Relational ethics and advocacy in nursing: literature review

AIM: The purpose of this paper is to analyse themes from accounts of nurses' experiences with advocacy that may expand our understanding of advocacy in nursing practice. BACKGROUND: Although the ethical obligation to advocate is universal, a lack of clarity persists about the nature of advocacy in nursing practice. METHOD: This discussion of advocacy is based on a synthesis of qualitative studies that focus on nurses' experiences with advocacy in practice. Empirical studies were retrieved through searches on the CINAHL and Academic Search Premier databases for the years 1993-2005. The search terms used were advocacy, advocate role, ethics, nursing practice and qualitative research. FINDINGS: Empirical studies related to the role of advocacy in nursing are limited in number. Nurses' experiences with advocacy reveal important themes in relation to factors that influence the application of advocacy in nursing practice. Evidence suggests that the nature and context of relationships plays a significant role in influencing the enactment of advocacy. CONCLUSION: The application of advocacy in nursing practice is complex. The philosophy of relational ethics emphasizes the contextual features of relationships. An examination of relational ethics as it applies to advocacy in nursing brings us closer to a deeper understanding of the process by which nurses make advocacy choices in practice, and raises implications for the development of advocacy in nurses' practice. Advocacy is universally considered a moral obligation in nursing practice, and thus advancement of our knowledge about its nature in nursing is relevant to nursing across multiple contexts and cultures.     

Motivation for health behaviours: a systematic review of the nursing literature

AIMS AND RATIONALE: This research review examines nursing and allied health studies exploring motivation for health behaviours to identify the state of understanding of this construct within nursing. This review contributes to nursing science by synthesizing nursing research regarding motivation for health behaviour. METHODS: Integrative research review methodology. FINDINGS: Problems of existing research include nonprobability sampling of heterogeneous populations, low statistical power, and colinearity. Studies identifying predictors of motivation explained large proportions of variance using regression. Motivation was not a significant predictor of health behaviours for over one-third of the studies. Overall, the studies suggest that either motivation is not being effectively measured because of a lack of conceptual clarity or that motivation is not an essential determinant of health behaviours. The latter cannot be verified until psychometric research advances current measurement of motivation to a higher level. LIMITATIONS; The literature for this review was accessed through the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database. Databases for other disciplines were not included in this search. This work represents a first step towards understanding motivation for health behaviour as it is currently defined in the literature. Future studies are necessary to broaden this understanding beyond nursing. CONCLUSIONS: Motivation is a frequently cited rationale underlying the adoption and maintenance of health behaviours in research and practice. Motivation is complex and multidimensional, and clearer definitions for motivation are needed. Populations that have been underrepresented in motivation research need to be targeted in future research. Researchers and practitioners are challenged to examine carefully the role of motivation for health behaviours and explore other factors that may more strongly influence health behaviours.     

Nurses' codes of ethics in practice and education: a review of the literature

The purpose of this review was to provide an overview of the empirical literature on nurses' codes of ethics in practice and education covering the time from 1980 to August 2007. The focus was on methodological issues, main domains of interest and findings of the studies. The aim of the review was to identify knowledge gaps and to provide recommendations for further research. Research on the codes of ethics in nursing is scarce. The main domains of interest were education, nurses' knowledge and use of the codes, the content and functions of the codes, and moral behaviour and values related to the codes. Education of the codes was important, and it had a positive impact on students' moral behaviour measured by an instrument based on the codes. Nurses' knowledge and use of the codes was deficient. Nurses' practice was guided by environmental contexts and personal experiences rather than the codes. However, nurses' values espoused those of the codes. The nurse–patient relationship was the best known aspect of the codes. Methodological diversity, a small number of studies focusing on several domains of interest warrants care in the interpretation of the findings. Further research should focus particularly on the education of the codes, covering the realization of the teaching process, evaluation of outcomes and organization of education. Cooperation between theoretical education and clinical practice should be explored. Research of the meaning of the codes and their functions for nurses, nurses' moral behaviour and professional values is needed. Research should cover all levels and areas of nursing and reach beyond the nurse–patient relationship to relationships with colleagues, other health professions, organizations and the society. The use of more varied methodological approaches is suggested.     

Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review

AIM: This paper reports a systematic literature review examining relationships between contextual factors and research utilization in nursing, examining the strength of these relationships, and mapping the contextual factors to the Promoting Action on Research Implementation in Health Services model of research implementation. BACKGROUND: Healthcare organizations have long struggled with how to improve clinical care outcomes. Understanding which contextual factors enhance nursing research utilization may support organizations in creating environments that facilitate the uptake of evidence in nursing practice to improve these outcomes. METHODS: A search of five electronic bibliographic databases and a manual search of specific journals were conducted for studies that were published in English and examined contextual factors as independent variables and research utilization as the dependent variable from the perspective of nurses working in clinical practice. The studies were assessed for quality of design, sample, measurement and statistical analysis. RESULTS: Ten papers met the search criteria. Six contextual factors were identified as having a statistically significant relationship with research utilization, namely the role of the nurse, multi-faceted access to resources, organizational climate, multi-faceted support, time for research activities and provision of education. The contextual factors could successfully be mapped to the dimensions of context in the Promoting Action on Research Implementation in Health Services framework (context, culture, leadership), with the exception of evaluation. CONCLUSION: The strength of the relationship between the six contextual factors and research utilization by nurses is still largely unknown as (a) few studies were found of sufficient quality because of methodological limitations and (b) the results in reviewed studies were mixed. More robust methods in future work would yield a better understanding of the full impact of contextual factors on nurses' use of research.     

Professional codes in a changing nursing context: literature review

BACKGROUND: Professional codes played a definitive role during a specific period of time, when the professional context of nursing was characterized by an increasing professionalization. Today, however, this professional context has changed. AIM: This paper reports on a study which aimed to explore the meaning of professional codes in the current context of the nursing profession. METHOD: A literature review on professional codes and the nursing profession was carried out. The literature was systematically investigated using the electronic databases PubMed and The Philosopher's Index, and the keywords nursing codes, professional codes in nursing, ethics codes/ethical codes, professional ethics. CONCLUSION: Due to the nursing profession's growing multidisciplinary nature, the increasing dominance of economic discourse, and the intensified legal framework in which health care professionals need to operate, the context of nursing is changing. In this changed professional context, nursing professional codes have to accommodate to the increasing ethical demands placed upon the profession. Therefore, an ethicization of these codes is desirable, and their moral objectives need to be revalued.     

Nursing intervention studies on patients and family members: a systematic literature review

The development of evidence-based practice is a major current challenge in the fields of nursing practice and nursing research. A concerted effort is needed to develop and test interventions and to assess their impacts. The illness of one family member inevitably affects other family members and the whole family. Nursing interventions should be so designed that they support and enhance the life situation of both patients and their families. The aim of this study is to undertake a systematic review of nursing intervention studies on patients and family members published in international databases in 2001–2006. The main focus was on the targets, methods and impacts of interventions. The articles for the review were searched from Medline and Cinahl (n = 31) and analysed by content analysis and the RE-AIM evaluation model. The results showed that the interventions were targeted at patients with chronic diseases and individual family members. In addition to support components, the interventions included elements of teaching, counselling and education. The preliminary evidence indicated that the interventions were effective in relieving the burden of care and depressive symptoms of family members of Alzheimer, cancer, stroke and schizophrenia patients as well as in promoting their quality of life and coping. Nursing interventions are still in the development and testing phase. The challenge for the future is to broaden the scope and application of interventions in different nursing environments. Assessments of the efficacy of interventions should also consider their adaptation, implementation and maintenance in practical nursing.     

Prevalence of heart failure in nursing homes: a systematic literature review

Scand J Caring Sci; 2010; 24; 202–208
Prevalence of heart failure in nursing homes: a systematic literature review
Introduction:  Heart failure is an important problem in western countries. In nursing home residents heart failure is expected to be highly prevalent. However, accurate diagnosis of heart failure in these patients is often hampered due to atypical findings and concomitant co-morbidity. In order to deliver adequate nursing care and medical treatment, it is important to get insight into the prevalence of heart failure in this target group of patients.
Objectives:  To assess the prevalence of heart failure as well as the co-morbidity interfering with heart failure in nursing home residents.
Methods and results:  A systematic literature review was conducted in Medline, Embase, Cinahl and the Cochrane Library. Ten studies were ultimately included. Findings indicate that the mean prevalence of heart failure is 20% (range 15–45%) and that there is a significant level of co-morbidity (dementia, diabetes mellitus and chronic obstructive pulmonary disease) in nursing home residents with heart failure.
Conclusion:  The reported prevalence of heart failure in nursing home residents is higher than in the general population and is associated with considerably co-morbidity. However there are also indications that the prevalence of heart failure in nursing home residents is underestimated, negatively affecting quality of life and quality of care. Therefore, prospective prevalence studies and studies aiming to improve the care for nursing home residents with heart failure are warranted.     

Nursing resistance as ethical action: literature review

BACKGROUND: Much has been written about nursing as a predominantly female profession whose members display passivity, submission, obedience and powerlessness. Alternatively, some authors have presented evidence of nurses' capacity to exercise power, revealing the possible relationship between powerlessness and ethical compromise. Thus, empowerment strategies for nurses can yield ethical action. AIM: The aim of this paper is to use analysis of the literature to demonstrate how the actions and responses of nurses to ethical concerns are examples of nurses exercising power. METHOD: Empirical studies published in the nursing literature between 1990 and 2003 have been analysed to illustrate how nurses' actions of resistance can ensure that moral values are realized in practice. Foucauldian notions of power relations and feminist ethics provide the theoretical framework. CONCLUSIONS: Nurses were found to resist in situations where they experienced moral conflicts in relation to the actions of health professionals; however, instances were cited where they did not. Consequently, strategies for nursing education and management are proposed to increase nurses' understanding of the potential acts of resistance that they could employ in situations of moral conflict or concern.     

Peer review in nursing and midwifery: a literature review

Aims and objectives. The Clinical Education Project investigated clinical education in nursing and midwifery settings. The aim of this phase was to investigate and evaluate the processes and outcomes of clinical assessment of preregistration nurses and midwives, focusing on the assessment interview, and to evaluate the feasibility of introducing peer review of the clinical assessment interview in acute clinical settings. Background. Peer review is common in many professional areas. The literature describes various applications of peer review and makes recommendations for its use. However, there is a shortage of studies investigating the use of peer review in nursing and midwifery education and practice. Design. The project involved a systematic literature review and a qualitative exploratory study. This article describes the first part of the study: a systematic literature review of peer review. The second part of the study is reported elsewhere. Methods. The systematic literature review investigated international articles written since 1994 that contained information on peer review in pre/post registration nursing and midwifery within higher education or practice. Results. From the available literature, 52 specific initiatives were analysed. The majority of articles originated in America and involved nursing staff working in secondary care settings. Fifty‐one articles had missing information varying from not stating the sample size to not including information about evaluations. Conclusions. The literature review found that whilst peer review is commonplace in nursing and midwifery practice, there is a lack of robust literature about its use. Relevance to clinical practice. Peer review in clinical settings such as nursing and midwifery can facilitate the sharing of good practice and personal and professional growth. It allows participants to learn from each other and gain insight into their development.     

Feeding and dementia: a systematic literature review

AIM: This paper reports a systematic review of the literature on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty between 1993 and 2003. BACKGROUND: Older people with dementia commonly experience difficulty with feeding, especially in the later stages of the condition. This topic and related nursing care was reviewed in 1993 and the conclusion was that there was little research into interventions that nurses could use to alleviate feeding difficulty. METHOD: A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE and Cochrane databases and the search terms 'feeding', 'eating' and 'dementia' combined as follows: '(feeding or eating) and (dementia)'. A second search was carried out combining the search terms 'mealtimes' and 'dementia' as follows: 'mealtimes and dementia'. The literature search was carried out on 1 December 2003 and papers were included in the review if retrieved by 31 December 2003. English language papers only were retrieved. RESULTS: Sixty-seven papers were retrieved, of which 13 addressed interventions aimed at helping older people with dementia to feed. All studies reported positive outcomes but only one randomized controlled trial was reported. Music was the most common intervention but there were no standardized interventions or outcomes across the studies and none reported the use of power analysis to decide on sample size. There were problems in some studies with confounding variables. CONCLUSIONS: Further research is needed into interventions aimed at how nurses can help older people with dementia to feed. There are some promising lines of enquiry, with music being one of these, but future studies need to use adequate samples and to use power calculations and account adequately for confounding variables. There is also a need to standardize interventions and outcomes across such studies to facilitate meta-analysis.     

The relationship between nursing leadership and patient outcomes: a systematic review

AIM: The purpose of this review was to describe findings of a systematic review of studies that examine the relationship between nursing leadership and patient outcomes. BACKGROUND: With recent attention directed to the creation of safer practice environments for patients, nursing leadership is called on to advance this agenda within organizations. However, surprisingly little is known about the actual association between nursing leadership and patient outcomes. METHODS: Published English-only research articles that examined formal nursing leadership and patient outcomes were selected from computerized databases and manual searches. Data extraction and methodological quality assessment were completed for the final seven quantitative research articles. RESULTS: Evidence of significant associations between positive leadership behaviours, styles or practices and increased patient satisfaction and reduced adverse events were found. Findings relating leadership to patient mortality rates were inconclusive. CONCLUSION: The findings of this review suggest that an emphasis on developing transformational nursing leadership is an important organizational strategy to improve patient outcomes.     

The systematic review of literature: Synthesizing evidence for practice

Purpose. With current emphasis on evidence‐based practice, nurses are searching for answers to questions generated at the bedside. One method to identify and evaluate the existing evidence is to conduct or read a systematic review of the literature. The purpose of this paper is to describe the process of conducting a systematic review of literature. Conclusion. Defining attributes, rationale for, and steps in conducting systematic reviews are presented. Examples from published reviews on pediatric nursing are included. Practice Implications. Pediatric nurses may consult professionally prepared systematic reviews, such as The Cochrane Collection, or conduct their own reviews with the help of electronic search engines.     

Empirical studies of clinical supervision in psychiatric nursing: A systematic literature review and methodological critique

The objective of this paper was to systematically review and critically evaluate all English language research papers reporting empirical studies of clinical supervision in psychiatric nursing. The first part of the search strategy was a combination of brief and building block strategies in the PubMed, CINAHL, and PsycINFO databases. The second part was a citation pearl growing strategy with reviews of 179 reference lists. In total, the search strategy demonstrated a low level of precision and a high level of recall. Thirty four articles met the criteria of the review and were systematically evaluated using three checklists. The findings were summarized by using a new checklist with nine overall questions regarding the studies' design, methods, findings, and limitations. The studies were categorized as: (i) effect studies; (ii) survey studies; (iii) interview studies; and (iv) case studies. In general, the studies were relatively small scale; they used relatively new and basic methods for data collection and analysis, and rarely included sufficient strategies for identifying confounding factors or how the researchers' preconceptions influenced the analyses. Empirical research of clinical supervision in psychiatric nursing was characterized by a basic lack of agreement about which models and instruments to use. Challenges and recommendations for future research are discussed. Clinical supervision in psychiatric nursing was commonly perceived as a good thing, but there was limited empirical evidence supporting this claim.     

Comparing midwife-led and doctor-led maternity care: a systematic review of reviews

sutcliffe k., caird j., kavanagh j., rees r., oliver k., dickson k., woodman j., barnett-paIge e. & thomas j. (2012)?Comparing midwife-led and doctor-led maternity care: a systematic review of reviews. Journal of Advanced Nursing68(11), 2376-2386. ABSTRACT: Aims. A report of a systematic review of reviews which examines the impact of having midwives-led maternity care for low-risk women, rather than physicians. Background. A rising birth rate, increasing complexity of births, and economic constraints pose difficulties for maternity services in the UK. Evidence about the most effective, cost-effective, and efficient ways to give maternity services is needed. Data sources. Searches were carried out in August-September 2009 of ten electronic databases, 16 key nursing and research websites, and reference lists of 56 relevant reviews. We also contacted 38 experts for information. No date restrictions were employed. Review methods. A narrative review of systematic reviews or 'meta review' was conducted using transparent and systematic procedures to limit bias at all stages. Systematic reviews that compared midwife-led care during pregnancy and birth with physician-led care were eligible for inclusion. Results. Three meta-analytic reviews were included. Midwife-led care for low-risk women was found to be better for a range of maternal outcomes, reduced the number of procedures in labour, and increased satisfaction with care. For some maternal, foetal, and neonatal outcomes reviews found no evidence that care led by midwives is different to that led by physicians. No adverse outcomes associated with midwife-led care were identified. Conclusions. For low-risk women, health and other benefits can result from having their maternity care led by midwives rather than physicians. Moreover, there appear to be no negative impacts on mothers and infants receiving midwife-led care.