Professional Accountability of Caring for Patients with COVID-19: A Phenomenographic Study.

The purpose of this study was to explore nurses' care experiences for COVID-19 patients during the pandemic in Taiwan. The qualitative approach of phenomenography was used. Thirty-four nurses were recruited from two assigned hospitals in which COVID-19 patients were treated in Taiwan from July to May 2021. The method of data collection in the study involved a semi-structured interview and drawing. Interviews were audio-recorded and transcribed verbatim. Phenomenographic analysis was used to analyze the qualitative data. Four categories of description of experiences of caring for COVID-19 patients were identified: facing uncountable stresses from all sides, strict implementation of infection control interventions to provide safe care, confronting ethical dilemmas and making difficult decisions, and reflecting on the meaning of care in nursing. Professional accountability was the core theme found to represent the central meaning of nurses caring for COVID-19 patients. Nurses were under enormous stress while caring for COVID-19 patients during the pandemic and were negatively affected physically, psychologically, and socially. Professional accountability in caring for COVID-19 patients can be enhanced through adequate support from nursing managers and by in-service training designed to update knowledge and skills related to infection control intervention.

Family Caregivers' Experiences of Preventing Harm to Older People during Hospitalization: A Phenomenographic Study.

Hospital admission is associated with a high risk of harm, particularly for older people, and family members play a critical role in providing care. The aim of this study was to explore family caregivers' experiences in preventing harm to older people during hospitalization. The phenomenographic approach was applied. Thirty family caregivers were asked to describe their experiences of preventing harm to older people. Semi-structured interviews were audiotaped and transcribed. Participants described preventing harm as "essential care", "an important step toward recovery", "a load off the mind", "outcomes of collaboration among caregivers and health professionals", and "improvement in the quality of life after discharge". The core theme was to achieve the goal of integrated care for older people. The results can help improve caregiving processes and prevent harm to older people during hospitalizations. They can assist in developing strategies for the delivery of safe care for older people.

How Emergency Nurses Develop Resilience in the Context of Workplace Violence: A Grounded Theory Study.

PURPOSE: To understand how emergency nurses develop resilience in the context of workplace violence. DESIGN: This study employed grounded theory methodology. Thirty nurses from three hospital emergency departments in Taiwan were interviewed between August and December 2018. METHODS: Semistructured interviews were used to collect data. Interviews were audio-recorded and transcribed verbatim. FINDINGS: The process through which emergency nurses who had experienced workplace violence developed resilience took place in three stages: the release of emotions after the assault; the interpretation of conflicting thoughts and actions; and the establishment of strategies to cope with workplace violence in the future. The core theme was the motivating role of professional commitment to emergency patient care. CONCLUSIONS: The results of this study can inform the development of support systems to enhance the resilience of nurses experiencing workplace violence by alerting healthcare administrators and governing institutions to their needs. CLINICAL RELEVANCE: Emergency nurses viewed professional growth and professional commitment as an invisible motivator in the development of resilience following an encounter with workplace violence.

Alternative career pathways for international medical graduates towards job market integration: a literature review.

OBJECTIVES: To inform the current level of research about alternative career pathways for international medical graduates and synthesize knowledge of the barriers, facilitators and potential outcomes of alternative career pathways for international medical graduates. METHODS: We searched MEDLINE, EMBASE, Scopus, and Google Scholar for relevant publications to February 2020. From 809 articles, after two levels of screening, 23 articles were selected. We conducted thematic content analysis and reported the findings of the study following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. RESULTS: All 23 articles reported on alternative careers for international medical graduates in either the United States or Canada. A variety of study methods were noted, including original research, scoping reviews, reports for organizations, and commentaries. Studies incorporated a variety of methods, including surveys, focus groups, interviews, analysis of administrative documents, and program evaluation. Many potential benefits of alternative careers were reported for both international medical graduates and stakeholders. Barriers to pursuing alternative careers included both individual- and systemic-level barriers. Facilitators included skill-building workshops, targeted bridging programs, connecting with employers, supporting organizations, and international medical graduates. CONCLUSIONS: The scarce literature on alternative career pathways indicates that this research is beneficial for both international medical graduates and their host countries. Initiating capacity building programs for alternative career pathways for international medical graduates might be a worthy investment for host countries, especially in underserved areas. Pilot initiatives incorporating bridging programs for international medical graduates are recommended.

The Relationship of Urban Form on Children and Adolescent Health Outcomes: A Scoping Review of Canadian Evidence.

Urban form can have an impact on health outcomes in children, and the synthesis of findings can identify gaps in the literature and regional reviews may help guide policymakers. This study aims to complete a scoping review of the research relating urban form to health outcomes in children and adolescents from urban Canadian settings. Thirteen online databases were searched to identify studies that had objective measures of urban form and health outcomes. Two research assistants independently reviewed 27,444 titles and abstracts, and 176 full-text articles, returning 32 unique studies with youth-specific data. The majority of the included studies were cross-sectional or ecological (n = 26). Six studies used Canada-wide data and the rest were from Ontario (n = 11), Alberta (n = 6), and Quebec (n = 6). Urban form characteristics included neighbourhood food environment (n = 11), parks/natural space/greenness (n = 10), road or intersection characteristics (n = 7), and aggregated urban form measures (n = 7). Studies examined a variety of health outcomes: the majority considered weight status (n = 16) and injury (n = 10). Although there is over-reliance on mainly cross-sectional study designs, there is evidence suggesting that urban form is associated with health outcomes in Canadian youth, with parks/greenspace, road connectivity, and road characteristics most consistently associated with health outcomes in youth.

Professional integration of immigrant medical professionals through alternative career pathways: an Internet scan to synthesize the current landscape.

BACKGROUND: There is a growing recognition that underutilization and underemployment of skilled immigrants, especially internationally trained health professionals, creates a financial burden on individuals and economic losses for the host country. Albeit a missed opportunity for both the immigrants and the receiving country, no public policy and systemic measures are in place to address this issue. Nevertheless, certain individuals and organizations have made some isolated efforts, but no synthesized knowledge is available for understanding what initiatives exist altogether and how they function. We have conducted a methodological Internet scan to identify the existing individual, private, and systemic initiatives and resources that support these health professionals. This will provide health and workforce policymakers, settlement service providers, and relevant academics with the knowledge base for potential different strategies to address this issue and guide them towards developing solution-oriented initiatives. METHODS: To identify those we have systematically searched the three most popular search engines (Google, Bing, and Yahoo!) adapting the Canadian Institute for Health Information's grey literature review protocol. We identified relevant websites per our predefined inclusion criteria, charted the data from those sources, collated, summarized, and reported the results. RESULTS: From 280 webpages initially identified through keyword search, we included 26 in our full-page screen and extracted data from 16 finally selected webpages. We have found webpages with information on different alternative careers namely, regulated and non-regulated, available resources to pursue those careers, and what skills they have that can be transferred to the alternative careers. CONCLUSION: More systemic policies and IMG specific and ACP-focused employment support programmes are required. Research and development of programmes for facilitating IMGs' alternative career support need to be increased and strengthened.

Unmet Healthcare Needs Among Migrant Populations in Canada: Exploring the Research Landscape Through a Systematic Integrative Review.

OBJECTIVES: Migrants are a growing part of the Canadian population, yet they encounter many unmet healthcare needs. These needs arise from the difference between the services deemed necessary, often based on their unique socio-cultural background, and the services actually received. Therefore, a systematic integrative review was conducted to (1) identify the literature on unmet healthcare needs among different migrant populations in Canada, and (2) compile the reported factors associated with these unmet needs in various migrant groups. DESIGN: We systematically searched all major databases and grey literature sources. We included original articles that studied unmet healthcare needs among immigrants, refugees, and/or temporary migrants in Canada. RESULTS: Thirty-one studies reported unmet healthcare needs among migrants in Canada. We found five categories of unmet needs across different groups of migrants including immigrants, refugees, and temporary migrants. Immigrants and refugees face unique factors that influence the development of unmet needs, such as socio-cultural differences, communication difficulties, and lack of information. Alternatively, temporary migrants have unmet needs due to factors associated with their immigration clauses, such as healthcare coverage being conditional to work permit renewal or precarious living conditions associated with work-related housing. CONCLUSION: Further research is required on unmet needs of migrants that considers the variation of unmet needs and their causal factors within different groups of migrants, in particular, refugee claimants, foreign workers, international students, and elderly migrants.

Activities and programmes that support the emotional wellness and well-being of refugees, immigrants and other newcomers within settlement agencies: a scoping review protocol.

INTRODUCTION: Obstacles to successful settlement-social isolation, language hardship, issues with employment, housing questions, transportation, barriers to health, education and government service access-all potentially play a role in emerging physical and mental health problems. The objective of this scoping review is to map the available evidence in order to provide an overview of the services and resources offered to refugees, immigrants and other newcomers by settlement agencies to support emotional wellness and well-being. METHODS AND ANALYSIS: The protocol to be followed for this scoping review is based on the Joanna Briggs Institute to provide a map of the current and emergent literature, and examine the extent, range and nature of this literature. The proposed scoping review will also identify the gaps in research pertaining to the emotional wellness of refugees, immigrants and other newcomers as well as summarise and disseminate research findings and provide direction for future reviews. Key databases for this scoping review include APA PsycINFO, Medline, Embase, Cumulative Index of Nursing and Allied Health Literature Plus, Academic Search Complete, and Education Research Complete. The database search start and end dates for this scoping review will be from inception to July 2020. The article searches will take place between August and October 2020. ETHICS AND DISSEMINATION: Ethics is not required as the research will not involve human or animal subjects. The research is a scoping review, and thus relies on published and grey literature studies and documents. The findings of this proposed scoping review will be disseminated through future publications as well as presentations to relevant stakeholders, including immigrant serving agencies. We anticipate that this scoping review will identify gaps in research pertaining to the emotional wellness of refugees, immigrants and other newcomers. The results of this review will be the first comprehensive recent survey of emotional wellness practices employed by settlement agencies.

Barriers to Breast Cancer Screening Among Immigrant Populations in Canada.

The objective of this study is to summarize the current knowledge about barriers to breast cancer screening among immigrant and ethnic women and to determine future research opportunities in this area. A scoping review of the literature was conducted following a five-stage framework. Electronic databases of peer-reviewed articles and grey literature were searched based on comprehensive sets of key words, without restricting the time period or language. Barriers were classified into six themes: socioeconomic, cultural, communication, healthcare-system-related, knowledge-related, and personal barriers. Lack of education, lack of physicians' recommendation, a preference for female physicians, the inability to speak one of the official languages, and embarrassment were some of the common barriers identified. The reported barriers can be used as a source of information for policymakers, healthcare providers, and researchers to decide the future direction of research in this field.

A scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence. / Examen de la portée sur les associations entre aménagement urbain et santé : les données quantitatives canadiennes.

INTRODUCTION: Despite the accumulating Canadian evidence regarding the relations between urban form and health behaviours, less is known about the associations between urban form and health conditions. Our study aim was to undertake a scoping review to synthesize evidence from quantitative studies that have investigated the relationship between built environment and chronic health conditions, self-reported health and quality of life, and injuries in the Canadian adult population. METHODS: From January to March 2017, we searched 13 databases to identify peer-reviewed quantitative studies from all years that estimated associations between the objectively-measured built environment and health conditions in Canadian adults. Studies under-taken within urban settings only were included. Relevant studies were catalogued and synthesized in relation to their reported study and sample design, and health outcome and built environment features. RESULTS: Fifty-five articles met the inclusion criteria, 52 of which were published after 2008. Most single province studies were undertaken in Ontario (n = 22), Quebec (n = 12), and Alberta (n = 7). Associations between the built environment features and 11 broad health outcomes emerged from the review, including injury (n = 19), weight status (n = 19), cardiovascular disease (n = 5), depression/anxiety (n = 5), diabetes (n = 5), mortality (n = 4), self-rated health (n = 2), chronic conditions (n = 2), metabolic condi-tions (n = 2), quality of life (n = 1), and cancer (n = 1). Consistent evidence for associations between aggregate built environment indicators (e.g., walkability) and diabetes and weight and between connectivity and route features (e.g., transportation route, trails, pathways, sidewalks, street pattern, intersections, route characteristics) and injury were found. Evidence for greenspace, parks and recreation features impacting multiple health outcomes was also found. CONCLUSION: Within the Canadian context, the built environment is associated with a range of chronic health conditions and injury in adults, but the evidence to date has limitations. More research on the built environment and health incorporating rigorous study designs are needed to provide stronger causal evidence to inform policy and practice.

Barriers to cervical cancer screening faced by immigrant women in Canada: a systematic scoping review.

BACKGROUND: The objective of this scoping study is to review the published literature and summarize findings related to barriers experienced by immigrant women in Canada while accessing cervical cancer screening. METHODS: Electronic databases of peer-reviewed articles and grey literature were searched using comprehensive sets of keywords, without restricting the time period or language. Articles were selected based on the following criteria: (a) the study population consisted of Canadian immigrant women and healthcare providers and other stakeholders serving immigrant women, (b) the research focused on the barriers to accessing cervical cancer screening, and (c) the study was conducted in Canada. RESULTS: Extracted data were grouped and analyzed, resulting in barriers comprised of six themes: economic barriers, cultural barriers, language barriers, healthcare system-related barriers, knowledge-related barriers, and individual-level barriers. Lack of education, low income, preference for a female physician, lack of knowledge, lack of effective communication, and embarrassment were some of the most common barriers mentioned. CONCLUSIONS: Immigrant access to health services, including cervical cancer screening, is a complex issue concerning a wide range of barriers. Our findings offer insights into barriers to cervical cancer screening in immigrant communities in Canada that can be used to assist policymakers, healthcare providers, and researchers enhance the health and well-being of these populations by mitigating barriers and improving screening.

Nursing and music: Considerations of Nightingale's environmental philosophy and phenomenology.

A philosophy of nursing is to express our considered opinion on what we believe to be true about the nature of the profession of nursing and provide a basis for nursing activities. It affirms the ethical values that we hold as fundamental to our practice. For many of us in nursing, our philosophy derives from Nightingale and phenomenology. We believe Nightingale and phenomenology are uniquely placed within nursing philosophies, to assist the nurse to understand the use of music within a holistic, caring-healing paradigm, as nursing continues to adapt and evolve in the 21st century. This article proposes that both Nightingale's environmental philosophy and phenomenology are excellent intellectual and practice frameworks for nurses to consider music-based interventions for older adults who experience dementia. The potential outcome is an enhanced understanding of the well-being of this vulnerable group of older persons.

Elders' Experiences During Return Visits to the Emergency Department: A Phenomenographic Study in Taiwan.

BACKGROUND: Elders often experience multiple chronic diseases associated with frequent early return visits to emergency departments (EDs). There is limited knowledge of the experiences and concerns of elders during ED return visits. OBJECTIVES: The purpose of the research was to explore the experiences of elders during ED return visits, with a view toward identifying factors that contribute to return visits. METHODS: The qualitative approach of phenomenography was used. Data were collected at one ED in a 3,000-bed medical center in Taiwan. Inclusion criteria were aged 65 or above and return visits to the ED within 72 hours of discharge from an index ED visit. The seven steps of qualitative data analysis for a phenomenographic study were employed to develop understanding of participants' experiences. RESULTS: Thirty return-visit elders were interviewed in 2014. Four categories of description were established from the participants' accounts. These were "being tricked by ED staff," "doctor shopping," "a sign of impending death," and "feeling fatalistic." The outcome space of elders with early return visits to ED was characterized as "seeking the answer." CONCLUSION: Index ED visits are linked to return visits for Taiwanese elders through physiological, psychological, and social factors.

Workplace violence against emergency nurses in Taiwan: A phenomenographic study.

BACKGROUND: Workplace violence (WPV) is a serious problem in health care in Taiwan, as it is worldwide. Among all nursing staff, emergency department (ED) nurses are at the highest risk of WPV; yet, little attention has been paid to nurses as WPV victims. PURPOSE: The purpose of the study was to understand ED nurses' WPV experiences and perspectives. METHODS: An interpretive qualitative phenomenographic design was used to answer the following research question: what are the qualitatively different ways in which nurses in Taiwan experience WPV in the ED? Thirty ED nurses who identified as experienced with WPV were interviewed, and phenomenographic analysis was used to assess the data. FINDINGS: Four categories of description emerged. WPV was seen as a continuing nightmare, a part of daily life, and a direct threat, and it had a negative impact on nurses' passion for emergency care. WPV adversely affected nurses on physical, psychological, social, personal, and professional levels. CONCLUSION: The findings of this study have practical implications for in-service WPV training programs and may be used to inform potential changes to policy and legislation designed to establish a safer ED environment for staff.

Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses.

Triage classifies and prioritizes patients' care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses' decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients' health status, and nurses' experiences. This study suggests ensuring the patient's privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public's understanding of the ED visits. These will make ED triage more efficient.

Waiting and hoping: a phenomenographic study of the experiences of boarded patients in the emergency department.

AIMS AND OBJECTIVES: To understand the experiences and concerns of patients in the emergency department during inpatient boarding. BACKGROUND: Boarding in the emergency department is an increasingly common phenomenon worldwide. Emergency department staff, patients and their families become more stressed as the duration of boarding in the emergency department increases. Yet, there is limited knowledge of the experiences and concerns of boarded patients. DESIGN: The qualitative approach of phenomenography was used in the study. METHODS: The phenomenographic study was conducted in one emergency department that treats approximately 15,000 patients each month. Twenty emergency department boarding patients were recruited between July-September 2014. Semi-structured interviews were used for data collection. The seven steps of qualitative data analysis for a phenomenographic study - familiarisation, articulation, condensation, grouping, comparison, labelling and contrasting - were employed to develop an understanding of participants' experiences and concerns during their inpatient boarding in the emergency department. RESULTS: The perceptions that emerged from the data were collected into four categories of description of the phenomenon of emergency department boarding patients: a helpless choice; loyalty to specific hospitals and doctors; an inevitable challenge of life; and distrust of the healthcare system. The outcome space for the emergency department boarding patients was waiting and hoping for a cure. CONCLUSION: The experiences and concerns of emergency department boarding patients include physical, psychological, spiritual and health system dimensions. It is necessary to develop an integrated model of care for these patients. RELEVANCE TO CLINICAL PRACTICE: Understanding the experiences and concerns of patients who are placed on boarding status in the ED will help emergency healthcare professionals to improve the quality of emergency care. There is a need to develop a care model and associated intervention measures for emergency department patients during the boarding process. The results of this study will help health regulatory authorities to develop an appropriate emergency department boarding system so that patients receive better emergency care.

The emergency patient's participation in medical decision-making.

AIMS AND OBJECTIVES: The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. BACKGROUND: Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. DESIGN: This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. METHODS: Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. RESULTS: The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. CONCLUSIONS: The findings fill a gap in knowledge about the decision-making process among emergency patients. RELEVANCE TO CLINICAL PRACTICE: The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.

Registered Nurses and Discharge Planning in a Taiwanese ED: A Neglected Issue?

Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses' perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents' and relatives' attitudes were barriers to implementing discharge teaching in the ED.

Non-family support for breastfeeding maintenance among career women in Taiwan: a qualitative study.

The purpose of the study was to describe the influence of non-family-based support on breastfeeding practices among career women in Taiwan during the first four postnatal months. A qualitative, case study approach was used to investigate the phenomenon. A purposive sample of 14 women was recruited and took part in two to three in-depth interviews. The data were transcribed and analysed using descriptive content analysis. It was found that non-family supports had significant influence on their efforts to maintain breastfeeding. Women faced a number of challenges to breastfeeding. The services provided by in-centre care organizations, the resources and organizations accessed through the Internet, and the support provided by colleagues in their workplaces supported women's efforts to maintain breastfeeding. Given the low breastfeeding maintenance rates in Taiwan and the changing societal structure where fewer families rely on family support, the findings highlight the resources, programmes and nursing practice which might support women's needs and promote breastfeeding among career women.

. . . that the social order prevails: death, ritual and the 'Roman' nurse.

In this article, the importance of ritual as a collective response to death is discussed. A case example, taken from a larger ethnographic study, is used to explore the responses and reactions of a group of Italian nurses to death as it occurs within an intensive care unit in Rome, Italy. The material presented is used to analyse the significance that cultural, religious and social beliefs and quasi-beliefs can have in nursing practice. The issues highlighted in this examination of the place of ritual in death are located and discussed within their highly specific cultural context and suggest that, where emphasis remains on nurses as a collective rather than on the individual nurse, ritual acts to ensure that social and moral order prevails.