Nursing Reports — Open Access Journal

Postoperative handover of patients has been described as a complex work process challenged by interruptions, time pressure and a lack of supporting framework. The purpose of this study was to investigate involved personnel’s experiences with the quality of patient handovers between the operating room and the postoperative anesthesia care unit (PACU) before and after implementation of a structured tool for communication. The study was conducted in a hospital in South-eastern Norway. Personnel completed a questionnaire before (n=116) and after (n=90) implementation of the Identification-Situation-Assessment- Recommendations (ISBAR)- tool. Analysis included summative statistics, t-tests and generalized linear regression analysis. Statistical significance assumed at P<0.05.The overall impression of quality in handovers improved significantly after implementation of the ISBAR (P=0.001). Personnel’s experiences were improved in relation to that handovers followed a logical structure, available documentation was used and all relevant information was communicated (P<0.001). Moreover, personnel found it easier to establish contact at the beginning of the handover, ambiguities were resolved and documentation was more complete (P=0.001). Profession was associated with seven of the statements, relating to whether relevant information is clearly communicated, whether possible risks and complications are discussed, contact easily established, and to completeness of documentation and information. In addition, findings indicate significantly more negative experiences among receiving personnel both pre- and post-implementation.Implementation of a structured tool for communication in patient handovers, may improve quality and safety in patient handovers between the operating room and the PACU. Research is needed to define optimal patient handovers and to determine the effect of handover quality on patient outcomes. Full article

The aim of this literature review is to bring to the forefront knowledge about the suitability of videoconferencing (VC) in nursing for patients and their families living at home. A systematic literature review that included studies of VC in nursing care. Inclusion criteria were original studies relevant to concept of study. Computerized bibliographic databases (PubMed, CINAHL and PsycINFO) were searched from January 2008 to October 2016. In total, 325 articles were identified. Eight articles (1539 participants) met the inclusion criteria, and were finally included. The eight articles covered VC used in follow-up care for patients living in their homes after surgery, postpartum, chronic illnesses, families with premature infants, and children with cancer. A conventional content analysis was conducted. The results show that the success of VC depends on satisfying network access. Nurses as well as patients thought VC was similar to meeting in person. VC seems to support person-centred nursing, promote self-management and motivate patients and families to engage in their health. The use of VC requires further organization of the nursing practice. The study indicates that VC can be a suitable alternative to traditional nursing follow-up when network access and technology function properly and the nursing service is well organized. VC seems to underpin person-centred nursing. Knowledge gaps identified, more research needed as bases for assessment of VC suitability in nursing for individual persons in different treatment situations. Full article

The purpose of this study was to investigate whether glycaemic control and diabetes self-management could be improved in patients with type-2 diabetes following education using the EMMA dialogue tools facilitated by a health care professional. Glycosylated haemoglobin (HbA1c) and Summary of Diabetes Self Care Activities (SDSCA) scores were collected at baseline and three months after the intervention from 22 participating patients. Participants significantly improved self-reported foot care (P<0.001) and exercise (P<0.001) whereas no significant changes were found in HbA1c (P=0.606) blood sugar measurements (P=0.213), and diet (P=0.061). In conclusion, the dialogue tools had a positive effect by improving diabetes self-management regarding foot care and exercise. The purpose of this study was to investigate whether glycaemic control and diabetes self-management could be improved in patients with type-2 diabetes following education using the EMMA dialogue tools facilitated by a health care professional. Glycosylated haemoglobin (HbA1c) and Summary of Diabetes Self Care Activities (SDSCA) scores were collected at baseline and three months after the intervention from 22 participating patients. Participants significantly improved self-reported foot care (P<0.001) and exercise (P<0.001) whereas no significant changes were found in HbA1c (P=0.606) blood sugar measurements (P=0.213), and diet (P=0.061). In conclusion, the dialogue tools had a positive effect by improving diabetes self-management regarding foot care and exercise. Full article

Relationship was introduced as an essential element of care since the beginning of theorizing in nursing. However therapeutic relationship has been conceptualized by different theorists, an integrated approach is not provided. This study aimed to perform a systematic review to explain the therapeutic relationship in the contemporary nursing practice. Electronic databases were searched from conception to October 2015 using keywords including therapeutic, relationship, communication, nurse, and patient. We used PRISMA guideline to report data. Original studies relevant to the therapeutic relationship were included. Exclusion criteria include abstracts that were irrelevant to the concept of study, grey literature and review and commentary articles. Disagreements between researchers were solved by consensus. Twenty studies were finally included into the review process. Data were organized into three categories including composition of therapeutic relationship, context of therapeutic relationship and confirmation of therapeutic relationship. The therapeutic relationship is composed of significant knowing and meaningful connecting with patients. Few studies confirmed applicability of therapeutic relationship in nursing practice. Therapeutic relationship ensures humanity to be preserved during nursing care and patients’ hospital stay; it faces with strong barriers such as nursing shortage. The nursing shortage seriously threatens the heart of nursing. Therapeutic relationship needs to be investigated further in order to be supported by evidence-based nursing in order to confirm the applicability of relationshipbased caring theories. Full article

The research approach of grounded theory (henceforth as GT) is one of the common qualitative methodology in social sciences and lately in Nursing which has constantly been confronted with ambiguities regarding its application and particularly its operationalization. It is attempted in this article to offer the true nature, application and measures for a more suitable application of this approach by reviewing its relevant literature in different disciplines. This article is the result of reviewing different databases through 1990 to 2011 and also referring to the main texts in GT research. At the end, it must be mentioned that although the GT research approach is an appealing method, especially in Nursing and enjoys a lot of rigor with regard to dealing with the favorite phenomena of the nurses, the researcher’s expectations must be realistic about it. In addition, alongside clarification, which is a social process among a group of individuals, it can be used in presenting model and instrumentation by following the principles and also for providing examination and caring manuals and the required interventions by using the qualitative outcome analysis in order to operationalize it. Full article

Intuition in clinical practice is the ability to experience the elements of a clinical situation as a whole, and to solve a problem or reach a decision with limited concrete information. Benner theorized that the expert nurse acts on intuition, but that he/she also deals with some ambiguities. However, there is a lack of studies about intuitive nursing in the critical care arena, where more critically ill patients are admitted. So, this study was conducted to explore the features of the intuitive nurse in critical care practice. In a descriptive-phenomenological study, twelve nurses employed in critical care units of the hospitals affiliated to Kermanshah University of Medical Sciences were recruited to the study, as purposive, a semi-structured interview was administered to them, then written down verbatim. The data was managed by MAXQDA 10 software (VERBI GmbH, Berlin, Germany) and analyzed as qualitative through the seven-stage approach of Colaizzi. Of the 12 nurses who participated in the study, seven (58.3%) were female and married, 88.3% (10 people) had a Bachelor of Nursing and the mean and standard deviations of the participants’ age, job experience and critical care experience were 36.66±7.01, 13.75±6.82 and 7.66±3.36 years, respectively. From the qualitative analysis of the data, we extracted three main themes, including proficiency, connection and benevolence, and ten sub-themes. The intuitive nurses were substantially proficient in terms of knowledge, skill and experience, and relationships to patients. They desired to help the patients based on their consciences. Full article

Interest in the nursing profession is growing in the United States (US). Currently, there are more applicants for nursing school than nursing school capacities can accommodate. At the same time qualified applicants are unable to enter nursing school related to program capacities, 18% of admitted students leave nursing schools prior to graduation. The abundance of applicants should make nursing school attrition, in the US, practically nonexistent. US nursing programs must determine more effective criteria for screening applicants so that the students, most likely to succeed, are admitted to programs. Full article

The tobacco epidemic kills half of its users annually and 600,000 deaths occur in people exposed to cigarette and water pipe tobacco (WT) smoking. A population-based cross sectional study was conducted to explore the knowledge and perceptions on health effects of WT smoking amongst Bahraini adults in the popular coffee shops of Bahrain and in women’s congregations. Randomly, 206 Bahraini adults of both genders were selected and distributed with a developed questionnaire to collect data; results were analyzed using SPSS (SPSS Inc., Chicago, IL, USA). Among the WT smokers, the highest proportion (45%) was observed between 21 and 30 age group and in the higher educational category. Majority smoked daily. The leading motives of WT smoking were meeting friends, passing of time and pleasure. Many smokers believed WT as less harmful than cigarettes, but affect the respiratory system, and causes: cancers, cardiovascular disease and pregnancy-related disorders. The knowledge scores were significantly higher in the younger age group, higher educational qualifications, and higher income. A considerable proportion of smokers perceived WT smoking as a sign of maturity, acceptable by the society. The perception scores were significantly higher in women and in the age group of >40. This study has revealed a lack of knowledge amongst the Bahraini adults who assume that health risks of WT are lower than cigarettes demanding further research to evaluate WT smoking risks, health effects, environmental effects of smoke, and regulatory services in Bahrain for a responsive approach to curb the WT tobacco epidemic. Full article

Sweet solutions reduce procedural pain in infants but there is uncertainty about effectiveness beyond infancy. A blinded pilot randomized controlled trial (RCT) was conducted to inform a full-scale RCT. Hospitalized children aged 12- 36 months were randomized to 24% sucrose or water prior to and during venipuncture. Primary outcomes were crying time and FLACC (Face, Legs, Activity, Cry, Consolability) scores. Secondary outcomes parental report of child’s pain, parental perception of effectiveness and nurse’s score of child’s compliance with study solution. Twenty-one children were studied. There were no differences in pain outcomes between groups. Median FLACC scores at time of needle insertion were high (8/10), and mean crying time during procedure was 61%. Most parents (n=17) would use the same treatment next time and most (n=17) toddlers were compliant with receiving the solutions. The pilot RCT informed the conduct of a future full scale RCT in terms of feasibility, acceptability, data collection, data analysis and sample size estimation. Full article

Falls have been a major safety concern in view of its high incidences and potential detrimental consequences. This article described a systematic review about effectiveness of interventions for the assessment and prevention of falls in adult psychiatric patients conducted previously. These patients possessed unique fall-related risk factors such as altered mental status, physiological symptoms, past history of falls, mobility and gait problems, concurrent medical conditions, and polypharmacy that might warrant specific tailored fall prevention interventions. Following the systematic review, a care bundle for fall prevention in a tertiary psychiatric hospital would be implemented, taking into account these risk factors and evidence relating to fall prevention. Full article

Nursing and allied health care students use online learning resources with their own perspective of learning, often combined with curiosity. Although, students are overwhelmed with access to an enormous pool of information, we hypothesized that students may not possess the skills to appraise the merits of all online resources. Our pilot survey results have shown that students’ knowledge of literature appraisal is inadequate. Circumventing this barrier requires adopting a three-phase protocol for literature triage such as: selection, appraisal, and critical reading. These skills would facilitate assessing all aspects of the literature, and identifying the best learning material. Full article

We clarify patient participation by developing a systematic structure of 34=81 models spanned out by three subcategories for each of four categories. Choosing a qualitative descriptive research design, and applying purposive sampling, four doctors, seven nurses, and seven patients were selected to ensure a broad representative sample with experts of varying ages and sexes from medicine and nursing. The preferences of these were mapped onto the theoretical structure. Applying content analysis, meaning units were identified, condensed and coded. The four categories information dissemination, formulation of options, integration of information and control were shown to be exhaustive, and mutually exclusive through time causing a topdown process where one occurs before the other through four stages. The three subcategories specify how patients, healthcare professionals, or both, operate within each category. That is, either patients are active in some sense that is specified, or healthcare professionals are active in some sense, or both are active. Delineating a structure of 34=81 models, based on four categories and three subcategories, gives a richer structure than what has earlier been available. This almost all-embracing structure enables pinpointing the exact nature of any culture involved in care of patients, which illuminates how the culture reflects or can potentially be altered to reflect values of patient care that we respect. Full article

Mucositis is one of the most common side effects of chemotherapy and radiotherapy. In order to develop an evidence-based clinical practice guideline for the management of tumor therapy-induced-oral mucositis, it was necessary to capture the patients’ perspective. Therefore the aim of this critical literature review was to explore the experience of patients with therapy-induced-oral mucositis. Searches were carried out using a systematic search strategy in CINAHL and Medline. Qualitative studies investigating the view of cancer patients receiving chemotherapy and/or radiotherapy and suffering from oral mucositis were included. Study selection and quality assessment were performed by two independent reviewers. Only two qualitative studies (n=28 patients) met the inclusion criteria. Oral mucositis caused by cancer therapy is associated with serious complications concerning pain, eating, swallowing, speaking, sadness, lack of energy, and distress. Mucositis was described as the worst side effect of cancer therapy. Providing patient-centered care requires understanding the experience and the needs of patients and their families. Mucositis is associated with complex physical, psychological and social consequences. Unfortunately, both studies were performed in different cultural backgrounds and health care systems, so the results cannot simply be transferred to German-speaking countries. Further research is needed to gain a deeper understanding of living with mucositis. Full article

Early home visits provided by public health nurses (PHNs) around the world have been proven to positively impact physical, social, emotional and mental health outcomes of mothers and babies. Most of the research has focused on home visiting programs delivered by public health nurses and lay home visitors to support at risk or targeted mothers. Little research has been conducted to examine universal home visiting programs for mothers who are perceived to be lower-risk. The purpose of this research was to explore how universal and targeted early home visiting programs for mothers and babies were organized, delivered and experienced through the everyday practices of PHNs, mothers, and managers in one city in Atlantic Canada. Feminist post-structuralism was used to collect and analyze data through semi-structured face-to-face interviews with 16 PHNs, 16 mothers and 4 managers. Personal, social and institutional discourses of program delivery were examined using discourse analysis. Four main themes of the study include: i) understanding targeted and universal programming; ii) health outcomes; iii) building relationships; and iv) exploring a new surveillance. This article will discuss the first theme; understanding targeted and universal programming. Full article

Pain management is an integral challenge in nursing and includes the responsibility of managing patients’ pain, evaluating pain therapy and ensuring the quality of care. The aims of this study were to explore patients’ experiences of pain after lung surgery and evaluate their satisfaction with the postoperative pain management. A descriptive design was used which studied 51 participants undergoing lung surgery. The incidence of moderate postoperative pain varied from 36- 58% among the participants and severe pain from 11-26%, during their hospital stay. Thirty-nine percent had more pain than expected. After three months, 20% experienced moderate pain and 4% experienced severe pain, while after six months, 16% experienced moderate pain. The desired quality of care goal was not fully achieved. We conclude that a large number of patients experienced moderate and severe postoperative pain and more than one third had more pain than expected. However, 88% were satisfied with the pain management. The findings confirm the severity of pain experienced after lung surgery and facilitate the apparent need for the continued improvement of postoperative pain management following this procedure. Full article

Studies that explore the subjective experiences of younger people with dementia living at home are rare. Therefore, the aim of this study was to gain an understanding of the lived experience of younger persons (<65 years) who lived at home and suffered from earlyonset dementia, and the meanings that might be found in those experiences. The researchers conducted a qualitative study using a phenomenological hermeneutic approach. Data were collected through narrative interviews with four informants. Two men and two women ages 55 to 62 participated. Three of the informants lived with their spouses, and one lived alone, close to his children. The informants’ subjective experiences revealed the following four key themes: entrapment by circumstances, loss of humanity, the preservation of hope and willpower, and the desire to ensure one’s quality of life. These themes provide a deeper understanding of the experiences of younger people with dementia who live at home. The theme of preserving hope and willpower rebuts prejudicial contentions that life with Alzheimer’s syndrome does not have anything more to offer and may be seen as diminishing a patient’s humanity. Patients’ autonomy and self-determination should not be ignored. In all phases of the progression of dementia, the person in charge of giving care to the relative with dementia should be ethically aware of and reflective to the progress of his/her illness. Full article

Medication administration errors are common, costly and the cause of adverse events in clinical practice. Interruptions during medication administration rounds are thought to be a prominent causative factor of these medication errors. In this observational study, data were collected on the number and duration of several different sources of verbal and non-verbal interruptions using unobtrusive structured observations on 32 medication administration rounds. Interruptions occurred very often (6.9 times per nurse each hour), differed in frequency among the medication administration rounds and were from a variety of sources. The most frequent interruptions were caused by nursing colleagues (43%) and non-verbal interruptions from the ward environment (25%), such as noises from pagers, conversations in the vicinity of the nurse, the work of cleaners, or stock management by pharmacy staff. The longest durations of interruptions were from nursing colleagues’ verbal interrup- interruptions. When comparing the medication rounds, more and longer interruptions were observed during the morning rounds than those at noon. A comparison between surgical and non-surgical units showed that interruptions occurred more often and lasted longer in non-surgical units than those in surgical units. But the observed differences were not statistically significant. In conclusion, interruptions during medication administration rounds are frequent and originated from different human and environmental sources. Interventions should target not only interruptions by colleagues, but should also consider ways to reduce self-initiated interruptions and those arising from the immediate ward environment. Full article

The prevalence of diabetes in the childbearing population is increasing globally. Pregnant diabetic women are considered to be at high risk, and thus require specialized, multidisciplinary prenatal care in which midwives play an integral part. These women’s views and experiences of encounters with midwives during diabetes care have not yet been investigated. Our aim was to use an exploratory interpretive approach to investigate the experiences of pregnant women and their perceptions towards the meaning of prenatal consultation provided by midwives in the prenatal care team. A purposive sample was recruited from four hospital-based prenatal diabetes outpatient clinics in the urban areas of Norway: 10 pregnant women (5 primiparous, 5 multiparous) aged 28-45 and diagnosed with different types of diabetes. Data from semi-structured interviews were transcribed and subjected to thematic analysis. Three main themes emerged: being in an open atmosphere, being seen as a person, and being reassured. Together, these themes created a construct that we labeled being in an oasis-a restorative and reassuring place. The counterpoint of this view was a more negative perspective described as having insufficient time, feelings of being objectified and rushed, and diseaseoriented care. The women valued the focus on surveillance in the consultations, although at their best, the midwife-woman encounters complemented and counteracted the iatrogenic effect of the biomedical focus in specialist prenatal care. However, the organization of care may have contributed to and created feelings of suffering, as these women had limited scope for addressing their concerns in the consultation. We conclude that these consultations are complex co-created activities in which interpersonal aspects of the midwifewoman encounters, such as the midwives’ openness and responsiveness to the women, seem to be significant in developing a personal approach. Full article

In the period 1945-1965 most women in the state of Queensland, Australia, gave birth in hospitals and thereafter they used a variety of services and individuals for advice on infant feeding. The services available were similar throughout the period. As mothers rarely worked outside the home, being good mothers was important to their identity. In this historical study, telephone interviews and written responses involving 44 mothers and former nurses from every region of this geographically vast state were used in order to investigate sources of personal advice on infant feeding used during this period, mothers’ experience relating to this advice, and the extent to which they followed the advice. The free, nurse-run well-baby clinics and related services conducted by the state’s Maternal and Child Welfare service were the most commonly mentioned services. However, the uptake of advice from this source showed considerable variation as women also drew upon family members, their general practitioners, advice columns, radio broadcasts, other mothers and their own judgment. Only rarely was a specialist pediatrician consulted. A minority of mothers was advised by pharmacists, private baby nurses, or entered residential mothercraft facilities. An important finding is that attendance at the baby clinics did not necessarily equate with compliance, especially as mothers became more experienced. Full article