Contemporary Nurse最新文献

Background: In Indonesia, information on and research into how Indonesian nurses perceive and experience leadership and leadership roles is limited.

Aims: This study was designed to identify Indonesian nurses' perceptions and experiences of leadership and nurse leadership roles in the hospital setting.

Design: A qualitative study with semi-structured interviews.

Methods: The study was conducted in a large, urban hospital in Indonesia. Twenty nurses who had worked in this hospital for more than a year were interviewed. A thematic approach was used for data analysis. This study is conducted and reported according to the SRQR checklist.

Results: The participants' perceptions and experiences of leadership were organized within three themes: searching for a description of leadership, viewing leadership and management as the same, and experiencing limited leadership opportunities.

Impact statements: The study revealed little evidence that nurses were being empowered to provide leadership within the organization. Although nurses in many developed countries now serve on governing boards, this is not immediately foreseeable for nurses in Indonesia.

Conclusions: The participants' view of leadership in nursing was not overtly critical. Perhaps they did not understand that leadership is a dynamic concept and that it might be perceived differently depending on the context.

Background: Heart failure is a chronic condition with various implications for individuals and families. Although the importance of implementing palliative care is recommended in best practice guidelines, implementation strategies are less clear.

Aims: This study sought to; (1) determine Australian and New Zealand cardiovascular nurses and physicians' end of life care attitudes and specialist palliative care referral in heart failure and; (2) determine self-reported delivery of supportive care and attitudes towards service names.

Methods: An electronic survey was emailed to members of four peak bodies and professional networks. Participants were also recruited through social media. Paper-based versions of the survey were completed by attendees of the 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, August 2018.

Findings: There were 113 completed responses included in the analyses. Participants were nurses (n = 75), physicians (n = 32) and allied health professionals (n = 4). Most (67%) reported they were comfortable with providing end of life care; however, fewer respondents agreed they received support for their dying patients and one-third experienced a sense of failure when heart failure progressed. Most (84-100%) participants agreed they would refer a heart failure patient later in the illness trajectory. There was a more favourable attitude towards the service name 'supportive care' than to 'palliative care'.

Conclusion: Comfort with end of life discussions is encouraging as it may lead to a greater likelihood of planning future care and identifying palliative care needs. Peer support and supervision may be useful for addressing feelings of failure. The use of needs-based assessment tools, adopting the service name 'supportive care' and further research focusing on primary palliative team-based approach is required to improve palliative care access.

Impact statement: Cardiovascular nurses and physicians are comfortable providing end of life care, but referrals to palliative care in the later stages of heart failure persists.

Background: In Asian countries, clinical practice places little emphasis on developing the clinical decision-making skills and social problem-solving abilities of nursing students.Objective: This study explored whether a 3-months-in-1-unit training program improved nursing students' clinical decision-making skills and social problem-solving abilities compared to the 1-month-in-1-unit rotation program.Methods: A quasi-experimental study was conducted. A 3-months-in-1-unit training program was conducted in the intervention group (n = 77), rountine1-month-in-1-unit rotation was conducted in the control group (n = 73). Clinical decision-making skills and problem-solving abilities were measured using the Chinese version of the Clinical Decision-Making Nursing Scale and the Social Problem-Solving Inventory-Revised.Results: Nursing students in the intervention group scored higher clinical decision-making skills (t = 7.677, p < 0.05), positive problem orientation (t = 18.359, p < 0.05), negative problem orientation (t = -3.711, p < 0.05), and rational problem-solving (t = 2.312, p < 0.05) than the control group.Conclusions: The 3-months-in-1-unit specialized training program had a significant positive impact on students' clinical decision-making skills and social problem-solving abilities.

Background: Compassion is considered the cornerstone of nursing practices and professionalism. However, a decrease in compassion may increase medical errors and adversely affect patient safety.

Aims: The study was conducted to determine clinical nurses' compassion levels and their tendency to make medical errors, and to find whether their compassion levels affect their tendency to make medical errors.

Methods: A cross-sectional, descriptive and correlational design was used. The study was conducted with 309 nurses working at a university hospital. The study data were collected by using the Compassion Scale and Medical Error Tendency Scale in Nursing.

Results: The nurses' compassion levels were moderate, and their medical error tendency levels were low. The comparison of the mean scores obtained from the Compassion Scale and Medical Error Tendency Scale in Nursing revealed a weak positive significant relationship (p < .001). No statistically significant difference was determined between the mean scores obtained from the Compassion Scale by the participants who made medical errors at least once during their professional life and the mean scores obtained by the participants who did not (p > .05). It was found that the mean score for the mindfulness subscale of the Compassion Scale and the length of service were determined to be the factors that significantly affected the participants' tendency to make medical errors (R = 0.42, R² = 0.181, F = 3.771, p = .000).

Conclusion: The nurses' tendency to make medical errors decreased as their compassion levels increased, and that compassion was an important predictor of tendency to make medical errors.

Background: Iranian asylum seekers are amongst the highest number of boat arrivals to Australia who have been subject to compulsory detention. Women face more health-threatening problems rather than men in detention, yet, remain understudied in health research. This study aimed to inform healthcare providers about the experiences of living in immigration detentions, which might affect asylum seekers' mental health.

Method: A qualitative study using semi-structured interviews and thematic analysis.

Results: 17 participants shared their experiences: Living in a prison-like environment was a punishment for their boat arrival and violated their privacy and dignity. In contrast, a sense of security, free access to healthcare services, and building social networks were positive aspects of short-term detention.

Conclusion: To prevent further trauma, living conditions in detention must be conducive to promoting coping and adjustment. The length of detention should be minimised and limited to preparing asylum seekers for facing a new socio-cultural environment.

Physical activity/exercise has consistently been shown to improve objective measures of functional capacity, enhance quality of life, improve coronary risk profile, and reduce mortality for individuals with coronary heart disease. Despite the gains achieved by those who attend cardiac rehabilitation (CR) many individuals fail to maintain lifestyle changes.

The aims of this study were to evaluate the effectiveness of motivational interviewing as a strategy for promoting maintenance of cardiac risk factor modification in patients who had participated in standard, 6-week outpatient CR programs.

In a randomized controlled trail, participants in usual care and intervention group (Motivational interviewing supplemental to a standard 6-week CR program) were followed up at 6-weeks and 12-months. The primary outcome was distance walked on the six-minute walk test (6MWT), used as both an indicator of functional capacity and habitual physical activity. Secondary outcomes included modifiable coronary risk factors (smoking, self-reported physical activity, waist circumference, body mass index and medication adherence), psychological status (depression, anxiety, stress, perceived cardiac control, perceived social support, exercise self-efficacy) and quality of life.

Total 110 patients, usual care (n = 58) and intervention (n = 52), consented to participate in the study. Overall, demographic and clinical characteristics did not differ between groups at baseline. Motivational interviewing was no more likely to promote maintenance of cardiac risk factor modification (both primary and secondary outcomes) than a standard CR program alone. Both intervention and control groups maintained the gains achieved during CR at the 12-month follow-up except for weight loss.

Although both groups maintained the gains achieved during CR for physical activity, there was no effect of the intervention on maintenance of cardiac risk factor modification on both primary and secondary outcomes.

Background: Black, Asian and Minority Ethnic nurses and midwives are under-represented in higher and managerial roles.

Aims: This study explored the presence and nature of career progression delays for Black, Asian and Minority Ethnic nurses and midwives and investigated where the barriers to progression were.

Design: A secondary analysis of data from a wider cross-sectional survey investigating workplace experiences, burnout and patient safety in nurses and midwives.

Methods: 538 nurses and midwives were recruited from four UK hospitals between February and March 2017. A career progression delay was viewed as being present if Black, Asian and Minority Ethnic nurses and midwives had spent longer on the entry level nursing grade and less time on higher grades in the previous 10 years. The analysis included items pertaining to: receipt of professional training, perceived managerial support for progression, likelihood of submitting applications and application success rates. Data were analysed using linear regression, odds ratios and t-tests. Results were reported using the STROBE Checklist.

Results: Black, Asian and Minority Ethnic nurses and midwives (n = 104; 19.4%) had spent more months working at the entry-level grade (M = 75.75, SD = 44.90) than White nurses and midwives (n = 428; 79.7%; M = 41.85, SD = 44.02, p < 0.001) and fewer months at higher grades (M = 15.29, SD = 30.94 v 29.33, SD = 39.78, p = 0.006 at Band 6; M = 6.54, SD = 22.59 v M = 19.68, SD = 37.83, p = 0.001 at Band 7) over the previous 10 years. Black, Asian and Minority Ethnic nurses and midwives were less likely to have received professional training in the previous year (N = 53; 53.0% v N = 274; 66.0%, p = 0.015) and had to apply for significantly more posts than White nurses and midwives before gaining their first post on their current band (M = 1.22, SD = 1.51 v M = 0.81, SD = 1.55, p = 0.026).

Conclusions: Interventions are needed to improve racial equality regarding career progression in nurses and midwives. Increasing access to professional training and reducing discriminatory practice in job recruitment procedures may be beneficial.

Impact statement: Black, Asian and Minority Ethnic nurses and midwives experience career progression inequalities. Interventions should improve transparency in recruitment procedures and enhance training opportunities.

Background: Heart failure is a chronic, progressive condition which affects over six million Americans and 26 million people worldwide. Evidence-based guidelines, protocols, and decision-support tools are available to enhance the quality of care delivery but are not implemented consistently.

Aims: To examine the effect of clinical decision-making support during patient discharge on 30-day hospital readmission among patients admitted with heart failure and evaluate provider utilization and satisfaction of clinical decision support tool.

Design: A quasi-experimental study.

Methods: An intervention group of hospitalized patients (N = 55) with heart failure were provided the intervention over a 3-month period and compared to the pre-intervention comparison group (N = 109) of patients who did not receive the intervention. An evidence-based discharge checklist and a pocket guide was implemented by an advanced practice nurse to assist health providers with clinical decision making. Descriptive statistics among samples, 30-day readmission rates, and provider utilization and satisfaction were examined.

Results: Readmission rates slightly decreased (N = 109, 9.2% vs. N = 55, 9.1%) in the post-intervention period, but no significant difference. Heterogeneity between the two groups were minimal related to use of specific medications, age, length-of-stay and comorbidities. Descriptively, there was a significant difference the use of diuretics among each group (p = .002).The discharge checklist was used regularly by 67% of (N = 15) providers, and 93% expressed satisfaction with use.

Conclusion: There was no significant reduction in 30-day readmission rates between both groups. However, a slight reduction was noted which indicates the need for further examination into how the use of checklists for clinical decision support can reduce readmissions. A well-designed evidence-based discharge plan remains a critical component of the patient discharge process. Advance practice nurses are uniquely qualified to implement evidence-based interventions that promote practice change among health care providers and improve health outcomes.