Delivering culturally competent care to the lesbian,gay, bisexual,and transgender (LGBT) population: Education for nursing students

PurposeDespite well-documented healthcare disparities in the lesbian, gay, bisexual, and transgender (LGBT) community, nursing education has lagged other health professions in promoting culturally competent care to members of this minority group.MethodsUsing national guidelines, the author developed an educational program for BSN students to improve competency in providing care for LGBT individuals. One hundred twenty-four students completed online modules and a simulation exercise, which explored LGBT healthcare topics. One hundred eight participants completed surveys pre-, post-, and 1 month after the intervention.ResultsOverall LGB competence scores improved from pre- (M = 4.42) to post-test (M = 5.20) and did not significantly decrease at one-month (M = 5.03, p < .001). Similar findings were observed in the transgender cultural competence scores (pre- (M = 4.02); post- (M = 5.08); one-month (M = 4.92, p < .001)).ConclusionEducational content focused on cultural competency for nurses may lead to improved health outcomes among the LGBT community.     

Clinicians’ attitudes towards escalation and management of deteriorating patients: A cross-sectional study

BackgroundInternationally, rapid response systems have been implemented to recognise and categorise hospital patients at risk of deterioration. Whilst rapid response systems have been implemented with a varying amount of success, there remains ongoing concern about the lack of improvement in the escalation, and management of the deteriorating patient. It also remains unclear why some clinicians fail to escalate concerns for the deteriorating patient.ObjectiveThe objective of this study was to explore clinicians’ attitudes towards the escalation, and management of the deteriorating patient.MethodsA cross-sectional online survey of conveniently sampled clinicians from the acute care sector in a regional health district in Australia was conducted. The Clinicians’ Attitudes towards Responding and Escalating care of Deteriorating patients scale, was used to explore attitudes towards the escalation and management of the deteriorating patient.ResultsSurvey responses were received from medical officers (n = 43), nurses (n = 677), allied health clinicians (n = 60), and students (n = 57). Years of experience was significantly associated with more confidence responding to deteriorating patients (p < .001) and significantly less fears about escalating care (p < .001). Nurses (M = 4.16, SD = .57) and students (M = 4.11, SD = .55) in general had significantly greater positive beliefs that the rapid response system would support them to respond to the deteriorating patient than allied health (M = 3.67, SD = .64) and medical (M = 3.87, SD = .54) clinicians, whilst nurses and medical clinicians had significantly less fear about escalating care and greater confidence in responding to deteriorating patients than allied health clinicians and healthcare students (p < .001).ConclusionNurses and medical officers have less fear to escalate care and greater confidence responding to the deteriorating patient than allied health clinicians and students. Whilst the majority of participants had positive perceptions towards the rapid response system, those with less experience lacked the confidence to escalate care and respond to the deteriorating patient.     

Determining the effectiveness of an Elder Abuse Nurse Examiner Curriculum: A pilot study

ObjectivesTo pilot and evaluate a novel Elder Abuse Nurse Examiner Curriculum and its associated training materials for their efficacy in improving Sexual Assault Nurse Examiner (SANE)s' knowledge of elder abuse and competence in delivering care to abused older adults.MethodsPilot training was held with 18 SANEs from across Ontario, Canada. A 52-item pre- and post-training questionnaire was administered that assessed participants' self-reported knowledge and perceived skills-based competence related to elder abuse care. A curriculum training evaluation survey was also delivered following the training. Qualitative non-participant observational data were collected throughout the training.ResultsThere were statistically significant improvements in self-reported knowledge and perceived skills-based competence from pre-training to post-training for all content domains of the curriculum: older adults and abuse (p < 0.0001), documentation, legislative, and legal issues (p < 0.0001); interview with the older adult, caregiver, and other relevant contacts (p < 0.0001); assessment (p = 0.0018); medical and forensic examination (p < 0.0001); case summary, discharge plan, and follow-up care (p < 0.0001). The post-training evaluation survey demonstrated satisfaction among participants across all components of the curriculum and its delivery, particularly with reference to the comprehensiveness of the curriculum, and the clarity and appropriateness of the training materials.ConclusionsThe Elder Abuse Nurse Examiner Curriculum and associated training materials were efficacious in improving SANEs' self-reported knowledge of and perceived competence in delivering elder abuse care. Future steps will further evaluate these materials as a component of a pilot of a larger comprehensive Elder Abuse Intervention at multiple sites across Ontario.     

Evaluation of a nurse-led education program to improve cross-cultural care for older people in aged care

BackgroundCultural diversity is significant in aged care facilities. Registered nurses play a leading role in the care setting. Nurse-led education interventions to improve the cultural competence of aged care workers are in high demand.AimThe aims of the study were to evaluate the effect of a nurse-led cross-cultural care program on cultural competence of Australian and overseas-born care workers.DesignA pre- and post-evaluation design and a sub-group analysis.Settings and participantsThis study was undertaken in four large-sized aged care facilities in Australia. Direct care workers were invited to participate in the study.MethodsThe intervention lasted 12 months. Data were collected at baseline, 6 months and 12 months using the Clinical Cultural Competency Questionnaire and site champion reports. One-way ANOVA was applied to determine the changes of outcomes over time for the whole group. A mixed effect linear regression model was applied in the sub-group analyses to compare the differences of outcomes between the Australian-born and overseas-born groups.ResultsOne hundred and thirteen staff participated in the study including Australian-born (n = 62) and overseas-born (n = 51). Registered nurses were trained as site champions to lead the program. The results showed a statistically significant increase in participants' scores in Knowledge (p = .000), Skills (p = .000), Comfort Level (p = .000), Importance of awareness (p = .01) and Self-Awareness (p = .000) in a 12-month follow-up. The increased scores in the Skills (p = .02) and Comfort Level (p = .001) were higher in the Australian-born group compared to the overseas-born group. The results also showed a statistically significant increase in participants' overall satisfaction scores with the program at 12 months (p = .009). The overseas-born group demonstrated a higher score in Desire to Learn More (p = .016) and Impact of the Program on Practice (p = .014) compared to the Australian-born group.ConclusionA nurse-led cross-cultural care program can improve aged care workers' cultural competence.     

Using unfolding case studies to develop critical thinking skills in baccalaureate nursing students: A pilot study

BackgroundResearch has consistently demonstrated that new graduate nurses do not possess sufficient critical thinking skills when they transition to clinical practice. Unfolding case studies encourage students to participate in a number of critical thinking skills including information-seeking, logical reasoning, and analyzing of clinical data.ObjectiveThe aim of this study was to determine how the use of unfolding case studies as a learning modality affected baccalaureate students' critical thinking skills in their Adult Health Theory course. The researcher compared course examination scores earned by nursing students who were taught using traditional case studies to scores obtained by nursing students who completed unfolding case studies.SettingThe pilot study took place at a moderate-sized comprehensive university in Wisconsin.DesignA non-experimental correlational design using course examination scores data was employed to examine how the use of unfolding case studies as a learning modality affected baccalaureate students' critical thinking skills in their Adult Health Theory course.ParticipantsA total of 160 students comprised the intervention group while an additional 142 students represented the control group in the study.MethodsAn independent-samples t-test was performed to explore differences in mean scores between the intervention and control groups.ResultsResults of the t-test indicate that mean examination scores were significantly higher for the intervention group (M = 234.9, SD = 13.1) than for the control group (M = 228.2, SD = 13.3); t(299) =, p < .001.ConclusionsResults of this study suggest that unfolding case studies more effectively develop students' critical thinking skills than do a more traditional, static case study.     

The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center,Controlled before-after Study in China

BackgroundEffective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown.AimsThe current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients.DesignA single-center, propensity score-matched, controlled before–after study.MethodsThe patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses’ pain knowledge and attitude between group A and group B.ResultsA total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X² = 38.926, p < .05; vomit: X² = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05).ConclusionOur study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.     

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic

BackgroundPain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management.AimExamine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication.MethodsA sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit.ResultsSignificant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001).ConclusionsPatients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.     

Nursing student and faculty competency improvement through a nurse-bridging program in Cambodia

BackgroundAn adequate number of high-quality nurses are a key factor for superior patient outcomes. However, in 2015, Cambodia reported only 52 nurses with bachelor's degrees, three with master's degrees, and one with a doctorate. The fast track to getting a highly educated nursing workforce requires providing a bridging program for associate's degree nurses to achieve baccalaureate degrees.ObjectivesTo assess improvement in the competency of nursing students and faculty members through a program that prepares associate's degree nurses to obtain bachelor's degrees in Cambodia.DesignMixed methods.SettingEducational institutes in Phnom Penh, Cambodia.ParticipantsA total of 45 Cambodian nursing students participated in the Cambodian nurse-bridging program and 12 Cambodian faculty members served as co-teachers.MethodsWe conducted three surveys to compare the competence of nursing students and faculty members before, during, and after the bridging program. We conducted focus-group interviews to support the qualitative results and explored changes in student and faculty competencies after the program.ResultsQuantitative analysis revealed significant improvements in students' nursing competency (p < .001), critical thinking (p < .001), and research competency (p < .001) and faculty members' teaching competency (p < .001) and research competency (p < .001) after the program. Through qualitative analysis, students showed improvement in physical assessment, patient communication, critical thinking, evidence-based nursing, and research competency. Faculty members indicated they had experienced new teaching strategies and subjects, gained increased confidence in teaching, and even though research competency had been improved, more training was required.ConclusionsThis study provides evidence to support the effectiveness of higher nurse education in developing countries, and illustrates an opportunity to produce high-quality human resources in nursing.     

A training intervention to enhance self-management support competencies among nurses: A non-randomized trial with mixed-methods evaluation

AimTo evaluate the process and outcomes of INTENSS, a training intervention grounded in Self-Determination Theory to enhance nurses’ competencies for self-management support.DesignNon-randomized intervention study with mixed-methods evaluation approach (2019–2020).MethodsThe multifaceted training was implemented in six groups. Cluster-assignment to study arm 1 or arm 2. Arm 1 received a basic training module and arm 2 the basic module with additional video-interaction guidance. Focus groups were held to detect what was helpful in competency enhancement. Intervention effectiveness was determined on trainees’ attitude, motivation, self-efficacy and skills for self-management support (multiple time-points by self-reports and observations).ResultsTrainees (N = 50) indicated the video-interaction guidance, the connectivity within the training group, the constructive feedback from trainers as well as from peers, as helpful for the acquisition of self-management support skills. At 2-month post-training, participants slightly improved in their competencies for the assess (p = .03), agree (p = .02), arrange (p < .01) phase and partnership skills (p < .01). Between the study arms, video-trained participants significantly reduced their use of controlling approaches (p = .03). Observations indicated that trainees mostly used an autonomy-supportive approach, seldom we observed the use of competence supportive, controlling or chaotic approaches. The interviews gave indications that obligatory training in this field needs to be questioned.ConclusionThe outcome evaluation of the INTENNS training indicated most improvement in nurses’ skills for collaborative goal setting and partnership with patients. The mixed-methods evaluation emerges transferable principles to implement the training amongst nurses and, by extension, other healthcare professions. A training intervention involving patient experts can add value to further pave the way towards a true partnership between patients and healthcare professionals.ImpactA training intervention taking into account the complexity of supporting patients towards self-management is available. Important elements for growth are: connectivity within training group, a safe learning climate where ‘failure’ is allowed and video-interaction guidance. Obligatory training participation can be questioned.     

A Five-step Systematic Therapy for Treating Plugged Ducts and Mastitis in Breastfeeding Women: A Case–Control Study

PurposeThis study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct.MethodsThis retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST.ResultsAfter a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ² = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ² = 25.65, p < .001).ConclusionFSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.     

Impact of Different Illness Perceptions and Emotions Associated with Chronic Back Pain on Anxiety and Depression in Patients Qualified for Surgery

BackgroundAnxiety and depression are known comorbidities of chronic back pain. Their psychological predictors are not well established in patients with chronic back pain qualified for neurosurgery.AimsThe purpose of this study was to determine the psychological predictors of depression and anxiety in patients with chronic back pain qualified for surgery.DesignThis was a cross-sectional study.SettingsA neurosurgical ward in Gdańsk, Poland.Participants/SubjectsAll patients who were admitted to the neurosurgical ward and met the inclusion criteria were recruited for the study. Finally, 83 patients with chronic back pain waiting for surgery were recruited.MethodsA battery of questionnaires, including Illness Perceptions Questionnaire–Revised, Multidimensional Health Locus of Control Scale, Hospital Anxiety and Depression Scale, and Brief Pain Inventory, was used in 83 spinal surgery candidates.ResultsHigher anxiety was predicted by stronger beliefs about negative consequences of illness (β = .205, p < .05), worse illness coherence (β = .204, p < .05), negative emotional representations of illness (β = .216, p < .05), and depression (β = .686, p < .001). Higher depression was predicted by anxiety (β = .601, p < .001), pain interference (β = .323, p < .01), lower personal control over pain (β = −.160, p < .05), and lower external control of health (β = −.161, p < .05) but, surprisingly, higher internal control of health (β = .208, p < .01).ConclusionsAnxiety and depression commonly coexist in chronic back pain sufferers qualified for spine surgery but are derived from dissimilar beliefs. The results highlight the usefulness of advising about the disease and treatment in comprehensive care for this group of patients.     

The use of cluster analysis to identify different burnout profiles among nurses and care assistants for older adults

The twofold purpose of this study was to identify specific burnout patterns among nurses and care assistants for older people, and to determine whether these profiles differ according to socioprofessional variables.A sample of 279 healthcare professionals completed an online survey comprising the Maslach Burnout Inventory and socioprofessional items. Cluster analysis identified five profiles on a burnout-engagement continuum. Participants with the Engaged profile had low scores on all three burnout dimensions (p < .001), while those with the Burnout profile had high scores on all three dimensions (p < .001). Three intermediate profiles were described. The Disconnected profile was characterized by higher depersonalization (p < .001), the Overextended profile by high emotion exhaustion (p < .001), and the Ineffective profile by low personal accomplishment (p < .001). Less experienced professional caregivers were more prone to burnout in terms of depersonalization (p < .01), while more experienced professional caregivers tended to have an ineffective burnout profile (p < .01). Identifying profiles of burnout symptoms can help to develop personalized interventions.     

Effectiveness of a Virtual Program on Nurses’ Pain-Related Knowledge and Pain-Measurement Skills

BackgroundAim: To test whether a comprehensive virtual program for using pain scales to manage neonatal pain improved nurses’ knowledge and skill acquisition.MethodsThis non-blind randomized controlled trial included 64 participants who were randomly divided into intervention and control groups; changes in scores between pre- and posttests were compared. Certified neonatal intensive care nurses were recruited from across Japan. The learning intervention group received online training in pain measurement using structured scales, such as the Face Scale for Pain Assessment of Preterm Infants and the Japanese version of the Premature Infant Pain Profile. The control group received no training. Independent t tests and χ² tests were used to compare the baseline scores. The outcome measure was score change on a 40-point test (20 for knowledge and 20 for skill) before and after the e-learning program.ResultsNo differences in baseline data were found between the groups. Generalized linear regression models yielded a significant difference in the least squared means (95% confidence interval [CI]) for the amount of change in the total, knowledge, and skill scores between groups: 6.22 (4.18, 8.26; p < .001) for total score, 4.66 (3.37, 5.95; p < .001) for knowledge score, and 1.53 (0.06, 3.00; p = .041) for skill score.ConclusionsThe results showed that the e-learning program improved nurses’ neonatal pain knowledge and pain-measurement skills compared with no training.     

The daily relationships between staffing,safety perceptions and personality in hospital nursing: A longitudinal on-line diary study

BackgroundThe association between poor staffing conditions and negative patient safety consequences is well established within hospital nursing. However, many studies have been limited to nurse population level associations, and have used routine data to examine relationships. As a result, it is less clear how these relationships might be manifested at the individual nurse level on a day-to-day basis. Furthermore, personality may have direct and moderating roles in terms of work environment and patient safety associations, but limited research has explored personality in this context.ObjectiveTo further our understanding of these associations, this paper takes a within-person approach to examine nurses’ daily perceptions of staffing and patient safety. In addition, we explore the potential role of personality factors as moderators of daily level associations.MethodWe recruited eighty-three hospital nurses from three acute NHS Trusts in the UK between March and July 2013. Nurses completed online end-of-shift diaries over three–five shifts which collected information on perceptions of staffing, patient–nurse ratio and patient safety (perceptions of patient safety, ability to act as a safe practitioner, and workplace cognitive failure). Personality was also assessed within a baseline questionnaire. Data were analysed using hierarchical linear modelling, and moderation effects of personality factors were examined using simple slopes analyses, which decomposed relationships at high and low levels of the moderator.ResultsOn days when lower patient–nurse ratios were indicated, nurses reported being more able to act as a safe practitioner (p = .011) and more favourable perceptions of patient safety (p = <.001). Additionally, when staffing was perceived more favourably, nurses reported being more able to act as a safe practitioner (p = <.001), more favourable perceptions of patient safety (p = <.001) and experienced less workplace cognitive failure (p = <.001). Conscientiousness and emotional stability emerged as key moderators of daily level associations between staffing and patient safety variables, with many relationships differing at high and low levels of these personality factors.ConclusionThe findings elucidate the potential mechanisms by which patient safety risks arise within hospital nursing, and suggest that nurses may not respond to staffing conditions in the same way, dependent upon personality. Further understanding of these relationships will enable staff to be supported in terms of work environment conditions on an individual basis.     

Dimensions of the Burnout Measure: Relationships with shame- and guilt-proneness in neonatal intensive care unit nurses

BackgroundBurnout in neonatal intensive care unit (NICU) nurses has been correlated with personality proneness to shame. However, the structural validities of the one-factor Burnout Measure (BM) and the two-factor Personal Feelings Questionnaire-2 (PFQ-2) used to assess burnout and shame-proneness, respectively, in these nurses were not evaluated.ObjectivesThe aim of the study was (i) to perform factor analyses of the BM and the PFQ-2 and (ii) to determine the relationships of burnout dimensions retrieved by factor analysis with similarly validated dimensions of shame- and guilt-proneness in NICU nurses.MethodsThis is a multicentre cross-sectional cohort study that involved 142 (24%) of 585 NICU nurses who were currently providing direct newborn care in six level 3–4 NICUs in New South Wales, Australia.ResultsThe BM was a multidimensional measure of burnout composed of three latent factors: demoralisation, exhaustion, and loss of motive. Based on burnout dimension mean scores of 4 or more, worryingly high levels of demoralisation, exhaustion, and loss of motive were reported by 21%, 84%, and 24% of nurses, respectively. Shame and guilt together explained 41%, 9%, and 15% of the variance in demoralisation, exhaustion, and loss of motive, respectively. Shame controlled for guilt made respective large and moderate contributions to the variance in demoralisation (β = .62, p < .001) and loss of motive (β = .33, p < .001). Guilt moderated the effect of shame on loss of motive (ΔR² = .031, p = .027).ConclusionsFactor analysis of the BM showed burnout in NICU nurses was a multidimensional syndrome comprising exhaustion, demoralisation, and loss of motive. Worryingly high levels of exhaustion, demoralisation, and loss of motive were not uncommon. The demoralisation dimension had a strong correlation with shame-proneness. Understanding the nature of demoralisation and the phenomenology of shame and guilt should be psychoeducational components of the holistic management of burnout in NICU nurses.