An Integrative Literature Review of the Factors That Contribute to Professional Nurses and Midwives Making Sound Clinical Decisions.

PURPOSE: To identify available literature concerning the factors that contribute to nurses and midwives making sound clinical decisions. METHOD: This is an integrative literature review. FINDINGS: Thirty-eight articles revealed four main domains that influence nurses' and midwives' clinical decision making-nurses and midwives' personal characteristics (n = 30), e.g., clinical experience; organizational factors (n = 26), e.g., colleagues; patient characteristics (n = 26), e.g., physical and clinical status; and environmental factors (n = 9), e.g., time. These four domains of factors combined influence sound clinical decision making in the context of nursing and midwifery. CONCLUSIONS: Understanding the role of the factors influencing clinical decision making will help to improve patient and health outcomes. PRACTICE IMPLICATIONS: Further understanding about the extent of the impact some factors have on clinical decision making is needed.

Integrative review of benefit levers' characteristics for system-wide spread of best healthcare practices.

AIM: To critically analyse the characteristics of the benefit levers that are required for effective system-wide spread of evidence-based practice. BACKGROUND: Evidence-based nursing practice is the cornerstone of quality patient care and merits system-wide implementation. Achieving system-wide spread of evidence-based innovations requires adoption of four benefit levers (the facilitators for spreading innovations), conceptualized by Edwards and Grinspun: alignment, leadership for change, permeation plans and supporting and reinforcing structures. Although these concepts have been explored and described in primary studies, they were only recently identified as benefit levers and their characteristics have not been reviewed in the context of health care using an integrative literature review. DESIGN: An integrative literature review using an adapted Whittemore and Knafl design. DATA SOURCES: A comprehensive search using multiple sites such as Scopus, EBSCOhost, ProQuest, ScienceDirect, Cochrane Library, Nexus, SAePublications, Sabinet, Google Scholar and grey literature was conducted (January-March 2012) and updated (December 2014). After reading the abstracts, titles and full-text articles, forty (N = 40) research and non-research documents met the inclusion criteria. REVIEW METHODS: Thirty-five documents remained after critical appraisal. A systematic approach was used to analyse and synthesize the data and formulate concluding statements. RESULTS: Data revealed characteristics about alignment (personal, organizational and contextual attributes), permeation plans (phases), leadership for change (types, strategies, position, attitude and support) and supporting and reinforcing structures (types and requirements). CONCLUSION: Benefit levers should be used to promote the spread of evidence-based practices. However, more studies concerning benefit levers, specifically regarding 'alignment' and 'permeation plans', are required to promote system-wide spread of best healthcare practices.

Health information needs of professional nurses required at the point of care.

BACKGROUND: Professional nurses work in dynamic environments and need to keep up to date with relevant information for practice in nursing to render quality patient care. Keeping up to date with current information is often challenging because of heavy workload, diverse information needs and the accessibility of the required information at the point of care. OBJECTIVES: The aim of the study was to explore and describe the information needs of professional nurses at the point of care in order to make recommendations to stakeholders to develop a mobile library accessible by means of smart phones when needed. METHOD: The researcher utilised a quantitative, descriptive survey design to conduct this study. The target population comprised 757 professional nurses employed at a state hospital. Simple random sampling was used to select a sample of the wards, units and departments for inclusion in the study. A convenience sample of 250 participants was selected. Two hundred and fifty structured self-administered questionnaires were distributed amongst the participants. Descriptive statistics were used to analyse the data. RESULTS: A total of 136 completed questionnaires were returned. The findings highlighted the types and accessible sources of information. Information needs of professional nurses were identified such as: extremely drug-resistant tuberculosis, multi-drug-resistant tuberculosis, HIV, antiretrovirals and all chronic lifestyle diseases. CONCLUSION: This study has enabled the researcher to identify the information needs required by professional nurses at the point of care to enhance the delivery of patient care. The research results were used to develop a mobile library that could be accessed by professional nurses.

Allopathic and traditional health practitioners' collaboration.

BACKGROUND: Professional collaboration between traditional and allopathic health practitioners in South Africa is proposed in the Traditional Health Practitioners Act and could benefit and complement healthcare delivery. OBJECTIVES: To explore and describe the collaborative relationship between allopathic and traditional health practitioners regarding the legalisation of traditional healing, and these health practitioners' views of their collaborative and professional relationship, as role-players in the healthcare delivery landscape in South Africa. METHODS: A qualitative design was followed. The research population comprised 28 participants representing three groups: allopathic health practitioners (n = 10), traditionalhealers (n = 14), and traditional healers who are also allopathic health practitioners (n = 4). Purposive and snowball sampling was used. Data collection involved unstructured interviews, a focus group interview and modified participant observation. RESULTS: Results indicate both allopathic and traditional health practitioners experienced negative attitudes towards each other. Mutual understanding (in the form of changing attitudes and communication) was considered crucial to effective collaboration between these two health systems. Participants made suggestions regarding capacity building. CONCLUSIONS: Considering realities of staff shortages and the disease burden in South Africa, facilitating collaboration between allopathic and traditional health practitioners is recommended. Recommendations could be used to develop strategies for facilitating professional collaboration between traditional and allopathic health practitioners in order to complement healthcare delivery.