Hardiness as a Resilience Factor for Adaptation in Families of Children With 22q11.2 Deletion Syndrome: A Mixed Methods Study of Parents' Perspectives.

22q11.2 deletion syndrome is a rare multisystem genetic disorder with over 200 associated characteristics, occurring in various combinations and severity. Extensive biomedical research has been undertaken on 22q11.2 deletion syndrome, however, there is a dearth of research on families' experiences of managing a family member with this condition. The complex and at times serious phenotypical presentation of the syndrome can make the management of the condition difficult for families. The aim of this mixed method explanatory sequential study was to investigate family hardiness as a resilience factor for adaptation in families of children with 22q11.2 deletion syndrome from parents' perspectives. We found that adaptation scores increased by 0.57 points (95% CI: 0.19-0.94) for every one-point increase in family hardiness score. Qualitative results indicated that acceptance of the child's diagnosis and support positively influenced hardiness whereas fears about the future and their experiences of loss negatively influenced hardiness.

Family members' perspectives of hope when supporting a relative experiencing mental health problems.

Current research views hope as a process that plays a positive role in the recovery of individuals with mental health problems. However, little attention has been given to the role of hope in the lives of their families. We aimed to address that gap. We deployed a qualitative descriptive design and carried out individual interviews with nine family members who supported a relative with mental health problems. A cross-comparison of the data generated three major themes: understandings of hope; factors that diminish hope and factors that nurture hope. The participants viewed hope as a positive and productive feeling or attitude that was life-affirming, and empowering. They also associated it with behaviours and dispositions such as attentiveness and empathy and the possibility of a return to a more stable and 'normal' life. The participants experienced hope as initially eroded when their relative was first diagnosed and institutionalized. Hope was further diminished due to the poor communication practices of some mental health professionals and the stress of the caring role itself. On the other hand, hope was nurtured through the support of other family members, friends, neighbours and peers. Acquiring knowledge and understanding about the relative's state of mental health nurtured hope and enabled the participants to have a more meaningful role in their recovery process. Practices of self-care such as independent activities and counselling also strengthened hope and some mental health professionals played a positive role in supporting these. Most striking about the reports of many of the participants was their assertion of their abiding love for their relative. Their account of their ability to see beyond the illness of their relative was an insight that we did not find in other accounts of the experiences of family members. We highlight the need for family members to have timely access to relevant information about their relatives' illness. We conclude that hope is relational at its core because of the interplay of intrapersonal, interpersonal and social factors that diminish or nurture it over time. Specifically, we propose that friends, neighbours and peer support groups as key actors in nurturing the hope of both family members and their relatives.

"Nursing and speech and language students' perspectives of reflection as a clinical learning strategy in undergraduate healthcare education: A qualitative study".

AIM: The aim of this study was to explore nursing and speech and language students' perspectives of reflection as a clinical learning strategy during years three and four of their undergraduate education programmes. BACKGROUND: Reflection is recognised as a core student learning activity which is widely used in undergraduate healthcare education for clinical practice. Studies indicate that structured models and frameworks do help novice students to develop the process of reflection-on-practice particularly in years one and two. However, there is limited research on healthcare students' perspectives of reflection as a clinical learning strategy in the latter years of their undergraduate healthcare education (years 3 and 4). DESIGN: A qualitative descriptive design was used. METHODS: Using a self-reporting method whereby students respond to a series of questions posed by the researchers, data were collected from nursing (n = 20) and speech and language students (n = 26) in one university in Ireland and analysed using thematic analysis. RESULTS: The findings from both nursing and speech and language students were similar. Three themes identified included: description of reflection, undertaking reflection and contribution to clinical learning. Most students expressed beneficial effects of reflection for personal and professional clinical learning. Some students reported negativities to the written reflections, expressing a preference for more diverse and less structured strategies and more face-to-face reflective discussions with clinical educators. CONCLUSIONS: Whilst the benefits of reflection for clinical practice are well versed in this study, the authors suggest that academic and clinical educators employ more diverse and innovative reflective tools for healthcare students who are at a more competent level of their undergraduate education programme. Further interprofessional research in relation to different clinical reflective strategies for healthcare students in years three and four of their undergraduate education programmes is warranted.

A new therapeutic communication model "TAGEET" to help nurses engage therapeutically with patients suspected of or confirmed with COVID-19.

AIM: To design and present a new communication model "TAGEET" to help nurses engage therapeutically with patients suspected of or confirmed with COVID-19. BACKGROUND: COVID-19 is a highly contagious disease that brings with it fear and anxiety for all involved inclusive of nurses and patients. New guidelines for nurses to follow such as attention to physical distance coupled with the wearing of defined personal protective equipment, gloves, long-sleeved disposable gown, FFP2 face mask and eye protection place additional strain on nurses to engage therapeutically with patients. Evidence suggests that the wearing of face masks and personal protective equipment acts as barriers to effective therapeutic engagement with patients. We found an absence of communication models to help nurses engage therapeutically with patients. DESIGN: This is a position paper that draws on previous research to inform the design of a new model for nurses to engage therapeutically with patients suspected of or confirmed with COVID-19. METHOD: We reviewed the literature on caring for patients in isolation, the barriers to therapeutic communication and the psychological impact of infectious diseases on nurses and patients. CONCLUSION: Remaining emotionally present to self, whilst being present to others can be challenging for nurses in a pandemic environment. We believe that the "TAGEET" model (T-Tune-in, A-Approach and introduce, G-Ground self, E-Engage and respond, E-End encounter, T-Tune-out), although devised for nurses to engage therapeutically with patients suspected of or confirmed with COVID-19 could be used by all healthcare professionals in any challenging clinical environment. RELEVANCE TO CLINICAL PRACTICE: This new therapeutic communication model will provide support for nurses with how to manage self in the context of caring for others in a COVID-19 environment.

A Theoretical Framework to Underpin Clinical Learning for Undergraduate Nursing Students.

The aim of this is paper is to propose Benner's "Novice to Expert" Framework to underpin learning for students as they progress through the clinical components of an undergraduate nursing educational program. Steinaker and Bell's "Experiential Taxonomy" is presented as a practical medium for itemizing the nursing activities novices are exposed to at the initiation of clinical experience and to the clinical competencies expected of nurses on completion of their educational program. The authors also propose a range of theories of learning applicable to the clinical education of undergraduate nursing students, which can be maximized to enhance clinical learning.

Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review.

AIM: To review the evidence on the effects/impact of electronic nursing documentation interventions on promoting or improving quality care and/or patient safety in acute hospital settings. BACKGROUND: Electronic documentation has been recommended to improve quality care and patient safety. With the gradual move from paper-based to electronic nursing documentation internationally, there is a need to identify interventions that can effectively improve quality care and patient safety. EVALUATION: We conducted a systematic review on the effectiveness of electronic nursing documentation interventions on promoting or improving quality care and/or patient safety in acute hospital settings. KEY ISSUES: Six articles reporting on six individual studies met all eligibility criteria. They were uncontrolled pre/post intervention studies reporting positive impacts on at least one or more outcomes. Most outcomes related to documentation practice and documentation of content. CONCLUSION: Some evidence from our review indicates that implementing electronic nursing documentation in acute hospital settings is time saving, reduces rates of documentation errors, falls and infections. IMPLICATIONS FOR NURSING MANAGEMENT: A planned approach from management over time to allow nurses adapt to new electronic systems of documentation would seem a good investment in terms of efficiency of work time, possibly resulting in more time for clinical care.

Addressing ethical concerns arising in nursing and midwifery students' reflective assignments.

BACKGROUND: Written reflections on practice are frequently requirements of nursing curricula. They are widely accepted as necessary for improving critical thinking and problem-solving skills. Faculty, are expected to review reflections and provide feedback that helps professional development and facilitates good practice. It is less clear what the actions of nurse educators should be when ethical infractions are revealed in the narratives. OBJECTIVES: We had two aims: 1) To combine insights from a literature review of empirical and theoretical research related to responding to ethical issues revealed in student reflections with our experiences reviewing the reflections of undergraduate nursing and midwifery students, and 2) to construct and analyze a hybrid case from these insights in order to develop guidelines for nurse educators. RESEARCH DESIGN: A literature review was conducted using CINAHL, MEDLINE, PsycINFO, SocINDEX and ERIC databases and pertinent key words. A hybrid case was constructed of commonly encountered ethical issues using insights from the literature review and the authors' experiences. The case was analyzed by combining Beauchamp and Childress' principlist approach with Campbell and McCarthy's ethical decision-making tool (Table 1). Participants and Research Context: No human participants Findings: A gap in the literature exists related to addressing ethical issues revealed in student practice reflections. However, a combination of insights from the literature and the authors' experiences facilitated the development of a hybrid case. Subsequent case analysis facilitated the development of a series of guidelines that can be utilized to address a range of issues commonly emerging in the reflections of nursing students during practice experiences. DISCUSSION: A number of recommendations and guidelines are provided to enable the safeguarding of students and staff and support them in practicing ethically. CONCLUSION: Structured ethical analysis of a constructed hybrid reflection of commonly revealed ethical issues was useful in developing guidelines for educators.

Nursing and midwifery students' stress and coping during their undergraduate education programmes: An integrative review.

OBJECTIVES: The aim of this review is to examine the literature related to the sources of stress, coping mechanisms and interventions to support undergraduate nursing and midwifery students to cope with stress during their undergraduate education. DESIGN: Integrative literature review. DATA SOURCES: The databases CINAHL, PubMed and PsycINFO were searched for articles published between 2010 and 2016. Search terms in various combinations were used for example; student nurse, student midwife, undergraduate, stress, coping and interventions. REVIEW METHODS: An integrative review based on Whittemore and Knafl's approach was used to conduct the review. RESULTS: The search generated 25 articles that met the inclusion criteria. The key sources of stress emanated from clinical, academic and financial issues but predominantly from the clinical environment. Students used a variety of coping strategies, both adaptive and maladaptive. These appear to be influenced by their past and present circumstances such as, their needs, what was at stake and their options for coping. Interventions for student nurses/midwives to cope with stress were varied and in the early stages of development. Mindfulness showed some promising positive results. Interventions focussed on the individual level excluding the wider social context or organisation level. CONCLUSIONS: Stress is pervasive in all aspects of undergraduate nursing and midwifery education. Nursing and midwifery educators need to be aware of this impact and provide appropriate support to students in both the clinical and academic environments. Further research is needed to capture the experience of stress from the students' perspective as well as the barriers and facilitators to supporting students from the preceptors'/mentors' perspectives. Finally, more intervention studies are needed to identify and compare what interventions are effective in supporting students to cope with stress during their undergraduate education.

Coping with stressful events: A pre-post-test of a psycho-educational intervention for undergraduate nursing and midwifery students.

BACKGROUND: Knowledge of coping mechanisms is important for nursing and midwifery students to cope with stressful events during undergraduate education. OBJECTIVES: To evaluate the impact of a psycho-educational intervention "Coping with Stressful Events" with first year undergraduate nursing and midwifery students. DESIGN: A quasi-experimental, one-group pre-post-test. SETTINGS: One school of nursing/midwifery in one university in Ireland. PARTICIPANTS: A convenience sample of all first year undergraduate nursing and midwifery students (n=197). Of these 166 completed the pretest and 138 students completed the post test. METHODS: Using the COPE Inventory questionnaire (Carver et al., 1989) data was collected pre and post-delivery of the psycho-educational intervention "Coping with Stressful Events" by two research assistants. Data were analysed using the IBM SPSS Statistics version 22 (NY, USA). RESULTS: Results demonstrated improved coping skills by students. There were statistically significant differences between pre and post intervention for some coping subscales. For example, the mean subscale scores were lower post-intervention for restraint and mental disengagement, and higher for use of emotional and instrumental social support indicating improved coping strategies. CONCLUSIONS: This intervention has the potential to influence undergraduate nursing and midwifery students coping skills during their first year of an undergraduate programme.

The effect of adult Early Warning Systems education on nurses' knowledge, confidence and clinical performance: A systematic review.

AIMS: This review aims to determine the effect of adult Early Warning Systems education on nurses' knowledge, confidence and clinical performance. BACKGROUND: Early Warning Systems support timely identification of clinical deterioration and prevention of avoidable deaths. Several educational programmes have been designed to help nurses recognize and manage deteriorating patients. Little is known as to the effectiveness of these programmes. DESIGN: Systematic review. DATA SOURCES: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Psychology and Behavioral Science Collection, SocINDEX and the UK & Ireland Reference Centre, EMBASE, the Turning Research Into Practice database, the Cochrane Central Register of Controlled Trials (CENTRAL) and Grey Literature sources were searched between October and November 2015. REVIEW METHODS: This is a quantitative systematic review using Cochrane methods. Studies published between January 2011 - November 2015 in English were sought. The risk of bias, level of evidence and the quality of evidence per outcome were assessed. RESULTS: Eleven articles with 10 studies were included. Nine studies addressed clinical performance, four addressed knowledge and two addressed confidence. Knowledge, vital signs recording and Early Warning Score calculation were improved in the short term. Two interventions had no effect on nurses' response to clinical deterioration and use of communication tools. CONCLUSION: This review highlights the importance of measuring outcomes using standardized tools and valid and reliable instruments. Using longitudinal designs, researchers are encouraged to investigate the effect of Early Warning Systems educational programmes. These can include interactive e-learning, on-site interdisciplinary Early Warning Scoring systems training sessions and simulated scenarios.

Emotional resistance building: how family members of loved ones undergoing chemotherapy treatment process their fear of emotional collapse.

AIMS: To explore family members' experiences when their loved one is undergoing chemotherapy treatment as an outpatient for newly diagnosed colorectal cancer and to develop an explanatory theory of how they process their main concern. BACKGROUND: Most individuals with cancer are now treated as outpatients and cared for by family members. International research highlights the many side effects of chemotherapy, which in the absence of specific information and/or experience can be difficult for family members to deal with. Unmet needs can have an impact on the health of both patients and family members. DESIGN: Classic grounded theory methodology was used for this study. METHOD: Using classic grounded theory methodology, family members (n = 35) of patients undergoing chemotherapy treatment for cancer were interviewed (June 2010-July 2011). Data were analysed using the concurrent processes of constant comparative analysis, data collection, theoretical sampling and memo writing. FINDINGS: The main concern that emerged for participants was fear of emotional collapse. This fear was dealt with through a process conceptualized as 'Emotional Resistance Building'. This is a basic social process with three phases: 'Figuring out', 'Getting on with it' and 'Uncertainty adjustment'. The phases are not linear, but interrelated as participants can be in any one or more of the phases at any one time. CONCLUSION: This theory has the potential to be used by healthcare professionals working in oncology to support family members of patients undergoing chemotherapy. New ways of supporting family members through this most difficult and challenging period are articulated within this theory.

Patients' perceptions of how healthcare providers communicate with them and their families following a diagnosis of colorectal cancer and undergoing chemotherapy treatment.

PURPOSE: Chemotherapy can result in many unpredictable and often debilitating side-effects hence patients undergoing chemotherapy treatment may have to rely on their loved ones to support them through this most challenging period. In view of this possibility then good communication skills between patients, healthcare providers and family members is of paramount importance for effective patient outcomes. The aim of this study therefore, was to explore patients' perceptions of how healthcare providers communicate with them and their family members whilst undergoing chemotherapy treatment for cancer. METHODS: Using a qualitative methodology and a descriptive design, data were collected using unstructured interviews with patients undergoing chemotherapy (n = 14) and analysed by content analysis. RESULTS: Participants expressed that both they and their family members were treated with compassion, kindness, empathy and understanding. They appreciated the time given to them and their family members to listen and answer their questions before, during and/or after treatment. In addition they commented positively on the warm and cheerful environment and the selective use of appropriate humour by oncology healthcare providers in the chemotherapy units. CONCLUSION: The data highlights in particular the positive communication encounters between patients with cancer and their healthcare providers and family members. Oncology nurses were identified as being particularly supportive to both patients and their family members. Despite chemotherapy units being a difficult place to be a part of, this study highlights that healthcare providers can help make this a less daunting place for patients and their family members through their appropriate use of professional communication.

Integrating psychology with interpersonal communication skills in undergraduate nursing education: addressing the challenges.

The inclusion of the social, behavioural and bio-sciences is acknowledged as essential to the development of the art and science of nursing. Nonetheless, the literature highlights on-going debate about the content and delivery of these subject areas in undergraduate nursing education. The bio-sciences and social sciences in particular have received much attention but more recently the inclusion of psychology in nursing curricula is gaining momentum. Studies conducted on nursing students' views of these supporting sciences have also highlighted problems with their understanding, relevance and application to nursing practice. Although broad guidelines are given as to what should be included, no detail is given as to how much detail or at what level these subjects should be taught. Subsequently, approved institutions are responsible for their own course content. This has resulted in inconsistent and varied approaches to integrating the sciences in undergraduate nursing curricula. Following a recent review of the undergraduate nursing curriculum in one university in the Republic of Ireland a decision was made to combine the teaching, learning and assessment of Applied Psychology with Interpersonal Communication skills. This paper will describe the developmental process and evaluation of the integrated module.

Family members of patients with cancer: what they know, how they know and what they want to know.

BACKGROUND: Recent changes in healthcare management generally and in cancer care in particular, indicate a major shift in the clinical management of cancer from hospitals and healthcare professionals (HCPs) to patients and families. In light of these changes national and international policies and reports by the Department of Health and Children (2001, 2006) and the World Health Organisation (2004) have recommended that HCPs support family members (FMs) to care for loved ones. The purpose of this review therefore was to explore the extent to which FMs' needs are realised by HCPs in practice. OBJECTIVES: To examine recent research (2000-2010) in relation to; the type of information that FMs of patients with cancer generally seek, how they seek this information from HCPs, and, FMs' experiences of communicating with HCPs in this context. METHODS: A review of the literature was conducted using key databases Medline, Pub med, Psych-Info and CINAHL. RESULTS: Thirty four papers were included in the review. Overall the studies demonstrated that FMs of patients with cancer have similar information needs and demonstrate similar strategies for seeking information. While many FMs report positive communication experiences with HCPs and have information needs met, the majority of FMs report negative communication encounters with HCPs. CONCLUSION: HCPs are highly significant in the lives of FMs of patients with cancer. The review concludes with identifying; FMs most wanted information needs, their struggles with accessing HCPs and the type of communication encounters FMs most desire to have with HCPs. Recommendations for education, practice and research are addressed.

Preceptors' experiences of clinically educating and assessing undergraduate nursing students: an Irish context.

AIM: To explore preceptors' views and experiences of preceptoring undergraduate nursing students. BACKGROUND: Undertaking a preceptoring role is acknowledged internationally as complex and challenging. With the introduction of the undergraduate degree programme in Ireland (2002), preceptors were assigned a more formal role in the teaching and assessing of students. As this was a new programme for students and an additional responsibility for preceptors, it was important to investigate how preceptors found this new experience. METHODS: Data were collected using a mixed methods descriptive approach. RESULTS: Many preceptors wanted to become a preceptor and enjoyed the role. The majority of preceptors found the role stressful and burdensome and did not feel adequately supported by their clinical managers. Preceptors expressed the need for protected time, support, feedback and recognition from management for undertaking this role. CONCLUSION: Findings validate problems experienced with preceptoring in other English-speaking countries and contribute further to building a case for vital change in this component of nursing education and nursing practice. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should focus on the challenges expressed by preceptors in this study and identify appropriate strategies to carefully select, monitor and support preceptors in this complex role.

Person-centred communication: design, implementation and evaluation of a communication skills module or undergraduate nursing students - an Irish context.

Despite wide agreement about the importance of effective communication in nursing there is continuing evidence of the need for nurses to improve their communication skills. Consequently, there is a growing demand for more therapeutic and person-centred communication courses. Studies on communication education reveal considerable variability on the design and operationalisation of these programmes. Additionally, the literature highlights that nurse educators are continually challenged with developing and implementing these programmes. Communication skills are generally taught in years one and two of undergraduate nursing degree programmes. This is a stage when students have minimal contact with patients and clients. We suggest that a communication skills module should be included in all final years of undergraduate nursing programmes. With an array of clinical experiences to draw from, final year nursing students are better placed to apply the skills of effective communication in practice. In this paper, we present the design, implementation and evaluation of an advanced communication skills module undertaken by fourth year undergraduate nursing students completing a Bachelor of Science (BSc) degree - nursing programme at one university in the Republic of Ireland.

Assessing undergraduate nursing students in clinical practice: do preceptors use assessment strategies?

Health care organisations such as the World Health Organisation (WHO) and An Bord Altranais (ABA, The Irish Nursing Registration Board) demand higher standards of new graduate nurses than heretofore. This is in conjunction with the implementation of degree programmes for undergraduate nurse education. These organisations stipulate that graduates must be well-educated, accountable, and can demonstrate the skills of a safe, caring and competent decision-making practitioner. The Bachelor of Science (BSc) four-year degree programme for undergraduate nurse education was introduced in Ireland in 2002, and is provided in universities and colleges of higher education throughout The Republic of Ireland. During the implementation process, each university and college of higher education developed a range of assessment strategies to clinically assess students. Preceptor nurses were subsequently assigned the responsibility of clinically assessing students, a remit previously undertaken by Clinical Ward/Unit Nurse Managers. Preceptors are qualified nurses, working in clinical units who are specially prepared to support BSc students during clinical placements. The purpose of this study was to explore to what extent preceptor nurses use the devised assessment strategies to clinically assess BSc students in one university in The Republic of Ireland. Data were collected by using a questionnaire distributed to all known preceptors in General, Psychiatric and Intellectual Disability nursing, during year four of the first cycle of the BSc programme. Findings from this descriptive study revealed that many preceptors were inexperienced, did not fully comprehend the assessment process and were not applying all of the recommended assessment strategies when assessing students in clinical practice. In light of these findings suggestions are made in the context of further research, management and education.

Translating person-centred care: a case study of preceptor nurses and their teaching practices in acute care areas.

AIMS AND OBJECTIVES: The research aims to explore how preceptors interpret, operationalize, document and teach person-centred care as they guide students within an acute surgical environment. BACKGROUND: Person-centred care is a term that is widely used in the nursing literature; however, its interpretation in nursing practice remains virtually unexplored. This is of great significance to nurses in general but to Irish nurses in particular on whom this study is focused. As preceptor nurses have been identified as key people in the education of clinical students, it was considered important to explore how clinical preceptors promote person-centred care to current undergraduate nursing students. DESIGN AND METHOD: Using a case study design and a qualitative approach, six preceptors were chosen to participate in this study. Data were collected by means of participant observation, review of nursing care records and semi-structured interviews. Data were analysed in two stages. The first stage involved the identification of themes. In the second stage data were analysed using a number of propositions to examine and explain what was gleaned from the data in the context of what was originally identified in the literature. RESULTS: Findings highlighted that preceptors had a limited conception of person-centred care. Measures of care reflected the medical model of nursing. Beyond that, preceptors expressed care in terms of good manners or respectful etiquette. Preceptors also had limited appreciation of what learning entails and were sceptical about classroom theory other than what they considered essential for safe practice. CONCLUSIONS: This study highlights that preceptors need both internal and external support to implement the changes advocated by the Commission in Nursing in 1998, the Nursing Education Forum in 2000, the Department of Health and Children in 2001 and An Bord Altranais in 2003. RELEVANCE TO CLINICAL PRACTICE: Person-centred care is a relatively new concept in nursing and recommended for practice. Preceptors need facilitation with its implementation. In an effort to promote changes in the delivery of health care, it is suggested that university-based lecturers empower students to practice evidence-based nursing as students and subsequently as qualified nurses.