Utilização da música na gestão da ansiedade perioperatória: Perceção de enfermeiros de cirurgia de ambulatório / Using music to manage perioperative anxiety: Perceptions of ambulatory surgery nurses

O presente Relatório de Estágio é constituído por duas componentes: uma referente ao estágio de natureza profissional e outra, de natureza investigativa, subordinada ao tema da perceção de enfermeiros de cirurgia de ambulatório sobre a utilização da música na gestão da ansiedade perioperatória. A seleção deste tema prendeu-se com a necessidade de se identificarem estratégias inovadoras para garantir intervenções diferenciadas dos enfermeiros, direcionadas ao bem-estar físico e psicológico da pessoa alvo dos cuidados, na medida em que muitas das pessoas que são submetidas a procedimentos cirúrgicos, e que necessitam de hospitalização, experienciam elevados níveis de ansiedade no percurso perioperatório. Assim, a utilização de música tem sido identificada na literatura como uma das opções que proporcionam distração e redução da ansiedade em diversos contextos de prestação de cuidados, incluindo no período perioperatório. O estágio de natureza profissional decorreu no serviço de Cirurgia de Ambulatório do Centro Hospitalar e Universitário de Coimbra, onde foram adquiridas e desenvolvidas competências comuns do enfermeiro especialista e competências específicas do enfermeiro especialista em enfermagem médico-cirúrgica, e que aqui temos oportunidade de relatar. Na componente de investigação foi desenvolvido um estudo descritivo de natureza interpretativa, com recurso a entrevistas individuais a enfermeiros com experiência profissional em contexto de cirurgia de ambulatório, e que teve como objetivo identificar a perceção de enfermeiros de cirurgia de ambulatório sobre a aplicabilidade e aspetos que poderão influenciar uma intervenção com música na gestão da ansiedade da pessoa em situação perioperatória. Os resultados permitiram destacar três categorias no que respeita à perceção dos enfermeiros relativamente à utilização de uma intervenção musical: i) a experiência a realizar intervenção com música; ii) a viabilidade da utilização de música em regime de cirurgia de ambulatório; e iii) os principais efeitos de uma intervenção musical. Deste modo, foi subsidiado o conhecimento sobre a aplicabilidade de uma intervenção não farmacológica, sustentada em música, nos processos de gestão da ansiedade perioperatória de pessoas submetidas a cirurgia de ambulatório, contribuindo para a melhoria da qualidade dos cuidados de enfermagem.

Strategies employed by developed countries to facilitate the transition of internationally qualified nurses specialty skills into clinical practice: An integrative review.

BACKGROUND: Recruitment of internationally qualified nurses as a labour source is a long-standing human resource strategy being implemented to address the current and increasing global nursing shortage. Internationally qualified nurses transitioning into the health workforce of developed countries following immigration often possess specialty skills. A lack of a clear pathway of specialty skill utilisation makes recognising and using these specialty skills complex for many nurses. The ability for nurses to transition between countries and maintain specialty practice demands immediate attention in the current atmosphere of the global pandemic and the predictions to recruit more specialist nurses from overseas. AIM: To identify and synthesise strategies taken by various developed countries in transitioning specialist internationally qualified nurses into practice. METHODS: An integrative review was conducted to identify common themes, patterns, and best practices in order to inform policy development and improve the successful integration of internationally qualified nurses into the healthcare systems of developed countries. The study employed the Whittemore and Knafl five-stage integrative review approach. To conduct a comprehensive search, four electronic databases, namely Medline, CINAHL Complete, ProQuest Health, and EMBASE, were systematically searched in October 2021. The search was updated in March 2022 to ensure the inclusion of the most recent literature. Additionally, Google Scholar was utilised to avoid overlooking any important articles. Prior to the full-text review, three reviewers independently evaluated titles and abstracts. The included papers' quality was determined using the JBI critical appraisal tools. RESULTS: This study included 10 papers, comprising three studies and seven reports. However, none of these documents provided information on how internationally qualified nurses could transfer their specialty skills acquired overseas to developed countries after immigrating. The guidelines and policies reviewed only offered generic advice on becoming a specialist nurse. Although some countries mentioned that post-graduate qualifications were not mandatory for nurse specialists, the majority of documents in this review emphasised the need for a national framework of education at level eight or higher (equivalent to a post-graduate level) to attain the status of a nurse specialist. Moreover, the included documents did not provide clear information on whether an international specialisation degree would be recognised during the registration process. As a result, confusion persists regarding the requirement of post-graduate qualifications for nurses aiming to specialise and the recognition of international specialisation degrees during the registration process. DISCUSSION: The lack of consistency in defining nurse specialty and the skill transferability among institutions and state borders were evident in this review. According to all the 10 documents analysed, developed countries appear to have minimum policies on the transfer of internationally qualified nurse's specialty skills. Recommendations for policymakers, employers, and aspirant migrants have been proposed. Limited research has been done on how developed countries used their internationally qualified nurses' overseas-acquired specialist skills after immigration, indicating a lack of a distinct specialist skill transition pathway. CONCLUSIONS: This review presents data to support the need for greater research in this area to better utilise the abilities that internationally qualified nurses bring from their home country and put them to constructive use in the host country, especially in the context of a global pandemic.

Processo de Enfermagem como potencializador da prática da acupuntura / Proceso de Enfermería como potencializador de la práctica de acupuntura / Nursing Process as a potentializer of acupuncture practice

Resumo Objetivo Analisar a utilização do Processo de Enfermagem na prática da acupuntura, no período de 1997 a 2015. Método Qualitativo, com abordagem Histórico-Social, por meio da história oral temática aplicada a 20 enfermeiras especialistas em acupuntura, fundamentado na Sociologia das Profissões, de Eliot Freidson. Da análise temática, construíram-se duas categorias: Processo de Enfermagem como organizador da prática da acupuntura; e Desconhecimento da importância do Processo de Enfermagem na prática da acupuntura. Resultados A aplicação do Processo de Enfermagem na consulta de enfermagem, com foco na prática da acupuntura como cuidado e tratamento, possibilita uma atuação diferenciada, maior compreensão e reconhecimento diagnóstico, escolha mais adequada de técnicas favoráveis à qualidade e o bem-estar dos usuários, além de consolidar a sua utilização como prática especializada. Considerações finais O Processo de Enfermagem possibilita um avanço tecnológico aplicado na consulta de enfermagem, ao se implementar a acupuntura como tratamento e reabilitação, colaborando na evolução e prognóstico no atendimento, e uma estratégia facilitadora para a enfermeira acupunturista junto ao cliente.

Resumen Objetivo Analizar el uso del Proceso de Enfermería en la práctica de la acupuntura de 1997 a 2015. Método Cualitativo con abordaje Histórico-Social, a través de la historia oral temática aplicada a 20 enfermeras especializadas en Acupuntura, basado en la sociología de las profesiones de Eliot. Freidson. A partir del análisis temático se construyeron dos categorías: Proceso de Enfermería como organizador de la práctica de la acupuntura; y desconocimiento de la importancia del Proceso de Enfermería en la práctica de la acupuntura. Resultados La aplicación del Proceso de Enfermería en la consulta de enfermería con un enfoque en la práctica de la acupuntura como cuidado y tratamiento, posibilita un desempeño diferenciado, mayor comprensión y reconocimiento diagnóstico, elección más adecuada de técnicas que favorezcan la calidad y el bienestar de los usuarios, además de consolidar su uso como práctica especializada. Consideraciones finales El proceso de Enfermería permite un avance tecnológico aplicado en la consulta de enfermería con la implementación de la acupuntura como tratamiento y rehabilitación, colaborando en la evolución y pronóstico en el cuidado y una estrategia facilitadora para la Enfermera Acupunturista con el cliente.

Abstract Objective To analyze the use of the Nursing Process in the practice of acupuncture, from 1997 to 2015. Method A qualitative, with a Social-Historical approach, through thematic oral history applied to 20 nurses specialized in acupuncture, based on Eliot Freidson's Sociology of Professions. From the thematic analysis, two categories were constructed: Nursing Process as an organizer of acupuncture practice; and Unawareness of the importance of the Nursing Process in acupuncture practice. Results The application of the Nursing Process in the nursing consultation, focusing on the practice of acupuncture as care and treatment, enables a differentiated performance, greater understanding and diagnostic recognition, more appropriate choice of techniques favorable to the quality and well-being of users, and consolidates its use as a specialized practice. Final Considerations The Nursing Process enables a technological advance applied in the nursing consultation, when implementing acupuncture as treatment and rehabilitation, collaborating in the evolution and prognosis in the care, and a facilitating strategy for the acupuncturist nurse with the client.

A J curve of interprofessional change: co-locating non-health partners in an oncology unit.

BACKGROUND: Internationally, clinicians face increased demand, pressure on resources and unmet patient needs. A community social support service was co-located within cancer clinics in Glasgow, Scotland to help address some of these needs. AIM: To analyse the impact of the service on clinical staff and to propose an explanatory theory of change. METHOD: Qualitative exploratory design, using thematic analysis of semistructured interviews with 8 nurse specialists and 2 medical oncologists from lung, breast, head and neck, and gastrointestinal oncology teams in Glasgow in 2018-2019. FINDINGS: Four themes captured this process: 'The conversation', 'A better experience', 'Freedom to focus' and 'Working hand in hand'. CONCLUSION: Together, these four themes explained the process of effective interprofessional working. This process would have been predicted by the J-curve literature on diffusion of innovations. Linking J-curve theory to this successful process provides new understanding that could prove essential for clinical teams who are implementing change within their practice.

Impact of the Diabetes Inpatient Care and Education (DICE) project on length of stay and mortality.

AIM: To determine whether the Diabetes Inpatient Care and Education (DICE) programme, a whole-systems approach to managing inpatient diabetes, reduces length of stay, in-hospital mortality and readmissions. RESEARCH DESIGN AND METHODS: Diabetes Inpatient Care and Education initiatives included identification of all diabetes admissions, a novel DICE care-pathway, an online system for prioritizing referrals, use of web-linked glucose meters, an enhanced diabetes team, and novel diabetes training for doctors. Patient administration system data were extracted for people admitted to Ipswich Hospital from January 2008 to June 2016. Logistic regression was used to compare binary outcomes (mortality, 30-day readmissions) 6 months before and after the intervention; generalized estimating equations were used to compare lengths of stay. Interrupted time series analysis was performed over the full 7.5-year period to account for secular trends. RESULTS: Before-and-after analysis revealed a significant reduction in lengths of stay for people with and without diabetes: relative ratios 0.89 (95% CI 0.83, 0.97) and 0.93 (95% CI 0.90, 0.96), respectively; however, in interrupted time series analysis the change in long-term trend for length of stay following the intervention was significant only for people with diabetes (P=0.017 vs P=0.48). Odds ratios for mortality were 0.63 (0.48, 0.82) and 0.81 (0.70, 0.93) in people with and without diabetes, respectively; however, the change in trend was not significant in people with diabetes, while there was an apparent increase in those without diabetes. There was no significant change in 30-day readmissions, but interrupted time series analysis showed a rising trend in both groups. CONCLUSION: The DICE programme was associated with a shorter length of stay in inpatients with diabetes beyond that observed in people without diabetes.

The Role of the Specialist Nurse in Gynaecological Cancer.

PURPOSE OF REVIEW: To explore the role of the specialist nurse within gynaecological cancer. RECENT FINDINGS: There are many different job titles associated with the role of the specialist nurse. Nursing roles are evolving not only to meet the increasing demands on services but also within the ever changing landscape of cancer treatments and improvement in survival. Women and their families need specialist nurses to guide and support them on their cancer journey, along the treatment trajectory and into survivorship. This paper explores specialist nurse roles generally, and within our service which have been adapted to meet service and patient needs within a gynaecological cancer centre. Irrelevant of title, specialist nurses are best suited to meet the patients' needs. The fundamental ethos of the care should always remain having the patients' best interest at heart, acting as their advocate - in essence giving them a voice when they need it.

Implementation of a gerontology nurse specialist role in primary health care: Health professional and older adult perspectives.

AIMS AND OBJECTIVES: To explore an innovative primary healthcare gerontology nurse specialist role from the perspectives of older people and health professionals. BACKGROUND: Primary care is struggling to meet the needs and demands of complex older people. New models which incorporate holistic assessment and care coordination are necessary. DESIGN: A qualitative descriptive general inductive design was used. METHODS: Older people at risk of health and functional decline were identified and received a comprehensive gerontology assessment and care coordination. Older adults (75 years+) enrolled within one of three primary healthcare practices in Auckland, New Zealand were eligible. Healthcare professionals directly involved with the primary healthcare gerontology nurse specialist model were invited for study participation. Face-to-face interviews were held with five older people and six health professionals were interviewed by telephone. A semistructured interview guide was used for all interviews. A general inductive approach was undertaken for analysis to systematically identify codes and themes. RESULTS: Data analysis revealed two central themes from the older people perspective: "holistic expertise" and "communication." Two main themes were identified from the health professional perspective: "competency" and "service delivery." Results showed the gerontology nurse specialist role was highly regarded by both older people and the health professionals. The in-home comprehensive geriatric assessment was identified as greatly beneficial. CONCLUSIONS: The competence and care coordination of the gerontology nurse specialist reduced fragmentation and were deemed immensely valuable. Care coordination should be recognised as a key component to meeting the complex needs of at-risk older people in the community. RELEVANCE TO CLINICAL PRACTICE: The expert knowledge of the gerontology nurse specialist and in-home comprehensive geriatric assessment were crucial aspects of the new model. Equally important was the assimilation of primary and secondary care infrastructure to upskill and deliver mentorship to the gerontology nurse specialist.

The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services.

OBJECTIVES: International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement. DESIGN: A cross-sectional survey of hospital and community-based DNS in Ireland. METHODS: Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave. RESULTS: The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration. CONCLUSIONS: Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed.

A Guideline for Parkinson's Disease Nurse Specialists, with Recommendations for Clinical Practice.

BACKGROUND: Parkinson's Disease Nurse Specialists (PDNS) play an important role in the care for patients with Parkinson's disease (PD) and their caregivers. Until now, there were no nursing guidelines in PD, and interventions were based solely on daily clinical practice because there is no evidence to support the merits of nursing interventions. Consequently, there is little uniformity in current care delivery. OBJECTIVE: Developing a guideline for PDNS. METHODS: We developed a guideline based on a questionnaire among PDNS and a literature review, supplemented with expert opinion plus the input of patients and caregivers. The questionnaire was filled in by 97 PDNS and 51 generic nurses with knowledge of PD to identify barriers in PD nursing care. Subsequently, we did a systematic literature search and transformed these sources of information into practice recommendations, which were developed according to international standards for guideline development. RESULTS: Based on the results of the questionnaire we identified seven specific core areas: defining the role of PDNS in terms of caseload, education, competences and care coordination; medication adherence; provision of information and education; coping; caregiver support; urogenital function and orthostatic hypotension. The systematic literature search identified 186 studies, of which 33 studies were finally analyzed. Furthermore, we developed practice recommendations based on good clinical practice for the following areas: self-care, mental functioning, mobility, nutrition, sexuality, work, sleep, palliative care and complementary (integrative) care. CONCLUSION: This guideline provide ground to harmonize care delivery by PDNS in clinical practice, and offer a foundation for future research.

Clinical Nurse Specialist Perceptions' of Spiritual Care: Nurses Need Support, Care Falls Short.

The clinical nurse specialist (CNS) is positioned to influence spiritual care at three levels of practice: patient, nurse, and system. This study, the first to explore CNS spiritual care, reports on CNSs' perceptions in providing spiritual care. Four themes were extracted from interview data: 1) Providing direct spiritual support for patients, 2) Nurses need support in providing spiritual care, 3) Using existing resources, and 4) Spiritual care falls short. Not one CNS mentioned barriers to their direct provision of spiritual care. Results support that CNSs can improve spiritual care delivery.

National variation in the composition of rheumatology multidisciplinary teams: a cross-sectional study.

The objective of this study is to describe the composition of multidisciplinary teams (MDT) working within rheumatology departments across the UK. All rheumatology departments in the United Kingdom (UK) were invited to participate in a national electronic survey between February 2014 and April 2015 as a part of a national audit for the management of rheumatoid and early inflammatory arthritis commissioned by Healthcare Quality Improvement Partnership. Rheumatology departments were asked to report their MDT composition; defined as a rheumatologist (consultant or specialist trainee), specialist nurse, occupational therapist physiotherapist, and podiatrist. The data were collected as Whole Time Equivalent (WTE) of each professional group at each department adjusted to 100,000 population. The data were grouped according to British Society for Rheumatology regions to study regional variations. The survey was completed by 164/167 departments (98% response rate). All departments reported an MDT comprising a rheumatologist (consultant or specialist trainee) and almost all included a specialist nurse but only 28 (17%) of the departments had MDTs comprising all the professional groups. There was a high degree of regional variation in the provision of Allied Health Professionals (physiotherapists, occupational therapists, and podiatrists) in the UK. MDT care is recommended for the management of inflammatory arthritis, but few UK rheumatology departments have a full complement of healthcare professionals within their MDT. There is a high degree of regional variation in the composition and staffing levels of the rheumatology MDT across the UK; the impact of which warrants further investigation.

Collaboration: A critical exploration of the care continuum.

The purpose of this research was to explore the concept of collaboration within a specific healthcare context and to include the perspectives of healthcare users, a position largely lacking in previous studies. In applying a critical theoretical approach, the focus was on, as an exemplar, mothers with newborn babies who had spent more than 48 hr in a special care nursery. Semistructured interviews were undertaken with child health nurses, midwives and mothers. The three key theoretical findings on collaboration generated in the study point to layers of meanings around identity, knowledge and institutions of care. Findings from the interview data analysis were further examined through the lens of key policy documents. The research outcomes indicate that the concept of collaboration serves an important function in healthcare in obscuring the complexities and ambiguities that characterise the care continuum. The study concludes the need for a more critical approach to the assumptions that underlie the language of collaboration and the implications for practice in healthcare.