Nursing Staff Caring Research Articles

The importance of ward-based education in the postoperative assessment of free flaps

Background: Despite the theoretical and practical advantages of adjunct-based free flap failure detection, the introduction of ultrasonographic techniques has not changed free flap failures rates and their use remains secondary to clinical assessment. Our study aims to develop an educational framework to improve the confidence of nursing staff caring for free flaps, with an emphasis on early detection of flap failure, thereby improving postoperative outcomes. Methods: Nursing staff in intensive care units and surgical wards caring for free flaps completed standardised questionnaires either before or after an educational seminar detailing clinical and Doppler assessment of free flaps. Differences between cohorts were summarised descriptively with frequencies and percentages. Overall confidence scores for pre-education and post-education cohorts were compared. Results: Overall, 173 responses were collected. Most staff were from intensive care units (n = 114) and almost one-third completed surveys following the educational intervention (n = 51). Microsurgical ward staff had more experience in the postoperative care of free flaps than intensive care unit staff (29% vs 18% had experience caring for > 50 free flap cases). Confidence in assessing a free flap by clinical, implantable Doppler or external Doppler ultrasound was universally increased among ward staff compared to intensive care unit staff (p ≤ 0.007). Altogether, 51 per cent of intensive care unit staff had never identified a failing flap compared with 35 per cent of ward staff. Education increased confidence in managing and escalating failing flaps unanimously. Most failing flaps were identified by clinical assessment alone or combined with adjunct-based methods (94%). Conclusion: This study demonstrates that the provision of targeted education for nursing staff, both in intensive care units and on surgical wards, is useful for increasing confidence in the clinical assessment and early detection of free flap compromise. Increased confidence and improved clinical assessment may allow for early intervention and improved salvage rates for a threatened free flap, thereby improving patient outcomes.

Experiences of nursing staff caring for COVID-19 patients. Exploratory study

Introduction: Nursing staff are responsible for providing care to people in public health crises such as the COVID-19 pandemic. In previous epidemics, studies were carried out in developed countries with a quantitative approach in which it was observed that this group suffered from conditions in their mental health, although it was not possible to delve into their experiences or explore them in the Latin American context, so the aim of this study was to explore the experiences of nursing staff while caring for COVID-19 patients.Methodology: Qualitative phenomenological study that allows identifying the experiences and feelings of the informants during the care they provided to people with COVID-19.Outcomes: Two large categories were identified: 1) Emotions with three subcategories: a) Emotions at the beginning of the pandemic, b) Emotions during the pandemic and c) Emotions at the end of the pandemic; and 2) Qualities of nurses during the COVID-19 pandemic with three subcategories: a) Commitment to humanity, b) Companionship and c) Nurse-patient moments.Conclusion: The experiences of the Mexican nursing staff who cared for people with COVID-19 focus on the emotions they experienced in three moments, at the beginning: fear and uncertainty; during the pandemic: fear, anxiety, stress and depression, and at the end of the pandemic: self-confidence and satisfaction when facing the pandemic with commitment to humanity, camaraderie, satisfaction and pride in having provided care to infected people despite various obstacles.

Analysis of The Impact of Excellent Event Management on the Safety of Patients and Clinical Caregivers

Objective: To investigate the impact of excellent event management in improving patient safety and nursing staff care satisfaction. Methods: The study was analyzed by retrospective comparison, and routine management from January 2022 to December 2022 was set as the control group, and excellent event management from January 2023 to January 2024 was set as the study group. The differences in nursing outcomes between both groups were compared. Results: The rate of adverse events in the study group (0.61%) was lower than that in the control group (0.96%), and the rate of excellent events in the study group (2.57%) was higher than that in the control group (0.97%) (P < 0.05). Meanwhile, the satisfaction level of nursing safety in the study group reached 98.81%, which was much higher than in the control group (92.21%) (P < 0.05). Conclusion: Nursing excellent event management had a positive impact on improving patient care safety satisfaction, reducing the rate of adverse events, and increasing the rate of reporting excellent events.

Assessment of the Need, Demand, and Access to Mental Health Care Services by Nursing Staff in Dispensaries Within Mombasa County, Kenya

Mental health and well-being are crucial for a fulfilling life. Work related stress negatively impacts health care providers' professionalism, quality of care delivery, efficiency, and overall quality of life. It is important to identify and mitigate these work-related risk factors to protect the mental health well-being of healthcare workers. The aim of this study was to assess the provision, demand and awareness of need for mental health care services amongst nursing care staff stationed in dispensaries within Mombasa County, Kenya. This is a cross-sectional study that targeted nurses at the dispensary level, facility in-charges, and County health personnel. Quantitative data was collected using GAD-7 to measure anxiety, PHQ 9 to measure depression and PCL 5 to measure PTSD. Qualitative data was collected through IDI and key informant interviews with the facility in charges and the Sub-County County nurse officials. Quantitative data was analyzed descriptively while qualitative data was analyzed following Creswell six steps. The research discovered the proportion of nurses in Mombasa County affected by PTSD severe anxiety and severe depression as 12.6%, 22.6% and 3.2% respectively. These conditions have their origin in work and personal matters with work-related matters being the main contributors. Fear of stigmatization from colleagues and the community negatively affected care seeking behavior. Nine county facilities offered mental health services although understaffed with only 9 specialized staff. The county has made some investment in mental health service provision, this investment is however focused on service provision to the general public as opposed to health care workers.

Internationally Educated Nursing Staff Caring for Older Adults: A Scoping Study.

Internationally Educated Nursing staff (IENs) are born and obtained their initial educational preparation in their home country before relocating to work in high-income countries (e.g., United States). Older adults are recipients of IENs' care. The study purpose was to synthesize relevant findings on IENs' experiences caring for older adults in various settings. Arksey and O'Malley's framework approach to Scoping studies was employed. The PubMed, CINAHL, PsycINFO, Web of Science, and Google Scholar databases were searched. A labor and employment relations researcher and a health science librarian were consulted. Three main themes (transitional challenges; IENs' experiences working with older adults; factors affecting IEN service delivery) and seven subthemes emerged. Cultural beliefs and communication barriers posed particular challenges to IENs as they worked with Western peers, older adults, and families. Facilitating factors revealed can inform administrative leaders of practice initiatives. Research gaps and limitations identified can guide future study approaches.

Knowledge, attitude, and practice towards neonatal palliative care of medical and nursing staff in an Indian context: A web-based survey

Objectives: Neonatal palliative care (NPC) is a holistic and interdisciplinary approach towards newborns with life-limiting conditions and encompasses their physical, psychosocial, and spiritual care and the redressal of pain. This study was designed to determine the knowledge, attitude, and practices towards NPC by the medical and nursing staff involved in neonatal care. Material and Methods: It was a questionnaire-based prospective cross-sectional study done at a tertiary care hospital in India by collecting data using the Neonatal Palliative Care Attitude Scale (NiPCAS) survey which has 26 attitudinal questions on a Likert scale. Results: There were 87 participants including 58 doctors (66.7%) and 29 (33.3%) nurses. Almost all of the respondents agreed that palliative care was necessary in neonatal nursing and medical education; but less than half had received education for the same. There was an overall agreement in the organization, resources, and clinician subscale by both medical and nursing respondents. Conclusion: There were similarities and differences in perceptions of NPC between medical and nursing staff. Several facilitators and barriers of NPC were identified. Efforts should be taken to strengthen facilitators while simultaneously mitigating barriers.

Working dilemmas in care for breastfed newborns: An exploratory study in a single center in Taiwan.

Clinical medical staff should be aware of and examine the correlation between breastfeeding and neonatal hospitalization. Additional attention should be paid to work dilemmas experienced by the nursing staff caring for newborns to avoid exposing newborns to hospitalization risk. The present study investigated the working dilemmas by neonatal nurses caring for breastfed newborns and risk of newborn hospitalization. This hospital-based study in Taiwan surveyed 84 neonatal nurses using a structured questionnaire entitled "Working Dilemmas in Clinical Care for Breastfed Newborns." Collected data were analyzed statistically (descriptive analysis, chi-square test, and t test) using Statistical Package for the Social Sciences (SPSS) software. Neonatal intensive care unit (NICU) staff noted that breastfed newborns showed a high risk of hospitalization and nursery staff highlighted a lack of manpower and time. NICU staff experienced more working dilemmas (117.460±12.260) than nursery staff (87.410±15.820) when caring for breastfed newborns (t = 1.080, P < 0.001). NICU staff reported a higher risk of hospitalization in breastfed newborns and experienced more working dilemmas caring for these patients compared with nursery staff, who reported a lack of manpower and time. Our findings highlight the working dilemmas by neonatal nurses and can serve as a foundation for further critical studies.

Factors affecting the willingness of nursing care staffs for cooperation with heart failure care and the role of internet video education.

With the aging of heart failure (HF) patients, collaboration between medical and nursing care facilities is essential for HF care. The aims of this study were: (1) to identify the factors that affect willingness of nursing care staffs to cooperate with HF care; (2) to test whether the internet video education is useful in improving their willingness to collaborate. A web-based questionnaire was e-mailed to 417 registered medical corporations that operated nursing care facilities in the prefecture where the authors work. Medical and care staff working at each facility were asked their willingness to cooperate with HF care and their problems about collaboration. Machine learning analysis was used to assess the factors associated with unwillingness to cooperate. After watching a 6-min YouTube video explaining HF and community collaboration, we reaffirmed their willingness to cooperate. We received responses from 76 medical and care staff members. Before watching the video, 32.9% of participants stated that they were unwilling to cooperate with HF care. Machine learning analysis showed that job types, perceived problems of collaboration, and low opportunities to learn about HF were associated with unwillingness to cooperation. After watching the video, we observed an increase from 67.1% to 80.3% (p < 0.05) of participants willing to cooperate with HF care. Job types, perceived problems of collaboration, and low opportunities to learn about HF are associated with unwillingness of nursing care staff for HF care. Internet videos are potential learning tool that can easily promote community collaboration for HF.

End-of-life care in the patient's home.

Providing end-of-life care in a patient's home is challenging, especially if the nurse is from a different ethnic background from the patient. Evidence shows that people from an ethnic minority background often experience poorer end-of-life care due to care providers not understanding their care needs. To explore the experiences of community nursing staff caring for patients with an ethnic minority background at the end of their life. Using a qualitative descriptive approach, 16 semi-structured interviews were conducted and the data was thematically analysed. Participants dealt with large tight-knit families, paternalism and controlling behaviours. There was a mistrust of Western palliative medicine. Language barriers and challenges were faced by the nursing staff, resulting in difficult conversations with the families. Different levels of the nursing staff's spiritual/cultural competencies were also identified. The COVID-19 pandemic intensified the challenges. This research has shed light on the challenges of individualising end-of-life care in a culturally diverse community in the UK. The nursing staff's cultural/spiritual competencies were challenged.

Assessment and management of upper limb lymphoedema in advanced disease: a case study.

Lymphoedema is thought to affect around 200 000 people in the UK (NHS England, 2023). Secondary lymphoedema is a relatively common complication of cancer and cancer treatment, and in advanced disease it may present a challenging issue for community nursing staff caring for patients approaching the end of their lives. In this article, a case study considers the assessment and treatment of upper limb lymphoedema in a patient with advanced metastatic breast cancer. Management of this complex and distressing condition requires holistic assessment and collaborative care planning with the patient and their wider care team, including onward referral to specialist lymphoedema and palliative care services. The case study considers the typical presentation of lymphoedema in an upper limb, exclusion of reversible causes for oedema, awareness of palliative care emergencies such as superior vena cava obstruction, and the provision of supportive therapeutic interventions in context of the patient's expressed wishes for her ongoing care.

IMPACT OF SHORTAGE OF STAFF NURSES ON QUALITY CARE OF PATIENTS AT SPECIALISED HOSPITALS IN LAHORE

The nursing shortage has been recognized as a global healthcare issue that can negatively impact the quality of patient care. Adequate staffing of nurses is an essential factor that can ensure the provision of high-quality healthcare services to patients. A shortage of nurses may lead to poor patient outcomes, including medication errors, patient falls, and hospital-acquired infections. Therefore, addressing the nursing shortage is critical to improve patient care and health outcomes. This study investigates the impact of nursing shortage on patient care in healthcare settings. This study used a quantitative cross-sectional descriptive study design to assess the impact of nursing shortage on patient care. The study was conducted in multiple healthcare settings across different regions. A convenience sampling technique was used to select participants for the study. The patients in settings with nursing shortages used and filled out a questionnaire according to international guidelines. The results of the study showed that the majority of the participants reported a negative impact of nursing shortage on patient care. The shortage of nurses was associated with decreased patient satisfaction with nursing staff care. Furthermore, the study found that nursing shortages often led to nurses being overworked and exhausted, leading to medical errors and declining patient quality of care. The study concluded that the nursing shortage significantly negatively impacts patient care in healthcare settings. The shortage of nurses leads to decreased quality of care, increased length of hospital stay, patient mortality rates, and decreased patient satisfaction with care. Therefore, addressing the nursing shortage is crucial for improving patient outcomes and ensuring the provision of high-quality healthcare services.

Confidence in dementia care and care approach toward dementia among the nursing staff in long-term care facilities in China: a cross-sectional survey.

Confidence and appropriate care approach toward dementia among nursing staff (nurses and care assistants) are crucial manifestations of competency to deal with the complexity of dementia care in long-term care facilities (LTCFs). The purpose of this study was to investigate the confidence in dementia care and care approach among nursing staff in LTCFs in mainland China. A cross-sectional study design was utilized in LTCFs in Shandong Province, mainland China. A convenient sample included of 317 nursing staff drawn from 15 LTCFs. Survey questions included (a) demographics, (b) dementia knowledge, (c) dementia care confidence, and (d) approach to care for people with dementia. Data were analyzed with descriptive statistics. Factors associated with confidence and care approach for people with dementia were examined using Pearson's correlation and multivariate regression analyses. Dementia care confidence was generally moderate. Factors affecting confidence to care for people with dementia included educational level, months of caring dementia patients, and dementia knowledge. Most nursing staff did not use a person-centered care approach which was significantly associated with their age, dementia-learning experience, and knowledge and confidence toward caring for people with dementia. A positive correlation was identified between confidence to care for people with dementia and nursing staff care approach. Clinical recommendations are provided to further develop education strategies tailored for nursing staff to meet the growing demand for dementia care services.

Digital ethical reflection in long-term care: Leaders' expectations.

Healthcare leader support and facilitation for ethics work are of great importance for healthcare professionals' handling of ethical issues, moral distress, and quality care provision. A digital tool for ethical reflection in long-term care was developed in response to the demand for appropriate tools. This study aimed to explore healthcare leaders' expectations of using a digital tool for ethical reflection among their home nursing care staff. A qualitative research design with vignettes and focus group interviews was used. The data were analyzed using reflexive thematic analysis. The sample comprised ten healthcare leaders from municipal long-term care in Norway. Participation was voluntary and based on informed consent. The Norwegian Agency for Shared Services in Education and Research approved this study. The analysis resulted in the development of three themes representing leaders' expectations of the tool: (i) giving staff a voice, (ii) revealing ethics in practice, and (iii) keeping the pot boiling. Leaders must be informed about the ethical issues experienced to engage in supportive measures for their staff. Digital channels can increase the democratization, safety, and efficiency of communication between employees and leaders and increase awareness of ethical aspects in daily care work. The leaders had positive expectations of employees' activities and benefits from using the tool for ethical reflection. However, they admitted that realizing the tool's potential to ensure continuity in ethics work requires considerable organizational and leader involvement. This study shows that healthcare leaders are open to digital solutions for managing ethics work in home nursing care. Both opportunities and important prerequisites for successfully implementing the digital tool were identified.

텍스트 마이닝 기법을 활용한 노인장기요양기관 부당청구 판례 분석 연구

The increasing number of unfair claims in long-term care facilities has emerged as a risk factor for threatening the finances of the Korean national health insurance and increasing medical expenses, considering the imminent danger to super-aged society, since the implementation of the Long-term Care Insurance Act for the Elderly. Therefore, we aim to provide alternatives for unfair claim prevention and recidivism. The court's precedents and text-mining analysis were used to identify issues and factors in unfair claims to meet our research goals. Ninety-one cases (i.e., eighty-five elderly care facilities and six elderly care communal homes) were collected from January 1, 2013, to December 31, 2020. Our results revealed that fourty-four were fined, seventy-two received probation, and eighteen were sentenced to imprisonment, of the first verdicts by trial courts for senior medical welfare facilities. Among the defendants (n = 146), ninety-nine were top managers; thirteen were care workers; and five were social workers. The indictments consisted of seven violations, and of three most representative contents were violations of the Long-Term Care Insurance Act for the Elderly, of the Act on the Aggravated Punishment of Specific Economic Crimes (fraud), fraud, violations of the Elderly Welfare Act, business embezzlement and forgery of private documents. In the first trial, TF-IDF analysis indicated four keywords, 'regulations and announcements,' 'working hours,' 'additions,' 'competition,' and mandatory personnel, such as physical therapists, social workers, and nursing assistants. In the second trial, 'field investigation,' 'sanitation,' and 'resident' were the main words. Topic Modeling of the first trial showed that 'nursing care workers &amp; sanitation center,' 'nursing care staff assignment standards,' 'social worker &amp; physical therapist,' 'notifications and laws,' 'working hours &amp; exploitation,' 'defendants &amp; victim.' In the second trial, 'accused &amp; supreme unjust (heavy),' 'placement criteria &amp; deception (acts),' 'long-term care benefit &amp; breach of working hours,' 'victim's claim &amp; crime of fraud,' 'false service,' 'staff assignment standards &amp; deceiving (acting),' and 'defendant's working rules &amp; field investigation.' Thus, we explored causes and issues with unfair claims. Finally, we proposed several preventative solutions: ①. change in the perception of operators and works of long-term care institutions, ②. transparent management, ③. a thorough understanding of relevant regulations, such as laws and public announcements, and prevention of errors in interpretation, and lastly ④. active countermeasures focused on improving unfair claims instead of punishment.

A qualitative exploration of the strategies used by patients and nurses when navigating a standardised care programme.

The main aim of this paper is to explore and discuss the interesting juxtaposition of patient involvement within a standardised Enhanced Recovery After Surgery care programme (ERAS). We address our aim by examining the work and strategies of nursing staff caring for patients during postoperative recovery from surgery, exploring how these two potentially competing priorities might effectively co-exist within a hospital ward. This was a qualitative exploratory study, with data generated through 42 semi-structured interviews with patients and nurses who had taken part in an ERAS programme in one of three hospital wards in the United Kingdom, adopting a reflexive thematic approach to data analysis. We shine a light on the work undertaken by patients and nurses during the navigation of postoperative recovery, identifying strategies of collaboration and negotiation during this journey. Furthermore, we also identify and consider patients engaged in peer-peer support during postoperative recovery. This paper adds to the existing literature and current ways of thinking in relation to the quest for standardised, clinically effective care balanced with the aspirations for individualised, patient-centred care. This paper also helps inform thinking about the use of care pathways in relation to service delivery, considering how best to initiate and deploy best practice aimed at safe and effective postoperative recovery.

Translation and psychometric testing of the sense of competence in Dementia Care Staff Scale in Chinese amongst dementia care staff in nursing homes of China

BackgroundAlthough China has the largest population of persons with dementia, there is no validated tool available to accurately assess formal caregivers’ competence in dementia care in long-term care settings. Appropriately assessing nursing staff’s level of competence in dementia care is the first step to develop precision training interventions to improve the quality of dementia care. The Sense of Competence in Dementia Care Staff scale (SCIDS) is a user-friendly tool with satisfactory reliability and validity. We adapted SCIDS into a Chinese version (SCIDS-C) and validated its uses in China’s socio-cultural context to assess nursing staff’s capability and competence in dementia care at nursing homes.AimsWe aimed to adapt and psychometrically test the tool among frontline nursing staff in long-term care settings in China.MethodsThe research employed a correlational design with repeated measures. In translation section, we adapted and tailored the original scale in the cultural and social context in China’s nursing homes. The scale’s adaptation consists of translating adaptation and semantic equivalence. In psychometric testing phase, we tested the validity and reliability of the scale with 174 nursing staff conveniently from six nursing homes. Construct validity was tested using exploratory factor analysis (EFA), including principal component analysis and maximum variance rotation method. Reliability was tested using Cronbach’s alpha value and intraclass correlation coefficient (ICC).ResultsThe SCIDS-C has 17 items, which belong to the two sub-scales, the Relationship-Centered Care(RCC) and Professional Care(PC). The Cronbach’s alpha value was 0.88, showing a good internal consistency. The full scale’s value of ICC was 0.94 which indicated good reliability. Exploratory factor analysis(EFA) extracted 2 common factors in each sub-scale, cumulative variance contribution rate was 56.71% and 53.92%, respectively. The named four factors are the same as the Sense of Competence in Dementia Care Staff (SCIDS) scale in English, including Building Relationships, Sustaining Personhood, Professionalism and Care Challenges.ConclusionThe SCIDS-C has shown good reliability and validity. It can be used as an appropriate tool to evaluate the competence of nursing care staff to provide dementia care for residents in nursing homes.

Impact of COVID-19 on the Surrounding Environment of Nursing Home Residents and Attitudes towards Infection Control and Oral Health Care among Nursing Home Staff in Japan

The environments of nursing home staff and residents have dramatically changed since the onset of the COVID-19 pandemic, with greater demand for infection control. This study aimed to clarify the changes and regional differences in the surrounding environment of nursing home residents as well as the working environment of staff, including oral health care, after the spread of SARS-CoV-2. A self-administered questionnaire survey was sent to nursing staff at about 40 nursing homes in different areas of Japan in September and October 2021. The questionnaire consisted of items centered around: (1) the surrounding environment of nursing home residents, (2) awareness and attitudes towards daily work among staff, and (3) attitudes to and procedures for oral health care among staff. A total of 929 respondents included 618 (66.5%) nursing care workers and 134 (14.4%) nurses. Regarding changes in resident daily life, 60% of staff perceived decreases in psychosocial and physical function after the start of the pandemic due to limited family communication and recreational activities, especially in urban areas. Concerning infection control, most respondents adopted routines of disinfecting hands before and after their duties. Oral health care was part of the regular duties of over 80% of respondents. Many participants answered that the frequency and time of oral health care only slightly changed after the onset of COVID-19, but many also reported disinfecting hands both before and after oral health care, particularly in rural areas. Our findings suggested that the COVID-19 pandemic decreased the daily living activities of residents, leading to psychosocial and physical decline, especially in urban areas. The results also indicated that the spread of SARS-CoV-2 triggered improvements in the awareness and attitudes towards infection control in daily work, including oral health care, among nursing care staff, notably in rural areas. Such an effect may contribute to a more positive perception of oral health care infection measures after the pandemic.

Protocol for a process evaluation of a stepped wedge randomised controlled trial to reduce unnecessary hospitalisations of older people from residential aged care: the EDDIE+ study

IntroductionThe Early Detection of Deterioration in Elderly residents (EDDIE+) programme is a theory-informed, multi-component intervention aimed at upskilling and empowering nursing and personal care staff to identify and manage early...

Comparison of Terminal Care Stress and Terminal Care of Long-term Care Hospital Nurses and Nursing Staff

Comparison of Terminal Care Stress and Terminal Care of Long-term Care Hospital Nurses and Nursing Staff

Time, resourcing, and ethics: how the routinisation of organ donation after circulatory death in the NHS has created new ethical issues

ABSTRACT Controlled Organ Donation after Circulatory Death (DCD) was re-introduced in the UK in 2008, in efforts to increase rates of organs for transplant. Following reintroduction there were debates about the ethics of DCD, leading to production of legal and ethical guidelines. Today, DCD makes up 40% of deceased organ donors, leading to claims that the UK has ‘overcome’ its ethical challenges. However, there is little understanding of how DCD works in practice and the ethical implications of making DCD routine in the context of the NHS. This paper draws on data from an ethnographic study examining the practices of DCD in two acute NHS Trusts in England. Interviews with Intensive Care staff and Specialist Nurses in organ donation, observations of organ donation committee meetings and analysis of Trust documents were conducted. Findings reveal that the routinisation of DCD has created new ethical issues relating to interactions between organisational timeframes for DCD and (under)resourcing for, and de-prioritisation of, donation within an NHS subject to austerity. They include: the perceived burden on families and implications for consent when there are delays in the donation process, due to theatre space and retrieval team shortages; family and staff distress when death does not happen ‘on time’; and the problem of where to take patients who do not die in time to donate. I argue these temporal-ethical issues are likely to become heightened as potential donor rates increase with the new opt-out legislation, unless the resourcing required to deal with these problems are also addressed.