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.     

Teamwork,clinical leadership skills and environmental factors that influence missed nursing care – A qualitative study on hospital wards

AimTo explore how nursing teams in clinical inpatient nursing hospital wards perform teamwork to prevent or reduce missed nursing care and how teamwork is influenced by clinical leadership skills and environmental factors.BackgroundEarlier studies on missed nursing care identified teamwork and leadership skills as promising factors in inpatient care that can positively influence quality of care and reduce missed nursing care. The effective use of teamwork in hospitals requires understanding what it is, how it is performed by nursing teams and how it is influenced by clinical leadership skills and environmental factors.DesignA qualitative exploratory study was undertaken between January and March 2021.MethodsA total of 16 registered nurses who worked on various hospital wards, participated in three online focus groups. Data were analyzed with thematic analysis according to Braun and Clarke.ResultsThematic analysis revealed four themes. First, nurses perform teamwork and clinical leadership skills in various ways. Some nurses work in pairs and have common goals, while other nurses work individually. This influences teamwork. Second, nurses are informal teachers, visible in teaching and learning from each other, contributing in constructive teamwork. Third, senior nurses are seen as informal leaders, forming connection between nursing wards and formal leaders, resulting in awareness of each other and the progress of patientcare. Finally, environmental factors influence the performance of teamwork.ConclusionsResults of this study show how knowledge regarding missed nursing care can be increased. Results can be used for developing training programs and embedding education in practice aimed at constructive teamwork, clinical leadership skills and missed nursing care.     

The experience of new nurses’ early working life: Learning in a hospital care context – An interview study

AimTo explore how nurses during their early working life learn to provide high-quality care in relation to organisational prerequisites in a hospital setting.BackgroundWhen nurses enter employment in contemporary hospital settings, they face multiple learning challenges. Organisational prerequisites that have been identified to affect their ability to learn to provide high-quality care are related to staffing turnovers, large patient groups and a lack of experienced staff to support their learning.DesignQualitative.MethodsThe study was conducted between 2018 and 2019 at a medium-sized hospital in Sweden. Data from interviews with 10 nurses with fewer than two years’ work experience were subjected to qualitative content analysis.ResultsThe results describe the nurses’ learning during their early working life in two categories: Performing tasks in relation to organisational prerequisites and Making use of clinical experiences to grasp the complexity of nursing care. The first theme reflected a learning process that was initially characterised by seeking confirmation and instructions from colleagues of how to act safely and by balancing the demands of time efficiency and sustaining patient safety. The second theme reflected that, after addressing organisational prerequisites, the nurses tried to understand and make use of clinical experiences to grasp the complexity of nursing care by encountering and processing clinical patient situations.ConclusionsThe results of this study revealed that nurses’ learning during early working life seemed to be primarily directed towards handling tasks, with sometimes limited opportunities to grasp the complexity of nursing care. Their learning depended largely on their own initiative and motivation and was strongly influenced by organisational prerequisites. The limited availability of experienced nurse colleagues and lack of time devoted for reflection needs to be dealt with to support nurses’ learning.     

Investigating factors associate to nurses' attitudes towards perinatal bereavement care

Aim. The purpose of this study was to explore nurses’ attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Method. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May–August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Results. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39·3% (n = 130) of nurses had bereavement related training. By contrast, about 89·8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses’ perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses’ attitudes towards perinatal bereavement care. Conclusions. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively.     

The content of advocacy in procedural pain care – patients’ and nurses’ perspectives

Title. The content of advocacy in procedural pain care ‐ patient’ and nurses’ Perspectives. Aim. This paper is a report of an exploration of the content of nursing advocacy from the point of view of patients and nurses in the context of procedural pain care. Background. Nursing advocacy is every nurse’s professional duty, grounded in patients’ legal and moral rights. Nevertheless, earlier research has approached advocacy as a whistle‐blowing event from the nurse’s perspective. Method. This cross‐sectional study was conducted with a cluster sample of otolaryngology patients (n = 405) and nurses (n = 118) in 11 hospital units in Finland during 2007. The data were collected using an instrument measuring the content of advocacy and analysed statistically. Results. Advocacy in procedural pain care is a process which takes place in the patient–nurse relationship through role identification in decision‐making about pain care. This prompts counselling and responding activities, which in turn lead to some degree of empowerment on the part of both patient and nurse. However, advocacy is partly dependent on the nurse’s own role identification: in the context of pain care it seems that the nurse’s pain care skills and influence over pain care plans are important factors in the decision to advocate or not. At best, patients have some role in decision‐making about their care; at worst, they are subjected to paternalism. Conclusions. Advocacy is an integral part of the nursing care process. It is important that this key ethical aspect of professional nursing is discussed in nursing education and systematically applied in nursing practice through on‐the‐job training, feedback and collaboration.     

Work stress and perceived organisational support on young Korean nurses’ care for COVID-19 patients

BackgroundSince the outbreak of COVID-19 worldwide, frontline nurses have faced tremendous stress. Younger nurses in their early-to-mid careers can be more exposed to burnout and work stress, and perceived organisational support can influence the quality of nursing care for vulnerable patients.AimTo identify the impact of younger nurses’ work stress and perceived organisational support on their willingness to care for COVID-19 patients.MethodsThe cross-sectional secondary data analysis included 211 hospital nurses (<35 years) in South Korea with a mean age of 24.60 years (SD=1.90). Multiple logistic regression analysis was used to identify the factors influencing willingness to care.FindingsSupplying personal protective equipment, training in the use of personal protective equipment, lower work stress, and positive perceptions of organisational support significantly increased early-career nurses’ willingness to care. For mid-career nurses, being male and higher work stress significantly increased their willingness to care.DiscussionSupport, including COVID-19-related education or training, should be provided to reduce work stress arising from being exposed to infection or while providing care to critically ill patients, especially among early-career nurses. Support from nurse managers, senior staff, and colleagues could help younger nurses cope better with the challenges of COVID-19, thus increasing their willingness to care.ConclusionPerceived organisational support may facilitate early-career nurses’ organisational commitment. Healthy work environments can relieve early-to-mid-career nurses’ work stress, thus facilitating patient-centred care.     

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.     

Understanding nursing practice in stroke units: a Q-methodological study

Abstract

Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses’ involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses’ practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Results: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. Conclusions: The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills.

• Implications for Rehabilitation

• Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care.

• Views of stroke unit team members on nurses’ involvement in rehabilitation have not been reported previously.

• Nurses can routinely incorporate rehabilitation principles in their care.

• Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

     

The Power of nursing: Guiding patients through a journey of uncertainty

PurposeThe objective of this qualitative study was to understand the experiences of oncology nurses in patient counseling and support services in the ambulatory care setting.Methods and sampleA qualitative study was conducted using grounded theory methods. Data were generated through four focus group interviews with 21 oncology nurses currently providing counseling and support services for cancer patients in Japan. The content was analyzed based on a constant comparison approach.ResultsThe power of nursing was identified through three themes: connecting with the patient (shared needs); personalized coordination (shared action); and realizing the patient's potential (reassurance). Oncology nurses should guide patients through the uncertain cancer trajectory by identifying patients' true needs based on an established relationship, providing personalized coordination, and developing their potential. Patient-centered care can be provided in non-physical care settings such as counseling and support services.ConclusionsOur study describes the uniqueness and significance of nursing, and provides insights into realizing the full potential of nurses. This conceptual model can be used as a guide for practice and an educational tool to build professional identity of nurses. Oncology nurses can take a leadership role in enhancing the visibility of the nurses in multidisciplinary environments.     

A “Co-CREATES” framework to foster a positive learning environment for nursing students’ professional development in Rwanda

AimThe future of the nursing profession in Rwanda in large part depends on the students who join the workforce and the education they have received. Preparing students with the necessary knowledge, values and judgement requires practice settings to be learner-centered. This study aimed at exploring strategies that might improve the current practice-based learning environment.DesignA focused ethnographic approach was used.MethodsNursing students, staff nurses, clinical instructors and nurse leaders from three hospitals and an educational program participated in individual interviews.ResultsFive key areas of improvement emanated from study data: 1) strengthening institutional support; 2) improving school-hospital collaboration; 3) building the capacity of nurses and clinical instructors; 4) restructuring clinical placement; and 5) reviewing the current supervision model. Based on these findings a “Co-CREATES” framework grounded in the actions of collaboration, care, recognizing, empowering, actively engaging, transforming, enhancement and support was developed. The framework offers a collaborative approach that engages every stakeholder in “cocreating” conditions that build positive practice environments which are conducive to preparing students as professional nurses.ConclusionThe positive outcomes stemming from such a collaborative approach can further enhance a positive culture of collaboration in nursing education and practice.     

新形势下医院护士专业化教育培训体系构建与实践

目的:构建新形势下医院护士专业化教育培训体系。方法:以开展高级护理专业技能培训为引领,以夯实基本素质培训为起点,以强化基本技能培训为基础,以拓展专科护理技能培训为支撑,构建医院护士专业化教育培训体系。结果:护士专业化教育培训体系的构建与实践显著提高了全院护理人员的综合护理技能与知识理论水平、提升了全院基础护理服务质量、提高了全院护理科研水平。结论:新形势下医院护士专业化教育培训体系的构建具有重要的实践意义。     

Factors influencing the optimal selection of central venous access devices: A qualitative study of health care team members’ perspectives

ObjectiveThis study aimed to explore health care team members’ understanding of the factors influencing the optimal selection of central venous access devices (CVADs).MethodsThe data of the study was collected using semi-structured interviews. Twenty-six hospital medical staff (four hospital manager, 15 head nurses, 7 nurse) with experience in peripheral or central catheterization from four regions (Northern China, Southern China, Northwest China, and Qinghai-Tibet China) in China were interviewed between June and October 2021. Content analysis was used to analyze the data.ResultsThe results revealed five themes and 14 sub-themes. Patients: concerns, resources, requirements, and evaluation (security concerns, support resources, life requirements, evaluation among patients); nurses: awareness, knowledge, and popularizing methods (awareness of intravenous therapy, understanding of professional knowledge, forms of popularizing methods); doctors: support and involvement (support for decision-making, involvement in intravenous work); hospital managers: authority, quality control and continuing education (management of catheterization authority, quality control of intravenous infusion, investment in continuing education) and environment: differences and commonalities (differences in social support, and current commonalities).ConclusionNurses and other healthcare team members’ understanding, selection, use, and recommendation of CVADs have an indirect effect on patients’ decision-making. Therefore, hospital managers and government departments can indirectly strengthen medical team cooperation and improve learning education in order to improve the safety of patients receiving intravenous infusions.     

Retracted: Investigating factors associated with nurses’ attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong

Aims. To explore nurses’ attitudes towards perinatal bereavement care and to identify factors associated with these attitudes. Background. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and that nurses with positive attitudes to bereavement care can help bereaved parents to cope during their grieving period. Design. Survey. Method. Data were collected through a structured questionnaire; 657 nurses were recruited from Obstetrics and Gynaecology units in Hong Kong and Shandong during 2006. Outcome measures included attitudes towards perinatal bereavement care, importance of hospital policy and training support for bereavement care. Results. The majority of nurses in this study had a positive attitude to bereavement care. Results show that only 21·6% (n = 141) of the nurses surveyed had bereavement‐related training. In contrast, about 89·8% (n = 300) believed they needed to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·5% (n = 592) would share their experiences with their colleagues and seek support when feeling under stress. A regression model showed that age, past experience in handling grieving parents, recent ranking and nurses’ perceived attitudes to hospital policy and training provided for bereavement care were the factors associated with nurses’ attitudes to perinatal bereavement care. Conclusions. Nurses in both cities emphasised their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used by nursing educators to educate their students on issues related to delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.     

Factors that contributed to burnout among intensive care nurses during the COVID-19 pandemic in Saudi Arabia: A constructivist grounded theory

BackgroundIntensive care unit (ICU) nurses experience high levels of burnout during the COVID-19 pandemic due to multiple stressors. It has long been known that burnout is negatively associated with patient and staff outcomes. Understanding the triggers for intensive care nurses’ burnout during the pandemic can help to develop appropriate mitigation measures.ObjectiveThe objective of this study was to examine intensive care nurses’ experiences during the COVID-19 pandemic in Saudi Arabia to develop insights into the factors that influenced burnout.MethodsThe study was informed by a constructivist grounded theory design. The study was conducted in an adult ICU in a tertiary hospital in the Makkah province in the Kingdom of Saudi Arabia. All participants were registered nurses with at least 6 months’ experience in intensive care and experienced caring for COVID-19 patients.FindingsThis paper reports on preliminary findings from interviews with 22 intensive care nurses. A core category ‘pandemic pervasiveness’ was identified from the interview data, which makes reference to the ever-present nature of the pandemic beyond the ICU context. Family, work, and the wider world context are the three groups of contextual factors that influenced nurses' experience and perception of burnout.ConclusionMany issues identified from the findings in this study can be attributed to shortages in the intensive care nursing workforce. Thus, we join others in calling for healthcare organisations and policymakers to be creative in finding new ways to meet nurses' needs, motivate, and empower them to maintain and sustain the nursing workforce in highly demanding areas, such as ICUs. Nursing managers can play a crucial role in mitigating nurses’ burnout by identifying and tackling sources of stress that exist among their staff, specifically team conflict, workplace harassment, and discrimination.     

Nurse perspectives of nurse-sensitive indicators for positive patient outcomes: A Delphi study

BackgroundPatient safety, quality of care, and nurse-sensitive indicators are common areas of focus in international research relating to patient outcomes. Recent literature relating specifically to nurse-sensitive indicators has leaned towards an emphasis upon negative outcomes, such as ‘missed care’, ‘delayed care’, ‘failure to rescue’ or a reduction in adverse events rather than focus on nursing activities that lead to positive outcomes. In addition, little is known about nurse perspectives of nurse-sensitive indicators for positive patient outcomes.ObjectiveTo identify and describe priority nurse-sensitive indicators linked to positive patient outcomes in the acute care setting.DesignA modified Delphi Technique consisting of three rounds of electronic questionnaires to 90 Clinical Nurse Specialists and Charge Nurse/Managers working in acute care settings in New Zealand.MethodsDelphi round one survey collected data on key nursing activities and tools important to patient outcomes. Delphi round two survey presented round one data for rating importance to patient outcomes using a rating scale question design. Delphi round three survey presented round two data to participants within the ‘Patient Experience Indicators’ identified by the New Zealand Health Safety and Quality Commission’s domains for ranking in order of importance via a ranking question design. Round one data were analysed to discover themes emerging from the responses to formulate activity options. In round two, responses were given an average rating score, calculated on the weight assigned to each answer choice. In round three the ranking average was calculated using weighting and response count.ResultsThe results from the third round presented activities from each domain and these were ranked from highest to least importance, with 75% or greater indicating consensus. Of highest importance within each domain were: Communication: Listening; Partnership: Establishing trust, building relationships; Coordination: The threshold of 75% consensus was not reached; Physical and Emotional Needs: Identification of rapid change/deterioration, observation/identification of patient status, and increased assessment skills.ConclusionSome nursing activities were difficult to rank in terms of importance as nurses perceived they were inter-related and of equal importance. The soft applied skills of nursing practice have been highlighted as important nursing activities by experienced nurses in this research, which poses a challenge for health care and nursing education sectors to label, value and support enactment of these skills in the nursing workforce as legitimate contributions to positive patient outcomes.