Background: There is a growing amount of literature that links missed nursing care (MNC) to negative patient outcomes, reduced patient safety and poor quality of care. However, only few studies have investigated this phenomenon in long-term rehabilitation settings.Aim: To explore MNC occurrence, type, reasons and predictors in three rehabilitation units.Design: A cross-sectional study was performed between August and September 2017.Method: 95 registered nurses and nursing assistants completed section A (interventions missed) and section B (perceived reasons for MNC) of the MISSCARE Survey tool. Descriptive, bivariate and linear regression analyses were performed.Findings: The top missed elements were patient ambulation (score 2.4 out of 5, Standard Deviation [SD] 0.8), mouth care (2.3, SD 0.8) and participation to multidisciplinary meetings (2.3, SD 1.1). Lack of personnel was the most frequent reason reported for MNC with a score of 2.9 out of 4 (SD 0.9). At the linear regression analysis, advanced nursing education (β = 3.58, CI 95% 1.32-5.84) and inadequate handovers (β = 3.64, CI 95% 0.37-6.91) both increased the perception of MNC occurrence.Conclusion: MNC occurrence in rehabilitation settings appears to be lower than in other contexts; however, the most commonly missed elements are similar to those reported in other settings. As good strategies to detect the difference between expected nursing care and the one delivered to patients, advanced education and good quality handovers seem beneficial. Further research is needed to establish more evidence on predictors by developing longitudinal study designs.
Background: Newly Graduated Nurses in different socio-cultural contexts confront dissimilar situations and influences on role transfer. It is important to understand how newly graduated nurses reconstruct their own professional concept of clinical nurses.
Objectives: This study aimed to explore how Taiwanese newly graduated nurses perceived their new role and the process through which they transition into the professional role.
Methods: Charmaz's constructivist grounded theory guided the study's design and implementation. Purposive and theoretical sampling and the snowball technique were used to recruit 30 participants from 3 tertiary and 2 community hospitals in Taiwan. Interviews were audio-recorded and transcribed verbatim into a readable format. Initial, focused and theoretical coding was utilized for data analysis. The criteria of credibility, originality, resonance and usefulness guided assessment of the study's quality and ensured the trustworthiness of the study process.
Results: The process of role transition to become a nurse comprised four stages: hesitation, psychological preparation, development and appreciation. The hesitation stage was interpreted as a phase of passive learning. In the psychological preparation, newly graduate nurses began to take full work responsibility. The development stage saw them gain work confidence and, in the appreciation stage, they acquired a full picture of their roles.
Conclusion: To bridge the gap between theoretical learning and practice and reduce the time new graduate nurses need for role adjustment contributes to an early stage of Hesitation rather than the Appreciation stage of role transition. The findings suggest the need for further research to explore newly graduated nurses' needs during the process of role transition.
Objectives: Oxygen was commonly used in the early management of patients presenting with Acute Coronary Syndrome (ACS) regardless of their oxygen saturation. Inappropriate administration of supplemental oxygen could potentially result in adverse patient health outcomes.Aim: To identify the effects of supplemental oxygen administration on the health outcomes of patients presenting with ACS and oxygen saturations >93%.Method: Systematic review. The CINAHL, PubMed, Cochrane and Medline databases were searched for relevant literature. Inclusion criteria included articles published from 2008-2019, adult participants, primary studies, and participants with uncomplicated ACS and have oxygen saturation >93%. Eligible studies were assessed for rigour using a critical appraisal tool.Results: Seven randomised controlled studies were included for analysis. Themes were also used to group the assessed endpoints. The three main outcomes analysed were: infarct size and cardiac function; adverse cardiac events; and mortality. Two of the seven studies found a statistically significant relationship between oxygen administration, infarct size, and adverse cardiac events. Conversely, five of the seven studies reported that supplemental oxygen did not have statistically significant benefit over room air.Conclusion: This review identified that oxygen should not be administered to patients who present with ACS and have oxygen saturations >93%. This is due to the potential risk of adverse outcomes: increased infarct size, mortality, and adverse events.Impact statement: Recent update of guidelines despite evidence opposing oxygen delivery in ACS means the education of nurses is imperative for safe practice.
Background: A major barrier to nurses adopting evidence-based practice (EBP) has been the limited awareness of evidence underpinning clinical practice, often due to poor access and understanding of the literature base. To address this, we piloted the development of educational posters summarizing the evidence base around clinical practices to see if they help nurses better understand the rationale behind their care. Our first poster focused on the evidence supporting the management of delirium in older persons, specifically delirium identification and its prevention.
Objective: To examine the effect of an evidence-based poster education on the delirium knowledge of student nurses.
Design: A prospective two-armed quasi-experimental study.
Methods: 188 student nurses were recruited in December 2017. Participants were alternated to receive either an evidence-based poster education session or a reflective education session as a control. Both groups were assessed on their general knowledge on delirium, knowledge on delirium detection and knowledge on delirium prevention. This was conducted both before exposure to either the intervention or control, and one week after exposure. Unpaired t-tests with 95% confidence intervals (CI) were applied to compare the mean change in pre-test and post-test delirium knowledge. We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist to report our methods and findings.
Results: Students in the poster education group reported greater improvements in mean scores of delirium identification (Mean increase = 1.0, p = 0.007, 95% CI: 0.3-1.6), delirium prevention (Mean increase = 1.6, p < 0.001, 9% CI: 1.0-2.2) and overall delirium knowledge (Mean increase = 2.7, p < 0.001, 95% CI: 1.5-3.8) than students in the control.
Conclusion: Summarised research evidence within a poster format can increase student nurses' access to the evidence base. This has shown to increase their knowledge to guide their clinical practice.
Impact statement: Exposure to poster summaries of research evidence underpinning delirium care increases student nurses' clinical knowledge of delirium identification and prevention.
Background: Unplanned representation of patients with diabetes recently discharged from the emergency department or in-patient hospital settings is a common but complex problem world-wide. This study set out to examine the feasibility of a risk screening interview and whether component characteristics may be associated with the unplanned representation of patients with diabetes to a tertiary metropolitan hospital.Methods: A screening interview comprised of demographic, social and clinical characteristics was developed and piloted using a prospective cross-sectional survey design. A convenience sample of 55 patients was recruited and screened. Outcomes were the occurrence of unplanned representation to hospital within 28 or 90 days of hospital discharge from the index presentation.Results: The screening interview was shown to be broadly feasible and acceptable for use by staff and patients, with identified areas for modification. Seventeen participants (30.9%) experienced unplanned representation within 90 days of hospital discharge; for 13 participants (23.6%) this occurred within 28 days. Characteristics linked with unplanned representation to hospital were identified.Conclusions: Preliminary data indicated the feasibility of tool use and informed refinement for future testing of the ability of the screening interview to predict those patients with diabetes at high risk of unplanned representation to hospital, to enhance effective care planning.Impact statement: Patients with diabetes commonly present to Emergency Departments, and demonstration of the feasibility of a screening interview to determine those at elevated risk of unplanned representation is an important step towards effective management. Data supported refinement and future testing of the new screening interview.
Mindfulness-based psychoeducation program (MBPP) has been proposed as a new approach to improve the overall outcomes for individuals with schizophrenia spectrum disorders. However, to date, limited studies have examined the participants' experiences of MBPP for schizophrenia.
The aim of this study was to explore the experiences of individuals with schizophrenia spectrum disorders (SSDs) who underwent an 8-week MBPP with respect to their perception of the benefits and unusual challenges of mindfulness training and self-practices.
Twenty-four (n = 24) individuals with SSDs were invited to participate in an 8-week MBPP. A total of eight participants were invited for semi-structured interview one week after the final class of MBPP. The semi-structured interview was conducted in Cantonese and data were transcribed by the first author. Of the eight participants, five participants had unusual experiences and three participants had a positive experience with MBPP. They were included to provide more candid understanding on the constituents of diverse experience towards MBPP. An interview guide was developed to understand the patients' perceptions of MBPP, the challenege in self-practising mindfulness, and the changes in how they coped with their illness during and after taking part in MBPP. Qualitative data from the semi-structured interview were recorded by a research assistant and the transcripts were proof-read by the participants to ensure accuracy. The Software NVivo 12 Pro was used to manage the qualitative data from the semi-structured interview. Thematic analysis was adopted to identify the major themes from the qualitative data.
Five themes emerged: developing a state of mindfulness, empowering illness management, learning a new way to regulate emotion, encountering barriers in self-practising mindfulness and preference for bodily mindfulness.
The findings provide comprehensive knowledge and deeper insights into treatment processes of mindfulness psychoeducation as an intervention for schizophrenia spectrum disorders.
Impact statement: This study establishes a body of knowledge regarding people with schizophrenia spectrum disorders who received mindfulness psychoeducation intervention. The results suggest that patients can develop a new way to regulate emotion and manage their illness through mindfulness psychoeducation. The perceived negative experience of some patients also warrants closer attention in mindfulness practice, especially for individuals with schizophrenia spectrum disorders. Further research could focus on factors leading to the negative consequences of mindfulness practice and the ways to minimize the negative consequeces.
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