Nursing Strategies Research Articles

Application of Individualized Nursing Strategy in Perioperative Nursing

Application of Individualized Nursing Strategy in Perioperative Nursing

Preceptorship as part of the recruitment and retention strategy for nurses? A qualitative interview study.

To explore aspects that are important for the integration of preceptorship and processes for recruitment and retention of nurses. The shortage of nurses is a global concern that has a major impact on health care systems around the world. However, earlier research has not considered whether preceptorship of nursing students can be an integral part of recruitment and retention of nurses. A descriptive design with a qualitative approach was used. Semi-structured interviews were conducted with ten preceptors and six ward managers in different health care specialties in Sweden. Three aspects were found central for integrating preceptorship with recruitment and retention: perceptions of preceptorship, the organisation of preceptorship and the way preceptorship operates in relation to recruitment and retention strategies. The findings suggest that preceptorship and recruitment strategies could both benefit from being integrated. It is central for nursing managers to develop organisational practices that enable the integration of preceptorship with recruitment and retention of nurses. This could increase the quality of both preceptorship and the work environment in general.

Analysis of the influencing factors and nursing strategy for acute atelectasis after traumatic brain injury surgery.

Acute atelectasis is common after traumatic brain injury (TBI), but the related factors and treatment are still unclear. This study is to analyze the independent risk factors for acute atelectasis after TBI and propose an interventional nursing strategy, in order to correct respiratory function and improve the prognosis of patients. The clinical data of 93 patients with TBI admitted to our hospital from April 2015 to October 2019 were retrospectively analyzed. Clinical data were analyzed by single factor analysis, the cutoff value of influencing factors was obtained by receiver operating characteristic (ROC) curve analysis, and the influencing factors for acute atelectasis after TBI were examined by multi-factor logistic regression. Twenty-two patients (23.66%) were complicated with acute atelectasis during the observation period, while the remaining 71 patients (76.34%) did not have acute atelectasis. Univariate analysis showed that there were significant differences in the Glasgow Coma Scale (GCS), history of vomiting and aspiration, mannitol use, mechanical ventilation, hypoalbuminemia, and serum hypoxia-inducible factor-1α (HIF-1α) between the acute atelectasis group and the non-acute atelectasis group (P<0.05). The AUC area of HIF-1α level predicting acute atelectasis was 0.896 [95% confidence interval (CI): 0.814-0.978, P=0.042], and the cut-off value was 2.12 mmol/L, with a sensitivity of 76.9% and a specificity of 93.3%. Logistic regression analysis showed that a history of vomiting and aspiration [odds ratio (OR) 3.908, 95% confidence interval (CI): 1.201-12.712], mechanical ventilation (OR 3.250, 95% CI: 1.139-9.271), hypoalbuminemia (OR 5.741, 95% Cl: 1.926-17.113), and HIF-1α ≥2.12 mmol/L (OR 6.623, 95% CI: 2.364-16.346) were independent risk factors for acute atelectasis after TBI. A history of vomiting and aspiration, mechanical ventilation, hypoalbuminemia, and high expression of HIF-1α are all independent risk factors for postoperative acute atelectasis in patients with TBI. In clinical practice, patients should be guided to swallow properly, breathe smoothly, eat well, and regularly check the relevant indexes.

Working alliance among mental health nurses in Indonesia: A comparative analysis of socio-demographic characteristics.

Working alliance between therapist and client in psychotherapy practice has become proven to compensate for a significant difference in various psychotherapy modalities. However, few studies have investigated the structure of alliance in the context of nurses working at mental health hospitals in Indonesia. This study aimed to compare the working alliance of mental health nurses according to socio-demographic characteristics. A cross-sectional research was performed at the Mental Health Hospital in West Java, Indonesia, as a referral hospital in Indonesia from May to December 2019. The inclusion criteria were nurses with a minimum of one year of working experience and a Diploma III certificate in nursing. Convenience sampling was used to recruit 120 nurses who agreed to join in this study. The working alliance was measured using Working Alliance Inventory-Short Revised-Therapist (WAI-SRT). The majority of the respondents were female (77.5%), holding a Diploma III degree in nursing (49.17%), having working experience ranged from 11 to 15 years (34.17%), and working at the chronic unit (32.5%). The mean score of the working alliance was 44.46 (SD = 11.32). The domain of agreement on goals had a higher mean score (17.65 ± 3.45), followed by the task domain (16.56 ± 5.81) and bond domain (22.10 ± 7.23). There was a significant difference in working alliance according to education level and working experience (p < 0.05), while no significant differences in terms of gender and working unit. Mental health nurses with higher education levels and more vast working experience had higher working alliances. Thus, nurse managers and hospital policymakers should provide Continues Nursing Education (CNE), working alliance training, and therapeutic strategies for nurses to improve their working alliances. It is also essential to cooperate with nursing schools to include working alliances as learning objectives.

Workplace Stressors and Coping Strategies of Intensive Care Unit Nurses at University Teaching Hospitals, in Rwanda

Background&#x0D; Nursing is widely known as a stressful profession but intensive care unit is the most stressful; when nurses fail to cope with workplace, stresses’ complications such as burnout and depression ensue, and this can compromise the quality of nursing care. In Rwanda, there is a limited literature about workplace stress and coping strategies.&#x0D; Research objectives&#x0D; To assess the workplace stress and coping strategies of intensive care unit nurses at University Teaching Hospitals.&#x0D; Methodology&#x0D; This study used a cross-sectional study design, recruited 92 ICU nurses through the census sampling method; ENSS and Brief COPE Inventory, while SPSS was used for data analysis. &#x0D; Results&#x0D; Eighty percent experienced moderate to high stress, while 19.6% had low stress. Married nurses tend to experience high stress than singles, while those with Bachelors or Master’s degree were less likely to be stressed. Main stressors are care for suffering/dying, or agitated patients; and heavy workload, while main coping strategies were alcohol use, emotion support from friends and religion comfort.&#x0D; Conclusions&#x0D; Nurses experience workplace stress, while workplace stressors are nursing care for suffering/dying or agitated patients and heavy workload. The coping strategies were alcohol use, emotional support and comfort from religion.&#x0D; Rwanda J Med Health Sci 2021;4(1):53-71

Operational nurse managers' perceptions on the competence of community service nurses in public settings in the Western Cape.

BackgroundCommunity service nurses placed in the Western Cape Government public health facilities render essential healthcare to underserved populations. Anecdotal evidence from operational nurse managers indicated concerns that community service nurses may lack competence in basic required nursing competencies.ObjectivesTo investigate operational nurse managers’ perceptions of the competence of community service nurses in public health facilities in the Western Cape.MethodA quantitative survey was conducted with an all-inclusive sample of 297 operational nurse managers in the Western Cape. A self-administered questionnaire with 65 questions with a 4-point rating scale was used to rate perceived competence of community service nurses across the South African Nursing Council (SANC) competencies. Descriptive and inferential statistics were calculated per competency domain.ResultsThe survey (response rate: 59%) showed that the operational nurse managers perceived the community service nurses to be competent in the clinical patient care domain and mostly either developing proficiency or proficient in the SANC competencies of legal framework and ethical practice, interprofessional relationships, leadership, quality management and management competency domains.ConclusionCommunity service nurses were found to be competent in the clinical patient care, possibly because of the integration of theory and practice focus of work-integrated learning in the programme. Education and practice supportive strategies for community service nurses should be developed to support the successful transition from students to community service nurses, especially around the development of research and critical thinking skills.

Portuguese Nurses' Stress, Anxiety, and Depression Reduction Strategies during the COVID-19 Outbreak.

The COVID-19 pandemic has contributed to mental health problems worldwide. Nurses are particularly prone to stress because they directly care for individuals with suspected or confirmed cases of COVID-19. The aims of this study were (a) to explore the association between the mental health promotion strategies used by nurses during the COVID-19 outbreak and their symptoms of depression, anxiety, and stress; (b) to compare the symptoms of depression, anxiety, and stress of mental health nurses to those of non-mental health nurses; and (c) to compare the frequency of use of mental health strategies of mental health nurses to those of non-mental health nurses. A cross-sectional study was conducted with a sample of 821 nurses. Univariate and multivariate regression models were developed to identify potential protective factors of depression, anxiety, and stress. The chi-square test was also used to compare the use of strategies among mental health and non-mental health nurses. Portuguese nurses demonstrated high symptoms of depressive symptoms, stress, and anxiety. Healthy eating, physical activity, rest between shifts, maintaining social contacts, verbalizing feelings/emotions, and spending less time searching for information about COVID-19 were associated with better mental health. Mental health nurses had less depression, anxiety, and stress, and used more strategies to promote mental health than other nurses. We consider it important to promote nurses’ mental health literacy by encouraging them to develop skills and strategies aimed at improving their resilience and ability to deal with difficult situations while caring for the population.

Posttraumatic growth in Chinese nurses and general public during the COVID-19 outbreak

ABSTRACT COVID-19 as a pandemic disease, till 18 May 2020, has infected more than 84,494 people in China and 4721,051 abroad. While countries around the world concentrate on controlling the pandemic to minimize damage to this country, the positive psychology brought to nurses and general public (GP) by COVID-19 should not be ignored. This study aims to assess post-traumatic growth (PTG) of Chinese nurses and GP during the COVID-19 pandemic. The study employed PTG in Chinese nurses and GP with Posttraumatic growth inventory questionnaire (PTGI) via a mobile app-based questionnaire, anxiety and ways to copy with stress in nurses were also employed. A total of 455 nurses and 424 GP were included in the statistical analysis. Results indicated that score of total PTGI and three dimensions, new possibilities, personal strength and spiritual change, were different between nurses and GP. Furthermore, score of total PTGI and all domains were significantly different between 178 front-line nurses (FLNs) and 277 non-front-line nurses (nFLNs). Importantly, sex, marriage status, professional titles, fertility, anxiety and ways to copy with stress were associated with PTG in nurses. Moreover, marriage status and ways to copy with stress were the predictors of PTG in nurses. Interestingly, this study found that WeChat network psychological counseling and phone app of application self-relaxation were good and effective coping strategies for nurses to relieve stress. Thus, the development of valid intervention programs for nurses to diminish job burnout and increase care quality was also important.

Work experience of triage nurses in emergency departments during the prevalence of COVID-19

ObjectiveIn December 2019, the global outbreak of Corona Virus Disease 2019 (COVID 19) was reported. As of March 8, 2020, more than 90,000 cases were reported worldwide, resulting in a shortage of global medical resources. The purpose of this study was to understand the working experience of triage nurses in the emergency department (ED) of a large teaching general hospital in Shenzhen (Guangdong province, China) during the COVID-19 epidemic. This will provide a basis for improving the emergency nursing strategies and the epidemic response capabilities of triage nurse. MethodsTen triage nurses were selected as subjects by objective sampling for in- depth interviews, and the data were analyzed by the Colaizzi seven-step analysis method. ResultsThere were four themes in the working experience of triage nurses, including fear of infection and transmission, job stress, gratitude, and expectations of managers. ConclusionDuring the COVID-19, the work experience of triage nurses mainly included the fear of infection and transmission, the high work pressure, the sense of team strength and the care of leaders. It was suggested that nursing managers should ensure the human resources of triage nurses, increase training, strengthen emergency drills, improve emergency nursing countermeasures, and improve the response capability of triage nurses during the epidemic.

Effect of Tele-Nursing (Phone- Based Follow Up) and Educational Package on Life Style and Clinical Status for Diabetic Patients

Background: Diabetes mellitus is one of the global health problems. Tele-nursing is the use of technological resources and communication systems in nursing to provide patient care. Aim of the study: to evaluate the effect of tele-nursing (phone- based follow up) and educational package on life style and clinical status for diabetic patients. Research design: Quasi-experimental design. Setting: The study was conducted at endocrine & diabetic unit in Medical Department at Assiut University Hospitals. Sample: A purposive sample of 100 male and female adult patients diagnosed with diabetes mellitus, their age ranged from18 to 65 years. Tools: tool (I) Patients assessment sheet, it was consisted of three parts: Part I: Demographic data, Part II: Medical data, Part III: Clinical and laboratory data including Body Mass Index (BMI), weight, height, blood pressure, fasting, postprandial blood glucose (PPG), Glycated Hemoglobin (HbA1c). Tool (II): Health promoting life style profile. Results: There was significant difference of life style and clinical data for patients before and after telenursing education. Conclusion: Tele-nursing was effective nursing strategy for improving life style and clinical status for diabetic patients. Recommendations: Tele nursing should be programmed as a part of health plan for patients with diabetes mellitus in different health setting.

Mediating Effects of Role Perception of Life-sustaining Treatment in the Relationship between Knowledge of Life-sustaining Treatment Plans and Attitudes toward Withdrawal of Life-sustaining Treatment among Nursing College Students.

This study examined the relationship between Knowledge of Life-sustaining Treatment Plans and Attitudes toward Withdrawal of Life-sustaining Treatment among nursing college students, and attempted to identify the mediating effect of Role Perception on Life-sustaining Treatment in that relationship. It is hoped that the findings will ultimately contribute to the development of active nursing strategies. The participants were 142 nursing college students in the third and fourth years of study who had experienced clinical practice at two universities in cities Y and C. Data were collected from November 1 to 30, 2019. For data analysis, SPSS for Windows version 22.0 was used to calculate descriptive statistics, the t-test, Pearson's correlation coefficients, and multiple regression. To analyze the mediating effect, the Baron and Kenny bootstrapping method was used. Attitudes toward Withdrawal of Life-sustaining Treatment of nursing college students had a significant positive correlation with Knowledge of Life-sustaining Treatment Plans (r=0.34, P<0.001) and Role Perception on Life-sustaining Treatment (r=0.44, P<0.001). Role Perception on Life-sustaining Treatment partially mediated the relationship between Knowledge of Life-sustaining Treatment Plans and Attitudes toward Withdrawal of Life-sustaining Treatment (95% CI, 0.446~1.055). Based on the results of this study, improving nursing college students' Role Perception on Life-sustaining Treatment could be used as a coping strategy to establish positive Attitudes toward Withdrawal of Life-sustaining Treatment.

Implementation of an enhanced discharge teaching protocol to reduce 30-day hospital readmissions in adults diagnosed with Sickle Cell Disease

Background and objectives: Sickle Cell Disease is a painful genetic disorder characterized by abnormal hemoglobin that affects 1-in-365 African American births. Individuals with Sickle Cell Disease often experience frequent hospitalizations, resulting in 30-day readmission rates 2.5 times higher than those without Sickle Cell Disease. Discharge education programs have shown to improve 30-day readmissions and improve health outcomes.Methods: This advanced practice nurse-led initiative incorporated components of the Re-Engineered Discharge (Project RED) protocol, which included patient and medication education, specific discharge teaching, and post-discharge follow-up phone calls over a 12-week period. A pre/posttest design was used to evaluate 30-day readmission. Analyses included descriptive statistics and Fisher’s exact test.Results: Of the (N = 10) participants, eight (80%) were female, with a mean age of 31.08 (± 4.33) and all were African Americans. Although not statistically significant, there was a 48% reduction in 30-day readmissions rates between the pre/post intervention periods.Conclusions: The utilization of an enhanced discharge teaching protocol is a practical solution to increase patients’ readiness for discharge and to reduce 30-day readmission rates. Project RED discharge teaching protocol is an effective strategy for nurses to employ to improve patient outcomes and quality of care for persons with Sickle Cell Disease.

Nursing Management of General Ward under the COVID-19 Outbreak

&lt;p&gt;COVID-19 is complicated and is of high possibility of cross-infection. Patients should be isolated during treatment with a relatively long recovering period. Therefore, nursing management in general wards is critical in the prevention and control of the pandemic. This article summarizes the experience of nursing management and effective nursing strategies during outbreak of the pandemic, seeking to provide some references and suggestions to people who concerns.&lt;/p&gt;

Anxiety, depression and cognitive emotion regulation strategies in Chinese nurses during the COVID-19 outbreak.

AimsTo explore the association between cognitive emotion regulation strategies and anxiety and depression among nurses during the COVID‐19 outbreak.BackgroundNurses play a vital role in responding to the COVID‐19 outbreak, but many of them suffer from psychological problems due to the excessive workload and stress. Understanding the correlation between cognitive emotion regulation strategies and anxiety and depression will promote targeted psychosocial interventions for these affected nurses.MethodsThis cross‐sectional study of 586 nurses was conducted in Eastern China. Participants completed online questionnaires that investigated anxiety, depression and cognitive emotion regulation strategies.ResultsThe prevalence of nurses' anxiety and depression was 27.6% and 32.8%, respectively. Lower self‐blame, rumination and catastrophizing, as well as greater acceptance and positive refocusing, were related to fewer symptoms of anxiety or depression.ConclusionThe cognitive emotion regulation strategies of acceptance and positive refocusing contribute to reducing anxiety or depression. These strategies should be considered when implementing psychotherapeutic interventions to improve nurses' adverse emotional symptoms.Implications for Nursing ManagementThis study highlights the need to assess cognitive emotion regulation strategies use in screening for anxiety and depression. Nurse managers should develop psychosocial interventions including appropriate strategies to help nurses with adverse emotions during a pandemic.

Perceived Motivators and Barriers that Influence Early Career Nurses’ Consideration or Pursuit of Doctoral Education

Background: Currently, nurses with a doctoral education, which qualifies them to fill positions in academia, administration, clinical practice, and research, are in high demand. The development of strategies to ensure a seamless transition to doctoral programs for early career nurses may increase the number of nurses prepared to fill those positions. Methods: An interview-based qualitative phenomenology design was utilized to explore the motivators and barriers that influence early career nurses’ consideration or pursuit of doctoral education. For this study, an early career nurse was defined as a registered nurse who had obtained initial licensure within the past 10 years. Participants included (1) early career nurses who were currently enrolled in a nursing doctoral program and (2) early career nurses who were considering enrolling in a nursing doctoral program within one year. The final sample was comprised of 15 early career nurses. Results: A qualitative analysis of the data generated from the interviews identified the following primary themes as motivators: (1) personal and professional growth; (2) family, educator, and peer influence; (3) increased ability to serve; and (4) financial gain. The key themes identified as barriers were (1) time constraints, (2) length of study, (3) limited experience, and (4) finances. Primary themes for strategies to alleviate barriers were (1) financial support and (2)planning and shorter length of study. Conclusion: The motivators and barriers to pursuing doctoral education, as perceived by early career nurses, can be utilized to develop recruitment and retention strategies for nurses seeking doctoral education and create nursing curricula that promote a seamless transition to a doctoral program.

Care and Coping During COVID-19: Practice Changes and Innovations in the Oncology Setting.

The COVID-19 pandemic has required healthcare systems to transform the delivery of care. Although the core principles of care for patients with cancer have not changed, this pandemic has led to heightened awareness concerning the fragility of patients with cancer and how healthcare systems can protect them. The aims were to identify and implement inpatient and ambulatory care clinical practice changes during the COVID-19 pandemic, based on defining moments and coping strategies from clinical oncology nurses, advanced practice RNs, nurse leaders, and researchers. This article presents a Lean Six Sigma framework, accompanied by numerous rapid cycle tests of change. The COVID-19 pandemic required clinical healthcare providers at the authors' institution to focus on seven priority areas. Nurses tested and implemented practice changes.

Fall incidence in hospitalized patients and prediction of its risk factors using a weighted Poisson model

AimFalls in hospital as a major cause of disability and death threaten patients’ safety and quality of life. We studied fall incidence in hospital, and predicted its risk factors using weighted Poisson (WP) model versus other models.MethodThis cross-sectional study was performed on the patients referred to two central hospitals in Qazvin, Iran between 2017 and 2019. The data were collected using the Morse scale and fall reporting forms in the hospital patient safety units (288 falls). Factors including age, gender, time of fall, fall location, cause of fall and its complications, drugs administrated, disease history, post-fall care measures, presence of companion, and length of hospital stay were assessed. The WP model was compared with other models.ResultsFall incidence was 2.5 per 1000 patient days. Among them, 62.5% were elderly (mean age 65.7 ± 19.21 yr). Using the WP model, age, gender, fall location and fall cause, drugs administered, post-fall care measures (P < 0.001), and the presence of companion were identified as risk factors for falling (P < 0.001) Older females, those without a companion, and those without post-fall care measures and with medication history were at a higher risk. Falls from bed were the prevalent type of fall (IRR = 1.65). Falls in the internal ward were lower than in other wards (IRR = 0.67).ConclusionThe WP model is suggested as an appropriate model to predict fall risk factors. Fall rate may be reduced by combining information on risk factors with the strategies of training nurses or caregivers, or making possible changes in patients’ environment.

Psychological self-care strategies for ICU nurses under situation of public health emergency

Psychological self-care strategies for ICU nurses under situation of public health emergency

Influencing factors of survival rate after replantation of severed palm and fingers and related nursing strategies

Influencing factors of survival rate after replantation of severed palm and fingers and related nursing strategies

A framework for nurses working in partnership with substitute decision-makers for people living with advanced dementia: A discursive paper.

To describe and discuss clinical strategies for nurses working in partnership with substitute decision-makers for people living with advanced dementia. By providing person-centred care to patients living with advanced dementia, nurses are positioned to work in partnership with substitute decision-makers who make healthcare decisions related to advanced care. Because the experience of being substitute decision-makers is complex and stressful, nurses need skillsets for working in partnership with substitute decision-makers. In this discursive paper, an innovative framework for working in partnership with substitute decision-makers is proposed. Evidence-based findings from a systematic review provided five domain foci for the partnership framework. In each domain, two clinical strategies were discursively proposed. Clinical strategies were hypothesised from research findings and insights from the authors' nursing experiences. Then, topical literature was searched, and findings were used to support the discursively argued strategies. To deal with complexities and reduce stress for substitute decision-makers, an innovative Nurse-Substitute Decision-Maker Partnership Framework for use in the context of advanced dementia is proposed and discussed. The partnership framework consists of five domains: Building trust, Exploring emotions, Translating quality of life, Encouraging proactivity and Negotiating families. Within these domains, ten strategies to support the practices of clinical nurses to work in partnership with substitute decision-makers are discussed. In the framework, the ten clinical nursing strategies are designed to provide targeted care to substitute decision-makers in areas that are known to cause complexity and stress to them. The Nurse-Substitute Decision-Maker Partnership Framework has been designed to improve nurse-substitute decision-maker partnerships and reduce the stress experienced by substitute decision-makers as they work through the complexities associated with advanced dementia.