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BACKGROUND: The nursing work environment can be compromised due to workload, stress and many other issues. A good nursing work environment is needed to for the health and wellbeing of nurses and therefore measures are developed to improve nursing work environment. AIM: To determine whether measures designed to improve the work environment for nursing professionals are effective. METHODOLOGY: Online research in the Medline, Scopus, Web of Science, ERIC, CINHAL, PsycINFO, and American Doctoral Dissertations databases, along with manual search, was carried out. Primary experimental studies made up of intervention and control groups were included, with pre-/post-measure evaluation in the nursing team, based on the effects of the interventions. Risk of bias was calculated using the Cochrane tool. RESULTS: A total of 1997 studies were examined; 19 clinical trials met the inclusion criteria. A total of 1427 nurses participated in the selected studies. The fields of application of the interventions were personal and environmental. Out of the fields targeting individuals, three methodologies were identified: cognitive-behavioral techniques, stress management, channeling anxiety and physical well-being; and those aimed at environmental fields: aromatization and organization. The most evaluated characteristic was teamwork, and the most analyzed symptom was stress. Most of the interventions concluded with at least one significant improvement. CONCLUSIONS: Interventions aimed at enhancing the work environment are effective ways of increasing job satisfaction. The heterogeneity of the data did not allow us to determine which intervention is the most effective. The combination, type, and duration are variables that affect efficacy. IMPLICATION FOR NURSING AND NURSING POLICY: This systematic review provides resources for improving the work environment that affects nursing staff, other professionals, and patients. Encouraging a healthy atmosphere leads to excellence in care and improved safety.
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Recursos Humanos de Enfermagem, HumanosRESUMO
PURPOSE: It is aimed to raise awareness about the science of nursing for women's health and the use of nursing theories and models in research by reviewing the studies using theories or models in postpartum care. DATA SOURCES: The data of the study were obtained by searching YÖK National Thesis Center, EBSCOhost, PubMed, Web of Science, Cochrane, and ScienceDirect databases. Reviewed studies were analyzed in terms of the type of research, sample characteristics, purpose, the field of use of theory and model in the research, and research results. CONCLUSIONS: As a result of the review, it was noted that in the studies, Orem's Self-Care Deficit Nursing Theory/Model (n = 9), Roy's Adaptation Theory (n = 7), and Kolcaba's Theory of Comfort (n = 7) were the most used theories, theories and models were not used in a systematic structure at every stage of the research, and positive outcomes were obtained with the theory and model-based nursing interventions. IMPLICATIONS FOR NURSING PRACTICE: The application of theory and model in postpartum care can be chosen by nurses as it improves patient outcomes. Furthermore, the use of theories and models in research to develop nursing knowledge will benefit nursing science while increasing professional autonomy.
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Teoria de Enfermagem, Cuidado Pós-Natal, Humanos, Feminino, Gravidez, Modelos de Enfermagem, AutocuidadoRESUMO
OBJECTIVES: This study examined the relationship between moral distress, individual and professional values in oncology nurses. METHODS: Employing structural equation modeling, a descriptive-correlational study was conducted among 116 oncology nurses. Data were collected using the Moral Distress Scale-Revised Adult Nurses, the Nursing Professional Values Scale, and the Values Scale. RESULTS: The mean moral distress frequency was evaluated as low (1.6 ± 0.7) and the intensity as moderate (1.9 ± 0.8). Both the Nursing Professional Values Scale and Values Scale subdimension mean scores were at levels evaluated as high. There was no specific value that stood out from the others. Structural equation modeling analysis showed that individual values were found to have a direct and negative significant effect on moral distress intensity (ß = -0.70, p < 0.01) and frequency (ß = -0.58, p <0.01) and professional values had a direct positive and significant effect on moral distress intensity (ß = 0.37, p < 0.05) and frequency (ß = 0.25, p < 0.05). SIGNIFICANCE OF RESULTS: It is believed that more national and international studies need to be conducted to examine the relationship between the moral distress concept and values. While individual values were found to have a direct and negative significant effect on moral distress, professional values had a direct positive and significant effect on moral distress.
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Princípios Morais, Enfermeiras e Enfermeiros, Adulto, Humanos, Estresse Psicológico/complicações, Atitude do Pessoal de Saúde, Estudos Transversais, Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the accuracy of the defining characteristics of the nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot. METHOD: A diagnostic accuracy study with a cross-sectional design was carried out with patients with type 2 diabetes mellitus on outpatient diabetic foot treatment. We evaluated 134 patients with diabetic foot to determine the accuracy of the defining characteristics of ineffective peripheral tissue perfusion. A latent class model with random effects was used to establish the sensitivity and specificity of the defining characteristics assessed. RESULTS: Ineffective peripheral tissue perfusion was present in 83.79% of the patients. The defining characteristics color does not return to lowered limb after 1-minute leg elevation and edema had high sensitivity (0.8370 and 0.7213) and specificity (0.9991 and 0.9995). CONCLUSION: The defining characteristics color does not return to lowered limb after 1-minute leg elevation and edema are good clinical indicators that can be used for screening and confirming ineffective peripheral tissue perfusion in patients with diabetic foot.
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Diabetes Mellitus Tipo 2, Pé Diabético, Humanos, Pé Diabético/diagnóstico, Diagnóstico de Enfermagem, Estudos Transversais, Edema, PerfusãoRESUMO
BACKGROUND AND AIM: Identifying and evaluating the strengths and weaknesses of nursing care provided to improve the quality of nursing care is increasingly emphasized, and it requires using valid tools in this field. This study aimed to translate and determine the psychometric properties of the Persian version of the "Good Nursing Care Scale" (GNCS-P). METHODS: The present study is a methodological study in which the psychometric dimensions of GNCS-P were studied from the perspective of 200 patients who were admitted to the hospitals of Ardabil University of Medical Sciences. After translating the original version of the scale, its validity and reliability were evaluated and data analysis was performed using statistical package for social science (version 16) and analysis of moment structures (version 24). RESULTS: The effect score of the item in the evaluation of face validity for each item was above 2.4. The content validity ratio for the scale was 0.88, and the content validity index tool was 0.86. The correlation of total instrument scores with the standard instrument was 0.839. According to the results of factor analysis, the values of factor loading of items were between 0.62 and 0.91, which were all significant. Therefore, the seven dimensions introduced in the main tool were approved. In addition, Cronbach's alpha results of 0.865 and correlation of 0.894 in the test-retest showed that the questionnaire has internal consistency and acceptable stability. CONCLUSION: The Persian version of the GNCS-P has acceptable psychometric properties in the Iranian population and can be used as a valid tool in the areas of quality assessment of nursing care, education, and nursing research. IMPLICATIONS FOR NURSING PRACTICE: The results showed the validity and reliability of the tool and its usability as a valid tool in evaluating the quality of nursing care.
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Psicometria, Humanos, Irã (Geográfico), Reprodutibilidade dos Testes, Inquéritos e Questionários, Análise FatorialRESUMO
In this paper, we argue that nurses need to be aware of how the production of space in specific contexts - including health care systems and research institutions - perpetuates marginalized populations' state of social otherness. Lefebvre's idea regarding spatial triad is mobilized in this paper, as it pertains to two-spirited, lesbian, gay, bisexual, trans and queer populations (2SLGBTQ*). We believe that nurses can create counter-spaces within health care systems and research institutions that challenge normative discourses. Lefebvre's work provides us the necessary tools to understand how various places or environments produce identities. In understanding Lefebvre's principles, we believe that nurses can play an essential role in creating counter-spaces, thereby instigating counter-institutional practices, for those who experience otherness.
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Minorias Sexuais e de Gênero, Feminino, Humanos, Comportamento SexualRESUMO
OBJECTIVES: Measuring tools are essential in assessing the quality of care. This study aimed to evaluate the validity and reliability of the Turkish version of the Palliative Nursing Care Quality Scale (PNCQS-T) and the sociodemographic characteristics affecting the quality of care. METHODS: This methodological study, whose linguistic equivalence was confirmed by the translation/back translation method, was carried out with the participation of 209 nurses. Personal Information Form and PNCQS-T were used as data collection tools. Construct validity was determined by confirmatory factor analysis (CFA). Reliability was tested with internal consistency and item-total correlation coefficients. RESULTS: Adaptation results showed that the Turkish version of the scale is adequate for linguistic and content validation. The Turkish adaptation's original scale of 20 items was reduced to 18. As in the original scale, all items were combined under a single dimension in the Turkish adaptation. Modified CFA indicated a well-fitting model. PNCQS-T explained 42.1% of the total variance. Cronbach's alpha value was 0.92. The lowest score obtained from the scale is 18; the highest score is 90. Higher scores indicated that the palliative care provided by nurses was of good quality. SIGNIFICANCE OF RESULTS: The Turkish version of the PNCQS-T is reliable for assessing the quality of palliative care provided by nurses in Turkey.
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Enfermagem de Cuidados Paliativos na Terminalidade da Vida, Humanos, Turquia, Psicometria/métodos, Reprodutibilidade dos Testes, Inquéritos e QuestionáriosRESUMO
Among all industrial accident-induced diseases, musculoskeletal disorders (MSDs) are most prominently observed among nurses. The physical load of everyday tasks involved in nursing work was assessed in this study using a developed risk index, whereby the physical burden was evaluated using the exposure duration and work intensity levels. This survey targeted nine small, medium and large-sized hospitals in South Korea and categorized representative nursing tasks into six groups. The subtasks within these six categories (evaluated as high risk) included changing a patient's posture and assisting with walkers or wheelchairs, transporting/handling drug carts, bathing patients, replacing bedding, traction therapy, cardiopulmonary resuscitation and artificial manual breathing unit, and computer work. The risk index ratio was significantly different by task type for each task. We demonstrated that the risk index developed in this study can be used to evaluate MSDs in hospitals.
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Doenças Musculoesqueléticas, Doenças Profissionais, Humanos, Doenças Musculoesqueléticas/epidemiologia, Ergonomia, Inquéritos e Questionários, Acidentes de Trabalho, República da Coreia/epidemiologia, Doenças Profissionais/epidemiologia, Fatores de RiscoRESUMO
The COVID-19 pandemic has affected the educational, social, and psychological lives of children and young people. Many countries have transitioned to online education because of the pandemic. This study aimed to examine the levels of fear of nursing students about COVID-19 and their attitudes towards e-learning. This study was designed as a cross-sectional and descriptive study. The data were collected using the COVID-19 Phobia Scale and the Attitude Scale Towards E-learning. This research was conducted with nursing students (n = 301) who received online education due to the COVID-19 pandemic. The students' mean COVID-19 Phobia Scale score was 49.26 ± 15.88; the mean Attitude Scale Towards E-learning score was 59.46 ± 17.00, and a significantly positive relationship was found between the participants' scores on both scales (r = 0.122; p < 0.034). The COVID-19 pandemic has caused students to experience psychological and social problems. It is essential to have sufficient infrastructure to effectively maintain online education.
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COVID-19, Instrução por Computador, Estudantes de Enfermagem, Criança, Humanos, Adolescente, Estudos Transversais, Pandemias, COVID-19/epidemiologia, MedoRESUMO
BACKGROUND: Despite the importance of rehabilitation nursing care in improving patient outcomes, the provision of this care in the early stages of diseases and injuries is limited. In this situation, analyzing the concept of rehabilitation nursing care can increase nurses' understanding of this concept and improve the provision of rehabilitation nursing care in the acute phase. This study aimed to analyze the concept of rehabilitation nursing care in acute phase of diseases with physical disability. METHOD: Walker and Avant's approach to concept analysis was performed in eight stages, including choosing a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case, identifying borderline and contrary cases, identifying antecedents and consequences, and defining empirical referents. RESULTS: The important characteristics of rehabilitation nursing are comprehensive, education-based, specialized, client and family centered, interprofessional, and need-based. The antecedents of rehabilitation nursing care are related to nurses, the care settings and the nursing profession. The most important consequence of rehabilitation nursing care is improving the quality of life of patients. Rehabilitation nursing care also has positive outcomes for nurses and the healthcare systems. CONCLUSION: The findings indicate that rehabilitation nursing care has several attributes that require antecedents such as knowledge and specialized skills such as teamwork skills, effective communication skills, cultural sensitivity, holistic perspective, intuitive thinking, and reasoning. The most important consequence of rehabilitation nursing care is improving the quality of life of patients.
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Enfermagem em Reabilitação, Humanos, Qualidade de Vida, Enfermagem, Resolução de Problemas, Formação de ConceitoRESUMO
PURPOSE: The purpose of this study was to describe the use of the nursing diagnosis Risk for Falls in Primary Care System of the Community of Madrid. METHODS: A retrospective review of the clinical histories was carried out in 262 health centers from January 2005 to December 2015. The study population are the patients who have recorded in their electronic health record the nursing diagnosis Risk for Falls. FINDINGS: Frequency of use of the Risk for Falls ND in the Community of Madrid was 53,340 diagnoses, increasing from 650 nursing diagnosis in 2005 to 14,695 in 2015. NOC Nursing Outcomes total identified were 109,145, which represents an average of 2.05 NOC Nursing Outcomes per diagnosis. NOC Nursing Outcomes frequently appeared as follows: Fall Prevention Behavior (35.9%), Safe Home Environment (11.3%), and Risk Control (10.5%). NIC Nursing Interventions total identified were 104,293, representing an average of 1.96 NIC nursing interventions per diagnosis. NIC Nursing Interventions frequently appeared as follows: Fall Prevention (45.9%), Environmental Management: Safety (27%), and Risk Identification (5.8%). CONCLUSIONS: Nursing diagnosis of Risk for Falls and the care process related to this diagnosis is starting to be used by the primary care nurses of the Community of Madrid. IMPLICATION FOR NURSING PRACTICE: Risk factors related to the nursing diagnosis of risk for falls identified in our study can be addressed with activities that nurses must implement to prevent falls. Nursing methodology in general and specifically the diagnosis of risk for falls must be included in guides and protocols for the prevention of falls, and its use should be promoted by primary care nurses.
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Diagnóstico de Enfermagem, Atenção Primária à Saúde, Humanos, Espanha, Estudos Retrospectivos, Fatores de RiscoRESUMO
PURPOSE: We aimed to investigate the nursing process linkages formed by Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) according to the primary NANDA-I diagnoses by registered nurses (RNs), customized to nursing home (NH) residents in Korea, using a developed smartphone application for NH RNs. METHODS: This is a retrospective descriptive study. Applying quota sampling, a total of 51 NHs from all operating 686 NHs hiring RNs participated in this study. Data were collected from June 21 to July 30, 2022. Data on NANDA-I, NIC, NOC (NNN) of nurses applied to the NH residents were collected through a developed smartphone application. The application consists of general organization and residents' characteristics, NANDA-I, NIC, and NOC. RNs selected randomly up to 10 residents and NANDA-I with risk factors and related factors over the past 7 days, followed by all applied interventions out of 82 NIC. RNs then evaluated residents through 79 selected NOC. RESULTS: We found the frequently used NANDA-I diagnoses, Nursing Interventions Classifications and Nursing Outcomes and Classifications applied for NH residents by RNs and developed the top five NOC linkages used to build care plan. CONCLUSION: It is time to pursue high-level evidence and reply to the questions raised in NH practice using NNN with high technology. The outcomes for patients and nursing staff are improved by the continuity of care made possible by uniform language. IMPLICATIONS FOR NURSING PRACTICE: NNN linkages should be used to construct and utilize the coding system of electronic health records or electronic medical records in Korean long-term care facilities.
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Enfermeiras e Enfermeiros, Terminologia Padronizada em Enfermagem, Humanos, Diagnóstico de Enfermagem, Estudos Retrospectivos, Smartphone, Casas de Saúde, América do NorteRESUMO
AIM: To explore graduates' perceptions of the impact on nursing practice of a new postgraduate course in child health, developed and implemented in the Solomon Islands in 2016. BACKGROUND: The Bachelor of Nursing - Child Health was implemented in 2016 to develop nurses' knowledge and skills in child health and paediatric care with the intent to improve national child health outcomes. DESIGN: A qualitative exploratory, descriptive design was used to evaluate the impact of the Bachelor of Nursing - Child Health on graduates' nursing practice. METHODS: Fourteen nurses who graduated from the first cohort of students enrolled in the child health course were purposively selected to participate. Participants engaged in individual semi-structured interviews, conducted between August and December 2018. A thematic analysis was undertaken following Braun and Clarke's six-phase process. RESULTS: Findings from the study demonstrate positive impacts of the course on graduates' nursing practice. These include a perceived enhanced quality of care through their commitment to evidence-based practice, the ability to contribute to capacity building of colleagues, the reinforcement of provincial public health programmes and expanded participation in managerial activities. Following graduation, most alumni took on senior roles and greater responsibilities, felt more confident in managing unwell children, felt there was better access to and quality of child health care at the community and broader country levels and felt recognised by colleagues and communities. Some graduates faced resistance from colleagues to change practice and felt that despite being given greater responsibilities, nursing levels and salaries remained unchanged. This reflected a potential lack of recognition from hospital or provincial managers, the Nursing Council as the regulatory body for the nursing profession, and the Ministry of Health and Medical Services. A lack of human and material resources also impacted quality of care. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Findings from this study underline the need for the Solomon Islands National University, the Nursing Council, the Public Service and the Ministry of Health and Medical Services to concord and delineate formal accreditation standards for child health nurses. Overall, collaborative efforts and commitments at local, regional and global levels are required to support child health nurses in their ability and ambition to improve national child health outcomes. CONCLUSIONS: Findings from this study demonstrate positive impacts of the course on graduates' nursing practice. The impact of increasing nurses' knowledge and skills on national child health outcomes could be significant. Ongoing implementation and recognition of this course in the Solomon Islands, as well as more broadly across the Pacific region, are recommended.
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Competência Clínica, Enfermeiras e Enfermeiros, Criança, Humanos, Saúde da Criança, Estudantes, HospitaisRESUMO
PURPOSE: The aim of this paper was to analyze and evaluate the middle-range theory, emancipatory nursing praxis (ENP): a theory of social justice in nursing. METHODS: Peterson and Bredow's method was utilized to complete the theory evaluation. The theory was evaluated systematically to ensure the appropriateness of application for research in nursing education and transforming nursing students into social justice allies. FINDINGS: The ENP theory has not been widely used since its introduction in 2017, although it is even more relevant today after the revelation of profound societal inequities during the pandemic. The theory lacks testing and empirical indicators for utilization in nursing practice. CONCLUSION: ENP addresses the mandate from the American Association of Colleges of Nursing for nurse educators to foster the development of students as social justice leaders and competent caregivers across the life span. This theory provides a framework to apply in nursing education to improve the professional competency in social justice and disparities. However, further research is needed to develop tools to measure outcomes and generalizability. IMPLICATIONS FOR NURSING PRACTICE: ENP middle-range theory could support nursing educators and nursing programs to develop learning strategies and curricula to facilitate nursing students' knowledge and application in social justice advocates, allies, and leaders, thus improving individual, community, and global health outcomes.
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Bacharelado em Enfermagem, Educação em Enfermagem, Estudantes de Enfermagem, Humanos, Teoria de Enfermagem, Justiça Social/educação, CurrículoRESUMO
AIM: To describe stress and analyze its associated factors among nursing students. INTRODUCTION: Stress is a common mental health problem among medical students, especially nursing students. Therefore, understanding stress and its associated factors is necessary to improve stress in students. METHODS: A cross-sectional study was conducted among 300 nursing students using the stratified sampling method. This study used questionnaires such as demographic form, the Depression Anxiety Stress Scale 21, and the Stressors in Nursing Students scale. The STROBE checklist was used for reporting this study. RESULTS: Results showed that nearly half of the nursing students were stressed at various levels. Students experienced stress the most due to financial stressors, followed by education, clinical, and confidence stressors. Most of the factors in the four groups-clinical, education, confidence, and finance-increased the risk of stress in nursing students. There was a close relationship between personal problems other than health and the students' risk of stress (p < 0.001). CONCLUSIONS: This study indicated that stress in nursing students was at a high level. Determining the prevalence and associated factors of stress in nursing students will help schools, families, and society take measures to reduce stress among students. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Educational administrators need to develop policies to support nursing students, such as reviewing the academic load of nursing students, improving the design of curricula, and supporting finance for students with difficult situations. Support services should be organized and make it easier for students to access mental health counseling services.
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Estudantes de Medicina, Estudantes de Enfermagem, Humanos, Estudos Transversais, Estudantes de Enfermagem/psicologia, Prevalência, Vietnã/epidemiologia, Estresse Psicológico/epidemiologia, Inquéritos e QuestionáriosRESUMO
AIMS: To measure nurses' compliance with standard precautions during the COVID-19 pandemic, compare findings with previous assessments and describe the barriers affecting nurses' compliance. BACKGROUND: Healthcare providers' compliance with standard precautions is still limited worldwide. Implementation of infection control policies in hospitals is needed internationally, especially during a pandemic. Surprisingly, studies exploring nurses' compliance with standard precautions are lacking during COVID-19. METHODS: A multicenter cross-sectional study was adopted in two Italian hospitals. Nurses' compliance with standard precautions was measured through The Compliance with Standard Precautions Scale (Italian version). An open-ended question explored the barriers to nurses' compliance with standard precautions. Reporting, followed the STROBE guidelines. RESULTS: A total of 201 nurses were enrolled in 2020. Nurses' compliance with standard precautions was suboptimal. A statistically significant improvement in the compliance rate with standard precautions was observed between pre- and during COVID-19 assessments. High compliance was found in the appropriate use of surgical masks, gloves and sharps disposal. Nurses perceived personal, structural and organizational barriers to standard precautions adherence. CONCLUSION: Nurses' compliance with standard precautions was not 100%, and different factors impeded nurses to work safely. Our findings provide institutional leaders and educators with the basis for implementing policies to optimize nurse safety, well-being and patient care. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Nurses have the right to work safely, and when the shortage of personal protective equipment and nurses during an emergency threatens healthcare quality worldwide, policymakers are challenged to act by establishing an effective allocation of resources for consistent compliance with standard precautions. Moreover, nurses should actively engage in the implementation of infection control policies to improve safe behaviours among citizens and students accessing hospitals.
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COVID-19, Enfermeiras e Enfermeiros, Humanos, Estudos Transversais, Pandemias/prevenção & controle, COVID-19/epidemiologia, Controle de Infecções, Fidelidade a Diretrizes, Inquéritos e QuestionáriosRESUMO
BACKGROUND: COVID-19 is associated with increased nursing workload, therefore a high nurse-to-patient ratio would be required. AIM: To analyse difference in nursing workload, as expressed with the Nursing Activities Score (NAS), between COVID-19 patients versus control patients without COVID-19 disease (NCOVID-19 group) in an Italian Extracorporeal Membrane Oxygenation (ECMO) centre. STUDY DESIGN: Retrospective analysis of prospectively collected data, enrolling consecutive patients admitted to a general Intensive Care Unit, between 1st May 2019 and 28th February 2021. A multivariate analysis was then performed to assess if COVID-19 disease was an independent predictor of higher NAS and to assess which other factors and procedures are independently associated with increased workload. RESULTS: We enrolled 574 patients, of which 135 (24%) were in the COVID-19 group and 439 (76%) in the NCOVID-19 group. The average NAS was higher in the COVID-19 group (79 ± 11 vs. 65 ± 15, T = -10.026; p < 0.001). Prone positioning, continuous renal replacement therapy (CRRT) and ECMO were used more frequently in the COVID-19 group. A higher fraction of patients in the COVID group showed colonization from multidrug resistant bacteria. COVID-19 group had a higher duration of mechanical ventilation and longer ICU stay. The COVID-19 diagnosis was independently associated with a higher NAS. Other independent predictors of higher NAS were the use of prone positioning and continuous renal replacement therapy (CRRT). Colonization from multidrug resistant bacteria and ECMO support were not independently associated with higher NAS. CONCLUSIONS: The higher nursing workload in COVID-19 patients is mainly due to specific procedures required to treat the most hypoxemic patients, such as prone positioning. Colonization with multidrug resistant bacteria and ECMO support were not independently associated with a higher NAS. RELEVANCE TO CLINICAL PRACTICE: Higher workload in COVID-19 patients was due to specific interventions, such as prone positioning and CRRT, with the related nursing activities, as continuous presence at patient's bed, mobilization, positioning and complex hygienic procedures.
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COVID-19, Carga de Trabalho, Humanos, Estudos Retrospectivos, Teste para COVID-19, COVID-19/terapia, Unidades de Terapia IntensivaRESUMO
INTRODUCTION: Oral health therapists (OHTs) are a valuable resource for increasing access to dental care for the frail elderly in nursing homes (NHs). However, OHTs face several barriers and their skill-set continues to be under-utilized. AIMS: To evaluate the perceptions of OHTs regarding the barriers towards oral care provision for the elderly residents in NHs. METHODOLOGY: Semi-structured interviews were conducted with 11 OHTs to discuss the factors that may hinder them from providing oral health services in NHs. An inductive thematic analysis directed by the grounded theory approach was performed. RESULTS: Four major themes emerged: (i) lack of opportunity, (ii) lack of adequate education and training, (iii) limited work scope and registration status, and (iv) lack of adequate financial remuneration and adequate equipment. OHTs also raised the lack of awareness among OHTs and the various stakeholders, of how the skill-set of OHTs may be relevant for oral care provision in NHs. CONCLUSION: Findings revealed underlying educational and regulatory barriers which need to be addressed in tandem. Addressing these barriers can be impactful in informing future strategies for the greater utilization of the skill-set of OHTs in Singapore.
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Casas de Saúde, Saúde Bucal, Humanos, Idoso, Singapura, Inquéritos e QuestionáriosRESUMO
In recent years, the phenomenon of moral distress has been critically examined-and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re-examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re-centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of 'narrow' moral distress and the value of re-considering moral distress. Finally, we provide an action-oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency.
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Ética em Enfermagem, Humanos, Princípios Morais, Conhecimento, Estresse PsicológicoRESUMO
BACKGROUND: Nurses are members of multidisciplinary teams providing care to extracorporeal membrane oxygenation-supported patients (ECMO-SP). There are no valid and reliable measurements available to assess nursing activities in the care of ECMO-SP. AIM: To develop and evaluate psychometric properties of a new 27-item nursing activities in the care of ECMO-SP scale. STUDY DESIGN: A convenience sample was recruited of 76 registered nurses (mean age 41.3 ± 8.7; 71% female) in Israel. The nurses participated in an online survey with software Qualtrics, between March and June 2022. Content and construct validity, as well as internal consistency of the scale were evaluated. The participants also completed the perceived knowledge and skills in the treatment of ECMO-SP scale. The correlations between nursing activities in the care of ECMO-SP and ECMO knowledge were examined using Pearson's correlation. RESULTS: Exploratory factor analysis extracted four factors, and seven items were excluded from the 27-item scale making it a 20-item scale in its final form. Internal consistency was acceptable for the total scale (α = 0.84) and the four subscales: Factor 1: Nursing care of ECMO-SP not related to the ECMO device (α = 0.90), Factor 2: Activities on ECMO device in emergency (α = 0.82), Factor 3: ECMO device calibrating and monitoring (α = 0.72), and Factor 4: Medication and blood administration through ECMO device (α = 0.73). When examined in confirmatory factor analysis, the 20-item scale yielded acceptable fit indices. A positive correlation was found between perceived ECMO knowledge and all four factors of the nursing activities in the Care of ECMO-SP scale. CONCLUSIONS: The 20-item scale examining nursing activities in the care of ECMO-SP is ready for use for clinical, educational, and research purposes. RELEVANCE TO CLINICAL PRACTICE: Because there are still no standards for nursing care of ECMO-SP and no agreed quality indicators, this novel scale may help in building such standards and quality indicators.
