Understanding the application of genomics knowledge in nursing and midwifery practice: A scoping study

BackgroundWith the increased realisation of the benefits of genomic testing, nurses and midwives are being exposed to genomic care as a part of normal clinical practice.AimTo explore how Queensland nurses and midwives are applying genomics knowledge in clinical practice to understand how best to support the workforce to meet patient needs in response to increased genomic testing rates.MethodsA scoping methodology was used whereby the research question was defined, relevant studies were identified for the purposes of a literature review, followed by interviews with 32 nurses and midwives to support the interpretation of the literature review and to understand the implications for practice.FindingsNurses and midwives are working in partnership with their patients and families to support genomic decision making. The emerging needs of patients to understand their diagnostic and treatment pathway is forcing nurses and midwives to self-educate to keep pace with current practice demands. This approach to upskilling is not adequate for those nurses and midwives currently who are regularly exposed to patients requiring genomic support.DiscussionDespite national and local policy documents identifying genomics workforce capacity as a strategic priority action and clinicians reporting their involvement in genomics care, there is a lack of succession planning, organisational support and educational opportunities to support these advances in practice.ConclusionThere is a need to address the emerging genomic workforce and education requirements to ensure nurses and midwives are capable of supporting patients undergoing genomic testing.     

Registered nurses' clinical reasoning in home healthcare clinical practice: A think-aloud study with protocol analysis

BackgroundThe home healthcare context can be unpredictable and complex, and requires registered nurses with a high level of clinical reasoning skills and professional autonomy. Thus, additional knowledge about registered nurses' clinical reasoning performance during patient home care is required.ObjectivesThe aim of this study is to describe the cognitive processes and thinking strategies used by recently graduated registered nurses while caring for patients in home healthcare clinical practice.DesignAn exploratory qualitative think-aloud design with protocol analysis was used.SettingsHome healthcare visits to patients with stroke, diabetes, and chronic obstructive pulmonary disease in seven healthcare districts in southern Norway.ParticipantsA purposeful sample of eight registered nurses with one year of experience.MethodsEach nurse was interviewed using the concurrent think-aloud technique in three different patient home healthcare clinical practice visits. A total of 24 home healthcare visits occurred. Follow-up interviews were conducted with each participant. The think-aloud sessions were transcribed and analysed using three-step protocol analysis.ResultsRecently graduated registered nurses focused on both general nursing concepts and concepts specific to the domains required and tasks provided in home healthcare services as well as for different patient groups. Additionally, participants used several assertion types, cognitive processes, and thinking strategies.ConclusionsOur results showed that recently graduated registered nurses used both simple and complex cognitive processes involving both inductive and deductive reasoning. However, their reasoning was more reactive than proactive. The results may contribute to nursing practice in terms of developing effective nursing education programmes.     

Current status and future directions of U.S. genomic nursing health care policy

BackgroundAs genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing’s holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care.PurposeTo examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation.MethodsWe conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health.FindingsGenomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed.DiscussionNine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas.ConclusionsTo advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.     

An exploratory model of advance care planning clinical training for oncology nurses: A constructivist grounded theory study

AimThe purpose of this study was to explore and construct the ACP clinical training model for oncology nurses to provide the theoretical references for nursing educators to develop ACP clinical training program for oncology nurses.BackgroundOncology nurses are the primary forces of advance care planning (ACP) clinical practice. However, the systematic ACP clinical training for clinical nurses, especially oncology nurses, is still not visible in mainland China.DesignA constructivist grounded theory study.SettingsThis study included participants from three tertiary hospitals in northeastern China.ParticipantsA total of 23 oncology nurses who directly care for cancer patients.MethodsA constructivist grounded theory approach was adopted to explore the ACP clinical training model for oncology nurses. Semi-structured interviews were completed to collect qualitative data for constructing the theoretical model. A three-level coding procedure with continuous comparisons was adopted to analyze the qualitative data.ResultsAs a result of the study, a total of 32 open coding categories and 13 axial coding categories were extracted and four selective coding categories were formed, namely, external driving forces, self-development, training needs and training key elements. Based on the above categories, the demand-driven ACP clinical training model for oncology nurses was finally developed.ConclusionsOncology nurses have a strong desire for ACP clinical training and their ACP training needs are diverse. The ACP clinical training model provide the theoretical references for nursing educators to develop ACP clinical training programs for oncology nurses to promote high-quality ACP clinical practice.     

Theoretical framework construction on care complexity in Chinese hospitals: A grounded theory study

ObjectivesThis study aims to construct a theoretical framework to analyze risk factors and explore hospital nurses’ perspectives on care complexity.MethodsThe grounded theory method was adopted, and semi-structured in-depth interviews regarding the understanding of care complexity were conducted among the participants, including 31 nurses and nine doctors. In addition, data were coded and strictly analyzed in accordance with the coding strategy and requirements of grounded theory.ResultsOur study reveals three factors that are closely related to care complexity, namely, (1) patient factors, including patients’ condition, age, self-care abilities, compliance, social support systems, psychological conditions, expectations, and requirements; (2) nursing staff factors, including work experiences, education, knowledge and operational skills of caring, and communication skills; and (3) organization and equipment factors, including nursing workforce, nursing workload, support from multidisciplinary teams and ancillary departments, and the conditions of medical and hospital services.ConclusionsThis study defines care complexity on the basis of its factors. Care complexity refers to the difficulty of nursing tasks during patient care plan implementation, which are affected by patients, nurses, and other factors in nursing and multisectoral, multidisciplinary cooperation. The framework can be beneficial for nursing education and for the improvement of the quality and efficiency of clinical nursing practice.     

Point-of-care used in the treatment of older patients with cancer. The perception and experience of nurses

BackgroundNursing tasks are changing as the proportion of people over the age of 65 years is increasing and is expected to double over the next four decades. New innovative solutions such as Point of Care Treatment (POCT) are being tested in oncological settings in order to optimise treatment, and this changes the nurse management in oncology. There is a need to explore oncology nurses' perception and experience when implementing the innovations in order to understand the implications for nursing and the treatment of older patients with cancer.MethodsQualitative research with face to face interviews with nurses working in oncology. Sample size (Mean = 8). Data were recorded verbatim, transcribed, and thematic analysis used.ResultsThree themes were identified: a, A great advantage in nursing, b, Change of practice in nursing care, c, Challenges in shifting roles. A majority of the participants had the perception that POCT treatment was an advantage not only for the nursing profession but for the older patients in cancer treatment as well. Monitoring the older patients with cancer at home would prevent them from accessing the hospital and get exposed to viral infections as well as saving them the journey to the hospital. Involvement from relatives, clear communication and management of the device and data transferred is essential.ConclusionsThe use of POCT in oncology will shift the nurses' tasks on the ward as well as improve treatment for older patients with cancer.     

Blended Oncology Nursing Training: A Quality Initiative in East Africa

PurposeLack of education and awareness about cancer treatment may result in suboptimal care of patients with cancer. Unlike high-income countries, resource-limited countries lack the standardized training and scope of practice in oncology nursing. This quality improvement project was conducted to assess nurses’ knowledge gain, retention of knowledge and clinical skill set, and feasibility of a blended learning approach in the care of adult oncology patients across four hospitals in Kenya and Tanzania.MethodWe used a combination of computer-led eLearning sessions and face-to-face interactions over 12 months for cancer education to oncology nurses. Pre- and posttests with each training session were combined with face-to-face clinical skills training at beginning and completion of the course. A comprehensive postassessment was conducted immediately after the training, and at 6, 9, and 12 months to evaluate knowledge gain and retention.ConclusionOf 21 participants across four sites, there was a statistically significant improvement in knowledge scores for 12 participants (P value < .05). The mean pre- and posttest results found significant differences across 10 sessions individually and cumulatively (P value < .01). Results from a one-way repeated measures analysis of variance (ANOVA) test on comprehensive test results suggested that there was no significant difference in knowledge retention across 9 months (F(2, 30) = 1.648412, P > .05).Implications for Nursing PracticeBlended learning is an effective tool in improving knowledge, skills, and self-efficacy for clinicians practicing in resource-limited countries. Developing a structured oncology training program has implications for bridging knowledge gaps among clinicians in resource-limited countries and promoting international knowledge exchange.     

Healthcare professionals’ experiences with highly qualified nurses working in acute care teams in primary healthcare settings

ObjectiveStrengthening primary healthcare with highly qualified nurses in acute care units or teams is a new Danish initiative intended to detect acute diseases and the deterioration of chronic diseases and to develop treatment for outpatients. This study explores healthcare professionals’ experiences with this initiative.DesignQualitative semi-structured interviews conducted in 2019–2020. Analysis was conducted with a systematic text condensation.SettingThis study is based on an acute care team in one Danish municipality called Acute Team Odense (ATO). ATO delivers acute nursing in patients’ own homes (including nursing homes) in collaboration with different healthcare professionals.SubjectsIndividual interviews with general practitioners (GPs) (n = 15), five focus-group interviews with nurses and nursing assistants from the municipality (n = 19) and one focus-group interview with staff from the emergency department (ED) (n = 10).Main outcomesExperiences of different healthcare professionals’ experiences with ATO.ResultsIn general, all of the participants were very satisfied with the new acute care team and the cross-sectorial possibilities. The GPs usually referred ATO to assessments in which paraclinical equipment, competencies, accessibility, response time and communication were important. The municipal nurses and nursing assistants tended to use ATO if they needed second opinions or acute nurse assistance. The ED most often used ATO to assist with intravenous therapy after an ED visit. All participants reported that ATO increased what could be assessed and treated in patients’ homes, which is central to preventing unnecessary hospitalisations.ConclusionsATO created new possibilities in patient’s homes which potentially might prevent unnecessary hospitalisations.

KEY POINTS

• Acute care units or teams are mandatory in Danish health care, but limited knowledge in the area is found.
• Healthcare professionals found that the acute care teams provided new possibilities to assess and treat patients in their own homes.
• Healthcare professionals experienced that the acute care team potentially prevented hospitalisations by fast clinical nurse assessments with paraclinical tests.

     

Canadian nursing in the genomic era: a call for leadership

With developments in genomics, there is an urgent need for Canadian nurses in all settings to be informed and involved in the incorporation of this new knowledge into healthcare. The purpose of this paper was to synthesize the literature on genetic nursing roles to provide a foundation for Canadian nursing leaders as they take on the challenges of nursing in the genomic era. A comprehensive review of 98 articles published between 1994 and 2004 revealed strong support for genetic nursing roles and recommendations for levels of genetic nursing practice. The few studies on genetic nursing roles suggested that nurses and other health professionals support the integration of genomics into nursing practice. Issues that need to be addressed related to nursing practice, education and research are offered to engage nursing leaders in advocating for the incorporation of genomics into nursing in Canada.     

Qualitatively exploring the attributes of adaptability and resilience amongst recently graduated nurses

AimTo explore newly graduated nurse’s understandings and practices of adaptability and resilience in clinical environments.BackgroundThe everyday practice of nursing work involves managing emotional and practical everyday demands related to the role. Adaptability and resilience are two critical attributes that equip nurses for this by enabling them to manage challenges and be flexible with their practices and expectations in the face of rapidly changing and unpredictable circumstances.DesignInformed by the theoretical underpinnings of the Person-centred Practice Framework, semi-structured interviews using topic guides were conducted with nine newly graduated registered nurse participants recruited through purposive sampling. Interviews occurred between March-October 2020 with participants working across seven different healthcare settings in three Local Health Districts in NSW, Australia.ResultsAnalysis of the data generated the core themes of: 1) ‘Making sense’ explored how nurses defined resilience and adaptability; 2) ‘Surviving as the nurse’ focused on how nurses experienced adaptability and resilience as a newly qualified nurse; 3) ‘Trusting oneself’ reflected the interconnection of nurses’ developed adaptability and resilience to their clinical self-assurance; and 4) ‘Doing it again’ described how adaptability and resilience can be further supported by the university sector. Findings demonstrated that adaptability and resilience in combination are essential attributes and required for effective nursing practice post-graduation. However, both collegial and organizational support were found to be lacking in positively reinforcing these attributes in this study.ConclusionNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.Tweetable abstractNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.     

Education outcomes related to including genomics activities in nursing practice in Singapore

Pestka E, Lim SH, Png HH. International Journal of Nursing Practice 2010; 16 : 282–288
Education outcomes related to including genomics activities in nursing practice in Singapore The purpose of this study was to describe the impact of a genomic educational intervention by measuring the extent participants could apply the class content to practice. A sample of 76 nurses employed by Singapore Health Services, Singapore, participated in a nursing genomics seminar in 2008 and completed a survey form with a response rate of 89%. Every respondent was able to identify use of a genomic assessment or intervention item with a patient from their clinical practice. The mean use of genomic assessment and intervention items was 5.8 out of a possible 10. The most frequently used items were assessment of family history information, environmental factors and genomic physical findings. Findings provide evidence that nurses are able to include genomic assessments and interventions in their practice following targeted education. This study highlights how informed nurses are able to apply genomic assessments and interventions to individualize patient care.     

Nurses’ perceptions on the skills,knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia: A qualitative study

BackgroundPeople experiencing homelessness have unmet healthcare needs often related to chronic health conditions and injury. Nurses are often the first and only point of contact for people experiencing homelessness accessing healthcare. However, education that prepares them to meet the needs of this vulnerable population is limited.AimTo qualitatively explore nurses’ perceptions on the skills, knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia that could underpin an educational pathway.DesignSemi-structured interviews with registered nurses and nurse practitioners.MethodsParticipants of a national survey were invited to undertake an interview. Interview data were analysed thematically and reported here in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.FindingsThe registered nurses (n = 11) and nurse practitioners (n = 6) had varying levels of experience providing care for homeless Australians. Overarching themes that arose from the registered nurse and nurse practitioner participants included equitable access to care, knowledge around homelessness, contribution of nursing, and nurses’ role. However, nurse practitioners had a greater sense of agency and empowerment to enact care, while registered nurses perceived being underprepared and overwhelmed by the unmet needs of people experiencing homelessness.ConclusionsThe findings suggest that nursing practice holds opportunities to improve access and care provision for people experiencing homelessness. Capitalising on these opportunities requires that nurses are educationally prepared with the skills, knowledge, and attributes to meet the needs of this vulnerable population without necessarily becoming nurse practitioners. These findings will be used to underpin the development of an educational pathway for nurses to enhance their response to homeless populations.     

A cross-sectional study on oncology nurses’ knowledge and practice of oral mucositis among cancer patients in Jordan

ObjectivesThis study was conducted to evaluate oncology nurses’ knowledge and compliance with oral mucositis (OM) management guidelines.MethodsA cross-sectional design with a nonparticipant observation approach was utilized. In phase Ⅰ, a cross-sectional convenience sample (n = 140) of oncology nurses completed the knowledge test. In phase Ⅱ, a random sample (n = 20) of oncology nurses from participants in phase Ⅰ was observed during their practice.ResultsFifty-seven (40.7%) of the participants had an unsatisfactory level of knowledge. Most of them had knowledge deficits regarding pathology, OM definition, assessment, scoring, treatment, and patient education and advice. A significant difference existed among nurses with diploma, bachelor, and postgraduate degrees as determined by one-way ANOVA (P = 0.001). There were no significant difference between average scores of male and female nurses were higher than those of nurses (P = 0.45). No significant difference was observed among knowledge scores of nurses with different job titles (P = 0.51). The average score of male nurses in terms of skill performance was higher than that of female nurses (29.20 ± 2.10 vs 27.10 ± 1.80) without statistical significance.ConclusionThe knowledge and compliance with OM management guidelines among Jordanian oncology nurses need to be improved. National OM prevention and management guidelines are adopted in Jordan. Continuing education and training are also recommended.     

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.     

Understanding the complexity of working under time pressure in oncology nursing: A grounded theory study

BackgroundThe international nursing shortage has implications for the quality and safety of patient care. Various studies report that nurses do not have time to complete all necessary nursing care tasks, potentially resulting in nurse-perceived time pressure. Providing good care in the current nursing environment often poses a real ethical challenge for nurses. How nurses experience caring for cancer patients under time pressure and how they deal with the limited time available in achieving an ethical nursing practice remains unclear.ObjectivesTo report qualitative research grounded in oncology nurses’ experiences with time pressure, its perceived impact on nursing care and the ways in which they deal with it.DesignA qualitative study design with a grounded theory approach was conducted to explore and explain oncology nurses’ experiences with time pressure and its underlying dynamics.Setting and participantsPurposive and theoretical sampling led to the inclusion of 14 nurses with diverse characteristics from five inpatient oncology nursing wards in one academic hospital.MethodsIndividual, semi-structured, in-depth interviews were conducted over a six-month period in 2015 and 2016. Data collection and analysis occurred simultaneously. The interview data was analysed using the Qualitative Analysis Guide of Leuven and NVivo software.ResultsThe conceptualised phenomenon of time pressure, grounded in empirical data, illuminated its complexity and helped us to explicate and describe what nurses felt when working under time pressure. The interviewed nurses described time pressure as a shared yet nuanced reality. We uncovered that nurses dealt with time pressure in varied ways, with a broad range of proactive and ‘ad hoc’ strategies. According to our interviewees, time pressure was a significant barrier in providing good nursing care. They illustrated how time pressure particularly affected the interactional aspects of care, which most nurses considered as essential in an oncology setting. Underlying personal, cultural and context-related factors seemed to play a key role in nurses’ individual experiences with time pressure.ConclusionTime pressure is a widely recognised and experienced phenomenon among nurses which has substantial negative implications for the quality and safety of patient care. Our findings reinforce the need to establish better support for nurses and to reduce the circumstances in which nurses are ethically challenged to provide good care due to time pressure. Based on our findings, we recommend investing more in the nursing culture and nurses’ personal development, in addition to optimising nurse staffing levels.     

Global Oncology Nursing Recruitment and Retention: A SWOT Analysis

ObjectivesThis article documents the current status of global recruitment and retention of oncology nurses. A strengths, weaknesses, opportunities, and threats model was used to identify internal-to-nursing recruitment and retention factors/influences and external opportunities and threats as well as strategies and initiatives to improve the current situation.Data SourcesData sources include published and grey literature from around the world.ConclusionDespite the increasing cancer burden threatening public health worldwide, recruitment and retention of oncology nurses remains challenging. Nursing strengths include action by oncology nursing associations, prelicensure nurse recruitment and preceptorships, and models of hospital shared governance. Nursing weaknesses include nurse bullying, practice models that curtail clinical nurses’ autonomy, and hierarchical and inflexible nursing leadership. External to nursing are opportunities exemplified by international partnerships in oncology care and international oncology conferences for networking and learning. Examples of external threats are a lack of oncology nursing faculty, disrespectful media portrayal of nurses, community misconceptions about cancer curability, and hazards of cancer nursing.Implications for Nursing PracticeGovernments and hospital authorities wishing to successfully address cancer control must strategically plan for the recruitment and retention of an adequate nursing workforce. Opportunities such as government recognition of oncology specialty training, shared governance, continuing specialized education, advanced practice nursing roles and career paths, and participation in national cancer control planning will increase and sustain a critical oncology nursing workforce.