What is a comprehensive mental health nursing assessment? A review of the literature

Assessment is the foundation on which nursing care is delivered. The aim of this paper is to better understand the content (what information nurses seek about consumers) and the process (how they go about gathering that information) of a comprehensive mental health nursing assessment in practice. Using terms, such as 'nursing', 'mental health', and 'assessment', the CINAHL, Medline, and PsycINFO databases were searched for studies that describe the content and process of a comprehensive mental health nursing assessment. Although studies of aspects of mental health nursing assessment, such as the assessment of risk or carer burden, were found, no single study described both the content and process of a comprehensive mental health nursing assessment in practice. In Australia, a comprehensive assessment is codified as a competency to practice nursing; however, the standards of practice set for mental health nurses are less clear on what constitutes a comprehensive assessment or how this should be undertaken. The peer-reviewed literature describes assessment as both an independent and interdependent activity. It is described as informal, and there is evidence that comprehensive mental health nursing assessments are not well documented. The credibility of training and research into mental health nursing requires that the content and the process of a comprehensive mental health nursing assessment needs to be clearly defined.     

Moral distress in nurse leaders—A scoping review of the literature

Nurse leaders face immense organizational pressures exacerbating their distress, which has not been prioritized as much as frontline nurses. This review synthesized the literature to examine theoretical models, measures, contributing factors, outcomes, and coping strategies related to moral distress in nurse leaders. PubMed, Embase, CINAHL, and PsycINFO were searched, and 15 articles—2 quantitative and 13 qualitative studies were extracted. The scoping review identified one study using a theoretical model and two measures—the ethical dilemmas questionnaire and the Brazilian moral distress scale. Contributing factors of moral distress include internal and organizational constraints, increased workload, and lack of support impacting physical and emotional well-being and intention to quit. This review did not yield any intervention studies emphasizing the need for research to identify specific predictors of moral distress and examine their relationship to nurse leader retention, so organizations can explore targeted interventions to promote coping and mitigate distress.     

What are nurses doing to patients? A review of theories of nursing past and present

• ? This paper looks critically at the nature of nursing theory from three perspectives.
• ? Firstly, it examines the current state of nursing theory with a particular focus on Patricia Benner's work. This examination concludes that nursing theory is currently beset by the problems of scientific and moral relativism and philosophical incoherence because it has abandoned a traditional realist approach to the care of patients.
• ? Secondly, the roots of this contemporary nursing position are analysed and the conclusion is reached that nursing theorists are implicitly presuming this traditional ‘common sense’ view of nursing, although their own philosophical assumptions do not support it and indeed are removing the ground from beneath it.
• ? The traditional theory underpinning the quality of the nurse's care, and hence the ethos of nursing, is rearticulated.
• ? In conclusion it is suggested that nursing needs to debate the modernist views that are now holding sway in nursing and rediscover a theory for the care of patients that holds together the personal, the pastoral, the scientific and the technological aspects of patient care.

     

Teaching nursing students about spiritual care – A review of the literature

AimThis paper examines that examines content, process and outcome of spirituality teaching programmes for nursing students.BackgroundIncreased secularisation in Europe and resulting ambivalent attitude towards spirituality and religion is contrasted with increased professional and public interest in this topic. Additionally there are concerns that patient's spiritual needs are not being met and nurses are often ill equipped to provide this care. Nurses while positively disposed towards spiritual care delivery, and often carrying out spiritual care in practice, do so with little preparation. While teaching spiritual care to nursing students is advocated there is little research on this topic.MethodA search was conducted using CINAHL database spanning the years 2007–2012 using the key words ‘spirituality’ and ‘education’.FindingsThree papers were identified that examined teaching approaches with nurses and nursing students. Due to methodological issues such as small sample sizes and limited testing generalising from these studies is difficult. Approaches used were firmly rooted in a religiosity framework.ConclusionFurther research is required, using rigorous approaches, examining the benefits of teaching approaches. Analysis of the need for spiritual education is also required. Issues that are of concern to educators are the definitions and understandings of spirituality, assessment and how, best to teach this topic.     

What do we know about educating Asian ESL nursing students? A literature review

Because of cultural differences and language barriers, some Asian nursing students who speak English as a second language (ESL) have not realized their full potential and career goals. Based on an exhaustive search through existing electronic databases in health sciences, this article synthesizes the published literature between 1980 and 2010 on this subgroup of nursing students in four domains: conceptual frameworks, language and communication, support and infrastructure, and instructional strategies. However, some of the classic works were published before 1980. Findings indicate that a body of literature on ESL nursing students has emerged in the last decades, with several limitations. Based on this review, implications for future educational practice and research are elaborated, with an emphasis on an evidence-based approach.     

What are the postoperative experiences of patients who have undergone hip and knee joint replacement? A literature review

Background: There are an increasing number of people undergoing hip and knee joint replacement each year; approximately 68,000 hip and 76,000 knee replacements, respectively, are performed in England and Wales. Joint replacements serve to reduce pain and improve function.

Objectives: The purpose of this qualitative literature review is to gain an in depth understanding into participants’ postoperative experiences following hip and knee replacement in order to establish if participants can be better supported post joint replacement and whether preoperative education can be enhanced.

Methods: Searches were carried out in 13 online scientific databases (January 1995 to October 2016) to identify relevant studies. The quality of studies was assessed, data were extracted and analysed using thematic synthesis.

Results: A total of 197 studies were identified and screened against the inclusion/exclusion criteria. Seven studies met the inclusion criteria. Three broad themes were identified; coping with pain, recovering function and the challenges of discharge. In general, pain was poorly understood and difficulties arose with the appropriate management postoperatively. The recovery process took commitment and required individuals to have realistic expectations. Participants also felt the need for individualised care as they approached discharge.

Conclusions: Overall qualitative evidence surrounding postoperative views of participants is limited. It appears current preoperative education does not fulfil the majority of participants’ needs. Utilising the views of participants may help to tailor preoperative education or provide alternative support postoperatively. Future research should focus on clarifying the effect of a well-constructed and well-delivered preoperative education sessions.     

What is the impact of advanced primary care nursing roles on patients, nurses and their colleagues? A literature review

OBJECTIVES: To review and draw together the existing research evidence to assess the impact of advanced primary care nursing roles, particularly first contact nursing roles, for patients, nurses themselves and their colleagues in order to highlight salient issues for policy, practice and research. BACKGROUND: Internationally, nurses' roles continue to expand in response to doctor shortages and policy drives to provide effective and efficient health services. A body of research exists from which to evaluate the impact of advanced nursing roles on various dimensions of healthcare delivery and organisation. DESIGN AND DATA SOURCES: Medline, CINAHL, Applied Social Sciences Index and Abstracts, British Nursing Index, Cochrane Library, EMBASE, National Research Register, and PsycINFO databases were searched, including relevant websites. Studies were included if published in English and relevant to the primary/community care setting. Of a total of 211 papers identified, 88 were of relevance and included in the review. RESULTS: Nurses working in many advanced primary care roles such as acute/minor illness, minor injury and long-term conditions provide safe and effective care, and patient satisfaction is generally high. Many factors influence patient satisfaction with, and access to, such services but are little understood. Evidence on cost-effectiveness, efficiency and impact on other health care professionals is inconclusive though research suggests the introduction of extended roles can create uncertainty and intra-/inter-professional tensions. CONCLUSIONS: Evidence is of variable quality, often ignoring potentially important effect mediators such as the experience and educational level of advanced nurses, the effect of service 'maturation', organisational characteristics and differing patient preferences. The complex range of factors that influence patient satisfaction, access and outcomes of care need further investigation. Recent UK developments in nurse prescribing and the introduction of a national post-registration competency framework may improve working relations and patient understanding and experience of advanced nursing roles in primary care.     

What are patients' priorities when facing the end of life? A critical review

This critical review aimed to investigate what patients' priorities are when facing the end of life, in order to gain further understanding of this issue. Academic databases were searched using key terms, and through a method of elimination and deduction using specific inclusion/exclusion criteria, suitable research studies were found. These articles were then assessed for their quality, and specific data was extracted from the final selection using appropriate information-gathering tools. In these final four articles the methodological processes used to explore terminally ill patients' needs were generally appropriate, although there was a lack of reflexivity (researcher reflection on the experience). Useful narrative themes were produced from all four papers for further discussion. The patients had similar priorities across all four articles, which were related to understanding and accepting their changing health status, the need to hold on to some normality in life, the need to feel supported by friends and family and to know they will be taken care of after the death, and the need to have good and trusting relationships with health professionals.     

Blended learning in undergraduate nursing education – A scoping review

ObjectivesTo provide a comprehensive scoping review of the existing literature regarding the use of blended learning in undergraduate nursing education. To align the varied educational terms and definitions with the broad definition of blended learning.DesignScoping review following established methodology.Data sourcesIn consultation with library services, the academic literature was searched. Electronic databases searched included ERIC (OVID), Medline (OVID), PubMed, Nursing and Allied Health, and CINAHL Plus.Review methodsA total of 189 potentially relevant nursing research articles published between the years of 2009 and 2019. Three reviewers independently reviewed the articles, leaving 37 relevant primary articles in the nursing field to be included in the scoping review.ResultsNursing content delivered using blended learning approaches were organized into 8 themes. Themes include Professional Nursing Skills; Mental Health Nursing; Bioscience; Pharmacology, Specialty Populations; Nursing Assessment; Acute Care Nursing; and the Art of Nursing. A variety of blended learning approaches are being utilized in Undergraduate nursing education, the majority of which are happening in the classroom.ConclusionThis scoping review presents explicit the degrees to which blended learning is referred to in the nursing education literature and expanded the definition of blended learning to encompass the terminology associated with distributed, decentralized, hybrid, and flexible learning. There is a wide, varied, and expanding number of blended learning approaches currently being utilized in nursing education to teach a wide range of nursing content and skills. An expanded scoping review focused on blended learning in psychiatric nursing, licenced practical nursing, nurse practitioners, and all graduate level nursing education programs is recommended as is additional research into the use of blended learning in the lab or clinical setting.     

What are the sources of health policy that influence nursing practice?

This article seeks to fill a gap in the existing nursing literature by answering the question, "Where does health policy come from?" Nursing leaders agree that nurses should be involved in developing health policy, yet most nurses are not engaged. Many factors contribute to nurses' low rates of involvement, but the primary drivers is that nurses believe they lack the knowledge and skills to influence policy formulation. This article proposes a framework of the sources of health policy. We classify health policy sources as public, organizational, or professional, and provide examples. Nurses with a deeper understanding of the varied sources of health policy can enhance their political competence and more readily act in the policy domain.     

What are our priorities? Addressing the looming shortage of nursing faculty

Let's get our priorities straight. As we continue the essential educational upgrading of the profession through research-focused doctoral programs, and through the new CNL and DNP programs, let's be sure that at least some of these programs attend to the critical need for well-prepared nursing faculty (i.e., provide opportunities for and encourage students to take advanced coursework in nursing education). Let's also pay attention to the reality of limited capacity in our research-focused doctoral programs and look to other viable approaches to having a cadre of well-prepared faculty. For example, let's recognize, value, and reward the important role master's-prepared nurses, especially those with advanced coursework in nursing education, can and must play in our basic programs. And let's be sure that we have faculty in our ranks who have the training, aptitude, and credentials to conduct the research so critical to progress in nursing education.     

What paradigm shifts occurred in the management of acute diverticulitis during the COVID-19 pandemic? A scoping review

BACKGROUNDAcute colonic diverticulitis (ACD) is common in Western countries, with its prevalence increasing throughout the world. As a result of the coronavirus disease 2019 (COVID-19), elective surgery and in-patients’ visits have been cancelled or postponed worldwide. AIMTo systematically explore the impact of the pandemic in the management of ACD.METHODSMEDLINE, Embase, Scopus, MedxRiv, and the Cochrane Library databases were searched to 22 December 2020. Studies which reported on the management of patients with ACD during the COVID-19 pandemic were eligible. For cross sectional studies, outcomes of interest included the number of hospital admission for ACD, as well as key features of disease severity (complicated or not) across two time periods (pre- and during lockdown).RESULTSA total of 69 papers were inspected, and 21 were eligible for inclusion. Ten papers were cross sectional studies from seven world countries; six were case reports; three were qualitative studies, and two review articles. A 56% overall decrease in admissions for ACD was observed during lockdown, peaking 67% in the largest series. A 4%-8% decrease in the rate of uncomplicated diverticulitis was also noted during the lockdown phase. An initial non-operative management was recommended for complicated diverticulitis, and encouraged to an out-of-hospital regimen. Despite initial concerns on the use of laparoscopy for Hinchey 3 and 4 patients to avoid aerosolized contamination, societal bodies have progressively mitigated their initial recommendations as actual risks are yet to be ascertained.CONCLUSIONDuring the COVID-19 pandemic, fewer patients presented and were diagnosed with ACD. Such decline may have likely affected the spectrum of uncomplicated disease. Established outpatient management and follow up for selected cases may unburden healthcare resources in time of crisis.     

What is the place of thrombolysis in acute stroke? A review of the literature and a current perspective

The global burden of stroke, the undisputed success of intravenous thrombolysis in the management of myocardial infarction and subsequent evidence from animal models of cerebral infarction have all fuelled intense interest in the potential role for thrombolytic agents in the acute management of stroke in clinical practice. Before any clinical treatment is introduced universally its safety and efficacy must be demonstrated in the routine clinical environment and not just within the ideal conditions of controlled clinical trials. Similarly, the cost effectiveness of a new treatment modality is an essential consideration before its use is promulgated. This paper reviews the current scientific evidence for thrombolysis in stroke with reference to issues of safety, efficacy and cost effectiveness.     

Problem-based learning within health professional education. What is the role of the lecturer? A review of the literature

With the increasing popularity of using problem-based learning (PBL) within health professional curricula, it could be argued that the health lecturer's role in education is changing. As a lecturer, I have only recently become involved in using PBL. With increasing exposure to the process and through reviewing the literature, I have come to realise that the role of the lecturer is fraught with difficulty. The literature is often conflicting with PBL meaning different things to different people (Barrows 1986). It provides no consistent guidelines as to how the lecturer should adapt to undertake this new role. This article explores the issues around the role of the lecturer within PBL and through reviewing the literature, investigates the level of intervention the lecturer should provide when students are undertaking the PBL process. Suggestions will be made to 'facilitate' the lecturer into facilitating an effective teaching strategy.     

What are the unmet supportive care needs of people with cancer? A systematic review

Goals of work  The identification and management of unmet supportive care needs is an essential component of health care for people with cancer. Information about the prevalence of unmet need can inform service planning/redesign. Materials and methods  A systematic review of electronic databases was conducted to determine the prevalence of unmet supportive care needs at difference time points of the cancer experience. Results  Of 94 articles or reports identified, 57 quantified the prevalence of unmet need. Prevalence of unmet need, their trends and predictors were highly variable in all domains at all time points. The most frequently reported unmet needs were those in the activities of daily living domain (1–73%), followed by psychological (12–85%), information (6–93%), psychosocial (1–89%) and physical (7–89%). Needs within the spiritual (14–51%), communication (2–57%) and sexuality (33–63%) domains were least frequently investigated. Unmet needs appear to be highest and most varied during treatment, however a greater number of individuals were likely to express unmet need post-treatment compared to any other time. Tumour-specific unmet needs were difficult to distinguish. Variations in the classification of unmet need, differences in reporting methods and the diverse samples from which patients were drawn inhibit comparisons of studies. Conclusion  The diversity of methods used in studies hinders analysis of patterns and predictors of unmet need among people with cancer and precludes generalisation. Well-designed, context-specific, prospective studies, using validated instruments and standard methods of analysis and reporting, are needed to benefit future interventional research to identify how best to address the unmet supportive care needs of people with cancer.