Nursing Strategies Research Articles

Nursing Disruption for Achieving Sustainable Development Goals by 2030.

Sixteen million nurses, the largest global health care workforce, contribute to achievement of 17 United Nations Sustainable Development Goals through strategic and disruptive research, education, practice, and policy. Responsible for advancing the well-being of individuals, families, communities, and society, nurses are positioned to influence and impact health across the life span. They do this from promoting prenatal health and early childhood success to encouraging healthy aging and end-of-life transitions. They utilize both predictive analytics that prevent rehospitalization and evidence-based practices, such as rocking and kangaroo care, that encourage survival and thriving of preterm newborns. Nurses have a scope of practice that necessitates their presence essentially everywhere. Direct nursing care is delivered in homes, schools, correctional settings, districts, hospitals, helicopters, combat zones, refugee camps, and postnatural disaster or homeless shelters. Nurses advancing system-level health are positioned in health care administration, higher education, international nongovernmental organizations, and governmental offices. Nurse educators and researchers shape tomorrow's practitioners and practice. In general, nurses innovate and generate solutions to improve global health. Shared in this article are strategies for nurses to employ to disrupt the status quo and aggressively contribute to achieving the 2030 Sustainable Development Goals.

Rapid establishment of teat order and allonursing in wild boar (Sus scrofa)

AbstractTransfer of milk is the fundamental common characteristic of mammalian reproduction, but species differ considerably with respect to nursing strategies. The consequences of teat orders and allonursing have been studied intensively in domestic pigs. However, whether similar nursing strategies also exist in wild boar, the ancestor of domestic pigs is so far not known. The occurrence of allonursing in wild boar is only described anecdotally, and the question whether a teat order is established has not yet been investigated. Studying suckling behaviour of 29 piglets from six primiparous wild boar females in a semi‐natural environment we found a surprisingly fast development of a rigid teat order among littermates, which established within 2.2 hr after birth. This suggests strong fitness benefits of this phenomenon that may ultimately explain the evolution and maintenance of this trait. We further found a strong synchrony of oestrus and delivery among the females of a group, as well as the occurrence of allonursing. By determining the amount of allonursing for the first time quantitatively, we demonstrate the importance of this trait and its presumably pivotal role for juvenile survival under truly natural conditions.

The social context of substance use among older adults: Implications for nursing practice.

AimThe purposes of this paper are (a) to critically analyse the social context of substance use among older adults and (b) to offer strategies for nurses and other health care providers to support the health of older adults experiencing problematic substance use.DesignDiscussion paper.MethodsThis analysis is informed by two theoretical lenses: an intersectional lens in examining the various factors influencing health and health care access; and a social justice lens, focusing on promoting health equity for older populations.ResultsAs a result of various social and sociopolitical factors, key issues are likely to arise for older adults experiencing problematic substance use including health and social inequities, stigma, and discrimination, all of which can result in serious negative health outcomes. Health care providers can help mitigate these effects by (a) promoting harm reduction principles; (b) participating in social justice actions; and (c) engaging in contextual assessments of substance use.

Strategies nurses use when caring for patients with moderate-to-severe traumatic brain injury who have cognitive impairments.

Adults with moderate-to-severe traumatic brain injury (TBI) may have immediate and chronic cognitive impairments that require use of specific nursing strategies. Nurses must be knowledgeable about strategies to use to accommodate these impairments. However, available clinical guidelines and research lack information to direct nonacute nursing management of cognition, limiting guidance for nurses when developing their care plans. The purpose of this study was to investigate strategies nurses use when caring for patients with moderate-to-severe TBI who have cognitive impairments. Cross-sectional, exploratory study. A total of 692 nurses from three hospitals answered the following open-ended question via electronic survey: "Imagine you are caring for a patient with moderate-to-severe TBI who has problems with cognition (e.g., issues with memory, attention, and executive function). Please state your typical nursing routine to care for this type of patient." Data were analysed using summative content analysis. Methods are reported using COREQ guidelines (See File S1). Most respondents were female (89%), middle-aged (40.3years), staff registered nurses (77%) practicing on an inpatient unit (51%) with prior experience caring for patients with moderate-to-severe TBI (95%). Nurses described 189 strategies used in their care plan when caring for patients with TBI who have cognitive impairments, including the following: (a) cognitive techniques; (b) communication techniques; (c) patient safety techniques; (d) agitation and behaviour management techniques; and (e) education techniques. Findings have implications for education and training of nurses, direction for future research aimed at determining the effectiveness of nursing strategies with this patient population, and for development of clinical guidelines for nonacute nursing management of patients with moderate-to-severe TBI who have cognitive impairments. Findings provide foundational knowledge on strategies nurses use when caring for patients with TBI who have cognitive impairments, which could be used to direct evidence-based nursing care of this patient population.

A Correlational Study on the Knowledge, Stress and Self-care Performance among Tuberculosis Patients

Purpose: This study was conducted to analyze the correlations among the knowledge, stress, and self-care performance in tuberculosis patients. Methods: The participants consisted of 140 outpatients who had been diagnosed with tuberculosis in S University Hospital. Data were derived from self-report questionnaires and analyzed by SPSS 22.0. Statistical analysis included descriptive statistics and Pearson's correlation coefficients analysis. Results: Means of stress and self-care performance were 1.76 and 3.21, respectively. Percentage of correct answer of knowledge about tuberculosis was 71.8. Knowledge about tuberculosis was significantly different according to age (F=21.81, p<.001), marital status (F=13.79, p<.001), education (F=36.63, p<.001), and monthly income (F=16.23, p<.001). Stress was significantly different according to gender (t=3.58, p<.001). Self-care performance was significantly different according to age (F=5.74, p=.004), marital status (F=8.79, p<.001), education (F=9.15, p<.001), monthly income (F=7.87, p=.001), and attendance of tuberculosis education (t=2.34, p=.020). Self-care performance had significant correlation with knowledge about tuberculosis and stress. Conclusion: This study suggests that knowledge about tuberculosis and stress had significant correlations with self-care performance. Therefore, the nursing strategies of increasing knowledge about tuberculosis and decreasing stress which improve self-care performance should be developed for tuberculosis patients.

Effect of intervention of clustering nursing strategies on postoperative rehabilitation, quality of life and complications in laparoscopic gastric cancer during perioperative period

Objective To explore the influence of clustering nursing strategy intervention on postoperative recovery, quality of life and complications in laparoscopic gastric cancer during perioperative period. Methods A total of 61 patients undergoing laparoscopic gastrectomy for gastric cancer from September 2015 to September 2016 in this hospital were selected as the control group.Another 61 cases of laparoscopic gastric cancer surgery patients admitted by this hospital from October 2016 to October 2017 who received cluster nursing strategy intervention were selected as the observation group.The postoperative recovery, incidence of complications, and quality of life before and after nursing were compared between the two groups. Results The recovery time of bowel sounds, time of first discharge, retention time of gastric tube and length of stay in observation group were shorter than those in control group , and the differences were statistically significant(P<0.05). The incidence of dry halitosis, abdominal distension, nausea, vomiting and constipation in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). The scores of physiological function, physiological function, emotional function, vitality, physical pain, general health, mental health and social function in the observation group were all higher than those in the control group after 1 week of nursing, and the differences were statistically significant(P<0.05). Conclusions Intervention of clustering nursing strategy in the perioperative period of laparoscopic gastric cancer patients can effectively promote its postoperative rehabilitation, reduce the incidence of complications, improve the quality of life, and is worthy of clinical promotion. Key words: Cluster nursing strategy intervention; Laparoscopic; Gastric cancer; Postoperative rehabilitation; Complications

Using evidence-based debriefing to combat moral distress in critical care nurses: A pilot project

Objective: Moral distress (MD) is a problem for nurses that may cause despair or disempowerment. MD can have consequences like dissatisfaction or resignation from the nursing profession. Techniques such as evidence-based debriefing may help nurses with MD. Creating opportunities for critical care nurses to debrief about their MD might equip them with the tools needed to overcome it. Measuring MD by using the Moral Distress Thermometer (MDT) could provide insight into how debriefings help nurses. The purpose of this pilot project was to examine the impact of evidence-based debriefing sessions on critical care nurses’ sense of MD.Methods: This pilot project used a quasi-experimental, one-group, before-during-after design. Critical care nurses (N = 21) were recruited from one unit at a large academic medical center. Four debriefing sessions were held every 2 weeks. Participants completed the MDT 2 weeks before the first session, at the end of each session they attended, and 1 month after the debriefing sessions.Results: In the pilot project, participants felt that debriefing was helpful by increasing their self-awareness, giving them time to commune with colleagues, and encouraging them to improve self-care habits; however, MDT scores did not change significantly when comparing pre with post intervention scores (t(12) = 0.78, p = .450).Conclusions: The use of debriefing may help nurses gain self-awareness of MD and it may offer nurses strategies to build moral resilience.

Evidence-based application of self-made anti-carbon dioxide retention atomizer in patients with chronic obstructive pulmonary disease and respiratory failure

To apply the concept of evidence-based nursing in the practice of inhalation therapy for patients with chronic obstructive pulmonary disease (COPD) complicated respiratory failure, introduce the application method of self-made anti-carbon dioxide retention atomizer, and to observe the application effect. Patients with COPD combine respiratory failure admitted to the respiratory department of Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to April 2019 were enrolled. All patients received atomization inhalation therapy in addition to anti-infection and spasmolysis. By using self-made carbon dioxide retention atomizer time node, 40 patients in the prospective study using home-made carbon dioxide retention atomizer inhalation therapy from November 2018 to April 2019 were enrolled as observation group. Through evidence-based nursing strategy, the related literature at home and abroad was retrieved, to find the clinical evidence, formulation and implementation of care plan. Forty patients who received inhalation therapy with normal mask atomizer from May to October in 2018 were enrolled as the control group in the retrospective analysis. The peripheral arterial blood gas analysis indexes [pH value, arterial oxygen partial pressure (PaO2), arterial carbon dioxide partial pressure (PaCO2)], the disappearance of pulmonary asthma at 5 minutes before atomization inhalation and 20 minutes after atomization inhalation, and the patient's cooperation in treatment were compared between the two groups. All patients were included in the final analysis. There was no significant difference in blood gas analysis indexes between the two groups. After 20 minutes of atomization inhalation, the pH value, PaO2 and PaCO2 of the two groups were improved, and the improvement was more obvious in the observation group [pH value: 7.32±0.35 vs. 7.25±1.25, PaO2 (mmHg, 1 mmHg = 0.133 kPa) : 61.50±1.55 vs. 59.50±1.05, PaCO2 (mmHg) : 43.25±1.65 vs. 49.05±1.75, all P < 0.05]. The lung asthma in the two groups was significantly improved with 20 minutes of atomization inhalation as compared with that before atomization, and the improvement of lung asthma in the observation group was significantly better than that in the control group (asthma score: 0.91±0.29 vs. 1.65±0.35, P < 0.05). The good coordination rate of the observation group was significantly higher than that of the control group [90% (36/40) vs. 70% (28/40), χ2 = 3.828, P = 0.048]. Compared with the inhalation treatment with ordinary mask nebulizer, inhalation treatment with self-made anti-carbon dioxide retention atomizer for COPD patients with respiratory failure can reduce carbon dioxide retention, significantly improve respiratory failure symptoms and improve compliance.

Risk Factors of Nosocomial Infection in 383 Children with Hypospadias after Operation and Nursing Countermeasures

Objective To explore the main risk factors of hospital infection in children with hypospadias after operation and to formulate targeted nursing measures so as to provide accurate nursing strategies for effective prevention and control of hospital infection after operation. Methods Totally 383 children who underwent hypospadias surgery in the hospital from January 2016 to December 2017 were selected as the research objects. The clinical data of all cases were reviewed and sorted out. The hospital infection rate, infection site and main risk factors of hospital infection after operation were analyzed to formulate prevention strategies. Results 71 of 383 children suffered from hospital infection, and the incidence rate of hospital infection was 18.5%.The distribution of infection sites was: respiratory tract infection in 30 cases, accounting for 42.25%;Urinary tract infection was found in 25 cases (35.21%). Incision infection was found in 14 cases (19.72%).Gastrointestinal infection occurred in 2 cases (2.82%). Logistic multivariate analysis showed that age, length of hospital stay after operation were closely related to hospital infection. Conclusions The major risk factors for postoperative nosocomial infection in children with hypospadias are age and postoperative hospital stay.Nursing measures: The hospital stay of children after operation can be shortened as much as possible by reminding and standardizing the routine maintenance of urinary catheter and strengthening the cooperation between doctors and nurses through charts. Strict implementation of visiting and accompanying system, good environmental control, strengthening hand hygiene, standardization of preoperative skin preparation and other nursing measures are adopted to protect children to the greatest extent. Key words: Children after operation; Hypospadias; Hospital infection; Risk factors; Nursing countermeasures

The Effects of Prayer as a Coping Strategy for Nurses

To determine the effects of prayer as a coping strategy for nurses. Quantitative descriptive design. The population was the 15,000 members of the American Society of Perianesthesia Nurses. Twelve hundred fifty nine subjects completed a demographic questionnaire and the Prayer Functions Scale. The surveys were available on SurveyMonkey.com for 2weeks in the fall of2014. Results indicated at α=0.05 that the nurses surveyed experienced the effects of prayer, providing assistance, providing acceptance, providing calm, and deferring as benefits of use of prayer as a coping strategy. Reduction of nurses' stress through prayer is one way to ameliorate the ill effects that can impact nurses through stress. Nursing administration, nursing organizations, and academics could consider use of prayer as an effective coping mechanism in teaching, studying, and exploration of methods to help nurses cope with the inherent stressors of their profession.

Relationship of age, gender, hypertension history, and vulnerability perception with physical exercise compliance in elderly

The purpose of this study was to determine the relationship between the history of hypertension and the perception of susceptibility with the level of adherence to physical exercise in the elderly who experienced hypertension. The study used a cross-sectional design. A total of 108 elderly people who had hypertension were selected using purposive sampling technique. Chi-square was used to analyze the data. The results showed a significant relationship between family history (p-value=0.037), the perception of susceptibility (p-value=0.018) to physical exercise adherence in the elderly with hypertension, while age and sex did not have a significant relationship. Screening and developing community-based nursing strategies, providing health information early, and innovations in the development of physical training need to be done to motivate the elderly to do physical exercise.

Interprofessional collaboration within fluid teams: Community nurses' experiences with palliative home care.

To explore how community nurses experience the collaboration with general practitioners and specialist palliative home care team nurses in palliative home care and the perceived factors influencing this collaboration. The complexity of, and the demand for, palliative home care is increasing. Primary palliative care is provided by community nurses and general practitioners, often in collaboration with palliative home care team nurses. Although these professionals may each individually be part of a fixed team, a new temporary team is often composed for every new palliative patient. These membership changes, referred to as team membership fluidity, challenge professionals to work effectively. A qualitative research design, using semi-structured interviews with community nurses. Participant selection happened through regional palliative care networks in Belgium. The network's palliative home care team nurses selected community nurses with whom they recently collaborated. Twenty interviews were conducted. A constant comparative analysis approach was used. Consolidated criteria for reporting qualitative research guidelines were followed. Formal interprofessional team meetings were not common practice. The other's approachability and knowing each other positively influenced the collaboration. Time constraints, the general practitioners' lack of expertise, communication style, hierarchy perception and income dependency negatively influenced the collaboration with general practitioners and determined palliative home care team nurses' involvement. The coping strategies of community nurses balanced between a behaviour focused to the patient and to the professional relationship. Specialist palliative home care team nurses were relied upon for their expertise but also to mediate when community nurses disagreed with general practitioners. Community nurses showed to be highly adaptable within the fluid team. Strikingly, dynamics described in the doctor-nurse game 50years ago are still present today and affect the interprofessional communication. Interprofessional education interventions can contribute to improved interprofessional collaboration. The study findings uncovered critical knowledge gaps in interprofessional collaboration in palliative home care. Insights are relevant for and related to professional well-being and workplace learning.

Application of meta-cognitive strategies in cardiovascular specialized nurses training

Objective To explore the application effects of meta-cognitive strategy in cardiovascular specialized nurses training. Methods From September 2015 to September 2017, totally 53 nurses in Yancheng city were selected as participants of the study by convenience sampling. They were trained by a training scheme based on the meta-cognitive strategy for cardiovascular specialized nurses. After three months' off-duty full time training, the trainees were assessed for their scores in theory and practice, extended training back to hospital, and satisfaction degree on the training base and themselves. Results A total of 53 specialized municipal nurses were trained after three training sessions, and the qualification rate of the trainees was 100%. The development rate of specialized professional work, nursing teaching, nursing scientific research were all above 70%; the satisfaction degree towards the base reached above 94%; after training, the self-satisfaction rate of the trainees increased with a statistical significance (P<0.05) . Conclusions The training scheme of cardiovascular specialized nurses based on meta-cognitive strategy is effective in improving the nurses' comprehensive ability and provides theoretical basis for the training of cardiovascular specialized nurses in the future. Key words: Nurses; Meta-cognitive strategy; Cardiovascular specialty; Training

Contingency Help: The Main Strategy of Iranian Nurses in Dealing With the Family of the End-of-Life Patients.

Families are struggling with many challenges in the final stages of patient life. It is important to understand what actions nurses do for the family of the end-of-life (EOL) patients. This study aimed to explain the main strategy of nurses' dealing with the family of the EOL patients. Data were analyzed using conventional content analysis. Semistructured interviews were conducted on 32 nurses from hospitals in Tehran. Nurses used six measures of explaining the bitter reality, effective communication, management of violence, referral, consolation, and reinforcement. "Contingency help" was conceptualized as the main strategy. Nurses through "contingency help" were involved in solving the emotional, physical, financial, and spiritual needs of the family. Nurses will be able to apply the results of this study to the development of care policies for the family of the EOL patients.

Nurse suicide in the United States: Analysis of the Center for Disease Control 2014 National Violent Death Reporting System dataset

ObjectiveThis study explored nurse suicide in the United States. MethodsCharacteristics were compared between occupations using 2014 National Violent Death Reporting System data. ResultsFemale nurse suicides were significantly higher (11.97/100,000) than in the female population (7.58/100,000) (p < 0.001); similarly male nurses (39.8/100,000) compared to the male population (28.2/100,000) (p < 0.001). Benzodiazepines and opioids were the most commonly used substances used in clinician suicide. ConclusionThese results suggest a public health imperative for future research and development of effective preventative strategies for nurses; a largely understudied population.

An Interprofessional Approach to Improving Identification and Time to Treatment of Severe Hypertension in Pregnant Women

To develop and implement a protocol to improve the quality of care for women with severe hypertension during pregnancy and reduce adverse outcomes. Severe maternal morbidity associated with preeclampsia and eclampsia occurs in 12%–22% of pregnancies and is a leading cause of maternal death, contributing to 18% of maternal deaths in the United States. Other adverse outcomes include abruption, hemorrhage, disseminated intravascular coagulation, intrauterine growth restriction, intrauterine death, and increased health care costs. Organizational factors that contribute to adverse outcomes include delayed diagnosis and ineffective treatment. In Illinois, the goal is to treat 80% of women within 60 min of identification of severe hypertension. This quality improvement project was conducted in a Level III perinatal center in a community-based hospital with 2,600 births annually. In in March 2016, a multidisciplinary team was created that reviewed baseline data, identified areas for improvement in the care processes, and developed a treatment protocol followed by implementation of a multimodal educational strategy for physicians and nurses. An order set was created in the electronic medical record and visual reminders of the new protocol were posted. Data were collected from Calendar Year 2015 through the first quarter of 2018. Time-to-treatment within 1 hr was 8% in 2015 and 2016 and 90% in 2017; 100% of women were treated within 30 min in 2018. Rates of adverse maternal outcomes were at 17% (2016), 18% (2017), and 7% (2018). Findings support the effectiveness of our strategies to develop and implement a protocol to improve the quality of care for women with severe hypertension during pregnancy and reduce adverse outcomes. It is important to use an interprofessional approach to protocol development and education and to offer intensive initial education as well as ongoing education to sustain practice change. Use of the protocol was critical for empowering nurses to communicate more effectively with physicians about the status of patients and subsequent timely treatment to improve maternal outcomes.

Stressors and coping strategies of emergency department nurses and doctors: A cross-sectional study

BackgroundEmergency departments (EDs) are stressful workplaces. Limited research explores components ED staff find stressful and how they cope. The aim of this study is to describe ED staff perceptions of their working environment. MethodsA cross-sectional study was undertaken in 2017 in a public, teaching hospital ED situated in an outer-metropolitan low socio-economic area. ED doctors and nurses completed surveys exploring workplace stressors (the ED stressors tool), coping strategies (Jalowiec Coping Scale), and perceptions of the working environment (Working Environment Scale-10). Descriptive and comparative analyses were undertaken. ResultsA 40% response rate (161/400) was achieved. Staff reported high workload, moderate self-realisation, and low levels of conflict and nervousness. Heavy workload, poor skill-mix and overcrowding were ranked as high-stress, high-exposure (daily) events. The death or sexual abuse of a child and inability to provide optimal care were ranked highly stressful but infrequent. Coping strategies most often used included: trying to keep life as normal as possible (90%) and considering different ways to handle the situation (89%). ConclusionsImpacts of varying degrees of exposure of this young cohort of staff, with limited experience, to modifiable and non-modifiable stressors highlight site-specific opportunities to enhance staff perceptions of their working environment.

A Hidden Healthcare Crisis: Youth Homelessness

This article describes the complicated scope of youth homelessness and strategies for nurses to make an impact on this health care crisis. The article addresses the current state of youth homelessness and its effect on providers of healthcare and the entire community. The critical role of leadership and the efforts needed to sustain the work to eliminate youth homelessness is depicted.

The safe administration of medication: Nursing behaviours beyond the five-rights.

This paper discusses the findings from the observation phase of a more extensive, appreciative inquiry qualitative study exploring registered nurses' experiences of administering medications. The observations aimed to explore the participants' application of the five-rights of medication administration in practice. Twenty registered nurses working in inpatient medical/surgical units at a regional Australian hospital were observed administering medications from the commencement to the completion of their shift. A data collection tool based on the five-rights of medication administration was used. The findings indicated that medication administration was not as routine as the rights framework suggests. Indeed, what was observed rarely reflected all the criteria of the rights framework. Notably, in practice, some of the rights were unable to be observed because the critical thinking that underpins the rights are implicit. However, the participants were observed to implement strategies beyond those described by the rights framework that ensured safe and timely medication administration. In brief, medication administration in contemporary healthcare settings is more complicated than the linear process suggested by the rights framework. So more attention is warranted, to the safe practice strategies of nurses who, to deal with complex clinical contexts. Their person-centred strategies respond to patient circumstances and maintain safety.

A Phenomenographic Approach to Understanding the Expertise of Perioperative Nurses.

Understanding the ways that perioperative nurses view the acquisition of expertise may provide foundational information for perioperative nurse educators. Our study aimed to evaluate specific types of expertise exhibited by experienced perioperative nurses and identify how nurses perceived these areas of expertise. We interviewed 20 perioperative nurses working in a university hospital in Korea. We extracted six themes regarding perioperative nursing expertise: sticking to principles, using available resources in complex situations, paying close attention to details, seeing the whole picture, prioritizing actions according to patients' conditions, and organizing a team to maximize efficiency. These findings may help perioperative educators develop practical educational strategies for novice perioperative nurses by providing a common language regarding the areas of expertise exhibited by experienced perioperative nurses.