Journal of Clinical Nursing最新文献

Aims and objectives: To investigate the barriers experienced by intensive care nurses and registered nurses and to provide optimal nursing for adult patients with a temporary tracheostomy in intensive care and general wards.

Background: Tracheostomy is widely used in intensive care units, around 20% of intensive care unit patients undergo tracheostomy insertions and expect high quality of care. Caring for patients with a tracheostomy is complex and challenging task. An investigation of barriers to care for adult patients with a temporary tracheostomy in a hospital setting is essential to ensure that these patients receive the highest quality of care and to identify areas for improvement.

Design: This paper applied secondary analysis to data from two qualitative studies, including narrative interviews and maximum variation sampling.

Methods: Secondary analysis of primary qualitative datasets is appropriate when the analysis extends rather than exceeds the primary. The analysis was based on interview data collected from six intensive care nurses and six registered nurses from two university teaching hospitals in Norway. The interviews were audio-recorded and transcribed. The data was analysed using the qualitative analysis suggested by Graneheim and Lundman. This study adhered to the consolidated criteria for reporting in a qualitative research (COREQ) checklist.

Results: Four main themes were identified as barriers to care for adult patients with a temporary tracheostomy in the hospital: encountering ambivalence, inadequate staffing levels, lack of patient continuity of care and lack of systematic follow-up.

Conclusions: Understanding barriers to care is crucial for hospitals and healthcare organisations to develop targeted interventions and educational programs to address these barriers and improve the care provided to adult patients with tracheostomies in hospital settings.

Aims: To investigate the impact of the nursing practice environment, nurse staffing, working overtime and compliance with hand hygiene standards on hospital-acquired infections.

Design: A multi-source quantitative study.

Methods: Nursing data were collected from selected wards in one hospital between 18 January 2021 and 15 March 2021. Hand hygiene compliance data were obtained retrospectively from Hand Hygiene Australia Audits between July 2018 and June 2021. Patient data were gathered from July 2018 to June 2021. Data from the three sources were linked together at the episode of care level. Descriptive statistics were used to summarise participant characteristics, and multiple logistic regression was employed to assess associations between the nursing practice environment, nurse staffing, overtime and hand hygiene with hospital-acquired infections.

Results: A total of 361 nurses participated in the nursing survey. There were 13,440 hand hygiene moments assessed, and 10,924 (81.3%) correct practices were observed. There were 71,257 patient care episodes, including 2037 with hospital-acquired infections. The odds of hospital-acquired infections decreased by 19% for every 10% increase in nurses' compliance with hand hygiene and decreased by 7% for each one standard deviation increase in the nursing practice environment scale. Each additional patient per nurse was associated with a 42% increase in the odds of a hospital-acquired infection.

Conclusion: This study found evidence that a favourable nursing practice environment, reduced nurse workload and compliance with hand hygiene are linked to a lower risk of hospital-acquired infections.

Impact: A favourable nursing practice environment contributes to fewer hospital-acquired infections. Monitoring of hand hygiene compliance provides important local information to support improvements in practice. Findings from this study can be used to support the implementation of safe nurse staffing policies that guide implementation of nurse-to-patient ratios.

Reporting method: RECORD Checklist.

Patient or public contribution: No Patient/Public Contribution.

Aims: To identify the characteristics and compare the codes of ethics enacted by the Korean Nursing Association and International Council of Nurses.

Design: A mixed-method collective case study.

Methods: This study adopted interpretive approaches comprising case definition and selection, data collection, analysis and interpretation. Based on the developed aspirational versus mandatory ethics analytic framework, we differentiated the aspirational and mandatory codes of the Korean Nursing Association and International Council of Nurses.

Results: The Korean Nursing Association placed greater emphasis on aspirational ethics (73.3%) than the International Council of Nurses (53.6%). The Korean Nursing Association addressed legal implications regarding adequate services and patient safety, whereas the International Council of Nurses emphasised informed consent and authorised practice. Compared to the Korean Nursing Association's code, the International Council of Nurses' code had one additional chapter and 67 more units. The additional chapter focused on global health.

Conclusion: Some implications can be considered for future revisions of the code of ethics for Korean nurses. Informed consent needs to be addressed as a legal implication for respecting the patient's right to self-determination. Furthermore, nurses' attention to global health could be discussed in the context of globalisation.

Implications for the profession: The findings of the analysis of the current codes of ethics of national and international nursing organisations may provide scientific evidence for future revisions. An evidence-based revision of ethical guidelines, as proposed by the findings, underscores the importance of fostering a moral identity consistent with established professional norms and values for nursing.

Reporting method: We adhered to the Standards for Reporting Qualitative Research.

No patient or public contribution: Given that this study is based on the literature, namely the codes of ethics, there is no direct/indirect involvement of patients or the public.

Aim: To investigate the risk factors associated with frailty in older patients with ischaemic stroke, develop a nomogram and apply it clinically.

Design: A cross-sectional study.

Methods: Altogether, 567 patients who experienced ischaemic strokes between March and December 2023 were temporally divided into training (n = 452) and validation (n = 115) sets and dichotomised into frail and non-frail groups using the Tilburg Frailty Indicator scale. In the training set, feature selection was performed using least absolute shrinkage and selection operator regression and random forest recursive feature elimination, followed by nomogram construction using binary logistic regression. Internal validation was performed through bootstrap re-sampling and the validation set was used to assess model generalisability. The receiver operating characteristic curve, Hosmer-Lemeshow test, Brier score, calibration curve, decision curve analysis and clinical impact curve were used to evaluate nomogram performance.

Results: The prevalence of frailty was 58.6%. Marital status, smoking, history of falls (in the preceding year), physical exercise, polypharmacy, albumin levels, activities of daily living, dysphagia and cognitive impairment were predictors in the nomogram. Receiver operating characteristic curve analysis indicated outstanding discrimination of the nomogram. The Hosmer-Lemeshow test, calibration curve and Brier score results confirmed good model consistency and predictive accuracy. The clinical decision and impact curve demonstrated notable clinical utility. This free, dynamic nomogram, created for interactive use and promotion, is available at: https://dongdongshen.shinyapps.io/DynNomapp/.

Conclusion: This nomogram may serve as an effective tool for assessing frailty risk in older patients with ischaemic stroke.

Relevance to clinical practice: The nomogram in this study may assist healthcare professionals in identifying high-risk patients with frailty and understanding related factors, thereby providing more personalised risk management.

Reporting method: TRIPOD checklist.

Patient or public contribution: No patient or public contribution.

Objectives: This study aimed to identify the spiritual responses of nurses providing direct patient care during the COVID pandemic and explore how religious/spiritual struggles are associated with selected nurse outcomes.

Methods: A quantitative, cross-sectional observational study was conducted, based on the STROBE checklist, with 364 registered nurses recruited via convenience sampling between January 24 and March 12, 2022, in hospitals in Iran admitting COVID-19 patients. Data were collected through a self-report questionnaire, including the Moral Injury Symptom Scale-Health Professionals, Religious/Spiritual Struggles Scale-Short Form, Posttraumatic Growth Inventory, Job Satisfaction Scale, Copenhagen Burnout Inventory, Turnover Intention Scale, and Employee Engagement Scale.

Results: Nurses reported high levels of moral injury during the pandemic, with an average score of 43.79 ± 15.20. Religious/spiritual struggles were generally low, with demonic struggles scoring the lowest (0.36 ± 0.68) and ultimate meaning struggles the highest (1.54 ± 0.99). Posttraumatic growth scores for spiritual change were moderately high (26.17 ± 4.73). Work-related burnout was moderate (64.31 ± 100.00), intention to leave was low (8.84 ± 3.92), and job satisfaction was moderate (3.67 ± 1.75).

Conclusion: The study found that nurses experienced both positive and negative spiritual responses during the pandemic. While most nurses reported a high level of moral injury and moderate job satisfaction, they experienced low religious/spiritual struggles and some spiritual growth. Incorporating spirituality into nursing practice may enhance professional fulfilment and nurse outcomes.