Nursing Assistants Research Articles

Alerta Cannabis: A Tailored-Computer Web-Based Program for the Prevention of Cannabis Use in Adolescents: A Cluster-Randomized Controlled Trial Protocol

BackgroundThe growing use of cannabis in adolescence is a public health problem that must be addressed through prevention. In Spain, the average age of initiation of cannabis use in the adolescent population is 14.8 years. At 14 years, the lifetime prevalence of cannabis use is 11.7%, which increases to 51.,5% at the age of 18; the prevalence of cannabis use in the population aged 14 to 18 years is 28.6%, a figure that must be tried to reduce, that is why this school prevention program is proposed: Alerta Cannabis.MethodsThe Alerta Cannabis research project consists of design, implementation, and evaluation. In the first phase, a computer-tailored eHealth program (Alerta Cannabis) is developed based on the I-Change Model, an integrated model based on three main behavioral change processes: awareness, motivation, and action. This program consists of four 30-minute sessions that will provide culturally adapted and personalized advice to motivate students not to use cannabis through text feedback, animations, and gamification techniques. This phase will also include usability testing. In the implementation phase, secondary school students from Western Andalusia, Spain (Seville, Cádiz, Huelva, and Córdoba) and Eastern Andalusia (Jaén, Málaga, and Granada) will be randomized to an experimental condition (EC) or a control condition (CC) for a cluster randomized clinical trial (CRCT). Each condition will have 35 classes within 8 schools. GI will receive the online intervention Alerta Cannabis. EC and CC will have to fill out a questionnaire at baseline, six months, and twelve months of follow-up. In the last phase, the effect of Alerta Cannabis is evaluated. The primary outcomes are the lifetime prevalence of cannabis use and its use in the last 30 days and at 6 months. At 12 months of follow-up, the prevalence in the last 12 months will also be assessed. The secondary outcome is the intention to use cannabis.DiscussionThe study tests the effect of the innovative program specifically aimed to reduce the use of cannabis in the adolescent population through eHealth in Spain. The findings aim to develop and implement evidence-based cannabis prevention interventions, which could support school prevention, for instance, the assistance of school nurses. If the program proves to be effective, it could be useful to prevent cannabis use on a national and international scale.Trial registrationNCT05849636. Date of registration: March 16, 2023.

Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study.

To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses. Mixed method explanatory sequential design. A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena. Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not. Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety. Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety. Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff. Complied with the APA Style JARS-MIXED reporting criteria for mixed method research. No patient or public contribution.

Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE): An Evidence-Based Wellness Program.

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

To work after retirement: a qualitative study among mental health nursing assistants

Significant shortages of nursing staff threaten the provision of sustainable and high-quality patient care, which may be partially addressed by encouraging experienced staff to postpone their complete exit from the workforce and extend their careers. This qualitative study explored the transition to retirement, the motivation to engage in post-retirement work, and experiences of working after retirement among retired nursing assistants (aged 67–75 years) working in inpatient psychiatric care in Sweden. Interpretative Phenomenological Analysis (IPA) was used and allowed for a detailed, in-depth systematic analysis of data from seven individual interviews. Four superordinate themes were identified: (1) Adjustment difficulties to life as fully retired; (2) Good health as a precondition to work and a consequence of working; (3) The intrinsic joy of working and the importance of feeling competent; and (4) Work and organization-related factors contributed to well-being at work and facilitated an extended working life. Post-retirement work was found to facilitate the transition to retirement and contribute to well-being. Furthermore, good health was considered a prerequisite for, and a consequence of, continued working. Intrinsic motivation to work, being competent in performing the job, along with different work and organizational factors were considered important to continuing working after retirement. The findings contribute to informing the design of work environments and tailored HR strategies that facilitate aging-in-workplace and encourage extended working lives.

Work Environment Differences Between Outpatient and Inpatient Surgery: A Pilot Study on the Vascular Surgeons’ Perceptions

BackgroundIn France, outpatient endovascular surgical procedures have been slowly implemented in hospitals since 2015. Their development has been heterogeneous across France and is not yet the standard of care despite their benefits concerning patients’ outcomes and healthcare professionals’ satisfaction. However, since the COVID-19 pandemic, the demand for patient beds has been increasing, while human resources have been decreasing. This encouraged the surgery service reorganization and accelerated the shift from inpatient to outpatient surgery. Consequently, services had to adapt rapidly and this may have caused some strain on the hospital medical workforce. The objectives of this pilot study were to document and analyze the nursing staff (nurses and certified assistant nurses) well-being and workload as perceived by the vascular surgeons working with them. It also wanted to assess the link between the nursing staff’s psychosocial stress and the surgeons’ concentration and serenity in their workplace, based on the assumption that the well-being of both parties is inextricably linked. MethodsAn observational study was conducted using an online questionnaire distributed to the senior members of the French society of vascular and endovascular surgery (n=490) between October 10 and October 18, 2022. ResultsIn total, 125 surgeons completed the questionnaire (25% response rate). The main finding was that according to 68% of vascular surgeons, the nursing staff’s psychosocial stress significantly impaired their serenity and concentration at work and this frequently affected the surgical procedure safety. The main sources of psychosocial stress were the high work pace (64%), demand for flexibility (56%), lack of anticipation of schedule changes (82%), and difficulties encountered in relaying these concerns to hospital managers (44.6%). ConclusionsThis study demonstrated that concomitantly with the forced acceleration of outpatient activity implementation, the vascular surgeons’ perceptions of their working environment is deteriorating, especially in conventional (inpatient) surgery wards where the workload is increasing and patients have more comorbidities. The worsened psychosocial stress of surgeons and staff affects the care provided.

Nurse assistants’ perception of caring for older persons who are dying in their own home

BackgroundAs the proportion of older persons in society increases, there is a growing trend towards providing end-of-life care in their homes. Palliative care is a complex and knowledge-demanding form of care, and nurse assistants are those who work closest to the older person at the end-of-life in their own homes. However, nurse assistants sometimes have low educational and insufficient levels of knowledge in palliative care, which can affect the quality of care they provide. Moreover, nurse assistants’ experiences are relatively unexplored in this context. The purpose of the study was to illuminate nurse assistants’ experiences in caring for dying older persons at home.MethodAn empirical, qualitative interview study was conducted with 14 nurse assistants with experience of palliative care in homecare. The material was analyzed using thematic content analysis.ResultsFrom the nurse assistant’s experiences, one main theme emerged: doing everything possible for the dying older person despite challenges. Moreover, three sub-themes emerged: making a difference at a crucial time, death awakens emotions, and balancing personal and professional relationships. The nurse assistants’ saw their role primarily as relieving symptoms but also focusing on next of kin. The following are described as essential parts of their role: carrying out practical nursing tasks, focusing on the physical environment, working alone and seeking help from colleagues due to a physical distance to the other members of the multidisciplinary team. The nurse assistants experienced a lack of support as there was no structured guidance or debriefing available in difficult emotional situations. Furthermore, they disclosed that they were left alone to deal with their feelings.ConclusionThis study demonstrates that nurse assistants strive to provide comprehensive care for dying older persons despite facing obstacles from their working conditions and work organization. They lack supervision and education in palliative care, but they rely on their experience-based knowledge to a large extent and provide care according to the four cornerstones of palliative care.

Patient Care Technician Staffing and Outcomes Among US Patients Receiving In-Center Hemodialysis

Dialysis patient care technicians (PCTs) play a critical role in US in-center hemodialysis (HD) care, but little is known about the association of PCT staffing with patient outcomes at US HD facilities. To estimate the associations of in-center HD patient outcomes with facility-level PCT staffing. This was a retrospective cohort study, with data analysis performed from March 2023 to January 2024. Data on US patients with end-stage kidney disease and their treatment facilities were obtained from the US Renal Data System. Participants included patients (aged 18-100 years) initiating in-center HD between January 1, 2016, and December 31, 2018, who continued receiving in-center HD for 90 days or more and had data on PCT staffing at their initial treating HD facility. Facility-level patient-to-PCT ratios (number of HD patients divided by the number of PCTs reported by the treating facility in the prior year), categorized into quartiles (highest quartile denotes the highest PCT burden). Patient-level outcomes included 1-year patient mortality, hospitalization, and transplantation. Associations of outcomes with quartile of patient-to-PCT ratio were estimated using incidence rate ratios (IRRs) from mixed-effects Poisson regression, with adjustment for patient demographics and clinical and facility factors. A total of 236 126 patients (mean [SD] age, 63.1 [14.4] years; 135 952 [57.6%] male; 65 945 [27.9%] Black; 37 777 [16.0%] Hispanic; 153 637 [65.1%] White; 16 544 [7.0%] other race; 146 107 [61.9%] with diabetes) were included. After full adjustment, the highest vs lowest quartile of facility-level patient-to-PCT ratio was associated with a 7% higher rate of patient mortality (IRR, 1.07; 95% CI, 1.02-1.12), a 5% higher rate of hospitalization (IRR, 1.05; 95% CI, 1.02-1.08), an 8% lower rate of waitlisting (IRR, 0.92; 95% CI, 0.85-0.98), and a 20% lower rate of transplant (IRR, 0.80; 95% CI, 0.71-0.91). The highest vs lowest quartile of patient-to-PCT ratio was also associated with an 8% higher rate of sepsis-related hospitalization (IRR, 1.08; 95% CI, 1.03-1.14) and a 15% higher rate of vascular access-related hospitalization (IRR, 1.15; 95% CI, 1.03-1.28). These findings suggest that initiation of treatment in facilities with the highest patient-to-PCT ratios may be associated with worse early mortality, hospitalization, and transplantation outcomes. These results support further investigation of the impact of US PCT staffing on patient safety and quality of US in-center HD care.

Feasibility of alcohol interventions in cardiology: a qualitative study of clinician perspectives in Sweden.

This study aimed to identify barriers and facilitators to implementing alcohol screening and brief interventions (SBI) in cardiology services. This was a qualitative study. Individual, semi-structured interviews were conducted with 24 clinical cardiology staff (doctors, nurses, and assistant nurses) of varying experience levels and from various clinical settings (high-dependency unit, ward, and outpatient clinic), in three regions of Sweden. Reflexive thematic analysis was used, with deductive coding applying the Capability, Opportunity, Motivation (COM-B) theoretical framework. A total of 41 barriers and facilitators were identified, including 12 related to capability, 9 to opportunity, and 20 to motivation. Four themes were developed: (i) uncharted territory, where clinicians expressed a need to address alcohol use but lacked knowledge and a roadmap for implementing SBI; (ii) cardiology as a cardiovascular specialty, where tasks were prioritized according to established roles; (iii) alcohol stigma, where alcohol was reported to be a sensitive topic that staff avoid discussing with patients; and (iv) window of opportunity, where staff expressed potential for implementing SBI in routine cardiology care. Findings suggest that opportunities exist for early identification and follow-up of hazardous alcohol use within routine cardiology care. Several barriers, including low knowledge, stigma, a lack of ownership, and a greater focus on other risk factors, must be addressed prior to the implementation of SBI in cardiology. To meet current clinical guidelines, there is a need to increase awareness and to improve pathways to addiction care. In addition, there may be a need for clinicians dedicated to alcohol interventions within cardiology services. OSF (osf.io/hx3ts).

Perceptions, barriers, and challenges of oral care among nursing assistants in the intensive care unit: a qualitative study

BackgroundAlthough oral hygiene is closely related to various diseases, it is sub-optimal in the Intensive Care Unit (ICU). Oral care in the ICU is challenged by nursing workloads, low staffing, and higher acuity patients, there are few policies and written guidelines for oral care. Nurses often delegate oral care to nursing assistants (NAs) whose role is overlooked. This study is to explore the perspectives, obstacles, and challenges of NAs in the oral care of the ICU.MethodsA qualitative study and semi-structured interviews were conducted with NAs in three ICU units, and Colaizzi’s phenomenological method was used to analyze the records.ResultsInitially, 13 NAs met the inclusion criteria, and two did not participate in this study as they refused to be recorded. Finally, 11 ICU NAs were interviewed, with three receiving face-to-face interviews and eight receiving telephone interviews. Using Colaizzi’s phenomenological method, two themes and eight subthemes emerged from the data, we examined the self-perception, barriers and challenges of NAs regarding oral care and identified the subthemes: (1) The target audience, frequency, and importance; (2) Role; (3) Evaluation; (4) Patient-related factors; (5) Oral care tools; (6) Psychology of NAs; (7) Lack of education and training; (8) Lack of team support.ConclusionNursing assistants whose roles are overlooked by the nursing team are important members of the ICU team. Though oral care is closely related to disease prevention, it is rarely considered an essential task. Major barriers to implementing oral care in the ICU environment and patients include the psychological quality of participants, non-standard education and training, and inadequate team support. The expectation is that medical personnel will prioritize oral hygiene and recognize the significance of NAs in nursing work. Furthermore, future ICU oral care should investigate suitable tools and mouthwashes, simplified and standardized processes, standardized training, and multidisciplinary team collaboration.

THRIVE: A Theory-Based Program to Support Hospital Nursing Assistants.

Nursing assistants are vital healthcare team members who often experience personal challenges to professional success. The Transformational Healthcare Readiness through Innovative Vocational Education (THRIVE) program is designed to combat these challenges through coaching and curriculum that is steeped in adult learning and social theories. The program's goal is to increase retention and success of newly hired nursing assistants through personal and professional support. Components of THRIVE can be adapted in a variety of healthcare settings.

Impacts on oral health attitude and knowledge after completing a digital training module among Swedish healthcare professionals working with older adults

Oral health care is essential, and digital training may influence healthcare professionals’ attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals’ experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals’ attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

Being used for the greater good while fighting on the frontline: care staff’s experiences of working with older people during the COVID-19 pandemic in Sweden

BakgroundWorldwide, older people were more severely affected during the COVID-19 pandemic than others. In Sweden, those living in residential care facilities had the highest mortality rate, followed by those receiving home care services. The Swedish and international literature on the working environment for assistant nurses and care aides during the pandemic shows an increase in stress, anxiety, depression and post-traumatic stress syndromes. Care organisations were badly prepared to prevent the virus from spreading and to protect the staff from stress. In order to be better prepared for possible future pandemics, the health and well-being of the staff, the care of older people and the experiences of the staff both during and after a pandemic are important aspects to take into account. Therefore, this study aims to describe the experiences of assistant nurses and care aides working in the care of older people during the COVID-19 pandemic in Sweden, their working conditions and the impact all this had on their lives. MethodologyThe study has a qualitative, descriptive design. The data was collected in four focus group interviews with 21 participants and analysed using qualitative content analysis.ResultsThe results revealed the theme, Being used for the greater good while fighting on the frontline, which was then divided into three categories: portrayed as a risk for older people, not being valued and being burnt out. The worsening working conditions that the pandemic contributed to resulted in a high degree of stress and risk of burnout, with staff members both wanting to and actually leaving their employment. After the pandemic they felt forgotten again and left to cope in an even worse situation than before.ConclusionsThe pandemic had a major effect on assistant nurses and care aides in terms of their working environment and their private lives. To be better prepared for future pandemics or disasters, organisations with responsibility for the care of older people will need to ensure that their staff have the necessary competencies and that there is adequate staffing in place. This also means that adequate government funding and multiple interventions will be needed.

Improving the Timing of Acute Care Insulin Delivery.

Variations in nursing practice were observed across our hospital, a 520-bed acute care teaching facility in the northeast United States, regarding the timing and frequency of insulin administration in adult patients with diabetes. Chart audits noted that RNs administered insulin more than one hour after blood glucose results were obtained 97% of the time. In addition, insulin was given at bedtime only 37% of the time. The purpose of this quality improvement (QI) project was to improve the care of inpatients requiring insulin by implementing protocols and adjusting practice to align with best practice recommendations. The clinical nurse education specialist met with a team of staff nurses, providers, nurse leaders, and patient care technicians (PCTs) to formulate protocols and design interventions to ensure improvements in the quality of care for inpatients with diabetes. A sequence of education sessions and an online learning module were developed and assigned to nurses and PCTs to address knowledge gaps, specifically in the pharmacodynamics and safe administration of insulin, as well as how best to provide care to patients with diabetes. Monthly adherence data were disseminated to nurse leaders and educators and reviewed with clinical staff at daily safety huddles and staff meetings. Additional interventions to enhance nursing practice in caring for patients with diabetes included ensuring both bedtime insulin administration and timely insulin delivery. This project began in May 2017 and ended five years later. Two weeks after initial education sessions began in May and June 2017, the frequency of giving bedtime insulin based on the order set and according to the patient's blood glucose levels rose from 37% to 82%, and adherence to best practice protocols continued until final chart audits were performed in May 2022. The frequency of giving insulin less than one hour after obtaining blood glucose results improved from 3% to 64% between October and December 2019, and increased to a sustained level above the project's 92% goal two years later. Protocol development, targeted education, and audits with feedback led to improved care delivery for patients requiring insulin and increased nursing confidence.

Abstract WP36: Proven Strategies for Educating Staff and Reducing Hospital-Acquired Pressure Injuries in Stroke Hospital Units

Introduction: Hospital-Acquired Pressure Injuries (HAPI) are preventable complications that stroke patients are at risk for developing during hospitalization due to changes in mobility, nutrition, and continence as complications of stroke. The stroke units at a large teaching hospital saw an increase in HAPI’s during fiscal years (FY) 21 and 22 with 16 collective HAPIs in FY21 and 25 in FY22. Additionally, 12.5% of their unit-acquired HAPIs were reportable to the state’s Department of Public Health (DPH) in FY21 and 20% were reportable to the DPH in FY22. Nursing leadership hypothesized that a multi-year and multi-faceted plan would reduce unit-acquired HAPIs. Methods: In the first year of the plan, all RNs and Patient Care Assistants (PCAs) participated in a “Room of Wounds” education intervention in which they identified HAPI prevention errors in a simulation, matched appropriate dressings to wound images according to hospital policy, identified documentation gaps in a mock medical record, and completed a case study in which they applied the hospital’s Skin Injury Prevention Protocol (SIPP) to a patient scenario. The following year, the RNs all reviewed a handout on the hospital’s SIPP which included “Do’s and Don’ts” of documentation and participated in a Skills Day where an educational game was utilized identify wounds and appropriate dressing types. Additionally, unit leadership completed daily audits and provided timely feedback to RNs about patient care and documentation gaps. Results: Together, the neuroscience units saw a 48% reduction in HAPIs from FY22 to FY23 thus far with one of the units seeing a 71% reduction. In addition, none of the neuroscience units had a DPH reportable HAPI in FY23 thus far. Conclusion: Multi-faceted education approaches are critical when implementing education to counteract gaps in nursing care because they ensure that all learner types receive meaningful education. Consistent Auditing and feedback also improves patient care and staff accountability. A multi-faceted approach is a successful strategy that can be utilized when providing education about HAPI prevention, a major risk to patients after stroke, to staff members of multiple roles within the hospital’s stroke units.

Exploring barriers to employee voice among certified nursing assistants: A qualitative study.

Research shows that voice-the communication of ideas, concerns, and perspectives by employees to those in positions to instigate changes-is related to job satisfaction, retention, and organizational improvement. Nevertheless, health care professionals often do not exercise voice. Although researchers have explored the barriers registered nurses working in hospitals experience in expressing their voices, there has been a notable lack of attention in research and practice to the voice of certified nursing assistants working in long-term care settings. Ensuring that certified nursing assistants can exercise voice is essential for the welfare and well-being of this occupational group and critical for the success of their organizations. Therefore, we explore the barriers certified nursing assistants encounter that hinder them from exercising voice. We conducted seven focus groups in which 24 Dutch certified nursing assistants participated. The results show that respondents were not always willing to exercise voice, which stemmed primarily from negative prior experiences with exercising voice. Respondents were further not always able to exercise voice, as the conditions under which they had to do so were unfavorable. Finally, respondents sometimes lacked the necessary skills to convey their ideas, concerns, and perspectives effectively. Our findings indicate that health care managers must address multiple factors if they wish to enhance the voice of certified nursing assistants.

Abstract WP43: Improving Nurse Retention Through Orientation Restructuring, Planned Professional Development, and Leadership-Employee Support: One Unit’s Journey

Introduction: Increasing RN turnover rates are a noteworthy and nuanced problem for many nurse leaders. It is a particular challenge within specialty units, resulting in the loss of specialty nursing knowledge, assessment, and critical thinking skills relevant to specific patient populations. RN turnover rates increased over a two-year period on a stroke unit in a large teaching hospital that provides specialty care as part of a Comprehensive Stroke Center. Many of the RNs leaving the unit pursued critical care roles, and their knowledge was lost with their attrition. This prompted the nurse leadership to re-examine the orientation process, professional development plan, and leadership-employee support methods that were being utilized. Methods: Using the PDSA model, orientation was reorganized allowing new RNs to be trained solely on the stroke unit for 10-12 weeks then working independently on that unit for 6 months prior to training on the epilepsy monitoring unit, as opposed to training and working on both units from the start of their employment. Professional development plans that included one-on-one resource nurse training with the Assistant Nurse Manager and cross-training to the neuroscience stepdown unit after one year of employment were created for each RN. Each staff member was supported with mentorship check-ins by an assigned Clinical Leader and with bi-monthly check-ins with the Nurse Manager. Quarterly staff meetings were held to promote staff engagement and provide staff members with an opportunity to cascade information on their individual projects, councils, or initiatives to their peers. Results: These changes, including the training of 10 RNs to the stepdown unit, resulted in an 82% decrease in the number of RNs who left their job on the stroke unit in the first year. Conclusion: This process improvement plan demonstrated that thoughtful modifications to the orientation process, a structured professional development plan, and an organized leadership-employee support method can decrease RN turnover. It allowed the preservation of specialty stroke knowledge, thus ensuring that stroke patients continue to receive high-quality, specialized care and that specialty knowledge is transmitted to new staff as they start their careers.

Electronic medication administration record (eMAR) in Swedish home healthcare-Implications for Nurses' and nurse Assistants' Work environment: A qualitative study.

The electronic medication administration record (eMAR) is an eHealth system that has replaced the traditional paper-based medication administration used in many healthcare settings. Research has highlighted that eHealth technologies can change working methods and professional roles in both expected and unexpected ways. To date, there is sparse research that has explored how nurses and nurse assistants (NA) in home healthcare experience eMAR in relation to their work environment. The aim was to explore how nurses and nurse assistants experienced their work environment, in terms of job-demand, control, and support in a Swedish home healthcare setting where an electronic medication administration record had been implemented to facilitate delegation of medical administration. We took a qualitative approach, where focus groups were used as data collection method. The focus groups included 16 nurses and nine NAs employed in a Swedish municipality where an eMAR had been implemented 6 months before the first focus groups were performed. The analysis adapted the job-demand-control-support model, by condensing the professionals' experiences into the three categories of demand, control, and support, in alignment with the model. NAs experienced high levels of job demand and low levels of job control. The use of the eMAR limited NAs' ability to control their work, in terms of priorities, content, and timing. In contrast, the nurses described demands as high but manageable, and described having a high level of control. Both professions found the eMar supportive. Nurses and NAs in home healthcare experienced changes in their work environment regarding demand, control, and support when an eMAR was implemented to facilitate delegation of medical administration. In general, nurses were satisfied with the eMAR. However, NAs felt that the eMAR did not cover all aspects of their daily work. Healthcare organisations should be aware of the changes that digitalisation processes entail in the work environment of nurses and NAs in home healthcare.

The dilemma of the split between theory and reality as experienced by primary healthcare professionals: a mixed methods study of evidence-based practice in a primary care context

BackgroundPrimary care depends upon a good information flow across professional and structural boundaries to provide the best care for patients. Previous research has mainly focused on Evidence-Based Practice (EBP) within specific professions. Mapping of pan-professional experiences of and attitudes to EBP in publicly funded clinical practice is necessary to deepen the understanding of EBP and its implementation. Thus, this study aimed to investigate healthcare professionals’ experiences of and attitudes towards working in accordance with EBP in primary care.MethodsThe study used a convergent mixed methods design divided into two strands: a quantitative enquiry tool (Evidence-Based Practice Attitude Scale, EBPAS) and a set of qualitative interviews analysed by means of qualitative content analysis. Both strands included all primary care employees with patient interaction in the studied county (n = 625), including doctors, nurses, physiotherapists, psychologists and assistant nurses. Out of the original 625 healthcare professionals, 191 finished the first strand and 8 volunteered for the second strand (2 nurses, 2 physiotherapists, 1 psychiatrist and 3 doctors).ResultsThe EBPAS value of 2.8 (max 4) indicated a generally positive attitude towards EBP amongst the population, which was also evident in the interviews. However, there were additional experiences of not having the ability or resources to engage in EBP. This was illustrated by the theme that emerged from the qualitative content analysis: “The dilemma of the split between theory and reality”. Due to the organisational and managerial focus on efficiency rather than quality of care, there were few or no incentives for promoting individual educational or research development.ConclusionsAlthough the general attitude towards EBP is positive, experiences of practising it differ. There is a need to increase knowledge of EBP concepts, requirements and implementation in the clinical setting. The absence of opportunities to do research and collegial debate about new ways of finding and implementing research-based evidence results might influence the quality of care.

"I Like the Feeling of Connecting With People": A Mixed-Methods Study of Nursing Assistants Experiences Across the Care Continuum.

Nursing assistants (NAs) are critical professionals across the long-term care continuum. Despite the demands of NAs, these frontline personnel experience workplace challenges and turnover at a disproportionate rate compared to other professionals. Much research has explored the experiences of nursing assistants using federal survey data and national datasets. Guided by a socio-ecological model and the job-demands resource model, this study utilized a sequential mixed-methods approach to uncover a more nuanced understanding of NA workplace experience. Results from this combined qualitative (N = 17) and quantitative (N = 354) study found that there are several workplace aspects, such as organizational culture and supervisor relationships, that contribute to NA experiences across system levels. Further exploration of direct care tasks directly from nursing assistants is necessary to understand full intentions.

Readiness of nurses when faced with a patient's death.

The death of a patient negatively affects the professional dimension of nurses' functioning and also their private lives, where professional experiences and emotions are often transmitted. The main aim of the study was to discover how the nursing staff assessed their self-efficacy in dealing with the death of a patient. The researchers used a diagnostic survey method and a self-authored survey, Life Satisfaction Scale (SWLS), Coping Inventory for Stressful Situations (CISS), Generalized Self-Efficacy Scale (GSES), Courtauld Emotional Control Scale (CECS), The Death Anxiety and Fascination Scale with the Death Anxiety Subscale. The study group consisted of 287 individuals. Working in a hospital is stressful in the opinion of 79.44% of the respondents. 39.37% of the respondents feared death. In the course of work, the death of a patient in the department was sometimes experienced by 34.84% of the respondents, always experienced by 29.97%. The respondents usually did not make their compassion for a dying patient based on the patient's position in society (57.84%). In the case of the majority (84.67%) of the respondents, the employer did not provide mental support for the staff in difficult situations. The majority of the respondents did not feel the need to broaden their knowledge of death and dying (64.11%). The surveyed nurses most often presented low or average life satisfaction, high self-efficacy, average levels of stress and coping in all three styles (with a preference for avoidance-oriented), and a high level of death fascination and an average level of death anxiety. The majority of the nurses in difficult situations and when a stressful situation occurred did not receive support from their employer or from physicians, but could count on the assistance of fellow nurses and a divisional nurse. The majority of the respondents felt that psychological support in their work was important and would gladly benefit from it. Although most nurses did not feel the need to broaden their knowledge of death/dying, they would take part in such a course if it were possible.