Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective.

BACKGROUND: Intensive care unit (ICU) nurses working in South Korea report experiencing uncertainty about how to care for patients undergoing withdrawal of life-sustaining treatments (WLT). A lack of consensus on care guidelines for patients with WLT contributes to uncertainty, ambiguity, and confusion on how to act appropriately within current law and social and ethical norms. To date, little has been discussed or described about how ICU nurses construct meaning about their roles in caring for dying patients in the context of wider social issues about end-of-life care and how this meaning interacts with the ICU system structure and national law. We aimed to better understand how ICU nurses view themselves professionally and how their perceived roles are enabled and/or limited by the current healthcare system in South Korea and by social and ethical norms. METHODS: This qualitative descriptive study was conducted using in-depth, semi-structured interviews and discourse analysis using Gee's Tools of Inquiry. Purposive sampling was used to recruit ICU nurses (n = 20) who could provide the most insightful information on caring for patients undergoing WLT in the ICU. The interviews were conducted between December 2021 and February 2022 in three university hospitals in South Korea. RESULTS: We identified four categories of discourses: (1) both "left hanging" or feeling abandoned ICU nurses and patients undergoing WLT; (2) socially underdeveloped conversations about death and dying management; (3) attitudes of legal guardians and physicians toward the dying process of patients with WLT; and (4) provision of end-of-life care according to individual nurses' beliefs in their nursing values. CONCLUSION: ICU nurses reported having feelings of ambiguity and confusion about their professional roles and identities in caring for dying patients undergoing WLT. This uncertainty may limit their positive contributions to a dignified dying process. We suggest that one way to move forward is for ICU administrators and physicians to respond more sensitively to ICU nurses' discourses. Additionally, social policy and healthcare system leaders should focus on issues that enable and limit the dignified end-of-life processes of patients undergoing WLT. Doing so may improve nurses' understanding of their professional roles and identities as caretakers for dying patients.

How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study.

The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.

Capturing key function-focused care problems, nursing diagnoses, and interventions for nursing home patients using a web-based case management system.

PURPOSE: The aim of this study is to identify the key functional care problems, NANDA-I nursing diagnoses, and intervention plans related to function-focused care (FFC) using a web-based case management system for patients who present different cognitive status. METHODS: This study employed a retrospective descriptive research design. Data were obtained from system records on patients after the research team trained the case management system at a nursing home in Dangjin in South Chungcheong Province, South Korea. A total of 119 inpatient records were analyzed. RESULTS: The key physical, cognitive, and social functional problems, nursing diagnoses in six domains (health promotion, elimination and exchange, activity/rest, perception/cognition, coping/stress tolerance, and safety/protection), and intervention plans were identified. CONCLUSION: The identified FFC case management information of interdisciplinary caregivers will provide evidence for the implementation of effective interventions according to a patient's functional status. Additional studies related to the establishment of a large clinical database of advanced case management systems focusing on interdisciplinary caregivers' functional management are needed to support the prioritization of functional care.

How nursing students learn infection control education through undergraduate nursing programs: a phenomenographic research study.

BACKGROUND: Competency in infection control is crucial for implementing nursing best practices to ensure patient safety. However, research is lacking on the infection control education received by nursing students prior to entering clinical settings as nurses. This study aimed to explore how nursing students conceptualize infection control care in undergraduate nursing programs. METHODS: This study employed a qualitative research method using phenomenography. Universities providing undergraduate nursing programs in Korea. Thirty nursing students: 10 students each from the 2nd, 3rd, and 4th years of five undergraduate programs. Data were collected from May 2019 to February 2020 through semi-structured interviews and analyzed using a phenomenographic analysis procedure. RESULTS: Six descriptive categories were derived inductively for nursing students' frames of reference regarding infection control care and six descriptive categories of how nursing students learned about infection control care. The structural framework of the identified categories, about how nursing students learn about infection control care, was presented as an outcome space. CONCLUSIONS: Given that nursing students demonstrate diverse conceptualizations of infection control and are at varying levels of learning, professors and clinical mentors need to develop theoretical education and clinical practice opportunities that consider these differences.

How experienced wound care nurses conceptualize what to do in pressure injury management.

BACKGROUND: Conceptual understanding of the perceptions that wound care nurses use to determine how to manage pressure injuries may provide information for improving their pressure injury care competency. The aim of this study is to explore and describe the way wound care nurses experience and perceive pressure injury management. METHODS: A qualitative, phenomenographic approach, a method designed to explore the different ways in which people comprehend a phenomenon and develop a practical knowledge-based framework, was used in this study. Semi-structured interviews were used for data collection with twenty wound care nurses. All participants were female with a mean age of 38.0, mean total clinical experience of 15.2 years and mean clinical experience as wound care nurse of 7.7 years. The eight steps of qualitative data analysis for a phenomenographic study were employed to develop an understanding of participants' experience of pressure injury management. RESULTS: The analysis resulted in an assessment domain and an intervention domain, each containing three descriptive categories based on five identified conceptions. The categories were as follows: "comparison", "consideration", and "monitoring" in assessment, and "creation", "conversation" and "judgement" in intervention. CONCLUSIONS: This study has created a framework for understanding pressure injury management based on practical knowledge. This framework of the nurses' pressure injury care reflected the need for an awareness of a harmonious approach to patients and wounds. There is a pattern of transcending a reliance on only theoretical knowledge, and this key factor in the framework should be considered when developing education programs and tools for improving nurse pressure injury care competency and patient safety.

Exploring interprofessional communication during nursing home emergencies using the SBAR framework.

Communication breakdowns during emergencies threaten patient safety. In nursing homes (NHs) vulnerable residents may experience emergencies at any time. Concerns over clinical complexity and diverse communication styles among interprofessional practitioners heighten the need for standardized methods to improve practitioners' communication skills. This study explores communication structures among 32 practitioners in four NHs using in-depth interviews following a formalized Situation-Background-Assessment-Recommendation (SBAR) framework. Network analysis, a deductive approach to qualitative data analysis, and case analysis were performed for a comprehensive understanding of interprofessional communication in 48 emergency cases identified during interviews. Findings identified the flow of information, messaging, and management strategies that were expected of receivers during interprofessional communication. These results could help develop training regimens or guidelines to improve cooperative interprofessional communication, allowing practitioners to provide appropriate emergency care for NH residents.

For the interprofessional management of the discomfort of long-term care facility residents with dementia.

Educating interprofessional practitioners in long-term care facilities (LTCFs) is critical for managing discomfort of residents with dementia, which is often unnoticed and undertreated. A framework of education on discomfort management that is applicable in various environments in different facilities is necessary. We developed a preliminary framework to educate interprofessional practitioners on discomfort management of dementia residents in LTCFs. We conducted a three-step research process: a literature review using topic modeling, in-depth interviews, and Delphi surveys. We derived four categories for an interprofessional approach toward discomfort management education in LTCFs: identifying visual and nonvisual signs to communicate among professionals, close observation using comparison and contrast to share information for discomfort care, harmony in interprofessional roles, and applying common and specific professional knowledge for discomfort management. The findings provide the first outline for an educational framework for interprofessional discomfort management in LTCFs for residents with dementia. We recommend interventions across different cultures to verify the framework in future research.

Perspective of Emergency Pediatric Nurses Triaging Pediatric Patients in the Emergency Department: A Phenomenographic Study.

INTRODUCTION: Triage, a process to determine illness severity, is implemented by emergency nurses to prioritize treatment and provide care for a maximum number of patients using limited resources. The competency of emergency nurses and a highly reliable triage are crucial for the provision of emergency care. Pediatric patients are different from adult patients in certain aspects, such as growth-phase characteristics, communication ability, and the onset of disease; these aspects often pose challenges during their primary triage. This study explored how emergency nurses triage pediatric patients using the Korean Triage and Acuity Scale. METHODS: Eleven emergency nurses (N = 11) working in the pediatric emergency department of a university hospital in Seoul, South Korea, were recruited using purposive sampling methods. Phenomenography was used to investigate the strategies by which these nurses use the Korean Triage and Acuity Scale to triage pediatric patients. RESULTS: The findings comprised 2 descriptive categories: 6 approaches on how to triage patients (categories of how) and 3 strategies (categories of what) used by pediatric emergency nurses to triage pediatric patients with the Korean Triage and Acuity Scale. DISCUSSION: The experience and proficiency of emergency nurses are essential factors for the effective triage of pediatric patients. Our findings qualitatively elucidate different ways of understanding pediatric triage and indicate the need for pediatric triage education programs.

Ways that nursing home nursing staff build resilience: a phenomenographic approach.

BACKGROUND: Resilience has been studied as an effective concept in nursing that acts as a protective factor which aids in overcoming difficult situations and related mental problems. With the recent increase in demand for nursing homes, nursing home nursing staff are facing a variety of stresses and psychological burdens. Improving resilience has been suggested as one way to deal with the difficulties, such as stress, exhaustion, and burnout, that nursing home nursing staff are experiencing. In order to provide successful education aimed at improving such resilience, it is very important to understand how to perceive experience from the learner's point of view. AIM: The study's aim is to identify the ways that nursing home nursing staff build resilience. METHOD: This study used phenomenography, a methodology for exploring the relationship between subject and phenomenon. From January 15, 2022 to February 20, 2022, data collection was undertaken at three nursing homes located in the Republic of Korea. The data was collected through semi-structured interviews with 20 nursing staff members in NHs and a data analysis that strictly followed the 7-step analysis process of phenomenography. RESULTS: Eight categories were derived. The eight categories were then divided into two groups of four representing perception and strategy. Perception included four categories: 'grasping the situation', 'thinking about one's responsibility for the resident and personal values', 'considering one's strength' and 'thinking of an improved self'. Strategy included four categories: 'evaluation of oneself and one's environment', 'taking care of oneself', 'finding concrete ways to manage the problem' and 'self-development for growth'. Perception had three levels of awareness, valuing and assuring, while strategy had three levels of identifying, introspecting and concretizing. CONCLUSION: This study provides insight into how individual nursing staff build resilience, a complex and subjective concept. It provides a foundation for future resilience education of nursing home nursing staff and suggests future educational intervention development directions.

Exploring carer resilience in the context of dementia: a meta-synthesis.

AIMS: The aim of this literature review is to integrate the results of qualitative research on the resilience experiences of family carers of people with dementia (PWD). DESIGN: A qualitative meta-synthesis study was conducted. METHODS: The meta-ethnography method of Noblit and Hare (1988) was used. We searched five electronic bibliographic databases (PubMed, EMBASE, CINAHL, PsycINFO and Web of Science) using the keywords "caregivers", "family caregivers", "spouse caregivers", "qualitative research", "resilience, psychological" and "dementia." The inclusion criteria of the literature search found studies that explored the resilience experience of family carers of PWD, were qualitative, were published in English, and had participants 18 years of age or older. RESULTS: Eleven studies, 1 from Australia, 4 from USA and 6 from UK, were included in the analysis. Through the process, three themes emerged: 'Seeing the life of a carer as one's duty', 'Setting boundaries in life', 'Moving forward toward a developing life.' These themes illustrated how family carers of PWD overcome the adversities they encounter. CONCLUSION: This meta-synthesis showed how family carers of PWD adapt to and overcome the difficult situations they are confronted with as carers. This review suggests an important direction for enhancing the resilience of family carers of PWD.

An e-Problem-Based Learning Program for Infection Control in Nursing Homes: A Quasi-Experimental Study.

Infection is a significant factor adversely affecting the health of nursing home (NH) residents, potentially even leading to death. Therefore, educating NH staff to think critically is necessary to prevent and control infection. In this study, we developed an electronic problem-based learning (e-PBL) program using the Network-Based Instructional System Design model to enhance South Korean NH staff's critical thinking competencies; subsequently, its effectiveness was evaluated. This study utilized a quasi-experimental nonequivalent pretest-post-test design. The participants (n = 54) were randomly allocated into an experimental group (n = 28) and a control group (n = 26). The results indicate that the e-PBL program significantly improved the critical thinking disposition in the experimental group compared with in the control group.

How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia?

Behavioral and psychological symptoms of dementia (BPSD) are common in residents of long-term care facilities (LTCFs). In LTCFs, nursing staff, including nurses and care workers, play a crucial role in managing BPSD as those most in contact with the residents. However, it is ambiguous where their focus should be for effective BPSD care. Thus, this paper aims to reveal BPSD care competencies for nursing staff in LTCFs and to outline an initial frame of education. A multiphase mixed-methods approach, which was conducted through topic modeling, qualitative interviews, and a Delphi survey, was used. From the results, a preliminary educational framework for nursing staff with categories of BPSD care competence was outlined with the four categories of BPSD care competence: using knowledge for assessment and monitoring the status of residents, individualizing approaches on how to understand residents and address BPSD, building relationships for shared decision-making, and securing a safe environment for residents and staff in LTCFs. This preliminary framework illuminates specific domains that need to be developed for competent BPSD care in LTCFs that are centered on nursing staff who directly assess and monitor the changing and deteriorating state of residents in LTCFs.

A Meta-Synthesis Study of Person-Centered Care Experience from the Perspective of Nursing Home Residents.

PURPOSE: To systematically review and synthesize the evidence for the experience of person-centered care from the perspective of nursing home residents to understand their views in depth. METHODS: The seven steps of Nobit and Hare's meta-ethnography, a well-known meta-synthesis method, were applied. We used four databases for the literature search (PubMed, Web of Science, EMBASE, and CINAHL). RESULTS: A total of seven studies were included for review. As a result of synthesizing the results, three themes ("promotion of mutual understanding through communication", "care that acknowledges the independence of residents" and "finding the optimized state") and six sub-themes were derived. CONCLUSIONS: This study has provided an in-depth understanding of person-centered care and will contribute to increasing its practical application.

How do wound care nurses structure the subjective frame on palliative wound care? A Q-methodology approach.

BACKGROUND: Palliative wound care is important for stability in terminal care. It addresses both the physical and psychological needs of patients and facilitates other aspects of terminal care. Appropriate competencies of nurses regarding palliative wound care can improve patient outcomes and raise their quality of life. The purpose of this study was to identify how wound care nurses structure the subjective frames regarding palliative wound care. METHOD: This study utilized Q-methodology to analyze their subjective viewpoints. Forty nurses experienced in palliative wound care were asked to completely classify 35 Q-statements into a normal distribution shape. The PQ-Method program was used to conduct principal factor analysis and varimax rotation for data analysis. RESULTS: This study revealed 4 Q-factors of palliative wound care: "Focusing on care within the boundary of current patient demands," "Comparing continuously the priorities on wound healing and disease care," "Preparing and preventing from worsening via tracking care in advance," and "Moving forward with a clear direction by confronting the declining condition." CONCLUSION: We hope that the results of this study are used in the development of nursing education that reflects professional perspectives of palliative wound care, thus helping to improve nursing competencies in palliative care.

The resilience of nursing staffs in nursing homes: concept development applying a hybrid model.

BACKGROUND: The resilience of nursing home (NH) nursing staff is emphasized to improve the quality of care provided, but the concept has not been clearly defined. By composing such a definition through concept development, a basis for active research in the future can be established. AIM: To identify the definition and conceptual characteristics of the concept of resilience of NH nursing staffs. METHOD: In this study, the concept was developed using Schwartz-Barcott and Kim's hybrid model, which included theoretical, fieldwork, and final analysis stages. In the theoretical stage, a literature review on the definition and measurement of concepts was performed. For the fieldwork stage, 22 interviews were conducted with 7 participants, and a content analysis was performed. During the final analysis stage, the results of the theoretical and field work stages were integrated. RESULTS: Three dimensions, eight attributes, and three types were identified. The three dimensions are internal resources, external support, and positive coping with situations as they arise; the eight attributes are optimism, patience, mindfulness, supportive relationships, available resources, work-life boundary setting, self-development, and growth; and the three types are those who want to adapt themselves to the situation, those who actively seek to cope with stressful situations, and those who hold positive expectations for the future. CONCLUSION: Coping with difficult situations using internal resources and external support was a unique trait revealed in the resilience of NH nursing staff members. This study provided future research directions to improve the resilience of NH nursing staffs by revealing the characteristics of their resilience.

Bridging the Knowledge Gap for Pressure Injury Management in Nursing Homes.

BACKGROUND: Pressure injuries in nursing homes remain a consistent problem. Unfortunately, despite the variety of pressure injury education offered in nursing homes, the knowledge learned cannot be applied in practice, and as a result, the prevalence and incidence of such injuries are consistently high. This study aimed to address those gaps by analyzing the nursing competency for pressure injury management and implementing pressure injury education programs in nursing homes. METHODS: Two phases were conducted based on the action cycle in the knowledge to action model. During the first phase, a framework was constructed by analyzing nursing experience. The second phase consisted of the implementation and monitoring of the program to evaluate the effects of the framework. RESULTS: The main results for nursing competencies for pressure injury management in nursing homes are integrated thinking, understanding in an environmental context, interpersonal relationships for efficient decision making, and meeting any challenges to professional development. The results concerning the program's effects showed significant differences in the participants' knowledge, attitude, stage discrimination ability, and clinical management judgment ability. CONCLUSION: The educational framework and program derived from this study are expected to improve nurses' pressure injury management competency in nursing homes and to contribute to effective pressure injury management and quality of life for residents in nursing homes.

Exploring nurse perceptions and experiences of resilience: a meta-synthesis study.

AIM: To understand nurse resilience by integrating the qualitative research results on nurses' resilience-related experiences. METHODS: We applied the seven steps of the meta-ethnographic process by Noblit and Hare (1988). Five databases (PubMed, EMBASE, Web of Science, CINAHL and PsycINFO) were used to search for relevant studies published from January 2011 to September 2021. RESULTS: Sixteen qualitative studies were included. The four themes of "self-development based on one's inner self", "fostering a positive attitude towards life", "developing personal strategies for overcoming adversity" and "building professionalism to become a better nurse" illustrate that they want to improve their inner strength and develop themselves through self-examination. CONCLUSION: In this study, we examined nurse resilience, and the results can provide fundamental conclusions useful for the development of an intervention study to improve nurse resilience.

Nurses' conceptualizations of managing emergencies in nursing homes.

Emergencies can negatively affect the morbidity and mortality of nursing home residents. As nurses employed at nursing homes play a key role in such situations, their conceptualizations of emergency management should be considered to improve care. Accordingly, this study aimed to identify nurses' conceptualizations of managing emergencies in nursing homes. A qualitative research design was conducted using interviews with 20 nurses working in five different nursing homes in the Republic of Korea between September 2019 and August 2020. The data were analyzed using phenomenography. This study identified two main perspectives used by nurses in nursing homes to manage emergencies, depending on the resident's condition: emergency care and daily preventive care. Nurses' conceptualizations of care provided in emergencies were organized under the frames of assessment and intervention, whereas routine care carried out during daily life activities fell under the frame of prevention. This study's findings, which elucidate nurses' complex practical and experiential knowledge, provide insights for the development of emergency management training.

Can multifaceted educational intervention improve clinical practice and patient outcomes regarding delirium in nursing homes?

AIM: We aimed to develop and evaluate a multifaceted and evidence-based delirium educational program for practitioners in nursing home settings. METHODS: A pre- and posttest comparison group design was employed. The recruited practitioners included nurses and care workers from two nursing homes. The intervention group (n = 51) received the developed delirium educational program for 3 weeks, whereas the control group (n = 23) received a delirium handbook. We examined pre- and posttest differences in the scores for delirium knowledge and confidence in providing delirium care. We also examined the nurses' ability to clinically detect delirium in patients and delirium incidence for 8-week periods both before and after the intervention. RESULTS: There were significant improvements in the participants' aptitudes (delirium knowledge and confidence in providing delirium care) and clinical practice (ability to clinically detect delirium in the patients) only in the intervention group; however, there were no significant differences in patient outcomes (incidence of delirium) between either group. Additionally, it was observed that the nurses' improved understanding of distinct clinical features of delirium, such as acute change or fluctuation, was the key factor that directly affected the success of delirium screening. CONCLUSIONS: This study revealed that implementation of a multifaceted and evidence-based delirium educational program for practitioners in nursing home settings was effective in promoting the knowledge, confidence, and ability to detect delirium. The developed program can also be implemented in settings where most patients are older individuals, such as geriatric care units, or long-term care hospitals.