Nurses’ perspectives regarding the disclosure of errors to patients: A qualitative study

BackgroundThere is often a mismatch between patients’ desire to be informed about errors and clinical reality. In closing the “disclosure gap” an understanding of the views of all members of the healthcare team regarding errors and their disclosure to patients is needed. However, international research on nurses’ views regarding this issue is currently limited.ObjectivesExplore nurses’ attitudes and experiences concerning disclosing errors to patients and perceived barriers to disclosure.DesignInductive, exploratory study employing semi-structured interviews with participants, followed by conventional content analysis in which investigators read and discussed transcribed data to identify important themes.SettingsNursing departments from hospitals in two German-speaking cantons in Switzerland.ParticipantsPurposive sample of 18 nurses from a range of fields, positions in organisational hierarchy, work experience, hospitals, and religious perspectives.MethodsData were collected via individual, face-to-face interviews using a researcher–developed semi-structured interview guide. Interviews were transcribed in German and analysed using the qualitative data analysis software package Atlas-Ti (Berlin) and conventional content analysis. The most illustrative quotes were translated into English.ResultsNurses generally thought that patients should be informed about every error, but only a very few nurses actually reported disclosing errors in practice. Indeed, many nurses reported that most errors are not disclosed to the patient. Nurses identified a number of barriers to error disclosure that have already been reported in the literature among all clinicians, such as legal consequences and the fear of losing patients’ trust. However, nurses in this study more frequently reported personal characteristics and a lack of guidance from the organisation as barriers to disclosure. Both issues suggest the need for a systematic institutional approach to error disclosure in which the decision to inform the patient stems from within the organisation and is not shouldered by individual nurses alone.ConclusionsOur study suggests that hospitals need to do more to support and train nurses in relation to error disclosure. Such measures as hospitals establishing a disclosure support system, providing background disclosure education, ensuring that disclosure coaching is available at all times, and providing emotional support for all parties involved, would likely go a long way to address the barriers identified by nurses.     

Nursing students’ expectations of the process of writing a bachelor’s thesis in Sweden: A qualitative study

While performing various academic work, such as writing a bachelor’s thesis, are known to be challenging for university students, less is known about students’ expectations in this regard.AimThe aim was to describe students’ expectations of the upcoming process of writing a bachelor’s thesis.DesignThe study employed an explorative, qualitative approach with a single, written open-ended question design.MethodsThe data were collected consecutively 2013–2016 in class. A total of 93 final-year students volunteered and provided hand-written accounts which were analyzed using qualitative content analysis.ResultsThe students’ accounts revealed three generic categories of expectations: Gaining professional knowledge and competency, Planning and organizing the work, and Taking stock of personal resources. Writing a bachelor’s thesis was a new challenge for most of the students and the answers testify to mixed feelings about the upcoming work and its supervision.ConclusionsThe nursing students’ expectations included present and future competencies, skills and abilities. In promoting development of transferable skills and knowledge, educators of future health-care professionals would be well advised to invite students to reflect on and discuss, their expectations prior to writing a bachelor’s thesis and similar academic student papers. This study adds to the research on students’ studying and learning in nursing education by bringing to the fore students’ expectations of academic learning tasks as an important aspect to consider in higher education contexts, both nationally and internationally.     

Preceptors’ perceptions of supporting nursing students in prison health services: A qualitative study

BackgroundOur university commenced clinical placements for third-year nursing students in Prison Health Services (PHS) in 2014. Registered nurse preceptors employed in these services facilitated students’ experiential workplace learning, assessed their competence and assisted them to meet course objectives in this challenging environment. To date, no studies have examined preceptors’ experiences of supporting students in the prison health setting.AimThe study aim was to investigate preceptors’ perceptions of supporting nursing students undertaking clinical placements in PHS, in order to inform development of resources and processes.MethodsQualitative data were collected via a focus group and interviews with preceptors (n = 6) working in metropolitan PHS. Data underwent thematic analysis.FindingsParticipants valued the opportunity to support student learning, finding students contributed to the workplace by bringing in new ideas, and conducting beneficial projects. However, preceptors requested better rostering and workload management by their employer. They also wished for more detailed information from the university regarding student orientation and preparation to support student learning. They felt that the employer-provided preceptorship training did not fulfil their needs.DiscussionPreceptors in PHS settings shared many of the support needs of those in other settings, although some challenges were more specific to the setting.ConclusionThis paper makes recommendations on how preceptors in PHS can be better supported to fulfil the role.     

Undergraduate nursing students’ experiences of online education: A cross-sectional survey

During the coronavirus pandemic, UK Academics were required to adjust their learning and teaching environment and pedagogical approaches, with little guidance or time. Feelings of frustration and uncertainty around student engagement were commonplace across Higher Education Institutions. This was heightened in professionally regulated courses, such as nursing. The shift to online learning created a situation where academics were frequently faced with a ‘sea of black screens’ and unable to ascertain student engagement.This study investigated undergraduate nursing students’ experience of online education during the COVID-19 pandemic. An anonymous survey was distributed to each year of the undergraduate nursing programme and data subsequently analysed. Responses from 54 students revealed that engagement varied between different year groups. There were significant differences between those with pre-COVID (traditional face-to-face) teaching experience (years 2 and 3) and those without (year 1) in regard to self-reported engagement with online learning. The findings from this study revealed some powerful and emotional insights into the experience of online learning amongst UK students undertaking an undergraduate nursing programme during the COVID-19 pandemic.     

Midwives’ and health visitors’ collaborative relationships: A systematic review of qualitative and quantitative studies

ObjectivesInterprofessional collaboration between midwives and health visitors working in maternal and child health services is widely encouraged. This systematic review aimed to identify existing and potential areas for collaboration between midwives and health visitors; explore the methods through which collaboration is and can be achieved; assess the effectiveness of this relationship between these groups, and ascertain whether the identified examples of collaboration are in line with clinical guidelines and policy.DesignA narrative synthesis of qualitative and quantitative studies.Data sourcesFourteen electronic databases, research mailing lists, recommendations from key authors and reference lists and citations of included papers.Review methodsPapers were included if they explored one or a combination of: the areas of practice in which midwives and health visitors worked collaboratively; the methods that midwives and health visitors employed when communicating and collaborating with each other; the effectiveness of collaboration between midwives and health visitors; and whether collaborative practice between midwives and health visitors meet clinical guidelines. Papers were assessed for study quality.ResultsEighteen papers (sixteen studies) met the inclusion criteria. The studies found that midwives and health visitors reported valuing interprofessional collaboration, however this was rare in practice. Findings show that collaboration could be useful across the service continuum, from antenatal care, transition of care/handover, to postnatal care. Evidence for the effectiveness of collaboration between these two groups was equivocal and based on self-reported data. In relation, multiple enablers and barriers to collaboration were identified. Communication was reportedly key to interprofessional collaboration.ConclusionsInterprofessional collaboration was valuable according to both midwives and health visitors, however, this was made challenging by several barriers such as poor communication, limited resources, and poor understanding of each other’s role. Structural barriers such as physical distance also featured as a challenge to interprofessional collaboration. Although the findings are limited by variable methodological quality, these were consistent across time, geographical locations, and health settings, indicating transferability and reliability.     

Families’ perspectives of participation in patient care in an adult intensive care unit: A qualitative study

BackgroundWhen a relative is admitted to the intensive care unit (ICU), stress, anxiety, and failure to cope may place families, and the patient, at risk for adverse psychological outcomes. Family participation in patient care may improve patient and family outcomes. However, to date, little is known about how families perceive and participate in patient care in ICU, and there is limited research to guide clinicians about supporting family participation in this context.ObjectiveTo describe family perspectives of participation in patient care in adult ICU.MethodsUsing a qualitative design, observation and interview data were collected from a convenience sample of 30 family members in the ICU at two metropolitan hospitals in Melbourne, Australia. An independent third party was used to recruit potential participants. Naturalistic observations and semi-structured interviews explored families’ actions and perceptions of participation. Data were integrated and subject to thematic analyses.FindingsThe major theme Families as part of the healthcare team reflected family perspectives of their own significant contribution to supporting their relative’s recovery while they were in ICU. Families' perception of their participation in patient care was characterised by three sub-themes: 1) Motivators for family participation; 2) Family roles during recovery; and 3) Influences on family participation. Families' perceived reassurance and companionship as important contributions to patient care.ConclusionFamilies perceived their contribution to the patient's psychosocial and emotional well-being to be one of the most important aspects of participation. Nevertheless, their role in the healthcare team was influenced by several motivational factors. Results of this study can inform further research to test the effectiveness of clinical practice and educational interventions aligned with family preferences to promote participation and enhance patient and family-centered care in ICU.     

Nursing students’ perceptions and experiences of reflective practice: A qualitative meta-synthesis

Reflective practice is a vital component of nursing education. It allows for the integration of core theoretical knowledge and the clinical experience. Despite a small and growing body of literature exploring the nursing students’ perceptions and experiences of this process, a review of the qualitative literature has not been published. The purpose of this meta-synthesis is to examine the qualitative data of nursing students’ perceptions and experiences of reflective practice. This meta-synthesis provides a model that suggests quality reflection results in an improvement in practice. Students perceive that quality reflection occurs when all facets of this model have been met. This encompasses an understanding of knowledge including, learning and the barriers and enablers to knowledge, as well as self-discovery including, facing emotions and personal growth. Understanding these experiences and perceptions will permit further understanding of the motivations and factors that influence the quality of reflective practice.     

Nursing degree students’ clinical placement experiences in Australia: A survey design

AimThis study aimed to evaluate Australian nursing students’ views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET).BackgroundClinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences.DesignA survey design was used with a contemporary survey tool– the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed.MethodsA total of 1263 nursing students completed the Placement Evaluation Tool (PET) − 19 items (rated 1–5), one global rating (rated 1–10) − following placement in three Australian States (July 2019−February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall.ResultsThe total PET mean score was 78.3% with 29.8% being ‘extremely satisfied’ (10 out of 10 – Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle.ConclusionsWhilst students’ clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.     

Postoperative patients’ perspectives on rating pain: A qualitative study

BackgroundIn postoperative pain treatment patients are asked to rate their pain experience on a single uni-dimensional pain scale. Such pain scores are also used as indicator to assess the quality of pain treatment. However, patients may differ in how they interpret the Numeric Rating Scale (NRS) score.ObjectivesThis study examines how patients assign a number to their currently experienced postoperative pain and which considerations influence this process.MethodsA qualitative approach according to grounded theory was used. Twenty-seven patients were interviewed one day after surgery.ResultsThree main themes emerged that influenced the Numeric Rating Scale scores (0–10) that patients actually reported to professionals: score-related factors, intrapersonal factors, and the anticipated consequences of a given pain score. Anticipated consequences were analgesic administration—which could be desired or undesired—and possible judgements by professionals. We also propose a conceptual model for the relationship between factors that influence the pain rating process. Based on patients’ score-related and intrapersonal factors, a preliminary pain score was “internally” set. Before reporting the pain score to the healthcare professional, patients considered the anticipated consequences (i.e., expected judgements by professionals and anticipation of analgesic administration) of current Numeric Rating Scale scores.ConclusionsThis study provides insight into the process of how patients translate their current postoperative pain into a numeric rating score. The proposed model may help professionals to understand the factors that influence a given Numeric Rating Scale score and suggest the most appropriate questions for clarification. In this way, patients and professionals may arrive at a shared understanding of the pain score, resulting in a tailored decision regarding the most appropriate treatment of current postoperative pain, particularly the dosing and timing of opioid administration.     

A survey of Canadian cancer patients’ perspectives on the characteristics and treatment of breakthrough pain

Objective

Breakthrough pain is defined as a transient exacerbation of pain that occurs spontaneously or in response to a trigger despite stable and controlled background pain. The purpose of this study was to explore Canadian patients’ awareness of and experience with breakthrough pain in cancer (BTPc).

Methods

Four Canadian cancer centers participated in a non-interventional survey recruiting cancer patients who experienced breakthrough pain. These patients were asked about their pain, its impact on functioning, current management and interest in new treatments of BTPc.

Results

Ninety-four Canadian cancer patients participated in this study, with 96 % stating that cancer pain impacted their daily living with over half unable to go to work or shopping. Fifty percent of patients said that an episode of BTPc lasted greater than 60 minutes, with the pain score being on average 7.8/10, impacting normal work (7.2/10) and general activity (7.1/10). Only 35 % of patients were very satisfied with the speed of relief of their medications. Those who did not take their breakthrough pain medication for every episode stated that was because the pain was not always severe (37 %), or they were afraid of becoming tolerant (23 %) or addicted (12 %). Patients stated that the most important features of a new treatment for BTPc were the ability to relieve pain completely (47 %), and quickly (43 %). Patients expressed willingness to try transmucosal products (80 %) or nasal products (59 %).

Conclusion

Breakthrough cancer pain in Canadian cancer patients greatly impacts their daily lives. There is room for improvement in the management of BTPc, and the majority of patients would be willing to try new treatments.     

A qualitative assessment of mothers’ perspectives on hospital and community breastfeeding support in Mississippi

The objective of this exploratory qualitative study was to interview breastfeeding mothers who gave birth in three Mississippi areas in 2019, and to record their breastfeeding experiences since the statewide increase in Baby-Friendly activity. Five virtual focus groups were conducted (between February and March 2021) with mothers who gave birth in 2019 and initiated breastfeeding, from the Mississippi Delta, Meridian, and Jackson. Participants discussed their prenatal care, time in the hospital and experience at home after the birth, focusing on breastfeeding education, support, and beliefs. Five key themes regarding participants’ hospital and community breastfeeding support experiences and beliefs emerged.Participants reported conflicting breastfeeding support experiences. While several women reported improvements in the breastfeeding environment in Mississippi, some continue to experience inadequate hospital, community, and workplace lactation support. More work needs to be done to ensure optimal prenatal, in-hospital, and at-home breastfeeding education and support in Mississippi.     

Midwives’ experiences of completing written feedback: The emotions,challenges and solutions

AimWritten feedback is a valued learning tool for midwifery students, providing information on clinical performance with the aim to improve future practice.One aim of this study was to explore the experiences of midwives in completing written feedback in the clinical setting.DesignThis qualitative study is situated within a hermeneutic phenomenological framework.MethodsData were collected through focus groups and individual interviews, then transcribed and subjected to thematic content analysis.ResultsThree interconnected themes of Emotions, Challenges and Solutions were identified. Midwifery participants experienced strong emotional reactions (anxiety, guilt, frustration) around the completion of written feedback in the clinical setting due to four challenges (lack of time, continuity, clarity of feedback content and direct supervision), which resulted in solutions being employed to offset or minimise problematic written feedback.ConclusionsCompleting written feedback in the clinical setting was a challenging experience for participants in this study, affecting their ability to do so in some cases. This is concerning as the literature is supportive of the positive impact written feedback has on the growth and potential of students.