Gerontological educational interventions for student nurses: a systematic review of qualitative findings.

OBJECTIVES: This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing. METHODS: Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screened to include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies, and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies. CONCLUSIONS: Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated.

Self-care practices among professional nurses employed in primary health care clinics.

BACKGROUND:  Professional nurses typically promote and advocate self-care practices to their patients to achieve better health outcomes, but rarely engage in these practices themselves. METHODS:  A qualitative, descriptive phenomenological approach was used in this study. Ten professional nurses employed in different primary health care facilities were purposively sampled. Semi-structured interviews were conducted to collect data, which were analysed using Colaizzi's data analysis strategy, and data saturation was reached. RESULTS:  Two themes were identified. Theme 1: the participants expressed that internal and external factors compromised self-care practices, such as subconscious self-neglect, insufficient resources, and a depressed economy, which encouraged them to work extended hours. Theme 2: participants' holistic well-being was compromised, as they neglected their mental well-being. CONCLUSION:  Self-care practices among professional nurses seem unachievable. The extent of this population's self-care neglect was evident during the coronavirus disease 2019 (COVID-19) pandemic when professional nurses globally gave of themselves relentlessly.Contribution: This is the first study conducted on the topic in the City of Ekurhuleni, and the findings will provide relevant stakeholders with a directive on what strategies, policies, and guidelines to develop and implement to make self-care practices attainable for professional nurses.

Caregivers' and nurses' perceptions of the Smart Discharges Program for children with sepsis in Uganda: A qualitative study.

Sepsis arises when the body's response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program's effect on post-discharge care. We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.

"Jumping on the Blood Pressure Bandwagon": Nurse, GP, and Patient Perspectives of a General Practice Nurse-Led Hypertension Management Intervention.

To explore the perceptions and experiences of general practice nurses, general practitioners, and patients who participated in a nurse-led intervention to improve blood pressure control. Given the impact of hypertension on rates of premature death and disability, it is important that interventions be evaluated to reduce blood pressure. A key component of such evaluation is understanding the experiences of participants and clinicians. Understanding these experiences can provide insight into acceptability and feasibility that informs future research and implementation. Qualitative descriptive study within a mixed methods project. Semi-structured interviews were conducted post-intervention with six patients, five nurses, and three general practitioners. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. The COREQ checklist guided reporting. Three themes around the need for change, navigating change, and sustaining change were revealed. In highlighting the need for change, participants recognized that it was time to actively work toward improved blood pressure control. In navigating change, general practice nurses were perceived as ideally placed to communicate risks around uncontrolled blood pressure and support lifestyle change. The final theme, sustaining change revealed the feasibility of the intervention in practice, however, clinician participants identified that appropriate funding is required to ensure sustainability. Nurse-led intervention to improve blood pressure control in general practice is feasible in practice and acceptable to patients. This highlights an opportunity for nurses to play a more proactive role in hypertension management within general practice. To ensure sustainability, however, issues such as funding, teamwork, and collaboration need to be addressed. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12618000169246.

Predictors of depression, anxiety and stress symptoms among maternity nurses and midwives in a Middle Eastern country.

This study assessed anxiety, depression, and stress levels among midwives and maternity nurses in Oman using the DASS-21 questionnaire in a cross-sectional survey of 200 participants from three public hospitals. Results indicated that 27.0% experienced mild to moderate depression, while 33.5% and 32% reported mild to moderate anxiety and stress, respectively. No severe cases were observed, but the findings highlight significant predictors such as sleep quality, job satisfaction, caseload per shift, age, and working area. These factors were significantly associated with the mental health outcomes measured. The study underscores the importance of addressing the psychological and emotional well-being of midwives and maternity nurses through targeted support and interventions, given the substantial percentage experiencing mild to moderate symptoms. Continuous efforts are essential to mitigate these issues and promote a healthier work environment for these healthcare professionals.

Cette étude a évalué les niveaux d'anxiété, de dépression et de stress chez les sages-femmes et les infirmières de maternité d'Oman à l'aide du questionnaire DASS-21 dans le cadre d'une enquête transversale menée auprès de 200 participants de trois hôpitaux publics. Les résultats ont indiqué que 27,0 % souffraient de dépression légère à modérée, tandis que 33,5 % et 32 % rapportaient respectivement une anxiété et un stress légers à modérés. Aucun cas grave n'a été observé, mais les résultats mettent en évidence des prédicteurs importants tels que la qualité du sommeil, la satisfaction au travail, le nombre de cas par équipe, l'âge et la zone de travail. Ces facteurs étaient significativement associés aux résultats en matière de santé mentale mesurés. L'étude souligne l'importance d'aborder le bien-être psychologique et émotionnel des sages-femmes et des infirmières de maternité par le biais d'un soutien et d'interventions ciblés, étant donné le pourcentage substantiel de symptômes légers à modérés. Des efforts continus sont essentiels pour atténuer ces problèmes et promouvoir un environnement de travail plus sain pour ces professionnelles en soins.

Nurses' continuance intention to use electronic health record systems: The antecedent role of personality and organisation support.

Nurses play a crucial role in the adoption and continued use of Electronic Health Records (EHRs), especially in developing countries. Existing literature scarcely addresses how personality traits and organisational support influence nurses' decision to persist with EHR use in these regions. This study developed a model combining the Five-Factor Model (FFM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) to explore the impact of personality traits and organisational support on nurses' continuance intention to use EHR systems. Data were collected via a self-reported survey from 472 nurses across 10 public hospitals in Jordan and analyzed using a structural equation modeling approach (Smart PLS-SEM 4). The analysis revealed that personality traits, specifically Openness, Experience, and Conscientiousness, significantly influence nurses' decisions to continue using EHR systems. Furthermore, organisational support, enhanced by Performance Expectancy and Facilitating Conditions, positively affected their ongoing commitment to EHR use. The findings underscore the importance of considering individual personality traits and providing robust organisational support in promoting sustained EHR usage among nurses. These insights are vital for healthcare organisations aiming to foster a conducive environment for EHR system adoption, thereby enhancing patient care outcomes.

Up for the challenge: Power motive congruence drives nurses to craft their jobs and experience well-being.

Job crafting is the behavior that employees engage in to create personally better fitting work environments, for example, by increasing challenging job demands. To better understand the driving forces behind employees' engagement in job crafting, we investigated implicit and explicit power motives. While implicit motives tend to operate at the unconscious, explicit motives operate at the unconscious level. We focused on power motives, as power is an agentic motive characterized by the need to influence your environment. Although power is relevant to job crafting in its entirety, in this study, we link it to increasing challenging job demands due to its relevance to job control, which falls under the umbrella of power. Using a cross-sectional design, we collected survey data from a sample of Lebanese nurses (N = 360) working in 18 different hospitals across the country. In both implicit and explicit power motive measures, we focused on integrative power that enable people to stay calm and integrate opposition. The results showed that explicit power predicted job crafting (H1) and that implicit power amplified this effect (H2). Furthermore, job crafting mediated the relationship between congruently high power motives and positive work-related outcomes (H3) that were interrelated (H4). Our findings unravel the driving forces behind one of the most important dimensions of job crafting and extend the benefits of motive congruence to work-related outcomes.

Justice sensitivity among nurses and physiotherapists in a Croatian rehabilitation hospital.

The aim of this study was to investigate and compare justice sensitivity between self-perceived beneficiaries, victims, and observers in a sample of 90 healthcare workers (nurses and physiotherapists) at the Varazdinske Toplice Special Medical Rehabilitation Hospital, Croatia. For this purpose we used a questionnaire consisting of demographic data and the Croatian version of the justice sensitivity inventory developed by Schmitt. Regardless of its limitations, our study clearly shows that healthcare professionals at Varazdinske Toplice are most sensitive to injustice from the beneficiary's perspective, that is, as persons who personally benefitted from injustice, although they may not have been instrumental to this effect. They are less sensitive to injustice perceived on the outside (observer's perspective) or to injustice suffered by themselves (victim's perspective). Another important finding is that participants of female gender, rural residence, and nurses (who are all women) are significantly more sensitive to injustice, whereas age and marital status do not seem to contribute to justice sensitivity. Future research should investigate the perception of injustice over a longer timeframe and involve all healthcare workers. It could also address different approaches to management, especially in terms of worker rewards and career advancement. Qualitative research among healthcare workers could provide a broader and clearer idea of social injustice at their workplace.

Factors predicting the level of vaccine protection against hepatitis B virus infection among physicians and nurses in Sabac, Serbia.

As healthcare workers run a high and constant occupational risk of hepatitis B virus (HBV) infection through exposure to biological material, vaccination is mandatory as well as the monitoring of antibody levels one to two months after complete immunisation. The aim of this descriptive cross-sectional study was to determine HBV vaccine coverage of 200 primary and secondary healthcare workers (100 each) from Sabac, Serbia and their blood anti-HBs titre. We also wanted to identify factors that could predict the titre. Anti-HBV vaccination covered all participants, of whom 89.5 % were fully vaccinated, and 85 % had a protective antibody titre. We found a statistically significant association between antibody titre and the number of received vaccine doses, chronic jaundice, autoimmune disease, and cancer in our participants. The fact that 15 % did not achieve the protective antibody titre confirms the necessity of its control after immunisation, which is not routinely carried out in most countries, Serbia included. It is, therefore, necessary to develop a detailed strategy for monitoring vaccination and serological status of healthcare workers in order to improve their safety at work. An important role should also be given to continuous education of healthcare workers from the beginning of schooling to the end of their professional career.

Work Perceptions by Italian Nurses: Implications for Managers at the Point of Care.

The aim of this article is to report on Italian nurses' perceptions of their performance and work-related behaviors. The data for the study were derived from a questionnaire that included the items from the Individual Workplace Performance Scale, which was distributed via the internet during March 2021. The analysis of the responses found that women complained more about their work than men. Older nurses reported concerns about keeping up-to-date; they also thought that they carried out their work more efficiently than younger nurses and that they were better able to come up with creative solutions for new problems. The nurses who had been working for 6 to 10 years reported feeling more vulnerable in their positions. Further research is needed to help nurse managers manage their staff and reach their organizational goals.

Attitudes of nurses and physicians working in hard-to-heal wound management towards person-centred care.

OBJECTIVE: Person-centred care (PCC) is an important approach as it positively affects disease management. Guiding studies are needed on the use and development of PCC in hard-to-heal (chronic) wound management. This study aimed to determine attitudes and approaches of nurses and physicians working in hard-to-heal wound management towards PCC, and obtain their views and suggestions for its scope and improvement. METHOD: Participants of this descriptive survey study consisted of nurses and physicians responsible for hard-to-heal wound care and treatment in healthcare institutions at all levels in Turkey. Data were collected through a structured online survey shared with members of professional associations via social media platforms between March-November 2020. Descriptive statistics and qualitative inductive content analysis were used to analyse data. RESULTS: Participants (n=418) included physicians (84.2%) and nurses (15.8%). Mean participant-graded their person-centred behaviour level was 8.18±1.80 (out of 10 points). The majority of participants reported that they informed patients about care, treatment processes and options (87.3%) as well as including them in the decision-making process (74.6%). Responses of the participants regarding the scope of PCC were classified into five main categories, the most prominent being: 'individual', 'care', 'professional development' and healthcare system'. Suggestions for the improvement of PCC were classified into seven main categories, with 'personalised care', 'disease-specific care', 'continued training of healthcare professionals should be ensured' and 'home care system should be developed for the continuity of care' among the prominent subcategories. CONCLUSION: The findings of this study suggests that education on PCC is an important approach. Institutional protocols and guidelines can support person-centred hard-to-heal wound management. In this study, the level of person-centred behaviour of the participants was determined to be good. Although the results of the study cannot be generalised to all health professionals-the majority of the participants were physicians-it is recommended to develop and disseminate the PCC model in hard-to-heal wound management using the findings.

The Mediation Roles of Coping Modalities on the Relationship Between Stress and Quality of Life Among Jordanian Nurses.

Nurses are at the frontline, dealing with people's most immense healthcare needs in stressful and demanding work environments. Consequently, it is essential to thoroughly examine how various coping mechanisms might affect the relationship between stress and quality of life (QOL). This study aimed to examine the mediation effect of both problem-focused coping (PFC) and emotion-focused coping (EFC) mechanisms on mitigating the effect of stress on the QOL among Jordanian nurses. A multisite cross-sectional descriptive correlational design was used in this study. An online survey was completed by 203 nurses using a convenience sampling technique between October 2023 and January 2024. The study included nurses working in different Jordanian healthcare sectors including governmental, private, and university-affiliated hospitals. Several measures were used to collect data, including questionnaires on sociodemographics, QOL, coping, and stress. Two models were hypothesized for this study. The two models were analyzed using Andrew Hayes Process Macro Model 4 for testing the mediation effects. Additionally, descriptive and correlational analyses were run prior to the main analysis. The results showed that coping significantly mediated the relationship between stress and QOL with variations between PFC and EFC. In conclusion, psychological distress symptoms were common among Jordanian nurses; psychological distress, coping, and QOL are correlating variables. Nurses' stress levels and coping modalities can predict QOL with a superior effect of PFC compared with EFC. Strategies should be put in place to improve effective coping to improve nurses' QOL. The results of this study have important implications for nursing education, practice, future research, and policy.

Self-compassion and work engagement among Chinese nurses: exploring mediating effects of depression, anxiety, and stress.

Objective: Work engagement significantly influences both the quality of nursing care and nurses' job performance. In this study, we aimed to explore the mediating effects of negative emotions on the relationship between self-compassion and work engagement among Chinese nurses. Method: A cross-sectional study was performed on nurses in a tertiary A hospital located in Henan province from September, 2023 to December, 2023. Custom-designed digital surveys were disseminated to gather pertinent data. Structural Equation Modelling (SEM) were utilised to analyse the data and determine relationships among self-compassion, negative emotions and work engagement. Results: A total of 1,201 nurses were included. According to the statistical model, self-compassion (ß = 0.116, CI: -0.036 to -0.008, p < 0.001) and negative emotions (ß = -0.372, CI: -0.053 to -0.033, p < 0.001) were correlated with work engagement. Furthermore, our analysis revealed that negative emotions partially mediated the relationship between self-compassion and work engagement (ß = 0.174, CI: -0.066 to -0.020, p < 0.01). Conclusion: These findings indicate that incorporating self-compassion and negative emotion regulation in interventions targeting work engagement may enhance the overall level of work engagement among nurses, thereby improving job satisfaction and the quality of patient care.

Nurses's Attitudes in Preventing Suicide: a Survey.

INTRODUCTION: Nowadays, suicide represents a serious public health problem worldwide. Nurses can play a critical role in suicide prevention. Knowing risk factors and recognizing warning signs for suicide should be part of the professional background of any nurse training programs. METHODS: Our study presents the preliminary descriptive findings from an online survey in nursing staff operating in various areas (medical, surgical, critical and emergency) in the Apulia region. The survey aimed to assess the current knowledge, attitudes, behaviors and training needs of nurses regarding suicide prevention. We administered a questionnaire created with Google forms to a sample of subjects obtained through sampling a reasoned choice. RESULTS AND CONCLUSIONS: Our study highlighted the lack of perceived competence toward the suicidal patient and the need to implement specific training programs for nurses on the management of patients at risk of suicide. An adequate level of knowledge and competence regarding suicide prevention among healthcare professionals could significantly contribute to improving the quality of care provided to patients at risk for suicide, reducing the risk of suicidal events and improving the overall quality of the care pathway.

An exploration of teacher and school-based nurse perceptions of current HPV education offered to students 15-16 years old in post-primary schools in Northern Ireland, UK.

INTRODUCTION: Human papillomavirus virus (HPV) is highest among young adults 15-24 years old. High-risk strains are responsible for the development of cancers including cervical, vaginal, vulvar, anal, oropharyngeal and penile. Despite HPV school-based vaccination programmes in the UK, HPV vaccination uptake rates continue to fluctuate due to misinformation and vaccine hesitancy post COVID-19. The aim of this study is to explore perceptions of post-primary school teachers and nurses regarding the current HPV education provision and the need to provide HPV education to students 15-17 years old when they are most likely to be becoming sexually active. METHODS: A qualitative study was conducted using online semi-structured interviews between February-August 2022 with post-primary teachers and nurses in Northern Ireland, UK. Stratified random sampling was used to contact schools to recruit participants. Recruitment continued until data saturation was reached. Braun & Clarke's six-phase framework for reflexive thematic analysis was used to analyse the data. RESULTS: Twelve teachers and six nurses participated in the study. Four themes arose based on the analysis including 1) the importance of HPV education 2) self-consent to the HPV vaccine 3) design of the HPV education and 4) delivery of the HPV education. Identified barriers to implementation of HPV education included lack of parental education, religion and the conservative culture of Northern Ireland. DISCUSSION: Participants perceived HPV education to be poor or non-existent in their schools but placed high importance on this education. They indicated that a non-judgemental health professional would be the ideal person to deliver interactive HPV education as part of a mandated spiral curriculum. CONCLUSION: HPV education at 15-17 years old provides students with an opportunity to learn about their HPV risk, their HPV vaccination status and an opportunity to self-consent to the HPV vaccine. The Education Authority and Department of Health should support health professionals to deliver consistent robust HPV health information to students of this age.

Investigating nurses' self-efficacy in pressure injury management within surgical services.

BACKGROUND: New research is crucial in addressing the role of nurses in preventing pressure injuries (PIs) and remedying deficiencies in their self-efficacy in this area. PURPOSE: The aim of this study was to examine the self-efficacy perceptions of nurses in managing PIs within surgical services. METHODS: The study involved 186 nurses from surgical services. Data were collected using a self-efficacy scale and a personal information form designed to assess nurses' PI management skills. Analysis involved descriptive (number, percentile) and inferential statistics (ANOVA, t- s) in SPSS-24. RESULTS: Surgical nurses reported their self-efficacy in managing PIs with a mean score of 47.38 ± 21.87 on a self-efficacy scale, indicating a broad range of perceptions. Average scores were 43.55 ± 23.47 for evaluation, 48.39 ± 25.65 for planning, 43.68 ± 25.34 for surveillance, and 50.64 ± 22.23 for decision-making. Of note, nurses reported the lowest self-efficacy scores for evaluation. No significant differences were found based on employment duration, gender, or education. Significant differences were observed based on age, service level, and post-graduate education (P < .05). CONCLUSION: This study highlights the need for enhanced nurse self-efficacy in PI management in surgical services, emphasizing the role of education programs focused on evaluation skills.

Knowledge and Performance on Intravenous Medication Administration to Patients: A Cross-Sectional Observational Study Among Nurses of Nepal.

AIM: To evaluate knowledge and performance levels regarding intravenous (IV) medication administration to patients among nurses working in paediatric centers of Nepal. DESIGN: A cross-sectional descriptive observational study. METHODS: Enumerative sampling method was used for participant selection from the four hospitals having paediatric units. Data were collected using knowledge survey and observational checklist on four phases of IV medication administration. RESULTS: Of 115 nurses, 14 (12.2%) had adequate knowledge about IV medication administration whereas none had good level and only 20 nurses (17.4%) had fair level of performance. There was a weak negative correlation between knowledge and practice scores. Nurses working 8-h shifts had better performance than those working 6-h shifts; however, the recommended nurse-patient ratio was not maintained in 80% of observed shifts. The findings highlight the importance of upgrading nurses' knowledge and professional competencies on medication administration to improve the quality of patient care.

[Research on the effect of training program based on service-oriented leadership theory on nurses' job burnout].

Objective: To explore the effect of training program based on service-oriented leadership theory on alleviating the degree of job burnout of clinical nurses, and provide reference for improving the situation of job burnout of nurses. Methods: From January to December 2023, 10 head nurses of a Grade A general hospital were selected by random number table method for training, and 5 nurses were selected from the department of each head nurse by random number table method, a total of 50 nurses were selected as research objects. Through the training program based on the service-oriented leadership theory, the selected head nurses were trained on the service-oriented leadership theory, job burnout and burnout mitigation methods and passed the examination. The training period was 2 months. The general data of 50 nurses were collected, and the job burnout of nurses was investigated by using the Maslach Burnout Inventory before and 6 months after the training of head nurses, and the changes of scores of each dimension were compared by paired t-test. Results: The nurses were (30.4±5.5) years old and their working life was (8.1±6.1) years. The total detection rate of job burnout before training was 100% (50/50), the detection rate of moderate to severe emotional exhaustion was 60% (30/50), and the detection rate after training was 36% (18/50). The detection rate of moderate to severe depersonalization was 72% (36/50) and 40% (20/50) after training. The detection rate of moderate to severe lack of job accomplishment was 86% (43/50) and 54% (27/50) after training. After 6 months of head nurses training, the scores of emotional exhaustion and depersonalization of nurses were significantly lower than those before training, while the scores of personal achievement were significantly higher than those before training, with statistical significances (P<0.05) . Conclusion: The training program based on service-oriented leadership theory can scientifically prevent and alleviate nurses' job burnout after receiving training of administrators, which is helpful to improve the current situation of nurses' job burnout and reduce the degree of nurses' job burnout, and can play a positive role in promoting nurses' physical and mental health.

Nurses' experience of nasogastric tube feeding under restraint for Anorexia Nervosa in a psychiatric hospital.

BACKGROUND: Anorexia nervosa is a complex mental disorder that has severe physical and psychological consequences, often requiring hospitalisation, and in the most severe cases, patients receive coercive treatment. Among the various nursing tasks associated with encountering these patients, the administration of nasogastric tube feeding under restraint stands out. It is crucial to recognise and address the unique practical and ethical challenges nurses face when caring for adults struggling with severe anorexia nervosa. The aim of the study was to gain a deeper understanding of registered nurses' experience of nasogastric tube feeding under restraint in hospitalised patients with severe anorexia nervosa. METHODS: A naturalistic design guided this study. Narrative interview data were analysed using reflexive thematic analysis. The participants were twelve registered nurses recruited from an inpatient ward for adult patients with an eating disorder in a Norwegian psychiatric hospital. RESULTS: Three main themes were developed: providing good nursing care during coercive treatment; having ethical concerns about nasogastric tube feeding under restraint when the patient reaches a body mass index that is not immediately life-threatening; and having concerns about involving personnel from another ward in the nasogastric tube feeding under restraint procedure. CONCLUSIONS: Nurses find nasogastric tube feeding under restraint to be part of life-saving nursing for patients with severe anorexia nervosa. It raises ethical concerns, especially with patients with a body mass index that is no longer life-threatening. Our results demonstrate the vulnerability of nurses as well as the difficulties and ethical dilemmas of nursing during nasogastric tube feeding under restraint.

Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences.

BACKGROUND: The development of controlled donation after circulatory death (cDCD) is both important and challenging. The tension between end-of-life care and organ donation raises significant ethical issues for healthcare professionals in the intensive care unit (ICU). The aim of this prospective, multicenter, observational study is to better understand ICU physicians' and nurses' experiences with cDCD. METHODS: In 32 ICUs in France, ICU physicians and nurses were invited to complete a questionnaire after the death of end-of-life ICU patients identified as potential cDCD donors who had either experienced the withdrawal of life-sustaining therapies alone or with planned organ donation (OD(-) and OD( +) groups). The primary objective was to assess their anxiety (State Anxiety Inventory STAI Y-A) following the death of a potential cDCD donor. Secondary objectives were to explore potential tensions experienced between end-of-life care and organ donation. RESULTS: Two hundred six ICU healthcare professionals (79 physicians and 127 nurses) were included in the course of 79 potential cDCD donor situations. STAI Y-A did not differ between the OD(-) and OD( +) groups for either physicians or nurses (STAI Y-A were 34 (27-38) in OD(-) vs. 32 (27-40) in OD( +), p = 0.911, for physicians and 32 (25-37) in OD(-) vs. 39 (26-37) in OD( +), p = 0.875, for nurses). The possibility of organ donation was a factor influencing the WLST decision for nurses only, and a factor influencing the WLST implementation for both nurses and physicians. cDCD experience is perceived positively by ICU healthcare professionals overall. CONCLUSIONS: cDCD does not increase anxiety in ICU healthcare professionals compared to other situations of WLST. WLST and cDCD procedures could further be improved by supporting professionals in making their intentions clear between end-of-life support and the success of organ donation, and when needed, by enhancing communication between ICU physician and nurses. TRIAL REGISTRATION: This research was registered in ClinicalTrials.gov (Identifier: NCT05041023, September 10, 2021).