Work In Clinical Settings Research Articles

Role development and utilization of master’s-prepared omani nurses working in clinical settings: A multiple case study

Background and aim: The roles of master’s-prepared nurses in clinical settings differ by country. Examples include nurse practitioners, clinical nurse specialists, nurse managers, educators, and researchers. Little is known regarding the role development and utilization of master’s-prepared nurses in Oman. The aim is to explore the role development and utilization of master’s-prepared Omani nurses working in clinical settings in Oman’s governmental healthcare system.Methods: Multiple case study methodology involving two governmental acute care hospitals in Oman. Individual semi-structured interviews were conducted with master's-prepared Omani nurses (n = 19), policymakers (n = 8), and co-workers (n = 8). Relevant documents, including job descriptions and nursing career pathway were reviewed. Interviews and documents were analyzed using thematic analysis.Results: Master's-prepared Omani nurses were mainly utilized in management, education, and nurse specialist roles. Four overarching themes were identified: 1) Drivers for master's-preparation in clinical settings, 2) The journey after pursuing a master's education, 3) Master’s- prepared nurses' roles, their development, and their scope of practice, and 4) Perspectives about the current utilization of master's-prepared Omani nurses. Participants indicated utilization of master’s-prepared Omani nurses in clinical settings could be enhanced.Conclusions: Master’s-prepared nurses could play a vital role in supporting the needs of patients and addressing gaps in clinical settings if their advanced knowledge and competencies were fully utilized. Linking master’s-prepared nurses’ roles to patient, organization, and system needs and engaging stakeholders in developing their roles will enable optimum utilization of this valuable human resource.

Betwixt and between student and professional identities: UK medical students during COVID times

The COVID-19 pandemic lockdown in Spring 2020 brought about unprecedented disruption to medical education in the United Kingdom (UK). Medical students were encouraged to take up paid roles in the National Health Service to help with workforce shortages. This article explores medical students’ views and experiences of the COVID-19 pandemic vis-à-vis their professional identity formation. Semi-structured interviews were conducted with 22 medical students from all five undergraduate years in one UK medical school, between April and June 2020. Three themes were generated: (1) disruption to medical education involving suspension of clinical placements, cancellation of assessments and ceremonial markers; (2) decision-making around joining the clinical workforce, decisions which were influenced by students’ sense of professional obligation, perceived personal gains, and health and safety considerations; (3) experiences of working in clinical settings during the pandemic, including reflections about managing risks and challenges, learning on the job and becoming a better doctor. The findings provide evidence that the UK’s first lockdown destabilised many medical students’ expectations tied to their educational and career trajectory, requiring them to improvise to address gaps in learning and professional development. Taking on a paid healthcare role catapulted them into a liminal period, working in a space ‘betwixt and between’ a medical student and healthcare professional. This swift readjustment of roles and responsibilities accelerated their identity formation as ‘future doctors’. Support for medical students around negotiating such dual role is important in present and future public health crises.

Alexithymia or general psychological distress? Discriminant validity of the Toronto Alexithymia Scale and the Perth Alexithymia Questionnaire

BackgroundAlexithymia is an important transdiagnostic risk factor for emotion-based psychopathologies. However, it remains unclear whether alexithymia questionnaires actually measure alexithymia, or whether they measure emotional distress. Our aim here was to address this discriminant validity concern via exploratory factor analysis (EFA) of the 20-item Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ). MethodUnited States general community adults (N = 508) completed the TAS-20, PAQ, and the Depression Anxiety Stress Scales-21 (DASS-21). EFA was used to examine the latent dimensions underlying these measures' scores. ResultsOur EFA extracted two higher-order factors, an “alexithymia” factor and a “general distress” factor (i.e., depression, anxiety, stress). All PAQ scores loaded cleanly on the alexithymia factor, with no cross-loadings on the distress factor. However, for the TAS-20, Difficulty Identifying Feelings (DIF) facet scores cross-loaded highly on the distress factor. LimitationsOur sample consisted of general community adults; future work in clinical settings will be useful. ConclusionsOur data indicate that the PAQ has good discriminant validity. However, the TAS-20 appears to have significant discriminant validity problems, in that much of the variance in its DIF facet reflects people's current levels of distress, rather than alexithymia. The TAS-20, which has traditionally been the most widely used alexithymia questionnaire, may therefore not be the optimal alexithymia tool. Our findings add to the body of evidence supporting the validity and utility of the PAQ and suggest that, moving forward, it is a superior option to the TAS-20 for alexithymia assessments.

It is like “Chasing Your Tail”: The Experiences of Black African Nurses Working in the National Health Service

Objective: The National Health Service (NHS) is made up of diverse workforce, however, not much is known about the experiences of black African mental health nurses working in NHS health care setting. The aim of this research is to unravel the experiences of black African mental nurses working in the NHS. Methods: A qualitative method and interpretative phenomenological analysis was used. Semi-structured interviews were used to collect data from five experienced registered mental health nurses from sub-Saharan Africa actively practicing in England. Results: Three subordinate themes emerged namely: A little bit shocking, am I valued? and team dynamics and diversity. The analysis highlights explicit insights into participants’ experiences of working in clinical settings in England. Conclusion: It is essential for every nurse to feel valued and realise their full potential, it is essential that we develop holistic and innovative strategies for encouraging diversity and inclusivity in the clinical environment.

Nursing action towards the sustainable development goals: Barriers and opportunities

BackgroundClimate change, poverty, hunger and complex diseases are just some of the many wicked problems impacting human health. The Sustainable Development Goals aim to alleviate these and many other global issues. Although the nursing profession is paramount to successfully achieving the goals, nurses require increased education to maximise their contributions. ObjectivesThe aim of this study was to determine the impact of education on graduate nurses' action towards the Sustainable Development Goals. DesignThis study applied a qualitative case study methodology. SettingThe study took place within an Australian Higher Education institution. Graduate nurses working in clinical settings were invited to reflect on the Sustainable Development Goals. ParticipantsParticipants included thirteen graduate nurses (n = 13) working in a variety of clinical settings that had completed the final year capstone subject. MethodsIndividual semi-structured interviews were undertaken with graduate nurses who undertook education on the Sustainable Development Goals in an undergraduate Bachelor of Nursing capstone subject. The interviews were transcribed and thematically analysed. FindingsData was analysed through two lens focusing on the barriers and opportunities for action towards the Sustainable Development Goals. Three core barriers were identified as ‘Drowning’; ‘Powerless’; and ‘Invisible’. Three key opportunities were designated as ‘War on Waste’; ‘Front and Centre’; and ‘Revolutionary Leadership’. ConclusionsEducating undergraduate nurses on the Sustainable Development Goals had limited impact on specific graduate nurses' action towards the goals due to significant barriers within the healthcare system. However, graduate nurses recognised the importance of contributing to the goals and identified opportunities for future action. Education providers and the healthcare industry should work in partnership to create a more sustainable future for healthcare.

Physicians' perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study.

Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization's recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians' perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS. This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TSTS. A total of 1250 physicians participated in the quantitative aspect of the study. Among the participants, 56.6% had good perception of TSTS in the management of hypertension while about two-thirds (67.5%) agreed that TSTS program in the management of hypertension could be successfully implemented in Nigeria. Male gender (p = 0.019) and working in clinical settings (p = 0.039) were associated with good perception. Twenty physicians participated in the qualitative part of the study. Qualitative analysis showed that TSTS will improve overall care and outcomes of patients with hypertension, reduce physicians' workload, improve their productivity, but may encourage inter-professional rivalry. Wide consultation with stakeholders, adequate monitoring and evaluation will facilitate successful implementation of TSTS in Nigeria. This study showed that more than half of the physicians have good perception of TSTS in hypertension management while about two-thirds agreed that it could be successfully implemented in Nigeria. This study provides the needed evidence for increased advocacy for the implementation of TSTS in the management of hypertension in Nigeria. This will consequently result in improved patient care and outcomes and effective utilization of available health care personnel.

Attending Pain, Ethnographically.

What might ethnography-as both practice and text-offer for thinking about and with non-narrative forms of pain representation? Ethnography operates as an inherently fragmentary, episodic form of knowledge-making: the central acts of observing and writing social life rest upon moments plucked and crafted from the unruly, relentless rush of intersubjective experience. Bringing an ethnographic sensibility to bear on clinical encounters around pain thus attunes us to both the partiality and the sociality of representation. Drawing from ongoing research into how clinicians encounter patients' pain, here I hold together two ethnographic moments, reading across them to explore the consequential forms of attention and of representation at work in the ephemeral utterances and exchanges of everyday work in clinical settings.

Current Status of Pediatric Oncology Clinics and Nursing Practices in Turkey.

Background: Cancer is a significant health problem in Turkey with pediatric cancer being the fourth leading cause of death among children. Pediatric oncology has been acknowledged as a pediatric subspecialty since 1983, and 3,000 new cases of childhood cancer are expected every year. Method: We describe our country's geography, the number and distribution of pediatric oncology centers, the profile of clinical and academic nurses, and our clinical practice. We present two nurse-led research projects. Results: Although nursing practice differs according to centers, treatment and care are usually evidence-based, especially in university and public hospitals in big cities. Nurses with an undergraduate education work in pediatric oncology units; however, few nurses with graduate degrees work in clinical settings. The Turkish Oncology Nurses Association supports the development and implementation of guidelines for evidence-based nursing care. Nurses' clinical responsibilities include patient admission to the clinic, patient and family education, care coordination, patient care, symptom management, palliative, and intensive care services. Results of two recent nurse-led studies highlight challenges to meet the needs of patients and families from surrounding countries, including refugees, and opportunities for nurses to provide holistic support to parents of hospitalized children. Discussion: Increasing the number of nurses is a priority to improve pediatric oncology nursing care. Actions to advance pediatric oncology nursing include developing advanced clinical roles for nurses with graduate degrees; supporting nurses caring for children and families from outside Turkey, including language support services; and resources to conduct national and international studies related to professional and holistic care delivery.

Trauma, Help-Seeking, and the Strong Black Woman

Research suggests when confronted with hardship, Black women in the United States seek help less than other. This finding may be explained by the cultural stereotype of the Strong Black Woman (SBW). SBW consists of three factors: Mask of Strength, Self-Reliance/Strength, and Caretaking. The current study examined the connection between self-endorsement of SBW and help-seeking behavior and intention, following a traumatic event for Black college women. The SBW full scale was not significantly related to actual help-seeking or intention to seek help. However, post-hoc analyses indicated the three SBW subscales had both positive and negative effects. Greater endorsement of the Caretaking and Self-Reliance subscales positively predicted actual help-seeking and formal actual help-seeking, respectively. However, greater endorsement of the Mask of Strength subscale predicted less help-seeking and fewer intentions to seek help. The findings indicated a more nuanced approach may be needed when studying SBW or working in clinical settings. It may be helpful to bolster aspects of the stereotype, such as the desire to be a good caretaker, while redefining other aspects, such as emotional invulnerability.

A Question-Based Framework for Co-Constructing Supervision in Clinically Based Teacher Preparation

The field of teacher education has embraced robust models of clinically based teacher preparation. In part because these models rely upon school-university partnerships for which shared missions are an essential component, they also demand increasingly complex, co-constructed conceptions of supervision to support teacher candidates’ learning during clinical practice. However, even as the need for supervision has grown, good supervision is seldom clearly defined. Many supervisors begin supervising largely underprepared for the complexity of their work in clinical settings. In response to these challenges, this paper proposes a framework for co-constructing supervision consisting of four key components—conceptions, models, tasks, and techniques—that could simultaneously inform supervision scholarship and offer a practical tool for building shared understandings of supervision in clinically based teacher preparation contexts.

Diversity, Disparities, and the Allergy Immunology Pipeline

Disparities in health outcomes in under-represented racial and ethnic minority groups are evident in allergic/immunologic diseases and have been most completely described in asthma. The last 2 decades have not led to any substantive improvement in these disparities, with under-represented minorities (URMs) receiving worse care in several quality measures. Increasing physician workforce diversity is one strategy to improve access to care and address the health disparity problem because URM physicians more often choose to both work in clinical settings and pursue research that benefits underserved communities.

A mobile app to promote alcohol and drug SBIRT skill translation among multi-disciplinary health care trainees: Results of a randomized controlled trial

Background Adherence to clinical practice guidelines for alcohol and drug screening, brief intervention, and referral to treatment (SBIRT) is often inadequate. Mobile apps developed as clinical translation tools could improve the delivery of high fidelity SBIRT. Methods: This study tested the effectiveness of an SBIRT mobile app conceptually aligned with the Theory of Planned Behavior (TPB) to support SBIRT delivery by health care trainees (nursing, social work, internal medicine, psychiatry, and psychology) working in clinical settings (N = 101). Bivariate analyses examined the rate of SBIRT delivery between trainees assigned to the experimental (app) and control (no app) study conditions; as well as the relationship between TPB-based constructs, intention to deliver SBIRT, and screening rates. Results: No significant differences were identified between the study conditions in SBIRT delivery. Significant correlations were found between intent to screen and TPB variables including attitudes/behavioral beliefs concerning substance use treatment (r = .49, p = .01); confidence in clinical skills (r = .36, p = .01); subjective norms (r = .54, p = .01) and perceived behavioral control over appointment time constraints (r = .42, p = .01). Also significant were correlations between percent of patients screened and confidence (r = .24, p = .05); subjective norms (r = .22, p = .05) and perceived behavioral control (r = .28, p = .01). Conclusions: The negative results of the study condition comparisons indicate the need for further investigation of strategies to optimize mobile app utilization, engagement, and effectiveness as a clinical translation tool. Findings of significant correlations between substance use screening rates and both norms and confidence support the potential value of the TPB model in explaining behavior of health care learners in SBIRT delivery.

Critical thinking among clinical nurses and related factors: A survey study in public hospitals.

The study investigated clinical nurses' critical thinking levels in public hospitals and related factors. Since health care environments have become more complex, the critical thinking skills of clinical nurses are more important in daily problem-solving and decision-making processes. However, little research was conducted on this topic among clinical nurses. It was a cross-sectional study at five public hospitals between December 2018 and January 2019. The study followed the STROBE guideline. Data were collected from 559 nurses by a survey consisted of a data form and the Turkish version of the Nursing Critical Thinking in Clinical Practice Questionnaire. Nurses' mean critical thinking scores were moderate level. Total critical thinking scores of the clinical nurses significantly differed according to education, hospital type, shift work, professional category and role. There was a significant effect on the total critical thinking scores of the clinical nurses according to variables. This study found that critical thinking levels of nurses' working in clinical settings in public hospitals were moderate level. Hospital type, shift work, professional and educational level and role were significantly associated with clinical nurses' critical thinking levels. This study provides evidence related to the levels of critical thinking of clinical nurses working in public hospitals. Since the critical thinking scores of the manager nurses, daytime working nurses' and nurses with bachelor's and master's degree education are higher, hospital managers may benefit from the study to implement effective strategies to improve the competence of critical thinking levels of nurses.

Predictors of nutrition care process knowledge and use among dietitians internationally.

The nutrition care process (NCP) and its associated standardised terminology (NCPT, referred to collectively as NCP/T) forms a problem-solving framework fundamental to dietetic practice. Global implementation would assist in confirming outcomes from dietetic care, but implementation rates have varied between countries. We investigated which factors predict NCP/T knowledge and use among dietetic professionals in an international cohort, aiming to understand how implementation can be strengthened. The validated International NCP Implementation Survey was disseminated to dietitians in 10 countries via professional networks. Implementation, attitudes and knowledge of the NCP/T along with workplace and educational data were assessed. Independent predictive factors associated with higher NCP/T knowledge and use were identified using backward stepwise logistic regression. Data from 6149 respondents was used for this analysis. Enablers that were independent predictors of both high knowledge and frequent use of NCP/T were peer support, recommendation from national dietetic association and workplace requirements (all p < 0.001). Country of residence and working in clinical settings (p < 0.001) were demographic characteristics that were independent predictors of high knowledge and frequent use of NCP/T. A high knowledge score was an independent predictor of frequent NCP/T use (p = 0.002). Important modifiable enablers for NCP knowledge and use rely on organisational management. National dietetic organisations and key stakeholders such as employers are encouraged to integrate active NCP/T support in their leadership initiatives. This could take the form of policies, formalised and structured training strategies, and informatics initiatives for the integration in electronic health records.

The impact and experience of debriefing for clinical staff following traumatic events in clinical settings: A systematic review.

Health care professionals are more frequently exposed to potentially traumatic events than individuals in other professions. Repeated trauma exposure can significantly impact both physical and mental health. In clinical settings, the term "debriefing" refers to a group meeting during which clinical events and decision-making are reviewed and discussed to improve clinical practice. The present review investigated the use of debriefing for clinical staff in clinical settings following exposure to direct and vicarious trauma. We examined whether the use of posttrauma debriefing impacts symptoms of distress and explored how clinical staff experience debriefing; we also investigated the factors that influence this experience. A systematic search of five electronic databases was conducted between August 31 and September 2, 2019. Included articles (N = 13) described the use of debriefing in clinical settings with clinical staff following a traumatic event. We assessed methodological quality and performed a narrative synthesis. Four studies found some evidence of the benefits of debriefing for reducing psychological sequelae to traumatic events. Seven studies commented on factors that clinical staff perceived to be important for the debriefing to feel helpful, including the being given the opportunity for reflection, gaining a shared experience, and having the right peer facilitator. Some evidence suggests that debriefing with staff working in clinical settings can reduce posttraumatic distress symptoms, and subjective evidence suggests that clinical staff members perceive debriefing to be useful. Due to the limited literature, no firm conclusions could be drawn, and further methodologically sound research is required.

Effects of a hospital-based leisure activities programme on nurses' stress, self-perceived anxiety and depression: A mixed methods study.

AimsTo determine the effects of a hospital‐based leisure activities programme on nurses' stress, self‐perceived anxiety and depression.BackgroundNursing work in clinical settings is highly stressful and may result in an increase in nurses' turnover rate, which threatens the quality of nursing care and patient safety.MethodsWe used a mixed methods design and a three‐month intervention (January to April, 2019) involving a convenience sample of 176 nurses working at a Chinese tertiary hospital. We conducted 12 semi‐structured interviews and performed a content analysis. The pre‐ and post‐intervention comparisons of nurses' stress, self‐perceived anxiety and depression were performed using a paired t test.ResultsThe 3‐month leisure activities programme significantly decreased nurses' job stress (t = 3.80, p < .01), perceived personal stress (t = 3.30, p < .01), self‐perceived anxiety (t = 3.76, p < .01) and depression (t = 2.73, p < .01). The qualitative findings revealed five mechanisms linking leisure activities to subjective well‐being: detachment recovery, autonomy, mastery, meaning and affiliation.ConclusionsA hospital‐based leisure activities programme had a positive effect on job stress, self‐perceived anxiety and depression, thus improving nurses' well‐being.Implications for Nursing ManagementA hospital‐based leisure activities programme provides a beneficial strategy for ameliorating nurses' psychosocial issues. Interventions aimed at facilitating or increasing nurses' participation in leisure activities are greatly needed.

Prevalence and predictors of depression, anxiety, and stress among Jordanian nurses during the coronavirus disease 2019 pandemic

Background COVID-19 is an infectious disease with a wide range of physical and psychological health threats among health care workers, in particular, nurses because they spend a long time caring for their patients. Aims To investigate the prevalence and predictors of depression, anxiety, and stress among Jordanian nurses. Methods This study was conducted among 405 nurses using an online survey from March 3, 2020 to March 24, 2020. The Arabic version of the Depression, Anxiety, and Stress Scale (DASS) was used. Results the findings of this study showed that depression, anxiety, and stress were highly prevalent among nurses (57.8, 42.4, and 50.1%, respectively). Those who had close contact with a coronavirus disease 2019 (COVID-19) patient showed stronger psychological reactions than their counterparts. The full regression models in terms of depression, anxiety, and stress which contained gender, number of children, and dealing with a person with COVID-19 were statistically significant (F (3, 216) = 11.801; p < 0.001), (F (3, 216) = 10.501; p < 0.001), and (F (3, 216) = 11.659; p < 0.001), respectively. Conclusion In the COVID-19 pandemic, the levels of depression, anxiety, and stress are high among Jordanian nursing working in clinical settings. Hence, the mental health status of nurses should be given a priority, with a specific emphasis on those who are in contact with infected patients with COVID-19, female nurses, and those who have children.

Occupational stress and coping strategies in experienced Australian veterinarians.

Veterinarians have been identified as being at particularly high risk of stress in the workplace, this predisposes them to anxiety, depression and suicide. Previous quantitative studies have identified causes of stress and common coping strategies used by veterinarians. The current research aimed to gain a deeper understanding of the experience of veterinarian stress and ways of coping using qualitative methods. Twelve practicing small animal veterinarians in Australia were recruited. They took part individually in semi-structured research interviews. Interpretative phenomenological analysis (IPA) was used to design the study and to analyse the transcripts. Analyses of the interview data identified an overarching theme: spending less time working in clinical settings and four main themes: Preoccupation, self-doubt, conflicting responsibilities (between care of the animal, the human client and financial demands of the business) and insufficient support. The results give a deeper understanding of sources of stress and the difficulties experienced in coping. These findings can help explain why veterinarians are leaving the profession or reducing their work hours, as well as emphasize the importance of continuing education of veterinarians on self-care and coping with stress, help with resolving ethical dilemmas, and working as a team.

Approche clinique et psychopathologique du burn out : discussion à partir de la psychodynamique du travail

AimThis article aims to discuss the semiological and etiological aspects of burnout from the analysis of the psychological processes involved in the encounter with work, in particular, care work. MethodThe discussion highlights the central place of the subjective relationship to work in the genesis of disorders designated as burnout. In particular, the concepts of recognition, hyperactivity, and sublimation are discussed. ResultsThe analyses highlight the role of the psychological motivations of subjects’ engagement in work, both from an individual and also a collective point of view, and their relationship with the risk of psychopathological decompensation. DiscussionThe discussion suggests that the hyperactive subjective relationship to work might be an important intermediate link in the etiology of situations relating to burnout. Practical implications of listening to patients’ discourse about work in clinical settings are also considered. ConclusionThe elucidation of the psychopathological issues linked to burnout is based on an etiological approach that is able to take into account the nature of the suffering and the psychic processes involved in the work situation.

Knowledge and attitude among healthcare workers towards COVID-19: a cross sectional study from Jeddah city, Saudi Arabia.

The emergence of the new Coronavirus disease 2019 (COVID-19) has caused a major impact on global health system. This cross-sectional study was designed to appraise the knowledge and attitude of healthcare workers towards COVID-19 and find out their understanding about clinical aspects of the infection. A total number of 1023 of healthcare workers responded to an online questionnaire and provided their data between February and March, 2020 in Jeddah city, Western province, Saudi Arabia. The questionnaire was distributed to physicians, nurses, pharmacists, technical staff and administrative staff working in clinical settings. Results revealed that mean scores for knowledge and attitude were 20.793 ± 2.436 and 4.744 ± 0.297 respectively. More than 88% of participants displayed positive knowledge and attitude towards COVID-19. Knowledge data showed that social media and the workplace, were the main sources of information for the majority of respondents. Approximately 99.12% of respondents were aware of the viral pandemic, and the causative agent. Statistically significant association was found when compared the demographic characteristics with the mean knowledge while no statistical significance was observed when compared demographic characteristics with the mean attitude score except with marital status. This study showed that healthcare workers had sufficient knowledge and positive attitude towards COVID-19. However, hospital staff should be periodically given sufficient training to effectively cope with such outbreaks in the future.