Nursing Open最新文献

Aims: To identify the effects of moral distress and terminal care stress on the terminal care performance of nurses who cared for COVID-19 patients.

Design: This study was cross-sectional descriptive research.

Methods: Using a convenience sampling method from June to October 2022, nurses who provided terminal care for COVID-19 patients in a Korean tertiary hospital within the last 6 months from the time of the study were selected as participants. Socio-demographic and work characteristics of the participants were collected, and COVID-19 moral distress, terminal care stress and terminal care performance were assessed. A total of 140 self-report questionnaires were distributed and returned (response rate: 100%).

Results: In the terminal care performance, it was found that nurses performed relatively well in the physical area, but less well in the emotional and spiritual areas. Moral distress and terminal care stress were both positively correlated with terminal care performance for nurses who cared for COVID-19 patients. The predictors of terminal care performance were moral distress (β = 0.27, p = 0.003), gender (β = 0.20, p = 0.015) and experience in a dedicated COVID-19 unit (β = 0.22, p = 0.020).

Conclusions: The study identified moral distress as the most significant factor influencing terminal care performance among nurses caring for COVID-19 patients. To enhance terminal care performance, it is crucial to address moral distress and provide clear guidelines and support, especially in the emotional and spiritual care domains. Future research should explore additional factors that may influence terminal care performance in pandemic situations.

Patient or public contribution: No patient or public contribution.

Aim: To assess the knowledge, attitude and practice (KAP) towards unnecessary urinary catheterisation among nurses in Taicang City, China.

Design: Cross-sectional study.

Methods: This study included nurses from our hospital and was conducted between February 2023 and June 2023.

Data sources: A self-administered questionnaire was designed to collect their demographic characteristics and KAP.

Results: A total of 233 valid questionnaires were collected. The mean KAP scores were 13.44 ± 1.62 (possible range: 0-17), 45.28 ± 3.87 (possible range: 10-50) and 43.85 ± 5.98 (possible range: 10-50), which indicated moderate knowledge, positive attitude and proactive practice, respectively. The Pearson's correlation analysis showed positive correlations between knowledge and attitude (r = 0.253, p < 0.001), knowledge and practice (r = 0.279, p < 0.001), as well as attitude and practice (r = 0.441, p < 0.001). Partial correlation analysis adjusted for age, gender, department, working experience and experience in treating patients with catheter-associated urinary tract infections also showed positive correlations among KAP. A structural equation modelling showed that both knowledge (β = 0.501, p = 0.047) and attitude (β = 0.691, p < 0.001) had direct effect on practice.

Conclusion: This study found moderate knowledge, positive attitude and proactive practice among the participants. Both knowledge and attitude might affect their practice.

Impact: We wanted to know the knowledge, attitude and behaviour of nurses in Taicang City towards unnecessary catheterisation. Moderate knowledge, positive attitude and proactive practice were found among the participants. The findings would provide evidence for policymakers to develop targeted educational intervention to improve nurses' practice and might improve the outcomes of patients.

Reporting method: This study was reported to be adhered to the STROBE guideline.

Patient or public contribution: No patient or public contribution.

Implications for the profession and/or patient care: Targeted educational intervention was needed to improve nurses' practice.

Aim: To determine the prevalence and factors associated with antenatal depression risk among pregnant women attending antenatal care at a district hospital in Kumasi, Ghana.

Study design: This was a hospital-based cross-sectional study.

Methods: A questionnaire was used to collect data from 207 pregnant women attending antenatal care at Manhyia District Hospital from September 2020 to November 2020. The Edinburgh Postnatal Depression Scale was used to screen for depression risk. Factors associated with antenatal depression risk were evaluated using logistic regression analysis.

Results: The prevalence of antenatal depression risk was 13.5% (n = 28). The most commonly reported intimate partner violence that contributed to depression risk was physical abuse (16.9%, n = 35). Factors such as physical abuse (AOR = 3.36, 95% CI: 1.13-10.02), domestic abuse (AOR = 3.88, 95% CI: 1.01-15.00) and self-harm ideation (AOR = 8.50, 95% CI: 2.44-29.63) were associated with increased odds of antenatal depression risk among the study participants.

Conclusion: This study revealed a low prevalence of antenatal depression risk. Extra attention should be given to factors such as intimate partner violence (domestic and physical abuse) and self-harm ideation. Also, screening all pregnant women, especially those with risk factors, for the risk of antenatal depression and early diagnosis and treatment of the risk of depression are important for the health of the mother, fetus and newborn.

Aims: To explore clinical facilitators' understanding, experiences and perceptions of their role in supporting registered nurse students (RNS) who experience workplace violence (WPV) during clinical placement.

Design: An exploratory, qualitative design.

Methods and data source: Data were collected between September and November 2022 using semi-structured interviews of 1-h duration with 11 clinical facilitators working in South Australia. The interviews were transcribed verbatim and analysed using thematic analysis.

Results: Participants reported that WPV is experienced in many forms, including verbal and physical violence towards RNS during clinical placements. Clinical facilitators are not always aware of this experience and have mixed abilities to resolve the damage. Most importantly, clinical facilitators saw themselves as disempowered to provide the support required by RNS after WPV incidents as they perceived themselves as visitors to the facilities.

Conclusion: Findings indicate that a clinical facilitator's scope and ability to support a RNS is often not at a level where real impact and safety can occur. Varying perceptions of what WPV is, what is acceptable, and the authority or influence of a clinical facilitator have all informed this issue and need to be considered in developing strategies to address WPV towards RNS.

Implications for the nursing profession: This study highlights that by understanding the causation of WPV and recognising the lack of influence and scope of clinical facilitators to act to support RNS during WPV events, positive industry changes can be instigated to promote student placement experiences and healthcare provision.

Impact: Clinical facilitators felt limited in their role to support RNS experiencing WPV. This research impacts future nursing students, education providers, clinical facilitators and clinical placement providers.

Reporting method: COREQ guidelines were utilised to report qualitative research.

No patient or public contribution: This paper explores specifically the clinical facilitators' perceptions of WPV.

Aim: To validate the defining characteristics (CDs) of the nursing diagnosis 'Activity intolerance [00092]' in patients with acute coronary syndrome (ACS).

Design: Cross-sectional study. Patients over 18 years of age with a confirmed medical diagnosis of hospitalised ACS were included and those who were haemodynamically unstable, with alterations in the mental sphere or with communication limitations were excluded. The CDs were previously operationalised for standardised measurement and independently assessed by nurses.

Results: A total of 111 patients with ACS were studied. The CDs with prevalence > 50% were: generalised weakness (80.56 vs. 78.70%), discomfort on exertion (72.07% vs. 75.68%) and ECG changes (71.17% vs. 68.47%). Inter-rater agreement for determining the CDs ranged from 0.69 to 1.00.

Conclusions: This study established the clinical validation of the CDs of the nursing diagnosis 'Activity Intolerance [00092]' in patients with ACS identifying three major CDs: EKG changes, generalised weakness and exertional discomfort.

Patient or public contribution: No patient or public contribution the research was developed in its entirety by the authors.

Implications for the profession and/or patient care: The clinical validation of the defining characteristics of the activity intolerance diagnosis was conducted. This validation was based on operationalising each characteristic using commonly employed nursing scales and instruments. This process contributes significantly to the establishment of evidence-based nursing practices. The customisation of nursing diagnoses gains further ground through the validation studies of NANDA-I diagnoses. This process solidifies standardised nursing language as a valuable strategy in nursing care, providing substantial support for practical decision-making. Among the evaluators, EKG changes, generalised weakness and discomfort on exertion emerged as the most frequently encountered defining characteristics with substantial agreement. This discovery offers crucial insights for devising individualised and collective care plans within coronary units.

Aim: To explore how postgraduate leadership education is translated into practice and how leadership practices and behaviours are sustained following completion of a leadership program.

Design: A qualitative exploratory study using an appreciative inquiry approach.

Methods: A single Health District, partnered with a regional university, offering a 12-month leadership program, the Effective Leadership in Health Program. Four semi-structured group interviews were undertaken with 11 registered nurses (RNs) and allied health professionals. Data were audio-recorded and transcribed before being analysed using thematic analysis.

Results: Four themes were revealed relating to how the learning was translated and sustained in clinical practice, namely, within (1) self, (2) others, (3) relationships and (4) sustained leadership. All participants agreed that their participation in the leadership program impacted on their subsequent approach to leadership in multiple contexts, relationships and interactions.

Aim: Parents' postnatal sense of security is often mentioned in recent publications, but there is no consensus on its definitions and measurement. A concept analysis was conducted to clarify the definition, the attributes, antecedents and the consequences of parents' postnatal sense of security and to promote consistency in its usage.

Design: Walker and Avant's eight-step concept analysis model was adopted to define the concept of parents' postnatal sense of security.

Methods: A comprehensive search of multiple databases (Sinomed, CNKI, Wanfang database, CINAHL, PubMed, Embase, Web of Science, ProQuest, PsyInfo and Cochrane Library) was conducted to identify relevant articles from the inception of the databases until December 2022. In addition, a manual search was performed to gather any additional papers related to the topic. Ultimately, a total of 48 articles were included in the concept analysis.

Results: Three attributes were identified: perceive one's physical well-being not being threatened, feel confident and in control of the parenting role, feel confident in one's available relationships. The identified antecedents were: being prepared for child rearing, being in familiar or safe environment, general well-being of the baby and parents, support from medical staff and family members, being empowered by medical staff. Consequences of parents' postnatal sense of security included successful adaptation to the parental role, decreased postpartum depression symptoms in mothers, successful infant care and the development of parent-infant relationship.

Aim: To assess the occurrence and risk factors of gastrointestinal (GI) dysfunction during enteral nutrition (EN) in critically ill patients supported with mechanical ventilation.

Design: Prospective observational study.

Methods: Totally 252 patients admitted at a mixed medical-surgical ICU were enrolled. GI symptoms and the potential risk variables were recorded during the first 14 days of EN.

Results: The incidence of GI dysfunction was 65.5%, and the incidence of diarrhoea, constipation, abdominal distension, and upper GI intolerance was 28.2%, 18.3%, 6.7% and 12.3%, respectively. The median onset days of constipation, diarrhoea, abdominal distension and UDI was 3, 5, 5 and 6 days, respectively. Multivariable Cox regression analysis showed a significant relationship between GI dysfunction and age (HR = 2.321, 95% CI: 1.024-5.264, p = 0.004), APACHE-II score at ICU admission (HR = 7.523, 95% CI: 4.734-12.592, p = 0.018), serum albumin level (HR = 0.594, 95% CI: 0.218-0.889, p = 0.041), multidrug-resistant bacteria-positive culture (HR = 6.924, 95% CI: 4.612-10.276, p<0.001), negative fluid balance (HR = 0.725, 95% CI: 0.473-0.926, p = 0.037), use of vasopressor drugs (HR = 1.642, 95% CI: 1.297-3.178, p<0.001), EN way (HR = 6.312, 95% CI: 5.143-11.836, p<0.001), infusion rate (HR = 1.947, 95% CI: 1.135-3.339, p<0.001), and intra-abdominal hypertension (HR = 3.864, 95% CI: 2.360-5.839, p<0.001).

Conclusion: Critically ill patients supported with mechanical ventilation are at a high risk of GI dysfunction. Interventions such as the use of laxatives or prokinetic agents, control of EN infusion rate, and maintaining a normal state of hydration, might be beneficial for the prevention of GI dysfunction in critically ill patients.

Patient or public contribution: No.

Aim: To analyse experience in postnatal nurses returning to work within 3 months following the delivery of a second or third child and recommend appropriate measures to relieve pressure and enhance work engagement among this group.

Methods: This study adopted a descriptive phenomenological approach. Semi-structured interview was carried out with 12 postnatal nurses who had returned to work in the postpartum period following the delivery of a second or third child. The collected data were analysed using the Colaizzi method.

Results: Experience among postnatal nurses with two or three children was found to stem from three factors: declining physical quality after childbirth (pelvic floor disorder, fatigue, postpartum memory decline and sleep disturbance), poor psychological adjustment after childbirth (work-family conflict, conflict between clinical work and breastfeeding and role maladjustment) and lack of clear career planning.

Conclusion: This study emphasised the importance of psychological experience when postnatal nurses returning to clinical work in the early phase. Postnatal nurses and nurse leaders can use these results to make comprehensive solution in order to improve work engagement in the postpartum return.

Public contribution: No patient or public contribution.

Aim: To compare the perspective of nurses, long-stay immigrants and cultural mediators on intercultural communication in care encounters.

Design: Qualitative secondary analysis of data obtained in two primary studies.

Methods: Two sets of data from two primary studies on nurses and long-stay immigrants (including in total two focus groups and 15 in-depth interviews) were merged. The sample was extended to include a focus group of cultural mediators. An amplified analysis was conducted using Charmaz's approach to grounded theory.

Results: The results are structured under the core category "Agreements and discrepancies in intercultural communication," split into two subcategories: (1) Communication and the role of culture; (2) (Non) equitable and culturally (in)sensitive care. Immigrant patients and mediators detect barriers associated with generic aspects of communication, while nurses and mediators value culture. Nurses recognise paternalistic attitudes, while long-stay immigrants sometimes detect biased treatment that mediators do not see. Immigrant patients and mediators value informal conversation as a strategy for cultural learning and building mutual trust, while nurses request regulated training.

Conclusion: The findings show that there are always discrepancies in this relationship. Changes to health care should be based on the participation of all actors. Communication skills training programs should be implemented.

Implications for the profession and/or patient care: The convergences and divergences of nurses, immigrants and mediators expose new ways to approach care. Communication skills training programs should be implemented. Changes to health care should be based on the participation of all actors, including immigrant patients and mediators, and allow them to voice their opinions and make decisions.

Impact: This study addresses intercultural communication from three different perspectives: nurses, long-stay immigrants and cultural mediators. Nurses, long-stay immigrants and cultural mediators sometimes show convergence but never completely agree. The research may have an impact on primary-care nursing by making it more culturally competent.

Patient or public contribution: Each participating long-stay immigrant, nurse and cultural mediator reviewed their own interview. The findings were reviewed by a verifier member of each group (a nurse, patient and mediator).