Nurs. Rep., Volume 11, Issue 3 (September 2021) – 22 articles

Background: Patient-centered outcomes research seeks to answer patient-centered questions. The process includes varied locations and individuals throughout the care continuum to address individual differences and constraints in implementation and dissemination. Problem: This paper intends to answer this question: do academic nurses practice what they preach by assisting patient-centered outcomes research and researchers through their engagement with patients, caregivers, and other community stakeholder partners in nursing research? Approach: This paper provides an overview of how academic nurses in a single institution (the University of Texas Medical Branch at Galveston School of Nursing) began to embrace patient-centered outcomes research. Conclusion: Whether academic nurses are practicing what they preach in terms of patient-centered outcomes research remains uncertain. More examples from academia are required to make that determination. Academic nurses worldwide have embarked on a steep learning curve to embrace patient-centered outcomes research. This journey will require patience and a systematic strategy. Full article

Decision-making processes (DMPs) can be altered by several factors that might impact patient outcomes. However, nurses’ views and experiences regarding the multitude of personal and organizational factors that may facilitate or inhibit their decision-making abilities have rarely been studied. Purpose: To explore the personal and organizational factors that influence nurse DMPs in clinical settings at Ministry of Health hospitals (MOH). Method: A qualitative research design was conducted. A purposive sample of 52 nurses was recruited from general and critical wards in two major Ministry of Health hospitals in Hail, Saudi Arabia. A total of eight focus groups (semi-structured interviews) were conducted to elicit participant responses. Results: In this study, the personal differences covered nurses’ experience, physical and psychological status, autonomy, communication skills, values, and cultural awareness. Organizational factors included the availability of resources, organizational support, workload, the availability of educational programs, the availability of monitoring programs, and the consistency and unity of policies, rules, and regulation applications. Conclusions: The major contribution of this study is the comprehensive illustration of influential factors at both the personal level and the organizational level that impact DMPs to achieve desired outcomes for patients and health organizations. This study utilizes a framework that could explain the nature of nurse DMPs. Full article

As a professional value, the love of the profession can significantly affect nurses’ professional practice, behaviors and commitment. Many different factors can affect the love of the profession. The exploration of nurses’ experiences of these factors can provide valuable data for development of the love of the profession. The aim of this study was to explore nurses’ perceptions of the factors contributing to the development of the love of the profession. This qualitative study was conducted in 2020–2021 using the conventional content analysis approach. The participants were thirteen nurses with different organizational positions purposively recruited from different settings in Iran. The data were collected via semi-structured interviews, and were analyzed via the conventional content analysis approach proposed by Graneheim and Lundman. The factors contributing to the development of the love of the profession were categorized into four main categories, namely the public perception of the profession (with three subcategories), educational variables (with two subcategories), the characteristics of the profession (with four subcategories), and nurses’ self-evaluation (with three subcategories). The love of the profession is affected by a wide range of personal, educational, professional and social factors. The manipulation of these factors would help to develop nurses’ and nursing students’ love of the profession, and encourage people to choose nursing as a career. Full article

Community paramedicine (CP) has extended the role of paramedics and the main goal is to provide non-emergency care, which reduces the visits to emergency departments. The aim of this study was to describe the Finnish CP and examine the factors that were involved in CNPs’ decision-making processes. The study was based on data from 450 consecutive CP patient records from three hospital districts. A more detailed analysis was carried out on 339 cases in patients’ homes and elderly care homes, and the data analysis included multivariate logistic regression to examine the impact of variables on the CNPs’ decisions. These patients’ most common health issues were general weakness (15.9%) and fever (10.6%), and over half (58.7%) could remain at home after the CP visit. There were five independent factors associated with the CNPs’ decisions of the patient’s care continuum: the hospital district, if the patient could walk, whether the troponin test was performed, a physician was consulted, and the nature of the task. CP units played a valuable role in non-emergency care. Understanding the factors associated with CNP decision-making can increase the safety and effectiveness of reducing hospital visits, by providing patient care at home, or in elderly care facilities. Full article

Background: Internationally, there are very few guidelines regarding how near relations can be taken care of on a children’s intensive care unit. Despite knowledge about the positive effects of parental presence, staff frequently reject parents out of insecurity. This study aimed to investigate health professionals’ understanding of letting parents be present throughout critical situations. A qualitative method with semi-structured interviews was used to answer the aim of his study. Nine persons participated in the study, both physicians and nurses. The result showed that health professionals’ main view is that parents’ presence is positive. However, their presence often has lower priority than the medical focus of the child and the health professionals’ concern of failure. Conclusion: Health professionals have the power to decide if parents can be present in critical situations. Only when a parent demands to be present does that demand beat the decisions made by health professionals. Lack of resources within the team and fear of parents becoming a disturbance or a distraction are cited as the primary reasons not to let parents be present. Full article

This study aimed to assess the impact of workforce agility on private hospital nursing staff’s safety behavior with the mediating role of mindful organizing. This study was cross-sectional. A self-administered questionnaire was used to collect data from 369 nursing staff. The structural equation modeling (SEM) technique was used to check the internal consistency, convergent validity, discriminant validity, and hypotheses testing. For mediation analysis, the bootstrapping technique was used. Our findings suggested that workforce agility is the possible predictor of mindful organizing, as all of these dimensions have a positive impact on mindful organizing. Reference to safety performance sub-dimensions, proactivity, adaptability, and resilience had a positive significant impact on (a) safety compliance, and proactivity had a positive impact on (b) safety participation. Further, mindful organizing was also found to be positively associated with safety performance. Evidence for mediation between workforce agility and safety performance was also observed. Proactivity, adaptability, and resilience can enhance safety performance for the nursing staff. Workforce agility can also help the organization to attain mindful organizing, which will help them to achieve operational excellence, whereas in the past, high-reliability organizations were mainly found practicing mindful organizing. This study demonstrated the key impact of workforce agility and mindful organizing on safety behaviors directly and indirectly. Full article

Home visiting programs for marginalized families have included both Public Health Nurses (PHNs) and Community Home Visitors (CHV). Support for families requires health care providers to implement effective communication and collaboration practices; however, few studies have examined how this is carried out. The purpose of this qualitative research study was to explore how an Enhanced Home Visiting (EHV) program in Nova Scotia Canada was organized, delivered through the experiences of PHNs and CHVs. Feminist post-structuralism informed by discourse analysis was used to understand how their experiences were socially and institutionally constructed. Individual semi-structured interviews were conducted with 6 PHNs and 8 CHVs and one focus group was held with 10 of the participants. A social discourse on mothering layered within a social discourse of working with a vulnerable population added a deeper understanding of how communication was constructed through the everyday practices of PHNs and CHVs. Findings may be used to inform reporting and communication practices between health care providers who work with marginalized families. Full article

The number of women treated for gynecological cancer is increasing. At the same time, the duration of in-patient hospitalization has decreased, and follow-up with its primary focus on early recognition of recurrence does not meet all patients’ needs. One method of follow-up may be digital intervention. This study describes the development of a psychoeducational Internet-delivered intervention targeting women’s psychosocial needs during the follow-up period after treatment for gynecological cancer. The project consisted of three phases following the UK Medical Research Council Framework guidelines for the development of complex interventions. Phase one identified the evidence in the field, phase two identified the relevant theoretical framework, and phase three included a two-year work process including focus group interviews and think aloud interviews with users. Through the steps of literature review, theoretical framework, and an iterative development process with users and other stakeholders, a six-week program was developed. The program included psychoeducational information, multimedia, exercises, and weekly telephone follow-up with a dedicated nurse. This Internet-delivered intervention can be a novel method for addressing the gap in the provision of follow-up for women after treatment for gynecological cancer. Full article

Stress is common among nursing students and it has been exacerbated during the COVID-19 pandemic. This study examined nursing students’ stress levels and their coping strategies in clinical practice before and during the COVID-19 pandemic. A repeated-measures study design was used to examine the relationship between nursing students’ stress levels and coping strategies before and during the pandemic. Confirmatory factor analyses were conducted to validate the survey and a student T-test was used to compare the level of stress and coping strategies among 131 nursing students. The STROBE checklist was used. During COVID-19, there was a reliable and accurate relationship between stress and coping strategies. Furthermore, both stress and coping strategy scores were lower before COVID-19 and higher during COVID-19. Nursing students are struggling to achieve a healthy stress-coping strategy during the pandemic. There is a need for the introduction of stress management programs to help foster healthy coping skills. Students are important resources for our health system and society and will continue to be vital long term. It is now up to both nursing educators and health administrators to identify and implement the needed improvements in training and safety measures because they are essential for the health of the patient as well as future pandemics. Full article

A universal mask use was instituted in healthcare during COVID-19 pandemic in 2020. The extensive growth in the consumption of surgical masks and respirators brought new challenges. Healthcare workers had to get accustomed to wearing the facemasks continuously, raising concerns on the patient, occupational, and environmental safety. The aim of this study is to describe frontline healthcare workers and other authorities’ views and experiences on continuous use of surgical masks and respirators (facemasks) and their attitudes towards environmental and sustainability issues. A cross-sectional web-based survey was conducted in Finland during the COVID-19 pandemic in autumn 2020. The respondents(N = 120) were recruited via social media, and the data were collected using a purpose-designed questionnaire. Descriptive statistics and inductive content analysis were used to analyze the quantitative data and qualitative data, respectively. The healthcare workers perceived their own and patient safety, and comfortability of facemasks as important, but according to their experiences, these properties were not evident with the current facemasks. They considered protection properties more important than environmental values. However, biodegradability and biobased material were seen as desired properties in facemasks. Based on the results, the current facemasks do not meet users’ expectations well enough. Especially the design, breathability, and sustainability issues should be taken more into account. Full article

Quality assurance in long-term care settings requires outcome evaluation reflecting client-specific needs of service use. This study aimed to explore the clients’ needs of adult day care (ADC). Data of 360 clients from 11 ADC agencies in Japan were analyzed. Clients’ needs for ADC use were evaluated by their respective ADC staff using 17 items of four domains: “social participation,” “hygiene and health,” “exercise and eating habits,” and “family support.” The prevalence of four domain needs was calculated and the relationship between physical independency and the presence of needs in the four domains was examined by the chi-squared test. A total of 291 (80.8%) clients had one or more needs while 69 (19.2%) clients had none. The social participation need was most prevalent (270, 75.0%) and 249 clients (69.1%) had combination needs, including social participation, along with another domain. “Feeling like revisiting the ADC” was the most common need (60.6%); it was more frequently needed by those with a higher level of independence (p = 0.003). The study findings suggest that an outcome measure relevant to social participation can be considered as the most common benefits of ADC use. However, ADCs with clients who are more dependent should consider hygiene, nursing, and family support needs. Full article

One hundred twenty-six assessment skills are taught in prelicensure nursing health assessment courses, yet 30 skills are used on a routine basis in practice. New nurses struggle to apply their acquired knowledge in clinical settings. Method: A literature review was completed. Based on the results, a first semester health assessment course in a southeastern accelerated baccalaureate nursing program was redesigned. Lectures and skills labs were adjusted to focus on the most critical assessment skills. To foster critical thinking and clinical judgement, a health assessment post conference was added where students completed concept maps, system specific case studies, nursing priority setting, and patient teaching plans. Results: Outcome surveys were completed by second semester faculty. Prior to course adjustments, 33 percent of students did not meet the benchmark. Following course changes, all students met or exceeded the benchmark. Conclusion: Focusing on critical assessment skills will increase student nurses’ ability to deliver safe patient care. Full article

Patients with chronic obstructive pulmonary disease (COPD) often require frequent hospitalization due to worsening symptoms. Preventing prolonged hospital stays and readmission becomes a challenge for healthcare professionals treating patients with COPD. Although the integration of health and social care supports greater collaboration and enhanced patient care, organizational structure and poor leadership may hinder the implementation of patient-oriented goals. This paper presents a case of a 64-year-old chronic smoker with severe COPD who was to be discharged on long-term oxygen therapy (LTOT). It also highlights the healthcare decisions made to ensure the patient’s safety at home and further provides a long-lasting solution to the existing medical and social needs. The goal was accomplished through a discharge plan that reflects multidisciplinary working, efficient leadership, and change management using Havelock’s theory. While COPD is characterized by frequent exacerbation and hospital readmission, it was emphasized that most failed discharges could be attributed to bureaucratic organizational workflow which might not be in the patient’s best interest. It was further demonstrated that healthcare professionals are likely to miss the window of opportunity to apply innovative and long-lasting solutions to the patient’s health condition in an attempt to remedy the immediate symptoms of COPD. Full article

Musculoskeletal disorders can be significantly disabling, particularly those related to work, when the underlying mechanisms and clinical variables are not well known and understood. Nurses usually remain in standing positions or walk for long periods, thus increasing the risk for the development of musculoskeletal disorders, particularly on the foot, such as plantar fasciitis or edema. This type of disorders is a major cause of sickness, absence from work, and also dropout ratios among nursing students, which contributes to the shortage of nursing professionals. This review will address foot disorders that arise from prolonged standing in nursing professionals and describe the main clinical parameters characterizing them, with exclusions for other health professions or disorders with other identified causes. English, French, Portuguese, and Spanish published studies from 1970 to the current year will be considered. The review will follow the JBI methodology, mainly though the PCC mnemonic, and the reporting guidelines for Scoping Reviews. The search will include main databases and relevant scientific repositories. Two independent reviewers will analyze the titles, abstracts, and full texts. A tool developed by the research team will aid in the data collection. Full article

It is mandatory that healthcare workers wear personal protective equipment (PPE) while caring for COVID-19 patients. Studies have shown that wearing PPE for a prolonged time may lead to symptoms of physical discomfort including headache. The aim of this study is to assess the prevalence and association between prolonged use of PPE and headaches. This was a cross-sectional study. A convenience sample of healthcare workers who worked with COVID-19 patients in clinical settings was recruited. The data were collected through an electronic survey shared as a link through social media. This study included 1060 participants, 753 (71%) female and 307 (29%) male. Participants were divided into two groups. Group A had 628 (60%) participants who did not have chronic headache before the COVID-19 pandemic, while Group B contained 432 (40%) participants who had a previous chronic headache. Headaches differed significantly between Groups A and B in frequency, type, location, and quality during the COVID-19 period. The analysis found a significant relationship between duration of PPE use and headache occurrence. The significant relationship between the duration of PPE usage and headache occurrence among healthcare workers should be considered when refining policies and procedures regarding prolonged PPE use. Full article

Existential vacuum and psychological burnout are becoming increasingly important issues in healthcare professions, especially nursing. This study aimed to investigate the contribution of several demographic factors including gender, work position, experience, and educational level as well as existential vacuum and locus of control (external and internal) in predicting burnout among nurses. A convenience sample of 181 nurses was selected to represent the study sample. Participants were assessed using an existence scale, locus of control scale, and burnout scale. The study showed that 40.3% of nurses had severe existential vacuum. It was found that 93.9% of nurses had experienced a moderate level of burnout. External locus of control was the most common personality trait among participating nurses in this study. It also was found that existential vacuum and external locus of control were the main predictors of psychological burnout among nurses. The findings of our study highlight major problems facing nursing, such as existential vacuum and psychological burnout. It is recommended to enhance nurses’ workplace, provide proper psychological prevention programs, and teach advocacy skills. Full article

Interprofessional collaboration (IPC) among health care professionals has been identified as essential to enhance patient care. Interprofessional education (IPE) is a key strategy towards promoting IPC. Several factors including the nature of facilitation shape the IPE experience and outcomes for students. Stereotypes held by students have been recognized as a challenge for IPE and IPC. This study aimed to explore institutional rules and regulations that shape facilitators’ work in IPE interactions problematized by students’ stereotypes at a university in Atlantic Canada. Employing institutional ethnography as a method of investigation, data were collected through observations, interviews, focus groups, and written texts (such as course syllabi). Participants included three facilitators, two undergraduate nursing students, and two IPE committee members of an IPE program. Findings revealed four work processes conducted by facilitators in local IPE settings related to students’ stereotypes. These processes were shaped by translocal discourse and included the work used to form teams, facilitate student introductions to team members, facilitate team dynamics, and provide course content and context. Study results included the identification of several strategies to address student stereotypes and enhance collaboration, including directions for future curriculum decisions and the pedagogical organization of IPE. Full article

The aim of this study was to assess how the healthcare professionals in the Castellón Province (Spain) perceive healthcare quality and management during the first COVID-19 wave. A cross-sectional study was carried out. An online survey on healthcare quality and management during the first COVID-19 wave was sent to healthcare professionals. Almost half of the sample believed that healthcare quality worsened during the first COVID-19 wave (45.3%; n = 173). Heavier workload (m = 4.08 ± 1.011) and patients’ complexity (m = 3.77 ± 1.086) were the factors that most negatively impacted healthcare quality. Health department 3, primary care center, and other doctors assessed human and material resources management as significantly worse (p < 0.05). Human and material resources management and the healthcare organization negatively affected healthcare quality during the first COVID-19 wave. Significant differences were observed according to departments, services, and professionals. Full article

Background. Insomnia is one of the major health problems related with a decrease in quality of life (QOL) and also in poor functioning in night-shift nurses, that also may negatively affect patients’ care. The aim of this study is to evaluate the prevalence of insomnia in night shift nurses. This observational online web-based survey using Google^®® modules specifically aimed to investigate the prevalence and risk factors for insomnia among Italian nurses. Methods. Data collection for this study lasted one month, with the questionnaire available from 1 March 2021 to 1 April 2021. Continuous variables were considered as either mean ± standard deviation (SD) or median and interquartile range (IQR) based on their distribution. Comparison among insomnia categories was assessed by one-way ANOVA or Kruskal–Wallis test according to variable distribution. Categorical variables were analyzed using chi-square test. Results. A total of 2355 responses were included in the final analysis, with 917 from the Northern zone, 815 from the Western zone, and 623 from the Southern zone of Italy. The prevalence of insomnia in the overall population was 65.4% (1524 out 2355 nurses suffered from insomnia). Conclusions. Nursing is a high-pressure profession, with heavy duties and high professional risks. We found an important prevalence of insomnia in night shift nurses, and we hope it may help to solicit further studies aimed to identify the risk factors for this working disorder among nurses. Full article

Background/Objectives: When aging adults are hospitalized due to a major health event, they often turn to care partners (‘family members or friends’) for support. Assessment of care partners’ needs during hospital care may be important to inform and target information and skills training that will equip them to fulfill caregiving tasks for the aging adults. The objectives of this study were to develop and complete content validation of the Care Partner Hospital Assessment Tool (CHAT). Methods: Based on standard instrumentation methodology and an assessment framework recommended by the National Center on Caregiving at the Family Caregiving Alliance, three steps were followed to develop and validate CHAT: (1) generation of a 24-item tool grouped into three content domains (background, plans and preferences, skills and supports), and a survey by a multidisciplinary team, (2) administration of an online survey of care partners and experts, and (3) assessment of item and scale-content validity indices (I-CVI and S-CVI). Results: A total of four care partners that provide unpaid care to a family member or friend age 65 years or older with a chronic illness or disability either before or after a hospitalization, and 19 leading experts in gerontology, caregiving, and health services completed an online survey in English. Twenty-two items were accepted by having an I-CVI at or above the acceptable 78% cut point; the S-CVI for the tool was 85%. Most revisions to the tool were associated with modifying or clarifying language within each item. For example, participants shared the following open-ended suggestions for revising CHAT: (1) change the “do you prefer” sentence stem to “do you want” (n = 12), define “training” (n = 6), and (2) allow care partners to provide an unsure response (n = 5). Conclusion: CHAT may be a promising way to increase health care practitioner’s understanding of care partners’ backgrounds, preferences and plans, and potential information or training needs during a patient’s hospital stay. Initial evaluation of CHAT reveals strong conceptual development and content validity. Full article

Aim. To evaluate the influence of time on arterial blood gas values after artery puncture is performed. Method. Prospective longitudinal observational study carried out with gasometric samples from 86 patients, taken at different time intervals (0 (T0), 15 (T15), 30 (T30) and 60 (T60) min), from 21 October 2019 to 21 October 2020. The study variables were: partial pressure of carbon dioxide, bicarbonate, hematocrit, hemoglobin, potassium, lactic acid, pH, partial pressure of oxygen, saturation of oxygen, sodium and glucose. Results. The initial sample consisted of a total of 90 patients. Out of all the participants, four were discarded as they did not understand the purpose of the study; therefore, the total number of participants was 86, 51% of whom were men aged 72.59 on average (SD: 16.23). In the intra-group analysis, differences in PCO₂, HCO₃, hematocrit, Hb, K⁺ and and lactic acid were observed between the initial time of the test and the 15, 30 and 60 min intervals. In addition, changes in pH, pO₂, SO₂, Na and glucose were noted 30 min after the initial sample had been taken. Conclusions. The variation in the values, despite being significant, has no clinical relevance. Consequently, the recommendation continues to be the analysis of the GSA at the earliest point to ensure the highest reliability of the data and to provide the patient with the most appropriate treatment based on those results. Full article

Aim: This study’s aim was to assess the knowledge, attitudes, and practices of mothers regarding childhood vaccination during the first five years of children’s lives in Saudi Arabia. Method: A cross-sectional, descriptive study was conducted with the application of convenience sampling, and 262 questionnaires were completed by Saudi mothers who had children aged 5 years or younger. Results: The majority of the participants were aged 25–31 years (57%), 61% held a bachelor’s degree, and 60.3% had children aged 2–5 years. The knowledge score was 86%, 2492 out of a total score of 2893; the attitude score was 89.1%, 973 out of a total score of 1052; the practice score was 80.5%, 1059 out of a total score of 1315. There was no evidence of an association (p > 0.05) between the knowledge, attitudes, and practice of mothers regarding vaccination and their sociodemographic aspects. Conclusion: The Saudi mothers in our sample were knowledgeable, with positive attitudes regarding vaccination, and they demonstrated good practices. This might be explained by the higher educational level of our sample. Recommendations: We recommend using multiple educational methods to support the practice of mothers regarding the management of complications of vaccinations. Full article