Clinical Nurses Research Articles

Clinical gerontological nursing competence among licensed practical nurses in healthcare services—A descriptive cross‐sectional study

AbstractAimThis study aimed to describe self‐assessed clinical gerontological nursing competence and its associated factors among licensed practical nurses.DesignA descriptive cross‐sectional design was adopted for the study.MethodsData were collected in Autumn 2023 from 394 licensed practical nurses working in healthcare services for older people in one well‐being services county in Finland. The nurses, recruited through convenience sampling, were surveyed using a 40‐item self‐assessment clinical gerontological nursing competence instrument (on a Likert scale from 1 = poor to 5 = excellent). Descriptive statistical methods were used to analyse the results.ResultsParticipants mainly assessed their clinical gerontological competence as good. Competence in using assistive devices to support functional ability was assessed as very good, while competence in postoperative wound care was assessed as the weakest. Participants working in 24‐h services assessed their competence as the weakest among the three clinical gerontological nursing areas. Participants under 40 years of age with 5–10 years of work experience self‐assessed statistically significantly stronger competence in disease‐specific nursing than those over 40 with less work experience.ConclusionThe self‐assessed competence of licensed practical nurses varies across different service and care units. Competence in wound care requires more focus and education in the future. Attention should also be paid to competence development in different educational areas, for example, through continuous education and competence development models. The results could facilitate licensed practical nurses' competence development and management in clinical gerontological nursing. The study's insights can also guide allocating resources and education to ensure high‐quality care in different service areas.

The impact of psychological violence in the workplace on turnover intention of clinical nurses: the mediating role of job satisfaction

The impact of psychological violence in the workplace on turnover intention of clinical nurses: the mediating role of job satisfaction

Effect of an online training intervention on evidence-based practice in clinical nurses. #Evidencer Project.

Online learning is becoming increasingly essential for health professionals, and it is necessary to understand how this modality affects clinical nurses' learning of Evidence-Based Practice (EBP). For this reason, the present study sought to assess the effectiveness of an online training program in improving nurses' EBP competence. A quasi-experimental study with a pretest-posttest design was conducted with a control group and without randomization for a period of 6months. The intervention was an online self-learning course based on Melnyk's seven steps of Evidence-Based Practice (EBP). The course was structured into sequential modules requiring 72h of work, with task completions and tests necessary for progression. Participants had three months to complete the course. EBP competence was measured with the EBP-COQ Prof© questionnaire. Data analysis included percentages, means, standard deviations, chi-square tests, student's t-tests, and a two-way repeated measuresanalysis of covariance (ANCOVA). The analysis of the changes observed in each dimension and the overall EBP competence between the intervention group (IG) and the control group (CG) showed a significant group*time interaction in three of the four dimensions of the questionnaire. The results indicated that the online Evidence-Based Practice (EBP) course significantly improved knowledge, skills, and utilization three months after its completion. In the IG, the mean score was 44.04 (standard deviation (SD) = 7), compared to 37.83 (SD = 8.5) in the CG (p < 0.001). Regarding skills, the IG had a mean score of 24.24 (SD = 3.8), while the CG scored 23.01 (SD = 3.1) (p = 0.008). For utilization, the mean score in the IG was 36.77 (SD = 6.8), and the CG was 33.12 (SD = 6.3) (p = 0.005). Overall competence also showed a statistically significant difference, with the IG achieving a mean score of 141.22 (SD = 20.0) compared to the CG with a mean score of 130.34 (SD = 16.7) (p < 0.001). Training through an online education platform for three months (72h) is an effective tool for improving the competence in Evidence-Based Practice (EBP) of clinical nurses. A significant increase was observed in knowledge and moderate improvements in skills and the application of EBP. These online courses, adapted to the needs of professionals, can be an efficient way to prepare nurses and improve their application of EBP in a clinical setting.

Dance for Wellness: Indigenous adolescents’ Perspectives on Mental Health, Wellness, and Dance

ABSTRACT Purpose Indigenous adolescents living on reservations in Canada experience mental health disparities, and there is an urgent need to address this as mental illness and suicide increase. Therefore, a dance program was initiated to attempt to improve mental health and wellness for Indigenous adolescents The reaearch purpose was to gain insight into theexperiences of mental health and wellness in Indigenous adolescents and identify if and how a four-week dance program affected their mental health and wellness. Design A trauma-informed, qualitative, single-case study design was used. Method Semi-structured interviews and symbol-based data were used to interview eight adolescents aged 11 – 16 years living in a Denesuliné community from February to June 2022. Findings Three multidimensional themes emerged: It Helped My Mental Health and Everything (Dance Helps Me Escape, Dance Makes Me Feel Good, and Dance Is Just Really Fun); A Little Bubble Around Me When I Dance (I Can Be More Confident and I Can Be Myself), and We Won’t Judge You Here (Creation of Friendship, He Said I Was Really Good, and Improved School Attendance). Conclusions The dance program impacted the participants’ mental health and wellness by providing positive activities to engage the adolescents. Clinical Evidence Community health nurses (CHNs) assist in promoting health and wellness in Indigenous adolescents living on reservation and can use these findings to advocate for funding for the development of dance-based mental health and wellness programs.

BS SO10 - Predictive Factors in the Development of Dumping Syndrome After Bariatric Surgery

Abstract Background Dumping syndrome (DS) is a recognised complication of Roux En-Y Gastric Bypass (RYGB) and rarely Sleeve Gastrectomy (SG). The prevalence of DS is unclear, with current literature ranging from 10-50%. The condition is characterised by gastrointestinal and vasomotor symptoms resulting in a significant impact on quality of life. This study aimed to prospectively utilise Sigstad scoring to evaluate post-operative patients, investigating the timing of symptom onset and its correlation with pre-existing diabetes, revision surgery, and percentage of Total Body Weight Loss (TBWL). Method We used the Sigstad scoring questionnaire, administered by our bariatric Clinical Nurse Specialists (CNS) at outpatient clinics to assess patients for DS between January to May 2024. Data collected included patient demographics, surgery type and date, TBWL, Body Mass Index (BMI), and whether the patient had a diagnosis of Diabetes Mellitus type II (DMII). A diagnosis of DS was confirmed if a patients score ³7 points on the Sigstad questionnaire. We explored factors influencing the development of DS. Results In total, 64 patients were evaluated for DS of whom 86% were female and the median age was 44 years (IQR: 35-45). Most patients (67%) had undergone primary RYGB, 19% SG, 11% conversion from SG to RYGB and 70% were assessed within one year of surgery. DS symptoms emerged in 25% of patients, predominantly within the first-year post-operation (60%). The median TBWL was 12% (IQR: 9-22%), showing no correlation to DS onset. Patients with DMII exhibited a higher propensity for DS (66% vs 20%, p=0.029). Patients undergoing revisional surgery also had a higher incidence of DS (33% vs 6%, p=0.117). Conclusion A quarter of patients undergoing bariatric surgery will develop DS, most of whom within the first-year post-surgery. Revisional surgery and pre-existing DMII are the primary predictors in developing DS. There was no observed association between TBWL and DS onset. Further extensive studies are needed to confirm these observations.

Developing a quality indicator system for evaluating internet plus home care nursing services based on the SERVQUAL model: a Delphi-analytic hierarchy process study

Background In the context of global population aging and the rapid development of information technology, the demand for Internet Plus Home Care Nursing (Internet+ HCN) services have been on the rise, especially in China. Internet+ HCN services have the potential to maximize existing human resources to counter the shortage of medical healthcare services. However, at present, Internet+ HCN services are difficult to scale due to the lack of standardized service quality governance. Quality indicators for service evaluation of Internet+ HCN services are under-defined. Objective To develop a quality indicator system for evaluating Internet+ HCN services, and to shed theoretical light on assessing mHealth service quality from a user experience perspective. Methods An initial quality indicator system was established based on scenarios related to Internet+ HCN services. The Delphi Method was applied to modify the indicators according to experts’ opinions, and the analytic hierarchy process (AHP) was applied to calculate the indicator weight. Finally, a quality indicator system for evaluating Internet+ HCN services was developed based on the SERVQUAL model. Results Altogether, 17 experts from relevant fields such as nursing education, clinical nursing, health management, and health informatics were consulted through email surveys. The response rates in both rounds of Delphi and the AHP were 100%. The average expert authority coefficients were 0.912 and 0.925 respectively in the two rounds of Delphi. Kendall’s W, indicating variation coefficients, ranged from 0.262 to 0.265. Finally, a quality indicator system for evaluating Internet+ HCN services, comprising five primary indicators and 15 secondary indicators, was developed. Primary indicators and their AHP generated the following weights: assurance (0.245), reliability (0.240), tangibles (0.192), responsiveness (0.190), and empathy (0.132). Conclusions By measuring the services quality gap between user expectations and perceptions, the proposed SERVQUAL model-based quality indicator system shows potential in improving the quality of Internet+ HCN services through the perspective of user experiences.

Growth Overcoming Obstacles as a Clinical Nurse Educator: A Qualitative Study.

Clinical nurse educators (CNEs), responsible for nursing education, have begun to address unresolved issues in nursing education overlooked by preceptorship. However, research on this topic is lacking in South Korea, despite the government's 2019 launch of the CNE support project. This study explored the role experience of CNE in South Korea, focusing on their role challenges and the process of overcoming them. Fifteen CNEs from tertiary or secondary general hospitals in South Korea participated in semi-structured, in-depth interviews conducted between August and December 2023. Interviews were recorded and transcribed for conventional content analysis. Four categories emerged: challenges in the role of CNE, personal strategies for growth as a CNE, external support systems for growth as a CNE, and role evolution and emerging challenges for CNEs. This study demonstrates previously unexplored CNE role experiences in South Korea and provides valuable recommendations for enhancing CNE support projects.

Development and validation of a nomogram for circuit lifespan of regional citrate anticoagulation-continuous renal replacement therapy in intensive care patients with acute kidney injury.

Regional citrate anticoagulation-continuous renal replacement therapy (RCA-CRRT) has a wide range of applications in clinical practice, but unplanned downtime due to RCA-CRRT circuit coagulation is as high as 15.75%-66.70%. To build a nomogram model for predicting the lifespan circuits of RCA-CRRT. A prospective observational cohort study was conducted in Sichuan, China. The collected clinical data from 404 RCA-CRRT sessions involving 135 patients were utilized. The patients' basic information, laboratory indicators and RCA-CRRT parameters were used as independent variables, and the survival status and survival time of RCA-CRRT circuits were used as dependent variables. A Cox multivariate analysis was performed to build the nomogram model for predicting the lifespan of RCA-CRRT circuits. The model was validated internally and externally. The median lifespan of RCA-CRRT circuits was 28.0 (12.0-46.5) h, and the unplanned downtime rate was 23.76%. In the Cox multivariate analysis, venous pressure, haemoglobin, Sequential Organ Failure Assessment (SOFA), lactate, and blood transfusion were identified as statistically significant predictive factors for the lifespan of RCA-CRRT circuits (p < .05). Subsequently, a nomogram model for predicting the lifespan of RCA-CRRT circuits was developed. The AUC values for internal and external validation within the 12-72-h timeframe ranged from 0.648 to 0.816 and 0.613 to 0.956, respectively. Both the calibration curve and clinical decision curve demonstrated the model's good performance. The nomogram model developed in this study demonstrates its efficacy in accurately predicting the lifespan circuits of RCA-CRRT. Clinical nurses can use the prediction model to assess the lifespan of RCA-CRRT circuits, so as to formulate a personalized RCA-CRRT treatment plan for patients, thus reducing the unplanned downtime of RCA-CRRT.

Effects of Work Engagement and Barriers on Evidence-Based Practice Implementation for Clinical Nurses: A Cross-Sectional Study

Effects of Work Engagement and Barriers on Evidence-Based Practice Implementation for Clinical Nurses: A Cross-Sectional Study

Adoption of quick response codes as a digital microlearning tool among clinical nurses: a quasi-experimental study.

The rapid growth of technology forced enormous changes in the provision of healthcare services. Different strategies are used to keep nurses up to date with rapid changes in health systems. Microlearning is one of the new methods of teaching professional skills to health workers. This method is effective in care settings that have many limitations in terms of time and place. However, it is very important to test the acceptability of this method among nurses before practical measures are taken for its widespread use. This study aimed to determine nurses' acceptance rate of quick response code as a microlearning tool in workplace. This is a cross-sectional study was conducted in medical and surgical wards in hospitals affiliated to Guilan University of Medical Sciences. 185 nurses participated in the study. A number of selected medical devices were labeled with quick response codes containing educational content. The eligible nurses were instructed how to use the QR codes. After two months, they were asked to complete a questionnaire adapted from the technology acceptance model 3. SPSS 21 software was used to analyze the data. 166 nurses and 19 head nurses with mean age of 34.26 ± 8.17 years and mean work experience of 10.46 ± 7.64 years completed the questionnaires. Most participants were female, married, with a bachelor's degree, worked on rotating shifts, in medical wards. The findings showed that the acceptance of the quick response code as a learning tool was at a moderate level (M = 66.1, SD = 16.6). Statistically, there was no significant relationship between nurses' demographic characteristics and the total acceptance rate (P > 0.05). However, the analyses at the multivariate level, using multiple linear regression, showed a significant superiority of the total acceptance score in head nurses compared to nurses (b = 7.97, P = 0.047) and in nurses who had previous experience of using quick response codes, compared to colleagues without such experience (b = 5.18, P = 0.036). Based on the coefficient of determination, only 6.1% of the changes in the total acceptance score of quick response codes of nurses are explained by their personal-occupational characteristics (R2 = 0.061). The provision of QR code requirements such as necessary infrastructure and training by the health authorities could increase the acceptance of this tool as a microlearning measure.

"I'm quite proud of how we've handled it": health professionals' experiences of returning additional findings from the 100,000 genomes project.

Participants in the 100,000 Genomes Project (100kGP) could consent to receive additional finding (AF) results, individual variants relating to genes associated with susceptibility to cancer and familial hypercholesterolemia (FH). In the study reported here, qualitative interviews were used to explore the experiences of National Health Service (NHS) professionals from across England who were tasked with returning over 80,000 "no AF" results and 700 positive AF results to 100kGP participants. Interviews were conducted with 45 professionals from a range of backgrounds, including Genetic Counsellors, Clinical Geneticists, FH Clinical Nurse Specialists and Clinical Scientists. Interviews were analysed using a codebook thematic analysis approach. Returning AF results has been a significant endeavour, with challenges for pathways, administrative processes and clinical and laboratory time when the capacity of NHS services is already stretched. Professionals discussed going "above and beyond" to prioritise patient care through pathway design, additional clinics, overtime, longer appointments and provision of follow-up appointments. Professionals also described facing practical and emotional challenges when returning AFs. Benefits for patients from receiving AFs in the 100kGP were highlighted and professionals were generally positive about offering clinically actionable AFs within routine NHS clinical care. Professionals were, however, cautious around the implementation of AFs into routine care and felt more research and discussion was needed to determine which AFs to offer, approaches to consent and communication of results, costs and the potential strain on NHS capacity and resources. Further consultation is required with careful review of pathways and resources before offering AFs in clinical practice.

Interdisciplinary cooperation with solution-focused brief therapy to reduce job stress, burnout, and coping in Chinese nurses: A randomised controlled trial

BackgroundIncreased job stress and burnout are common among clinical nurses in China, reducing their work efficiency and nursing quality. Multiple studies have been conducted on brief interventions to reduce job stress and burnout among nurses. However, research has been hampered by a lack of psychological knowledge among nursing staff. AimTo assess a short-term intervention designed to improve nurses' coping strategies and to mitigate job stress and burnout through interdisciplinary cooperation DesignThis randomised controlled trial Settingsand participants: We randomly allocated 60 nurses working at a tertiary general hospital in a city in China to an experimental (n = 30) or a control group (n = 30). MethodsA collaborative research team comprising psychology and nursing specialists was established to conduct this study. The control group received routine psychological intervention, whereas the intervention group received a short-term interdisciplinary treatment approach that focused on cooperation. Chinese nurses’ job stressors, job burnout, and simplified coping style scales were used to evaluate both groups before and after the intervention. ResultsA comparison of the scores for job burnout, total job stress, and positive coping before and after the interventions revealed significant improvements in the test group, whereas the scores for emotional exhaustion, depersonalisation, and total work stress in the control group demonstrated statistically significant differences. No significant differences were observed in the scores for negative coping, personal achievement, and simple coping style between the test and control groups before and after the intervention. ConclusionsSolution-focused brief therapy implemented through interdisciplinary collaboration effectively enhances clinical nurses' active coping style, alleviates job stress and burnout, and offers valuable guidance for nursing management practices.

Elements Supporting Translation of Evidence Into Practice: A Model for Clinical Nurse Specialist and Nurse Scientist Collaboration.

To present evidence-based elements supporting the synergistic relationship between nurse scientists and clinical nurse specialists to improve the translation of evidence into practice. Using best-practice elements to support the improvement of evidence-based translation, we define the roles and synergies between nurse scientists and clinical nurse specialists within clinical environments. Five themes were identified in the literature review:● Although clinical nurse specialists and nurse scientists differ in focus and competencies, they are in key positions to collaborate to meet healthcare demands.● Clinical nurse specialists are well-equipped to implement the science developed by nurse scientists.● To meet the increased demands and complexity of the healthcare system and patient needs, organizational leadership must lend support to clinical nurse specialists and nurse scientist collaboration.● Clinical nurse specialists are well-positioned to foster interprofessional partnerships and generate opportunities for evidence-based project initiatives across healthcare disciplines.● Clinical nurse specialists should utilize professional models to inform practice to improve the review, translation, and implementation of research into practice. Projects conducted using a collaborative structure had a system-level impact and long-term sustainability capabilities. Additionally, projects were more likely to be disseminated by clinical nurse specialists within a formal structure.

Exploring nurse educators' preparation of clinical nurses and midwives for research utilization in practice: A qualitative study

Exploring nurse educators' preparation of clinical nurses and midwives for research utilization in practice: A qualitative study

Implementing a Trauma-Informed Approach in Undergraduate Nursing Student Clinical Education: Strategies for Clinical Nurse Educators

AimTo discuss strategies for clinical nurse educators to integrate a trauma-informed approach while supporting undergraduate nursing students’ learning in the clinical environment. BackgroundUndergraduate nursing students’ risk of exposure to clinical related critical incidents coupled with their higher rates of personal traumas such as adverse childhood experiences, adds to the complexity of experiential learning. Clinical related critical incidents may compromise nursing students’ academic abilities and their well-being. The implications of clinical related critical incidents may extend to future nurse retention and recruitment as students question the perception of the profession’s identity. The cumulative effect from trauma may impact nursing students’ mental health making them vulnerable to trauma-related symptoms and disorders. DesignA discussion paper is used to support the application of a trauma-informed approach throughout clinical learning experiences. MethodWith relevant literature, a trauma-informed approach is emphasized for developing and maintaining safe environments that foster learning and optimize the health and well-being of nursing students. ResultsThe key assumptions and principles of a trauma-informed approach as outlined by the Substance Abuse and Mental Health Services Administration underpinned the proposed strategies that clinical nurse educators may use while preparing for clinical, during and after experiences. ConclusionA trauma-informed approach may encourage undergraduate nursing students to adopt key tenets into their future clinical practices so they can effectively support patients, families and their colleagues.

Out of the Hospital, Out of the Box: Utilizing the CNS Role in Home Healthcare Settings.

The United States has poorer population health outcomes compared to similar developed nations despite higher healthcare spending. Multiple factors contribute to this problem, including high healthcare costs, insurance coverage limitations, and a lack of focus on preventive care and wellness. Clinical Nurse Specialists (CNSs), primarily known for their impact in acute care settings, increasingly demonstrate their value in outpatient settings like home healthcare. CNSs possess graduate-level training, equipping them with the skills and expertise to develop and implement strategies that improve population health outcomes in home health settings. CNSs provide clinical leadership and support to staff while remaining at the forefront of ensuring the organization delivers high-quality patient care. Understanding the specific skills and competencies of the CNS to support the patient, family, staff, and organization is necessary to improve outcomes for patients in outpatient settings. The CNS delivers care through direct patient care, supporting nurses and nursing practice, and improving organizational systems. This unique skill set allows CNSs to influence home healthcare outcomes across various levels of care positively. This article sheds light on how CNSs enhance patient outcomes in outpatient settings like home healthcare.

Mediating effect of Felt obligation between Inclusive leadership and Caring behavior of Chinese nurses

PurposeIt aims to validate the mediating role of felt obligation between inclusive leadership and the caring behavior of clinical nurses using a structural equation model. MethodsAll of the nurses were investigated with the general Information Questionnaire, Caring Behavior Scale, Felt Obligation Scale and Inclusive Leadership Questionnaire. AMOS 21.0 was used to construct the structural equation model and analyze the mediating effect of felt obligation, and Bootstrap method was used to test the mediating effect model. ResultsThe total scores of caring behavior, felt obligation and inclusive leadership were 125.25±18.31,21.38±3.36 and 38.04±6.56 respectively. Felt obligation played a partial mediating role in the relationship between inclusive leadership and caring behavior of nurses, and the mediating effect accounted for 43.5%. ConclusionsFelt obligation plays a partial mediating effect between inclusive leadership and caring behavior of nurses. Nursing managers can adopt the leadership concept of inclusive leadership to enhance the level of felt obligation of nurses, so as to better improve the caring behavior of nurses.

Addressing US Military Transgender Care Inequalities: Clinical Nurse Specialist Bridging Healthcare Gaps.

There are more than 130 000 US veterans and more than 12 500 active-duty service members who identify as transgender. Lack of training in transgender and gender-affirming care among healthcare providers in the military is still reported. The article aims to explore and advocate for the unique role of advanced practice registered nurses, especially clinical nurse specialists, in providing culturally sensitive and evidence-based care to the transgender population within the US military. The clinical nurse specialists' pivotal role in policy advocacy and translation of evidence to improve the quality of care and patient outcomes for transgender service members is highlighted. The article also explores the historical journey of transgender care in the US military, addressing discriminatory policies and the implications of the ever-evolving regulations in military transgender healthcare. The article aims to create awareness of clinical nurse specialist utilization in US military healthcare services to improve the care of transgender individuals in the military. The uncertain future for transgender service members highlights the ongoing commitment needed to navigate complex military healthcare policies and foster inclusive, evidence-based practices. Therefore, the clinical nurse specialist plays a pivotal role in shaping the future of transgender healthcare within the US military.

Describing Clinical Nurse Specialist Practice: A Mixed-Methods Study.

To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes. Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022). Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool. Phase 2: Time and motion studies (n = 25; 203 hours 5 minutes) described clinical nurse specialist practice. Phase 3: A rapid literature review and study participants' feedback informed the dashboard's development. Analysis: Descriptive statistics, with content analysis for qualitative data. The proportion of time clinical nurse specialists spent in role dimensions included clinical (22.8%), education (11.2%), administrative/leadership (48.6%), research (9.6%), and personal (7.7%). On average, they spent 17% of work time with patients, but this varied across specialties and locations. Key dashboard characteristics and uses were identified. Important differences were noted in clinical nurse specialist time spent in activities across specialties and regions in Québec. Approximately one-fifth of work time was spent in direct patient care. Additional research is needed to examine the link between clinical nurse specialist practice and outcomes in other jurisdictions and test the implementation of a dashboard to make their practice more visible.

Piloting an Innovative Collaboration Between a Clinical Nurse Specialist Program and a Professional Organization.

Piloting an Innovative Collaboration Between a Clinical Nurse Specialist Program and a Professional Organization.