Embodied knowledge in chronic illness and injury

When people experience chronic illness or serious injury, changes occur not just within their physical bodies but also in their embodiments, that is, how they view the world through their bodies. For such patients, dualistic (mind-body) notions of the body as object and the mind as subject can devalue experiences that are necessary for healing and for managing everyday problems related to their illness or injury. Nurses need to be able to guide people with illness or injury to new levels of wellness, but may lack appropriate theoretical conceptualizations. Philosophies that underlie embodied knowledge--in particular, philosophies of Merleau-Ponty and Polanyi--were explored yielding two new ways to understand the body. The body as "silent partner" fosters an appreciation of the body's own subjectivity that can be enhanced in nursing care through sensitivity, listening, and creative coaching. Nurses can assist their patients to identify new and positive understandings of what their bodies mean to them after bodily changes. The body as "informant" holds much promise for solving some of the everyday problems that people with chronic illness or injury experience. By using phenomenological and other naturalistic methods, researchers and patients can find clues to solving such problems, clues that are known through daily living but hidden beneath conscious awareness. As a result, some of the practical know-how of the body as "informant" can be transformed into testable nursing interventions.     

Knowing the family: Interpretations of family nursing in oncology and palliative care

PurposeFamilies are acknowledged as a focus of care in oncology nursing in many countries but the meaning of “family nursing” in this practice setting has received little attention from researchers and theorists. In this article, we report the findings of a study that explored family nursing practices in three adult cancer care settings: ambulatory care (medical and radiation oncology clinics), a palliative care service, and an in-patient unit.MethodData included in-depth interviews with 30 nurses and 19 families, as well as participant observations in each practice setting. The interviews were transcribed verbatim and the analyses guided by philosophical hermeneutics.ResultsWe identified several narratives related to family nursing practices, and in this article we offer the interpretations of two of these narratives: 1) knowing the family and being known; and 2) addressing family concerns and distress. In knowing the family and being known nurses opened relational space for families to become involved in the care of their loved ones and gained an understanding of the family by “reading” non-verbal and para-verbal cues. Knowing the family created opportunities for nurses to address family concerns and distress in meaningful ways. These included guiding families by being a bridge, helping families to conserve relationships, and negotiating competing family agendas. Nurses relied on questioning practices to create relational space with, and among, family members.ConclusionsImplications for the development of family nursing practice, theory, and education are discussed.     

Ethical elements in priority setting in nursing care: A scoping review

BackgroundNurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses’ professional and moral values.ObjectiveTo explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses.Design, data sources and methodsA scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis.ResultsNurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients’ daily care needs, prioritising work by essential tasks and participating in priority setting for patients’ access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient’s situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses’ moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise.ConclusionsAnalysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.     

Nurses' Perceptions of Patient Participation in the Postanesthesia Care Unit—A Qualitative Focus Group Study

PurposeTo explore postanesthesia care unit (PACU) nurses' experiences and perception of patient participation during PACU care.DesignQualitative focus group study based on a phenomenological hermeneutic approach.MethodsWe conducted three focus group interviews with 18 nurses from three different PACUs. Themes were created based on interpretive theory inspired by Ricoeur.FindingsFour themes and 11 subthemes were found. Patients’ clinical condition and situation, time management, ethical aspects, and the patient-nurse relationship all had a high impact on postanesthesia nursing practice and conditions for involving patients.ConclusionsPACU nurses want patients to participate in their own treatment and care in the PACU; however, nurses perceive patient participation differently. Nurses experience challenges including patients’ impaired autonomy, absence of a holistic approach, and lack of time and resources. Nurses highlight that these barriers should not become an excuse for noninvolvement.     

Surgical nurses’ responses to worry: A qualitative focus-group study in the Netherlands

BackgroundHospital nurses observe and respond to deterioration using the ‘National Early Warning Score 2’. Surgical nurses are highly engaged in the early recognition of and response to deterioration. Responses to deterioration are based on deviating vital signs, while nurses also act on subjective indicators like worry. Scientific literature and (inter)national guidelines do not mention any information about acting upon worry.ObjectiveTo gain an in-depth understanding of the actions nurses on surgical wards undertake to generate an appropriate response to nurses’ worry when the ‘National Early Warning Score 2’ does not indicate deterioration.MethodA qualitative focus-group study with surgical nurses working at a hospital in the Netherlands. Data was collected by focus-group interviews supported by vignettes and analysed thematically.FindingsFour focus-group interviews with a total of 20 participants were conducted between February and April 2020. Two sequential themes emerged: ‘Searching for explanation and confirmation’ and ‘Responding by actively applying nursing interventions’. Nurses gathered additional information about the patient and searched for a reference point to place this information in perspective. Nurses also approached others for co-assessment and verification. However, nurses faced barriers in calling for medical assistance. They felt physicians did not take them seriously. After gathering additional information, nurses responded by applying nursing interventions to comfort the patient.ConclusionNurses mainly try to formalise an in-depth understanding of their feeling of worry to convince a physician to accurately treat the patient. Spending much time on a search to this understanding leads to delays in escalating care.     

Chinese Perspectives on Culture and Mental Health

Central to providing culturally appropriate nursing care is sensitivity to and knowledge about the group being cared for. Although “mental health” and “mental illness” are artificial concepts among people who do not differentiate and treat mind, body, and spirit separately, and who may not differentiate illness from other problems of living, many individuals ethnically rooted in one or more Asian cultures enter Western mental health care systems. Quality nursing care requires understanding and respect for traditional values, beliefs, and practices that may differ significantly from those typical of Western European-based societies. Whether clients are traditional in orientation or highly acculturated to Western ways, nurses are responsible for providing culturally appropriate care. This article discusses mental health and nursing care from various perspectives of Asian and Asian-American clients, and in particular those of Chinese descent.     

Practice standards for Australian cardiovascular nurses: An electronic Delphi study

BackgroundProfessional standards for nurse practice protect the public and define the scope of nursing broadly and in specialty areas. Nurses encounter patients with cardiovascular disease in a variety of clinical contexts, and specialty practice standards have the potential to articulate the scope and role expectations for nurses caring for this population. Practice standards and role expectations for nurses caring for cardiovascular patients in Australia were developed through electronic Delphi (eDelphi) technique.AimTo present the development of practice standards and role expectations for Australian cardiovascular nurses.MethodsThree-round eDelphi survey with experts from a broad range of contexts who identified as cardiovascular nurses to reach a consensus on the Practice Standards for Australian Cardiovascular Nurses. External stakeholder agreement was also sought on the final version prior to publication.FindingsThree domains were identified: Clinical Care, Cultural Safety, and Person-Centred Care, and Leadership and Teamwork, and their supporting elements. Role expectations reflected the varied context and scope of practice.DiscussionThese standards describe the scope of cardiovascular nursing practice regardless of context. Underpinning the standards is the recognition of person-centred care and cultural safety. The standards provide a framework for professional recognition, support the delivery of patient care, and may be used to aid curriculum development in cardiovascular nursing education.ConclusionThe eDelphi technique and external stakeholder agreement validated the expected capability of nurses involved in the assessment, management, and evaluation of care for the cardiovascular patient. The standards and role expectations reflect the various contexts where care for the cardiovascular patient occurs.     

Emergency Nurses' Experiences in Treating Patients With Mental Illness: A Qualitative,Interpretive Metasynthesis

IntroductionEach year, emergency departments are seeing an increase in the number of patients with mental illness. Nurses often do not feel equipped with the knowledge or skills for this patient population while caring for them. Although there is published literature about nurses caring for patients with mental illness, there is a gap in knowledge about the lived experiences of these frontline workers.MethodsTo gain a better understanding of the experiences of emergency nurses in treating patients presenting with psychiatric issues, a qualitative interpretive metasynthesis of 5 qualitative articles was conducted.ResultsThree themes emerged from the synthesis: (1) feeling unprepared and unqualified, (2) feeling anxious and hesitant, and (3) the need to keep the patient environment safe.DiscussionThe overarching finding in our QIMS was the prevalent feeling of general concern regarding treating patients with mental illness despite the nurses' own preconceptions and apprehensions. It is important to understand the lived experiences of nurses treating patients with mental illness to learn be better prepared for future encounters.     

Missed nursing care in pediatric emergency departments in Turkey: A cross-sectional study

ObjectiveA pediatric emergency department deals with a vast number of patients and a high load of emergent/high-priority healthcare practices. Therefore, at times, it is possible to experience missed nursing care in this department. This study aims to ascertain the types of and reasons for missed nursing care cases in pediatric emergency departments in Turkey.MethodThis is a cross-sectional survey study. Survey data were collected from 155 nurses using the “Introductory Information Form” and the “MISSCARE-Pediatric Emergency Department Survey.”ResultsGastrostomy care, colostomy care, tracheotomy care, and teaching about hospital discharge were the care practices most often missed. The volume of patients, urgent patient situations, an inadequate number of nurses in charge, too many inexperienced nurses in the department, and assignment of work outside the scope of the job are the main reasons for missed care.ConclusionPediatric emergency department patients experience missed nursing care and nurses should be supported more in order for them to provide efficient care to children.     

Screening for Symptoms of Postpartum Traumatic Stress in a Sample of Mothers with Preterm Infants

People with serious mental illness are at high-risk for physical illnesses and premature death, and nurses can contribute to ensuring mental health services address these risks. There is very little research examining the role of nurses in mental health who provide physical health care. To identify the levels of participation in physical health care of people with serious mental illness (SMI), a national Internet-based survey of nurses working in mental health in Australia was conducted (n = 643). The survey included an adapted version of the Robson and Haddad Physical Health Attitude Scale. Data were analysed through comparison of frequencies, correlations, principal components analysis, and Mann-Whitney tests. Nurses reported regular physical health care in 12 of the 17 tasks presented to them. The three most common self-reported physical health care activities were inquiring about consumers’ contact with GPs, doing physical assessments, and providing information on drug use and lifestyle. Although some practices were less common (e.g., contraceptive advice) nurses who provided one type of care tended to do other types as well. In addition, credentialing in mental health nursing was associated with slightly more regular engagement in all practice domains except screening and assessments. Nurses in mental health in Australia may be engaged in improving physical health of consumers with SMI more than is assumed.     

Knowledge of,and participation in,advance care planning: A cross-sectional study of acute and critical care nurses’ perceptions

BackgroundNurses have a core role in facilitating discussions and enacting decisions about end-of-life issues for patients in hospitals. Nurses’ own knowledge and attitudes may influence whether they engage in meaningful end-of-life conversations with patients.AimsTo determine in a sample of nurses working in acute and critical care hospital wards:1) their knowledge of advance care planning, including the authority of substitute decision-makers and legal validity of advance directives;2) their own participation in advance care planning decision-making practices; and3) associations between nurses’ socio-demographic characteristics; clinical expertise; and knowledge and behaviour in relation to advance care planning practices.DesignQuestionnaire-based, cross-sectional study.Setting and participantsThe study was conducted with 181 registered and enrolled nurses employed in acute and critical care wards of three metropolitan hospitals in Australia.ResultsNurses were least knowledgeable about items relating to the authority of medical (56%) and financial (42%) substitute decision-makers. Few nurses had prepared advance directives (10%) or appointed medical (23%) or financial (27%) decision-makers, when compared to discussing end-of-life wishes (53%) or organ donation (75%). Overall, 15% of nurses had not engaged in any advance care planning practices. Nurses who had cared for 11–30 dying patients in the last six months were more likely to have an increased knowledge score. Older nurses were more likely to participate in a greater number of advance care planning practices and an increase in shifts worked per week led to a significant decrease in nurses’ participation.ConclusionNurses have a key role in providing advice and engaging dying patients and their families in advance care planning practices. Nurses’ own knowledge and rates of participation are low. Further education and support is needed to ensure that nurses have an accurate knowledge of advance care planning practices, including how, when and with whom wishes should be discussed and can be enacted.     

Exercise,diet, and sleep habits of nurses working full-time during the COVID-19 pandemic: An observational study

BackgroundHealthy diet, exercise, and sleep practices may mitigate stress and prevent illness. However, lifestyle behaviors of acute care nurses working during stressful COVID-19 surges are unclear.PurposeTo quantify sleep, diet, and exercise practices of 12-hour acute care nurses working day or night shift during COVID-19-related surges.MethodsNurses across 10 hospitals in the United States wore wrist actigraphs and pedometers to quantify sleep and steps and completed electronic diaries documenting diet over 7-days.FindingsParticipant average sleep quantity did not meet national recommendations; night shift nurses (n = 23) slept significantly less before on-duty days when compared to day shift nurses (n = 34). Proportionally more night shift nurses did not meet daily step recommendations. Diet quality was low on average among participants.DiscussionNurses, especially those on night shift, may require resources to support healthy sleep hygiene, physical activity practices, and diet quality to mitigate stressful work environments.     

Achieving therapeutic clarity in assisted personal body care: professional challenges in interactions with severely ill COPD patients

Aim and objectives. This paper aims to present a theoretical account of professional nursing challenges involved in providing care to patients suffering from chronic obstructive pulmonary disease. The study objectives are patients’ and nurses’ expectations, goals and approaches to assisted personal body care. Background. The provision of help with body care may have therapeutic qualities but there is only limited knowledge about the particularities and variations in specific groups of patients and the nurse–patient interactions required to facilitate patient functioning and well‐being. For patients with severe chronic obstructive pulmonary disease, breathlessness represents a particular challenge in the performance of body care sessions. Design. We investigated nurse–patient interactions during assisted personal body care, using grounded theory with a symbolic interaction perspective and a constant comparative method. Methods. Twelve cases of nurse–patient interactions were analysed. Data were based on participant observation, individual interviews with patients and nurses and a standardized questionnaire on patients’ breathlessness. Findings. Nurses and patients seemed to put effort into the interaction and wanted to find an appropriate way of conducting the body care session according to the patients’ specific needs. Achieving therapeutic clarity in nurse–patient interactions appeared to be an important concern, mainly depending on interactions characterized by: (i) reaching a common understanding of the patient's current conditions and stage of illness trajectory, (ii) negotiating a common scope and structuring body care sessions and (iii) clarifying roles. Conclusion. It cannot be taken for granted that therapeutic qualities are achieved when nurses provide assistance with body care. If body care should have healing strength, the actual body care activities and the achievement of therapeutic clarity in nurses’ interaction with patients’ appear to be crucial. Relevance to clinical practice. The paper proposes that patients’ integrity and comfort in the body care session should be given first priority and raises attention to details that nurses should take into account when assisting severely ill patients.     

Being family: the family experience when an adult member is hospitalized with a critical illness

Aims and objectives. The purpose of this qualitative study was to understand and interpret the ‘family experience’ with an adult member hospitalized with a critical illness. Background. Nursing practice in critical care settings has traditionally focused on individual patient needs with only tangential recognition of family needs. Investigation to describe the family experience to illuminate family nursing practice has been lacking. The majority of studies thus far related to critical illness and family are quantitative and reveal constraints to family care and problematic nurse–family interactions. The logical next step is a new kind of family research to enhance nursing of the family as a whole. Design. Family systems theory and existential phenomenology provided the frameworks guiding the study. Methods. Semi‐structured ‘family as a group’ interviews were performed with 11 families. Data were analysed using Van Manen's hermeneutic method. Rigor was addressed with trustworthiness criteria. Results. The family experience was analysed within Van Manen's framework of lived space, lived relation, lived body and lived time. A constitutive pattern of being family was revealed. Conclusions. Being family bonds families and makes them exceedingly strong during the critical illness experience. Being a family unit is what gives most families the ability to endure the emotional upheaval and suffering that come with the critical illness experience. Relevance to clinical practice. Nurses have profound power to help families bear this experience. Family caring is enhanced with the presence of nurses who recognize the importance of ‘Being Family’ for the family, acknowledge the significance of the nurse–family relationship and act on a commitment to be with and for the family.     

Rethinking the birthing body: Cartesian dualism and perinatal nursing

AIM OF THE PAPER: This paper highlights the pervasive influence of a Cartesian metaphysics on the medical paradigm and its profound impact on the practice of perinatal nursing in North America. BACKGROUND: Modern perinatal health care practices are founded on a Cartesian metaphysics that reduce birthing women to the status of object. Such practices deny the holistic aims of perinatal nursing. METHODS: A philosophical inquiry informs the tenets of this metaphysical discussion regarding the foundations of perinatal nursing practices. FINDINGS: Although perinatal health care is founded on a Cartesian metaphysics, an alternative paradigm of embodied practice is suggested as a way of viewing birthing women as embodied subjects. CONCLUSION: If the foundations of health care, which have been built on a Cartesian metaphysics, are not re-examined, perinatal nurses will be providing care that further reduce women to the status of object.     

Data Science and Precision Oncology Nursing: Creating an Analytic Ecosystem to Support Personalized Supportive Care across the Trajectory of Illness

ObjectivesThe authors’ objective is to present an overarching framework of an analytic ecosystem using diverse data domains and data science approaches that can be used and implemented across the cancer continuum. Analytic ecosystems can improve quality practices and offer enhanced anticipatory guidance in the era of precision oncology nursing.Data SourcesPublished scientific articles supporting the development of a novel framework with a case exemplar to provide applied examples of current barriers in data integration and use.ConclusionThe combination of diverse data sets and data science analytic approaches has the potential to extend precision oncology nursing research and practice. Integration of this framework can be implemented within a learning health system where models can update as new data become available across the continuum of the cancer care trajectory. To date, data science approaches have been underused in extending personalized toxicity assessments, precision supportive care, and enhancing end-of-life care practices.Implications for Nursing PracticeNurses and nurse scientists have a unique role in the convergence of data science applications to support precision oncology across the trajectory of illness. Nurses also have specific expertise in supportive care needs that have been dramatically underrepresented in existing data science approaches thus far. They also have a role in centering the patient and family perspectives and needs as these frameworks and analytic capabilities evolve.