The use of eHealth technologies to support communication with parents in the neonatal unit; an updated literature review for the COVID-19 era

IntroductionSince the outbreak of COVID-19, there has been a drive towards digital healthcare solutions. This review provides an update as to how eHealth technologies have been used in neonatal intensive care unit settings to help communication with parents and parental education since the last reviews published.MethodsA systematic search of MEDLINE and CINAHL via Ovid was conducted using the keywords ‘eHealth’, ‘mHealth’, ‘telemedicine’, ‘neonatal’, ‘intensive care’ and ‘NICU’. CASP methodology was used to identify bias and limitations.ResultsElectronic searching yielded 69 and 39 papers respectively. Six papers were considered eligible for full text review. Four studies focussed on eHealth interventions post-discharge from NICU, two of which showed reduced emergency visits to hospital.ConclusionseHealth may benefit infants post-discharge from neonatal intensive care units and is generally well-received by parents. However, technological and organisational adaptions may be necessary for its wider application. More research is needed in the use of communication technologies during infants’ admission, and to empirically test educational resources.     

Mental health service user involvement in nurse education: exploring the issues

This paper reports on findings and issues arising from a study designed to promote mental health service users' involvement in a preregistration nursing curriculum. Users' views about the knowledge, skills and attributes required by mental health nurses were explored to inform the curriculum design. Strategies that would facilitate long term, active user involvement in the design and delivery of the curriculum were also explored. Findings are presented with concurrent discussion of issues arising from the research process in relation to user involvement in education. The issue of 'conflict' explores findings relating to users' views of a 'good' mental health nurse and inherent conflicts between user and professional views are highlighted. The representativeness of the research participants is explored and debated in relation to service user involvement in nurse education. Finally, the concepts of 'involvement' and 'tokenism' are discussed and recommendations made about how active user involvement in nurse education can be achieved.     

Neonatal Nurse Practitioners: Influences on Career Choice

BackgroundThere is a nationwide shortage of neonatal nurse practitioners (NNPs). Strategies to increase NNPs must be informed by an understanding of their career motivations and decision processes.MethodsMail survey of all NNPs who applied to take the initial certification exam between January 2010 and June 2011 (N = 491).ResultsResponse rate was 84.6%. Most NNPs (60%, n = 214) decided to pursue education as an advanced practice nurse while in practice as an RN and 22% (N = 80) prior to becoming an RN.ConclusionsTo increase the number of practicing NNPs, the most robust recruitment efforts should occur among current RNs.     

Factors associated with the perceptions of eHealth technology of Chinese nurses and nursing students

AimThe current study sought to assess the perceptions of eHealth technology of nurses and nursing students in China and to examine the association between these perceptions and demographic factors.BackgroundDespite the increasing use of eHealth technologies in China and across the globe, the perceptions of practicing and student nurses remain minimally explored. Findings from such an inquiry can potentially inform actions and policies to improve the uptake of eHealth technologies among Chinese nurses.DesignThis was a cross-sectional study with a real-time online survey.MethodsA convenience sample of 1338 nurses and nursing students from Mainland China participated in the study. Their perceptions of eHealth technology were collected using the Chinese version of the Perceptions of eHealth Technology Scale. The Kruskal-Wallis test and multiple linear regression analysis were used to examine the relationship between demographic variables (age group, gender, occupation, education level, position and clinical experience) and perceptions of eHealth technology. All study procedures adhered to the STROBE guidelines.ResultsMost participants were aged between 20 and 29 (55.8%). Nearly half (42.5%) were frontline clinical nursing staff, some were nursing students (36.2%), academic nursing staff (12.3%) and clinical nursing management staff (9.0%). Regardless of the differences in their demographic characteristics, the participants had higher mean scores in “Perception of eHealth applications” and lower mean scores in “Knowledge of eHealth technology”. Participants with doctoral degree had a higher mean total score and higher sub-scale scores in knowledge of eHealth technology, perception of the advantages of eHealth technology and perception of eHealth applications; and the lowest scores in perception of the disadvantages of eHealth technology and perception of eHealth applications. Occupation, position and clinical experience were found to be the demographic characteristics associated with eHealth perceptions, before adjusting for age and gender. Education level was associated with eHealth perceptions regardless of adjustment.ConclusionOverall, participants had higher scores on perceptions of eHealth applications but lower scores on knowledge of eHealth technology. Considering the association between education and all subscales and overall scores, it may be essential to implement continuing professional education for nurses to improve their knowledge of eHealth applications. Encouragement to use available eHealth digital technologies may also be helpful to improve perceptions of eHealth.     

Survey: Is workplace-based learning meeting the needs of the 21st century neonatal nurse in Australia?

AimThe aim of this research was to identify the challenges of workplace-based education for neonatal nurses in clinical practice.MethodElectronic survey of neonatal nurses across Australia.ResultsOne-quarter of the neonatal nursing workforce will retire in the next decade. Only one-third of participants are enrolled in further studies. Part-time and casualisation, busy workplaces, carer responsibilities, financial costs and limited organisational support are barriers to education, both in the workplace and through external studies.LimitationsThe small population sample is a prominent limitation to this study. However, the findings reflect other studies exploring workplace-based learning, suggesting the conclusions drawn may be transferable to other contexts.ConclusionsConceivably, the next decade will see 27% of the neonatal nursing workforce retiring. There is a need to recruit and educate the future workforce. Current strategies for workplace-based education may not be meeting the learning needs of neonatal nursing staff. More novel approaches to workplace-based education may be required for the 21st century neonatal nurse.     

Reducing noncommunicable disease risk in midlife adults using eHealth: The GroWell for Health Program feasibility study

BackgroundMidlife adults are at increased risk of noncommunicable disease due to the lifetime cumulative effect of unhealthy behaviours and increased prevalence of overweight and obesity.AimThis study evaluates preliminary effectiveness and feasibility of an eHealth intervention (GroWell for Health Program) designed for primary prevention of modifiable risk factors in midlife adults.MethodsThe sample comprised community dwelling adults 40 to 59 years, able to read English with access to a personal computer/tablet. Following consent, participants were randomly allocated to a structured 8-week intervention including an eBook (Arm A) or an eBook plus nurse coaching (Arm B). Outcome measures include self-report physical activity, diet, stage of change; anthropometric measures; and feasibility.FindingsOverall 40 people consented to participate in the study. The majority were female (89.2%) with a mean age of 50.6 (SD = 6.3) years. Significant within groups change over time was observed in Arm A for physical activity, fruit, vegetable intake and exercise stage of change; and daily vegetable and fruit intake, fruit, and exercise stage of change than in Arm B.DiscussionThe direction of change in outcomes suggests the intervention content and structure is likely to be effective in supporting behaviour change in midlife adults. Health coaching from nurses improved retention, although for motivated participants completing the program independently using the eBook is a cost-effective option.ConclusionPromising results suggest the nurse delivered eHealth intervention is feasible and likely be effective in addressing modifiable risk factors for NCD in midlife adults.     

Neonatal kangaroo care - What we know and how we can improve its practice: An evidence review

PurposeThe purpose of this evidence search was to review past and current kangaroo care practice and explore the Iiterature relating to improving kangaroo care for preterm infants.MethodA literature review of evidence was undertaken in order to answer pre specified questions. The literature search was undertaken on CINAHL, Google Scholar and Pubmed. Key search terms were kangaroo care, skin to skin care, kangaroo mother care, preterm infants, benefits, practices, enablers and education.ConclusionA lack of training and formal education greatly inhibits kangaroo care provision in the neonatal environment. The level of confidence a nurse has in their ability to decide whether the infant is clinically stable or not, will determine if kangaroo care is offered. Neonatal nurse education is imperative in order to improve kangaroo care practice in the clinical setting.     

Digital adaptability competency for healthcare professionals: a modified explorative e-Delphi study

AimTo establish items of the digital adaptability competency for healthcare professionals.BackgroundWhile the application and deployment of eHealth has continued at a rapid pace, healthcare professionals are expected to keep up and join the digital evolution. The implementation of eHealth requires a change in the healthcare professionals’ competencies of which the ability to adapt to technological change is fundamental. There’s more needed than just ICT skills, overall competencies to be digitally adaptable between patientcare and the use of eHealth are needed. Today, a distinct and relevant list of items for healthcare professionals related to the competency of digital adaptability is missing.DesignAn exploratory modified e-Delphi study.MethodsThis study was conducted in Flanders, Belgium. An expert group (n = 12) consisting of 2 policymakers of the Belgian federal government, 3 eHealth managers of large organizations in the Belgian healthcare sector, 1 nurse, 1 midwife, 2 health service users and 3 researchers specialized in eHealth research.Through a literature review an initial list of items was developed, consisting of 67 statements. A two-round Delphi survey was performed where experts could rate the relevance of each item. The third round comprised an online meeting, where the expert group discussed the remaining items until agreement was reached to retain, modify, or eliminate the item.ResultsIn round 1, eleven items were included to the final document. In round 2, ten items were included. In round 3, the panel unanimously agreed to add six items, one item was modified into two separate items. In total, 29 items were included in the final document.ConclusionsThe rather abstract concept of digital adaptability is now transformed into a more pragmatic concept of 29 items, reflecting the practical competencies of healthcare professionals necessary to be digital adaptable.     

Implementation of a nurse-led family centered engagement intervention for caregivers of extremely premature infants in the neonatal intensive care unit

ObjectiveThe objective of this feasibility study was to examine the implementation and usefulness of an intervention for extremely premature infant (EPI) caregivers.ResultsOne caregiver and five nurses provided feedback with a mean score of 4.4 out of 5 pertaining to helpfulness.ConclusionsImplementation of the Caregiver's Guide was feasible and was positively received by NICU nurses and caregivers. We recommend implementing a revised version of this tool based on nurse and caregiver feedback. The delivery of education should be divided between dayshift and nightshift nurses so that one nurse is not responsible for providing all the information. The education should be categorized by gestational age and day of life and only given when it is pertinent to the care of the child. A section should be added to include a quick reference guide for the medical jargon used in the NICU.     

The evolution of the neonatal nurse practitioner role in Australia: A discussion paper

AimThe neonatal nurse practitioner role originated in the 1960's in the Unites States from a short fall in physicians. This occurred because of changes in medical training which reduced time in specialist areas and in conjunction, the demand for neonatal care increased due to the survival of premature babies and advances in specialised care. The aim of this review is to identify the discrepancies between roles and responsibilities, highlight the challenges NNP face and explore possible role development opportunities to make the position sustainable.MethodCurrent review of the literature (MESH TERMS – neonatal and/or nurse practitioner, Australia) revealed fourteen published articles and government documents identifying requirements for endorsement and standards for nurse practitioner practice.ResultNeonatal nurse practitioners spend most of their time delivering direct patient care regardless of the clinical setting, however elements of research, education and leadership are still incorporated within clinical practice. Alongside the clinical role, antenatal counselling, facilitation of communication amongst the multidisciplinary team and parents, prescribing, ordering diagnostic tests have all became core components to define the scope of the NNP. However, as the role has expanded NNP must adapt to changes to continue to be recognised as a valuable member of the multidisciplinary team especially as registered nurses start to take on extended roles.ConclusionThe senior clinical role of the neonatal nurse practitioner continues to evolve. There are challenges to be overcome, however there are now more than thirty neonatal nurse practitioners in Australia and together the possibilities for expansion of their role are limitless. This can only be of benefit to our babies, their families and the nursing profession.     

‘Meet Me Where I Am’: Mental health service users’ perspectives on the desirable qualities of a mental health nurse

Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users’ perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co‐produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub‐themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery‐oriented practice. These findings were utilized to directly inform development of a co‐produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.     

Becoming a Psychiatric/Mental Health Nurse in the UK: A Qualitative Study Exploring Processes of Identity Formation

Identity studies are well established across the social science literature with mental health nursing beginning to offer evidenced insights into what may, or may not, constitute key identity performances. For mental health nursing these performances remain contested, both from within the profession and from international contexts that favour generic constructions of mental health. This paper offers findings from a qualitative study that focused upon the process of how mental health nursing identity development is influenced, rather than what that identity may or may not be. These findings highlight that mental health nurses (MHNs) not only form their identity around service user centred education and training, but that many also use the education as a means to leave the profession. Through highlighting the impact of informal education (i.e., through work), formal education, and training upon the formation of mental health nursing identity, nurses are potentially alerted to the importance of clinically focussed mental health being prominent within curricula, rewarding mental health nursing skills specialisation, and the importance of the role of the service user in mental health nurse education and, hence, identity formation.     

Service user involvement in nurse education: a report on using online discussions with a service user to augment his digital story

Service user involvement is a key element within current pre- and post-registration nurse education in the U.K. but achieving this is challenging. Most service user involvement is through classroom visits. Digital stories, film and audio are alternatives but lack the interactivity and development of reflection that can be achieved through face-to-face contact. This report reviews the background to service user involvement in healthcare professional education then provides a reflective account of a novel initiative whereby a spinal-injured patient was involved in creating a digital story around some of his in-hospital experiences and then engaged in online discussions with post-registration nursing (degree) and practice educator (masters) students. These discussions provided a richer experience for the students enabling them to reflect more deeply on how nursing care is delivered and perceived by service users. The report concludes that digital stories can be used with repeated groups to inspire discussion and reflection. Augmenting such digital stories with online discussions with the service user whose story is told helps practitioners develop greater empathy, insight and understanding which are beneficial for improving service delivery and nursing care.     

Hospital and unit characteristics associated with nursing turnover include skill mix but not staffing level: An observational cross-sectional study

BackgroundNursing turnover is expensive and may have adverse effects on patient care. Little is known about turnover's association with most hospital and nursing unit characteristics, including nurse staffing level and registered nurse skill mix.ObjectiveTo explore associations between nursing unit turnover rates and several hospital- and unit-level variables, including staffing level and skill mix.DesignObservational cross-sectional study of longitudinal data.Settings1884 nursing units in 306 U.S. acute care hospitals.MethodsDuring a 2-year period units reported monthly data on staffing and turnover. Total nursing staff turnover and registered nurse turnover rates were modeled as dependent variables in hierarchical Poisson regression models. The following hospital characteristics were considered as predictors: Magnet^® status, ownership (government or non-government), teaching status, locale (metropolitan, micropolitan, or rural), and size (average daily census). The U.S. state in which the hospital was located was included as a covariate. Unit-level variables included total nursing hours per patient day, size of nursing staff, registered nurse skill mix, population age group (neonatal, pediatric, or adult), and service line (critical care, step-down, medical, surgical, medical/surgical, psychiatric, or rehabilitation).ResultsGovernment ownership, Magnet designation, and higher skill mix were associated with lower total turnover and registered nurse turnover. Neonatal units had lower total and registered nurse turnover than pediatric units, which had lower total and registered nurse turnover than adult units. Unit service line was associated only with total turnover. Psychiatric, critical care, and rehabilitation units had the lowest mean turnover rates, but most differences between service lines were not significant. The other explanatory variables considered were not significant.ConclusionsSeveral hospital and unit characteristic variables have significant associations with nursing turnover; these associations should be taken into account in nursing turnover research and need to be explored further. Controlling for hospital ownership, Magnet status, unit service line, and unit population age group, registered nurse skill mix is apparently more important than total nurse staffing level in predicting nursing turnover.     

Antibiotic prescribing in primary care: The need for interprofessional collaboration

Abstract

Patients with self-limiting respiratory tract infections (RTIs) are frequently seen in general practice. Although antibiotics are ineffective for these conditions, they are often prescribed by general practitioners (GPs), and perceived patient expectations for an antibiotic plays an important role in the decision to prescribe one. Superfluous use of antibiotics contributes to antimicrobial resistance. High numbers of nurse prescribers work alongside GPs and these prescribers see education and self-management advice as central to the care of these patients. Multi-faceted interventions, designed to reduce antibiotic prescribing, only exist for GPs. Such interventions should foster interprofessional collaboration and, as such, consider the needs and experiences of the different prescribers, and the views of patients. This paper outlines a research study in which a questionnaire will be distributed to patients who consult with a nurse prescriber to see whether their expectations influence their satisfaction with the consultation outcome. Findings will guide the development of an interprofessional intervention designed to promote collaborative practice and appropriate and responsible antibiotic prescribing in primary care.