A peek behind the curtain: An integrative review of sexual harassment of nursing students on clinical placement.

AIMS AND OBJECTIVES: This integrative review aimed at systematically searching, analysing and synthesising multiple sources of evidence, to build a temporal understanding of nursing students' experiences of sexual harassment whilst on clinical placement, and to discuss the social context which enables this. BACKGROUND: Sexual harassment is highly prevalent in workplaces globally. Contemporary social understandings contextualise sexual harassment as a significant form of interpersonal violence. This is the first literature review to go beyond prevalence to synthesise the experience, implications and responses to sexual harassment encountered by student nurses on clinical placement. DESIGN: Whittemore and Knafl's (2005) integrative review methodology is used to structure a rigorous analysis and synthesis of evidence. METHODS: The PRISMA checklist supported sound reporting of the search strategy. Three databases (CINAHL, Scopus and Medline) were searched using a Boolean strategy. Papers with a significant focus on sexual harassment of nursing students in the clinical setting were included with no limitation on publication date. Papers were excluded if they were not published in English or were only published as abstracts. RESULTS: A synthesis of 26 papers demonstrated that sexual harassment has significant impacts on student nurses and the nursing profession. The intimacy of close body care, dominant social perceptions of nursing as women's work and the sexualisation of nurses increase student vulnerability to sexual harassment. Workplace power imbalances further exacerbate sexual harassment and shape responses to incidents. CONCLUSIONS: Sexual harassment of nursing students is widespread and impacts student well-being and learning. RELEVANCE TO CLINICAL PRACTICE: Education is a strong protective factor and should target students, clinicians, clinical facilitators and academics. Attention to workplace culture, and processes that support disclosure and reporting, is also required to meaningfully address the sexual harassment of nursing students.

Being tied down-The experience of being physically restrained while mechanically ventilated in ICU.

AIMS: To explore the experience of physical restraints during mechanical ventilation in intensive care from the perspectives of patients and family members. DESIGN: This research was a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. METHOD: In-depth, semi-structured conversations were conducted with five patients and six family members who had either personally experienced or witnessed their loved ones being physically restrained during mechanical ventilation in intensive care. Data collection occurred between March 2018 and June 2019. These conversations were audio-recorded and transcribed. Reflexive thematic analysis was used to analyse the data. RESULTS: Three major themes emerged from the data. These themes were: Being tied down; Feeling helpless; and Finding light in the darkness. CONCLUSION: The experience of physical restraints during mechanical ventilation in intensive care leads to traumatic experiences which can impact patients and families long after their ICU stay. Holistic care, which considers the physical, emotional and psychological needs of patients and families, should be more thoroughly explored when managing treatment interference to minimize harm. IMPACT: This study gained insight into the physical, emotional and psychological consequences of applying physical restraints to patients who are mechanically ventilated as an intervention for preventing treatment interference. The findings of this study have the potential to improve ICU patient and family outcomes by influencing current physical restraint practices. Recommendations from this research can contribute to practice change by informing policy, shifting workplace culture and norms about restraints, and encouraging education and training.

Understanding nurses' perspectives of physical restraints during mechanical ventilation in intensive care: A qualitative study.

AIMS AND OBJECTIVES: This study explored the experiences of nurses using physical restraints on mechanically ventilated patients in intensive care. BACKGROUND: Physical restraints are frequently used to prevent treatment interference and maintain patient safety in intensive care units worldwide. However, physical restraints are found to be ineffective in preventing treatment interference and cause negative outcomes for patients. The practices surrounding physical restraints are inconsistent due to a lack of education, training and protocols. DESIGN: This research was conducted as a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. METHODS: Twelve in-depth, semi-structured conversations were conducted with registered nurses who have experience working in intensive care and have cared for patients who were physically restrained and mechanically ventilated. These conversations were audio-recorded and transcribed. Thematic analysis was used to analyse the data. RESULTS: Three major themes emerged from the data. The themes were as follows: the ICU culture and its impacts on physical restraint practices; the consequences of physical restraints through a nursing lens; and understanding the ways of learning. CONCLUSION: The insights into the ICU culture, the nurses' understanding of the consequences of physical restraints and the ways in which nurses learn physical restraint practices have provided a greater depth of knowledge and understanding of the realities of current practice in ICU. This new information demonstrates nurses' understanding of the potential harm caused by physical restraints and the way in which current practices are guided more-so by workplace norms and expectations rather than on critical thinking and decision-making. RELEVANCE TO CLINICAL PRACTICE: These insights provide valuable information to intensive care clinicians, educators and policymakers to guide future practice and improve patient outcomes by highlighting the importance of education on physical restraint practices and informing the development of policies and guidelines.

Physical restraints in intensive care-An integrative review.

BACKGROUND: Physical restraints (PRs) are commonly used in intensive care units (ICUs) worldwide for the prevention of treatment interference. While PRs are fundamentally used to maintain patient safety, they can negatively impact the experiences of patients and their families and cause moral and ethical dilemmas for ICU nurses. OBJECTIVES: The aim of this integrative review was to explore the current literature on the use of PR in intensive care. METHODS: This article used an integrative review framework to explore the current literature available on the experiences of PR in ICU. Research published between January 2007 and July 2016 was considered. Databases searched included CINAHL, Proquest, Medline, PubMed, and Cochrane. Inclusion/exclusion criteria were used to screen for eligibility. Methodological quality was evaluated using a quality assessment checklist, adapted from Walsh and Downe, and based on the Critical Appraisal Skills Programme tool. The findings were analysed and synthesised into major themes. RESULTS: Seventeen articles from Europe, Asia, and the United States of America were included. Five major themes emerged: (i) prevention of treatment interference; (ii) nurses' role as primary decision-makers PR application and removal; (iii) adherence to PR protocols; (iv) moral and ethical dilemmas faced by nurses; and (v) experiences of patients and families. The literature identified the prevalence of PR in today's ICUs, the drawbacks of current practice, and the paucity of knowledge of the lived experiences of PR. CONCLUSION: PR is the first choice in preventing of treatment interference, and most clinicians believe there is a valid place for them in ICU. However, its effectiveness in preventing self-extubation is questionable, and there are obvious flaws within this practice including inconsistencies surrounding PR protocols and the shortage of education and training provided to nurses. Further research into lived experiences of PR to gain deeper insights may lead to possible solutions and improve current practice.

Nursing students' experiences of using flipcharts as a learning tool during the COVID-19 pandemic.

BACKGROUND: Building mastery of clinical skills is essential for nursing students to ensure readiness for clinical placements. During the coronavirus disease (COVID-19) pandemic, limited face-to-face teaching and student access to campus facilities, along with the rapid adoption of online methods, increased the need to develop innovative teaching tools to support students. OBJECTIVE: This study aimed to explore nursing student perceptions and experiences of using Flipcharts for learning clinical nursing skills during the COVID-19 pandemic. DESIGN: This study used a qualitative descriptive design. METHODS: Second-year nursing students were invited to participate at the end of the semester to share their experiences of using Flipcharts in their clinical simulation laboratory. A total of 12 nursing students participated in individual semi-structured interviews conducted between December 2020 and February 2021. Data were analysed using Braun and Clarke's six-step method of thematic analysis. RESULTS: The findings of the study demonstrated that students considered Flipcharts to be beneficial in developing their clinical skills and were additionally valuable in supporting students with English as a second language. Three major themes were identified: the perceived value of Flipcharts during limited face-to-face teaching, the role of Flipcharts in supporting skills acquisition across learning domains, and the practicality and accessibility of this learning resource across different mediums. CONCLUSION: Students perceived the use of Flipcharts to be valuable in achieving mastery of clinical skills during COVID-19. The students' experience of using Flipcharts was positive overall and found the learning tool practical and accessible in supplementing learning.

One size does not fit all - overcoming barriers to participant recruitment in qualitative research.

BACKGROUND: It can be challenging to recruit participants for qualitative research. Recruitment can be affected by factors such as systemic barriers, as well as potential participants being reluctant to enrol in research they view as time-consuming and burdensome - particularly research exploring sensitive topics. AIM: To analyse and describe the implementation of multiple recruitment strategies used to overcome the recruitment barriers in a qualitative study exploring the use of physical restraints during mechanical ventilation in intensive care. DISCUSSION: Recruitment strategies that are helpful for one study may not be successful in another. Qualitative researchers may face many recruitment challenges specific to the contexts of their studies. Overcoming these challenges can be costly, time-consuming and often frustrating, so it is important that researchers develop qualities and skills that enable them to navigate these barriers. CONCLUSION: Nurse researchers must consider the contexts of their target populations and tailor their recruitment strategies to the populations' needs. They must also be flexible, innovative and persistent in their approach, despite the challenges they face. IMPLICATIONS FOR PRACTICE: This paper provides insights into the recruitment barriers faced during a qualitative study and possible solutions. These insights can guide nurse researchers facing similar challenges in qualitative research.

PHYSICAL RESTRAINTS IN INTENSIVE CARE: EXPERIENCES OF PATIENTS, FAMILIES AND NURSES.

Critically ill patients admitted to an intensive care unit (ICU) often require many invasive procedures and medical devices (Martin and Mathisen 2005). While these interventions are a necessity, they can potentially cause patients a great amount of pain and discomfort, often leading to restlessness and agitation (Langley et al. 2011).

Evaluation of community-based strategies for Aedes aegypti control inside houses

Introduction: Dengue viruses transmitted principally by the urban mosquito Aedes aegypti, cause one of the major public health problems confronting tropical cities. Insecticide spraying has been the mainstay of mosquito control; however, its continuous use has selected for resistance. Other important methods of control involve community participation. Objective: This study evaluated two control methods for Ae. aegypti that can be used by the community: Lethal ovitraps (LOs) and Bacillus thuringiensis var israeliensis (Bti) briquettes. Materials and methods: The project study was carried out in four similar neighborhoods within a representative district in the city of Cali, Colombia. Three interventions (LO, Bti, LO+Bti plus education and one control (education only) area were evaluated for efficacy in post-intervention entomological surveys. Additionally, entomological indices were also compared to results from a pre-intervention survey carried out on a sample of city blocks in the same neighborhoods. Relative vector abundance in relation to weather conditions using the same entomological sampling methods was compared. Results: The interventions did not achieve significant differences in vector abundance among the treatments. However, the interventions achieved a significant reduction in entomological indices compared with those observed during the pre-intervention survey: House index 15.1% vs. 8.5%, mean pupae per house 1.15 vs. 0.073, and Adult index 56.3% vs. 34.8% (p<0.05). Conclusions: The lack of significant differences among the interventions, and between treated and control blocks suggested that educational activities together with periodic visits to the houses produced similar reductions of immature and adult Aedes aegypti.

Introducción. Los virus del dengue transmitidos principalmente por el mosquito urbano Aedes aegypti, causan uno de los mayores problemas de salud pública que confrontan las ciudades tropicales. La aplicación de insecticidas ha sido la base para el control de mosquitos; sin embargo, su continuo uso ha servido para seleccionar individuos resistentes en las poblaciones de mosquitos. Otro método importante para el control involucra la participación comunitaria. Objetivo. Este estudio evaluó dos métodos de control para Ae. aegypti que podrían ser usados por la comunidad: las ovitrampas letales (OL) y las briquetas de Bacillus thuringiensis var israeliensis (Bti). Materiales y métodos. El estudio se llevó a cabo en cuatro barrios similares de la Comuna 16 de Cali, Colombia. Se evaluaron tres intervenciones (OL, Bti, OL y Bti) más educación y un área control (sólo educación) para medir la eficacia de la vigilancia entomológica posterior a la intervención. Además, los índices entomológicos se compararon con los resultados de una vigilancia antes de la intervención llevada a cabo en bloques de casas seleccionadas aleatoriamente en los mismos barrios. La abundancia relativa del vector en relación con las condiciones climáticas se comparó usando los mismos métodos del muestreo entomológico. Resultados. Las intervenciones no produjeron diferencias significativas entre los tratamientos en la abundancia del vector. Sin embargo, las intervenciones lograron una reducción significativa de los índices entomológicos comparados con los observados en la vigilancia antes de la intervención: índice de casa, de 15,1% a 8,5%; promedio de pupas por casa, de 1,15 a 0,073, e índice de adultos, de 56,3% a 34,8% (p<0,05). Conclusiones. La ausencia de diferencias significativas entre las intervenciones y el bloque control sugiere que las actividades educacionales junto con las visitas periódicas a las casas producen reducciones similares de los estadios inmaduros y adultos de Ae. aegypti.