How clinicians make decisions for patient management plans in telehealth.

AIM: This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth. BACKGROUND: Telehealth is a modality of care that has gained popularity due to the development of digital technology and the COVID-19 pandemic. It is recognized that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood. DESIGN: A systematic integrative review. DATA SOURCES: Databases include CINAHL, APA PsycInfo, Academic Search Complete, PubMed, Web of Science and Google Scholar. REVIEW METHODS: This systematic integrative review method was informed by Whittemore and Knafl (2005). The databases were initially searched with keywords in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesize the data. RESULTS: The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included. Five studies were qualitative, one quantitative and four were mixed methods. Five main themes relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor and external influencing factor. CONCLUSIONS: The decision-making process in telehealth is a complicated cognitive process influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors. IMPACT: Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalized and made transparent, to prepare junior clinicians with skills to minimize risks associated with telehealth. PATIENT OR PUBLIC CONTRIBUTION: Not applicable.

What do nurses experience in communication when assisting in robotic surgery: an integrative literature review.

BACKGROUND: Communication in surgery is integral to the fundamentals of perioperative nursing practice and patient safety. Research exploring team communication in robotic-assisted surgery (RAS) is evident in the literature but little attention has been focused on how the experiences of operating room nurses' communication affect safety, practice and patient care outcomes. OBJECTIVE: To synthesise current evidence regarding communication during robotic-assisted surgery as experienced by registered nurses. DESIGN: An integrative literature review informed by Whittemore and Knafl's (2005) methodology was used to conduct a rigorous analysis and synthesis of evidence. METHODS: A comprehensive database search was conducted using PRISMA guidelines. CINAHL, Pubmed, PsychINFO and British Nursing Web of Science databases were searched using a Boolean strategy. RESULTS: Twenty-five relevant papers were included in this literature review. Thematic analysis revealed two main themes with four related subthemes. The two main themes are: 'Adaptive operating room nursing in RAS' and 'RAS alters team dynamics'. The four subthemes are: 'Navigating disruptions in RAS', 'RAS heightens interdependence on team working', 'Augmented communicative workflow in RAS', and 'Professional empowerment to speak up'. CONCLUSIONS: This integrative review identifies how current research largely focuses on communication in the wider OR team. However, current evidence lacks the input of nurses. Therefore, further evidence is needed to explore nurses' experiences to highlight their perspectives. CLINICAL RELEVANCE: Robotics significantly benefit patients, and this review identifies different challenges that robotic-assisted surgery nurses encounter. A better understanding of the communication from the perspective of nurses is needed to guide future research, practice education, policy development and leadership/management.

Bedside nurses' perspective on the Fundamentals of Care framework and its application in clinical practice: A multi-site focus group interview study.

BACKGROUND: A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives. OBJECTIVE: To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice. DESIGN: A descriptive qualitative design informed by the Fundamentals of Care framework. SETTING(S): The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019. PARTICIPANTS: A total sample of 53 registered nurses working at the bedside participated. Participants had a wide variety of clinical experience and represented a range of different nursing practice areas. METHODS: Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach. RESULTS: Bedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership. CONCLUSIONS: The Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides bedside nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for bedside nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework. TWEETABLE ABSTRACT: Bedside nurses recognise their clinical practice within the Fundamentals of Care framework, showing the core of modern nursing.

Using immersive technology and architectural design to assist head and neck cancer patients' recovery from treatment: A focus group and technology acceptance study.

PURPOSE: Head and neck cancer patients can face debilitating treatment related side-effects, resulting in requirement for support and negatively impacting on care outcomes. This study aimed to develop a digital recovery support package and assess its acceptability with head and neck cancer patients to support their information needs and assist with their self-management. It provided additional support through development of a WebXR platform 'recovery' package, which allowed patients to live a 'virtual reality' experience, entering and moving inside a 'virtual room', accessing targeted resources and specific learning materials related to their cancer. METHOD: A qualitative intervention development study consisting of three phases. This study followed the COREQ checklist for qualitative research. Phase 1- Focus groups with seven head and neck cancer patients and six healthcare professionals. Phase 2- Development of 'recovery' package based on the focus group data which informed the content and design of the WebXR recovery platform. Phase 3- Technology acceptance study. Once developed, the platform's acceptability of the experience lived inside the virtual room was assessed via qualitative interviews with six different patient participants. RESULTS: Most participants felt comfortable using the virtual reality platform, finding it a realistic and useful support for identifying resources and signposting to relevant materials. Participants agreed the WebXR platform was a feasible tool for the head and neck cancer setting and helped reduce anxiety. CONCLUSIONS: Head and neck cancer patients welcome specific targeted, information and advice to support their ability to self-manage their rehabilitation and thus focus their nursing care. The platform was implemented during the Covid-19 pandemic, demonstrating its versatility and accessibility in providing complementary support to head and neck cancer patients, to empower them to adjust to their 'new' normal as part of their ongoing cancer journeys.

Learning from nursing students' experiences and perceptions of their clinical placements in nursing homes: An integrative literature review.

OBJECTIVES: This paper aims to investigate pre-registration nursing students' experiences and perceptions of their clinical placements in nursing homes in order to develop recommendations for nurse educators. Evidence indicates that nursing students do not view nursing home placements as favourably as acute hospital placements. Therefore, nurse educators are challenged to facilitate a change in students' perceptions towards working in the nursing home environment. DESIGN: An integrative literature review allowed for the analysis and synthesis of the data relating to students' experiences and perceptions of nursing home practice, from studies with diverse research designs. METHODS: An electronic database search of CINAHL (Ebsco), Pubmed, British Nursing Database (BND), ERIC and social service abstracts, published from 2008 to April 2020 in English was completed. Papers were included using pre-allocated criteria and 649 qualified for closer examination. After exclusion, 21 papers underwent final analysis and synthesis using NIVIO 12. RESULTS: Five main themes were derived from the literature; i) the importance of effective supervision; ii) students' experiences and perceptions of the learning environment; iii) understanding the roles of care staff, iv) comprehensive orientation to the learning environment, and v) curriculum preparation. From these five categories, two synthesised themes were developed: nursing home placement encounters and enhancing learning opportunities. CONCLUSIONS: Increasing the visibility of caring for older people in the curriculum is urgent in order to address nursing students' perceived misconceptions about placements in nursing homes. The development of standalone older people pathways, delivered by experienced and knowledgeable faculty, as well as the provision of compulsory clinical placements in settings exclusive to nursing older people and supervised by registered nurses are recommended. Failing to resolve this immediate problem will result in a further shortage of nurses who are adequately prepared to meet future nursing needs.

What is a theory-practice gap? An exploration of the concept.

In nursing literature, the phrase 'theory-practice gap' is widely used without common definition or description of its underlying concept. This review paper presents a concept analysis using Rodgers (2000) evolutionary process to define and clarify the concept of the theory-practice gap as part of a doctoral study. In so doing it provides a deeper understanding of the concept to enable its consistent application within nurse education. A theoretical definition is developed, the data search that was undertaken is described and a discussion of the attributes, antecedents and consequences is provided. We conclude by offering, a model case, which is employed to illustrate the concept.

How to care for a patient after death in the community.

Rationale and key points This article provides nurses with information about how to care for a patient after death, and support their family and loved ones in the community setting. ▶ Care after death involves supporting the family and significant others, and providing personal care to the patient. ▶ It is important to ensure privacy, dignity and respect of the deceased and to recognise this is a sensitive and difficult time for families. ▶ Staff undertaking care after death should be offered support. ▶ Local and national guidelines should be followed. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice, reflect on and write a short account of: 1. How reading this article will change your practice. 2. How this article could help you to consider the support mechanisms in place for the provision of care after death in the community setting. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

Relationships between self-reported lifetime physical activity, estimates of current physical fitness, and aBMD in adult premenopausal women.

Osteoporosis is common, and physical activity is important in its prevention and treatment. Of the categories of historical physical activity (PA) examined, we found that weight-bearing and very hard physical activity had the strongest relationships with areal bone mineral density (aBMD) throughout growth and into adulthood, while for measures of strength, only grip strength proved to be an independent predictor of aBMD. PURPOSE/INTRODUCTION: To examine relationships between aBMD (total body, lumbar spine, proximal femur, tibial shaft, distal radius) and estimates of historical PA, current strength, and cardiovascular fitness in adult premenopausal women. METHODS: One hundred fifty-two adult premenopausal women (40 ± 9.6 years) undertook aBMD (dual-energy X-ray absorptiometry (DXA)) and completed surveys to estimate historical physical activity representative of three decades (Kriska et al. [1]), while subsets underwent functional tests of isokinetic strength (hamstrings and quadriceps), grip strength (hand dynamometer), and maximum oxygen uptake (MaxV02; cycle ergometer). Historical PA was characterized by demand (metabolic equivalents, PA > 3 METS; PA > 7 METS) and type (weight-bearing; high impact). RESULTS: Significant positive independent predictors varied by decade and site, with weight-bearing exercise and PA > 3 METS significant for the tibial shaft (10-19 decade) and only PA > 7 METS significant for the final two decades (20-29 and 30-39 years; total body and total hip). A significant negative correlation between high impact activity and tibial shaft aBMD appeared for the final decade. For strength measures, only grip strength was an independent predictor (total body, total hip), while MaxV02 provided a significant independent prediction for the tibial shaft. CONCLUSIONS: Past PA > 7 METS was positively associated with aBMD, and such activity should probably constitute a relatively high proportion of all weekly PA to positively affect aBMD. The findings warrant more detailed investigations in a prospective study, specifically also investigating the potentially negative effects of high impact PA on tibial aBMD.

Impact exercise and bone density in premenopausal women with below average bone density for age.

PURPOSE: To study the effects of two home-based impact exercise programs on areal bone mineral density (aBMD) in adult premenopausal women with below average aBMD for age (negative Z-scores; 40.8 years; n = 107). METHODS: Two unilateral impact exercise programs were employed, one targeting the total hip and lumbar spine (n = 42 pairs), the other the distal radius (n = 24 pairs) with some individuals performing both. Force plate data were used to establish exercise loading characteristics (peak loads, time to peak), dual-energy X-ray absorptiometry (DXA) provided bone data. Calcium intake, health and extraneous physical activity (PA) were determined by survey. Exercise for both hip and spine consisted of unilateral landings from adjustable steps (maximum height 63.5 cm) while impacts were delivered to the forearm by arresting falls against a wall. An exercise log was used to provide the exercise prescription, record each exercise bout and any injuries. Participants were randomly assigned to exercise or control groups and pair-matched (age, BMI, Z-score, aBMD). Compliance was calculated as the number of sessions completed divided by the total prescribed number (mean ~50 %). RESULTS: The programs delivered significant gains pre to post at each site compared with significant losses in controls (forearm: 3.9 vs -3.9 %; total hip: 2.0 vs -2.6 %; lumbar spine: 2.8 vs -2.9 % exercise and controls, respectively, all p < 0.001). No exerciser lost bone at the target site regardless of compliance which was strongly correlated with bone gains (R (2) = 0.53-0.68, all p < 0.001). CONCLUSIONS: Impact exercise provides an effective means of improving below average aBMD without supervision in this at risk population.

Rituals in nursing: intramuscular injections.

AIMS AND OBJECTIVES: To consider to what extent intramuscular injection technique can be described to remain entrenched in ritualistic practice and how evidence-based practice should be considered and applied to the nursing practice of this essential skill. BACKGROUND: The notion of rituals within nursing and the value or futile impact they afford to this essential nursing skill will be critically reviewed. DESIGN: Discursive paper. METHOD: Literature review from 2002-2013 to review the current position of intramuscular injection injections. RESULTS: Within the literature review, it became clear that there are several actions within the administration of an intramuscular injection that could be perceived as ritualistic and require consideration for contemporary nursing practice. CONCLUSIONS: The essential nursing skill of intramuscular injection often appears to fit into the description of a ritualised practice. By providing evidence-based care, nurses will find themselves empowered to make informed decisions based on clinical need and using their clinical judgement. RELEVANCE TO CLINICAL PRACTICE: For key learning, it will outline with rationale how site selection, needle selection, insertion technique and aspiration can be cited as examples of routinised or ritualistic practice and why these should be rejected in favour of an evidence-based approach. The effect on some student nurses of experiencing differing practices between what is taught at university and what is often seen in clinical practice will also be discussed.

Using the ventrologluteal site for intramuscular injection.

The administration of intramuscular injections is a common nursing intervention in clinical practice. This article aims to raise awareness of the use of the ventrogluteal site for administering intramuscular injections. It describes the main reasons for using this site and outlines the complications associated with the dorsogluteal site. It is hoped that this review of the literature will shift everyday practice in favour of the ventrogluteal site.