Stakeholder Perspectives on Improving an Advance Practice Provider Emergency Department Critical Care Step-Down Unit

In response to concerns about the continued care and safety of critically ill and injured patients, our academic, urban, tertiary care, level I trauma center adult emergency department (ED) created an advanced practice provider (APP)-staffed critical care step-down unit (CCSU). We conducted semistructured interviews of ED physicians, APPs, and nursing staff about the value added by the CCSU as well as suggestions for its improvement. The results from the interviews showed staff were highly complimentary of the CCSU and recommended expansion of its hours and APP staffing, but indicated areas of improvement. Future research can evaluate how implementation of stakeholder suggestions improved the CCSU’s operations.     

“金课”理念下的线上线下混合式教学对科研护士的培养

目的 探讨在“金课”理念下的线上线下混合式教学对科研护士培养的探索和实践效果。方法 选取长沙市某三级综合医院36名有意向申请2021年科研护士岗位的临床护士为研究对象,在“金课”理念下基于线上线下混合式教学的形式,围绕科研能力及批判性思维能力培养,更加侧重学员的“分析、评价、创造”3个高级认知阶段,分别展开护理科研培训与实践。结果 培训后临床护士科研能力、批判性思维能力得分均高于培训前,差异均有统计学意义（P<0.05）。结论 “金课”理念下的线上线下混合式教学能有效提高临床护士科研能力及批判性思维能力。     

Action research as a catalyst for change: Empowered nurses facilitating patient participation in rehabilitation

Based on action research as a practitioner‐involving approach, this article communicates the findings of a two‐year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice‐oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.     

Experiencias de mujeres jóvenes colombianas mastectomizadas: un estudio etnográfico

ObjectiveTo explore the experiences of a group of young women in relation to the reconstruction of their breasts after mastectomy.MethodFocused ethnography, performed in the League against Cancer- Huila Section (Colombia). Through casual sampling oriented by criteria, semi-structured interviews were conducted with eight young women (diagnosed at 45 years or earlier) with breast cancer (reconstructed or not reconstructed after mastectomy) until saturation of discourse. Data collection was carried out between August-November 2017, after the endorsement of the Ethics Committee and the consent of the participants. Data was analysed using the thematic analysis technique after being anonymised.ResultsThree issues emerged in the women's discourses: The social stigma of being a young woman with breast cancer; learning to live with a body transformed by disease and treatment, and surviving, which is the most important thing.ConclusionsBeing a young woman, and suffering from breast cancer implies a diversity of changes that permanently alter the lives of women and their bodies. Women prioritise survival in order to take care of others over breast reconstruction. At a healthcare level, the cultural and gender perspective must be incorporated to design individualised nursing interventions that contribute to better care.     

To transfer or not to transfer: Aged care nurses’ decision-making in transferring residents to the emergency department

BackgroundNurses are key decision makers in residential aged care facilities and play a significant role in the transfer of residents from residential aged care facilities to emergency departments. There is scant literature about the role of nurses in the transfer decision-making process.AimTo describe the experiences of residential aged care facility nurses who engage in decision-making to transfer residents to emergency department.MethodsThis research has adopted interpretive qualitative approach of phenomenography. In-depth interviews were undertaken with 20 residential aged care facility nurses across two sites. Uniquely, drawing was used as one way to collect rich, textured data in these in-depth interviews.FindingsSix categories emerged to represent residential aged care facility nurses’ conceptions of decision-making about transferring a resident to the emergency department: “Being a marionette”; “Too dumb to have an opinion”; “Making the family happy”; “Not about the resident”; “Having experience”; and “Being on your own”.DiscussionResidential aged care facility nurses experienced decision-making as not being able to do what is right for the resident most of the time due to a myriad of factors, with heavy influence of other key stakeholders.ConclusionDecision-making is described as a professional responsibility wherein residential aged care facility nurses face dilemmas related to the transfer of a resident to the emergency department and perceived as a constraint.