Competent Patient Care Research Articles

The Potential of Artificial Intelligence Tools for Reducing Uncertainty in Medicine and Directions for Medical Education.

In the field of medicine, uncertainty is inherent. Physicians are asked to make decisions on a daily basis without complete certainty, whether it is in understanding the patient's problem, performing the physical examination, interpreting the findings of diagnostic tests, or proposing a management plan. The reasons for this uncertainty are widespread, including the lack of knowledge about the patient, individual physician limitations, and the limited predictive power of objective diagnostic tools. This uncertainty poses significant problems in providing competent patient care. Research efforts and teaching are attempts to reduce uncertainty that have now become inherent to medicine. Despite this, uncertainty is rampant. Artificial intelligence (AI) tools, which are being rapidly developed and integrated into practice, may change the way we navigate uncertainty. In their strongest forms, AI tools may have the ability to improve data collection on diseases, patient beliefs, values, and preferences, thereby allowing more time for physician-patient communication. By using methods not previously considered, these tools hold the potential to reduce the uncertainty in medicine, such as those arising due to the lack of clinical information and provider skill and bias. Despite this possibility, there has been considerable resistance to the implementation of AI tools in medical practice. In this viewpoint article, we discuss the impact of AI on medical uncertainty and discuss practical approaches to teaching the use of AI tools in medical schools and residency training programs, including AI ethics, real-world skills, and technological aptitude.

Using a Board Game to Learn a Physical Assessment Course in Nursing Education: A Randomized Controlled Study

Objective: Nursing students are expected to acquire the skills necessary to provide competent patient care in complex healthcare settings. This study aimed to explore the effect of a physical assessment board game on nursing students’ knowledge level and determine their opinions about the game. Methods: A randomized controlled study design was used. The study was conducted from December 2019 to January 2020 among 56 nursing students (game group= 28, control group= 28) enrolled in an undergraduate nursing program in Türkiye. The data were collected using the Kolb’s Learning Styles Inventory to determine students’ learning styles, the Knowledge Evaluation Form for physical assessment, and the Student Opinion Form for students’ opinions about the game. Mean scores for the pre-test and post-tests were compared using independent and paired sample t-tests. Results: A significant difference was found between the pre-test and post-test knowledge scores of the game group (P<.05). The mean post-test knowledge score of the students in the game group was higher than that of the students in the control group, and the difference between the groups was statistically significant (P<.05). Conclusion: The game was beneficial for teaching physical assessment course. Future studies should incorporate different game samples, such as the development of a web-based game, as this study focused on a board game that supported physical assessment skills.

Experiences of Family Medicine Specialists in Providing Health Care for Lesbian, Gay, Bisexual and Transgender Patients: A Qualitative Study in East Coast Peninsular Malaysia

INTRODUCTION: Lesbian, Gay, Bisexual and Transgender (LGBT) patients continue to report discrimination in healthcare setting despite the efforts of the primary healthcare offering community friendly services in Malaysia. This qualitative study aimed to provide understanding of this current issue and to explore the challenges that family medicine specialists (FMSs) from East Coast of Peninsular Malaysia face when dealing with LGBT patients. MATERIALS AND METHODS: 30 FMSs working in East Coast Peninsular Malaysia were interviewed through a phenomenological framework using semi-structured in-depth interviews of LGBT patients. The interviews were recorded in audio format, transcribed verbatim, and subjected to Braun and Clarke’s thematic analysis. We discerned common themes that can be elucidated through the lens of Leininger’s Theory of Culture Care (TCC) and the Sunrise Enabler Model (SEM). RESULTS: Three overlapping themes of the transcriptions were developed; (1) Multidimensional understanding of LGBT described how FMSs saw the LGBT community as diverging from societal norms, yet acknowledge their vulnerability as integral members of the society, (2) obstacles to providing culturally competent care stemmed from inadequate training, an unsupportive clinic environment, and the self-stigma experienced by patients, and (3) barriers to incorporating spiritual needs for holistic care arose in situations where there was insufficient spiritual health training or a preference to concentrate on physical and emotional well-being to uphold trust. CONCLUSION: The findings on this study reflect the need for proper training of healthcare personnel to deliver a holistic, culturally competent care for LGBT patients. A collaborative effort with relevant authorities is also needed to successfully overcome those challenges.

Lesbian, gay, bisexual, transgender, and queer health-related educational experiences in undergraduate medical curricula among Thai medical schools (LEAD-IN)

Purpose In Thailand, Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals face significant health disparities and discrimination in healthcare. A primary cause is the lack of knowledge among doctors and their negative attitudes towards LGBTQ people. The purpose of this study was to explore the current undergraduate medical curricula of medical schools in Thailand concerning learning outcomes, contents, teaching and learning methods, and assessment methods in the field of LGBTQ health. It also sought to gather opinions from principal stakeholders in curriculum development. Methods The authors employed a mixed-methods approach with a convergent design to conduct the research. Quantitative data were collected from 23 deputy deans of educational affairs using a standardized interview form, and qualitative data were obtained through in-depth interviews with key stakeholders including 16 LGBTQ healthcare receivers, 22 medical students, and three medical teachers. Both datasets were analyzed simultaneously to ensure consistency. Results The findings indicate that none of the medical schools had established learning objectives related to LGBTQ healthcare within their curricula. Of the institutions surveyed, 8 out of 15 (53.3%) offered some form of teaching on this topic, aligning with the qualitative data which showed 7 out of 17 institutions (41.2%) provided such education. The most frequently covered topics were gender identity and sexual orientation. Lectures were the predominant teaching method, while multiple-choice questions were the most common assessment format. There was a unanimous agreement among all principal stakeholders on the necessity of integrating LGBTQ healthcare into the M.D. program and the professional standards governed by the Thai Medical Council. Conclusions Although some Thai medical schools have begun to incorporate LGBTQ health into their curricula, the approach does not fully address the actual health issues faced by LGBTQ individuals. Future teaching should emphasize fostering positive attitudes towards LGBTQ people and enhancing communication skills, rather than focusing solely on the cognitive aspects of terminology. Importantly, medical educators should serve as role models in providing competent and compassionate care for LGBTQ patients.

Improving Knowledge and Competency in Gender-Affirming Patient Care Among New Nurses in Sexual and Reproductive Health Care

ObjectiveTo improve knowledge and competency in providing gender-affirming patient care among newly licensed registered nurses (RNs) working in sexual and reproductive health (SRH). DesignPilot, pretest/posttest, descriptive design. Setting and ParticipantsParticipating RNs were employed at a large academic health center in the southeastern United States. All RNs were providing SRH nursing and participating in the health center’s new nurse residency program. Methods and InterventionParticipants completed an online synchronous training that introduced topics such as sex versus gender, gender dysphoria, and health disparities. This education was followed by in-person training, where an unfolding case study applied concepts to theoretical patient scenarios specific to reproductive health. Participants completed a 20-item survey with a single assessment retrospective pre–post design to measure change in knowledge and competency. ResultsTwelve RNs participated in this pilot study. Fewer than half had previously received instruction on providing care to trans∗ persons. Seven self-perceived knowledge and competency areas were evaluated with paired retrospective pre–post design questions. All areas measured showed increases from pretraining to posttraining. Participants also had the opportunity to respond to open-ended questions. Common themes identified in these responses include participants planning to maintain a greater awareness and intentionality with language and abandoning cisgender assumptions. Several participants also described health care–specific systemic barriers that could prevent a trans∗ patient from feeling comfortable. ConclusionProviding new graduate nurses with education specific to trans∗ patients may help them to feel more knowledgeable and competent when caring for these individuals in SRH settings.

Strengthening the Indomitable Spirit of Nurses Through Targeted Resilience Education

AbstractNurses face complex stressors in their work including routine exposure to human suffering and potentially traumatic events. Consequently, nurses are at risk of moral distress, workplace burnout, and compassion fatigue. The aim of this study was to design, develop, and test a health-promoting resilience education program for nurses. The research questions were as follows: (1) Are resilience scores of nurses affected by resilience education? (2) How do nurses understand resilience in the context of their workplace? (3) What role does resilience play in nurses’ mental health? (4) Is single-session targeted resilience education effective in maintaining resilience scores over time? Nurses in this study are moderately resilient as noted by their pre-education scores on the Resilience Scale (RS) and the Resilience at Work (RS@W) Scale. Resilience scores significantly increased immediately after resilience education and were sustained over time. Nurses have an array of health strategies for maintaining their resilience; these were further enhanced through experiential education. Increased resilience scores resulted in changes in nurses’ behavior and thinking, and new strategies were integrated into the nurses’ “toolbox” of cognitive and behavioral skills. Building and sustaining a strong foundation of resilience and well-being is key for nurses to maintain mental health, cope with work-related stressors, and provide safe competent patient care. Study outcomes offer opportunities to change the narrative from nursing as perilous and risky to one of strength, flourish, and growth. Beyond individual resilience, system-level change is required to support the well-being of healthcare personnel.

Transgender Patient Preferences When Discussing Gender in Health Care Settings

Transgender (trans) patients report frequent discriminatory and harmful experiences in health care settings; gender-affirming, competent health care improves trans individuals' health and well-being. To identify factors influencing trans patients' decision-making regarding sharing gender-related information with providers (clinicians, health care organizations, health care systems) and trans patient preferences for gender-related questions, as well as the subsequent impact on health care experiences. A qualitative, interpretivist phenomenological study was conducted via telephone or video (using Zoom) in English and Spanish from August 10 to September 11, 2020. Participants were recruited via trans-specific social media groups and email listservs. Interviews were transcribed verbatim and analyzed from October 2020 to January 2022 using thematic analysis by a majority trans research team. Semistructured interviews explored patient health care experiences and preferences. Participants included 27 trans and/or nonbinary adults (mean [SD] age, 30.9 [10.4] years; range, 21-69 years) from 13 US states. Four themes were identified: (1) impact of provider behaviors, (2) engaging in relational risk assessment, (3) receiving affirming vs medically competent care, and (4) "how are you going to fit [me] into your system?" The first theme reflected the impact of provider actions, including level of flexibility in care and interpersonal interactions, ability to explain medical relevance of gender-related questions, and preparedness to work with trans patients. Second, respondents weighed a variety of implicit or explicit safety cues when deciding whether and how to share information with providers. Third, participants spoke at length about affirming and medically competent care, noting that they have had to prioritize one over the other. Last, participants reported their needs often being at odds with health care system norms and standards of care. In this qualitative study of trans patient preferences when discussing gender-related information with providers, it was found that equitable, gender-affirming, and competent health care requires flexibility and responsiveness to patient preferences. It requires provider humility and engagement, as well as institutional policies that support competent and gender-affirming spaces. Future research could identify additional roles that providers, administrators, and systems can play in ensuring competent care for trans patients.

Enhancing interprofessional education readiness in undergraduate dental students: a scenario-based peer learning programme.

Interprofessional Education (IPE) is an educational approach that brings together students from different healthcare professions to foster collaborative learning and teamwork. Before integrating IPE into the curriculum of health preprofessional students, it is necessary to increase their readiness for IPE. Dentistry increasingly values interprofessional collaboration and teamwork for enhanced patient care and healthcare team competencies, an emphasis also echoed by recent dental education authorities. The aim of this quasi-experimental research was to assess the influence of Scenario Based Learning Peer Learning (SBPL) programme, which involved scenarios necessitating interprofessional communication, on the readiness for IPE among a cohort of undergraduate dental students studying within the framework of the European Higher Education Area (EHEA). This study investigates undergraduate dental students' readiness for IPE and the influence of SBPL programme on their readiness. Participants (n = 25) from 18 EHEA countries completed the Readiness for Interprofessional Learning Scale(RIPLS) before and after SBPL programme, held at the 70th European Dental Students' Association (EDSA)meeting. Data were analyzed using the Wilcoxon Signed Rank Test (p = 0.05). After the SBPT programme, there was a statistically significant increase (p < 0.05) in the mean of the total scale, teamwork and collaboration, roles and responsibilities and professional identity subscale. In general, SBPL programme showed a constructive effect on interprofessional readiness. Although there was no statistically significant increase only in items 9,12,18 of the 19 items of the RIPLS, there was an increase in the averages in all except item 12. Our research emphasizes the importance of diverse perspectives and IPE in the realm of dental education. Within the limits of this study, it showcases the efficacy of a brief half-day SBPL programme with interprofessional scenarios in enhancing participants' readiness. The programme notably enhanced dental students' readiness in grasping crucial aspects of IPE: teamwork and collaboration, professional identity, and roles and responsibilities. However, this study does not delve into the potential impact of a comprehensive, long-term curriculum integrating IPE principles. This gap underscores the need for further exploration into the sustained influence of IPE on the interprofessional skills of dental school graduates.

Optimizing care for patients with infectious diseases: Roles of emergency medical services and nursing

Background: Internal medicine (IM) and its subspecialties have seen a shift in care delivery, increasingly relying on nonphysician practitioners (NPPs) such as nurse practitioners (NPs) and physician assistants (PAs). This article focuses on the development of a curriculum and competency framework for advanced care practitioners (ACPs) specializing in infectious diseases (ID). Aim: To establish a comprehensive competency-based education (CBE) model for NPs and PAs in ID, aiming to enhance their skills and optimize patient care. Methods: The framework incorporates six core competencies endorsed by various regulatory and professional organizations. An interprofessional approach was utilized to develop a curriculum that addresses the educational needs of ACPs in ID practice, along with assessing Entrustable Professional Activities (EPAs). Results: The proposed guidelines outline specific clinical responsibilities and milestones for ACPs over a one-year training period. This structured approach ensures that ACPs develop competencies in patient care, medical knowledge, interpersonal skills, professionalism, and systems-based practice, allowing them to effectively manage common and complex infectious diseases. Conclusion: The integration of ACPs into infectious disease practice is vital for enhancing patient care and alleviating resident workload.

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

IntroductionThe field of neurosurgery faces challenges with the increasing involvement of other medical specialties in areas traditionally led by neurosurgeons. This paper examines the implications of this development for neurosurgical practice and patient care, with a focus on specialized areas like pain management, peripheral nerve surgery, and stereotactic radiosurgery. Research questionTo assess the implications of the expanded scope of other specialties for neurosurgical practice and to consider the response of the EANS Frontiers in Neurosurgery Committee to these challenges. Materials and methodsAnalysis of recent trends in neurosurgery, including the shift in various procedures to other specialties, demographic challenges, and the emergence of minimally invasive techniques. This analysis draws on relevant literature and the initiatives of the Frontiers in Neurosurgery Committee. ResultsWe explore a possible decrease in neurosurgical involvement in certain areas, which may have implications for patient care and access to specialized neurosurgical interventions. The Frontiers in Neurosurgery Committee's role in addressing these concerns is highlighted, particularly in terms of training, education, research, and networking for neurosurgeons, especially those early in their careers. Discussion and conclusionThe potential decrease in neurosurgical involvement in certain specialties warrants attention. This paper emphasizes the importance of carefully considered responses by neurosurgical societies, such as the EANS, to ensure neurosurgeons continue to play a vital role in managing neurological diseases. Emphasis on ongoing education, integration of minimally invasive techniques, and multidisciplinary collaboration is essential for maintaining the field's competence and quality in patient care.

Investigating the Integration of Anatomical Variabilities into Medical Education as a Potential Strategy for Mitigating Surgical Errors

Introduction: Surgical errors burden health-care systems globally, with anatomical variations being a significant contributor. This review examined the role of these variations and offers valuable insights for medical practitioners, educators, and policymakers to develop strategies to address and mitigate challenges posed by these variations. Materials and Methods: They keywords were generated from the title and online databases were searched with the help of a search string of keywords and Boolean operators. Results: A total of 13 articles were included in the present review. Thematic data analysis identified seven key themes highlighting the significance of anatomical variations in medical education. These include incorporating variations, determining optimal introduction and contact levels, identifying significant variations, teaching methods, visualization techniques, and challenges in integrating them. This systematic review has shown that earlier literature underscores the importance of anatomical variations in the context of medical education. However, there is evidence that students and trainees lack the necessary skills to effectively understand the concepts of anatomical variability and their application in the clinical setting. The final theme discusses potential solutions to enhance students’ understanding of human anatomy. Conclusion: Medical education aims to produce qualified physicians who provide competent and safe patient care. However, students and trainees often lack the skills to understand anatomical variations, leading to misdiagnoses and health-care malpractice. Active medical education professionals should ensure familiarization with anatomical variations to clear misconceptions about the human body, provide valuable knowledge about patient uniqueness, and spark interest in physicians.

Addressing quality medication use among migrant patients: Establishment of an organization to provide culturally competent medication care

As the global landscape continues to witness an increase in migration, the healthcare community faces an evolving challenge: the provision of quality medication care to migrant patients. Language barriers, cultural differences, and a lack of understanding of the local healthcare system can often impede the effective management of medications and access to healthcare services among migrant populations. Pharmacists, as medication experts, are dignified to make a substantial impact in bridging the gap between migrants and quality healthcare. Their expertise in medication management, accessibility, and counseling positions them as critical healthcare providers for this patient population. Pharmacies and pharmacists can serve as trusted hubs where migrants receive not only essential medications but also culturally sensitive support in navigating the healthcare system. This commentary article highlights the critical importance of culturally competent medication care for migrant patients and the central role that pharmacists can play in this endeavor. By establishing organization dedicated to this cause lead by pharmacists, we can not only address an urgent healthcare concern but also set a precedent for a healthcare system that values inclusivity, cultural competence, and equitable access to quality medication care for all, regardless of their cultural background.

Eye on the Prize: Patient Outcomes Research in Medical Education.

The overarching goal of medical education is to train clinicians who achieve and maintain competence in patient care. Although the field of medical education research has acknowledged the importance of education on clinical practices and outcomes, most research endeavors continue to focus on learner-centered outcomes, such as knowledge and attitudes. The absence of clinical and patient-centered outcomes in pulmonary and critical care medicine medical education research has been attributed to barriers at multiple levels, including financial, methodological, and practical considerations. This Perspective explores clinical outcomes relevant to pulmonary and critical care medicine educational research and offers strategies and solutions that educators can use to accomplish what many consider the "prize" of medical education research: an understanding of how our educational initiatives impact the health of patients.

The impact of tutoring on nursing students' clinical judgment: A quasi-experimental study.

Nurses' lack of clinical judgment often leads to adverse patient outcomes due to failure to recognize clinical deterioration, intervene, and manage complications. Teaching clinical judgment through a nursing process can help nursing students provide safe and competent patient care with improved health outcomes and to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The aim of this study was to examine the effect of tutoring on clinical judgment of undergraduate nursing students utilizing Lasater's Clinical Judgment Rubric (LCJR). This study also compared the clinical judgment of male and female nursing students and students from different semester levels. This quasi-experimental study utilized a single group pretest, posttest design. A convenience sample of n = 40 undergraduate nursing students from the Los Angeles County College of Nursing and Allied Health participated in the study. The participants underwent a pretest simulation, four sessions of the Clinical Judgment Model (CJM)-based tutoring, and a posttest simulation. The posttest clinical judgment scores (35.70 ± 3.6) were significantly different from the pretest scores (25.78 ± 5.20). The tutoring had a significant effect on the clinical judgment of nursing students t(39) = -11.64, n = 40, p < .001, at 95% CI of the mean difference. Enhancing nursing students' clinical judgment is crucial to provide high-quality, safe patient care with improved health outcomes. The CJM-based tutoring is an effective strategy for developing clinical judgment in nursing students. This new teaching approach can train students to critically think, develop clinical judgment, and prepare for the complex healthcare environment. Therefore, nurse educators should focus on integrating clinical judgment into the prelicensure nursing program curriculum as a priority.

When Feedback is Not Perceived as Feedback: Challenges for Regulatory Body-Mandated Peer Review.

Safe and competent patient care depends on physicians recognizing and correcting performance deficiencies. Generating effective insight depends on feedback from credible sources. Unfortunately, physicians often have limited access to meaningful guidance. To facilitate quality improvement, many regulatory authorities have designed peer-facilitated practice enhancement programs. Their mandate to ensure practice quality, however, can create tension between formative intentions and risk (perceived or otherwise) of summative repercussions. This study explored how physicians engage with feedback when required to undergo review. Between October 2018 and May 2020, 30 physicians representing various specialties and career stages were interviewed about their experiences with peer review in the context of regulatory body-mandated programs. Twenty had been reviewees and reviewers and, hence, spoke from both vantage points. Interview transcripts were analyzed using a 3-stage coding process informed by constructivist grounded theory. Perceptions about the learning value of mandated peer review were mixed. Most saw value but felt anxiety about being selected due to being wary of regulatory bodies. Recognizing barriers such perceptions could create, reviewers described techniques for optimizing the value of interactions with reviewees. Their strategies aligned well with the R2C2 feedback and coaching model with which they had been trained but did not always overcome reviewees' concerns. Reasons included that most feedback was "validating," aimed at "tweaks" rather than substantial change. This study establishes an intriguing and challenging paradox: feedback appears often to not be recognized as feedback when it poses no threat, yet feedback that carries such threat is known to be suboptimal for inducing performance improvement. In efforts to reconcile that tension, the authors suggest that peer review for individuals with a high likelihood of strong performance may be more effective if expectations are managed through feedforward rather than feedback.

Enhancing cultural competence in caring for lesbian, gay, bisexual, and transgender patients: An online training program for Taiwanese student nurses and nurses

BackgroundHealth disparities exist among lesbian, gay, bisexual, and transgender (LGBT) populations worldwide. However, student nurses and nurse staff have limited knowledge and skills in providing culturally competent nursing care for LGBT patients in Taiwan. ObjectivesThis paper describes the development, implementation, and evaluation of an online training program for the cultural competence of student nurses and nurses in Taiwan. DesignA one-group pre-/post-test study design. SettingsThe study was conducted in five nursing schools, 10 nursing associations, and 37 long-term care facilities. Two prominent online bulletin boards (PTT Nurse and Dcard Nurse) and one Taiwanese nursing group on Facebook were used to recruit participants. ParticipantsIn total, 301 student nurses and nurses participated in the study and responded to pre- and post-test questionnaires. MethodsAn online training program for culturally competent nursing care was developed and implemented. The pre- and post-test questionnaires contained three sections: (1) demographics, (2) knowledge of LGBT health, and (3) the Sexual Orientation Counselor Competency Scale. Three open-ended questions were included in the post-test questionnaire to evaluate the online training program. ResultsThe online training program significantly improved the participants' knowledge and cultural competence skills. However, their attitudes towards cultural competence did not change after the program was implemented. Regarding qualitative feedback of the online training program, feedback on the strengths and limitations of the program was summarized under three themes: program content, website design, and online modules. ConclusionsThe results suggest the importance of an online training program which may contribute to reducing health disparities among the LGBT population.

Caring for nonbinary patients

Nonbinary is an umbrella term that encompasses any person whose gender identity is outside the binary construct of man or woman . An estimated 1.2 million people in the United States identify as nonbinary, a number that most likely will continue to increase as the visibility of people who live outside binary gender increases in our society. Healthcare providers are likely to encounter nonbinary patients but may lack confidence in treating these patients appropriately. This article describes terminology, concepts, and suggestions for clinicians to provide basic respectful and competent care for nonbinary patients.

What are the Trends in Racial Diversity Among Orthopaedic Applicants, Residents, and Faculty?

What are the Trends in Racial Diversity Among Orthopaedic Applicants, Residents, and Faculty?

Ohio community pharmacists’ provision of inclusive care for transgender and gender-diverse patients

BackgroundCommunity pharmacists have potential challenges to overcome to care for transgender and gender-diverse patients properly. The American Pharmacists Association and Human Rights Campaign released a resource guide in March 2021 with best practices for gender-affirming care, yet there are no reports of community pharmacists’ awareness or implementation of the guide. ObjectivesThis study’s primary objective was to assess community pharmacists’ awareness of the guide. Secondary objectives were to determine whether their current practices align with the guide’s recommendations and whether they are interested to learn more information. MethodsAn anonymous, institutional review board-approved survey developed from the guide’s framework was e-mailed to 700 randomly selected Ohio community pharmacists. As an incentive, respondents could select a charitable organization to receive a donation. ResultsOf the 688 pharmacists receiving the survey, 83 completed it (12%). Only 10% were aware of the guide. A range in self-reported ability to define key terms was found, from 95% for “transgender” to 14% for “intersectionality.” Among the guide’s suggested practices, collection of preferred names (61%) and consideration of transgender, gender-diverse, or nonheterosexual patients in their staff training (54%) were most often reported. Fewer than 50% reported pharmacy software with key gender-related data management capabilities. Most respondents indicated an interest in learning more about components of the guide, but gaps remained. ConclusionThere is a need to raise awareness of the guide and to provide foundational knowledge, skills, and tools to ensure culturally competent care for transgender and gender-diverse patients and improve health equity.

Registered nurses’ experience of care for adult patients with a temporary tracheostomy at general hospital wards. A phenomenological-hermeneutic explorative study

BackgroundCaring for adult patients with a temporary tracheostomy in general wards can be challenging and complex. Little research has explored registered nurses’ experiences with caring for these groups of patients. ObjectivesThis study sought to interpret and describe registered nurses’ lived experiences of caring for adult patients with a tracheostomy in general wards. Research design/methodologySix registered nurses were interviewed in this study. The interviews were analysed to gain comprehensive knowledge about caring for adult patients with a temporary tracheostomy. The interviews were transcribed, analysed, and interpreted by using Gadameŕs philosophical hermeneutics and Kvale and Brinkmann’s three steps of understanding. SettingThree different wards medical, surgical, and neurological of a teaching hospital in Norway. FindingsThree themes emerged from data analysis. These included experiencing clinically challenging patients, a lack of clinical support from the intensive care nurses, and a lack of professional confidence. ConclusionThis study highlighted the challenges surrounding the care of an adult patient with a tracheostomy in the general wards. Identifying these challenges would lead to further improvement in registered nurses’ experiences and, in turn, in the quality of competent care for adult patients with a tracheostomy in the general ward. Implications for Clinical PracticeUnderstanding the registered nurses’ experiences will assist the head nurses in planning and providing relevant information and education to provide safe and holistic patient care. Adequate support from intensive care unit nurses and professional development are required to ensure high-quality care. This study recommends that healthcare managers focus on establishing step-down units to improve patient outcomes, especially for high-risk patients and to increase the competencies of registered nurses in caring for adult patients with a tracheostomy as a whole person.