Pub Date : 2024-02-24DOI: 10.1016/j.ijnsa.2024.100187
Allison A. Norful , Katherine C. Brewer , Katherine M. Cahir , Andrew M. Dierkes
Background
Increasing evidence suggests that clinician well-being influences patient, workforce, and organizational outcomes. Despite increasing attention to well-being among licensed clinicians (e.g., nurses and physicians), collective evidence about well-being among healthcare assistants, such as nursing and medical assistants, is limited. Healthcare assistants make up a substantial portion of the clinical workforce delivering direct patient care. The well-being of healthcare assistants is critical to ensure an ample workforce supply. The objective of this systematic review was to contribute a reproducible search, summary, appraisal, synthesis, and critique of the literature about well-being among healthcare assistants, including factors that induce or inhibit burnout, and to identify gaps in evidence that warrant future research.
Methods
We performed a literature search across 4 databases with keywords using BOOLEAN operators. After an initial title and abstract screen, a search of relevant reference lists, and full text review was peformed independently by 2 researchers. Study quality was evaluated using Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. We extracted study characteristics, results, and deductively analyzed each study's alignment with the United States National Academy of Medicine's Clinician Well-Being Model.
Results
We identified 28 articles meeting our inclusion criteria. Our synthesis indicated that most studies investigated personal factors (e.g., financial stressors or physical, emotional, and spiritual health) as opposed to organizational or policy factors (e.g., occupational policies or workplace culture) that may impact well-being. Younger workers and those with fewer years of experience appear to have higher burnout risk. Sleep health, improved unit-based culture (respect and increased decision-making with nurses), shorter shifts, and increased social support appear to be the most protective against burnout.
Discussion
There remains a scarcity of evidence about factors impacting well-being among healthcare assistants. Existing literature focuses on individual, as opposed to external or organizational, contributory factors to burnout or well-being risk. Future studies should use specific methods to define and measure healthcare assistant roles, isolate harmful individual and organizational factors, and measure more specific sub-concepts of well-being such as depression. Such studies can contribute greatly to the overall understanding of healthcare assistant health and wellness, which subsequently may promote optimal patient and organizational outcomes.
Tweetable abstract
The hidden workforce: Systematic review demonstrates gaps in evidence about wellbeing and burnout among healthcare assistants and aides.
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Pub Date : 2024-02-24DOI: 10.1016/j.ijnsa.2024.100188
Pauline Calleja , Pamela Knight-Davidson , Andrew McVicar , Caroline Laker , Stephen Yu , Linda Roszak-Burton
Background
New graduate nurses are the nursing cohort at greatest risk for turnover and attrition in every context internationally. This has possibly been heightened during the COVID-19 pandemic. Workplace conditions significantly impact nursing turnover; however, interventions under the positive psychology umbrella may have a mediating impact on the intention to leave. New graduate nurses are generally challenged most in their first three years of clinical practice, and the need for support to transition is widely accepted. Gratitude practice has been reported to improve individual control and resilient response to setbacks and, therefore, is of interest in testing if this intervention can impact turnover intention in the workforce.
Objective
To report on a scoping review undertaken to identify whether ‘gratitude practice’ as an intervention had the potential to improve new graduate nurses’ wellbeing and resilience.
Methods
Arksey and O'Malley's scoping review approach. Primary research papers of any methodology, published in English between January 2010 and July 2022 were included. Literature was sourced from seven databases, including CINAHL PLUS, ERIC, MEDLINE, Professional Development Collection, APA PsychInfo, APA PsychArticles, and Psychological and Behavioural Sciences Collection.
Results
We identified 130 records, of which we selected 35 for inclusion. A large range of interventions were identified; most had some form of writing, journaling, or diarising. The next most common intervention was teaching gratitude strategies via workshops, and many interventions had some form of list or activity trigger for participants to complete. Five studies had complex combined interventions, while the rest were simple, easily reproducible interventions. Interventions were delivered both face-to-face or asynchronously, with some being online only and others sent out as a ‘kit’ for participants to work through.
Conclusion
Our review of existing literature shows a significant gap in research on gratitude practice and its impact on nursing populations. To ensure robust future studies, we suggest defining concepts clearly and selecting outcome measures and tools that are not closely related. Intervention design may not be as important as the choice of measures and tools to measure outcomes.
{"title":"Gratitude interventions to improve wellbeing and resilience of graduate nurses transitioning to practice: A scoping review","authors":"Pauline Calleja , Pamela Knight-Davidson , Andrew McVicar , Caroline Laker , Stephen Yu , Linda Roszak-Burton","doi":"10.1016/j.ijnsa.2024.100188","DOIUrl":"https://doi.org/10.1016/j.ijnsa.2024.100188","url":null,"abstract":"<div><h3>Background</h3><p>New graduate nurses are the nursing cohort at greatest risk for turnover and attrition in every context internationally. This has possibly been heightened during the COVID-19 pandemic. Workplace conditions significantly impact nursing turnover; however, interventions under the positive psychology umbrella may have a mediating impact on the intention to leave. New graduate nurses are generally challenged most in their first three years of clinical practice, and the need for support to transition is widely accepted. Gratitude practice has been reported to improve individual control and resilient response to setbacks and, therefore, is of interest in testing if this intervention can impact turnover intention in the workforce.</p></div><div><h3>Objective</h3><p>To report on a scoping review undertaken to identify whether ‘gratitude practice’ as an intervention had the potential to improve new graduate nurses’ wellbeing and resilience.</p></div><div><h3>Methods</h3><p>Arksey and O'Malley's scoping review approach. Primary research papers of any methodology, published in English between January 2010 and July 2022 were included. Literature was sourced from seven databases, including CINAHL PLUS, ERIC, MEDLINE, Professional Development Collection, APA PsychInfo, APA PsychArticles, and Psychological and Behavioural Sciences Collection.</p></div><div><h3>Results</h3><p>We identified 130 records, of which we selected 35 for inclusion. A large range of interventions were identified; most had some form of writing, journaling, or diarising. The next most common intervention was teaching gratitude strategies via workshops, and many interventions had some form of list or activity trigger for participants to complete. Five studies had complex combined interventions, while the rest were simple, easily reproducible interventions. Interventions were delivered both face-to-face or asynchronously, with some being online only and others sent out as a ‘kit’ for participants to work through.</p></div><div><h3>Conclusion</h3><p>Our review of existing literature shows a significant gap in research on gratitude practice and its impact on nursing populations. To ensure robust future studies, we suggest defining concepts clearly and selecting outcome measures and tools that are not closely related. Intervention design may not be as important as the choice of measures and tools to measure outcomes.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000158/pdfft?md5=d4424859088e205565a5a471bb11d747&pid=1-s2.0-S2666142X24000158-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140014203","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 : 2024-02-13DOI: 10.1016/j.ijnsa.2024.100185
Jorge Moncayo-Rizzo , Geovanny Alvarado-Villa , Clara Cossio-Uribe
Background
Burnout syndrome, characterized by physical, mental, and emotional exhaustion due to continuous exposure to high-stress work conditions, has been increasingly recognized as a serious occupational phenomenon, especially amongst healthcare professionals. Recent studies indicate that illegitimate tasks–activities unrelated to one's role are a significant factor contributing to burnout. However, given the variability of work environments across regions, these findings may not apply universally.
Objective
To investigate the behavior of the relationship between burnout and illegitimate tasks among healthcare professionals in Guayaquil, Ecuador.
Methods
We conducted a survey of 562 healthcare professionals, including physicians, nurses, and medical/nursing interns, employing the Copenhagen Burnout Inventory and Bern Illegitimate Task Scale. Regression models were developed to predict burnout levels based on multiple factors, including demographic characteristics, professional roles, and perceptions of illegitimate tasks.
Results
We revealed a statistically significant positive correlation between burnout and illegitimate tasks, with correlation coefficients ranging from 0.320 to 0.588, with higher levels of illegitimate tasks leading to increased burnout. Interestingly, we also found that age and length of service were negatively correlated with burnout, suggesting that these factors may serve as protective elements against burnout.
Conclusions
Illegitimate tasks had an impact on burnout amongst healthcare professionals and emphasized the need for organizational strategies aimed at better task management to mitigate burnout risk.
{"title":"The impact of illegitimate tasks on burnout syndrome in a healthcare system: A cross-sectional study","authors":"Jorge Moncayo-Rizzo , Geovanny Alvarado-Villa , Clara Cossio-Uribe","doi":"10.1016/j.ijnsa.2024.100185","DOIUrl":"https://doi.org/10.1016/j.ijnsa.2024.100185","url":null,"abstract":"<div><h3>Background</h3><p>Burnout syndrome, characterized by physical, mental, and emotional exhaustion due to continuous exposure to high-stress work conditions, has been increasingly recognized as a serious occupational phenomenon, especially amongst healthcare professionals. Recent studies indicate that illegitimate tasks–activities unrelated to one's role are a significant factor contributing to burnout. However, given the variability of work environments across regions, these findings may not apply universally.</p></div><div><h3>Objective</h3><p>To investigate the behavior of the relationship between burnout and illegitimate tasks among healthcare professionals in Guayaquil, Ecuador.</p></div><div><h3>Methods</h3><p>We conducted a survey of 562 healthcare professionals, including physicians, nurses, and medical/nursing interns, employing the Copenhagen Burnout Inventory and Bern Illegitimate Task Scale. Regression models were developed to predict burnout levels based on multiple factors, including demographic characteristics, professional roles, and perceptions of illegitimate tasks.</p></div><div><h3>Results</h3><p>We revealed a statistically significant positive correlation between burnout and illegitimate tasks, with correlation coefficients ranging from 0.320 to 0.588, with higher levels of illegitimate tasks leading to increased burnout. Interestingly, we also found that age and length of service were negatively correlated with burnout, suggesting that these factors may serve as protective elements against burnout.</p></div><div><h3>Conclusions</h3><p>Illegitimate tasks had an impact on burnout amongst healthcare professionals and emphasized the need for organizational strategies aimed at better task management to mitigate burnout risk.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000122/pdfft?md5=d4683d600a3ac139fb08029a831beac7&pid=1-s2.0-S2666142X24000122-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139743391","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 : 2024-02-06DOI: 10.1016/j.ijnsa.2024.100184
Mélanie Lavoie-Tremblay , Kathleen Boies , Christina Clausen , Julie Frechette , Kimberley Manning , Christina Gelsomini , Guylaine Cyr , Geneviève Lavigne , Bruce Gottlieb , Laurie N. Gottlieb
Background
Targeted interventions have been found effective for developing leadership practices in nurses. However, to date, no leadership training program based on the Strengths-Based Nursing and Healthcare Leadership approach exists.
Objectives
Demonstrate the effectiveness of a Strengths-Based Nursing and Healthcare Leadership 6-month program designed for nurse and healthcare leaders on leadership capacity and psychological outcomes.
Design
Concurrent mixed-methods with nurse and healthcare leaders from five healthcare organisations in Quebec and Ontario (Canada).
Settings
Participants were recruited from five Canadian health care organizations: two in Toronto (Ontario) and three in Montreal (Quebec).
Participants
A total of 50 nurse leaders and healthcare leaders were included in the quantitative component, and 22 (20 nurse leaders and two healthcare leaders) participated in the qualitative individual interviews.
Methods
Quantitative and qualitative (interviews) methods were used. Quantitative data (pre-post surveys) were collected from the participants before their participation in the program (Time 0), as well as after the completion of the program (Time 1). Qualitative data (individual interviews) were collected from participants at the end of the program (Time 1). Analysis was conducted using descriptive statistics, paired-sample t-tests, and thematic analysis.
Results
Quantitative results suggest a significant improvement in terms of leadership capabilities, work satisfaction, and reduction in perceived stress among participants. Three themes emerged from the qualitative data analysis: 1) focus on people's strengths, 2) structure and language based on Strengths-Based Nursing and Healthcare values, and 3) building support networks.
Conclusions
The Strengths-Based Nursing and Healthcare Leadership program developed to build the leadership capabilities of nurse and healthcare leaders was found to be effective. The positive impact of the 6-month program was demonstrated. It was also shown that the leadership program can help improve the leadership competencies, well-being, and work satisfaction of participating nurses and healthcare leaders.
Implication
This study reinforces the importance of working with educational, research, and healthcare organizations to establish leadership development programs and mentorship opportunities. Future leadership training should use a Strengths-Based Nursing and Healthcare Leadership lens when tackling leadership and stress in the workplace.
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Pub Date : 2024-02-05DOI: 10.1016/j.ijnsa.2024.100182
Mark Kenwright , Paula Fairclough , Jason McDonald , Louisa Pickford
Background
The movement of community mental health nurses into primary care is important for the delivery of primary care integrated teams. There is little evidence or guidance on how integration should be implemented, or on the effectiveness of mental health nurses in primary care.
Objectives
1. Examine one method of integrating community mental health nurses in a primary care mental health service to identify factors that both facilitated and hindered integration. 2. Report on the outcomes of community mental health nurses in delivering problem-specific evidence-based psychological interventions in primary care.
Design
A naturalistic observational cohort study
Setting
An integrated primary care mental health service in the UK North Midlands
Participants
1,582 referrals from 1st April 2019 – 31st March 2022.
Method
Anonymised patient records from routine treatment with community mental health nurses in an integrated primary care service were extracted and analysed to identify patient characteristics, content of treatment and outcomes. Features of service design were also examined to report on aids and barriers to primary care integration.
Results
Large and clinically significant pre to post treatment effect sizes of between 0.5 and 0.8 were observed in symptom reduction and functional improvement for patients treated by community mental health nurses for a range of mental health problems. Aids to integration were: A single line of clinical management and governance; shared training across all roles; a shared IT system/electronic appointment diary. Barriers to integration were: Different contract management structures, and different clinical IT systems across primary and secondary care.
Conclusions
Integrating community mental health nurses into one primary care mental health service comprising different mental health professionals provided a single point of access to different mental health treatments. Primary care community mental health nurses delivered effective evidence-based psychological interventions in a stepped-care model that reduced demands on secondary care services.
背景社区精神健康护士进入初级医疗对于初级医疗整合团队的实施非常重要。关于如何实施整合，以及精神健康护士在初级医疗中的有效性，目前还没有什么证据或指导。研究一种将社区精神健康护士整合到初级医疗精神健康服务中的方法，以确定促进和 阻碍整合的因素。2.2.报告社区心理健康护士在初级医疗中提供针对特定问题的循证心理干预的结果.DesignA naturalistic observational cohort studySettingA integrated primary care mental health service in the UK North MidlandsParticipants1,582 referrals from 1st April 2019 - 31st March 2022.MethodAnonymised patient records from routine treatment with community mental health nurses in an integrated primary care service were extracted and analysed to identify patient characteristics, content of treatment and outcomes.研究提取并分析了在初级医疗综合服务中接受社区心理健康护士常规治疗的匿名患者记录，以确定患者特征、治疗内容和结果。结果在社区精神健康护士治疗的一系列精神健康问题中，患者症状减轻和功能改善的治疗前后效应大小在 0.5 到 0.8 之间，具有显著的临床意义。有助于整合的措施有单线临床管理和治理；所有角色的共同培训；共同的信息技术系统/电子预约日记。整合的障碍有结论将社区精神健康护士整合到一个由不同精神健康专业人员组成的初级医疗精神健康服务中，为不同的精神健康治疗提供了一个单一的接入点。初级医疗社区心理健康护士以阶梯式护理模式提供有效的循证心理干预，减少了对二级医疗服务的需求。
{"title":"Effectiveness of community mental health nurses in an integrated primary care service: An observational cohort study","authors":"Mark Kenwright , Paula Fairclough , Jason McDonald , Louisa Pickford","doi":"10.1016/j.ijnsa.2024.100182","DOIUrl":"https://doi.org/10.1016/j.ijnsa.2024.100182","url":null,"abstract":"<div><h3>Background</h3><p>The movement of community mental health nurses into primary care is important for the delivery of primary care integrated teams. There is little evidence or guidance on how integration should be implemented, or on the effectiveness of mental health nurses in primary care.</p></div><div><h3>Objectives</h3><p>1. Examine one method of integrating community mental health nurses in a primary care mental health service to identify factors that both facilitated and hindered integration. 2. Report on the outcomes of community mental health nurses in delivering problem-specific evidence-based psychological interventions in primary care.</p></div><div><h3>Design</h3><p>A naturalistic observational cohort study</p></div><div><h3>Setting</h3><p>An integrated primary care mental health service in the UK North Midlands</p></div><div><h3>Participants</h3><p>1,582 referrals from 1st April 2019 – 31st March 2022.</p></div><div><h3>Method</h3><p>Anonymised patient records from routine treatment with community mental health nurses in an integrated primary care service were extracted and analysed to identify patient characteristics, content of treatment and outcomes. Features of service design were also examined to report on aids and barriers to primary care integration.</p></div><div><h3>Results</h3><p>Large and clinically significant pre to post treatment effect sizes of between 0.5 and 0.8 were observed in symptom reduction and functional improvement for patients treated by community mental health nurses for a range of mental health problems. Aids to integration were: A single line of clinical management and governance; shared training across all roles; a shared IT system/electronic appointment diary. Barriers to integration were: Different contract management structures, and different clinical IT systems across primary and secondary care.</p></div><div><h3>Conclusions</h3><p>Integrating community mental health nurses into one primary care mental health service comprising different mental health professionals provided a single point of access to different mental health treatments. Primary care community mental health nurses delivered effective evidence-based psychological interventions in a stepped-care model that reduced demands on secondary care services.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000092/pdfft?md5=661ae999b0231160bc84fa8f6649613e&pid=1-s2.0-S2666142X24000092-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139718485","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 : 2024-02-03DOI: 10.1016/j.ijnsa.2024.100183
Silje Christin Wang Linnerud , Camilla Olaussen , Jaroslav Zlamal , Monica Evelyn Kvande , Kristine Haddeland , Andréa Aparecida Goncalves Nes
Background
Nurse mentors require competence to mentor nursing students in clinical practice, including specific knowledge and skills. Evaluating mentor competence is crucial in developing and ensuring the high-quality mentoring of nursing students. The nursing student mentors’ competence instrument is one of the few valid instruments for assessing the competence of nurses as mentors.
Objectives
To translate the nursing student mentors’ competence instrument into Norwegian and evaluate its psychometric properties.
Design
The research employed a cross-sectional study design.
Settings
Data were collected from nurse mentors at nursing homes, hospitals, home nursing care and mental health care units in Norway from 2021 to 2022.
Participants
A total of 458 registered nurses with experience of mentoring nursing students participated in the study, of which data was used to conduct psychometric testing.
Methods
The nursing student mentors’ competence instrument was translated and evaluated in six steps: Forward translation, forward translation synthesis, backward translation, backward translation synthesis, cognitive debriefing and psychometric testing. The validity and reliability of the translated instrument were investigated using confirmatory factor analysis (CFA) and Cronbach's alpha.
Results
The translated instrument showed acceptability. The CFA goodness-of-fit indices showed acceptable model fit (χ2/df = 2.547, SRMR = 0.051, CFI = 0.919, RMSEA = 0.058), and the Cronbach's alpha values for the instrument's subscales ranged from 0.77 to 0.95.
Conclusions
The Norwegian version of the nursing student mentors’ competence instrument shows potential as a useful instrument for assessing current and required competencies of nurse mentors in clinical practice in nursing education.
{"title":"The Norwegian version of the nursing student mentors’ competence instrument (MCI): A psychometric validation study","authors":"Silje Christin Wang Linnerud , Camilla Olaussen , Jaroslav Zlamal , Monica Evelyn Kvande , Kristine Haddeland , Andréa Aparecida Goncalves Nes","doi":"10.1016/j.ijnsa.2024.100183","DOIUrl":"https://doi.org/10.1016/j.ijnsa.2024.100183","url":null,"abstract":"<div><h3>Background</h3><p>Nurse mentors require competence to mentor nursing students in clinical practice, including specific knowledge and skills. Evaluating mentor competence is crucial in developing and ensuring the high-quality mentoring of nursing students. The nursing student mentors’ competence instrument is one of the few valid instruments for assessing the competence of nurses as mentors.</p></div><div><h3>Objectives</h3><p>To translate the nursing student mentors’ competence instrument into Norwegian and evaluate its psychometric properties.</p></div><div><h3>Design</h3><p>The research employed a cross-sectional study design.</p></div><div><h3>Settings</h3><p>Data were collected from nurse mentors at nursing homes, hospitals, home nursing care and mental health care units in Norway from 2021 to 2022.</p></div><div><h3>Participants</h3><p>A total of 458 registered nurses with experience of mentoring nursing students participated in the study, of which data was used to conduct psychometric testing.</p></div><div><h3>Methods</h3><p>The nursing student mentors’ competence instrument was translated and evaluated in six steps: Forward translation, forward translation synthesis, backward translation, backward translation synthesis, cognitive debriefing and psychometric testing. The validity and reliability of the translated instrument were investigated using confirmatory factor analysis (CFA) and Cronbach's alpha.</p></div><div><h3>Results</h3><p>The translated instrument showed acceptability. The CFA goodness-of-fit indices showed acceptable model fit (χ<sup>2</sup>/df = 2.547, SRMR = 0.051, CFI = 0.919, RMSEA = 0.058), and the Cronbach's alpha values for the instrument's subscales ranged from 0.77 to 0.95.</p></div><div><h3>Conclusions</h3><p>The Norwegian version of the nursing student mentors’ competence instrument shows potential as a useful instrument for assessing current and required competencies of nurse mentors in clinical practice in nursing education.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000109/pdfft?md5=33187706b74d05bb63a7993174c8b3e2&pid=1-s2.0-S2666142X24000109-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139710291","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 : 2024-01-28DOI: 10.1016/j.ijnsa.2024.100181
Tongyao Wang , Juan Mu , Jialing Chen , Chia-Chin Lin
Background
The release of ChatGPT for general use in 2023 by OpenAI has significantly expanded the possible applications of generative artificial intelligence in the healthcare sector, particularly in terms of information retrieval by patients, medical and nursing students, and healthcare personnel.
Objective
To compare the performance of ChatGPT-3.5 and ChatGPT-4.0 to clinical nurses on answering questions about tracheostomy care, as well as to determine whether using different prompts to pre-define the scope of the ChatGPT affects the accuracy of their responses.
Design
Cross-sectional study.
Setting
The data collected from the ChatGPT was collected using the ChatGPT-3.5 and 4.0 using access provided by the University of Hong Kong. The data from the clinical nurses working in mainland China was collected using the Qualtrics survey program.
Participants
No participants were needed for collecting the ChatGPT responses. A total of 272 clinical nurses, with 98.5 % of them working in tertiary care hospitals in mainland China, were recruited using a snowball sampling approach.
Method
We used 43 tracheostomy care-related questions in a multiple-choice format to evaluate the performance of ChatGPT-3.5, ChatGPT-4.0, and clinical nurses. ChatGPT-3.5 and GPT-4.0 were both queried three times with the same questions by different prompts: no prompt, patient-friendly prompt, and act-as-nurse prompt. All responses were independently graded by two qualified otorhinolaryngology nurses on a 3-point accuracy scale (correct, partially correct, and incorrect). The Chi-squared test and Fisher exact test with post-hoc Bonferroni adjustment were used to assess the differences in performance between the three groups, as well as the differences in accuracy between different prompts.
Results
ChatGPT-4.0 showed significantly higher accuracy, with 64.3 % of responses rated as ‘correct’, compared to 60.5 % in ChatGPT-3.5 and 36.7 % in clinical nurses (X 2 = 74.192, p < .001). Except for the ‘care for the tracheostomy stoma and surrounding skin’ domain (X2 = 6.227, p = .156), scores from ChatGPT-3.5 and -4.0 were significantly better than nurses’ on domains related to airway humidification, cuff management, tracheostomy tube care, suction techniques, and management of complications. Overall, ChatGPT-4.0 consistently performed well in all domains, achieving over 50 % accuracy in each domain. Alterations to the prompt had no impact on the performance of ChatGPT-3.5 or -4.0.
Conclusion
ChatGPT may serve as a complementary medical information tool for patients and physicians to improve knowledge in tracheostomy care.
Tweetable abstract
ChatGPT-4.0 can answer tracheostomy care questions better than most clin
{"title":"Comparing ChatGPT and clinical nurses’ performances on tracheostomy care: A cross-sectional study","authors":"Tongyao Wang , Juan Mu , Jialing Chen , Chia-Chin Lin","doi":"10.1016/j.ijnsa.2024.100181","DOIUrl":"10.1016/j.ijnsa.2024.100181","url":null,"abstract":"<div><h3>Background</h3><p>The release of ChatGPT for general use in 2023 by OpenAI has significantly expanded the possible applications of generative artificial intelligence in the healthcare sector, particularly in terms of information retrieval by patients, medical and nursing students, and healthcare personnel.</p></div><div><h3>Objective</h3><p>To compare the performance of ChatGPT-3.5 and ChatGPT-4.0 to clinical nurses on answering questions about tracheostomy care, as well as to determine whether using different prompts to pre-define the scope of the ChatGPT affects the accuracy of their responses.</p></div><div><h3>Design</h3><p>Cross-sectional study.</p></div><div><h3>Setting</h3><p>The data collected from the ChatGPT was collected using the ChatGPT-3.5 and 4.0 using access provided by the University of Hong Kong. The data from the clinical nurses working in mainland China was collected using the Qualtrics survey program.</p></div><div><h3>Participants</h3><p>No participants were needed for collecting the ChatGPT responses. A total of 272 clinical nurses, with 98.5 % of them working in tertiary care hospitals in mainland China, were recruited using a snowball sampling approach.</p></div><div><h3>Method</h3><p>We used 43 tracheostomy care-related questions in a multiple-choice format to evaluate the performance of ChatGPT-3.5, ChatGPT-4.0, and clinical nurses. ChatGPT-3.5 and GPT-4.0 were both queried three times with the same questions by different prompts: no prompt, patient-friendly prompt, and act-as-nurse prompt. All responses were independently graded by two qualified otorhinolaryngology nurses on a 3-point accuracy scale (correct, partially correct, and incorrect). The Chi-squared test and Fisher exact test with post-hoc Bonferroni adjustment were used to assess the differences in performance between the three groups, as well as the differences in accuracy between different prompts.</p></div><div><h3>Results</h3><p>ChatGPT-4.0 showed significantly higher accuracy, with 64.3 % of responses rated as ‘correct’, compared to 60.5 % in ChatGPT-3.5 and 36.7 % in clinical nurses (<em>X <sup>2</sup></em> = 74.192, <em>p</em> < .001). Except for the ‘care for the tracheostomy stoma and surrounding skin’ domain (<em>X<sup>2</sup></em> = 6.227, <em>p</em> = .156), scores from ChatGPT-3.5 and -4.0 were significantly better than nurses’ on domains related to airway humidification, cuff management, tracheostomy tube care, suction techniques, and management of complications. Overall, ChatGPT-4.0 consistently performed well in all domains, achieving over 50 % accuracy in each domain. Alterations to the prompt had no impact on the performance of ChatGPT-3.5 or -4.0.</p></div><div><h3>Conclusion</h3><p>ChatGPT may serve as a complementary medical information tool for patients and physicians to improve knowledge in tracheostomy care.</p></div><div><h3>Tweetable abstract</h3><p>ChatGPT-4.0 can answer tracheostomy care questions better than most clin","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000080/pdfft?md5=deec54a55b2e4390941888b959a5b0f5&pid=1-s2.0-S2666142X24000080-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139640119","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 : 2024-01-23DOI: 10.1016/j.ijnsa.2024.100180
Francesca Taylor , Sarah Galloway , Kris Irons , Lorna Mess , Laura Pemberton , Karen Worton , Mary Chambers
Background
Enhancing the quality of therapeutic engagement between nurse and service user is related to positive impact on care, safety, and recovery outcomes. Achieving improved therapeutic engagement remains challenging in the acute mental health inpatient setting, characterised by complex social processes and contextual features that constrain behaviour change. The Therapeutic Engagement Questionnaire is an evidence-based tool co-produced with service users and nurses to improve therapeutic engagement.
Objectives
The objectives of this quality improvement project were to identify the organisational and nursing behaviour changes associated with the Therapeutic Engagement Questionnaire and to understand the active behaviour change ingredients of the improvement tool and how they exert their influence.
Design
A qualitative multi-site case study design in which data were collected from study site field notes and document review.
Setting
Four acute mental health inpatient case study sites in England.
Methods
Data referencing Therapeutic Engagement Questionnaire-linked behaviour change in project meeting field notes and documents from each study site were analysed using an inductive and deductive approach with thematic analysis. The Capability Opportunity Motivation-Behaviour model was employed as a theoretical framework.
Findings
The therapeutic engagement tool had the capacity to prompt behaviour change across all three components of the behaviour change model: Capability – through nurses sharing good therapeutic engagement practice and use of statements in the questionnaire to build nurses’ knowledge and skills; Opportunity – through organisational barriers being addressed and ward-level practice and culture changes; Motivation – through nurses’ awareness of their influence on service user recovery, nurses’ alertness to their therapeutic work, and connections between the therapeutic engagement tool and nursing core values. However, the tool did not accord with the values of some nurses, reported to be unmotivated by the recognition it gave their profession for contribution to service user recovery. In sites evidencing more prominent behaviour change, senior leader and ward-level agents of change played a valuable facilitative role.
Conclusion
The therapeutic engagement tool had the potential to prompt behaviour changes at organisation and ward level and to the ways individual nurses therapeutically engage with service users, helping strengthen therapeutic engagement practice. Leadership at senior organisational and ward level was important to address contextual barriers to change. The project resulted in a conceptual framework to explain and understand the behaviour change techniques and functions linked to the therapeutic engagement tool. Longevity of the behaviour changes and their
{"title":"Understanding organisational and nursing behaviour changes associated with a therapeutic engagement improvement tool in acute mental health inpatient settings: A qualitative analysis","authors":"Francesca Taylor , Sarah Galloway , Kris Irons , Lorna Mess , Laura Pemberton , Karen Worton , Mary Chambers","doi":"10.1016/j.ijnsa.2024.100180","DOIUrl":"10.1016/j.ijnsa.2024.100180","url":null,"abstract":"<div><h3>Background</h3><p>Enhancing the quality of therapeutic engagement between nurse and service user is related to positive impact on care, safety, and recovery outcomes. Achieving improved therapeutic engagement remains challenging in the acute mental health inpatient setting, characterised by complex social processes and contextual features that constrain behaviour change. The Therapeutic Engagement Questionnaire is an evidence-based tool co-produced with service users and nurses to improve therapeutic engagement.</p></div><div><h3>Objectives</h3><p>The objectives of this quality improvement project were to identify the organisational and nursing behaviour changes associated with the Therapeutic Engagement Questionnaire and to understand the active behaviour change ingredients of the improvement tool and how they exert their influence.</p></div><div><h3>Design</h3><p>A qualitative multi-site case study design in which data were collected from study site field notes and document review.</p></div><div><h3>Setting</h3><p>Four acute mental health inpatient case study sites in England.</p></div><div><h3>Methods</h3><p>Data referencing Therapeutic Engagement Questionnaire-linked behaviour change in project meeting field notes and documents from each study site were analysed using an inductive and deductive approach with thematic analysis. The Capability Opportunity Motivation-Behaviour model was employed as a theoretical framework.</p></div><div><h3>Findings</h3><p>The therapeutic engagement tool had the capacity to prompt behaviour change across all three components of the behaviour change model: Capability – through nurses sharing good therapeutic engagement practice and use of statements in the questionnaire to build nurses’ knowledge and skills; Opportunity – through organisational barriers being addressed and ward-level practice and culture changes; Motivation – through nurses’ awareness of their influence on service user recovery, nurses’ alertness to their therapeutic work, and connections between the therapeutic engagement tool and nursing core values. However, the tool did not accord with the values of some nurses, reported to be unmotivated by the recognition it gave their profession for contribution to service user recovery. In sites evidencing more prominent behaviour change, senior leader and ward-level agents of change played a valuable facilitative role.</p></div><div><h3>Conclusion</h3><p>The therapeutic engagement tool had the potential to prompt behaviour changes at organisation and ward level and to the ways individual nurses therapeutically engage with service users, helping strengthen therapeutic engagement practice. Leadership at senior organisational and ward level was important to address contextual barriers to change. The project resulted in a conceptual framework to explain and understand the behaviour change techniques and functions linked to the therapeutic engagement tool. Longevity of the behaviour changes and their","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000079/pdfft?md5=5139277cc4c23010e45a20444d1c5d0c&pid=1-s2.0-S2666142X24000079-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633468","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 : 2024-01-17DOI: 10.1016/j.ijnsa.2024.100179
Melissa A. Carlson, Elizabeth A. Fradgley, Christine L. Paul
Background
Despite the impact of cognitive decline during brain cancer care, implementing routine cognitive assessment can be challenging. Effective implementation of cognitive assessment necessitates an understanding of implementation from the patient perspective. However, little is known about how people with glioma and their caregivers experience cognitive changes, assessment and support.
Objective
To understand the lived experiences of changes in cognition for people with glioma and their caregivers including experiences of: i) perceived or objectively measured cognitive decline (or absence of decline); ii) cognitive assessment following diagnosis, and; iii) met and unmet cognition-related supportive care needs.
Design
Semi-structured qualitative telephone interviews were conducted with people with gliomas and support persons and analysed using reflexive thematic analysis.
Setting(s)
Two Australian cancer services
Participants
18 people with glioma and caregivers
Methods
Semi-structured qualitative telephone interviews were conducted with people with gliomas and caregivers and analysed using reflexive thematic analysis.
Results
People with glioma (n = 5) and caregivers (n = 13) completed interviews. Four themes were identified: Cognition needs to be considered within the context of glioma diagnosis and treatment; concerns about cognition were initially subordinate to survival but become important; there are challenges identifying and communicating about people with gliomas’ changes in cognition; cognition-related supportive care can be helpful but challenging for people with glioma and caregivers to identify and access.
Conclusions
Changes to cognition can have considerable impacts of people with glioma and their caregivers which may be overshadowed by treatment and survival. A multi-disciplinary approach to timely cognitive screening, structured referral pathways, and communication with caregivers may provide opportunities for support.
Registration
n/a
Tweetable abstract
Identifying cognitive changes in people with glioma is important and challenging. A multidisciplinary approach and inclusion of care coordination and caregivers can help.
{"title":"Understanding experiences of cognitive decline and cognitive assessment from the perspectives of people with glioma and their caregivers: A qualitative interview study","authors":"Melissa A. Carlson, Elizabeth A. Fradgley, Christine L. Paul","doi":"10.1016/j.ijnsa.2024.100179","DOIUrl":"10.1016/j.ijnsa.2024.100179","url":null,"abstract":"<div><h3>Background</h3><p>Despite the impact of cognitive decline during brain cancer care, implementing routine cognitive assessment can be challenging. Effective implementation of cognitive assessment necessitates an understanding of implementation from the patient perspective. However, little is known about how people with glioma and their caregivers experience cognitive changes, assessment and support.</p></div><div><h3>Objective</h3><p>To understand the lived experiences of changes in cognition for people with glioma and their caregivers including experiences of: i) perceived or objectively measured cognitive decline (or absence of decline); ii) cognitive assessment following diagnosis, and; iii) met and unmet cognition-related supportive care needs.</p></div><div><h3>Design</h3><p>Semi-structured qualitative telephone interviews were conducted with people with gliomas and support persons and analysed using reflexive thematic analysis.</p></div><div><h3>Setting(s)</h3><p>Two Australian cancer services</p></div><div><h3>Participants</h3><p>18 people with glioma and caregivers</p></div><div><h3>Methods</h3><p>Semi-structured qualitative telephone interviews were conducted with people with gliomas and caregivers and analysed using reflexive thematic analysis.</p></div><div><h3>Results</h3><p>People with glioma (<em>n</em> = 5) and caregivers (<em>n</em> = 13) completed interviews. Four themes were identified: Cognition needs to be considered within the context of glioma diagnosis and treatment; concerns about cognition were initially subordinate to survival but become important; there are challenges identifying and communicating about people with gliomas’ changes in cognition; cognition-related supportive care can be helpful but challenging for people with glioma and caregivers to identify and access.</p></div><div><h3>Conclusions</h3><p>Changes to cognition can have considerable impacts of people with glioma and their caregivers which may be overshadowed by treatment and survival. A multi-disciplinary approach to timely cognitive screening, structured referral pathways, and communication with caregivers may provide opportunities for support.</p></div><div><h3>Registration</h3><p>n/a</p></div><div><h3>Tweetable abstract</h3><p>Identifying cognitive changes in people with glioma is important and challenging. A multidisciplinary approach and inclusion of care coordination and caregivers can help.</p></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000067/pdfft?md5=b23ac6992f988a23a83434cfcea4e373&pid=1-s2.0-S2666142X24000067-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139640035","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 : 2024-01-13DOI: 10.1016/j.ijnsa.2024.100178
James McMahon , David R. Thompson , Jan Cameron , Christine Brown Wilson , Loreena Hill , Paul Tierney , Doris Yu , Debra K. Moser , Karen Spilsbury , Nittaya Srisuk , Jos M. G. A. Schols , Mariëlle van der Velden , Gary Mitchell
Background
Heart failure has an estimated global prevalence of 64.3 million cases, with an average age of a person living with heart failure at 75.2 years. Approximately 20% of residents living in nursing homes (a long-term residential care environment for some individuals) report living with heart failure. Residents living with heart failure in nursing home environments are often frail, have reduced quality of life, higher rates of rehospitalisation and mortality, and greater complications in heart failure management. Further, nursing home staff often lack the knowledge and skills required to provide the necessary care for those living with heart failure. Interventions for improving heart failure management in nursing homes have proven effective, yet there is a lack of understanding regarding interventions for optimising care provision. The aim of this review was to synthesise the current evidence on educational interventions to optimise care provided to people with heart failure in nursing homes.
Methods
A scoping review with four databases searched: Medline, CINAHL, Web of Science, and EMBASE. Relevant reference lists were searched manually for additional records. Studies of nursing home staff or resident outcomes associated with changes in care provision (i.e., resident quality of life, staff knowledge of heart failure) were included. Results from the charting data process were collated into themes: intervention outcomes, changes to practice, and implementation and process evaluation.
Results
Seven papers were deemed eligible for inclusion. Most studies (n=6) were comprised of nursing home staff only, with one comprised only of residents. Study aims were to improve heart failure knowledge, interprofessional communication, heart failure assessment and management. Positive changes in staff outcomes were observed, with improvements in knowledge, self-efficacy, and confidence in providing care reported. No difference was reported concerning nursing home resident outcomes. Interprofessional communication and staff ability to conduct heart failure assessments improved post-intervention. Changes to practice were mixed, with issues around sustainability reported. Nursing home staff highlighted their appreciation towards receiving education, recommending that videos, images, and humour could improve the intervention content.
Conclusions
There is a paucity of evidence around educational interventions to support residents living with heart failure in nursing homes. However, available evidence suggests that educational interventions in nursing homes may improve care through improving staff self-efficacy and confidence in providing care, heart failure knowledge and interprofessional communication. The complexity of implementing educational interventions in the nursing home setting must be considered during the development process to improve implementation, effective
{"title":"Heart failure in nursing homes: A scoping review of educational interventions for optimising care provision","authors":"James McMahon , David R. Thompson , Jan Cameron , Christine Brown Wilson , Loreena Hill , Paul Tierney , Doris Yu , Debra K. Moser , Karen Spilsbury , Nittaya Srisuk , Jos M. G. A. Schols , Mariëlle van der Velden , Gary Mitchell","doi":"10.1016/j.ijnsa.2024.100178","DOIUrl":"https://doi.org/10.1016/j.ijnsa.2024.100178","url":null,"abstract":"<div><h3>Background</h3><p>Heart failure has an estimated global prevalence of 64.3 million cases, with an average age of a person living with heart failure at 75.2 years. Approximately 20% of residents living in nursing homes (a long-term residential care environment for some individuals) report living with heart failure. Residents living with heart failure in nursing home environments are often frail, have reduced quality of life, higher rates of rehospitalisation and mortality, and greater complications in heart failure management. Further, nursing home staff often lack the knowledge and skills required to provide the necessary care for those living with heart failure. Interventions for improving heart failure management in nursing homes have proven effective, yet there is a lack of understanding regarding interventions for optimising care provision. The aim of this review was to synthesise the current evidence on educational interventions to optimise care provided to people with heart failure in nursing homes.</p></div><div><h3>Methods</h3><p>A scoping review with four databases searched: Medline, CINAHL, Web of Science, and EMBASE. Relevant reference lists were searched manually for additional records. Studies of nursing home staff or resident outcomes associated with changes in care provision (i.e., resident quality of life, staff knowledge of heart failure) were included. Results from the charting data process were collated into themes: intervention outcomes, changes to practice, and implementation and process evaluation.</p></div><div><h3>Results</h3><p>Seven papers were deemed eligible for inclusion. Most studies (n=6) were comprised of nursing home staff only, with one comprised only of residents. Study aims were to improve heart failure knowledge, interprofessional communication, heart failure assessment and management. Positive changes in staff outcomes were observed, with improvements in knowledge, self-efficacy, and confidence in providing care reported. No difference was reported concerning nursing home resident outcomes. Interprofessional communication and staff ability to conduct heart failure assessments improved post-intervention. Changes to practice were mixed, with issues around sustainability reported. Nursing home staff highlighted their appreciation towards receiving education, recommending that videos, images, and humour could improve the intervention content.</p></div><div><h3>Conclusions</h3><p>There is a paucity of evidence around educational interventions to support residents living with heart failure in nursing homes. However, available evidence suggests that educational interventions in nursing homes may improve care through improving staff self-efficacy and confidence in providing care, heart failure knowledge and interprofessional communication. The complexity of implementing educational interventions in the nursing home setting must be considered during the development process to improve implementation, effective","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666142X24000055/pdfft?md5=6aed125d370f551fc4f6fb3a084c9f29&pid=1-s2.0-S2666142X24000055-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139487869","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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