Registered nurses' experiences with caring for non-English speaking patients

AimTo explore registered nurses' experiences with caring for non-English speaking patients and understand how those experiences influence their clinical practice.BackgroundThere is limited literature that examines nurses’ perceptions on caring for non-English speaking populations and the impact this increasing population has on the nurse.MethodsAn exploratory, qualitative study was conducted. Content analysis was used to identify major themes.ResultsTwo major themes emerged from 17 registered nurses responses: availability of resources and changes in nursing practice. Themes revealed the availability of resources provided supportive structure or could be a challenge to providing care. Changes in clinical practice included: increased awareness of patients' needs, personal development, increased knowledge of culture, and more time and resource management.ConclusionsContinued efforts are needed to increase cultural competence and ensuring healthcare institutions have easily accessible resources to improve the patient–provider experience for this population.     

Nurses’ perceptions of accessing a Medical Emergency Team: A qualitative study

BackgroundMedical Emergency Teams (METs) have been developed and implemented with the aim of improving recognition of and response to deteriorating patients. Yet, METs are often not activated or used effectively by nursing staff. The reasons for this are not fully understood.ObjectivesThe aim of this study was to explore nurses’ experiences and perceptions of using and activating a MET, in order to understand the facilitators and barriers to nurse's use of the MET.Design, setting and participantsAn interpretive qualitative approach was adopted to explore nurses’ experiences and perceptions of using and activating the MET. This study was set in a large public teaching hospital in Southeast Queensland, Australia. Fifteen registered ward nurses who had cared for patients who had deteriorated on the ward, and as a result of this deterioration were admitted to the Intensive Care Unit (ICU) as an unplanned admission, were interviewed about their experiences and perceptions of using a MET.MethodsIn-depth, semi-structured interviews were conducted with ward nurses who had cared for a patient who had deteriorated. Interviews were recorded and transcribed verbatim. The interviews were analysed thematically.FindingsFour themes relating to the participants’ experiences and perceptions of using a MET emerged from the data. These themes were: (1) sensing clinical deterioration; (2) resisting and hesitating; (3) pushing the button; and (4) support and leadership.ConclusionThis work identifies why nurses do not activate METs appropriately. This delay in MET activation potentially exposes the deteriorating patient to suboptimal care and increases the risk of adverse events.     

Undergraduate nursing students' perceptions of the current content and pedagogical approaches used in PIVC education. A qualitative,descriptive study

BackgroundThe peripheral intravenous catheter (PIVC) is the most frequently used invasive medical device. PIVCs fail for a variety of reasons and failure often results in serious adverse events leading to patient discomfort, delays in treatment, increased health care costs and even death. Undergraduate nurses assess and manage PIVCs as part of their clinical learning. To date, no study has explored undergraduate nurses' perceptions of the education they receive about PIVCs.AimWe sought to critically explore the current state of education regarding PIVCs from the perspectives of undergraduate nurses.MethodsThis qualitative study involved semi-structured interviews with third-year undergraduate nurses. Data were collected across two sites in Queensland, Australia. Fourteen face-to-face interviews were conducted and a modified 5-step qualitative content analysis was used to analyze the data.FindingsWe identified three key domains relating to participants' experiences of PIVC education: 1) Universities provide foundational knowledge about PIVC assessment, management and removal; 2) Clinical practice consolidates and drives undergraduate nurses' knowledge, skills and confidence about PIVCs; and 3) inconsistencies in clinical practice and between individual clinicians impedes learning and knowledge translation about PIVCs.ConclusionNursing students benefit from theoretical content delivered in the university setting. Practical application of theory and skill development whilst on clinical placement is variable. The current undergraduate curriculum, related to management of patients with a PIVC, is disjointed and inconsistent and this inconsistency may negatively impact patient safety.     

South African student nurses' experiences of professional nurses' role-modelling of caring

BackgroundStudent nurses are expected to implement a caring practice in order to become professional nurses. Caring has remained the art and science of nursing, which student nurses learn from professional nurses during clinical practice. The South African Nursing Council mandates professional nurses to teach and supervise student nurses to master the art of caring during clinical practice. Caring is taught through role-modelling of daily nursing activities.Research purposeThis study was performed to gain an understanding of South African student nurses' experiences of professional nurses' role-modelling of caring.MethodsPhenomenological, qualitative research. Purposive sampling of fourth-year student nurses. Data collection: focus groups, observations and field notes. The data were analysed using Giorgi's modified Husserlian five-step method. Ethical principles were respected.ResultsThree themes were identified. Theme 1: inconsistency in the clinical environment; Theme 2: effective and ineffective role-modelling of caring and Theme 3: carelessness cascading.ConclusionsThe study facilitated an understanding of student nurses' experiences of professional nurses' role-modelling of caring. Recommendations to facilitate professional nurses' role-modelling of caring in a public hospital were formulated: Mentorship training, recognition system for professional nurses, clinical support for student nurses, open channels of communication, random nurse leader rounds, employee wellness program, workshops and positive learning environment promotion.     

Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study

BackgroundAs complex chronic diseases are increasing, nurses' prompt and accurate clinical reasoning skills are essential. However, little is known about the reasoning skills of registered nurses.ObjectiveThis study aimed to determine how registered nurses use their clinical reasoning skills and to identify how the reasoning process proceeds in the complex clinical situation of hospital setting.DesignA qualitative exploratory design was used with a think-aloud method.MethodsA total of 13 registered nurses (mean years of experience = 11.4) participated in the study, solving an ill-structured clinical problem based on complex chronic patients cases in a hospital setting. Data were analyzed using deductive content analysis.ResultsFindings showed that the registered nurses used a variety of clinical reasoning skills. The most commonly used skill was ‘checking accuracy and reliability.’ The reasoning process of registered nurses covered assessment, analysis, diagnosis, planning/implementation, and evaluation phase.ConclusionsIt is critical that registered nurses apply appropriate clinical reasoning skills in complex clinical practice. The main focus of registered nurses' reasoning in this study was assessing a patient's health problem, and their reasoning process was cyclic, rather than linear. There is a need for educational strategy development to enhance registered nurses' competency in determining appropriate interventions in a timely and accurate fashion.     

Australian nurses' and midwives’ perceptions of their workplace environment during the COVID-19 pandemic

BackgroundWorking as a front-line worker during a pandemic is a unique situation that requires a supportive work environment. An informed understanding of nurses' and midwives’ workplace experiences during a pandemic, such as COVID-19, may enable better preparation and targeted support for future pandemics at an individual, organisational, and policy level.AimThe aim of this study was to explore nurses' and midwives’ workplace experiences during the COVID-19 pandemic response.MethodsA cross-sectional online survey consisting of open-ended questions was conducted with a convenience sample of nurses and midwives (n = 1003) working in New South Wales Health hospital settings, in Australia. Open-ended questions were analysed using content analysis.ResultsFive themes were identified; ‘organisational communication’, ‘workplace support’, ‘availability of personal protective equipment’, ‘flexible working’, and ‘new ways of working’. Nurses' and midwives’ workplace experiences during COVID-19 were influenced by leaders who were perceived to be adaptive, authentic, responsive, transparent, and visible. While many expressed a number of workplace challenges, including access to personal protective equipment, there was opportunity to explore, develop, and evaluate new and alternate models of care and working arrangements.ConclusionIt is important that nurses and midwives are supported and well prepared to cope during pandemics in the workplace. Organisational leadership and timely dissemination of transparent pandemic plans may support nurses’ adaptive workplace experiences.     

Exploring the opinions of registered nurses working in a clinical transfusion environment on the contribution of e-learning to personal learning and clinical practice: Results of a small scale educational research study

AimTo explore the opinions of registered nurses on the Learnbloodtransfusion Module 1: Safe Transfusion Practice e-learning programme to meeting personal learning styles and learning needs.MethodA qualitative research methodology was applied based on the principles of phenomenology. Adopting a convenience sampling plan supported the recruitment of participants who had successfully completed the e-learning course.AnalysisThematic analysis from the semi-structured interviews identified common emerging themes through application of Colaizzis framework.ResultsSeven participants of total sample population (89) volunteered to participate in the study. Five themes emerged which included learning preferences, interactive learning, course design, patient safety and future learning needs. Findings positively show the e-learning programme captures the learning styles and needs of learners. In particular, learning styles of a reflector, theorist and activist as well as a visual learner can actively engage in the online learning experience. In an attempt to bridge the knowledge practice gap, further opinions are offered on the course design and the application of knowledge to practice following completion of the course.ConclusionThe findings of the small scale research study have shown that the e-learning course does meet the diverse learning styles and needs of nurses working in a clinical transfusion environment. However, technology alone is not sufficient and a blended approach to learning must be adopted to meet bridging the theory practice gap supporting the integration of knowledge to clinical practice.     

Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care

Nurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress.AimThe aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer.Methods and sampleNurses (registered and enrolled) from three urban in-patient hospices, an oncology clinic and a surgery clinic and a palliative homecare team were, prior to the start of a training program, invited to write down their experiences of a critical incident (CI), in which existential issues were featured.ResultsEighty-eight CIs were written by 83 nurses. The CIs were analyzed with qualitative content analysis. Two main themes were found: Encounters with existential pain experiences, which concerned facing death and facing losses; and Encountering experiences of hope, which concerned balancing honesty, and desire to live.ConclusionsThis study points out that health care professionals need to be aware of patients' feelings of abandonment in exposed situations such as patients' feelings of existential loneliness. That there are some patients that express a desire to die and this makes the nurses feel uncomfortable and difficult to confront these occurrences and its therefore important to listen to patients' stories, regardless of care organization, in order to gain access to patients' inner existential needs.     

Teamwork and social cohesion are key: Nurses' perceptions and experiences of working in a new decentralised intensive care unit

BackgroundDecentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited.ObjectivesThe objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU).MethodsTwelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data.ResultsA total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction.ConclusionsImplementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.     

护士对继续教育中采用E—learning方式的态度和需求

目的了解实施护理继续教育时护士对采用电子学习（E-learning）的态度和需求。方法使用自行设计的问卷，对北京市某三级甲等医院158名在职护士进行问卷调查。结果有条件上网学习的护士占93．67％；认同E—learning方式者占76．58％；认为可以用E—learning代替传统方式的内容主要涉及伦理与法律、教学与科研、理论知识、礼仪与沟通等方面；认为不可完全替代的内容主要涉及护理技术操作。结论大多数护士认可网上学习并具备相应条件，应选择适合E-learning学习的课程，建立有效的监督和考核机制，充分发挥E—learning方式的优势，以保证继续教育的效果。     

Nurses' perspectives on advance directives before the establishment of the new well-dying law in Korea: A mixed methods study

AimThis study explored the attitudes, experiences, and perceptions of Korean nurses toward advance directives (ADs) before the establishment of new Well-Dying Law.MethodsA sequential explanatory mixed method design was applied. We administered a constructed questionnaire on attitudes toward ADs and end-of-life issues and experience related to end-of-life decision-making. A Korean-translated version of the KAESAD [Knowledge-Attitudinal, Experimental Survey on ADs] was administered by 245 nurses. Semi-structured interviews (N = 16) were audio-recorded, transcribed, and coded in a qualitative content analysis.ResultsThe quantitative results revealed the nurses' perspectives on ADs: that valuing patient's autonomy, authority, or rights is vital to the implementation of ADs and end-of-life decision-making. Also, nurses reported that patients should be knowledgeable and informed about ADs. These responses allowed us to generate an interview, which revealed four themes in adopting the Well-Dying Law, including ADs. Themes with ‘benefits’ and ‘roles of health care providers’ mainly supported the quantitative results. Themes with ‘ethical issues,’ such as disagreement between patients and family members on ADs, and ‘preparation,’ regarding adopting the new law, should be importantly considered when implementing ADs in clinical settings.ConclusionsOur study highlights that nurses need to develop sufficient knowledge on the laws, and communication skills to help patients be knowledgeable and make their own decisions regarding ADs. To successfully adopt the Well-Dying Law, our findings suggest that a nationwide public campaign and a continuing education program for nurses to manage ethical issues regarding ADs are required.