Clinical decision-making in the intensive care unit: A concept analysis

AimTo operationally define clinical decision-making as it relates to intensive care unit nursing.BackgroundClinical decision-making is an intricate cognitive process that is demanding on intensive care nurses due to the severity of their patients’ illnesses, consistent exposure to high-stakes situations, and prevalent patient mortality. When compromised, it can lead to adverse patient events. However, clinical decision-making specific to the intensive care unit is a concept seldom defined in nursing research.DesignConcept analysis.MethodsUsing Walker and Avant’s eight-step method, nursing databases were searched for studies between 1980 and 2022 describing the antecedents, defining attributes, consequences, and empirical referents of clinical decision-making in the intensive setting.FindingsIntensive care unit clinical decision-making is a complex cognitive process in which nurses recognize a clinical problem in their patient and respond promptly by implementing interventions to improve their patient’s rapidly and frequently changing health status to a more favorable condition in an intensive care setting. The defining attributes are: assessment of the patient situation, prompt recognition of cues, efficient comprehension of patient data abnormalities, prior knowledge and experience, prompt response to the clinical problem(s), colleague collaboration, formulation of interventions to treat clinical problem(s), and appraisal of risks/benefits.ConclusionIntensive care unit clinical decision-making is a skill that is different from traditional clinical decision-making in nursing. Prompt action characterizes this concept due to the unstable health status of these patients. More research on this concept is needed to enhance nurse performance and patient outcomes in intensive care.Implications for clinical practiceA definition of this concept opens doors for potential studies on promoting effective decision-making among intensive care nurses. This can improve the safety and outcomes of critically ill patients. Additionally, it generates new questions regarding how nursing schools and hospital orientation programs can promote and develop competent decision-making skills in future intensive care nurses.     

Patient satisfaction with nursing care: a concept analysis within a nursing framework

Title.  Patient satisfaction with nursing care: a concept analysis within a nursing framework.
Background.  Patient satisfaction is an important indicator of quality of care, and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in the healthcare market. Nursing care has a prominent role in patient satisfaction. Using a nursing model to measure patient satisfaction with nursing care helps define and clarify this concept.
Data sources.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The literature search used the keywords patient satisfaction, nursing care and hospital. The sample included 44 papers published in English, between 1998 and 2007.
Results.  Cox's Interaction Model of Client Health Behavior was used to analyse the concept of patient satisfaction with nursing care. The attributes leading to the health outcome of patient satisfaction with nursing care were categorized as affective support, health information, decisional control and professional/technical competencies. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes.
Conclusion.  The meaning of patient satisfaction continues to evolve. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.     

Healthcare Quality: A Concept Analysis

Worsening quality indicators of health care shake public trust. Although safety and quality of care in hospitals can be improved, healthcare quality remains conceptually and operationally vague. Therefore, the aim of this analysis is to clarify the concept of healthcare quality. Walker and Avant's method of concept analysis, the most commonly used in nursing literature, provided the framework. We searched general and medical dictionaries, public domain websites, and 5 academic literature databases. Search terms included health care and quality, as well as healthcare and quality. Peer‐reviewed articles and government publications published in English from 2004 to 2016 were included. Exclusion criteria were related concepts, discussions about the need for quality care, gray literature, and conference proceedings. Similar attributes were grouped into themes during analysis. Forty‐two relevant articles were analyzed after excluding duplicates and those that did not meet eligibility. Following thematic analysis, 4 defining attributes were identified: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these attributes, the definition of healthcare quality is the assessment and provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of optimal or desired health. This analysis proposes a conceptualization of healthcare quality that defines its implied foundational components and has potential to improve the provision of quality care. Theoretical and practice implications presented promote a fuller, more consistent understanding of the components that are necessary to improve the provision of healthcare and steady public trust.     

Therapeutic Alliance in Mental Health Nursing: An Evolutionary Concept Analysis

The concept of therapeutic alliance is relevant in contemporary mental health care, as the consumer-led recovery movement promotes the development of collaborative relationships, and is focussed on the consumer's individual concept of wellbeing. An evolutionary concept analysis was undertaken to establish a contemporary interpretation of therapeutic alliance for mental health nursing. The CINAHL, Scopus and PsycINFO databases were searched for articles (n = 322), with 52 deemed appropriate for analysis. Therapeutic alliance is characterised by mutual partnerships between nurses and consumers, and is dependent on a humanistic healthcare culture. Therapeutic alliance is associated with enhanced consumer outcomes and experiences with care.     

Best practice in nursing: A concept analysis

BackgroundSince the early 1990s a shift has occurred in the understanding of what constitutes quality healthcare. This is evidenced by the emergence of new concepts in the nursing literature, including best practice. Although authors have analyzed the concept of best practice in the healthcare sector, further analysis is required to distinguish the concept's unique meanings, and significance for the nursing discipline.ObjectivesThis paper seeks to clarify use of the concept of best practice in the nursing literature over the last two decades, and contributes to explaining its defining characteristics, applicability, and significance. It also distinguishes the concept's unique meanings and usefulness in comparison to other related terms.MethodsAn evolutionary concept analysis method was selected for this analysis. First, a representative sample of nursing sources was obtained utilizing the CINAHL database. This database was searched for sources in English, during the years 1993–2013, with both best practice and nursing in the title. Data was then collected from the sample of retrieved literature on attributes of best practice, antecedent and consequential occurrences, variations, and empirical references. The following related concepts were also explored for purposes of comparison and to situate the understanding of best practice in-context: practice development, evidence-based practice, and standard of care.FindingsUse of the concept of best practice in the nursing literature may be categorized into four distinct domains: educational, administrative, clinical and theoretical/conceptual. Exploration of defining attributes revealed that best practice may be characterized as: directive, evidence-based, and quality-focused. Antecedent occurrences in the sample sources were most commonly related to identification of a specified need or problem, somewhat defined by the domain. The implied consequential occurrences were ultimately better outcomes.ConclusionBest practice is more than practice based on evidence. It represents quality care which is deemed optimal based on a prevailing standard or point of view. Specific best practices in nursing are significant because they serve to direct nurses regarding solutions to identified problems/needs. Continued analysis of the concept of best practice is required to further distinguish it from related concepts, and to expand our understanding of the relative meaning of best from multiple perspectives.     

De-escalation of aggressive behaviour in healthcare settings: Concept analysis

BackgroundDe-escalation is the recommended first-line response to potential violence and aggression in healthcare settings. Related scholarly activity has increased exponentially since the 1980s, but there is scant research about its efficacy and no guidance on what constitutes the gold standard for practice.ObjectivesTo clarify the concept of de-escalation of violence and aggression as described within the healthcare literature.DesignConcept analysis guided by Rodgers’ evolutionary approach.Data sourcesMultiple nursing and healthcare databases were searched using relevant terms.Review methodsHigh quality and/or highly cited, or otherwise relevant published empirical or theoretical English language literature was included. Information about surrogate terms, antecedents, attributes, consequences, and the temporal, environmental, disciplinary, and theoretical contexts of use were extracted and synthesised. Information about the specific attributes of de-escalation were subject to thematic analysis. Proposed theories or models of de-escalation were assessed against quality criteria.ResultsN = 79 studies were included. Mental health settings were the most commonly reported environment in which de-escalation occurs, and nursing the disciplinary group most commonly discussed. Five theories of de-escalation were proposed; while each was adequate in some respects, all lacked empirical support. Based on our analysis the resulting theoretical definition of de-escalation in healthcare is “a collective term for a range of interwoven staff-delivered components comprising communication, self-regulation, assessment, actions, and safety maintenance which aims to extinguish or reduce patient aggression/agitation irrespective of its cause, and improve staff-patient relationships while eliminating or minimising coercion or restriction”.ConclusionsWhile a number of theoretical models have been proposed, the lack of advances made in developing a robust evidence-base for the efficacy of de-escalation is striking and must, at least in part, be credited to the lack of a clear conceptualisation of the term. This concept analysis provides a framework for researchers to identify the theoretical model that they purport to use, the antecedents that their de-escalation intervention is targeting, its key attributes, and the key negative and positive consequences that are to be avoided or encouraged.     

Compassion fatigue: a concept analysis

Compassion fatigue is a relatively new term in nursing. This term describes mood swings experienced by healthcare providers that are both complex in origin and intensify over time due to cumulative stress. Quality of care can be affected if compassion fatigue goes untreated. This paper presents a concept analysis of compassion fatigue using Walker & Avant's method. Results show the defining attributes of compassion fatigue to include: 1. accumulated patient and family suffering; 2. sufferer unable to release built-up stresses effectively; and 3. negative effects on physical, psychological, and spiritual health. Identified antecedents of compassion fatigue included: (1) working as a healthcare provider; (2) investing sympathy in others over a long period of time; and (3) ignoring stress symptoms and personal emotional needs over time. Identified consequences of compassion fatigue included: (1) decreased coping ability; (2) damage / destruction of patient relationship; and (3) increased medical care costs. This study conducted a concept analysis to offer a better understanding of the concept of compassion fatigue and provide a reference for nursing practice and compassion fatigue-related nursing research.     

Quality emergency care (QEC) in resource limited settings: A concept analysis

IntroductionProviding appropriate high-quality emergency care (QEC) commensurate with patients' needs is critical for continuity of care, patient safety, optimal clinical outcomes, reduced mortality, and patient satisfaction. This concept analysis aims to define and assist in understanding the concept of QEC in resource-limited settings.MethodsQuality emergency care concept analysis was conducted using Walker and Avant’s approach. Several literature review methods and dictionaries were used to explore the QEC concept.ResultsImmediate assessment, rapid diagnosis, and critical interventions are the attributes of QEC for life-threatening and time-sensitive conditions, leading to timely and safe care provision.DiscussionNurses serve as the backbone for most emergency care centers such as primary care, emergency department, and even prehospital care. The first few hours following a potential life- or limb-threatening condition are vital. The emergency care rendered to patients can significantly affect treatment's overall outcome; therefore, quality emergency care is critical.Conclusion.     

DNP and PhD scholarship: Making the case for collaboration

BackgroundThe Institute of Medicine calls for meaningful collaboration between doctor of nursing practice (DNP)- and doctor of philosophy (PhD)-prepared nurses to improve health outcomes.PurposeThe purpose of this paper is to answer the questions: 1) how do Colleges of Nursing influence DNP and PhD collaboration for faculty and students? 2) how does DNP and PhD collaboration in an academic setting impact health care practices and patient outcomes?MethodsTwo examples of DNP and PhD collaboration (one faculty and one student) are presented.ResultsShared faculty responsibilities and a supportive organizational culture influenced collaboration between faculty and students. Research and practice roles can complement and strengthen each other while improving health outcomes.ConclusionColleges of Nursing should build processes and culture that encourage faculty and students to collaborate across doctoral programs. Successful intraprofessional collaboration has the potential to positively impact healthcare quality, and outcomes, while advancing the nursing profession.     

Witnessed resuscitation: A concept analysis

BackgroundThe advance in the practice of resuscitation is globally recognised and fully sanctioned in scientific world. However, practicing family presence during resuscitation, also known as witnessed resuscitation, is yet to be endorsed by healthcare professionals. Many professional nursing and physician organisations have endorsed the practice of witnessed resuscitation by issuing guidelines. These organisations support family presence during resuscitation due to the research proving its benefit for patients and families.PurposeThe purpose of this paper is to analyse the concept of witnessed resuscitation.MethodA concept analysis was undertaken using Rodger’s (2000) evolutionary method.FindingsThe concept analysis suggests that witnessed resuscitation refers to the presence of a family member or relative during a resuscitation procedure, mostly in emergency and complex critical care areas. The defining attributes are family centred care approach, exercising patients and family rights and autonomy in end of life care decisions and involvement of family as active and passive observers during a resuscitation event.ConclusionClarity surrounding witnessed resuscitation will guide the development of a conceptual framework, expand nursing knowledge and identify the research required to advance understanding of witnessed resuscitation in practice.     

Business acumen for nursing leaders,optional or essential in today's health system? A discussion paper

BackgroundOver the last number of years, the healthcare system has become more complex in managing increasing costs and outcomes within a defined budget. To be effective through reform, especially moving forward from the COVID-19 pandemic, healthcare leaders, specifically in nursing, have an increased need for business acumen beyond traditional leadership and management principles.AimThis paper examines the concept of business acumen in the profession of nursing, specifically for managers and higher nurse leaders, establishing whether these skills are optional or essential.DiscussionNurses learn and develop broad skills in leadership and management, but less specifically about business or the broader system. With a contemporary Australian health system aiming to be more effective, nurses may require a greater level of business acumen to adequately understand the mechanics of business decision making in the system when designing care models, as well as representing the business potential of nursing in balance with clinical outcomes through reform.ConclusionThe modern nurse, in addition to clinical skills, may need a foundational understanding of business evolving throughout their career, to maximise innovative growth across the system, in meeting the healthcare needs of our community now and into the future. Without a foundation level of business acumen and an understanding of the system across the profession, nurses may not be empowered with their full potential of being a strong voice influencing health system reform.     

Current status and future directions of U.S. genomic nursing health care policy

BackgroundAs genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing’s holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care.PurposeTo examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation.MethodsWe conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health.FindingsGenomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed.DiscussionNine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas.ConclusionsTo advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.     

Pregnancy-related anxiety: A concept analysis

ObjectivesEvidence suggests that pregnancy-related anxiety is more strongly associated with maternal and child outcomes than general anxiety and depression are and that pregnancy-related anxiety may constitute a distinct concept. However, because of its poor conceptualization, the measurement and assessment of pregnancy-related anxiety have been limited. Efforts to analyze this concept can significantly contribute to its theoretical development. The first objective of this paper was to clarify the concept of pregnancy-related anxiety and identify its characteristics and dimensions. The second aim was to examine the items of current pregnancy-related anxiety measures to determine the dimensions and attributes that each scale addresses, noting any gaps between the current assessment and the construct of the concept.DesignA concept analysis was conducted to examine the concept of pregnancy-related anxiety.Data sourcesTo obtain the relevant evidence, several databases were searched including MEDLINE, PsycINFO, EBSCO's SocINDEX, Psychological and Behavioral Sciences Collection, CINAHL, SCOPUS, and EMBASE.Review methodsA modified approach based on Walker and Avant (Strategies for theory construction in nursing. 5th ed; 2011) was used. Qualitative or quantitative studies published in English that explored or examined anxiety during pregnancy or its dimensions prospectively or retrospectively were included.ResultsThirty eight studies provided data for the concept analysis. Three critical attributes (i.e., affective responses, cognitions, and somatic symptoms), three antecedents (i.e., a real or anticipated threat to pregnancy or its outcomes, low perceived control, and excessive cognitive activity, and four consequences (i.e., negative attitudes, difficulty concentrating, excessive reassurance-seeking behavior, and avoidance behaviors) were identified. Nine dimensions for pregnancy-related anxiety were determined, and a definition of the concept was proposed. The most frequently reported dimensions included anxiety about fetal health, fetal loss, childbirth, and parenting and newborn care. The content of five scales was analyzed to determine the attributes and dimensions measured by each tool. Our findings suggest that the Pregnancy-Related Anxiety Scale tapping five dimensions of pregnancy-related anxiety and the Pregnancy Outcome Questionnaire with six items pertaining to the consequences of pregnancy-related anxiety can respectively be considered the most useful tools for assessing the existence and severity of the concept.ConclusionsThe critical attributes of pregnancy-related anxiety are similar to those defined for anxiety disorders. However, the behavioral consequences of pregnancy-related anxiety appear to apply only some women and may serve as important indicators of the severity of the condition. Current tools are useful instruments to determine whether the concept exists and to capture selected domains of pregnancy-related anxiety. A tool that includes all dimensions of the concept and examines the severity of pregnancy-related anxiety is needed.     

Perceptions and concerns about sustainable healthcare of nursing students trained in sustainability and health: A cohort study

AimTo describe nursing students' perceptions of sustainable health education in the nursing curriculum and their concerns about sustainable healthcare and the impact of climate change on nursing.BackgroundSustainable health education involves education on the impact of climate change on health and the impact of healthcare on the environment. The effectiveness of sustainable health education in improving attitudes, knowledge and skills in sustainable healthcare has been demonstrated. However, there is a need to study students' perceptions of this and their concerns about achieving sustainable healthcare from the use and disposal of healthcare resources.DesignA cohort study with an inductive content analysis of open-ended questions included in a survey.MethodsThe study was carried out with undergraduate nursing students throughout their four-year undergraduate academic program using scenario-based learning and augmented reality related to sustainability, climate change and health. As students were exposed to three educational interventions, they completed a survey of open-ended questions about their perceptions of their environmental sustainability training in the nursing curriculum, their concerns about the resources’ used in healthcare and their perceptions of the impact of climate change on the nursing profession.ResultsStudents identified content in the nursing degree program on climate change and health and hospital waste segregation. They also demanded more content on 'low environmental impact nursing care' when their clinical practice training increased. Students were concerned about the excessive and unnecessary use of materials in healthcare, especially in the post-pandemic period, the lack of environmental awareness of healthcare professionals and the lack of power to change the situation. They recognised the lack of proper waste segregation in healthcare settings, no recycling bins and little reuse of materials. They were also concerned about the polluting disposal of material. They perceived important impacts of climate change on nursing, such as patient care due to increased pollution-related diseases, including foetal malformations and new health care needs arising from weather conditions. Finally, students were concerned about the impact this will have on nursing care work and require 'nursing leadership in environmental awareness'.ConclusionsStudents demand more training in low environmental impact healthcare and innovative educational practices are effective in this regard. Appropriate Sustainable Healthcare Education can make future health professionals more environmentally aware and enable them to lead the shift towards climate-smart care.Tweetable abstractStudents demand more training in low environmental impact healthcare and perceive significant impacts of climate change on nursing.     

Interdisciplinary health care training in the USA: lessons learned from a rural training grant program

Abstract

For almost half a century, research has identified that effective teamwork is essential in order to enhance care provision and health outcomes for patients. Although the value of teamwork is well-recognized in healthcare, the historically rooted dynamics of workplace relationships create a myriad of challenges to creating collaborative teams. Understanding the history of interpersonal dynamics between health professionals can provide direction for future interprofessional education and collaboration strategies. The aim of this paper is to provide a historical overview of the social positioning of nursing and medicine in the context of interprofessional collaboration. Few professions work as closely as nursing and medicine. Despite the well-recognized benefits of interprofessional collaboration, these two professions are often socially positioned in opposition to one another and depicted as adversarial. This analysis will seek to advance our understanding of the historical roots between these two professions and their relationships with and among each other in relation to career choice, early socialization and patient care delivery. An exploration of the historical social positioning of nursing and medicine can provide an enhanced understanding of the barriers to interprofessional collaboration and inform future successes in interprofessional education and practice among all health and social care professions.     

Care workers health in Swiss nursing homes and its association with psychosocial work environment: A cross-sectional study

BackgroundPrevious studies have demonstrated poor health of care workers in nursing homes. Yet, little is known about the prevalence of physical and mental health outcomes, and their associations with the psychosocial work environment in nursing homes.Objectives(1) To explore the prevalence of physical and mental health outcomes of care workers in Swiss nursing homes, (2) their association with psychosocial work environment.MethodsThis is a secondary data analysis of the cross-sectional Swiss Nursing Home Human Resources Project (SHURP). We used survey data on socio-demographic characteristics and work environment factors from care workers (N = 3471) working in Swiss nursing homes (N = 155), collected between May 2012 and April 2013. GEE logistic regression models were used to estimate the relationship between psychosocial work environment and physical and mental health outcomes, taking into account care workers’ age.ResultsBack pain (19.0%) and emotional exhaustion (24.2%) were the most frequent self-reported physical and mental health. Back pain was associated with increased workload (odds ratios (OR) 1.52, confidence interval (CI) 1.29–1.79), conflict with other health professionals and lack of recognition (OR 1.72, CI 1.40–2.11), and frequent verbal aggression by residents (OR 1.36, CI 1.06–1.74), and inversely associated with staffing adequacy (OR 0.69, CI 0.56–0.84); emotional exhaustion was associated with increased workload (OR 1.96, CI 1.65–2.34), lack of job preparation (OR 1.41, CI 1.14–1.73), and conflict with other health professionals and lack of recognition (OR 1.68, CI 1.37–2.06), and inversely associated with leadership (OR 0.70, CI 0.56–0.87).ConclusionsPhysical and mental health among care workers in Swiss nursing homes is of concern. Modifying psychosocial work environment factors offer promising strategies to improve health. Longitudinal studies are needed to conduct targeted assessments of care workers health status, taking into account their age, along with the exposure to all four domains of the proposed WHO model.     

Inter- and intra-disciplinary collaboration and patient safety outcomes in U.S. acute care hospital units: A cross-sectional study

BackgroundCollaboration among healthcare providers has been considered a promising strategy for improving care quality and patient outcomes. Despite mounting evidence demonstrating the impact of collaboration on outcomes of healthcare providers, there is little empirical evidence on the relationship between collaboration and patient safety outcomes, particularly at the patient care unit level.ObjectivesThe purpose of this study is to identify the extent to which interdisciplinary collaboration between nurses and physicians and intradisciplinary collaboration among nurses on patient care units are associated with patient safety outcomes.MethodsThis is a cross-sectional study using nurse survey data and patient safety indicators data from U.S. acute care hospital units. Collaboration at the unit level was measured by two 6-item scales: nurse-nurse interaction scale and nurse-physician interaction scale. Patient outcome measures included hospital-acquired pressure ulcers (HAPUs) and patient falls. The unit of analysis was the patient care unit, and the final sample included 900 units of 5 adult unit types in 160 hospitals in the U.S. Multilevel logistic and Poisson regressions were used to estimate the relationship between collaboration and patient outcomes. All models were controlled for hospital and unit characteristics, and clustering of units within hospitals was considered.ResultsOn average, units had 26 patients with HAPUs per 1000 patients and 3 patient falls per 1000 patient days. Critical care units had the highest HAPU rate (50/1000 patients) and the lowest fall rate (1/1000 patient days). A one-unit increase in the nurse-nurse interaction scale score led to 31% decrease in the odds of having a HAPU (OR, 0.69; 95% CI, 0.56–0.82) and 8% lower patient fall rate (IRR, 0.92; 95% CI, 0.87–0.98) on a nursing unit. A one-unit increase in the nurse-physician interaction scale score was associated with 19% decrease in the odds of having a HAPU (OR, 0.81; 95% CI, 0.68–0.97) and 13% lower fall rates (IRR, 0.87; 95% CI, 0.82–0.93) on a unit.ConclusionsBoth nurse-physician collaboration and nurse-nurse collaboration were significantly associated with patient safety outcomes. Findings from this study suggest that improving collaboration among healthcare providers should be considered as an important strategy for promoting patient safety and both interdisciplinary and intradisciplinary collaboration are critical for achieving better patient outcomes.