Gonzalez","doi":"10.1016/j.ijnsa.2024.100219","DOIUrl":"https://doi.org/10.1016/j.ijnsa.2024.100219","url":null,"abstract":"<div><h3>Background</h3><p>Learning basic mental health care competence is often challenging for the bachelor of science student nurses, and many lack basic mental health care competence to ensure safe and confident mental health care practice. Mental health assessment is an integrated part of this competence.</p></div><div><h3>Objective</h3><p>The objective of this study was to explore and describe in depth how student nurses experience learning and achieving basic mental health competence while on mental health placement with the support of a learning tool.</p></div><div><h3>Design</h3><p>An explorative and descriptive qualitative design was conducted to gain insight on how student nurses experienced learning basic mental health competence when on placement.</p></div><div><h3>Setting</h3><p>A diversity of mental health placement settings in which student nurses were involved with patient care or welfare were approached; general psychiatric wards (<em>n</em> = 2), psychiatric ward for elderly people (<em>n</em> = 1), community mental health in-patient facilities (<em>n</em> = 2) and unconventional placements in the community (<em>n</em> = 9). Unconventional placements are a diversity of non-clinical service contexts.</p></div><div><h3>Participants</h3><p>The participants comprised student nurses in their 3rd and final year while on mental health placement. Potential participants received information from course coordinators, the online learning platform, and from teachers in plenary. Using purposive sampling, 14 student nurses were recruited.</p></div><div><h3>Methods</h3><p>Individual semi-structured interviews were conducted online and in person at two campuses of one university in Norway between August 2020 and December 2021. The interviews were transcribed and thematically analysed as described by Braun and Clarke.</p></div><div><h3>Results</h3><p>Students expressed insecurity in a new clinical context. They engaged in new learning situations and realized the diversity of nursing practice. Unconventional placements were described as challenging contexts for learning basic mental health care competence.</p></div><div><h3>Conclusions</h3><p>This qualitative study provided insight into how student nurses experience learning mental health assessment, and gaining relational, communicative, and ethical competence while on placement. Students revealed their insecurities and challenges in learning in a new context. Awareness of clinical learning opportunities on placement when preparing student nurses to learn basic mental health competence may help improve their confidence.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000468/pdfft?md5=bbac92b37eac6cb8d3c3c49280c3ae04&pid=1-s2.0-S2666142X24000468-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20DOI: 10.1016/j.ijnsa.2024.100218
Background
The primary responsibility of the operating room nurse is to prevent adverse events and patient harm during surgery. Since most preventable adverse events are the result of breakdowns in communication and teamwork, or non-technical skills, training such skills should strengthen the operating room nurses’ error prevention abilities. Behavioural marker systems operationalise non-technical skills; however, previous systems for operating room nurses do not cover the full extent of non-technical skills used by operating room nurses. Thus, the Non-technical Skills for Operating Room Nurses (NOTSORN) behavioural marker system was developed.
Objective
The objective of this study was to establish face and content validity of the Non-Technical Skills for Operating Room Nurses behavioural marker system. This multi-item scale measures individual non-technical skills in operating room nursing.
Participants
A purposive sample of operating room nursing researchers, educators, and senior clinicians from nine countries worldwide.
Methods
A two round, Delphi panel with international experts in operating room nursing. The survey was administered online. Content validity index (CVI) was used to measure agreement among panel members.
Results
25 operating room nurse experts participated in the online Delphi study. After round 1, 56 items were accepted, 26 items were revised, and 1 item was dropped. Following round 2, all items (6 with minor revisions) were accepted. Thus, the Non-technical Skills for Operating Room Nurses tool comprise 81 items. The scale level CVI score for the final 81 item tool was 0.99. The individual item level CVI scores ranged from 0.9 to 1.0.
Conclusions
The Non-Technical Skills of Operating Room Nurses behavioural marker system is a nuanced tool with a myriad of non-technical skills operating room nurses need to undertake their work safely. The tool's intended use includes student/trainee supervision, supervision of novice operating room nurses, self-reflection for performance reports, and in operating room nursing education. Over time, use of the tool has the potential to contribute to patient safety in the operating room.
Tweetable abstract
The NOTSORN tool provides a comprehensive and holistic evaluation of OR nurses' non-technical skills for safe surgical performance
{"title":"Bi-lingual content validation of the Non-Technical Skills for Operating Room Nurses (NOTSORN) tool: A Delphi study","authors":"","doi":"10.1016/j.ijnsa.2024.100218","DOIUrl":"10.1016/j.ijnsa.2024.100218","url":null,"abstract":"<div><h3>Background</h3><p>The primary responsibility of the operating room nurse is to prevent adverse events and patient harm during surgery. Since most preventable adverse events are the result of breakdowns in communication and teamwork, or non-technical skills, training such skills should strengthen the operating room nurses’ error prevention abilities. Behavioural marker systems operationalise non-technical skills; however, previous systems for operating room nurses do not cover the full extent of non-technical skills used by operating room nurses. Thus, the Non-technical Skills for Operating Room Nurses (NOTSORN) behavioural marker system was developed.</p></div><div><h3>Objective</h3><p>The objective of this study was to establish face and content validity of the Non-Technical Skills for Operating Room Nurses behavioural marker system. This multi-item scale measures individual non-technical skills in operating room nursing.</p></div><div><h3>Participants</h3><p>A purposive sample of operating room nursing researchers, educators, and senior clinicians from nine countries worldwide.</p></div><div><h3>Methods</h3><p>A two round, Delphi panel with international experts in operating room nursing. The survey was administered online. Content validity index (CVI) was used to measure agreement among panel members.</p></div><div><h3>Results</h3><p>25 operating room nurse experts participated in the online Delphi study. After round 1, 56 items were accepted, 26 items were revised, and 1 item was dropped. Following round 2, all items (6 with minor revisions) were accepted. Thus, the Non-technical Skills for Operating Room Nurses tool comprise 81 items. The scale level CVI score for the final 81 item tool was 0.99. The individual item level CVI scores ranged from 0.9 to 1.0.</p></div><div><h3>Conclusions</h3><p>The Non-Technical Skills of Operating Room Nurses behavioural marker system is a nuanced tool with a myriad of non-technical skills operating room nurses need to undertake their work safely. The tool's intended use includes student/trainee supervision, supervision of novice operating room nurses, self-reflection for performance reports, and in operating room nursing education. Over time, use of the tool has the potential to contribute to patient safety in the operating room.</p></div><div><h3>Tweetable abstract</h3><p>The NOTSORN tool provides a comprehensive and holistic evaluation of OR nurses' non-technical skills for safe surgical performance</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000456/pdfft?md5=bb8434f00f4313821b88c68266743ecd&pid=1-s2.0-S2666142X24000456-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the lower-middle-income country of Kazakhstan, palliative care services are in the early stages of integration into healthcare services. No prior studies have investigated associations between palliative care service factors and a good death in lower-middle-income countries, nor explored how palliative care nurses contribute to a good death. In this paper, a good death is referred to as the control of pain and symptoms, clear decision-making, a sense of closure, being recognized and perceived as an individual, preparation for death, and still being able to contribute to others, all taken together.
Objectives
To identify new opportunities for palliative care service nurses by investigating associations between palliative care service factors and a good death, as measured by the Good Death Inventory.
Methods
Family caretakers of deceased patients from palliative care units and hospices were surveyed across six different regions of Kazakhstan. Data collected included demographics for patients and caregivers, palliative care service data, and Good Death Inventory items. Poisson regression analysis with r variance and linear regressions were conducted to identify determinants for achieving a Good Death and for the 18 Good Death Inventory domains.
Results
Two hundred and eleven family caregivers participated in the survey. Bivariate analysis revealed five statistically significant associations (p ≤ 0.05) with the outcome of a good death. In multivariate linear regression analyses, a palliative care duration of greater-than-6-months, compared to less-than-1-month, was associated with improvements in 10 out of 18 domains of the Good Death Inventory (p ≤ 0.05). More-than-once-weekly palliative care home visits by nurses, compared to no visits, were also associated with improvements in four domains (p ≤ 0.05).
Conclusion
We provide new directions for improvements in palliative care services in low-middle-income countries, giving impetus for resource allocation to palliative care home visits by nurses for achieving a good death for greater numbers of patients.
{"title":"Number of palliative care nurse home visits and duration of palliative care associated with domains of the Good Death Inventory: A national survey of bereaved family caregivers in a middle income country","authors":"Byron Crape , Makpal Akhmetova , Pana Akhmetniyaz , Faye Foster , Kamalzhan Nadyrov , Lyazzat Toleubekova","doi":"10.1016/j.ijnsa.2024.100217","DOIUrl":"10.1016/j.ijnsa.2024.100217","url":null,"abstract":"<div><h3>Background</h3><p>In the lower-middle-income country of Kazakhstan, palliative care services are in the early stages of integration into healthcare services. No prior studies have investigated associations between palliative care service factors and a good death in lower-middle-income countries, nor explored how palliative care nurses contribute to a good death. In this paper, a good death is referred to as the control of pain and symptoms, clear decision-making, a sense of closure, being recognized and perceived as an individual, preparation for death, and still being able to contribute to others, all taken together.</p></div><div><h3>Objectives</h3><p>To identify new opportunities for palliative care service nurses by investigating associations between palliative care service factors and a good death, as measured by the Good Death Inventory.</p></div><div><h3>Methods</h3><p>Family caretakers of deceased patients from palliative care units and hospices were surveyed across six different regions of Kazakhstan. Data collected included demographics for patients and caregivers, palliative care service data, and Good Death Inventory items. Poisson regression analysis with r variance and linear regressions were conducted to identify determinants for achieving a Good Death and for the 18 Good Death Inventory domains.</p></div><div><h3>Results</h3><p>Two hundred and eleven family caregivers participated in the survey. Bivariate analysis revealed five statistically significant associations (<em>p</em> ≤ 0.05) with the outcome of a good death. In multivariate linear regression analyses, a palliative care duration of greater-than-6-months, compared to less-than-1-month, was associated with improvements in 10 out of 18 domains of the Good Death Inventory (<em>p</em> ≤ 0.05). More-than-once-weekly palliative care home visits by nurses, compared to no visits, were also associated with improvements in four domains (<em>p</em> ≤ 0.05).</p></div><div><h3>Conclusion</h3><p>We provide new directions for improvements in palliative care services in low-middle-income countries, giving impetus for resource allocation to palliative care home visits by nurses for achieving a good death for greater numbers of patients.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000444/pdfft?md5=0ab225079b2b651c752e2da855251443&pid=1-s2.0-S2666142X24000444-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141399365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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