Equality as a central concept of nursing ethics: a systematic literature review

Scand J Caring Sci; 2010; 24; 824–832
Equality as a central concept of nursing ethics: a systematic literature review Background: Equality is a central concept in the Western way of thinking and in health care. In ethics research within nursing science, equality is a key concept but the meaning of its contents is more or less presumptive. Aim: The purpose of this study was to define the concept of equality as a value of nursing ethics research. Method: Data were collected through systematic literature review and analysed using deductive and inductive content analysis. Findings: Equality has been studied as a concept and in relation to ethical theories. In nursing ethics, research on equality on theoretical and functional level is presented. These levels consist of dimensions, i.e. themes, that equality is related to. The dimensions of the theoretical level are the equality of being, i.e. universal human value, and distributive equality, i.e. equal opportunities, circumstances and results. The dimensions of functional equality included themes such as critique of distributive equality, context, difference, power and care. Critique is aimed at incompatibility of theoretical level with practice. Context raises questions of each nursing situation in relation to equality. Variation within context is closely related to differences involving parties to nursing, and it is a starting point to questions of equality. Power is understood as comprising knowledge, skills and authority that create differences and questions of equality between nurses and patients and nurses and other professionals or students. Nursing as care always includes relationship between two or more persons and needs to be inspected from the point of view of equality. Conclusion: The concept of equality has been complex to achieve in practice. The dimensions of the levels of equality defined in this study provide an opportunity to reach a better understanding of equality in nursing ethics. There is still a great demand for more research on the concept of equality.     

Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration

ABSTRACT

Professionals in healthcare are increasingly encouraged to work together. This has acted as a catalyst for research on interprofessional collaboration. Authors suggest developing interprofessional collaboration is not just the job of managers and policy makers; it also requires active contributions of professionals. Empirical understanding of whether professionals make such contributions and if so, how and why, remains fragmented. This systematic review of 64 studies from the past 20 years shows there is considerable evidence for professionals actively contributing to interprofessional collaboration. Although the evidence is limited, we can show they do so in three distinct ways: by bridging professional, social, physical and task-related gaps, by negotiating overlaps in roles and tasks, and by creating spaces to be able to do so. Professionals from different professions seem to make different contributions. Moreover, differences exist between collaborative settings and healthcare subsectors. We conclude by proposing a research agenda to advance our understanding of these contributions in theoretical, methodological and empirical ways.     

A systematic review of healthcare professionals' core competency instruments

While technical and profession‐specific competencies are paramount in the delivery of healthcare services, the cross‐cutting core competencies of healthcare professionals play an important role in healthcare transformation, innovation, and the integration of roles. This systematic review describes the characteristics and psychometric properties of existing instruments for assessing healthcare professionals' core competencies in clinical settings. It was guided by the JBI methodology and used the COSMIN checklist (Mokkink et al., User manual, 2018, 78, 1) to evaluate the methodological quality of the included studies. A database search (CINAHL, Scopus, and PubMed) and additional manual search were undertaken for peer‐reviewed papers with abstracts, published in English between 2008 and 2019. The search identified nine studies that were included in the synthesis demonstrating core competencies in professionalism, ethical and legal issues, research and evidence‐based practice, personal and professional development, teamwork and collaboration, leadership and management, and patient‐centered care. Few instruments addressed competencies in quality improvement, safety, communication, or health information technology. The findings demonstrate the reviewed tools' validity and reliability and pave the way for a comprehensive evaluation and assessment of core competencies into clinical practice.     

The representation of healthcare end users' perspectives by surrogates in healthcare decisions: a literature review

Background: The representation of end users’ perspectives in healthcare decisions requires involvement of their surrogates when the end users, i.e. certain patients, elderly people, children and people with disabilities, are unable to present their views. Aims: To review critical issues, and the advantages and disadvantages of involving surrogates in representing end users’ perspectives in healthcare decisions. Methods: A systematic review of literature published in peer‐reviewed journals from 1990 to 2005. Results: Findings show that surrogates are used widely in health care and that they are necessary to represent end users’ perspectives in healthcare decisions when the latter are unable to do so themselves. Critical issues in using surrogates include key ethical, social, cultural, legal and medico‐technological factors; ascertaining the best interest of end users; potential conflict of interest; possible biased decisions and the burden on surrogates. The key advantage of surrogate involvement in healthcare decisions is their ability to represent end users’ needs, values and wishes. The main disadvantages include potential discrepancies between the decisions and conclusions of surrogates and end users; the failure of surrogates to predict end users’ preferences accurately and the lack of certainty that useful information will be obtained through the surrogacy process. Conclusion: This systematic review has revealed that the involvement of surrogates is an additional vital way to represent end users’ perspectives in healthcare decisions where for a range of reasons their opinions are unable to be effectively ascertained. However, because of the heterogeneity of surrogates and end users, the selection of appropriate surrogates and deploying surrogate decisions require particularly careful consideration of their value in individual cases; thus, subsequent decision‐making must be reviewed on a case‐to‐case basis to seek to ensure that the best interests, needs and wishes of the end user are fully and accurately represented.     

Acute outreach service to nursing homes: A systematic review with GRADE and triple aim approach

Background

People living in nursing homes face the risk of visiting the emergency department (ED). Outreach services are developing to prevent unnecessary transfers to ED.

Aims

We aim to assess the performance of acute care services provided to people living in nursing homes or long-term homecare, focusing on ED transfer prevention, safety, cost-effectiveness and experiences.

Materials & Methods

This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were eligible for inclusion if they were peer-reviewed and examined acute outreach services dedicated to delivering care to people in nursing homes or long-term homecare. The service models could also have preventive components. The databases searched were Scopus and CINAHL. In addition, Robins-I and SIGN checklists were used. The primary outcomes of prevented ED transfers or hospitalisations and the composite outcome of adverse events (mortality/Emergency Medical Service or ED visit after outreach service contact related to the same clinical condition) were graded with GRADE.

Results

Fifteen relevant original studies were found—all were observational and focused on nursing homes. The certainty of evidence for acute outreach services with preventive components to prevent ED transfers or hospitalisations was low. Stakeholders were satisfied with these services. The certainty of evidence for solely acute outreach services to prevent ED transfers or hospitalisations was very low and inconclusive. Reporting of adverse events was inconsistent, certainty of evidence for adverse events was low.

Conclusion

Published data might support adopting acute outreach services with preventive components for people living in nursing homes to reduce ED transfers, hospitalisations and possibly costs. If an outreach service is started, it is recommended that a cluster-randomised or quasi-experimental research design be incorporated to assess the effectiveness and safety of the service. More evidence is also needed on cost-effectiveness and stakeholders' satisfaction. Systematic review registration number: PROSPERO CRD42020211048, date of registration: 25.09.2020.     

Sexuality and amputation: a systematic literature review

Purpose. To systematically examine the state of research on sexuality and amputees.

Methods. A total of five publication databases were searched: Pubmed, Cinahl, Embase, Psychinfo and Recall.

Results. A total of 11 eligible studies was found. The studies were characterised by a diversity of study populations, sampling methods, gender and age distributions, assessment methods, and outcomes measures. The use of the terminology regarding sexuality was ambiguous. All studies found an impact of the amputation of a limb on some part of sexual functioning (or concerns about) to some degree.

Conclusions. Studies on sexuality and amputees are very diverse and terminology is ambiguous. Amputation of a limb has an impact on sexual functioning. Amputees complain that there is little support from professionals. The authors recommend the use of the ICF terminology. Suggestions for future research are given.     

Motivation for health behaviours: a systematic review of the nursing literature

AIMS AND RATIONALE: This research review examines nursing and allied health studies exploring motivation for health behaviours to identify the state of understanding of this construct within nursing. This review contributes to nursing science by synthesizing nursing research regarding motivation for health behaviour. METHODS: Integrative research review methodology. FINDINGS: Problems of existing research include nonprobability sampling of heterogeneous populations, low statistical power, and colinearity. Studies identifying predictors of motivation explained large proportions of variance using regression. Motivation was not a significant predictor of health behaviours for over one-third of the studies. Overall, the studies suggest that either motivation is not being effectively measured because of a lack of conceptual clarity or that motivation is not an essential determinant of health behaviours. The latter cannot be verified until psychometric research advances current measurement of motivation to a higher level. LIMITATIONS; The literature for this review was accessed through the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database. Databases for other disciplines were not included in this search. This work represents a first step towards understanding motivation for health behaviour as it is currently defined in the literature. Future studies are necessary to broaden this understanding beyond nursing. CONCLUSIONS: Motivation is a frequently cited rationale underlying the adoption and maintenance of health behaviours in research and practice. Motivation is complex and multidimensional, and clearer definitions for motivation are needed. Populations that have been underrepresented in motivation research need to be targeted in future research. Researchers and practitioners are challenged to examine carefully the role of motivation for health behaviours and explore other factors that may more strongly influence health behaviours.     

Advanced nursing roles: A systematic review

In this systematic literature review, we analyzed and synthesized the literature on one specialized advance practice nursing role in three countries for the purpose of describing and comparing these roles, as well as discussing whether an international consensus of the advance practice nursing definition is possible. A systematic search on CINAHL and PubMed Medline was conducted in 2011 to search the literature on the nurse consultant in the UK, the clinical nurse specialist in the USA, and the clinical nurse consultant in Australia. The studies (n = 42) were analyzed and combined using qualitative content analysis method. The roles of the nurse consultant, clinical nurse specialist, and clinical nurse consultant were similar. The variation in the roles appears to derive from organizational or individual choices, not the country in question. The study process comprised a synthesized representation of one specialized advance practice nursing role. More work is needed to further define the concept of the advance practice nursing, as well as its implementation on other cultures beyond this review. Based on this review, an international consensus regarding the definition of advance practice nursing and its subroles is possible.     

The effectiveness of nutritional intervention(s) and the treatment of pressure ulcers— A systematic literature review

This review aims to evaluate the effectiveness of nutritional intervention in the treatment of pressure ulcers. Four databases were searched systematically using the keywords formulated and papers were selected according to inclusion and exclusion criteria. The literature search period included articles published from 1 January 2000 to 30 December 2011 (inclusive). Six papers on randomized controlled trials were retrieved. All six trials showed positive outcomes in pressure ulcer healing with nutritional interventions. Secondary outcomes such as lower number of dressings required, less time spent on dressing changes and lower occurrence of infections were reported. The main results emerged from this study generally supported the use of nutritional interventions in the treatment of pressure ulcers. Various methodological issues associated with these trials were highlighted. The implications for clinical practice need to bear in mind both the methodological problems raised and limitations of this review.     

An exploration of usability issues in telecare monitoring systems and possible solutions: a systematic literature review

Abstract

Background: The idea of product usability has been discussed in several research areas including product research and development. Usability, in telecare monitoring systems, determines how much the system is effective and efficient for the telecare users. Usability has been considered an important factor in the acceptance of telecare monitoring systems by individuals who encounter challenges in the use of such systems and who possess a limited knowledge of their use.

Objectives: The purpose of this study is to explore the relevant usability issues and identify possible solutions to improve the usability of telecare monitoring systems.

Method: The study is based on eight research questions and to find the answers to those research questions, a systematic literature is performed.

Results: The research findings highlight various usability issues, including the complexity of the interface, difficulty in reading the text, and insufficient provision of instructions. These studies have also suggested solutions to enhance the usability of systems, including development of the technical skills of users, explanations of usability evaluation techniques for telecare monitoring systems, and engaging the appropriate users during the development of telecare monitoring systems.

• Implications for rehabilitation

• Successful implementation of telecare monitoring systems can increase the chances of acceptance of telecare monitoring systems by the users.

• Implementing an efficient and effective system will make telecare users more independent at their homes.

• The development of usable telecare monitoring systems can significantly contribute to a basis for clinical and home-based implementation of the telehealth technology to promote remote monitoring for elderly and people with disabilities.

• Considering the usability issues and solutions identified in this study, it will go a long way towards aiding subsequent researchers and developers in the implementation of more usable and valid telecare monitoring systems.