Nursing Model Research Articles

Trauma team training: A key to success

Background: Worldwide, trauma constitutes 10% of all causes of death. In the United Arab Emirates, trauma is the second leading cause of death for both national and expatriate populations, accounting for over 20% of all fatalities. Trauma affects all age groups, especially adolescents and young adults. Most trauma cases are preventable. Morbidity and mortality can be decreased after trauma by adopting a systematic approach towards trauma victims. Simulation-based training is beneficial in that it allows us to amplify a variety of real-life situations without compromising patient safety. Objectives: This study aims to assess the impact of trauma team training (TTT) on the performance of the trauma team and the time spent by the patient in the emergency department. Methods: In Sheikh Khalifa Medical City of Ajman, the TTT program was started early in 2016 for all members of the trauma team including (trauma team leaders, hand on surgeons, emergency room physicians, airway nurses, IV access nurses, documenting nurses and circulatory nurses) in addition to personnel recruited during trauma management like (anaesthetists, orthopaedic surgeons, blood bank physicians, radiology technicians, intensive care unit nurses, theatre nurses, laboratory and blood bank technicians, etc.). The 1-day training program, concentrated on the discipline of each member of the trauma team during simulated patient treatment, and his role in the team. Assessment of the impact of TTT on the performance of the trauma team was done by interrogating the participants in this training. The time spent to resuscitate the patient in the emergency department was measured before and after the training of the trauma team personnel. Results: After the TTT was employed, the results showed that there was a decrease by approximately 75% in the meantime of performance from 220.8 min to 54.48 min. This was in accordance to the patient's stay in the ER which decreased significantly from 9 to 827 min pre-training to 14–206 min post-training. Conclusion: Training reinforces the already learned skills, corrects and minimise mistakes. Implementation of TTT is of utmost importance to be adapted in every trauma centre to achieve optimal performance and benefit to the patient.

Determination of Key Inflection Points for Maladaptive Responses in US Nurses During the Pandemic: A Network Analysis.

During the pandemic, the nursing workforce is experiencing overwhelming workloads that carry a heavy psychological burden. A wide variety of psychological responses to the COVID-19 pandemic have been studied in nurses globally, but many are not studied or understudied in US nurses. Theoretical underpinnings of the current study are based on the disaster component of the Middle-Range Theory of Nurses' Psychological Trauma. To explore the associations of psychological responses (life satisfaction, perceived stress, posttraumatic stress disorder [PTSD] symptomatology, attitude toward life, and compassion satisfaction), years of experience, and general health in US nurses during the COVID-19 pandemic using network analysis. A cross-sectional study was conducted using an online survey from October to November 2020 in US nurses. Network analysis was used to model the data and analyze the centrality indices of betweenness, closeness, and strength. Data were reported according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist. In 128 nurses, 19.35% of nurses had probable PTSD. Network analysis showed strong significant correlations between life satisfaction and perceived stress (negative), between perceived stress and PTSD symptomatology (positive), and between attitude toward life and compassion satisfaction (positive). Low life satisfaction, high perceived stress, and low attitude toward life are key inflection points that signal the need for psychological intervention in the US nursing workforce during the continued pandemic. Based on 2021 Tri-Council of Nursing COVID-19 Report and the 2022 International Council of Nurses guideline, healthcare should implement scalable, system-level interventions to reduce psychological burden during the pandemic. The current study suggests targets for such intervention, which may promote a healthier, more effective US nursing workforce.

A Middle-Range Theory of Nurses' Psychological Trauma.

A Middle-Range Theory of Nurses' Psychological Trauma.

Estimating staffing requirements using workload indicators of staffing need at Braun District Hospital in Morobe Province, Papua New Guinea

BackgroundPapua New Guinea has seen some improvements in health indicators over the past years, but the pace of improvements is not as robust as expected. The Health Services Plan for Braun District Hospital redevelopment identified the importance of reflecting the hospital’s role in the broader health system, particularly in upgrading the services to service a bigger population. In August 2020, the hospital was upgraded from a health centre—level 3 to a district hospital level 4. The need for assessing human resources for health requirements for this level of care was thus necessary.MethodsThe National Department of Health approved the use of the workload indicators of staffing need as the best tool to support in estimating staff requirements for the newly upgraded hospital. The focus was on clinical and non-clinical staff. Using already developed workload components and activity standards by the expert working groups for level 4 facilities, we visited the facility and collected data through interviews with the Lutheran Health Services representative, hospital management and staff. The technical task force reviewed daily registers, monthly reports and the data in the electronic national health information systems. The information collected was analysed using the workload indicators of staffing need software and interpreted.ResultsThere were staffing shortages among the clinical staff like the medical officers, nursing officers, health extension officers, pharmacists, radiology staff unit and in the laboratory staff. Shortages among the non-clinical staff were recorded by the cashiers, security officers, drivers and boat skippers. The results showed that the facility lacks a medical laboratory technologist, pharmacists and a medical imaging technologist. The community health workers in this facility are utilized in all the areas where shortages are registered to multitask.ConclusionThe results from this WISN study provide evidence for basing staffing decisions on. The WISN results from Braun District Hospital show that the facility requires a total of 33 inpatient nurses against the existing 21 inpatient nurses thus giving a staff gap of − 12 and a WISN ratio of 0.67. It is thus recommended that the hospital management prioritizes recruitment of nurses or if no resources, reassign one of the outpatient nurses to alleviate the pressure among the inpatient nurses or the extra theatre nurses to offer some services in the inpatient wards. WISN results can help managers make decisions such as change of health facility status from a health centre to a district hospital.

Analytical comparison of the holistic perspectives of Islamic intellectuals and common philosophical approaches in nursing respecting human being

Background and aims: The nursing philosophy has moved from reductionism to holism in its manner of treating human being (HB). There are two main philosophical worldviews about holism, namely reciprocal interaction and simultaneous action worldviews, based on which most holistic nursing theorists formulated their works. Islam, as a perfect religion, also addresses all dimensions of HB and provides different instructions for their development. However, it is still poorly known whether there is a difference between western and Islamic holism. This study was conducted to analytically compare these two main philosophical worldviews with the Islamic worldview in nursing. Methods: This analytical study was conducted in 2020 through the library search method. The SID, Medlib, IranMedex, Magiran, Irandoc, ISI, Scopus, PubMed, and Islamic World Science Citation Center databases were searched using the "holism", "Islamic thought", "reciprocal interaction", and "simultaneous action" keywords. Moreover, the works of famous Islamic intellectuals, particularly Mohammad Hossein Tabatabaei and Morteza Motahhari, were assessed. Results: In the reciprocal interaction worldview, HB is considered as an organized and coherent whole with different biological, psychological, social, and spiritual dimensions and inter-relationships among these dimensions. Moreover, it considers HB as a metaphor, implying that HB is a unified, self-organizing, and regularly changing being that is in interaction with internal and external environments. In the Islamic worldview, HB is a unified truth with material and immaterial realms consisted of physical body connected with emotions, cognition, society, spirituality, and the universe. Conclusion: Although the simultaneous action worldview has a holistic view towards HB, it does not specifically address all HB dimensions. However, the reciprocal interaction worldview addresses some HB dimensions. Islamic intellectuals not only have a holistic view towards all HB dimensions, but also consider HB relationship with the universe. Such divine view to HB integrates the simultaneous action and the reciprocal interaction worldviews, provides nurses with a holistic view towards HB, and facilitates the application of the existing holistic nursing theories for nursing practice, research, and theorization.

Efficacy of Modified Betty Neuman Nursing Theory to Develop Evidence-Based Pandemic Care Pathway for Preadolescents in the School

Background: A study on the effect of COVID-19 on children shows that once we pay special attention to the psychological aspect of youngsters, the worst effect occurs, although less sensitive to COVID-19. There’s also evidence that nursing care supported by Betty Newman's model helps prevent 94% of patients with psychiatric cases within the medical care unit. A study that supported the appliance of the Betty Newman Systems model within the nursing care of patients with Covid-19 showed that it helps resolve the nursing problems of a patient affected by Covid-19. Supported by the above study, it's planned to develop a particular epidemic care pathway for preadolescents using the revised Betty Newman's nursing theory.
 Objectives: To evaluate the efficacy of modified Betty Newman’s Nursing Theory to develop an evidence-based pandemic care pathway for preadolescents between the experimental and control groups and associate the post-test score of preadolescents with their demographic variables.
 Methodology: Preadolescent students will be recruited for the Superiority trial. the standard and modified Betty Newman theory will be applied to the control and experimental group. The pre and posttest of both groups will be evaluated for their effectiveness.
 Expected Outcomes: The newly developed pandemic care approach will effectively reduce the psychological impact of pandemics in Preadolescent children.
 Conclusions: Generation of pandemic care pathway for preadolescents and Reduction of the psychological impact of the pandemic among preadolescents.

Edgework emotion management: A constructivist grounded theory of organ donation nurses' experiences and practices.

To explore nurses' experiences when approaching families for organ donation authorisation to guide nursing practice. Organ donation after brainstem death implies that bereaved families are approached to discuss organ donation authorisation, and in many countries, specialist nurses do this approach. The literature describes the social, psychological and emotional challenges of health professionals in this role. However, lack of conceptual clarity regarding nurses' experiences on approaching families to guide nursing practice was found. Constructivist grounded theory. Between October 2017 and July 2019, seven months of observations were conducted across two large public hospitals in Chile. Field notes, documents (n=80), interviews (n=27) and focus groups (n=14) with 71 participants (51healthcare professionals and 20 bereaved families) were included. Data collection and analysis followed the principles and practices of Charmaz' constructivist grounded theory. The COREQ checklist was followed in reporting the study. Edgework emotion management of organ donation nurses was developed as a threefold process: 1) being present to recognise inner and family emotions, 2) being on an emotional edge when approaching families and 3) extending the emotional edge to make sense of their experiences. The grounded theory was conceptualised using edgework emotion management by Lois (2003), which allowed to elucidate organ donation nurses' experiences and practices on managing their emotions. Organ donation nurses develop a sophisticated and complex emotional regulation process to approach and care for families when negotiating organ donation authorisation for transplantation. The experiences of specialist organ donation nurses entail a sophisticated emotion management process, which may explain the complexities of a critical role within healthcare institutions. Findings can be locally and internationally used to understand, educate and guide nursing practice, in an area of increasing specialisation and staffing shortages such as organ donation and transplantation.

Perceptions of nurse managers and staff nurses regarding Technological Competency as Caring in Nursing theory in general hospitals in Japan.

Nurses as primary healthcare providers demonstrate quality nursing care through competencies with healthcare technologies, while nurse managers assume the primacy of managing quality healthcare in their respective care settings. However, little is known about perceptions of the influence of care technologies on their nursing practice. This study aimed to determine managers' and staff nurses' perceptions regarding the Technological Competency as Caring in Nursing (TCCN) theory in general hospitals in Japan. This study employed a cross-sectional survey design, with 421 participants selected using a stratified sampling method. Technological Competency as Caring in Nursing Instrument-Revised (TCCNI-R) was used for online data collection using Survey Monkey©. Data were analyzed using Welch's t-test and ANOVA. Nurses with years of experience within the range of 20 to less than 30 years showed the highest TCCNI-R scores among the two groups. Nurses who had received education on caring in nursing showed significant differences for Factor 2 (Technological Competency as Caring), that of expressing Technological Competency as Caring. Three other factors showed no significant difference, namely in Factor 1 (Nursing Expression as Caring), Factor 3 (Technology and Caring), and Factor 4 (Technological Knowing). However, the average scores of these factors were high, which reflect high professional ethics and occupational discipline and increased awareness of caring in nursing. It was also found that the nurse managers were more aware of the TCCN than were the staff nurses. The nurse managers were also more aware of providing care using technology, recognizing the need-to-know patient needs through technology and providing care to the ever-changing patient's condition. The study discovered that continuing education is needed regarding the practice of nursing based on theory, enabling appropriate and accurate understanding of practicing knowing persons as caring in nursing.

Application Analysis of Inter-professional Cooperative Simulation Teaching in the Experimental Teaching of Internal Medicine Nursing

The course of internal medicine nursing is a professional basic course in higher nursing education. This course is based on nursing and basic nursing theory, has strong practicality and operability, and is an important part of clinical nursing professional courses. However, as far as the experimental teaching of this course is concerned, the actual development situation is not optimistic. The experimental teaching is lagging behind and students cannot get effective experimental exercises. Therefore, this article studies the application of inter-professional cooperative simulation teaching in the experimental teaching of internal medicine nursing. Analyze the effect of applying this kind of teaching method to the experimental teaching of internal medicine nursing, combining with the current status of experimental teaching of internal medicine nursing, explore the effective application strategies of promoting inter-professional cooperative simulation teaching in internal medicine nursing experimental teaching, in order to promote internal medicine nursing provide some ideas for improving the quality of experimental teaching.

Going above and beyond: using nursing theories to explore volunteerism during the COVID-19 pandemic.

Historically, nurses have volunteered to serve in wars and natural catastrophes. However, instead of a distant disaster, many nurses in the UK volunteered, working above and beyond, to assist their colleagues, local communities and health systems in the NHS during the peaks of the COVID-19 pandemic. Although the motivations and benefits to the community or self of volunteerism have been discussed in the literature, there is a paucity of literature and theoretical understanding from the field of nursing. Using a reflective and personal account of volunteering, this article aims to provide a better understanding of the concept of volunteerism in nursing. By exploring associated nursing theories from Jean Watson and Kristen Swanson, this article aims to illuminate and expand the knowledge base about nursing volunteerism. These nursing theories can frame the act of volunteerism and nursing and illustrate the interrelations of nursing theory and the practice of nursing volunteerism.

Transactional Self Care and Empathy Theory in Nursing (A Perspective)

Theory development as one of the highest forms of knowledge development that provides opportunity among health providers to identify new and modern approaches of understanding human transformation. This theory uprooted from the mere encounter between the nurse and the one nursed in the phenomenal field called “nursing situations.” The context clearly defines the major components of nursing as the person, environment, and health and how they interact to generate meanings, ideals, and intentions in nursing. The recognition of empathy as a critical essential of caring is highlighted in the theory. The expression of transactional caring and empathy as unending expression of caring in nursing becomes the pillar in the nurse-patient human encounters.

The Application of the Theory of Emotional Nursing in the Nursing of Patients with Rheumatoid Arthritis

The Application of the Theory of Emotional Nursing in the Nursing of Patients with Rheumatoid Arthritis

Operating theatre nurses' with managerial responsibility: Self-reported clinical competence and need of competence development in perioperative nursing.

AimThe aim of this study was to investigate operating theatre nurses (OTNs) with managerial responsibility, and their self‐rated clinical competence and need for competence development in perioperative nursing.DesignA cross‐sectional study was applied using a modified version of Professional Nurse Self‐Assessment Scale of Clinical Core Competence I.MethodData were collected from 303 OTNs in Sweden, 80 of whom indicated that they had managerial responsibility. Statistics analysis was used to identify the relationships between background variables to compare OTNs with and without managerial responsibility and their need for competence development.ResultsOTNs with an academic degree and managerial responsibility self‐rated their clinical competence higher compared with OTNs without an academic degree. It also turned out that OTNs with RN education and 1‐year advanced nursing in theatre care, and master's 60 credits had a lower need for competence development in cooperation and consultation, professional development and critical thinking.

A Face-to-Face Surgical Instrumentation Course During the COVID-19 Pandemic.

ObjectivesSurgical instrumentation teaching is included as an essential part of surgical training in the core surgical training syllabus. Access to formal teaching is variable, and opportunities for informal teaching have been further reduced by the COVID-19 pandemic. We aimed to design a course to fulfil these local trainees' needs. A move away from face-to-face teaching has occurred successfully during the pandemic, but little literature exists on how face-to-face courses can be best designed during this time. We aimed to describe the practicalities of running a face-to-face course with COVID restrictions.MethodsJunior doctors and nurses rotated around five stations led by theatre nurses and senior doctors, each with common instruments from different surgical subspecialties. Social distancing was observed, and level 2 personal protective equipment (PPE) was worn throughout the course. Matched pre- and post-course tests allowed evaluation of learning.ResultsThe course had 20 attendees, and the test scores improved following the course by an average of 9% (p = 0.009). All attendees (100%) found the course improved their knowledge and confidence. Feedback was overwhelmingly positive, and the significant improvement in the multiple-choice question (MCQ) scores demonstrates that this was an effective method of delivering teaching despite the COVID-19 restrictions on social distancing.ConclusionThis course shows that instrumentation training is valuable to trainees and provides a good example to other educators, showing the workings of how a practical course may be run face-to-face during the pandemic.

Chief Nursing Officer Perspectives on Nursing Theory-Guided Practice.

The purpose of this study was to identify what guides nursing practice. Change occurred when the Magnet Recognition Program® no longer required a nursing theory. This was a mixed-methods study to identify the process used to implement nursing theory-guided practice and the relationship to professional practice recognition. Deidentified quantitative data were collected from 36 chief nursing officers (CNOs). Seventeen CNOs participated in the qualitative interview. Thirteen CNOs were from a Magnet®-designated facility. Ten CNOs were on the Magnet journey, and 2 had no intent to seek Magnet recognition. Two CNOs were from a Pathway to Excellence®-designated facility. One CNO was on the Pathway to Excellence journey. The majority of respondents who were Magnet® recognized who participated in the survey used Watson's Theory of Human Caring. Themes were identified that share the benefits and strategies to integrate nursing-guided theory into nursing processes, structures, and outcomes. Findings will benefit CNOs as they make decisions related to pursuing Magnet status recognition.

Commentary: Missed nursing care and complexity theory: a conceptual paper.

Commentary: Missed nursing care and complexity theory: a conceptual paper.

Effectiveness of hierarchical, diversified soft skills training in clinical nursing training.

To explore the application effects of hierarchical, diversified soft skills training in clinical nursing training. This is a prospective study. There involved a total of 124 nurses who participated in the training in our hospital. The participants were randomly allocated to the study group and the control group, with 62 nurses in each group. Study group received hierarchical, diversified nursing soft skills training and control group received conventional nursing training only. The core competence, knowledge, operation skills and clinical competence of nurses in the two groups before and after training were measured and compared, and the satisfaction of doctors and patients in the two groups after training were observed. The scores of education and consultation, professional development, legal and ethical practice, interpersonal relationship, leadership, clinical nursing and critical thinking were compared between the two groups before the training (P>.05). After the training, however, the scores of abovementioned items in the two groups were higher than those before treatment, and compared with the control group, the scores in the study group were significantly higher (P<.05). Before the training, the scores of theoretical knowledge, operation skills and clinical competence of nurses in the two groups were compared (P>.05). After training, the scores of those items of nurses in the two groups were higher than those before treatment. Compared with the control group, the scores of theory, operation skills and clinical competence of nurses in the study group were significantly higher (P<.05). Moreover, the study group showed significant higher satisfaction of doctors and patients (P<.05). Hierarchical, diversified soft skills training in clinical nursing training programme obtained better outcomes in the core competence, knowledge, operation skills and clinical competence of nursing staff, and promoted the satisfaction of doctors and patients, which can be utilised for clinical practice.

424 Improving Interprofessional Teamwork in Plastic Surgery: A Novel Approach to Microsurgical Skills Training for Theatre Nurses

Abstract Aim Shared mental models between surgeons and scrub nurses allow them to effectively communicate with each other and react efficiently to intraoperative complications. Microsurgery poses unique challenges including the use of an operating microscope, fine instruments, and restricted views of the operative field. Our aim was to design and deliver a microsurgical skills session for theatre nurses and evaluate whether attendance influenced perceived understanding of microsurgery and ability in day-to-day role. Method A microsurgical training day for theatre nurses was delivered. This consisted of an introduction to and positioning of the operating microscope and three practical stations involving increasingly complex motor tasks, designed to highlight the importance of instrument handling and improve awareness of microsurgical challenges. Consultant plastic surgeons acted as scrub nurses to add an element of role-reversal. Qualitative and quantitative feedback was collected. Results Eight theatre nurses participated, all responded ‘strongly agree’ or ‘agree’ that the training was enjoyable, improved their understanding of microsurgery and was relevant and helpful to their day-to-day role. All attendees strongly agreed that they would partake in similar sessions in the future. Conclusions Role-reversal and skills-based training is a valuable tool in improving multidisciplinary collaboration in microsurgery. Increasing shared knowledge of complex procedures prospers effective teamwork and communication, which leads to improved efficiency and better patient care. Our study is a first step towards development of a standardized microsurgical skills course for theatre nurses and has broader implications for interprofessional education across all surgical specialties.

Spirituality in Daily Healthcare Provided in Brazil: Meanings and Practices of the Nursing Team

to understand the meanings and practices related to spirituality experienced by Nursing teams in the daily care provided in Oncology. qualitative research, guided by the theory of Holistic Nursing by Myra Levine, conducted with members of the Nursing team at an Oncology hospital in Brazil. Data collection was carried out in 2018, through an interview guided by a semi-structured script. Data analysis was performed using Lawrence Bardin's Content Analysis technique. two categories emerged: the first brought to light the meanings attributed to spirituality by the Nursing team and the second category presented the practices of spiritual care by Nursing personnel in their daily routine in Oncology, highlighting that professionals address spirituality with patients in different ways. the approach to spirituality in Oncology care and in the professional training of Nursing personnel is essential, as a way of providing holistic and humanized care, thus strengthening the psycho-spiritual dimension in daily care.

A pilot randomised controlled trial of patient education to improve umbilical cleanliness prior to laparoscopic surgery

Before laparoscopic abdominal surgery, surgeons frequently remove debris from patients' umbilici to prevent it from passing into the abdomen and optimise skin antisepsis. This task irritates the skin, takes time and contaminates sterile equipment. This pilot randomised controlled trial aimed to inform a definitive study investigating whether patient education improves umbilical cleanliness in these patients. To generate data on effect size and sample size, adult patients undergoing elective and emergency laparoscopic abdominal surgery were randomised to an intervention group, who received an education pack to clean their umbilicus prior to surgery, or a control group, who received no pack. Umbilical cleanliness was measured using a novel scale. To assess scale validity and reliability, all umbilici were scored by nine surgeons and surgical trainees using photographs and umbilici were swabbed to estimate bacterial load. Intervention acceptability was assessed via study consent and withdrawal rates and trial feasibility was evaluated using qualitative insights documented by investigators. Seventy-one percent (22/31) of the intervention group had clean umbilici versus 61% (19/31) in the control group. A definitive trial would require 712 participants to show statistical significance between study groups. The umbilical cleanliness scale had excellent interrater and test-retest reliability and a moderate degree of convergent validity with respect to bacterial load. The intervention was highly acceptable to participants, and theatre nurses and surgical trainees were central to trial feasibility. A definitive trial is warranted and would contribute to an evidence-based, standardised approach to preoperative care. Trial registration no. ACTRN12620000278932.