Contemporary nurse最新文献

Aim: To assess the knowledge, attitudes and practices of Registered Nurses working in residential aged care facilities pertaining to pain management for residents living with dementia.

Background: Sub-optimal pain management continues for people living with dementia in residential aged care. Registered Nurses are the pivotal staff responsible for complex assessment and management of people residing in residential aged care facilities.

Design and methods: :This integrative literature review was informed by Whittemore (2005). Searching and screening followed the PRISMA guidelines.

Results: Thirteen papers were identified, the major themes identified were gaps in knowledge and skills, uncertainty of assessment, and delays in treatment.

Conclusion: Registered Nurses require education on pain management for people living with dementia in residential aged care. Broader issues in residential aged care contribute to the problem and require examination. Research pertaining to Registered Nurses' roles pain management for residents living with dementia is required.

Background: Internationally, the nursing workforce is ageing. Chronic conditions are becoming more prevalent amongst the ageing nursing workforce. With an increase in chronic conditions and an ageing nursing workforce, understanding environmental influences on nurses' health and work capacity is vital to supporting this workforce.

Aim: A scoping review was conducted to explore the influence of a critical care environment on nurses' health and work capacity.

Design: A scoping review was conducted according to PRISMA-ScR guidelines.

Methods: Database extraction occurred in June 2023 and included MEDLINE Complete, PubMed, Scopus, CINAHL, and Embase.

Results: Eight studies met the inclusion criteria. Studies were conducted internationally with sample sizes from 20 to 500 critical care nurses (CCNs).

Conclusions: Findings identified the critical care environment had an impact on nurses' health and working capacity. Many CCNs self-reported having a chronic condition that influenced their nursing practice. Further research is needed to explore how to mitigate the influence of a chronic condition to support this valuable workforce.

Background: Growing evidence shows that metabolic syndrome and frailty are significantly associated. Screening and assessing frailty in patients with metabolic syndrome is important to help improve their clinical outcomes and quality of life. Therefore, understanding the prevalence of frailty in patients with metabolic syndrome is the first critical step, however, the prevalence reported in the literature varies widely.

Aim: To pool the overall prevalence of frailty among patients with metabolic syndrome.

Design: Systematic review and meta-analysis.

Methods: The Cochrane Library, PubMed, Web of Science, Embase, APA PsycINFO, Scopus, CINAHL Complete, CNKI, Wan Fang, SinoMed, and VIP databases were searched from the inception to March 6, 2024. Statistical analysis was performed using STATA15 software. The prevalence was pooled using the random-effects model. The sources of heterogeneity were investigated by using meta-regression and subgroup analyses.

Results: A total of 22 original studies published between 2007 and 2023 were included in this systematic review and meta-analysis, involving 19,921 metabolic syndrome patients. The prevalence of frailty and pre-frailty among patients with metabolic syndrome was 20% (95% CI: 16% to 25%, I²= 99.44%) and 45% (95% CI: 36% to 53%, I²= 99.20%). Subgroup analyses revealed differences in prevalence by frailty instruments, geographic regions, study settings, publication years, study quality, study design, and different components of metabolic syndrome.

Conclusions: This systematic review and meta-analysis showed the high prevalence of frailty and pre-frailty in patients with metabolic syndrome. In the future, more high-quality longitudinal studies and exploration of other potential demographic characteristics that may influence frailty are needed to understand more information on frailty in patients with metabolic syndrome.

Background: There is a growing number of online nursing graduate degree programs to address the professional development needs of working nurses. Work-related antecedents of online student engagement in graduate nursing studies are under-explored in the literature.

Aim: The aim of the study is to examine the relationship among demographic and work characteristics, work-life balance (WLB), and online student engagement (OSE) among registered nurses enrolled in online graduate studies.

Methods: This study design is convergent-parallel mixed methods, utilizing a survey approach to collect both quantitative and qualitative data. The target population is students of an online Master of Arts in Nursing program at a university in Cabanatuan City, Philippines. Respondents were recruited via email. Google Forms were used for data collection. Non-parametric, inferential statistical tests were used to examine relationships among variables. Inductive qualitative content analysis was used to draw insights from open-ended responses.

Results: A total of 173 graduate students responded to the survey. Quantitative results indicate high levels of WLB (Mdn = 4.8, IQR = 1.5) and OSE (Mdn = 3.7-4.0, IQR = 0.5-1.0). WLB was significantly lower among females (U = 3297.5, p < 0.01). Emotion OSE was significantly higher for respondents with managerial positions (U = 2987.5, p < 0.05). WLB had significant low to moderate positive correlations with the domains of OSE (r = 0.22 to 0.32, p < 0.01). Qualitative findings reveal various appraisals of online learning and factors influencing work-life-study balance, such as work, personal life, and school.

Conclusion: Work-life balance facilitates better online student engagement among graduate nursing students and is influenced by time management, work (i.e. job environment and stressors), personal (i.e. home life and leisure activities), and university factors (i.e. curriculum, modality, and professors).

Impact statement: Empirical evidence on the link between WLB and OSE can inform graduate nursing academics in developing initiatives to ensure the timely completion of the degree program.

Background: Bladder ultrasound (BUS) provides an accurate measurement of post-void residual (PVR) volume and bladder assessment. Access to BUS is dependent on practitioner availability with delays resulting in poor symptom management, delayed discharge and dissatisfaction. Developing nursing practice to perform BUS can address these patient's needs.Aims: Through a quality improvement initiative the aims were (1) to develop theoretical knowledge and practical competence of nurses to perform BUS, (2) to evaluate nursing activity in relation to BUS, (3) to evaluate stakeholders perceptions of the initiative.Methods: Based on the Deming Plan-Do-Study-Act (PDSA) cycle, an interprofessional team was created and a theoretical/practical based education program was devised. Activity in relation to the nurse-performed BUS was collected and analysed descriptively. Stakeholder perceptions were evaluated via patient and physician questionnaires subject to descriptive analysis and a focus group with nurses analysed descriptively.Results: The team developed a training program to perform BUS, certifying 11 nurses. Investigation of nursing activity related to BUS (n = 202) showed its use for PVR evaluation, and symptom and catheter assessment. It aided decision-making and nurse-physician communication. Stakeholders were satisfied with the initiative. Patients (n = 30) felt nurses were competent, clearly explaining the procedure, results and inspiring confidence. Physicians (n = 2) saw BUS as enhancing efficiency and care quality, while nurses (n = 7) felt this new skill enhanced nursing care providing a more holistic approach. Team reflection on the results of the evaluation confirmed BUS utility and activity, while nurses requested continuing education and a post-certification refresher course.Conclusion: Through reflection on clinical practice areas for improvement to enhance patient care were identified by the nursing team. Application of the PDSA cycle provided a structured approach to guide the quality improvement initiative. Improvements in nursing care and patient care processes have been observed and this has been a positive experience for stakeholders.

Background: Transition from education to the workforce has been recognised as difficult and linked to 'reality shock.' Due to the unprecedented circumstances of the COVID-19 pandemic, many student nurses opted in for NHS emergency placements and prematurely transitioned to the workplace, which calls for an in-depth investigation of the work readiness and transition experiences of this cohort.Aim: The aim of this study was to investigate self-perceived work readiness, the effectiveness of support provided by the universities and the NHS as well as explore the experiences of student nurses who responded to the COVID-19 crisis to understand the impact of this early transition to the clinical workforce.Design: A mixed methods study was conducted. It included two stages: (1) an online survey consisting of a work readiness questionnaire and close- and open-ended questions about received support; and (2) online semi-structured interviews that were thematically analysed.Methods: Participants were nursing students from Scottish universities who took on emergency NHS placements. Thirty-three (30 females and 3 males) participants completed the survey and 8 of them (all female) participated in semi-structured interviews. The Work Readiness Scale for graduate nurses along with questions about the support received were completed in the first stage of the study.Results: Organisational acumen was perceived by participants as higher than social intelligence, work competence and personal work characteristics. Three superordinate themes emerged: (1) participants expressed appreciation of and need for coordination of support from the university and the NHS as a key factor in easing into their role; (2) they indicated the sense of obligation as the key driver for taking up this placement; (3) placement was seen as an opportunity to understand their role and develop their professional identity.Conclusions: The findings found the importance of support from the clinical placement and academic teams to help with the integration and application of theory into practice.

Person-centred care is an international healthcare priority. Strategies are needed to support nurses and midwives to understand the meaning of person-centredness and support them to embed this philosophy into practice. Clinical supervision has been proposed as a strategy to support this but requires more evidence.The aim of this research was to evaluate a newly developed model of clinical supervision, underpinned by person-centred practice theory, to enhance the person-centred practices of new graduate nurses and midwives.

Design: Qualitative study (embedded within a mixed methods study) using focus groupsMethods: Group, online clinical supervision (named C.A.R.E.) underpinned by the Person-centred Practice Framework was provided to 103 new graduate nurses and midwives once per month for one hour, over six months. The researchers used [Braun, V., & Clarke, V. (2022). Thematic analysis; A practical guide. SAGE]. Thematic Analysis to analyse data.

Results: Twenty one participated in the qualitative evaluation. Four themes were identified (1) Person-centredness in Action (person-centredness experienced and delivered by the new graduates) (2) Enhancing the Transitioning Toolkit (professional and personal growth as an outcome of reflection and learning together) (3) The Transitioning Environment (care environment and C.A.R.E. environment) and (4) Challenges to C.A.R.E. (team and organisation, and personal).

Conclusion: This supportive safe space allowed new graduates to explore their and other's practices, in relation to person-centred practice theory. Through sharing their experiences, they increased their knowledge and confidence to incorporate new learning into their own practice. This clinical supervision model underpinned by the Person-centred Practice Framework provides person-centred benefits to the new graduates, patients and families. However, without organisational support the benefits will not be realised.

Background: The omission of time-critical medication doses may result in poor patient outcomes. There are few publications about the influence of electronic medication management (EMM) systems, including automated dispensing cabinets (ADC), on timely medication administration. The study aimed to evaluate the influence of EMM systems, including ADCs, on timely medication administration 6 and 30 months after EMM implementation, focussing on preventable time-critical medication dose omissions and documented reasons for not administering a dose.Methods: Data on doses of regular inpatient medications not administered were obtained from electronic medication records (EMR) over 1 week in March 2019 and 4 weeks in March 2021. An omission was a dose not administered before the next due dose. Time-critical medications were defined using the health service's guidelines. Reasons for doses not being administered were obtained from nursing documentation in the EMR collated from digital health reports. Reasons for time-critical medication doses not given were defined as 'valid' or 'preventable'.Results: In 2019 and 2021, 620 and 2524 patients with 44,756 and 146,940 scheduled medication doses were reviewed. Of these, 4385 (9.8%) and 19,610 (13.4%) doses were not administered. In 2019 and 2021, there were 593 (1.3%) and 1811 (1.2%), p < 0.0001, time-critical doses not administered. Preventable time-critical dose omissions decreased from 0.20% in 2019 to 0.15% (p = 0.015) in 2021. Wards with ADCs had a significantly lower rate of time-critical dose omissions compared to those without ADCs (1.1% vs 1.3%, p = 0.014).Conclusion: With the introduction of an EMM system, there was a decrease in the rate of time-critical medications not administered, including a reduced rate of preventable omissions over the 24-month period. Regular assessment of time-critical medication administration will help target patient safety improvements.

Background: Nurse Practitioners work independently and collaboratively within multidisciplinary teams to fill unmet service delivery needs. Despite strong evidence of the benefits of the nurse practitioner service model, organisational support for nurse practitioners varies in terms of resources and support from leadership and other healthcare professionals.

Aims: The study aimed to explore healthcare practitioners' experiences of implementation of a NP service in a rural setting.

Methods: Semi-structured interviews were conducted with ten healthcare practitioners to investigate their perspectives of a recently implemented NP service. Data were analysed inductively using thematic analysis.

Findings: Themes emerged related to facilitating collaborative practice, person-centred continuity of care and positive health outcomes for the community. Challenges and limitations related to operational role clarity, scopes of practice and leadership.

Conclusion: Healthcare practitioners were mostly satisfied with the service however challenges caused tension. Change management principles provide a framework to strengthen the effective clinical alignment of the service.