Professional Care Practices Research Articles

Foster care breakdown in adolescence: A retrospective view of young individuals on their experiences

Summary Placement with a foster family is one of the care arrangements available for children who cannot live at home. Many of those in foster care are teenagers. The complexity of the development during adolescence poses major challenges and may ultimately lead to what is known in the literature as “foster breakdown.” Most of the research in this area focuses on the point of view of social workers or foster parents. The current study examines this experience through a retrospective view of those who were teenagers at the time of foster care breakdown. To this end, semi-structured interviews were conducted with 14 Israeli young individuals (16–30 years old) who had experienced foster breakdown at various stages of adolescence. Findings The findings paint a complex and multidimensional picture of breakdown. While most of the interviewees described it as a sudden, unexpected event, closer examination revealed a dynamic process of collapse. This process comprised various factors, including those associated with the welfare system, the foster family, and characteristics related to the developmental stage of adolescence of the research participants. The combination of these factors led to the premature termination of the foster arrangement. Applications This study opens a window to the complex experience of foster breakdown in adolescence, an issue that has received very little research attention thus far. Understanding the dynamics of foster breakdown from the perspective of young individuals can improve professional foster care practices and policy and can benefit social workers in their work with foster families.

Development and validation of clinical implementation methods for patient-reported outcomes in Japanese multi-center palliative care units

BackgroundPatient-Reported Outcomes (PROs) are recommended for use in clinical oncology. However, they are not routinely used in professional palliative care practices in Japan. The reasons include both patient and healthcare provider factors and the implementation of PROs. This study aimed to develop and validate clinical implementation methods for PROs in Japanese palliative care units.MethodsThe Consolidated Framework for Implementation Research (CFIR) was conducted with four palliative care units in Japan. The study was conducted in six steps: unit assessment, development and implementation of a PRO implementation plan, PRO post-implementation survey and analysis of its utilization, a review of the PRO implementation process, creation of a PRO implementation method in a palliative care unit, and use and verification of the implementation method. Steps 1–5 were the development phase, and step 6 was the verification phase.ResultsInterviews were conducted with healthcare providers prior to PRO implementation. Intervention characteristics, patient needs in the palliative care unit, and factors related to the organization were identified as barriers. The implementation plan was developed, and the core members were selected. The implementation procedures were created in the above mentioned steps. PROs were used in the palliative care units. The same was true in the validation phase.ConclusionsThis study guided PROs in specialized palliative care unit in a clinical setting. The method was developed and validated for the implementation of PROs in the palliative care unit. In the PRO implementation process, it was important to assess the unit, address the barriers to implementation, and reduce the burden on healthcare providers. Furthermore, healthcare providers had to be supported by the champion, a person responsible for the implementation of PROs in the palliative care unit.

Teaching psychiatric nursing with films during the COVID-19 pandemic: A qualitative study.

Interactive learning environments are known to be among the most effective methods used in education. Some of the interactive methods used in psychiatric nursing education are simulations, group discussions, case studies and video and film presentations. In psychiatric nursing education, cinematic films are among the online methods used. It is known that films used in psychiatric nursing education are useful for understanding mental disorders, the nurse-patient relationship, the roles of the nurse and the therapeutic environment. The COVID-19 pandemic deeply affected nursing education, and the difficulties faced gave rise to many new perspectives. After this period, it is of prime importance to update the nursing curriculum and develop new strategies in clinical practice. Teaching with films can help students to understand people's feelings, make sense of them and empathize. This method can have an emotional impact on student nurses and take learning to a deeper level beyond simple theoretical understanding. The findings of the study suggest that teaching through film is an effective method that can be used practically in psychiatric nursing education. Standardizing these practices may be an effective strategy for developing students' professional identity as nurses. This study is focused on undergraduate students, but has implications for nurses in continuing education and professional development of nurses in developing a positive perspective towards psychiatric patients, increasing self-awareness and reducing prejudices. INTRODUCTION: The COVID-19 pandemic affected many areas of life and had a negative effect on education. This study investigated the impacts of using film as a method of education in students who were taking Psychiatric Nursing class during the COVID-19 pandemic, examining how this method contributed to theoretical and clinical practices of the students, their personal development and their viewpoint on psychiatric patients. This study adopted a qualitative research design. The study data were collected from 15 nursing students in June 2022. Interviews were conducted, audiotaped and transcribed verbatim. The method of education via film made contributions such as better theoretical understanding of the subjects taught, acquisition of analytical thinking skills and greater awareness of professional nursing skills and care practices. The students developed their professional perspectives, and their motivation increased. Using film is effective and practical when used in psychiatric nursing education. Standardizing these practices may be an effective strategy for developing students' sense of their identity as professional nurses. This study relates directly to undergraduate students and also has implications for nurses undergoing continuing education and professional development.

Abstract WP166: Bleeding Risks Among Hemorrhagic Stroke Patients Started on Serotonergic Antidepressants During Subacute Recovery

Background: Early initiation of antidepressants (ADs) are associated with improved functional recovery, but are associated with an increased risk of major bleeds among hemorrhagic stroke (HS) patients. Our objectives were to determine if increased bleeding risk remained if ADs were initiated during subacute recovery and if bleed risks were comparable between AD classes. Methods: A cohort of AD naive first time HS patients (ICD-10 codes 160-162) were identified from Electronic Medical Records of 70 large healthcare organizations (2003-2023). Patients without AD use were considered “No AD” whereas patients started on ADs during subacute recovery (i.e., at least 3 months after the indexed HS) were grouped as Selective Serotonin/Serotonin & Norepinephrine Reuptake Inhibitors (SSRI/SNRI) or “Other AD” (i.e., Mirtazapine, bupropion, trazodone, or tricyclic ADs). Baseline differences were adjusted for using 1:1 matched propensity score (PS). Outcomes included the 1-year risk of a major bleeding event (e.g., gastrointestinal/intracranial bleed or shock), recurrent HS, fall, ischemic stroke (IS) and death Results: The cohort consisted of n=257,595 patients split into 3 groups: No AD (n=250,103), SSRI/SNRI (n=4,180) or Other AD (n=3,312). Matching resulted in good covariate balance for both the SSRI/SNRI vs. No AD (n=8,250 patients) and Other AD vs. SSRI/SNRI (n=6,380 patients) comparisons. SSRI/SNRIs (vs. No AD) were associated with a 33% increase in the risk of a major bleed (RR: 1.33, 95%CI: 1.22-1.45) and significantly higher risks of recurrent HS, fall, IS and death. There were no significant differences in adverse outcomes between AD classes. Discussion: Increased risk of major bleeds and recurrent HS remains if ADs are started during subacute recovery, a time period which aligns with community-based recovery. Our findings may inform care practices of primary care providers and rehabilitation professionals to decrease preventable adverse outcomes.

The Impact of Qualification and Hospice Education on Staff Attitudes during Palliative Care in Pediatric Oncology Wards-A National Survey.

Our knowledge about the attitudes of healthcare staff to palliative care in pediatric oncology is scarce. We aimed to assess their perceptions of palliative care in Hungary and find answers to the question of how to provide good palliative care for children. Physicians (n = 30) and nurses (n = 43) working in the field of pediatric oncology (12 of them specialized in hospice care) were interviewed. Palliative care practice (communication, integration of palliative care, professionals' feelings and attitudes, and opportunities for improvement) was assessed by semi-structured interviews evaluated in a mixed quantitative and qualitative way by narrative categorical content analysis and thematic analysis. All providers displayed high negative emotions, positive evaluations, and used many active verbs. Nurses showed higher levels of denial, more self-references, and were more likely to highlight loss. Physicians emphasized the importance of communication regarding adequate or inadequate palliative care. Hospice specialists showed a higher passive verb rate, a lower self-reference, a lower need for psychological support, and a greater emphasis on teamwork and professional aspects. Our results show that nurses are more emotionally stressed than doctors in palliative care in pediatric oncology. To our knowledge, a study comparing doctors and nurses in this field has yet to be carried out. Our results suggest that pediatric oncological staff can positively evaluate a child's palliative care despite the emotional strain. Regarding hospices, professional practice in palliative care may be a protective factor in reducing emotional distress and achieving professional well-being.

Health professional assisted Kangaroo mother care practice in Ethiopian health care facilities: evidence from the 2016 Ethiopian demographic and health survey

BackgroundWorldwide, 15 million children born prematurely every year and over one million of them died because of prematurity caused complications. However, three-fourths of deaths from preterm related complications are preventable by using Kangaroo Mother Care (KMC). The Ethiopian government has been implementing a guideline that declares putting all low birth weight neonates at KMC. The aim of this study was to assess health professionals’ assisted KMC practice and its associated factors among Ethiopian mothers who gave birth at health facilities.MethodologyThis study used the 2016Ethiopian Demographic and Health Survey data (EDHS). The 2016EDHS used a stratified two stage sampling method to select a representative sample using validated questioner. The sample we used in this study after cleaning the children’s data set from the 2016EDHS was 2,960. Logistic regression model was used to assess the association of health professional assisted KMC practice and predictor variables.ResultsMothers who gave birth in health facilities and practiced kangaroo mother care were 1808(62.1%). In the multivariable logistic regression analysis, women from poorest (AOR, (95%CI)), (0.60, (0.43, 0.81)) and poorer (0.62, (0.46, 0.86)) socio-economic status were not practicing KMC.ConclusionsThe coverage of health professional assisted KMC practice was far lower than the expectation for mothers who gave birth in health facilities (100%). Low socio-economic status was associated with not practicing KMC. A further study on why mothers from low wealth index did not practicing KMC while they were in health facilities may be needed.

When the clinic becomes home: on the limits of kinship care in an eating disorder treatment centre in Italy

Drawing on fieldwork in a public residential facility for eating disorders in central Italy, the paper examines the relational temporalities of therapeutics by looking at how time affects treatment at the intersection of professional and family care practices. In arguing that ‘chronic cases’ put into question the specific kind of kinship care that is at the basis of treatment, the paper contributes to the anthropological literature on eating disorders by bringing time under the analytical lens, and to the literature on ‘chronicity’ by complicating simplified assumptions about structural care problems. In addition, the paper draws on and goes beyond anthropological works that have highlighted the potentially harmful side of kinship – including those that have explored how kinship can be framed as a source of mental distress and at the same time as a therapeutic tool. Kinship as a therapeutic tool here becomes risky because professionals need to borrow from kinship practices in their own work with patients, balancing those with the necessary clinical detachment. The paper shows that the time chronic patients need in residential treatment generates a particularly complex mix between what is seen as ‘functional’ and what is seen as ‘dysfunctional’ in kinship care, because the ‘efficacy’ of the kinship work that is at the basis of treatment rests on that being partial and temporary. Long term care in the facility complicates what otherwise allows clinical detachment: the treatment team ends up literally substituting the patient’s family, with professional and family care mixing ‘too much’ with one another.

Racionalidades teórico-metodológicas no cuidado aos familiares de pessoas com transtornos por uso de álcool

Abstract Objective: The present study aims to understand the theoretical-methodological rationales which guide psychological care practices for family members of people with alcohol use disorders. Method: For this theoretical-reflective study we conducted a systematic search for literature review articles to learn about the modality of interventions, their theoretical-methodological frameworks and clinical or efficacy results. Afterwards, a complementary search for articles and book chapters was conducted to map and analyze the most used professional care practices and their theoretical assumptions. Results: We identified six theoretical-methodological rationales that guide the professional’s clinical reasoning in caring for family members, which are organized around key concepts about their emotional suffering: 1) family stress; 2) family dynamics; 3) behavioral repertoire deficit; 4) codependency; 5) inflexibility; 6) potential for psychological change. Conclusion: The identification of these rationales can aid professionals when planning their practices in a critical and informed manner.

Achieving 6th Magnet Designation via Virtual Visit during the COVID-19 Pandemic

Despite the challenges encountered with the arrival of the COVID-19 pandemic, Baptist Hospital of Miami achieved the prestigious American Nursing Credentialing Center Magnet 6th designation. We describe the journey including writing the documents, preparing for the virtual visit, and efforts from key stakeholders to support the virtual site visit with the use of technology, to hold videoconferencing and tours “on wheels.” Nurses showcased their professional practice and excellence in patient care through exemplars and narratives presented during the virtual visit. Last, we provide recommendations for success to organizations contemplating a virtual site visit.

Work and practices of nursing in Primary Health Care in the state of Paraíba – Brazil: professional profile and care practices in the care dimension

RESUMO O trabalho de enfermagem envolve as dimensões assistencial e gerencial, refletidas na produção das ações de cuidado na atenção aos indivíduos, famílias e comunidades. Objetivou-se analisar o processo de trabalho de enfermagem da Atenção Primária à Saúde (APS) na Paraíba, considerando-se o perfil profissional e as práticas cotidianas individuais desenvolvidas por enfermeiras(os) na dimensão assistencial. Estudo de abordagem quantitativa, realizado nos serviços da APS na Paraíba entre novembro de 2019 e agosto de 2021. A análise dos dados quantitativos foi feita por meio do software SPSS® (Statistical Package for the Social Sciences), versão 21.0 para Windows®, mediante análise estatística descritiva e inferencial. Os resultados, evidenciaram dentre outros aspectos, que 93,3% dos profissionais são do sexo feminino; no que se refere à formação profissional, a especialização foi a modalidade de titulação mais realizada pelos profissionais pesquisados; dentre as práticas analisadas, a consultas pré-natal foi considerada a mais resolutiva, na percepção de 388 (84%) profissionais pesquisados. Conclui-se que referente ao perfil sociodemográfico, predomina o sexo feminino dentre as(os) enfermeiras(os) pesquisadas(os), quanto à formação, há necessidade de qualificação em níveis residências e de pós-graduação stricto sensu. Na dimensão assistencial, a consulta de enfermagem no pré-natal, como uma prática resolutiva do cuidado na APS na Paraíba.

The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada

BackgroundFamily practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care.MethodsThis mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses’ time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results.DiscussionThis project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.

Professional identity and care practice in adolescent psychiatry

In psychiatric wards, nurses are an essential professional group in institutional and hospital life. In full hospitalization units for adolescents with psychological disorders, their professional identity is constructed in a care approach, at the crossroads of care and education. Motivated by individuation and by a feeling of collective and institutional belonging in their care practices, this identity construction seems to be beneficial for the patients since it isreinvested in the therapeutic relationship between caregiver and patient.

Nutrition Care Practices of Dietitians and Oral Health Professionals for Oral Health Conditions: A Scoping Review.

Background: Oral health conditions, such as dental caries, pose a substantial burden worldwide. Although there are many risk factors for poor oral health, diet is often implicated as a cause of these issues. The purpose of this scoping review was to identify and map studies that have captured information on the “real-world” nutrition care practices of oral health professionals (OHPs) and dietitians to optimize oral health, and specifically the dentition and periodontium. Methods: A search of peer-reviewed articles was conducted using MEDLINE, CINAHL, and Embase. Articles that addressed the review objective and met the following criteria were included: English language, published since 2000, and study conducted in a high-income country. Results: Overall, 70 articles were included. Most articles reported on cross-sectional survey studies and provided self-reported data on OHP practices; few articles reported on dietitians. Most articles reported only general/unspecific information on assessment and intervention practices, such as dietary analysis, nutrition counselling, and diet advice, and lacked specific information about the care provided, such as the dietary assessment tools used, type of information provided, and time spent on these activities. Barriers to the provision of nutrition care by OHPs were common and included time and lack of remuneration. Few studies reported on collaboration between dietitians and OHPs. Conclusions: Several studies have captured self-reported information on nutrition care practices of OHPs related to oral health; however, there is limited information available on the details of the care provided. Few studies have examined the practices of dietitians.

Periodontal disease progression in the second half of life and following a single episode of scaling and root planing: A clinical study in the Sri Lankan tea plantation cohort with documented clinical parameters for more than 40 years.

To evaluate periodontal disease progression (PDP) and potentially detectable effects of a single episode of scaling and root planing (se-SRP) in subjects lacking professional dental care and oral hygiene practices for >40 years. In 2013, se-SRP was offered to all available subjects from the original cohort of 480 males initially established in 1970. From a total of 75 attending the previous examination in 2010 (baseline), 27 consented to receive the intervention while 18 declined and served as controls. Clinical data were recorded again in 2014 (follow-up) similarly to the previous surveys (1970 to 2010). Subjects' mean age in 2010 was 62.5 (± 3.6, test) and 61.9 (± 3.8, control) years. At follow-up, both groups presented with elevated tooth loss of 1.2 (from 15.5 ± 9.0, test) and 1.5 (from 17.9 ± 6.6, control) resulting in 1,392 (test) and 1,061 (control) sites available for further analysis. In both groups, clinical attachment level (CAL) loss and probing depths (PD) deteriorated. PD increase of 0.22mm (± 1.70) in the test group was significantly higher compared with the control group (0.08mm ± 1.30) (P<0.0001) demonstrating unaffected PDP. Computed estimates of further PDP revealed CAL and PD reductions in subjects aged ≥40 years. Specifically, the latter was positively correlated with tooth loss in subjects aged ≥40 years (P=0.69, P=0.0012) and ≥50 years (r=0.62, P<0.0001). se-SRP in previously untreated periodontitis subjects aged ≥50 years may be ineffective in reducing PDP thus demanding advanced preventive measures, treatment in the first half of life, and sustained access to supportive care.

Significance of Home Visiting in Providing Care to Filipino Mothers and Their Infants During the Postpartum Period.

Home visiting is recommended for mothers and young infants during the first week of life to provide needed support. This study describes the significance of home visiting in providing care to Filipino mothers and their infants during the postpartum period. Using a descriptive qualitative design, individual interviews were conducted with 10 mothers, four registered nurses, and five barangay health workers involved in home visits. Data analysis was guided by the four phases of Leininger's ethnonursing method. Three themes emerged: (1) home visiting provides accessible, affordable, and meaningful interventions; (2) home visiting allows for contextual understanding of mothers' behaviors and realistic planning of care; and (3) barangay health workers promote mothers' engagement in care. Home visits enable negotiation of differences between generic and professional care practices, thus enhancing professional collaboration with families and community workers, potentiating culturally congruent participation and empowerment of clients in their care.

Towards a relational conceptualization of empathy.

Empathy is a fundamental concept in health care and nursing. In academic literature, it has been primarily defined as a personal ability, act or experience. The relational dimensions of empathy have received far less attention. In our view, individualistic conceptualizations are restricted and do not adequately reflect the practice of empathy in daily care. We argue that a relational conceptualization of empathy contributes to a more realistic, nuanced and deeper understanding of the functions and limitations of empathy in professional care practices. In this article, we explore the relational aspects of empathy, drawing on sources that offer a relational approach, such as the field of care ethics, the phenomenology of Edith Stein and qualitative research into interpersonal and interactive empathy. We analyse the relational aspects of three prevalent components of empathy definitions: the underlying ability or act (i.e. the cognitive, affective and perception abilities that enable empathy); the resulting experience (i.e. empathic understanding and affective responsivity) and the expression of this experience (i.e. empathic expression). Ultimately, we propose four inter‐related understandings of empathy: (a) A co‐creative practice based on the abilities and activities of both the empathizer and the empathee; (b) A fundamentally other‐oriented experience; (c) A dynamic, interactive process in which empathizer and empathee influence each other's experiences; (d) A quality of relationships.

ETHNONURSING: CULTURAL CARE IN A MAPUCHE COMMUNITY IN PUERTO AGUIRRE, AYSÉN, CHILE

ABSTRACT Objectives: to understand the beliefs, expressions, and practices of generic care used by the Mapuche community in Puerto Aguirre and acknowledge the professional care offered to promote health. Method: a qualitative research based on ethnonursing carried out during seven trips to Puerto Aguirre between July 2018 and January 2019. A total of seven key informants and seven general informants were interviewed. Information was collected through observations, field notes, conversations, and interviews. Results: the scientific property of ethnonursing was verified. Three themes that structure the cultural care practices in the studied community emerged: Mapuche identity as the main value to preserve cultural care; The essesntial presence of women to carry out meaningful experiences and care practices among the Mapuche; and Mapuche value and use of cultural and professional care practices to promote health. Conclusion: the research recognizes the full validity of the Cultural Care Theory. Nursing and, in general, the different health professions tend to become popular, and professional knowledge is complemented, thus learning and improving cultural care in the community.

Discriminación social y conducta sexual de hombres que tienen sexo con hombres en América Latina: Una revisión sistemática

Introducción: los hombres que tienen sexo con hombres (HSH) son víctimas de discriminación, lo cual los lleva a presentar conductas sexuales de riesgo. Objetivo: examinar la evidencia disponible sobre la asociación entre discriminación social y conducta sexual de riesgo en HSH de América Latina con y sin diagnóstico de VIH/sida. Metodología: se realizó una revisión sistemática siguiendo los lineamientos PRISMA. Los criterios de inclusión fueron artículos de investigación en inglés y en español, sin restricción con respecto a los años de publicación; se construyeron cadenas de búsqueda. Las bases de datos utilizadas fueron: CONRYCIT, EBSCO, PUBMED, WEB OF SCIENCE, SCOPUS, CINAHL y ProQues. Resultados: se incluyeron 12 estudios publicados entre los años 2000 a 2014. La evidencia científica sugiere que los participantes con y sin VIH/sida sufren algún tipo de discriminación que se relaciona con el coito anal sin protección. Conclusión: se encuentra una falta de modelos explicativos que orienten de mejor manera la práctica de cuidado profesional.

Unresponsive wakefulness syndrome: Outcomes from a vicious circle.

Unresponsive wakefulness syndrome: Outcomes from a vicious circle.

Rise Above: Experiences of Spirituality Among Family Caregivers Caring for Their Dying Family Member in a Hospice Setting in Pakistan.

Family caregivers experience multiple transitions, resolutions, loss, and grief where their search for meaning becomes evident. Spirituality is an important dimension of palliative care, yet little attention has been given to this important aspect of spirituality especially among the family caregivers in a hospice setting. The study aimed to bring the hidden voices of family caregivers, their own spiritual experiences caring for their dying patients in a hospice setting, to guide and direct the care practices of health care professionals. An interpretive descriptive approach guided the study using a purposive sample of 18 family caregivers from a hospice in Karachi, Pakistan. Major themes were family love, attachment, and belongingness; honoring family values and dignity; acts of compassion and selfless service; and seeking God's kindness and grace. Spirituality enabled family caregivers to uncover meaningful engagement and provided strength and peace while serving a dying family member in challenging caregiving situations such as adversity and limited resources. They highly valued the love, respect, and honor of the family; showed compassion; believed in God's blessings; and experienced spiritual growth and self-transcendence. Spirituality was found to be a major resource of coping among family caregivers. Health care professionals need to integrate spirituality while developing family-centered interventions in hospice care.