Daily life without cranial bone protection while awaiting cranioplasty: a qualitative study.

PURPOSE: Decompressive craniectomy is occasionally performed as a life-saving neurosurgical intervention in patients with acute severe brain injury to reduce refractory intracranial hypertension. Subsequently, cranioplasty (CP) is performed to repair the skull defect. In the meantime, patients are living without cranial bone protection, and little is known about their daily life. This study accordingly explored daily life among patients living without cranial bone protection after decompressive craniectomy while awaiting CP. METHODS: A multiple-case study examined six purposively sampled patients, patients' family members, and healthcare staff. The participants were interviewed and the data were analyzed using qualitative content analysis. RESULTS: The cross-case analysis identified five categories: "Adapting to new ways of living," "Constant awareness of the absence of cranial bone protection," "Managing daily life requires available staff with adequate qualifications," "Impact of daily life depends on the degree of recovery," and "Daily life stuck in limbo while awaiting cranioplasty." The patients living without cranial bone protection coped with daily life by developing new habits and routines, but the absence of cranial bone protection also entailed inconveniences and limitations, particularly among the patients with greater independence in their everyday living. Time spent awaiting CP was experienced as being in limbo, and uncertainty regarding planning was perceived as frustrating. CONCLUSION: The results indicate a vulnerable group of patients with brain damage and communication impairments struggling to find new routines during a waiting period experienced as being in limbo. Making this period safe and reducing some problems in daily life for those living without cranial bone protection calls for a person-centered approach to care involving providing contact information for the correct healthcare institution and individually planned scheduling for CP.

Is this to be another project that fizzles out? Using the i-PARIHS framework to evaluate implementation of a mentoring programme.

It is well-known that the implementation of evidence into clinical practice is complex and challenging. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework conceptualizes successful implementation of evidence into practice. As the implementation of the mentoring programme proved to be a challenge, it seemed valuable to retrospectively study the implementation process using a framework like the i-PARIHS. AIM: The aim of this study was to evaluate implementation of a multifaceted mentoring programme for bedside nurses using the i-PARIHS framework, to identify factors that influenced the implementation. DESIGN: A secondary analysis of qualitative data using the i-PARIHS framework as the theoretical lens. METHOD: A directed content analysis was performed, driven theoretically by the i-PARIHS framework. The analysis focused separately on (a) characteristics of the innovation and (b) successful and hindering factors in the implementation process. RESULTS: The results showed that successful factors influencing implementation of the mentoring programme included supportive and actively involved formal leaders and supervisors at the unit level. A major hindering factor was lack of resources in the form of personnel, time and money. A lack of facilitators, particularly experienced facilitators, throughout the organization hindered implementation. The i-PARIHS framework offered a structured how-to guide to identify factors that influenced the implementation process. CONCLUSION: Implementation of the mentoring programme was a challenge for the organization. Investment into implementation should continue, with a more structured facilitation process. A structured and prioritized management system, including supportive leadership at the unit level, should be established by the hospital board. IMPLICATIONS FOR THE PROFESSION: There is a need for experienced facilitators throughout the organization. This is crucial to achieve sustainability in the mentoring programme and ensure that the large investments of staff resources and money do not fizzle out. IMPACT: What problem did the study address? Implementing a mentoring programme for nurses in a large university hospital proved to be a challenge. Therefore, it seemed valuable to retrospectively study the implementation process using a framework like the i-PARIHS. What were the main findings? A lack of facilitators, particularly experienced facilitators, throughout the organization hindered the implementation. The i-PARIHS framework offered a structured how-to guide to identify factors that influenced the implementation process. Where and on whom will the research have an impact? Our findings are important for leaders on all levels in a hospital setting, including the hospital board, heads of departments and nurse managers. REPORTING METHOD: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups is used. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Missed nursing care in surgical care- a hazard to patient safety: a quantitative study within the inCHARGE programme.

BACKGROUND: Missed nursing care occurs globally, and the consequences are severe for the patients when fundamental care needs are not fulfilled, nor delivered in a person-centred way. This study aimed to investigate the occurrence and cause of missed nursing care, and the relationship between registered nurses' and nursing assistants' perceptions of missed nursing care, in a surgical care context. METHODS: A quantitative study was performed using the MISSCARE survey, measuring missed nursing care and associated reasons, in three surgical wards with registered nurses and nursing assistants as the participants (n = 118), during May-November in 2022. The MISSCARE survey also covers background data such as job satisfaction and intention to leave. The survey was distributed paper-based and the response rate was 88%. RESULTS: Aspects of nursing care rated to be missed the most were 'attending interdisciplinary care conferences', 'turning patient every 2 h', 'ambulation 3 times per day or as ordered', and 'mouth care'. Differences between registered nurse and nursing assistant ratings were detected for eight out of 24 items, where registered nurses rated more missed nursing care. The uppermost reasons for missed nursing care were 'inadequate number of staff' and 'unexpected rise in patient volume and/or acuity on the unit'. Registered nurses and nursing assistants rated differently regarding six of 17 items. Almost every fourth staff member (24.6%, n = 29) had the intention to leave within a year in the present department. CONCLUSIONS: The occurrence of missed nursing care is frequent in the surgical context, and in combination with a high number of staff members intending to leave their employment, poses a hazard to patient safety. Registered nurses, holding higher educational levels, reported more missed care compared with the nursing assistants. The main reason for missed nursing care was an inadequate number of staff. These findings support a warranted investment in nursing within the organisation. The results can be used to form strategies and interventions, to reduce nurse attrition and optimise competence utilisation, and to achieve safe person-centered fundamental care.

Employers' requests when advertising for nurses-A national mapping of recruitment advertising for nurses in Sweden.

INTRODUCTION: There is a shortage of nurses and many are leaving the profession. Maintaining sufficient nursing staff is a major healthcare challenge for societies worldwide. Work conditions, job orientation, and career opportunities all factor into nurses' rates of attrition, exit, and turnover. Newly graduated nurses have requested structured introductory and/or mentoring programmes to ease their transition from education to work life and develop the skills and knowledge necessary in their particular work setting. Nurses also seek opportunities to continue learning and developing professionally. AIMS: To map and describe the content of recruitment advertisements for nurses. Research questions were: 'What qualifications do healthcare employers request when recruiting nurses?' and 'What sorts of professional development do healthcare employers offer nurses? MATERIALS AND METHODS: A comprehensive national mapping of recruitment advertisements for nurses in Sweden where all advertisements, N = 450, on 20 of the 21 regional hospital websites were collected. A qualitative and a quantitative content analysis was performed. RESULTS: Personal characteristics dominated requested competence in recruitment advertisements. Employers offered general nursing opportunities with unspecific work content and focused more on recruiting newly registered, rather than experienced, nurses. In only a few advertisements, employers asked for a master's degree. No employer requested nurses with a PhD or research experience. CONCLUSION: While the World Health Organization stresses the need for a sustainable recruitment and attainment of nurses to secure health care, employers' recruitment of mostly newly graduated nurses and offering little professional development and few career opportunities may be one explanation for the difficulties in securing safe nurse staffing.

InCHARGE: Co-creating, implementing and evaluating interventions to utilize nurses' competence and achieve person-centred fundamental care-A research protocol describing an action research approach.

AIM AND OBJECTIVES: This research protocol presents an action research project with the aim to demonstrate the value of person-centred fundamental care to nurses and nurse managers in surgical care units to encourage a far-reaching change in this direction. The objectives are to describe this process and to evaluate the effects on missed nursing care and person-centred fundamental care. METHODS: In a novel collaboration between nursing science and medical humanities the action research design will be used to interact with nursing staff and leaders in three surgical care units and design interventions with the purpose to affect the direction of nursing. Initially, the care units will be presented with interactive workshops including evidence-based education on person-centered fundamental care, person-centredness, nurse role responsibility and leadership. This will be followed by cocreation of interventions to stimulate person-centered fundamental care. The Fundamentals of Care framework will be used as the overarching theoretical framework. Data on missed nursing care, person-centred climate and person-centered fundamental care will be collected repeatedly from patient- and nursing stakeholders through interviews and validated questionnaires. Additionally, data from written reflections following clinical observations and focus group interviews will be included. The duration of the study will be approximately five years from ethical approval. DISCUSSION: It has been previously reported that the current working environments of registered nurses are forcing them to ration their caring responsibilities, leading to a lack of fulfillment of patients' fundamental care needs, with possible severe consequences for patients. The action research design helps researchers gain an understanding of the contextual factors important for forthcoming interventions, enabling reflective processes and cocreation of interventions with stakeholders. This may lead to feasible interventions and strengthen nursing leadership in the involved units.