Nursing Open最新文献

Aim: To investigate the factors that influence readiness for hospital discharge in Chinese patients after total knee arthroplasty and to identify priorities for nursing interventions.

Design: A cross-sectional study.

Methods: From January to August 2022, data were collected from 339 patients at two tertiary A-level hospitals in Jinan, Shandong Province. SPSS 26.0 and Mplus 8.3 software were used for statistical analysis.

Results: Results from multiple linear regression showed that patients' age, residence status, education level, knee pain during sleep, quality of discharge teaching, self-efficacy for rehabilitation, pain control knowledge, and social support were factors influencing their readiness for hospital discharge. The results of the structural equation model had shown that there were also indirect effects of the education level, knee pain during sleep, quality of discharge teaching, and pain control knowledge.

Conclusion: Patients' readiness for hospital discharge needs further improvement, hence physicians and nurses should judiciously allocate medical resources and concentrate their efforts on high-risk groups characterized by low readiness for hospital discharge.

Implications for the profession and patient care: This study underscores the importance of physicians and nurses prioritizing key factors such as age, residency status, education level, and social support in total knee arthroplasty patients to enhance their readiness for hospital discharge. By implementing targeted discharge planning, effective pain management, and comprehensive rehabilitation education, healthcare providers can improve patient outcomes.

Impact: This study identified key factors influencing readiness for hospital discharge in total knee arthroplasty patients, guiding targeted nursing interventions to improve post-operative care.

Reporting method: STROBE.

Patient or public contribution: The participants recruited for this study were actively engaged in the data collection process.

Aim: To develop a conceptual framework for nurses' protocol-based care decision-making.

Design: Miles & Huberman's bottom-up approach to developing conceptual frameworks was followed, using data collected from a multiple embedded case study examining protocol-based decision-making by nurses in three hospital wards within a university hospital in northern Spain.

Methods: The qualitative data from the case study, obtained through documentary analysis, observations, and interviews, underwent a secondary analysis consisting of four steps: data reduction, data display, comparison, and drawing conclusions.

Results: The framework for protocol-based care decision-making comprises four components: (1) protocol-based care, as a balance between standardisation and individualised care, (2) the process, (3) the context, and (4) the elements of protocol-based care decision-making. These components and their relationship as a context-dependent, linear, variable and multifactorial process, directly influenced by the perception of risk, are described and illustrated.

Conclusions: This study provides a rigorous bottom-up framework for nurses' protocol-based care decision-making. The framework could be a valuable resource for managers, clinical nurses, educators, and researchers to guide and evaluate nurses' decision-making, leading to improved care quality and reduced variability in clinical practice. Furthermore, the framework lays a foundation for further research and practical applications.

Impact: This study addressed the problem of understanding nurses' protocol-based care decision-making and the need for a specific conceptual framework. The main findings of the study contribute to the development of a rigorous bottom-up framework comprising four components of protocol-based care decision-making. The framework has the potential to improve care quality, reduce variability, enhance patient safety, and increase healthcare efficiency by guiding nurses' decision-making in various healthcare settings.

No patient or public contribution: Patient or public contribution was not applicable since the study focused on nurses' decision making.

Aim: To explore Finnish paramedics' perceptions of work-related performance expectations in relation to work experience, and understand how organizational socialization contributes to understanding paramedics' performance expectations.

Design: A qualitative design with a deductive-inductive approach utilizing a social constructivist framework. The organizational socialization framework by Wanberg was used as the theoretical basis.

Methods: Data were collected between May and August 2023, using group and individual interviews of newly graduated (n = 9) and experienced paramedics (n = 13). Participants were recruited via social media channels. Data were first analyzed deductively, according to constructs of the organizational socialization framework (role clarity, task mastery, and social acceptance), then inductively, using codes not utilized in the deductive phase.

Data sources: Interviewed Finnish paramedics (N = 22), both newly graduated paramedics (n = 9) and experienced paramedics (n = 13). The interviews were performed remotely and then transcribed into text.

Results: Our findings showed comparable performance expectations between newly graduated and experienced paramedics, mismatches in role clarity of paramedic work, challenges in both learning and upholding professional competence, and difficulties of social acceptance into the paramedic community. There were variations in how expectations were perceived between groups, indicating that experience might partly affect how paramedics identify and manage performance expectations. The organizational socialization framework enables the contextualization of these performance expectations.

Conclusions and implications: Paramedic work involves challenges to upholding clinical competence, aligning to a professional role, and social integration into the professional community. Our research contributes to understanding how paramedics perceive these challenges as performance expectations in different stages of their careers and how they could be managed utilizing a framework for organizational socialization. The socialization of paramedics into the workforce needs to account for these performance expectations, especially considering the changing paradigm of paramedic work, role, and societal expectations.

Patient or public contribution: No Patient or Public Contribution.

Aim: To explore the effects of demographic characteristics, mental workload, and Adversity quotient (AQ) on the job engagement of nurses in East China.

Design: A quantitative and cross-sectional study.

Method: The survey collected questionnaire data on mental workload, adversity quotient, and job engagement from 473 nurses selected working in 12 Grade-A tertiary hospitals based on informed consent in East China between July 2020 and March 2021.

Results: The total score of mental workload was 78.24 ± 11.65, the adversity quotient score was 128.26 ± 15.84, job engagement score was 42.32 ± 7.79. Job engagement has a remarkable positive correlation with adversity quotient (r = 0.613, p<0.001), and a negative correlation with mental workload (r = -0.499, p<0.001). Mental workload has an apparent negative correlation with adversity quotient (r = -0.291, p<0.001). Labor-management relationship with current organization, department, study to get a degree or diploma in spare time, attitude towards a career in Nursing, attitude towards the current career position, satisfaction with marriage, social support, load feelings, self-assessment, control, and endurance could predict 70.9% of job engagement of nurses.

Conclusions: The mental workload of nurses was higher, the AQ was at a medium level, and the job engagement of nurses was also slightly higher. Labor-management relationship with current organization, department, study to get a degree or diploma in spare time, attitude towards a career in Nursing, attitude towards the current career position, satisfaction with marriage, social support, load feelings, self-assessment, control, and endurance had predictive effects on nurses' job engagement. It is necessary to take a variety of measures according to the social-demographic characteristics, improve the adversity quotient, and evaluate the mental workload correctly, to improve the job engagement of nurses.

Impact: The epidemic situation and other emergencies make the work pressure of nurses in Grade-A tertiary hospitals increase suddenly. It should pay attention to the influence of different demographic factors, and pay attention to the correct guidance of work demand-mental workload, as well as the cultivation, and improvement of job resource-AQ, which can improve the job engagement of nurses to some extent.

Patient or public contribution: No patient or public contribution.

Aim: To investigate the current state and influencing factors of core competence of oncology specialist nurses as well as the relationship between core competence and perceived professional benefits.

Design: A cross-sectional correlational survey.

Methods: This questionnaire survey was conducted with oncology specialist nurses working in a Grade III A (tertiary) Public Cancer Hospital in Jinan, China in March 2021. Based on informed consent, a convenience sampling of 350 nurses participated in the study, with 322 valid questionnaires collected. Using IBM SPSS21.0, the data were analysed to perform descriptive statistics, analysis of variance (ANOVA), multiple stepwise regression analysis and Pearson's correlation analysis.

Results: The overall average score of nurses' core competence was 224.28 ± 7.95, a medium level and the overall average score of their perceived professional benefits was 132.99 ± 5.05. Nurses' core competence was positively correlated with perceived professional benefits. The differences in professional title, education, working years and perceived professional benefits were statistically significant.

Conclusion: The findings indicated that nurses' perceived professional benefit is an important factor affecting core competence. Nursing managers who take main responsibility for the quality of care should adopt measures to increase perceived professional benefits, which not only promote nurses' job satisfaction and happiness, but also enhance the development of their core competence and the quality of cancer care as well.

Patient or public contribution: All participants contributed to the conducting of this study by completing self-reported questionnaires.

Aim: To describe educators' conceptions of the pedagogical challenges involved in teaching practical topics to nursing students at clinical skills centres (CSCs).

Design: A qualitative descriptive design.

Methods: The study used a phenomenographic approach. Data were collected through individual qualitative interviews with 17 educators teaching at CSCs, between November 2020 and March 2021. The checklist called Consolidated Criteria for Reporting Qualitative Research for qualitative research was used.

Results: Three categories of description emerged regarding the educators' conceptions of the pedagogical challenges: teaching with credibility, teaching with confidence and creating a conducive learning environment. These conceptions were interrelated based on the way that the teaching was performed. Further, the results indicate that educators had to manage two different professional areas, that is, nursing and pedagogy, which both needed to be integrated in order to create the right learning environment.

Conclusion: To increase competence and confidence, it is recommended to develop educational course for the educators at the clinical skills centre where pedagogy and nursing are intertwined.

Implications for the profession: This study indicated the need for educators to be prepared with credibility and confidence when teaching at CSCs to create a conducive learning environment. In order to develop this, it is key to provide support through formal and informal mentoring and entail the need for educators to combine the two roles of nursing and pedagogy.

Reporting method: Consolidated criteria for reporting qualitative research (COREQ).

Public contribution: No patient or public contribution.

Aim: Geriatric patients are increasingly dominating the daily routine in emergency department (ED). The atypical clinical presentation of disease, multimorbidity, frailty and cognitive impairment of geriatric patients pose particular challenges for triage in the ED. Efficient and accurate emergency triage plays a key role in differentiating between geriatric patients who need timely treatment and those who can wait safely. The purpose of this study was to evaluate the performance of the modified Manchester Triage System (mMTS) in classifying geriatric patients.

Design: An observational retrospective study.

Methods: A retrospective study of 18,796 geriatric patients (≥65 years) attending the ED of a tertiary care hospital in Zhejiang province between 1 June 2020 and 30 June 2022. Baseline information on patients was collected and divided into two different study groups according to triage level: high priority (red/orange) and low priority (yellow/green). The sensitivity and specificity of the mMTS were estimated by verifying the triage classification received by the emergency geriatric patients and their survival at 7 days or the need for acute surgery within 72 h.

Results: The study included a total of 17,764 geriatric patients with a median age of 72 years in ED. 10.7% (1896/17,764) of the geriatric patients were assigned to the high priority code group (red/orange) and 89.3% (15,868/17,764) were in the low priority code group (yellow/green). The sensitivity of the mMTS associated with death within 7 days was 85.7% (77.5-91.4), specificity was 89.8% (89.3-90.2), and accuracy was 89.8% (89.3-90.2). 1.8% of patients required surgery within 72 h. The sensitivity was 62.6% (57.0-67.9), specificity was 90.3% (89.8-90.7), and negative predictive value was 99.2% (99.0-99.4).

Conclusions: The mMTS has good specificity, accuracy and negative predictive value for geriatric patients. However, its incorrect prediction of triage in high-priority code patients results in lower sensitivity, which may serve as a protective strategy for these individuals. The current emergency triage system does not completely screen geriatric patients with severe acute illness who present to the ED, and it is necessary to add comprehensive assessment tools that match the characteristics of geriatric patients to improve triage outcomes.

Aim: The present study aimed to assess professional autonomy among clinical nurses and identify its predictors using a native and contemporary tool, which is in line with the recent advancement in nursing professionalism in Iran.

Design: The study used an analytical cross-sectional design.

Methods: A total of 1601 nurses working in medical centres nationwide under the Ministry of Health participated in the study. The research instrument consisted of two parts, including individual and organizational characteristics and a questionnaire on clinical nurses' professional autonomy. Data analysis involved descriptive and inferential statistics as well as multiple logistic regression analysis using SPSS software.

Results: The results indicated that the total professional autonomy score among clinical nurses was 75.86 ± 12.03, with the majority (n = 1262, 78.9%) reporting high professional autonomy. Multiple logistic regression analysis revealed that nurses with 5-15 years of experience had 1.82 times higher odds (95% confidence interval: 2.47-1.35) of having high professional autonomy compared to those with less than 5 years of experience. Similarly, nurses with over 15 years of experience had 2.25 times higher odds (95% confidence interval: 1.56-3.26). Head nurses had 4.56 times higher odds (95% confidence interval: 2.60-7.99) of having high professional autonomy compared to clinical nurses.

Conclusion: Educational interventions to enhance the professional autonomy of less experienced nurses, with more experienced nurses serving as role models, are recommended. Additionally, measures such as supporting nurses, providing effective communication training and empowering nurses are essential to promote professional mutual respect among nurses.

No patient or public contribution: This study explored professional autonomy in clinical nurses in Iran. No patient or public contribution was investigated.

Aim: To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women during the COVID-19 epidemics' fifth wave.

Design: A cross-sectional study.

Methods: This study was conducted on 676 postpartum women admitted to postpartum wards of Mobini maternity hospital using a convenience sampling method between 2 Aug and 18 September 2021 in Iran. We used the general linear model and multiple linear regression analyses to determine predictors of birth satisfaction.

Results: The mean and standard deviation values of age and education were 28.7 ± 6.6 and 11.1 ± 4.1 (years), respectively. The mean scores of the three scales were as follows: FVC-19S (14.7 ± 7.5), WHO-5 (67.5 ± 13.0) and BSS-R (28.6 ± 7.3). Sixty-five point nine percent (65.9%) of the participants were multiparous. Overall predictors of low birth satisfaction were emergency caesarean, instrumental birth, episiotomy, Entonox analgesia, low level of well-being score < 50, fear of COVID-19, low satisfaction with pregnancy and low satisfaction with spouse's support. The overall proportion of the variance in birth satisfaction explained by all variables is 17.4%. Labor and birth variables explained 12.2% of the variance in birth satisfaction.

Patient or public contribution: None.

Aim: To explore the experiences and needs of postgraduate nursing students within the Nigerian context.

Design: This qualitative study was conducted using a descriptive phenomenological approach.

Method: Data were collected between February and April 2022 using a purposive sampling method and telephone semi-structured interviews. Colaizzi's method of Qualitative data Analysis was utilized. Twenty-two Nigerian postgraduate nursing students were interviewed.

Results: Three themes emerged: challenges of Nigerian postgraduate students before the pandemic, the impact of the pandemic on postgraduate education, and innovations to improve postgraduate education in Nigeria. The challenges include the burden of physical lectures, lack of infrastructure, and poor mentorship of postgraduate nursing students. The impact of the pandemic on postgraduate education includes abrupt disruption of the academic program, a prolonged academic calendar, and a communication gap between students and their research supervisors. Innovations to improve postgraduate nursing education in Nigeria also include adoption and sustainability of e-learning, upgrading post-basic to postgraduate nursing programmes, proper structuring of postgraduate nursing education, commencement of postgraduate nursing programmes in more universities and provision of financial aid for students. Our primary finding is that funding, mentorship and infrastructure were issues peculiar to all the respondents.

Conclusion: This study concludes that efforts should be made to maintain a seamless educational program by ensuring an uninterrupted flow of learning through virtual means, thereby enhancing effective teaching and learning.

Implications: Graduate nursing studies is one of the suggested solutions in the WHO strategic direction for nursing and midwifery globally to achieve Universal Health Coverage . The reason is that nurses can practice with more and better skills in any work setting, thus improving the quality of health care services. Our study provides insights into the experiences of postgraduate students and how these could discourage other nurses who might have thought about furthering their studies. Efforts should be made to provide all the support that these students need, using evidence from this study and similar studies to ensure they have a good learning experience and others can be motivated to learn at the graduate level as well. This will increase the proportion of nurses and midwives honed with better skills to provide more standard quality services that will improve patient care outcomes.