Neonatal nurses’ professional quality of life: An integrative review

BackgroundNurses working in critical care environments, such as intensive care units, are susceptible to impaired professional quality of life. Those caring for babies and children, even more so.AimTo appraise the extant literature regarding neonatal nurses’ professional quality of life and propose recommendations for neonatal nursing practice, policy, and research.MethodThis integrative review aligns with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and Whittemore and Knafl's five-stage methodology. A systematic search of the CINAHL, Medline, and PsychInfo electronic databases and grey literature was conducted. Peer reviewed articles referring to neonatal nurses’ work-related stressors and satisfiers which had been published in English language between 1990 and 2020 were included.FindingsNeonatal nurses of varying ages, experience levels and cultures, report burnout, secondary and post-traumatic stress; however, the cumulative impacts result in higher prevalence among experienced clinicians. Compassion fatigue is mitigated by compassion satisfaction.DiscussionNeonatal nurses’ report lower resilience and higher emotional exhaustion and sensitivity to organisational change than their medical colleagues. Despite workplace adjustments some nurses may remain disproportionately at risk due to factors associated with their personality traits, affect, and practice environments.ConclusionFurther research exploring the relationships between structural factors impacting neonatal nurses’ professional quality of life and organisational outcomes is required. The generalisability of future studies will be enhanced by longitudinal design, recruitment of heterogeneous samples, and use of scales with psychometric adequacy to capture complex interrelationships between variables.     

Newly qualified graduate nurses’ experiences of workplace incivility in healthcare settings: An integrative review.

AimTo explore, identify and integrate the existing knowledge to categorise the characteristics, likelihood, and consequences of workplace incivility among newly qualified graduate registered nurses. A particular focus of this review is on the experiences of new nurses related to these negative workplace behaviours and the strategies employed by these nurses and their organisations to manage workplace incivility.BackgroundWorkplace incivility has been widely recognised as a global problem in healthcare settings and is known to affect nurses in all facets of their professional and personal life. This might be particularly harmful for newly qualified graduate nurses, as they are unprepared to deal with this uncivil culture.DesignAn integrative review of the global literature, conducted according to the Whittemore and Knafl framework.MethodsDatabase searches (CINAHL, OVID Medline, PubMed, Scopus, Ovid Emcare and PsycINFO), and manual searching generated an aggregate of 1904 articles, which were further screened based on inclusion criteria and eligibility using the Mixed Methods Appraisal Tool (MMAT). Peer-reviewed empirical studies that explored the workplace incivility experiences of new graduate nurses were included in this review. Extracted data were grouped to develop themes and sub-themes.ResultsThis review included 14 studies in total with seven quantitative and seven qualitative studies. The data collected from these studies were categorised according to the research questions into a) expectations of civility, b) experiences and exposure to workplace incivility, c) forms and characteristics of incivility, d) sources of incivility, e) consequences of incivility, and f) managing and coping with incivility. Across studies, graduate nurses' views about the prestige and power of the nursing profession are conflicted due to experiences of incivility in clinical practice. New graduate nurses experienced a high but variable prevalence of incivility from their co-workers (25.6–87 %), with manifestations of incivility varying greatly, including eye rolling, yelling, exclusion and sexual harassment. Included studies primarily focused on professional and organisational effects and their outcomes relative to the physical and psychological effects on new nurses.ConclusionFindings from the literature demonstrate that incivility directed toward newly qualified graduate nurses is prevalent and can have significant negative impact on their self-esteem and confidence, which may ultimately impact on their workforce participation decisions and the quality of patient care. Supportive and empowering work environments are vital not only for improved nurse health and well-being, but also to retain new graduate nurses. The current nursing shortage emphasises the need for such conditions.     

An integrative review of primary health care nurses’ mental health knowledge gaps and learning needs

BackgroundThe global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues.AimTo critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care.Design and methodsAn integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis.Data sourcesCINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC.FindingsOf the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers.DiscussionDespite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care.ConclusionFindings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.     

Barriers and facilitators of nurses’ use of clinical practice guidelines: An integrative review

BackgroundPreventable harm continues to be one of the leading causes of patient death. Each year about 400,000 patients die from sepsis, hospital acquired infections, venous thromboembolism, and pulmonary embolism. However, as shown in the recent reduction in hospital acquired infections, the number of deaths could be reduced if healthcare providers used evidence-based therapies, which are often included in clinical practice guidelines (CPGs).PurposeThe purpose of this integrative review is to appraise and synthesize the current literature on barriers to and facilitators in the use of clinical practice guidelines (CPGs) by registered nurses.DesignWhittemore and Knafl integrative review methodology was used. Primary quantitative and qualitative studies about the nurses’ use of CPGs and published in peer-reviewed journals between January 2000 and August 2015 were included.MethodsThe Critical Skills Appraisal Program (CASP) was used to critically appraise the quality of sixteen selected quantitative and qualitative studies.ResultsInternal factors were attitudes, perceptions, and knowledge whereas format and usability of CPGs, resources, leadership, and organizational culture were external factors influencing CPG use.ConclusionGiven each barrier and facilitator, interventions and policies can be designed to increase nurses’ use of CPGs to deliver more evidence based therapy. In order to improve the use of CPGs and to ensure high quality care for all patients, nurses must actively participate in development, implementation, and maintenance of CPGs.     

Nurses’ experiences in voluntary error reporting: An integrative literature review

ObjectiveThis integrative review aimed to examine and understand nurses’ experiences of voluntary error reporting (VER) and elucidate factors underlying their decision to engage in VER.MethodThis is an integrative review based on Whittemore & Knafl five-stage framework. A systematic search guided by the PRISMA 2020 approach was performed on four electronic databases: CINAHL, Medline (PubMed), Scopus, and Embase. Peer-reviewed articles published in the English language from January 2010 to December 2020 were retrieved and screened for relevancy.ResultsTotally 31 papers were included in this review following the quality appraisal. A constant comparative approach was used to synthesize findings of eligible studies to report nurses' experiences of VER represented by three major themes: nurses' beliefs, behavior, and sentiments towards VER; nurses' perceived enabling factors of VER and nurses' perceived inhibiting factors of VER. Findings of this review revealed that nurses’ experiences of VER were less than ideal. Firstly, these negative experiences were accounted for by the interplays of factors that influenced their attitudes, perceptions, emotions, and practices. Additionally, their negative experiences were underpinned by a spectrum of system, administrative and organizational factors that focuses on attributing the error to human failure characterized by an unsupportive, blaming, and punitive approach to error management.ConclusionFindings of this review add to the body of knowledge to inform on the areas of focus to guide nursing management perspectives to strengthen institutional efforts to improve nurses' recognition, reception, and contribution towards VER. It is recommended that nursing leaders prioritize and invest in strategies to enhance existing institutional error management approaches to establish a just and open patient safety culture that would promote positivity in nurses’ overall experiences towards VER.     

New graduate nurses’ self-assessed competencies: An integrative review

Much of the ongoing shortage of nurses can be attributed to high turnover rates, and open positions are mostly filled by new graduate nurses who often lack the competencies required to provide quality patient care. An additional problem is that over 20% of these nurses leave their positions within 1 year, and low nursing competency is a main contributor to their decision. New graduate nurses' competencies are typically evaluated by experienced nurses who attempt to provide objective assessment of deficiencies, but this approach has not reduced turnover rates. Therefore, this integrative review explored new graduate nurses' self-assessed competencies. The review revealed that new graduate nurses' self-assessed deficiencies included advanced technical skills, critical thinking, communication, teamwork, helping role, and professionalism, most of which were associated with “soft” skills. New graduate nurses’ possession not only of “hard” nursing skills within the cognitive and psychomotor domains but also of soft skills that mostly lie within the affective domain is vital to achieve higher retention rates. Because soft-skill competencies are problematic to objectively evaluate, recommendations include development and frequent application of a more objective measure such as a rubric, greater emphasis on soft skills in education, and supervised hands-on training in supportive practice settings.     

Nursing students’ experiences with patient death and palliative and end-of-life care: A systematic review and meta-synthesis

AimTo synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settingsBackgroundNurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.DesignA qualitative systematic review and meta-synthesisMethodsPubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012–25 Feb 2023. Qualitative studies of any design reporting nursing students’ experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso’s 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.ResultsThe review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.ConclusionsWhile caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.     

Family members’ participation in palliative inpatient care: An integrative review

Aim

To analyse how family members participate in hospital inpatient palliative care, and how their participation could be supported.

Methods

This review followed a methodology outlined in the literature for integrative reviews. A literature search supplemented by a manual search was conducted on four electronic databases during 2020 to 2021: PubMed, CINAHL, PsycINFO, and Cochrane Library. A critical appraisal of the included studies was performed, and data were analysed using inductive content analysis.

Results

The literature search resulted in 4990 articles, of which 14 articles were included in this review. Four main categories were identified concerning the participation of family members in hospital inpatient palliative care: participation in the physical care, provision of emotional support, promoting good patient care, and support provided by healthcare professionals for family members’ participation. Family members’ participation can be supported in different ways, including active communication and adequate information.

Conclusion

Family members’ participation in hospital inpatient palliative care has been an important part of palliative care in hospital settings. Family members should be offered the opportunity to participate in patient care, and their presence in the hospital should be accommodated. Research on the topic is still scarce, and future research is needed from different perspectives, including intervention research.     

Intensive care nurses’ experiences and perceptions of delirium and delirium care

ObjectiveTo explore nurses’ experiences and perceptions of delirium, managing delirious patients, and screening for delirium, five years after introduction of the Confusion Assessment Method for Intensive Care into standard practice.Research design and settingTwelve nurses from a medical-surgical intensive care unit in a large teaching hospital attended two focus group sessions. The collected qualitative data was thematically analysed using Braun and Clarke’s framework (2006).FindingsThe analysis identified seven themes: (1) Delirium as a Secondary Matter (2) Unpleasant Nature of Delirium (3) Scepticism About Delirium Assessment (4) Distrust in Delirium Management (5) Value of Communication (6) Non-pharmacological Therapy (7) Need for Reviewed Delirium Policy.ConclusionNurses described perceiving delirium as a low priority matter and linked it to work culture within the intensive care specialty. Simultaneously, they expressed their readiness to challenge this culture and to promote the notion of providing high-quality delirium care. Nurses discussed their frustrations related to lack of confidence in assessing delirium, as well as lack of effective therapies in managing this group of patients. They declared their appreciation for non-pharmacological interventions in treatment of delirium, suggested improvements to current delirium approach and proposed introducing psychological support for nurses dealing with delirious patients.     

Barriers and facilitators to a ‘good death’ in heart failure: An integrative review

BackgroundHeart failure is the final common pathway of many cardiovascular diseases, and yet many individuals with heart failure die hospitalised, suffering needlessly and experiencing what could be termed a ‘bad death’. While it is essential to address the wishes of individuals and their families in improving the quality of end-of-life care for patients with heart failure, their unmet needs remain poorly understood.AimTo systematically review the literature describing a good death or end-of-life care in heart failure and to synthesise identified studies to describe how elements of heart failure care may contribute to a good death.MethodsPubMed and Scopus were searched from January 2001 to April 2018. The method of Whittemore and Knafl guided this review to identify emergent themes.FindingsOf the 436 studies identified, 43 met the inclusion criteria. Five themes associated with end-of-life care in heart failure and a good death were generated: (1) location of death, (2) preferred care, (3) palliative care utilisation, (4) interventions to improve the likelihood of a good death, (5) the intersection of individual, family, healthcare providers, and community-level factors.DiscussionThis integrative review highlights a number of factors that prevent patients with heart failure from receiving palliative care, such as difficulty predicting mortality, late referral misconception of the role of palliative care and low availability of resources.ConclusionThis review has identified modifiable barriers and facilitator of a good death and emphasised the importance of considering the intersection of patient, provider and healthcare system issues in facilitating a good death for patients with heart failure.     

Nurses’ perceptions and experiences of robotic assisted surgery (RAS): An integrative review

AimTo identify and review published literature on the perceptions and experience of nurses working with RAS.BackgroundRobotic assisted surgery (RAS) is rapidly becoming accepted as the elite modality for surgery since its introduction in the 1980 s, more recently there has been a rising trend of use with several specialities operating using this technology. The role of nurses in perioperative care has been described as maintaining the momentum of the patient’s journey. Patients undergoing RAS require nursing care throughout their journey, therefore knowledge of nurses’ experiences and perceptions of RAS is important to identifying nurse education and development needs.DesignIntegrative literature reviewDatabase sourcesDatabases searched for peer reviewed studies included CINAHL, Academic Search Complete, EMBASE, Scopus, ADA Psycinfo, Medline.Review methodsA comprehensive database search was conducted following PRISMA guidelines. Six databases were searched with 523 screened for eligibility. Ten studies were included in the review seven qualitative and three quantitative.ResultsTen studies were identified, critically appraised and synthesised using thematic analysis. All studies were conducted with nurses in the perioperative environment. Key findings were that nurses education regarding RAS is limited with more emphasis placed on surgeon education and training. There was evidence that nurses experienced a lack of education, training and information as barriers to their role which subsequently raised their stress levels.ConclusionEvidence suggests a clear need for education and training for nurses working with RAS. In addition, nurses working with RAS provide care preoperatively, intraoperatively, postoperatively and post discharge in the community. However, no research has been conducted with nurses outside of the perioperative environment. Further research is required to understand the experiences and perceptions of nurses working with RAS patients in all care settings to identify their education and development needs.     

Examining family and community nurses’ core competencies in continuing education programs offered in primary health care settings: An integrative literature review

AimTo identify gaps in existing family and community nurse (FCN) continuing education programs and to investigate whether FCN core competencies are covered in continuing education programs offered in primary health care settings.BackgroundIn global pandemics such as COVID-19, there is an urgent need for staff development using transformative learning and help registered nurses build up their competencies and form a new professional identity as family and community nurses (FCNs). Therefore, FCN education programs become of high importance to enhance nurses’ core competencies through continuing education.MethodsAn integrative review of the literature was conducted applying the Whittemore and Knafl methodological strategy for studies published between 2015– June 2021.ResultsFCN core competencies, including the “decision-making process, navigation as care coordinator and patient advocate and promoting individual and family health to support the quality of nursing care,” were poorly covered in the FCN programs. Specifically, e-health played a very limited role in FCN continuing education, while ethics, managing change, managing disparity and diversity and leadership skills, did not emerge at all.ConclusionThe identified gaps can be incorporated into future FCN continuing education programs and may help improve nurses’ competence and health care delivery and support new integrated models of care, namely, person-centered and community-based models.     

Critical care nurses’ experiences of withdrawal of treatment: A systematic review of qualitative evidence

BackgroundDeath and dying is a reality of the clinical context of the intensive care unit. Death often follows a decision to withdraw life-sustaining treatments. Critical care nurses, are the primary care providers to patients and families at the end-of-life in the intensive care unit.ObjectiveTo synthesize qualitative evidence on the experiences of critical care nurses who have cared for patients and families throughout the process of withdrawal of life-sustaining treatment.MethodsThis was a systematic review and qualitative evidence synthesis modeled on the Joanna Briggs Methodology. Pre-defined keywords were searched for in Medline, CINAHL, PsycInfo, and Web of Science to locate studies published in the English, French, and Greek languages in any year. Two reviewers independently screened articles for congruence with eligibility criteria, engaged in data extraction, and assessed quality of the included studies. Meta-aggregation was performed to synthesize the findings. A protocol was developed by two members of the review team prior to initiation of the study.ResultsThirteen studies were included in the review, 12 qualitative and one mixed-methods. Four key themes were identified from the original research: Navigating Complexity and Conflict; Focusing on the Patient; Working with Families; and Dealing with Emotions Related to Treatment Withdrawal. Critical care nurses provide care to patients and families during the process of withdrawal of life-sustaining treatment which is described as complex and challenging. Despite the inherent challenges, nurses strive towards doing their utmost for patients and families.