Professional Nursing Practice Research Articles

Omission of nursing care, professional practice environment and workload in intensive care units.

The present study aimed to characterize the omission of nursing care according to the nurses' perception, the professional practice environment and the nursing workload of intensive care units (ICU) in Brazil. Additionally, the influence of the practice environment and nursing workload on such omission was assessed, as well as the type of care omitted regarding priority classification. In order to ensure patient safety and quality of care, it is necessary to invest in improvements in nursing care practices. The present cross-sectional study was performed in three large ICU in Brazil. The omission of nursing care was identified using the MISSCARE-BRASIL instrument, and the environment and duration of professional nursing practice were analysed using the Practice Environment Scale (PES) and Nursing Activities Score (NAS), respectively. "Ambulation three times a day or as prescribed" was the form of care reported as the most omitted in the three studied units. The reasons for not performing care included the following: inadequate number of staff, inadequate physical blueprint of the unit/sector and the professional having more than one employment relationship. Upon characterizing the work environment in the ICU according to the PES, ICU 1 and 3 were considered "mixed" environments, whereas ICU 2 was considered a "favourable" environment. The professional practice environment, as well as the workload, may constitute predictive factors for the omission of care. The nursing workload and practice environment influence the omission of care. Moreover, the establishment of criteria for the prioritization of care when faced with adverse work conditions is necessary.

New graduate registered nurses’ experiences with psychological safety

The purpose of this study was to gain insight into new graduate registered nurses' experiences with psychological safety. Organizational learning allows acute care hospitals to consistently provide high-quality patient care. Psychological safety is critical for organizational learning. New graduate nurses in particular need to feel psychologically safe as they transition into professional nursing practice. Understanding new graduate registered nurses' experiences of psychological safety can guide leaders and others to create work environments that foster psychological safety and organizational learning. Semi-structured interviews were conducted with 13 newly graduated registered nurses working in inpatient hospital settings. Interviews were analyzed using thematic analysis. Four primary themes featured prominently in the new graduate nurses' experiences of psychological safety: building credibility, making personal connections, feeling supported and seeking safety. Understanding these themes will help nursing education programmes, nurse managers, nurse colleagues and new graduate registered nurses foster psychological safety and create environments conducive to organisational learning. All members of the health care team involved in the new graduate registered nurses' transition to practice have a role in fostering psychological safety. Additional research is needed to better understand psychological safety and how to foster it.

Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice.

The purpose of this article is to discuss the need to provide culturally sensitive care to the growing number of diverse health care consumers. A literature review of national standards and research on cultural competency was conducted and specifically focused on the field of nursing. This study supports the theory that cultural competence is learned over time and is a process of inner reflection and awareness. The domains of awareness, skill, and knowledge are essential competencies that must be gained by health care providers and especially for nurses. Although barriers to providing culturally sensitive care exist, gaining a better understanding of cultural competence is essential to developing realistic education and training techniques, which will lead to quality professional nursing practice for increasingly diverse populations.

Baccalaureate nursing students' experiences with multi-patient, standardized patient simulations using telehealth to collaborate.

Nurse faculty must utilize teaching strategies that promote student achievement of essential competencies, and simulation can provide experiential learning to help prepare students for professional practice. The purpose of this phenomenological qualitative study was to explore baccalaureate nursing students' experiences with multi-patient, standardized patient simulations that used telehealth to provide opportunities to learn and practice intra- and interprofessional collaboration. Student perceptions of their ability to utilize lessons from the simulations in clinical practice were also examined. Focus group interviews were conducted with 27 final-semester baccalaureate nursing students after they had participated in two telehealth-enhanced simulations. Analysis revealed five themes: Anxiety due to lack of experience, Improved clinical reasoning, Real world practice, How to communicate effectively, and Application to clinical practice. The use of telehealth helped overcome barriers to implementing collaborative simulations and provided students with experiential learning that addressed essential competencies for safe and effective professional nursing practice.

The delivery of compassionate nursing care in a tick-box culture: Qualitative perspectives from a realist evaluation of intentional rounding

BackgroundCompassion is integral to professional nursing practice worldwide and a fundamental value in healthcare. Following serious care failures at a healthcare provider in the United Kingdom, a government commissioned report (the Francis Report) made several recommendations for strengthening compassion in nursing care and consequently ‘intentional rounding’ was incorporated into nursing practice in the United Kingdom. Intentional rounding is a structured process implemented primarily in the United Kingdom, North America and Australia, whereby nurses conduct 1–2 hourly checks on every patient using a standardised protocol and documentation. ObjectivesTo examine the role of intentional rounding in the delivery of compassionate nursing care in England from multiple perspectives. MethodsThis paper reports qualitative findings from one phase of a realist evaluation of intentional rounding which used a mixed-methods approach. Individual, semi-structured interviews were undertaken with 33 nursing staff, 17 senior nurse managers, 34 patients and 28 family carers from three geographically spread case study hospital sites in England. Interviews elicited detailed reflections on the contexts, mechanisms and outcomes of intentional rounding and how it impacted the interviewee and those around them. ResultsThis study found little evidence that intentional rounding ensures the comfort, safety or dignity of patients or increases the delivery of compassionate care. The systematised approach of intentional rounding emphasises transactional care delivery in the utilisation of prescribed methods of recording or tick boxes rather than relational, individualised patient care. It has the potential to reduce the scope of nursing care to a minimum standard, leading to a focus on the fundamentals as well as the prevention of adverse events. Its documentation is primarily valued by nursing staff as a means of protecting themselves through written proof or ‘evidence’ of care delivered, rather than as a means of increasing compassionate care. ConclusionsThis large-scale, theoretically-driven study of intentional rounding – the first of its kind – demonstrates that intentional rounding prioritises data collection through tick boxes or a prescriptive and structured recording of care. Thus, intentional rounding neither improves the delivery of compassionate nursing care nor addresses the policy imperative it was intended to target. This study raises questions about the role, contribution and outcomes from intentional rounding and suggests a need for a wider, international debate within the nursing profession about its future use. If an intervention to increase compassionate nursing care is required, it may be better to start afresh, rather than attempting to adapt the system currently implemented.

Shared governance: a children's hospital journey to clinical nursing excellence.

Shared governance is examined through a framework for developing independent decision making in professional nursing practice and improving patient care outcomes. This study is designed to obtain a baseline measurement of the degree of shared governance in a selected children's hospital in Saudi Arabia. The study was guided by the Donabedian model. The Professional Nursing Governance Index was used. A total of 400 questionnaires were distributed to nurses working at the hospital, with a response rate of 77% (n = 307). Descriptive and inferential statistics were used for analysis. The results corresponded with those from nurses and managers in most subscales of the Index of Professional Nursing Governance (information, goals, resources, participation and practice). However, nurses working in the operating theatre and surgical unit have a perceived higher level of shared governance than those in critical care units and medical wards. The results could encourage shareholders and leaders in the nursing field to develop the perception of shared governance by adopting a shared governance model, which in turn might improve the quality of nursing care.

Magnet® Nurses of the Year Ignite Innovation.

Innovations in patient care, nursing, and the practice environment are the hallmark of Magnet organizations. Establishing new ways of achieving high-quality care is the result of transformational leadership, empowering structures and processes, and exemplary professional practice in nursing. From coast to coast, clinical nurses take advantage of these opportunities to change care for the better, improve the patient experience, and drive the science of nursing forward. American Nurses Credentialing Center's National Magnet Nurse of the Year Awards recognize and reward this work. Five outstanding clinical nurses are honored, 1 in each of the Magnet Model components: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes. This month's Magnet Perspectives column spotlights the 2019 award winners and their achievements and examines how Magnet environments support and encourage their success.

PROTOCOLO PARA USO SEGURO DE MEDICAMENTOS EM SERVIÇO DE TRANSPLANTE DE MEDULA ÓSSEA

Objetivo: elaborar e validar o conteúdo de protocolo para uso seguro de medicamentos.Método: pesquisa-ação realizada entre 2016 e 2017 em serviço de referência para transplantede células tronco-hematopoiéticas do Brasil. Estudo documental de eventos adversos e doperfil farmacológico subsidiou a elaboração o conteúdo amparado na literatura. Participaram31 profissionais de enfermagem do campo desta pesquisa em quatro encontros dos gruposde discussão, para aprimoramento do texto; a validação de conteúdo foi realizada por cincoespecialistas, com aplicação da Técnica Delphi.Resultados: dados relativos aos eventos adversos e perfil farmacológico subsidiaram a inclusão de139 medicamentos no protocolo. Este, composto por 18 capítulos, teve o conteúdo validado comÍndice de Validação de Conteúdo geral de 89% obtido em única rodada de avaliação.Conclusão: a construção participativa contribuiu para a elaboração de protocolo com conteúdoválido, compatível e aplicável na prática profissional de enfermagem com vistas ao uso seguro demedicamentos.

Perceptions of risk factors for phlebitis among Malaysian nurses.

Intravenous therapy is an integral part of professional nursing practice. Nurses have a responsibility to recognise risk factors for phlebitis. To investigate nurses' perceptions of risk factors for phlebitis in a tertiary teaching hospital in north-east Peninsular Malaysia. A cross-sectional study of 199 randomly selected nurses were surveyed for their perceptions of risk factors for phlebitis using a self-administered questionnaire. More than half of the nurses (56.8%) had a good perception levels of risk factors for phlebitis. There was a significant association between the clinical area and nurses' perceptions of risk factors for phlebitis (p=0.04). Nurses working in medical, orthopaedic, and surgical areas had slightly better perceptions than nurses working in multidisciplinary and oncology areas. These findings suggest that nurses need to continually improve their knowledge about risk factors for phlebitis to ensure safer nursing practice.

A taxonomy to assess the interaction between nurses and children: Development and reliability.

The aim of this study was to develop a valid and reliable instrument to assess the nurse-child interaction during medical or nursing interventions. Communication is an important competency for the professional practice of nurses and physicians. The nurse-patient relationship is fundamental for high-quality care. It has been suggested that if nurses have more skills to interact with children, care will be less distressing and less painful for the children. A qualitative observational psychometric study; the GRRAS checklist was used. In-depth video-analyses, taxonomy development (19 videos) and testing it is psychometric properties (10 videos). Three observers micro-analysed video recordings of experienced nurses changing children's wound dressing in a specialised Burn Centre. The nurse-child interaction taxonomy (NCIT) was developed to observe and score the interactional behaviour between nurse and child. The taxonomy has three main patterns: being considerate, attuning oneself, and procedural interventions, subdivided in eight dimensions. These dimensions contain 16 elements that can be observed and scored on a 7-point scale. Intra-rater, inter-rater reliability and agreement were good. This study shows that interaction between nurses and children can be assessed reliably with the NCIT by an experienced observer or alternatively, scoring by two observers is recommended. The development of the taxonomy is an important step to find evidence for the best way for nurses to interact with children during nursing interventions or medical events and as such, ultimately, contributes to providing the best care possible.

Registered nurses' perspectives on medically safe practices and sound ethical standards in aesthetic nursing: An interview study.

To explore the views of registered nurses experienced in aesthetic nursing regarding medically safe practices and sound ethical standards. Aesthetic nursing is an emerging field of modern-day healthcare encompassed within aesthetic medicine. There is a distinct lack of research regarding how registered nurses who specialise in this area of care view medically safe practices and sound ethical standards. This is important to explore, because, in the absence of mandatory regulations within the sector, and it is the aesthetic nurse's own obligation to uphold professional, medical and ethical standards. Qualitative study. Individual semi-structured interviews were conducted with 13 registered nurses who had worked in aesthetic nursing for at least two years. The interview transcripts were categorised using qualitative content analysis. The COREQ checklist was used to report the study. A main theme was generated during the analysis: Considering my professional, the clinic's and the patient's needs. The participants described that they considered medical and ethical aspects pertinent to their professional roles as registered nurses but also undertook practices in addition to what they already did as registered nurses, such as creating professional networks using social media. They also described the importance of establishing local medical and ethical guidelines for their clinics, and that they considered patients' individual needs such as using individual information relating to their patients' previous experiences. The study points to the positive tendencies of registered nurses in aesthetics to develop their own professional networks and create local medical and ethical guidelines until more robust mandatory regulations are in place. Considering that aesthetic nursing is a young industry, registered nurses are in an excellent position to utilise their professional networks and work with professional bodies to develop standards of professional nursing practice and education for this field.

Professional practice of nurses and influences on moral sensitivity

To understand the professional practice of nurses and their influence on the development of moral sensibility. A qualitative and descriptive study, conducted between November 2015 and February 2016 in the hospitalization units of the medical clinic of two large hospitals located in Belo Horizonte, Minas Gerais. 14 nurses participated. Data collection was done through interviews, guided by semi-structured scripts. The data were submitted to content analysis. Two categories emerged: Professional practice of the nurse: internal and external goods and Moral sensitivity and the interface with the professional practice of nurses. The development of the moral sensitivity of nurses is influenced by factors related to professional practice, such as interpersonal relations, ethical education and management activities. Final considerations: In the professional practice, moral sensibility is an integral part of the ethical decision-making process in services, being essential for quality care.

What is said and unspoken about the autonomy of a nurse: (dis) continuity in discourses.

to know how autonomy is constituted in the nurse's professional practice in the hospital context. Qualitative analytical study, based on Foucault's methodological theoretical framework. The empirical material consisted of articles published in the Revista Brasileira de Enfermagem and narrative interviews conducted with 18 nurses from a public hospital in southern Brazil. Data collection took place between December 2017 and May 2018, being analyzed through Foucauldian discourse analysis. Autonomy in the professional practice of nurses goes through the core of knowledge, the political positioning and the working conditions. These factors are revealed as power instruments in the construction of nurse governability. Final Considerations: It is believed that the investment focused on the debate of the nurse's autonomy interfaces could raise new attitudes about professional practice and favor the transformation of nursing practice.

Professional Autonomy of Nurses: A Qualitative Meta-Synthesis Study.

Background:Autonomy is the main element of professional practice in nursing. However, despite the many studies conducted on nursing autonomy, this concept is not fully understood and a comprehensive explanation of this concept in nursing is necessary. Meta-synthesis offers a way to increase the understanding of this concept using existing research findings. Thus, the present study aimed to explain the concept of professional nursing autonomy.Materials and Methods:This qualitative meta-synthesis was conducted based on a modified version of Noblit and Hare's meta-ethnography approach and qualitative studies on the concept of nursing autonomy published in databases such as PubMed, Scopus, Web of Science, Cochrane, SID, IranMedex, Magiran, and ScienceDirect in the past 15 years (2003–2018).Results:Thirteen articles that reported the experiences of nurses regarding professional autonomy were included in the research. Based on the meta-synthesis of findings, the final interpretation of the professional autonomy of clinical nurses was presented in the three themes of professional competence, professional decision making, and professional interactions.Conclusions:According to the results, the concept of professional autonomy is a developmental achievement based on patient-based professional competence along with self-reliance to provide the best care plan for the promotion of patients' health through the professional decision making and professional interactions with other professional team members.

Comprehensive care from the perspective of nurses: an ecosystem approach.

to verify nurses' perceptions about comprehensive care to human beings from the ecosystem perspective, with Therapeutic Touch use. an exploratory-descriptive, qualitative study, conducted with 11 nurses who use/used Therapeutic Touch in daily work. Data were collected through online semi-structured interviews and submitted to discursive textual analysis. The ecosystem framework was used. participants talked about the theme in a polysemic way, but understand that comprehensive care is associated with nursing professionals and intrinsic in their being and doing, considering the philosophical theoretical bases of nursing, which aim at the comprehensiveness of being. Therapeutic Touch was considered as a way to achieve comprehensive care caring to human being ins. The objective of the study was achieved; however, it is understood the need for other research to advance this knowledge and enable innovations in professional practice of nurses.

200 years of Florence Nightingale: contributions to the professional practice of nurses in hospitals.

Analyze the agreement of nurses, who work in hospital institutions, about Florence Nightingale's conceptions about nursing, people, health and the environment. Quantitative, observational and cross-sectional study, with the participation of 3,451 nurses from 36 Portuguese hospitals. Data collection took place from July 2015 to March 2016, using a questionnaire. For analysis, descriptive and analytical statistics were used. It was evident that 60% to 70% of participating nurses considered that Florence Nightingale's conceptions of nursing, person, health and environment were partly in agreement or totally in agreement with their practice. The variables that influenced agreement were: service, condition in which they practice the profession, length of professional practice, academic degree and region of the country. Florence Nightingale's conceptions continue to contribute to professional nursing practice, with the region and the service significantly influencing this continuity.

Development of the Emergent Theory of Aesthetic Nursing Practice (AesNURP)

Theory is necessary to science and science grounds legitimate and essential practice. This is true for Nursing as a discipline of knowledge and a practicing profession. Nevertheless, should all science or research within a scientific field be focused on theoretical development and testing? Currently, various nursing theories exist to describe and explain the phenomena of nursing. Often, the development of nursing theory is in response to advancing ontologies and epistemologies of nursing. The advent of technology is one of these advances challenging the professional practice of nursing. How will nursing practice be made visible and realistic in the face of traditional nursing care practice? Nursing practice processes, derived from theories of nursing, provide opportunities for demonstrating practice grounded in the science of nursing. The purpose of this article is to describe the development of the emergent theory of Aesthetic Nursing Practice, focus on illuminating caring for person through the process of encountering, co-creating caring relationships, and meaningful engaging between the nurse and nursed through caring encounters occurring in caring situations. Five assumptions and a model of practice are described. As a contemporary theory of Nursing, it describes caring for persons who remain wholes and enhance their well-being.

Strategic directions for strengthening nursing and midwifery: potentialities and connections in the complex perspective.

Objective:to understand from the complex perspective the connections established between the Strategic Directions for Strengthening Nursing and Midwifery, delimited by the World Health Organization; to discuss the implications of these strategies for the investment of human resources in nursing and midwifery, with a view to strengthening the technical health capacity to face global health demands.Method:a documentary research, carried out from official WHO documents, from September to October 2019. A categorical analysis technique was performed, and the interpretation of the data was achieved based on the theoretical framework of Complexity.Results:three interdependent categories were defined, namely: challenges for the training of human resources in nursing and midwifery in order to meet the needs for global health; challenges for the development of the work of nursing and midwifery professionals in different contexts of practice; challenges for governments, leaders and health services to strengthen human resources in nursing and midwifery.Conclusion:the strategic directions corroborate the complex perspective because they value multidimensionality in the challenges for the professional practice of nurses and obstetricians. However, these challenges are also related to contextual, political, and leadership factors.

Quality indicators of professional practice of nurses

Introduction: Quality in health is one of the key requirements that clients demand. To improve their practice nurses use quality indicators as an important strategy for assessment and changes in care. Objective: To identify the indicators that nurses of Integrated Continuous Care at Home Teams consider adequate to monitor the quality of their professional practice in the ambit of the caregiver. Methods: Qualitative, descriptive and cross-sectional study. Data collection using a semi-structured interview, recorded in audio, to a focus group of 11 nurses. The information was analyzed using Bardin's content analysis technique. Results: Identified 32 indicators, related to the acquisition of cognitive and instrumental skills necessary to meet the needs of the dependent person in self-care. Conclusion: The identified indicators are related to the process and outcomes of the Donabedian’s triad and highlights the importance of using a standardized terminology in nursing.

Perception of Nursing Student about Integrating Standardized Nursing Language into the Nursing Curriculum at Two Nigerian Universities

Standardised nursing language is needed in contemporary nursing practice and education to plan, deliver and communicate the contribution of professional nursing practice to other nurses, health care providers, and health consumers. This study assessed the perception of the nursing students about integrating standardised nursing language (SNL) into the nursing curriculum; nursing students’ awareness of the SNL, differences between the institution of the participants and their perception; as well as differences between the institution of the participants and their level of awareness about SNL. A cross-sectional research design was adopted. The participants were recruited by using the convenience sampling technique. Data were collected via self-structured questionnaires whose validity and reliability had been previously ascertained. The data collected were analysed, using the Statistical Package for Social Sciences (SPSS), version 20.0. Results showed that the majority of the nursing students that participated in the study were female (86.7%). Also, the majority (74.2%) were aware of SNL. While 58% had a very good perception that SNL is important and should be offered as part of their course system in the institution, only 60.6%, 13.3%, and 11.0% believed it should be offered at undergraduate, postgraduate, and other courses respectively. Further, there was no significant difference in the respondents’ institution and their perception while the respondents and their level of awareness were statistically significant, respectively.