Examining the hurdles in defining the practice of Nurse Navigators

BackgroundNurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care.PurposeA critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident.DiscussionNurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance.ConclusionNurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide.     

Advanced practice profiles and work activities of nurse navigators: An early-stage evaluation

Background

Effective coordination and integration of care between health care providers is critical to manage complex, chronic medical conditions.

Scaffolding behavioral health concepts from more simple to complex builds NP students' competence

BackgroundBehavioral health disorders (psychiatric illness and substance abuse disorders) represent a significant burden across the nation's health care system. About one half of the problems that present in primary health care settings are behavioral in nature. There is urgent need to improve the integration of behavioral health care services into primary care.MethodsThe purpose of this paper is to describe how an asynchronous online graduate nurse practitioner program utilized a constructivist paradigm to creatively combine online problem based learning cases and on campus learning intensives to scaffold student learning.ResultsStudent E-value scores were high and comments reflected improved knowledge, skill and comfort managing behavioral health problems in a primary care setting.ConclusionThis innovative model can serve as a template for other educational programs and improve student's ability to identify, manage and treat common behavioral health care problems that present in primary care settings.     

Intentional rounding in the context of student learning

Problem/backgroundIntentional rounding or regular patient checks were introduced in to healthcare settings to enhance patient safety and satisfaction. Patient and staff experiences have been explored in the literature, however the student nurse’ experience of this intervention has not been explored in the context of their learning on clinical placement.AimThis study aimed to explore students’ experience and understanding of intentional rounding in the clinical setting.MethodsSemi-structured interviews were conducted with 18 student nurses.FindingsIntentional rounding has raised many learning issues for students. The study found that intentional rounding creates a framework to reflect on the nexus between attending to patient need, and the learning student nurses undertake, and creates an avenue for them to be able to operationalise quality patient care.DiscussionStudent nurses need to be part of the ward ‘team’ to enhance their learning. There are limitations surrounding positive role modelling, sharing of information and formal education in such interventions, which impacts students’ confidence, involvement and understanding. If done effectively, participation in intentional rounding can increase students’ time management skills, assessment ability, and the safety of the patient.ConclusionModelling positive behaviours, and encouraging active and educated involvement in intentional rounding will enhance confidence and skill, and reduce the theory practice gap.     

Nursing students’ perceptions of community care and other areas of nursing practice – A review of the literature

ObjectivesTo review recent literature on student nurses’ perceptions of different areas of nursing practice, in particular community care. Healthcare is changing from care delivery in institutional settings to care to patients in their own homes. Problematic is that nursing students do not see community care as an attractive line of work, and their perceptions of community care do not reflect the realities of the profession. Understanding the factors influencing the perception of the professional field is important to positively influence students’ willingness to see community nursing as a future profession.DesignLiterature search with accompanying narrative synthesis of primary research.Data sourcesERIC^®, PsycInfo^®, Pubmed^®, and CINAHL^® (2004–2014) databases using the search terms: ‘nursing student’, ‘student nurse’, ‘community care’, ‘community nurse’, ‘image’, ‘attitude’, and ‘perception’.Review methodsAfter screening 522 retrieved article titles with abstracts, the number of articles was reduced based upon specified inclusion/exclusion criteria leading to inclusion of 34. Evaluation of the references in those articles yielded an additional 5 articles. A narrative synthesis of those articles was created to uncover students’ perception of community care, other areas of professional practice, and the factors influencing those perceptions.Results39 articles were selected. Results show that many nursing students begin their education with a lay person's conception of the profession, shaped by media representations. Work placements in different settings offer clinical experience that helps students orient themselves towards a future profession. Students prefer hospitals as a place of work, because of the acute nature and technologically advanced level of care offered there. Few students perceive mental health and elderly care as appealing. Perceptions of community care can vary widely, the most prevalent view being that it is unattractive because of its chronic care profile, with little technical skill, untrained workers, and a high workload. However, another view is that it offers challenging and meaningful work because of the variety of caregiving roles and the opportunity to work independently.ConclusionsFew nursing students choose community nursing as a future profession. They have a limited and often mistaken view of community care, and they underestimate the field's complexity because it is less visible than in the environment of acute care. Providing students with specific curricular content and employing a structured approach to preparation for work placement could help build a more positive perception of community care, leading to more students seeing/choosing community care as a desirable field of work.     

From Evidence-Based Practice to Knowledge Translation: What Is the Difference? What Are the Roles of Nurse Leaders?

ObjectivesNurses, as the largest healthcare workforce, are well-positioned to apply knowledge translation. The role of nursing leadership in facilitating evidence-based practice has been extensively discussed in the literature, but this is not the case for knowledge translation. The objective of this study was to examine the potential role of nurse leaders in applying knowledge translation across health settings.Data SourcesWe reviewed the existing literature for evidence-based practice as best practice in clinical care; examined how a complex systems approach to knowledge translation may extend beyond evidence-based practice, and considered nursing leadership approaches including transformational leadership.ConclusionIn this discursive article, we discuss the differences between evidence-based practice and knowledge translation, highlight the promise of transformational leadership in facilitating knowledge translation through a complex systems lens, and argue for the importance of nurse leaders in facilitating and supporting complex knowledge translation across healthcare settings.Implications for Nursing PracticeAlthough future research is needed to test our ideas, we argue that the advanced conceptual understanding generated in this article should inform a roadmap toward a future in which nurse leaders initiate, participate and advocate for complex knowledge translation across healthcare settings.     

Second victim phenomenon: Is ‘just culture’ a reality? An integrative review

BackgroundDespite rigorous and multiple attempts to establish a culture of patient safety and a goal to decrease incidence of patient deaths in the health care, estimations of preventable mortality due to medical errors varied widely from 44,000 to 250,000 in hospital settings. This magnitude of medical errors establishes patient safety as being at the forefront of public concerns, healthcare practice and research. In addition to the potential negative impact on patients and the healthcare system, medical errors evoke intense psychological responses in health care providers' responses that threaten their personal and professional selves, and their ability to deliver high quality patient care. Studies show half of all hospital providers will suffer from second victim phenomena at least once in their careers. Health care institutions have begun a paradigm shift from blame to fairness, referred to as ‘just culture’. ‘Just culture’ better ensures that a balanced, responsible approach for both providers who err and healthcare organizations in which they practice, and shifts the focus to designing improved systems in the workplace.ObjectivesThe aim of this review was to identify: how medical errors affect health care professionals, as second victims; and how health care organizations can make ‘just culture’ a reality.DesignAn integrative review was performed using a methodical three-step search on the concept of second victims' perceptions and responses, as well as ‘just culture’ of health care institutions.ResultsA total of 42 research studies were identified involving health care professionals: 10 qualitative studies; eight mixed-method studies; and 24 quantitative studies. Second victims' perceptions of the current ‘just culture’ included: 1) fear of repercussions of reporting medical errors as a barrier; 2) supportive safety leadership is central to reducing fear of error reporting; 3) improved education on adverse event reporting, developing positive feedback when adverse events are reported, and the development of non-punitive error guidelines for health care professionals are needed; and 4) the need for development of standard operating procedures for health care facility peer-support teams.ConclusionsSecond victims' perceptions of organizational and peer support are a part of ‘just culture’. Enhanced support for second victims may improve the quality of health care, strengthen the emotional support of the health care professionals, and build relationships between health care institutions and staff. Although some programs are in place in health care institutions to support ‘just culture’ and second victims, more comprehensive programs are needed.     

Qualitatively exploring the attributes of adaptability and resilience amongst recently graduated nurses

AimTo explore newly graduated nurse’s understandings and practices of adaptability and resilience in clinical environments.BackgroundThe everyday practice of nursing work involves managing emotional and practical everyday demands related to the role. Adaptability and resilience are two critical attributes that equip nurses for this by enabling them to manage challenges and be flexible with their practices and expectations in the face of rapidly changing and unpredictable circumstances.DesignInformed by the theoretical underpinnings of the Person-centred Practice Framework, semi-structured interviews using topic guides were conducted with nine newly graduated registered nurse participants recruited through purposive sampling. Interviews occurred between March-October 2020 with participants working across seven different healthcare settings in three Local Health Districts in NSW, Australia.ResultsAnalysis of the data generated the core themes of: 1) ‘Making sense’ explored how nurses defined resilience and adaptability; 2) ‘Surviving as the nurse’ focused on how nurses experienced adaptability and resilience as a newly qualified nurse; 3) ‘Trusting oneself’ reflected the interconnection of nurses’ developed adaptability and resilience to their clinical self-assurance; and 4) ‘Doing it again’ described how adaptability and resilience can be further supported by the university sector. Findings demonstrated that adaptability and resilience in combination are essential attributes and required for effective nursing practice post-graduation. However, both collegial and organizational support were found to be lacking in positively reinforcing these attributes in this study.ConclusionNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.Tweetable abstractNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.     

Job control,work-family balance and nurses’ intention to leave their profession and organization: A comparative cross-sectional survey

BackgroundThe shortage of nurses is a problem in many countries. In Japan, the distribution of nurses across different care settings is uneven: the shortage of nurses in home healthcare and nursing homes is more serious than in hospitals. Earlier research has identified numerous factors affecting nurses’ intention to leave work (e.g., job control, family-related variables, work-family conflict); however, these factors’ levels and effect size may vary between nurses in hospitals, home healthcare, and nursing homes.ObjectivesThis study measured job control, family-related variables, and work-family conflict among nurses in hospitals, home healthcare, and nursing homes, and compared these variables’ levels and effect size on nurses’ intention to leave their organization or profession between these care settings.DesignThe research design was cross-sectional.MethodsParticipating nurses from hospitals, home healthcare facilities, and nursing homes self-administered an anonymous questionnaire survey; nurses were recruited from the Kyushu district of Japan. Nurses from nine hospitals, 86 home healthcare offices, and 107 nursing homes participated. We measured nurses’ intention to leave nursing or their organization, perceived job control, family variables and work-family conflict. We analyzed 1461 participants (response rate: 81.7%).ResultsThe level of job control, family variables, and work-family conflict affecting nurses varied between hospitals, home healthcare, and nursing homes; additionally, these variables’ effect on nurses’ intention to leave their organization or profession varied between these care settings. Work-family conflict, family variables, and job control most strongly predicted nurses’ intention to leave their organization or profession in hospitals, home healthcare, and nursing homes, respectively.ConclusionsInterventions aiming to increase nurse retention should distinguish between care settings. Regarding hospitals, reducing nurses’ work-family conflict will increase nurse retention. Regarding home healthcare, allowing nurses to fulfill family responsibilities will increase nurse retention. Regarding nursing home nurses, increasing nurses’ job control will increase nurse retention.     

Competencias y perfil profesional de la enfermera de práctica avanzada

IntroductionThe advanced practice nurse can foster the development of innovative approaches in the design of patient, families and community care. This study has aimed to explain the importance of the advanced practice nurse, especially that of the clinical nurse specialist (CNS), within the care setting and to go deeper into the knowledge of this nursing profile.DesignA review of the literature.MethodThe following databases were used: CINAHL, PubMed and Medline. Search terms were ‘clinical nurse specialist,’ ‘implementation,’ and ‘advanced practice nursing.’ResultsThe sample included 24 publications. A synthesis of the findings generated a summary of the competencies of CNS and their definitions, with some examples in their daily practice and the outcome on its 3 spheres of influences: patients and families, staff and organization.ConclusionCNS emerges in the health systems in order to improve the outcomes in the patients, staff and the organization per se because of its competence as an agent of change and transformational leaderRelevance to clinical practiceNational policies and national strategies are needed to implement CNS on the Master's level in the Spanish National Health System given the evidence-based improvement in the care standards.     

Grief experiences of nurses after the death of an adult patient in an acute hospital setting: An integrative review of literature

ObjectiveThis integrative review explores current published literature examining grief experiences of nurses who work in hospital settings after the death of a patient in their care and the factors that may impact nurses experiencing grief within the workplace.BackgroundHealthcare workers such as nurses are required to be competent, skilled and resilient in preparation for the emotional variables and professional responsibilities when managing a patient death. There are publications exploring nurse’s grief experiences in palliative care, paediatric nursing or oncology settings, but to date, there is limited relevant literature identifying or exploring grief experiences of nurses working in other speciality areas in a hospital setting after the death of a patient in their care.MethodsComprehensive online database searches of CINAHL, EBSCO Host, PubMED, MEDLINE, Scopus, Joanna Briggs Institute (JBI) and Google Scholar was undertaken using key terms of articles published between 1990–2017. Screening of 317 articles resulted in 5 included for this review. Data analysis was guided by Whittemore and Knafl’s five stage process.FindingsThree main themes were identified were ‘the impact of formative death events in clinical practice’, ‘managing personal grief reactions and the factors that influenced these reactions’, and ‘the significance of colleague support when experiencing a patient death’.ConclusionPersonal grief responses displayed by a nurse after a patient has died can have both a positive and negative influence on their professional behaviour in the workplace. It also has the potential for grief complications for individual nurses, which highlights the importance of workplace support for nurses when making clinical decisions after the death of a patient.     

The impact of emotional intelligence in health care professionals on caring behaviour towards patients in clinical and long-term care settings: Findings from an integrative review

BackgroundOver recent years there has been criticism within the United Kingdom’s health service regarding a lack of care and compassion, resulting in adverse outcomes for patients. The impact of emotional intelligence in staff on patient health care outcomes has been recently highlighted. Many recruiters now assess emotional intelligence as part of their selection process for health care staff. However, it has been argued that the importance of emotional intelligence in health care has been overestimated.ObjectivesTo explore relationships between emotional intelligence in health care professionals, and caring behaviour. To further explore any additional factors related to emotional intelligence that may impact upon caring behaviour.DesignAn integrative review design was used.Data sourcesPsychinfo, Medline, CINAHL Plus, Social Sciences Citation Index, Science Citation Index, and Scopus were searched for studies from 1995 to April 2017.Review methodsStudies providing quantitative or qualitative exploration of how any healthcare professionals’ emotional intelligence is linked to caring in healthcare settings were selected.ResultsTwenty two studies fulfilled the inclusion criteria. Three main types of health care professional were identified: nurses, nurse leaders, and physicians. Results indicated that the emotional intelligence of nurses was related to both physical and emotional caring, but emotional intelligence may be less relevant for nurse leaders and physicians. Age, experience, burnout, and job satisfaction may also be relevant factors for both caring and emotional intelligence.ConclusionsThis review provides evidence that developing emotional intelligence in nurses may positively impact upon certain caring behaviours, and that there may be differences within groups that warrant further investigation. Understanding more about which aspects of emotional intelligence are most relevant for intervention is important, and directions for further large scale research have been identified.     

How to prepare Chinese-born nurses to care for patients at the end-of-life in Western settings: A discussion paper

BackgroundAs a result of globalisation, many Chinese-born nurses choose to work outside China. They are expected to be competent in providing end-of-life care and dealing with dying and death within the new country, where cultural beliefs, attitudes, and values towards dying and death may differ from their own. It is essential to consider the influence of Chinese culture on nurses’ confidence and preparedness for end-of-life care, especially for dealing with dying and death.PurposeTo discuss Chinese perspectives on dying and death, and death education and training in mainland China, from which we propose recommendations for nurse educators, clinical mentors and researchers in Western settings on how to prepare Chinese-born nurses to care for patients at end-of-life.DiscussionChinese-born nurses likely encounter significant cultural challenges when providing end-of-life care to dying patients in Western settings. Chinese-born nurses’ perspectives, attitudes and values toward dying and death are shaped by Chinese cultural and social beliefs, practices and expectations, which contrast with those of Western settings. Nurse educators, clinical mentors and researchers in Western settings are encouraged to support and guide Chinese-born nurses in building their cross-cultural understanding and world view to an international view of nursing; essential foundations to the provision of end-of-life care, and nurse coping with dying and death in Western settings.ConclusionThe development of death education programs and training to support Chinese-born nurses to attain their cultural competence is a priority in Western countries, to better promote these nurses’ competency in providing high-quality end-of-life care.     

Undergraduate registered nursing students working as assistants in nursing within the acute care environment: Program development and discussion

BackgroundMost pre-registration nursing students require employment during their studies which may entail undertaking another qualification.This paper describes how one university developed a program whereby undergraduate nursing students complete the national vocational education – HLT33115 Assistant in Nursing qualification through recognition of prior learning, a self-directed education package and completion of an objective structured clinical examination.ObjectiveTo discuss the development of an ‘Assistant in Nursing’ in the acute care environment program for pre-registration undergraduate nursing degree students using the national vocational education framework.DesignThis program maps the national ‘Assistant in Nursing- Acute Care’ vocational qualification to the pre-registration registered nurse degree. Upon successful completion of this program students can work as Assistants in Nursing within the acute care environment.ConclusionsThis program enables student nurses to work as Assistants in Nursing within the acute care environment. This provides employment in a health facility and opportunities for students to immerse themselves in the clinical environment whilst continuing their studies. This may assist students to gain a deeper insight into their future role as a nurse, build networks within the nursing community and assimilate into the clinical environment. This program design may prove useful as a template for other nursing faculties wishing to implement a similar program.     

Qualitative insights of patients and carers under the care of nurse navigators

Background

Nurse navigator roles aim to assist patients and their carers with navigating the healthcare system and accessing services to enable them to take a more active role in their own health care.

Quality of life of residents with dementia in traditional versus small-scale long-term care settings: a quasi-experimental study

BackgroundThe number of people living with dementia worldwide is increasing, resulting in a need for more residential care. In response to criticism of the traditional medical approach to residential dementia care, many large nursing homes are transforming their traditional care facilities into more home-like small-scale living facilities.ObjectivesThis study examined the assumed benefits of small-scale living for residents with dementia, compared to traditional long-term care in the Netherlands and Belgium. The primary outcome was quality of life, divided into nine different domains.DesignThe study had a longitudinal design within a one-year time interval.SettingsFive long-term care settings in the Netherlands and Belgium containing four traditional and twelve small-scale living units participated in the study.ParticipantsData were obtained from 179 residents with dementia (age > 65 years) (Dutch small-scale N = 51, traditional N = 51, Belgian small-scale N = 47, traditional N = 30).MethodsNurses and nursing assistants were trained to fill in the questionnaires.ResultsIn the Dutch sample, residents in small-scale settings had higher mean scores on ‘social relations’, ‘positive affect’, and ‘having something to do’ than residents in traditional settings. Moreover, mean scores on ‘caregiver relation’ and ‘negative affect’ remained stable over time among residents in small-scale settings, but decreased in traditional settings. These differences could not be explained by differences in behavioural characteristics, behavioural interventions, or social interaction. In the Belgian sample, fewer differences were found between traditional and small-scale settings. Nevertheless, residents in small-scale settings were reported to experience less ‘negative affect’ than those in traditional settings, which could be explained by differences in depression. Over time, however, residents ‘felt more at home’ in traditional settings, whereas no such increase was found for small-scale settings. Moreover, the mean quality of life scores on ‘restless behaviour’, ‘having something to do’ and ‘social relations’ decreased in small-scale settings, but remained stable in traditional settings.ConclusionsBoth small-scale and traditional settings appear to have beneficial effects on different domains of quality of life of residents with dementia. Future research should focus more on the quality and content of the care provided, than on the effects of the scale and design of the environment in long-term care settings.