Registered nurses’ experience of care for adult patients with a temporary tracheostomy at general hospital wards. A phenomenological-hermeneutic explorative study

BackgroundCaring for adult patients with a temporary tracheostomy in general wards can be challenging and complex. Little research has explored registered nurses’ experiences with caring for these groups of patients.ObjectivesThis study sought to interpret and describe registered nurses’ lived experiences of caring for adult patients with a tracheostomy in general wards.Research design/methodologySix registered nurses were interviewed in this study. The interviews were analysed to gain comprehensive knowledge about caring for adult patients with a temporary tracheostomy. The interviews were transcribed, analysed, and interpreted by using Gadameŕs philosophical hermeneutics and Kvale and Brinkmann’s three steps of understanding.SettingThree different wards medical, surgical, and neurological of a teaching hospital in Norway.FindingsThree themes emerged from data analysis. These included experiencing clinically challenging patients, a lack of clinical support from the intensive care nurses, and a lack of professional confidence.ConclusionThis study highlighted the challenges surrounding the care of an adult patient with a tracheostomy in the general wards. Identifying these challenges would lead to further improvement in registered nurses’ experiences and, in turn, in the quality of competent care for adult patients with a tracheostomy in the general ward.Implications for Clinical PracticeUnderstanding the registered nurses’ experiences will assist the head nurses in planning and providing relevant information and education to provide safe and holistic patient care. Adequate support from intensive care unit nurses and professional development are required to ensure high-quality care. This study recommends that healthcare managers focus on establishing step-down units to improve patient outcomes, especially for high-risk patients and to increase the competencies of registered nurses in caring for adult patients with a tracheostomy as a whole person.     

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care.BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards.DesignExplorative qualitative focus group study.MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.     

Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards

This study tested the theoretical proposition that qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards The research was undertaken in a local district general hospital during January 1995 The project aimed to look at local practices of qualified nurses related to oral care of patients hospitalized in medical wards Extent of knowledge and current practice of care was examined using a questionnaire Open and closed style questions were used The sample comprised nurses on one elderly care ward and three general medical wards and the sample size was 34 The results revealed gaps in knowledge of oral care procedures In particular, a lack of assessment and documentation was highlighted However, the nurses indicated a high level of interest at updating themselves in this area of nursing The limitations of this study are discussed     

Australian registered nurse medical device education: a comparison of life-sustaining and non-life-sustaining devices

Registered nurses are primarily responsible for the use of medical devices in direct patient care This cross-sectional survey compared how and what 139 registered nurses working in a variety of wards/units in a 1000-bed tertiary care hospital in South Australia initially learned about the life-sustaining and non-life-sustaining medical devices they use Furthermore, the consequences of device use both for patients and staff were explored How and what registered nurses initially learned about life-sustaining and non-life-sustaining devices were remarkably similar Consequences of device use, which included increased or decreased quality of care, increased nurse stress and patient harm, were related, in part, to knowledgeable and proficient device use Thus, device education for nurses is essential and warrants further exploration     

Challenges Encountered by Nurses Working in Acute Psychiatric Wards: A Qualitative Study in Iran

Background: The provision of care to patients with psychiatric disorders and working in a challenging environment lead to many problems among psychiatric nurses. The aim of this study was to explore the challenges nurses faced while working in acute psychiatric wards. Design: A qualitative design using content analysis was used. Fifteen nurses working in psychiatric wards in hospitals affiliated to a university hospital in an urban area of Iran were chosen using a purposive sampling approach. Semi-structured interviews were used for data collection. An inductive content analysis method was used to analyse the collected data. Results: Four themes were developed based on the analysed data: “experiencing psycho-social challenges,” “experiencing psychological challenges,” “encountering catalysts causing challenges,” and “employing various strategies for coping with challenges.” Conclusions: Given the importance of physical and mental well-being of nurses and the moral and professional responsibility of an organization to protect staff health, it is of prime importance to examine the inpatient psychiatric nurses' experiences to better understand them and hopefully use such knowledge so as to improve their work life.     

Nurses’ Perspectives on the Care of Adults with Mental Health Problems and Histories of Childhood Sexual Abuse

Despite growing awareness and evidence linking childhood sexual abuse (CSA) to numerous ongoing health problems in adulthood, the integration of this knowledge into nursing practice remains inconsistent. This article reports the results of a study that explored nurses’ perspectives on, and experiences with, providing care for adults with mental health problems who may also have histories of CSA. Nurses’ views underscore the challenges and complexities involved when providing care for this population. The themes of nurses’ knowledge and comfort levels, ethical practice, patient care considerations, and system issues are used to discuss nurses’ understandings, perspectives, and experiences.     

Nurses' experiences of caring for patients with a dual diagnosis of depression and alcohol abuse in a general psychiatric setting

The aim of this study is to describe mental psychiatric health nurses' experiences of caring for persons with the dual disorders of major depression and alcohol abuse. The study was conducted in 2003 on three psychiatric wards located in two general hospitals in Sweden. The study group comprised 11 registered nurses with experience of caring for patients with dual disorders. The data were analyzed by means of qualitative content analysis. The findings revealed three categories: Enabling a good level of cooperation with patients; Facilitating continued care and treatment; and Understanding barriers to cooperation with patients. Building a trusting relationship in order to enable cooperation with patients was the basis for continued care and treatment. The nurses needed more training and multidisciplinary knowledge in order to meet the particular clinical needs of this patient group. Nurses have an important obligation to utilize the best available evidence, including research findings and other scientific sources.     

Improving care on mental health wards with hourly nurse rounds

Hourly rounds are becoming more popular on inpatient medical wards and are known to be beneficial to patients and nurses. However, there is little evidence about their impact in psychiatry and what hourly rounds would look like on inpatient mental health units. This article examines the introduction of hourly nurse rounds on inpatient mental health wards in an American hospital, and how they were adapted to the needs of psychiatric patients. The positive effects on patient care and staff are reported.     

Multi-disciplinary interpretations of pain in older patients on medical units

The aim of this study was to assess the knowledge and attitudes of the health care team caring for older patients on acute medical wards. Pain is probably the most distressing symptom experienced by hospital patients. Pain management has traditionally been seen as part of the anaesthetist’s role, within the UK, establishment of acute pain teams was a response to the report ‘pain after surgery’ which cemented the link between pain and surgery. However, in 2004–2005, 63% of admissions to general medicine in the UK were individuals in the 60+ age group suggesting that older people are significant users of general medicine services. Treatment of pain is multi-disciplinary and effective pain management should be a universal response by health care professionals and non-professionals. A questionnaire was distributed to all nurses; registered and non-registered, junior doctors who worked on the acute medical wards, all physiotherapists and all pharmacists in the hospital. There were varying levels of pain management education identified across the professional groups and, whilst there is a reasonable level of pain knowledge both general and specific to the older person, there is still a need to improve the knowledge and attitudes of all health care professional groups caring for older patients in pain on acute medical wards.     

Mental health nurses' attitudes towards severe perinatal mental illness

Title.  Mental health nurses' attitudes towards severe perinatal mental illness.
Aim.  This paper reports on a study exploring the experiences and attitudes of generic mental health nurses towards care of women with severe mental illness during the perinatal period.
Background.  Severe mental disorder in the perinatal period is a global public health concern. However, there are concerns that mental health nurses other than dedicated perinatal mental health teams may lack knowledge, skills and experience in caring for such disorders, because of their low prevalence.
Methods.  Sixteen generic Registered Mental Nurses working in public adult mental health services participated in three focus groups during 2007.
Findings.  Participants did not perceive any difference between symptoms during perinatal and non-perinatal periods. There were mixed attitudes towards caring for women with severe mental illness in the perinatal period. Fear and anxiety was expressed by the nurses when caring or feeling responsible for the babies of clients. Lack of communication between professional groups and decreased clinical decision-making following the introduction of the Edinburgh Post Natal Depression Scale caused frustration. Confidence was displayed when working with known and trusted colleagues.
Conclusion.  Generic mental health nurses would benefit from more education on perinatal mental health and there may be a need for them to be supported by specialist perinatal mental health practitioners.     

Forensic mental health: Perceptions of transition and workforce experiences of nurses

BackgroundWith the growing need for nurses in forensic mental health settings, understanding the experiences of transition and perceptions of the setting is important to support staff retention.AimTo explore registered nurses’ experiences of working in a forensic mental health setting. In particular, to understand their transition experience, perceptions of the practice environment and intention to stay within the setting.MethodsRegistered nurses employed in a high-secure forensic mental health hospital in New South Wales, Australia, completed an online survey including the Revised Professional Practice Environment Scale and Nurse Retention Index.FindingsSixty-nine participants responded to the survey. During the first year of their employment, participants reported feeling isolated, lacking support and being anxious when providing patient care. In terms of the environment, participants perceived ‘internal work motivation’ as positive in the environment when compared to ‘handling disagreement and conflict’. While many intended to continue their nursing careers for the foreseeable future, 45.3% of participants were undecided about whether they would leave the forensic setting.DiscussionDue to the complexity of forensic mental health practice, the reporting of poor experiences of transition and issues regarding support and conflict is concerning. Considering the importance of workplace culture and teamwork in forensic mental health, strategies to enhance positive interpersonal relationships is essential.ConclusionGiven the predicted future workforce shortages, this study highlights a need for appropriate supports for nurses’ transitioning into forensic mental health employment to enhance workplace satisfaction and retention.     

Palliative care in district general hospitals: the nurse's perspective

Most patients with a terminal illness die in hospital, yet the opinions of their prime carers are largely ignored. This study investigated registered nurses' perceptions of palliative care in district general hospitals. A random sample of 263 nurses was surveyed, using a pre-piloted questionnaire, and results showed that 70% of general ward nurses believe that managing care of the dying is an integral part of hospital care. However, their dissatisfaction with the care they give is reflected in the mere 8% who consider hospital an ideal setting for patients who are dying. Although nurses are confident in their physical/clinical role, dealing with psychosocial issues is more problematic. A minority feel confident in discussing death and dying with the patient. Barriers to optical palliative care on general wards were perceived as lack of appropriate education and training, work pressures, and lack of support from medical colleagues and managers.