Nurses’ perspectives on responding to elder abuse in a hospital setting

BackgroundNurses caring for hospitalised older people are well situated to identify and respond to elder abuse. However, little is known about how nurses working in acute and subacute care recognise and respond to suspected abuse.AimThe project team aimed to explore how nurses detect, assess and respond to elder abuse as part of a quality improvement activity to develop a model of care to address elder abuse.MethodFocus group interviews were conducted with ward nurses and nurse educators (n = 19) working in both acute and subacute care settings in a tertiary teaching hospital. Transcribed interviews were coded and analysed thematically.FindingsPrimary themes identified included: perceived flags for elder abuse; the importance of relationship building to elicit disclosures; the challenges involved in substantiating abuse; and dealing with uncertain outcomes.DiscussionDifficulties encountered in substantiating abuse were often compounded by organisational factors and time constraints. Having the time to build a relationship with the older person enabled a more comprehensive assessment of risk factors, but for those working in fast-paced wards this was not always possible.ConclusionEffective responses to elder abuse require an organisational culture that recognises the importance of a relationship-based model of care.     

Nurses’ experiences of caring for patients with intellectual developmental disorders: a systematic review using a meta-ethnographic approach

Background

Research suggests that registered nurses (RNs) do not feel adequately prepared to support patients with intellectual disability disorder (IDD). This is unsurprising, as few European health sciences curricula include undergraduate and graduate training courses in IDD. As RNs are often in the front line of care, eliciting in-depth knowledge about how they experience nursing this group of patients is vital. Our aim in this study was to develop a conceptual understanding about RNs’ experiences of nursing patients with IDD.

Method

We undertook a systematic review and meta-ethnography to synthesise qualitative research studies found in PubMed, CINAHL, PsycINFO, ERIC databases and by manual searching to identify additional studies. We condensed translatable second-order constructs, and developed an idiomatic translation. Finally, we formulated line of argument (LOA) syntheses to capture the core of the idiomatic translations.

Results

We included eighteen published studies from eight countries involving 190 RNs. The RNs’ experience of nursing patients with IDD were reflected in 14 LOAs. Six of these reflected a tentatively more distinctive and at times unique conceptualisation of RNs’ experience of nursing this group of patients. The remaining eight LOAs represented a conceptualisation of nursing per se, a conceptualisation of nursing that was interpreted as a universal experience regardless of context and patient group.

Conclusion

Lack of awareness and knowledge are likely breeding grounds for the ‘otherness’ that still surrounds this group of patients. In encounters between patients and RNs, focusing on the person behind the disability label could be one way to secure relevant nursing care for patients with IDD. Undertaking appropriate under- and postgraduate education alongside the implementation of nursing models focusing on patient-centred care would help RNs in reducing the health and care inequalities this group of patients still face.

Trial registration

PROSPERO 2017: CRD42017077703.

     

Nurses’ and patients’ perceptions on interruptions on admission processes at an acute public hospital using cross-sectional survey

ProblemAdmissions are a critical component of patient care. However, nurses get interrupted during care provision. There is limited understanding of the dynamics regarding interruptions during admission and their effect.AimTo ascertain how often and why interruptions occurred; and whether these impacted patients.MethodsThe cross-sectional survey study took place in the hospital of a 327-bed regional acute public hospital in Queensland, Australia, during July 2020. Nurses completed a survey asking about the admissions and interruptions they had encountered. Patients completed a survey asking about their perceptions of admissions and interruptions during the admission process.FindingsNurses across five units completed 171 surveys, and patients completed 55 surveys. There was no statistical difference in interruptions per hour between admissions of 15-44 min, 45 min to 1 h 15 min, and over 1 h 15 min. When the admissions with and without interruptions were compared, the ‘interrupted’ group had a median admission time of 50 min (interquartile range 35?75), and the ‘non-interrupted' group was 30 min (20-39) (p < 0.01). Nurses identified three themes of what could be improved to streamline admission processes: Simpler admission paperwork, admission timing and process, and emergency department input on admission documentation. Overall, patients were satisfied with the admission process. Patients' satisfaction was not impacted by the interruptions.ConclusionWhile nurses reported that admission processes were repetitive and could be simplified, patients were not concerned with the interruptions during admission in our study. However, future research with robust measures is required.     

Is there a need for weekend face-to-face inpatient assessments by hospital specialist palliative care services? Evaluation of an out-of-hours service

There is an increasing demand for hospital specialist palliative care services to be made more accessible outside of normal working hours. However, it has been argued that extended service provision could be misused and that specialist telephone advisory services are an adequate response to this demand. A 'routine' Saturday face-to-face visiting service was introduced into a hospital palliative care team and the service was evaluated to determine whether it was being utilised appropriately. A retrospective notes review of out-of-hours assessments was undertaken. Anonymised data relating to the nature of the interaction with the palliative care team and the outcome of the consultation were entered into an electronic database. A random sample of routine weekday interactions was also evaluated. A total of 336 Saturday and 93 weekday assessments were analysed. Most of the Saturday assessments resulted in a significant change in management (57%) or were undertaken on patients close to death (10%). There were 39/336 (12%) new referrals assessed on Saturdays. There were few differences between the nature of the Saturday and the weekday service and no evidence of 'inappropriate' referrals. We found clear evidence of the need for a specialist out-of-hours face-to-face inpatient visiting service for hospital palliative care.     

Nurses’ perception of missed nursing care in a Western Australian teaching hospital: A cross-sectional study

BackgroundMissed nursing care (MNC) has gained increasing emphasis in nursing literature because of its association with nurse and patient outcomes in healthcare settings. While missed care has been widely studied, little evidence is available on the types and frequency of missed care, reasons for its occurrence, and predictors of missed care in Western Australia.AimsTo determine nurses’ perceptions of the types of MNC, reasons for missed care and to identify factors predicting missed care occurrence in Western Australian acute care settings.MethodsA cross-sectional study in medical and surgical wards was performed. The nurse MISSCARE survey tool was used to capture self-reported types and reasons for missed care and level of nurse job satisfaction from a sample of 204 nurses working in 16 acute care wards. Data analyses were carried out in International Business Machines Corperation located in Armonk, New York United States (IBM SPSS Statistics) (v 29).FindingsThe most common perceived missed activities included ambulation (87%), patient teaching (79%), interdisciplinary conference attendance (78%), mouth care (78%), intake and output (77%), and patient turning (75%). Labour resources ranked highest for reasons for missed care followed by material resources and communication. Significant relationships were observed between missed care and job satisfaction, role satisfaction, and teamwork.DiscussionWorking overtime, job dissatisfaction, inadequate staffing, and heavy admissions and discharges were related to increased likelihood for missed care occurrence.ConclusionAlthough further studies examining the link between MNC and staffing methodologies are needed, this study provides evidence on nurse-reported missed care and the impact of missed care in Western Australia.     

A child’s admission to hospital: a qualitative study examining the experiences of parents

Aims To compare the experiences of parents and children during inpatient admission to either a paediatric intensive care unit (PICU) or a general paediatric ward (GPW) with a specific focus on identifying factors which may influence psychological outcome.Methods Semi-structured qualitative interviews of 20 parents whose children had been admitted to hospital. Cases were sampled purposively to ensure representation of both groups (PICU and GPW admissions). Interviews were tape recorded, transcribed and subjected to a thematic analysis.Results The experiences of parents were explored with regard to illness onset, admission to PICU or GPW and the discharge period. In the PICU group, the sources of stress differed according to the stage: at onset, they were mainly related to their childs illness; during admission, concerns were focused on their childs appearance; finally, on discharge, possible relapse of the illness, impact of the admission on the child and family and the lack of clear follow-up were the central themes. In the GPW group, parents reported similar themes but with lower levels of associated stress. Both groups identified good communication with the medical team and opportunities for participation as helpful in reducing stress.Conclusions Admission to hospital is stressful for parents particularly if the child is admitted to PICU. Hospital staff should enhance communication with parents and maximise opportunities for parental participation in the childs treatment. Such interventions may reduce parents experience of stress during the admission and have the potential to improve psychological outcome.     

Young adults’ experiences of living with recessive limb-girdle muscular dystrophy from a salutogenic orientation: an interview study

Abstract

Purpose: To describe young adults’ experiences of living with recessive limb-girdle muscular dystrophy (LGMD2) from a salutogenic orientation. Methods: A qualitative explorative interview study, including 14 participants aged 20–30 years, was performed focusing on comprehensibility, manageability and meaningfulness in daily life. Content analysis was used for data analysis. Result: Living with LGMD2 not only implies learning to live with the disease and the variations between good and bad periods but also means trying to make sense of a progressive disease that brings uncertainty about future health, by striving to make the best of the situation. Disease progression involves practical and mental struggle, trying to maintain control over one’s life despite vanished physical functions that require continual adjustments to the body. Restrictions in a double sense were described, not only due to the disease but also due to poor comprehension of the disease in society. Lack of knowledge about LGMD2 among professionals often results in having to fight for the support needed. Conclusion: In order to manage daily life, it is important to be seen and understood as an individual in contacts with professionals and in society in general, to have informal social support and meaningful activities as well as access to personal assistance if necessary.

• Implications for Rehabilitation

• Recessive limb-girdle muscular dystrophy (LGMD2) is a group of progressive disorders, which manifest in physical and psychological consequences for the individual.

• According to the salutogenic orientation, people need to find life comprehensible, manageable and meaningful, i.e. to achieve a sense of coherence (SOC), but living with LGMD2 may recurrently challenge the individual’s SOC.

• Through the holistic view of the individual’s situation that the salutogenic orientation provides, professionals may support the individual to strengthen SOC and thereby facilitate the movement towards health.

     

Physiotherapists’ experiences of activity pacing with people with chronic musculoskeletal pain: an interpretative phenomenological analysis

Abstract

Purpose: Activity pacing is a strategy used by physiotherapists treating people with chronic pain. Questions as to the usefulness of activity pacing with people with chronic pain have been raised clinically and in research. This study explores physiotherapists’ experiences of using activity pacing with people with chronic musculoskeletal pain. Method: We interviewed six physiotherapists and used the methods of Interpretative Phenomenological Analysis (IPA) to explore the meaning of pacing. Results: We identified three master themes. First, activity pacing was perceived as part of a process whereby patients came to realize that change is possible, and that life could be different. Second, in order to use activity pacing effectively the physiotherapist needs to shift from a “fix it” to a “sit with” approach to the treatment. Third physiotherapists described how they used many combined therapeutic approaches in managing chronic pain. Conclusions: This study increases our understanding of activity pacing and will help to make the best use of activity pacing in clinical practice, and optimize outcomes for the patients. These findings suggest that physiotherapists need to develop reflective listening skills, and use an experiential learning approach to facilitate activity pacing.     

Chinese nurses’ perceived impact of international educational experiences and cultural beliefs following a 1-year study abroad program: an exploratory study

Objectives:To examine the perceived impact of international educational experiences and cultural beliefs before and after completing a 1-year Masters of Science in Nursing program.Methods:An exploratory study was conducted among Chinese nurses studying abroad in a private medium-sized university in the United States.The 27-item electronic pre-survey was administered within 1 week of starting the program and the post-survey was administered 1 year later at the completion of the program.Results:Majority of participants(n=25)were female,23–36 years of age.Findings revealed that the perceived impact of international educational experiences assessed at the start of the program was similar to the perceived impact measured at the end of the 1-year program,suggesting that the students learned and experienced what they anticipated.There was a significant impact on cultural beliefs from the start of the program compared with the end of the program suggesting that a 1-year study abroad program does influence cultural beliefs.Conclusions:Understanding what is important to provide in a study abroad program and providing the educational experiences identified by students as impactful are avenues to help host universities best develop their programs.Findings suggested that the 1-year program can influence foreign students’cultural beliefs,yet the professional and personal impact of this change warrants further study.