Competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica / Competencias de enfermería en el cuidado de personas con accidente cerebrovascular elegibles para terapia trombolítica / Nursing competencies in the care of patients with stroke who are eligible for thrombolytic therapy

Resumo Introdução: O acidente vascular cerebral isquêmico tem como tratamento a terapia trombolítica, aplicada ainda na fase aguda, promovendo melhora importante nas sequelas acarretadas por este agravo. Considerando a complexidade da terapia trombolítica, torna-se necessário que os enfermeiros compreendam suas competências para auxiliar no cuidado. Objetivo: Identificar evidências científicas acerca das competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica. Metodologia: Revisão integrativa composta por seis etapas em seis etapas (elaboração da questão, busca na literatura, coleta de dados, análise, discussão e apresentação da revisão), realizada nas bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase e CINAHL. A busca foi realizada entre agosto e setembro de 2022 adotando como critérios de inclusão estudos primários; gratuitos, disponíveis eletronicamente na íntegra; nos idiomas inglês, português e espanhol. Foram obtidos inicialmente 2.830 estudos, os quais passaram por uma seleção, onde foram incluídos aqueles que atendiam os critérios previamente estabelecidos. Resultados: Com base nos doze estudos incluídos nesta revisão identificaram-se competências voltadas à três atividades do cuidado: gestão do cuidado como trabalho em equipe, códigos, fluxos e protocolos, assistência ao paciente antes, durante e após a utilização da terapia trombolítica e educação em saúde para equipe, pacientes e familiares. Conclusão: Os achados desta revisão puderam evidenciar as competências do enfermeiro no cuidado aos pacientes elegíveis a terapia trombolítica, as quais perpassam diferentes áreas de atuação do enfermeiro. Para este estudo prevaleceram as competências assistências, seguida por competências gerenciais.

Resumen Introducción: El accidente cerebrovascular isquémico se trata con terapia trombolítica, aplicada incluso en la fase aguda, que promueve una mejoría significativa de las secuelas provocadas por este padecimiento. Considerando la complejidad de la terapia trombolítica, es necesario que las personas profesionales de enfermería comprendan sus competencias para ayudar en el cuidado. Objetivo: Identificar evidencias científicas sobre las competencias del personal de enfermería en el cuidado de pacientes con accidente cerebrovascular elegibles para terapia trombolítica. Metodología: Revisión integradora que consta de seis etapas (elaboración de la pregunta, búsqueda bibliográfica, recolección de datos, análisis, discusión y presentación de la revisión), realizada en las bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase y CINAHL. La búsqueda se realizó entre agosto y septiembre de 2022. Los criterio de inclusión fueron: estudios primarios, gratuito, disponible electrónicamente en su totalidad, en inglés, portugués y español. Inicialmente se obtuvieron 2830 estudios, los cuales fueron sometidos a un proceso de selección, que incluyó aquellos que cumplían con los criterios previamente establecidos. Resultados: A partir de los doce estudios incluidos en esta revisión, se identificaron competencias centradas en tres actividades asistenciales: gestión del cuidado como trabajo en equipo, códigos, flujos y protocolos, atención a pacientes antes, durante y después del uso de la terapia trombolítica y educación en salud para personal, pacientes y familias. Conclusión: Los hallazgos de esta revisión pudieron resaltar las competencias de las personas profesionales en enfermería en el cuidado de personas elegibles para terapia trombolítica, que abarcan diferentes áreas de actuación del personal de enfermería. Para este estudio, prevalecieron las habilidades asistenciales, seguidas de las competencias gerenciales.

ABSTRACT Introduction: Ischemic stroke is treated with thrombolytic therapy, applied even in the acute phase, promoting a significant improvement in the after-effects caused by this condition. Considering the complexity of thrombolytic therapy, it is necessary for nurses to understand the skills required to assist in care. Objective: To identify scientific evidence about the competencies of nurses in the care of patients with stroke who are eligible for thrombolytic therapy. Methodology: An integrative review consisting of six stages (elaboration of the question, literature review, data collection, analysis, discussion, and presentation), conducted in MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase, and CINAHL databases. The search was carried out between August and September 2022 using primary studies as the inclusion criteria: free of charge, fully available electronically, published in English, Portuguese, or Spanish. Initially, 2.830 studies were obtained, which underwent a selection process that included only those studies that met the previously established criteria. Results: Based on the twelve studies included in this review, competencies focused on three care activities were identified: care management such as teamwork; codes; flows and protocols; patient care before, during, and after the use of thrombolytic therapy; and education health education for staff, patients, and families. Conclusion: The findings of this review highlighted the nurses' competencies in the care of patients eligible for thrombolytic therapy, which encompass different areas of the nurse's work. For this study, assistance competencies prevailed, followed by management competencies.

Relação enfermeiro-pessoa afetada pela Tuberculose fundamentada na teoria do alcance de metas de imogene king / La relación enfermería-Persona afectada por la Tuberculosis, según la Teoría del logro de objetivos de imogene king / The nurse-tuberculosis patient relationship according to Imogene King's theory of goal achievement

Resumo Introdução: As ações desenvolvidas na Atenção Primária à Saúde são um dos pontos fortes de combate à tuberculose. Nesse nível de atenção, o contato contínuo do enfermeiro por meio da consulta de enfermagem permite manter relação com a população adoecida. Diante da relação enfermeiro-pessoa cuidada para o estabelecimento do vínculo e adesão ao tratamento contra tuberculose, compreende-se a importância do referencial teórico de Imogene King para estruturar a interação enfermeiro-pessoa cuidada e oferecer uma dinâmica para esse processo. Objetivo: Analisar a relação enfermeiro-pessoa afetada pela tuberculose fundamentada na Teoria do Alcance de Metas de Imogene King. Método: Estudo descritivo com abordagem qualitativa, com 14 enfermeiros da APS, selecionadas por conveniência. A coleta de dados ocorreu de agosto a novembro de 2018, por meio de entrevista semiestruturada, elaborada com base no Registro Meta-Orientado de Enfermagem de Imogene King. Os dados foram analisados de forme qualitativa pelo Software IRAMUTEQ. A pesquisa foi aprovada pelo Comitê de Ética. Resultados: Após a análise, emergiram quatro classes: 1) relação estabelecida com base no acolhimento; 2) relação enfermeiro-pessoa com tuberculose e o apoio de outros profissionais e familiares; 3) relação estabelecida com vistas ao cumprimento do tratamento; e 4) relação estabelecida para enfrentamento do preconceito diante da tuberculose. Conclusão: O acolhimento, a família e o vínculo entre profissional, paciente e equipe da Atenção Primária à Saúde fortalecem o enfrentamento da doença e reforçam a adesão ao tratamento medicamentoso.

Resumen Introducción: Uno de los puntos fuertes de la lucha contra la tuberculosis son las acciones desarrolladas en la atención primaria de salud. En este nivel asistencial, el contacto continuo de las enfermerías a través de la consulta de enfermería permite mantener una relación con la población enferma. Frente a la relación enfermería-persona para el establecimiento del vínculo y la adherencia al tratamiento contra la tuberculosis, se entiende la importancia del referente teórico de Imogene King para estructurar la interacción enfermería-persona y ofrecer una dinámica para este proceso. Objetivo: Análisis de la relación entre el personal de enfermería y las personas afectadas por la tuberculosis, a partir de la teoría del logro de objetivos de Imogene King. Método: Estudio descriptivo con abordaje cualitativo, con 14 enfermeras de atención primaria de salud, seleccionadas por conveniencia. La recolección de datos ocurrió de agosto a noviembre de 2018, a través de una entrevista semiestructurada, elaborada con base en el registro meta-orientado de enfermería de Imogene King. Los datos fueron analizados cualitativamente utilizando el software IRAMUTEQ. La investigación fue aprobada por el Comité de Ética. Resultados: Después del análisis, surgieron cuatro clases: 1) relación establecida con base en la recepción, 2) relación enfermería-persona con tuberculosis y apoyo de otras personas profesionales y familiares, 3) relación establecida con miras al cumplimiento del tratamiento y 4) relación establecida para combatir los prejuicios contra la tuberculosis. Conclusión: La acogida, la familia y el vínculo entre profesional, paciente y equipo de atención primaria de salud fortalecen el afrontamiento de la enfermedad y refuerzan la adherencia al tratamiento farmacológico.

Abstract Introduction: One of the main aspects in the fight against tuberculosis are the actions developed in Primary Health Care (PHC). At this level of care, the nurse's continuous contact through the nursing consultation allows them to maintain a relationship with the sick population. Regarding the nurse-patient relationship for establishing a bond and the compliance with tuberculosis treatment, we understand the importance of Imogene King's theoretical framework for structuring the nurse-patient interaction and offering a dynamic for this process. Objective: To analyze the nurse-tuberculosis patient relationship based on Imogene King's Theory of Goal Achievement. Method: A descriptive study with a qualitative approach, with 14 PHC nurses, selected by convenience. Data were collected from August to November 2018 through semi-structured interviews based on Imogene King's Meta-Oriented Nursing Record. The data were analyzed qualitatively using the IRAMUTEQ software. The research was approved by the Ethics Committee. Results: After the analysis, four classes emerged: 1) relationship established on the basis of welcoming; 2) nurse-tuberculosis patient relationship and the support of other professionals and family members; 3) relationship established towards treatment compliance; and 4) relationship established to confront prejudice associated with tuberculosis. Conclusion: The welcoming, the family, and the bond between the professional, the patient and Primary Health Care team strengthen the coping with the disease and reinforce the compliance with the pharmacological treatment.

Aplicabilidade das tecnologias na assistência de enfermagem com foco na segurança do paciente / The technology applicability in the aid of nursing focusing on the patient's safety / Aplicabilidad de tecnologias en la asistencia de enfermeria con enfoque en la seguridad del paciente

Objetivo: Conhecer a percepção dos enfermeiros em ambiente hospitalar sobre a implementação das tecnologias na assistência de enfermagem com foco na segurança do paciente. Métodos: Estudo descritivo, qualitativo, realizado com oito enfermeiros, responsáveis pelo gerenciamento de riscos em hospitais. Utilizou-se a técnica Snowball para eleger os participantes e a plataforma Skype para as entrevistas, realizadas no período de março a abril de 2021. Resultados: Apontou-se a utilização da tecnologia por meio do prontuário eletrônico, com a inserção de programa como o Tasy, o qual avançou para comunicação em rede, com vistas a facilitar checagens, auditorias, indicadores, gerenciamento e análise dos eventos. Desvelou-se também para a utilização do código de barras na identificação do paciente e no controle de dispensação e recebimento de medicamentos. No entanto, foram apresentadas limitações na implementação como dificuldade no manuseio das ferramentas digitais por profissionais antigos, caracterizada como resistência. Conclusão: A aplicabilidade das tecnologias na práxis da enfermagem contribui para a segurança do paciente face a favorecer o controle de eventos e o gerenciamento de riscos. Remete para a importância de capacitação e treinamentos dos profissionais para desenvolvimento de habilidades na utilização das ferramentas digitais. (AU)

Objective: Getting to know the perceptions from nurses on hospital environment about the technology implantation in the aid of patient's safety focused nursing. Methods: Descriptive, qualitative study made with eight nurses, responsible for risk management in hospitals. The Snowball technique was used to select the participants and the Skype platform used in the interviews, from March to April 2021. Results: The technology use was detected on the patient's electronic records through the Tasy program, which advanced to a net communication to facilitate checking, audits, pointers, management and event analysis. It was also detected by the use of bar codes in the identification of patients and control of medication dispensation and receiving. However, some limitations were found in the technology implementation, like elderly people having trouble using the digital tools, which is characterized by resistance. Conclusion: The technology applicability in the nursing practice contributes to the patient's safety to favor event control and risk management. It points to the importance of staff training and qualification to promote the ability of using digital tools. (AU)

Objetivo: Conocer las percepciones de las enfermeras del entorno hospitalario sobre la implementación de tecnologias enfocado en la seguridad del paciente. Métodos: Fue realizado un estudio descripctivo, cualitativo, con ocho enfermeras responsables de la gestión de riesgos en los hospitales. Se utilizó la tecnica snowball para elegir a los participantes y la plataforma skype para las entrevistas realizadas de marzo a abril de 2021. Resultados: Con el desarrollo de la tecnologia a través de historias clínicas eletrónicas, la inserción de un programa como Tasy, que avanzó a la comunicación em red, con el objetivo de facilitar verificaciones como auditorias, gestión y análisis en cualquier eventualidad. Tambien se dio a conocer para el uso de códigos de barras en la identificación de pacientes y en el control de la dispensación y recepción de medicamentos. Sin embargo, se presentaron limitaciones en la implementación, como la dificultad en el manejo de herramientas digitales por parte de algunos profesionales. Conclusión: La aplicabilidad de tecnologias en la enfermeria contribuye a la seguridad del paciente favoreciendo en el control de riesgos. Se refiere a la importancia de la calificación y formación de los profesionales, para desarrollar habilidades en el uso de herramientas digitales. (AU)

Gerenciamento do protocolo de prevenção de lesão por pressão: construção de painel de bordo informatizado / Management of the pressure injury prevention protocol: construction of a computerized dashboard / Gestión del protocolo de prevención de lesiones por presión: construcción de panel informatizado

Objetivo: Relatar a construção e implantação de painel de bordo, desenvolvido por enfermeiros e profissionais da tecnologia da informação, para gerenciamento do Protocolo de Prevenção de Lesão por Pressão. Métodos: Trata-se de um relato de experiência sobre a construção e implantação de painel de bordo informatizado para gerenciamento de protocolo em um hospital privado universitário, localizado no interior do estado de São Paulo. Resultados: A construção do painel de bordo foi dividida nas seguintes etapas: revisão e atualização do protocolo, construção do modelo eletrônico e implementação. A divulgação foi realizada pela Comissão de Prevenção de Lesão por Pressão. Conclusão: O painel de bordo possibilitou a visualização rápida e em tempo real dos riscos dos pacientes, intervenções propostas e efetividade das medidas de prevenção, além de promover a integração e empoderamento dos profissionais na gestão do cuidado. (AU)

Objective: To report the construction and implementation of a dashboard, developed by nurses and information technology professionals, to manage the Pressure Injury Prevention Protocol. Methods: This is an experience report on the construction and implementation of a computerized dashboard for protocol management in a private university hospital, located in the interior of the state of São Paulo. Results: The construction of the dashboard was divided into the following steps: review and update of the protocol, construction of the electronic model and implementation. The Pressure Injury Prevention Commission disclosed the tool. Conclusion: The dashboard enabled the quick and real-time visualization of patient risks, proposed interventions and effectiveness of prevention measures, in addition to promoting the integration and empowerment of professionals in the management of care. (AU)

Objetivo: Informar la construcción e implementación de un panel, desarrollado por enfermeras y profesionales de tecnologías de la información, para gestionar el Protocolo de Prevención de Lesiones por Presión. Métodos: Se trata de un informe de experiencia sobre la construcción e implementación de un panel computarizado para la gestión del protocolo en un hospital universitario privado, en el interior del estado de São Paulo. Resultados: La construcción del panel se dividió en los siguientes pasos: revisión y actualización del protocolo, construcción del modelo electrónico e implementación. La divulgación fue realizada por la Comisión de Prevención de Lesiones por Presión. Conclusión: El panel permitió la visualización rápida y en tiempo real de los riesgos del paciente, las intervenciones propuestas y la efectividad de las medidas de prevención, además de promover la integración y el empoderamiento de los profesionales en la gestión del cuidado. (AU)

Teorias de enfermagem utilizadas em pediatria / Nursing theories used in pediatrics / Teorías de enfermería utilizadas en pediatría

Objetivo: Mapear as teorias de enfermagem utilizadas nos diferentes contextos de assistência à criança e ao adolescente. Métodos: Revisão de escopo de acordo com a metodologia do Instituto Joanna Briggs, que incluiu estudos primários, publicados em inglês, espanhol e português, sem restrição de tempo, e disponibilizados nas bases de dados MEDLINE, WOS, BDENF, SCOPUS, CINAHL e SCIELO. Resultados: Foram incluídos nesta revisão 53 artigos, os quais evidenciaram 17 teorias de enfermagem aplicadas aos mais diversos contextos pediátricos, como hospitalização, terapia intensiva, cuidados para doenças crônicas e promoção da saúde. A teoria mais utilizada para direcionar o cuidado foi a Teoria da Adaptação de Roy. São várias as experiências exitosas no campo da pesquisa e prática assistencial com a utilização das teorias de enfermagem. Conclusão: Diferentes teorias de enfermagem embasam o cuidado de enfermagem pediátrica; e a escolha de cada teoria deve ser norteada por um propósito explícito ou assunto de interesse dos autores, com base em suas expectativas pessoais e nas evidências científicas. Por meio deste estudo foi possível vislumbrar o potencial de cada teoria para subsidiar a prática da enfermagem pediátrica. (AU)

Objective: To map the Nursing theories used in the different contexts of assistance to children and adolescents. Methods: Scoping review according to the Joanna Briggs Institute methodology and included primary studies, published in English, Spanish and Portuguese, with no time restrictions, and made available in the MEDLINE, WOS, BDENF, SCOPUS, CINAHL and SCIELO databases. Results: A total of 53 articles were included in this review, which evidenced 17 Nursing theories applied to the most varied pediatric contexts, such as hospitalization, intensive care, care for chronic conditions, and health promotion. The theory most used to direct care was the Roy's Adaptation Theory. There are several successful experiences in the field of research and care practice with the use of Nursing theories. Conclusion: Different Nursing theories support pediatric Nursing care; and the choice of each theory must be guided by an explicit purpose or subject of interest to the authors, based on their personal expectations and on the scientific evidence. Through this study it was possible to glimpse the potential of each theory to support pediatric Nursing practice. (AU)

Objetivo: Mapear las teorías de Enfermería utilizadas en los diferentes contextos de atención a la niñez y adolescencia. Métodos: Revisión de alcance según la metodología del Joanna Briggs Institute que incluyó estudios primarios, publicados en inglés, español y portugués, sin restricciones de tiempo, y disponibles en las bases de datos MEDLINE, WOS, BDENF, SCOPUS, CINAHL y SCIELO. Resultados: En esta revisión se incluyeron un total de 53 artículos, que evidenciaron 17 teorías de enfermería aplicadas a los más variados contextos pediátricos, como hospitalización, cuidados intensivos, cuidados de enfermedades crónicas y promoción de la salud. La teoría más utilizadas para dirigir el cuidado fue la Teoría de la Adaptación de Roy. Existen varias experiencias exitosas en el campo de la investigación y la práctica asistencial con el uso de las teorías de Enfermería. Conclusión: Diferentes teorías de Enfermería sustentan la atención de Enfermería pediátrica; y la elección de cada teoría debe estar guiada por un propósito explícito o tema de interés para los autores, con base en sus expectativas personales y en la evidencia científica.A través de este estudio se pudo vislumbrar el potencial de cada teoría para sustentar la práctica de la Enfermería pediátrica. (AU)

Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study.

OBJECTIVES: This study aimed to investigate whether a significant trend regarding inpatient falls in Swiss acute care hospitals between 2011 and 2019 could be confirmed on a national level, and whether the trend persists after risk adjustment for patient-related fall risk factors. DESIGN: A secondary data analysis was conducted based on annual multicentre cross-sectional studies carried out between 2011 and 2019. SETTING: All Swiss acute care hospitals were obliged to participate in the surveys. Except for emergency departments, outpatient wards and recovery rooms, all wards were included. PARTICIPANTS: All inpatients aged 18 or older who had given their informed consent and whose data were complete and available were included. OUTCOME MEASURE: Whether a patient had fallen in the hospital was retrospectively determined on the survey day by asking patients the following question: Have you fallen in this institution in the last 30 days? RESULTS: Based on data from 110 892 patients from 222 Swiss hospitals, a national inpatient fall rate of 3.7% was determined over the 9 survey years. A significant linear decreasing trend (p=0.004) was observed using the Cochran-Armitage trend test. After adjusting for patient-related fall risk factors in a two-level random intercept logistic regression model, a significant non-linear decreasing trend was found at the national level. CONCLUSIONS: A significant decrease in fall rates in Swiss hospitals, indicating an improvement in the quality of care provided, could be confirmed both descriptively and after risk adjustment. However, the non-linear trend, that is, an initial decrease in inpatient falls that flattens out over time, also indicates a possible future increase in fall rates. Monitoring of falls in hospitals should be maintained at the national level. Risk adjustment accounts for the observed increase in patient-related fall risk factors in hospitals, thus promoting a fairer comparison of the quality of care provided over time.

Nurses' and midwives' experiences of clinical supervision in practice: a scoping review protocol.

OBJECTIVE: To outline and examine what evidence exists related to nurses' and midwives' experiences of participating in clinical supervision. INTRODUCTION: The practice of clinical supervision is increasingly prevalent in nursing and midwifery, yet disparity remains in relation to professionals' understanding and experience of this clinical support and how it is implemented in practice. This scoping review will identify the available evidence and gaps in knowledge that exist in relation to nurses' and midwives' experience of this practice and examine how the various forms are defined in the literature. METHODS AND ANALYSIS: Comprehensive searches of CINAHL Complete, MEDLINE (EBSCO), PsycINFO (EBSCO), Embase, Scopus and the Cochrane Library will be carried out. Grey literature will also be searched and all results will be screened independently by two reviewers using identified inclusion and exclusion criteria. All empirical data that identify and report nurses' and midwives' experiences of clinical supervision will be included in the review. Studies that include other health and social care professionals will be excluded where the nursing and midwifery cohort is not reported independently. Data from all relevant studies will be extracted using a validated adapted data extraction form. Our review will be guided by the Joanne Briggs Institute Methodology and findings will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Extension for Scoping Reviews statement. ETHICS AND DISSEMINATION: This review does not require ethical approval. Our dissemination strategy includes peer-reviewed publication, presentation and conferences and sharing through stakeholder networks.

People's experiences of their involvement in nursing care: a systematic review protocol.

BACKGROUND: People's involvement and participation are the essential basis of nursing care. This phenomenon can be characterised as an approach based on the integration of the person's values, beliefs, and preferences during nursing care. This process contributes to improve the quality of care, satisfaction levels, and a better experience for people. To promote the person's participation in nursing care, it is necessary to better understand their experiences about this topic. AIM: To synthesise the available evidence on people's experiences of their involvement and participation in nursing care in a hospital setting. DESIGN & SETTING: A systematic review that will be conducted according to the JBI methodology for systematic reviews of qualitative evidence. METHOD: The study selection, critical appraisal, and data extraction will be conducted by two independent reviewers. This review will consider studies with a qualitative approach, published and unpublished, in Portuguese, English and Spanish with no temporal limit, that include adults, aged 18 years or older, who have experienced an admission in a hospital; that explore people's experiences of their involvement and participation in nursing care in hospital wards settings. Findings will be presented using meta-aggregation approach and narrative format, and the final synthesised findings will be graded according to the ConQual approach. CONCLUSION: It is expected that this qualitative synthesis will inform people, health professionals and policymakers, allowing them to develop recommendations to promote the person's participation in nursing care.

Professional voice use in health and nursing care - Time for reconsideration? A scoping review.

BACKGROUND: Communication is a key tool in the nursing profession. It is known that listeners are sensitive to the speaker's voice and interpret the speaker's intentions primarily from the non-verbal signal conveyed. AIM: To map and discuss the current state of knowledge and research evidence on professional voice use in health and nursing care. DESIGN AND METHOD: A scoping review adherent to the EQUATOR guidelines PRISMA-ScR. DATA SOURCES: Searches in the EBSCO, CINAHL, Medline, PubMed, PsychInfo and PsycArticles databases were conducted between 1 and 28 February 2023. RESULTS: According to the data (n = 23), health professionals use voice as a vital aspect of caring communication and caring relationships, and in leadership as well as inter-professional collaboration, to facilitate information exchange and understanding and promote shared decision-making. The data showed that there is also a rising tendency to explore vocal demands and problems among health professionals. No studies were found on the use of voice in digital health and nursing care services or by social robots. Most of the reviewed studies were cross-sectional, rather small, and focused primarily on the perspectives of healthcare professionals. CONCLUSION: The use of voice should be explored as a vital aspect of caring communication and caring relationships from the patients' perspective, and the effects of voice use on listeners' emotions and actions should be examined in different contexts with modern, voice-specific data collection methods. Studies focusing on voice use in digital health care and by social robots are also needed. By integrating training programmes, education and technological innovations, health care can leverage the full potential of voice-based communication to promote a more coordinated and patient-centred care environment, true inter-professional collaboration and effective leadership. IMPACT: Professional voice use is an essential part of all health and nursing care and an impressive method that should be used consciously. Therefore, the meaning and methods of voice use, including speech accommodation, should be systematically introduced into health and nursing care and included in nursing education.

Implementation of Family Centered Care for Neonates Admitted in a Special Care Baby Unit in Sierra Leone.

Purpose: To assess the feasibility of implementing family centered care and the impact this would have on parental satisfaction in a special care baby unit in Sierra Leone. Patients and Methods: A cross-sectional, mixed methods study was conducted at the Rokupa Government Hospital, Sierra Leone. 16 nursing staff of the Special Care Baby Unit and 7 caregivers of neonates admitted in the unit participated in the study. Quantitative data on feasibility was obtained from nursing staff using a five-point Likert scale administered to staff before and after implementation of family centered care in the unit. Qualitative data on perception of impact was obtained through focus group discussions for caregivers whose neonates had received family centered care and a control group who had received standard unit care. Quantitative data was analyzed using univariate analysis and thematic analysis was undertaken for qualitative data. Results: Before implementation, most nursing staff felt implementation of family centred care was not feasible (87.5%) and more than half of nursing staff either strongly agreed or agreed with each of the negative statements regarding the practice of family centred care indicating a generally negative perception. After implementation there was improvement in nursing staff perception of family centred care, however the majority still doubted the continued feasibility of this practice (68.8%). Qualitative discussions with caregivers demonstrated that caregivers whose babies received family centered care were less distressed and more satisfied during the period of admission than those who received routine care. Conclusion: Family centered care improved the experiences of caregivers in the unit. Nursing staff also demonstrated a better understanding of the benefits of family centered care after it was implemented. Concerns regarding understaffing and the unit being too small to accommodate caregivers and staff at the same time need to be addressed. There is need to integrate family centered care into hospital policy.

Critical care nurses' experiences of ethical challenges in end-of-life care.

BACKGROUND: In Swedish intensive care units, nine percent of patients do not survive despite receiving advanced life-sustaining treatments. As these patients transition to end-of-life care, ethical considerations may become paramount. AIM: To explore the ethical challenges that critical care nurses encounter when caring for patients at the end of life in an intensive care context. RESEARCH DESIGN: The study used a qualitative approach with an interpretive descriptive design. RESEARCH CONTEXT AND PARTICIPANTS: Twenty critical care nurses from eight intensive care units in an urban region in Sweden were interviewed, predominately women with a median age of fifty-one years. ETHICAL CONSIDERATIONS: This study was approved by The Swedish Ethics Review Authority. FINDINGS: Critical care nurses described encountering ethical challenges when life-sustaining treatments persisted to patients with minimal survival prospects and when administering pain-relieving medications that could inadvertently hasten patients' deaths. Challenges also arose when patients expressed a desire to withdraw life-sustaining treatments despite the possibility of recovery, or when family members wanted to shield patients from information about a poor prognosis; these wishes occasionally conflicted with healthcare guidelines. The critical care nurses also encountered ethical challenges when caring for potential organ donors, highlighting the balance between organ preservation and maintaining patient dignity. CONCLUSION: Critical care nurses encountered ethical challenges when caring for patients at the end of life. They described issues ranging from life-sustaining treatments and administration of pain-relief, to patient preferences and organ donation considerations. Addressing these ethical challenges is essential for delivering compassionate person-centered care, and supporting family members during end-of-life care in an intensive care context.

The Effect of Providing Education to Patients Undergoing Coronary Angiography on Vital Signs.

PURPOSE: This study was conducted to determine the effect of providing preprocedural education to patients undergoing coronary angiography on their vital signs. DESIGN: The study was a randomized controlled experimental study with a pretest/post-test control group design. METHODS: The study was conducted in the Cardiology Service of a hospital in Eskisehir between November 2021 and April 2022. Power analysis identified that it was appropriate to include 79 individuals in the experimental group, 79 individuals in the control group, and a total of 158 individuals. The experimental group was trained using the "Structured Education Manual" prepared by the researchers. FINDINGS: The education had an influence on the stabilization of vital signs after the procedure compared to preprocedure. When the comparison of vital signs before and after the education was analyzed, systolic blood pressure and diastolic blood pressure differed significantly between 11 measurements in both groups (P < .05). The systolic and diastolic blood pressure of the experimental group measured before the procedure was higher than their other measurements after the procedure. Heart rate, respiratory rate, and saturation value in both groups displayed a statistically significant difference between 11 measurements (P < .05). In the experimental group, heart rate and respiratory rate before the procedure were higher than the postprocedure measurements. The saturation value of the experimental group at 150 minutes after the procedure was higher than the other measurements. CONCLUSIONS: Education given to patients before undergoing a coronary angiography procedure had a positive effect on the patients' vital signs. It is recommended that patients undergoing a coronary angiography procedure be provided with audio-visual training by nurses before the procedure.

Nursing management of catheter-related non-infectious complications of PD: Your questions answered.

A review from the last seven years (August 2016-July 2023) of questions posted to the International Society for Peritoneal Dialysis (ISPD) website "Questions about PD" by nurses and physicians from around the world revealed that 19 of the questions were associated with optimal approaches for preventing, assessing, and managing issues related to PD catheter non-infectious complications. Our review focused on responses to these questions whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practices discussed. We combined similar questions, revised both the original questions and responses for clarity, as well as updated the references to these questions. PD catheter non-infectious complications can often be prevented or, with early detection, the potential severity of the complication can be minimized. We suggest that the PD nurse is key to educating the patient on PD about PD catheter non-infectious complications, promptly recognize a specific complication and bring that complication to the attention of the Home Dialysis Team. The questions posted to the ISPD website highlight the need for more education and resources for PD nurses worldwide on the important topic of non-infectious complications related to PD catheters, thereby enabling us to prevent such complications as PD catheter malfunction, peri-catheter leakage and infusion or drain pain, as well as recognize and resolve these issues promptly when they do arise, thus allowing patients to extend their time on PD therapy and enhance their quality of life whilst on PD.

Delegating care as a double-edged sword for quality of nursing care: a qualitative study.

BACKGROUND: Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care. METHODS: This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985). RESULTS: In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword". CONCLUSIONS: The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

Beyond technology acceptance-a focused ethnography on the implementation, acceptance and use of new nursing technology in a German hospital.

Introduction: Hospitalised patients could benefit from the emergence of novel technologies for nursing care. There are numerous technical products available, but these rarely find their way into practice. Further knowledge is required about the circumstances under which technology in nursing is accepted and used. In the research project "Centre for Implementing Nursing Care Innovations", technical innovations are implemented on a trauma surgery inpatient ward in Germany. After implementation, it was investigated: Which implemented technologies are accepted/rejected, and which factors influence the acceptance/rejection of technology for nurses? Material and methods: A focused ethnography was used, containing two approaches: First, participant observation was conducted to examine nurses' and patients' interaction with technologies. Observations were fixed in a field research diary and analysed using evaluative qualitative content analysis. Second, a questionnaire was used by nurses to provide information about the use frequency and technology suitability. The results of the study were consolidated and analysed using the UTAUT model. Results: Seven studied technologies can be summarised in four result categories: (1) A Mobilising mattress, a Special projector and a Sound pillow are accepted and used by nurses and patients, because they offer a way to provide high quality care with little additional effort. (2) A Fall prevention system is consistently used in patient care as a work obligation, but since nurses consider the system error-prone, acceptance is low. (3) An Interactive therapy ball is accepted but nurses cannot use it due to the high workload. (4) An App for nurse-patient communication and a work-equipment tracking system are not used or accepted because nurses do not see a practical benefit in the systems. Discussion: Acceptance or rejection of a product does not necessarily equate to use or non-use of the technology. Before implementation, technology acceptance among users occurs as prejudice-when users are given time to experiment with technology, intention-to-use can stabilize into sustained use. Accepted and used technologies can serve to mask problems (such as staff shortages) and encourage problematic developments, such as the reduction of contact time at the bedside. Therefore, technology acceptance should be qualified in asking to what accepted technology contributes.

Enhanced recovery urinary protocol for patients undergoing hip surgery: a quasi-experimental study.

INTRODUCTION: Postoperative urinary retention (POUR) is a common complication after hip surgery. The enhanced recovery urinary protocol (ERUP) is a tool that employs several perioperative strategies to facilitate optimal conditions for surgery and recovery. The aim of this study was to evaluate the effect of ERUP on POUR in patients undergoing hip surgery. METHODOLOGY: A controlled pre- and post-quasi-experimental study was conducted. Data was collected between May 2018 and January 2019 at the orthopedic department of one of the largest teaching hospitals affiliated with Menoufia University in Egypt. A convenience sample of 100 Egyptian patients (of both genders) undergoing elective hip surgery was equally allocated into two groups. The control group (n = 50) was given traditional routine perioperative nursing care, while the intervention group (n = 50) was subjected to ERUP. Data was collected from socio-demographic, medical, and surgical data sheets, preoperative medication assessment sheets, postoperative data sheets, and fluid balance charts. RESULTS: ERUP application significantly reduced the length of hospital stay and the incidence of POUR in the intervention group. CONCLUSIONS: Implementation of the ERUP is recommended for patients undergoing hip surgery, as it has a significantly positive effect on reducing the incidence of POUR.

Factors affecting nurses' compassion fatigue: A path analysis study.

BACKGROUND: Nurses often experience compassion fatigue as a result of exposure to chronic work-related stress. It is thought that nurses' mindfulness levels and patience attitudes might be effective on compassion fatigue. AIM: Therefore, in this study, it is aimed to examine the relationship between nurses' compassion fatigue, mindfulness levels and patience levels. METHODS: The study was carried out in a descriptive and relation-seeking type and was completed with the participation of 469 nurses. Data Form of Demographic and Professional Characteristics, Compassion Fatigue-Short Scale, Mindful Attention Awareness Scale and The Patience Scale were used as data collection tools. FINDINGS: As a result of the research, it was determined that there was a relationship between the mindfulness and patience levels of nurses and compassion fatigue. As the mindfulness and patience levels of nurses increase, compassion fatigue decreases (p < 0.05). As the mindfulness levels of the nurses increase, their patience levels increase as well (p < 0.05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Accordingly, it is recommended to increase the level of patience and reduce compassion fatigue by applying interventions that will increase the mindfulness levels of nurses.

Nurses' Views on Caring for Lonely Patients During the Pandemic: A Qualitative Study.

BACKGROUND: The implementation of safety measures in hospitals due to the COVID-19 pandemic, including family visitation restrictions, forced the family to be absent during the patient's hospitalization. Nurses were confronted with new roles and responsibilities, as caring for lonely patients was a new phenomenon that emerged during the pandemic. PURPOSE: The purpose of this study was to explore the nurses' views on caring for lonely patients during the COVID-19 pandemic. METHODS: A qualitative research method based on an inductive content analysis approach was used. Data collection was carried out using semi-structured interviews. The sample consisted of 11 nurses who worked in COVID-19 wards and units. Content analysis was used to analyze the interview data. RESULTS: The analysis of the data revealed three main themes: 1) caring for the patient and the family; 2) extending conventional care; and 3) developing supportive mechanisms for better care. Caring for lonely patients brought about changes in patients's management and care and significantly affected communication patterns as well as nurses' roles and responsibilities. Providing care beyond limits, supporting care through the utilization of new technologies, and transforming organization and care were mentioned as areas of challenge for nursing practice.  Conclusions: Maintaining communication and supporting the family's involvement in patient care are considered to be equal to healing for the lonely patient. Reshaping working conditions and caring practices to meet the needs of the nurses, the patients, and their families during health crises may contribute positively to the provision of holistic care for patients and their families.

A multiphase study protocol of identifying, and predicting cancer-related symptom clusters: applying a mixed-method design and machine learning algorithms.

Objectives: In recent years, there has been increasing attention on the cluster approach to symptom management. Two significant challenges in the symptom cluster (SC) approach are identifying and predicting these clusters. This multiphase protocol aims to identify SCs in patients with advanced cancer as the primary objective, with the secondary objective of developing machine learning algorithms to predict SCs identified in the first phase. Methods: The 2-MIXIP study consists of two main phases. The first phase involves identifying SCs, and the second phase focuses on developing predictive algorithms for the identified SCs. The identification of SCs involves a parallel mixed-method design (quantitative and qualitative). Quantitative and qualitative methods are conducted simultaneously and given equal importance. The data are collected and analyzed independently before being integrated. The quantitative part is conducted using a descriptive-analytical method. The qualitative analysis is conducted using a content analysis approach. Then, the identified SCs from both parts are integrated to determine the final clusters and use them in the second phase. In the second phase, we employ a tree-based machine learning method to create predictive algorithms for SCs using key demographic and clinical patient characteristics. Conclusion: The findings of the 2-MIXIP study can help manage cancer patients' symptoms more effectively and enhance clinical decision-making by using SCs prediction. Furthermore, the results of this study can provide guidance for clinical trials aimed at managing symptoms.

A nursing intervention based on the Zentangle® method: Experiences of patients diagnosed with borderline personality disorder.

Objective: The application of the Zentangle® Method in relation to relaxation and well-being has not been tested in patients with borderline personality disorder (BPD). This study was to analyze the practising Zentangle® experience in patients with BPD. Methods: With a phenomenological interpretative approach, this qualitative study conducted semi-structured interviews with patients who participated in a 6-session Zentangle® program accomplished monthly over six months in a Personality Disorders Unit. A total of 15 patients were interviewed for this study. Smith, Flowers & Larkin method was applied for evaluation in the data analysis. Results: Based on our findings, three categories were extracted: As you sow, so shall you reap (participants reported improvements in concentration, relaxation, interpersonal relationships, and interaction with their environment as well as positive experiences toward acceptance and change); Many hands make light work (patients admitted feeling better in a group and developed group membership. They described how a group environment influences individual behavior); Drawing your own path (this method provides a medium for self-expression and self-knowledge through drawing, improving well-being through emotional expression, enhancing creativity, and increasing self-confidence). Conclusions: By practicing Zentangle®, patients achieve behavioral responses such as flexibility and adaptability, reaching greater emotional well-being through anxiety management, impulse control, learning to cope with problems, or improving self-esteem or concentration. Mental health nursing plays a critical active role in the comprehensive treatment of BPD, as well as the mobilization and coordination of complementary and diverse interventions.