Factors affecting early career registered nurses' views of building good relationships with patients: A qualitative empirical research study.

AIM: To clarify the factors affecting early career registered nurses' (ECRNs') views on building good nurse-patient relationships. DESIGN: An exploratory qualitative research design was implemented using detailed individual semi-structured interviews. METHODS: Interview data were analysed using a thematic approach based on the systematic text condensation analysis proposed by Malterud. DATA SOURCES: Eleven consenting nurses working in four hospitals. RESULTS: Six characteristics were identified that influenced ECRNs' perceptions of building good nurse-patient relationships: finding clues through reflection, observing patients' reactions, clarifying their role as a nurse, doing their best for the patients, treating each patient as an irreplaceable individual and receiving support. CONCLUSIONS: We discovered that the factors affecting ECRNs' views could be divided into two categories: factors that contribute to ECRNs' views on developing positive relationships with patients, and factors that influence ECRNs' relationships with patients but do not directly lead to positive relationships. It is critical for ECRNs to reflect on their experiences of poor relationship-building and observe patients' reactions. ECRNs seldom recognize that they have developed good relationships with their patients. It is critical to consider organizational environment and support as variables in developing a nurse-patient relationship so that the responsibility does not fall solely on ECRNs. IMPLICATIONS: The results of this study provide clues to help ECRNs overcome difficulties in building relationships with patients. Furthermore, they can be used to develop educational programme for ECRNs. Future studies should use these findings to provide support to ECRNs and help them build relationships with patients.

Exploring older people's experiences of the interpersonal care relationship between nurses and patients during hospitalization in the pandemic period: A qualitative study.

AIM: This article presents the findings of a qualitative study focusing on the experiences of people aged over 70 years in the interpersonal nurse-patient care relationship in hospital settings during and after the COVID-19 pandemic. The aim was to analyse different aspects of this relationship, including nurses' behaviour and caring attitudes, the person-centred model of care, patients' involvement in their own care and communication in the hospital context. DESIGN: An exploratory qualitative study was conducted on the basis of an interpretative framework. METHODS: Six focus groups were conducted. A total of 34 participants were purposively recruited from three nursing homes in Spain, Italy and Portugal. Specific inclusion criteria were used to select participants. RESULTS: Five main categories were identified. Analysis revealed the importance of empathy and sensitivity in caring relationships, as well as the need for personalized and patient-centred care. The importance of effective communication and recognition of ageist behaviour by professionals was highlighted. In addition, independent of the pandemic, situational factors in the hospital environment were identified that influence the interpersonal care relationship. CONCLUSIONS: The study highlights the need to promote a person-centred model of care that takes into account the specific preferences and needs of older people. This is achieved by identifying elements of the interpersonal nurse-patient relationship. In addition to highlighting the disparity of opinion regarding an active or passive role in self-care and decision making, the importance of addressing ageism and improving communication is emphasized. WHAT PROBLEM DID THE STUDY ADDRESS?: The importance of the patient-nurse relationship in hospital care has been highlighted in previous studies. Critical elements of the patient care experience have been identified as empathy and effective communication. Ageism in healthcare has been recognized as a potential barrier to patient-centred care. WHAT WERE THE KEY FINDINGS?: The main findings highlight the importance of empathy and personalized care, emphasize the importance of effective communication and address ageist behaviours in the nurse-patient relationship. WHERE AND WHO WILL THE RESEARCH IMPACT?: By highlighting the need for person-centred care and improved communication strategies, particularly in the context of caring for older patients during and after the COVID-19 pandemic, this research will have an impact on healthcare professionals, policy makers and carers. REPORTING METHOD: The COREQ guideline was used. PATIENT OR PUBLIC CONTRIBUTION: This study adopted a collaborative approach to ensure that patient perspectives were integrated into the research process. We organized regular focus groups. Patients were actively involved in shaping the research questions, refining the study design and interpreting the emerging findings. Their valuable input helped us to understand the nuances of their experience and to prioritize the aspects that were critical to their well-being. In addition, their insights guided the development of practical recommendations aimed at improving the interpersonal care relationship between nurses and patients in hospital settings, ensuring that their voices were heard and reflected in the proposed interventions. This patient-centred approach fostered a sense of empowerment among the participants. It reinforced the notion that their experiences and opinions are integral to shaping healthcare practice.

Enhancing new graduate nurses and midwives person-centredness through clinical supervision during COVID-19; evaluation of a non-randomized intervention study.

AIM: The aim of the study was to evaluate a person-centred model of clinical supervision to enhance person-centredness. DESIGN: Experimental, quantitative. METHODS: One hundred and three New Graduates were supported to reflect through a person-centred lens (July-December 2020). Evaluation was undertaken at 6 months using: the Manchester Clinical Supervision Scale-26 (effectiveness of supervision) and the Person-centred Practice Inventory (measures attributes of the nurse/midwife, the care environment and person-centred processes). Due to participation difficulties, scores were calculated by attendance rates using descriptive and inferential statistics. RESULTS: Regular attendees scored higher on the supervision's effectiveness; however, this did not reach efficacy. 'Finding time' to attend contributed to low scores. Supervision scored well on its supportive function when attended. Many New Graduates perceived a decline in their care environment. Attendance aside, New Graduates averaged an increased in their person-centred attributes and processes. Greater participation was found in those who scored higher at baseline on their person-centred attributes and processes, and this higher scoring continued at 6 months than those who attended less. CONCLUSION: New Graduates who perceive themselves as person-centred and reflective at baseline are more likely to attend a person-centred clinical supervision and score higher at 6 months than those who attended less often. New Graduates found support within supervision during challenging times. IMPLICATIONS FOR PRACTICE FOR PROFESSIONAL AND/OR PATIENT CARE: For successful implementation of Person-centred Clinical Supervision, New Graduates need support to attend, as attendance supports them to begin seeing value in the process. IMPACT: This intervention kept person-centred practice at the forefront of New Graduates reflection, in a time of extreme change. The research has implications for nursing and midwifery management with the imperative to deliver person-centred care and create the person-centred cultures for staff to feel supported and empowered. REPORTING METHOD: Transparent Evaluation of Non-randomized Designs (TREND). PATIENT OF PUBLIC CONTRIBUTION: No patient or public contribution. CONTRIBUTION TO WIDER COMMUNITY: New Graduates grow their person-centredness over their transitioning year; however, this can be enhanced with regular clinical supervision underpinned by person-centred theory. Clinical supervisors can provide support to New Graduates when the environment is challenged.

Construction of nursing knowledge in commodified contexts: Views and experiences of nurses regarding primary care.

The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed-methods study was conducted that included a closed-question survey and in-depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in-depth interviews. The main findings of the survey were related to workload and limited time for nursing care. Six themes emerged from the in-depth interviews: (1) limited time for nursing, (2) feelings of burnout, (3) awareness of patient and family satisfaction, (4) organizational factors that favor nurses' needs, (5) organizational factors that hinder nurses' needs, and finally (6) public administration requirements. Participants perceive excessive workload and time constraints and feel that this affects their nursing care and their physical and mental health. However, nurses purposefully use knowledge patterns to cope with the problems associated with commodification. Nurses have multidimensional, contextualized, and integrated knowledge that allows them to optimize their care based on the needs of their patients. This research examines many challenges related to nursing practice and the nursing discipline and opens the door for further research that encompasses all areas of nursing.

Surgical wound care preferences and priorities from the perspectives of patients: a qualitative analysis.

OBJECTIVE: To explore patients' priorities and preferences for optimal care of their acute or hard-to-heal surgical wound(s). METHOD: This qualitative study involved semi-structured individual interviews with patients receiving wound care in Queensland, Australia. Convenience and snowball sampling were used to recruit patients from inpatient and outpatient settings between November 2019 and January 2020. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Emergent themes were discussed by all investigators to ensure consensus. RESULTS: A total of eight patients were interviewed, five of whom were male (average median age: 70.5 years; interquartile range (IQR): 45-80 years). Four interrelated themes emerged from the data that describe the patients' surgical wound journey: experiencing psychological and psychosocial challenges; taking back control by actively engaging in care; seeking out essential clinician attributes; and collaborating with clinicians to enable an individualised approach to their wound care. CONCLUSION: Findings from this study indicate that patients want to actively collaborate with clinicians who have caring qualities, professional skills and knowledge, and be involved in decision-making to ensure care meets their individual needs.

Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study.

AIMS AND OBJECTIVES: To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units. BACKGROUND: In mental health units, the therapeutic relationship is especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care. DESIGN: Action and observation stages of a participatory action research project. METHODS: Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used. RESULTS: The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice. CONCLUSIONS: This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse-patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice. RELEVANCE TO CLINICAL PRACTICE: These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day-to-day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.

Reflections on the implementation and evaluation of a system-wide improvement programme based on the fundamentals of care: Lessons learned.

AIM: To demonstrate how implementing a system-wide measurement and improvement programme can make the delivery of the Fundamentals of Care visible in practice. DESIGN: Discussion paper. DATA SOURCES: A retrospective evaluation of the experience of implementing a system-wide peer review programme using the Promoting Action on Research Implementation in Health Services framework. IMPLICATIONS FOR NURSING: Implementing this programme engages nursing leaders at all levels in fundamental care delivery, evaluation and improvement. It positions nursing leaders as accountable for and champions of fundamental care. CONCLUSION: The peer review programme offers a solution to the complex challenge of measuring the fundamentals of care in practice. Successful implementations of this programme at two New Zealand inpatient sites have shown positive results in improved care and patient experience. This makes it worthy of consideration for other health organizations. Nursing leadership has proven to be critical to success. The Promoting Action on Research Implementation in Health Services framework highlights the components that assist with successful implementation and assists in presenting a case for change. IMPACT: This paper addressed the problem of the lack of action and dearth of quality, integrated data, visibility of the patient experience and the contribution of nursing leadership in an inpatient setting. Findings indicate that the peer review programme is translatable, modifiable and sensitive to ethnicity and disability. Using the implementation framework to evaluate the process has provided a guide for future implementations.

The therapeutic relationship at the heart of nursing care: A participatory action research in acute mental health units.

AIMS AND OBJECTIVES: To explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse-patient therapeutic relationship. DESIGN: Participatory Action Research. METHODS: Ninety-six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used. RESULTS: The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change. CONCLUSIONS: This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar. RELEVANCE TO CLINICAL PRACTICE: The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units. NO PATIENT OR PUBLIC CONTRIBUTION: Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice.

Situaciones de violencia por parte de pacientes percibidos por personal de enfermería en un hospital público Corrientes capital 2021 / Situations of violence by patients received by nursing personnel in a public hospital Corrientes capital 2021

Describir las situaciones de violencia por parte de los pacientes percibidas por el personal de enfermería en una institución de salud pública de Corrientes capital durante 2021. Metodología: Estudio observacional, descriptivo, transversal. Muestreo de tipo consecutivo. La población personal de enfermería asistencial de un hospital. Variables: edad, género, instrucción, antigüedad laboral, área de trabajo, turno, identifcación de maltrato físico, verbal y asedio sexual, principal modo de actuar e impacto frente a situaciones de violencia. Recolección de datos mediante cuestionario Google Forms con consentimiento informado anónimo, que fue validado por prueba piloto. Análisis con Microsof Excel y Epidat 4.1. Resultados: Población estudiada 115 trabajadores de enfermería; 69,57% mujeres; rango etario 22-56 años, promedio 35,5 años. Formación: 58,26% enfermeros, 22,61% licenciados en enfermería y 19,13% auxiliares en enfermería. Turno: 37,39% mañana, 30,43% tarde, 17,39% noche y 14,78% rotativo. Área laboral: cuidados intensivos 27,83%, clínica médica 21,74%, clínica quirúrgica 15,65%, emergencias 15,65%, consultorios 10,43%, coronaria 8,70%. De los entrevistados, 89,56% había percibido algún tipo de violencia, de estos 61,17% estaba entre 22 y 38 años. La percepción de violencia mostró que 92,53% eran enfermeros, 88,46% licenciados y 81,81% auxiliares de enfermería. Los tipos de violencia identificados fueron maltrato verbal en el 86,09%, maltrato físico en el 72,17% y asedio sexual en el 24,35%. El principal género afectado por los hechos violentos fue el femenino y el turno de trabajo con mayor identificación de situaciones violentas fue el de la mañana. En cuanto a los modos de proceder para comunicar a la institución las situaciones vividas, el 66,96% lo reportaron a un superior Los hechos de violencia según área de trabajo se reportaron por 80% de los de unidad coronaria, 84,38% de unidad de cuidados intensivos, 88,89% de emergencias, 92% de clínica médica, 94,44% de clínica quirúrgica y 100% de consultorios externos. Conclusión: La violencia hacia enfermería está presente en el hospital y afecta más a las mujeres. La forma más frecuente es la verbal, seguida de la física y del asedio sexual. En general frente a las agresiones optan por no hacer nada[AU]

To describe the situations of violence by patients perceived by the nursing staff in a public health institution in Corrientes capital during 2021. Methodology: Observational, descriptive, cross-sectional study. Consecutive type sampling. Te nursing staff population of a hospital. Variables: age, gender, education, job seniority, work area, shif, identifcation of physical, verbal and sexual abuse, main mode of action and impact in situations of violence. Data collection through Google Forms questionnaire with anonymous informed consent, which was validated by pilot test. Analysis with Microsof Excel and Epidat 4.1.Results: Population studied 115 nursing workers; 69.57% women; age range 22-56 years, average 35.5 years. Training: 58.26% nurses, 22.61% nursing graduates and 19.13% nursing assistants. Shif: 37.39% morning, 30.43% afernoon, 17.39% night and 14.78% rotating. Work area: intensive care 27.83%, medical clinic 21.74%, surgical clinic 15.65%, emergencies 15.65%, doctor's ofces 10.43%, coronary 8.70%. Of those interviewed, 89.56% had perceived some type of violence, of these 61.17% were between 22 and 38 years old. Te perception of violence showed that 92.53% were nurses, 88.46% licensed and 81.81% nursing assistants. Te types of violence identifed were verbal abuse in 86.09%, physical abuse in 72.17% and sexual harassment in 24.35%. Te main gender affected by violent acts was female, and the work shif with the highest identifcation of violent situations was the morning shif. Regarding the ways of proceeding to communicate the situations experienced to the institution, 66.96% reported it to a superior Te acts of violence according to work area were reported by 80% of those in the coronary unit, 84.38% of intensive care unit, 88.89% emergencies, 92% medical clinic, 94.44% surgical clinic and 100% outpatient clinics. Conclusion: Violence towards nursing is present in the hospital and affects women more. Te most frequent form is verbal, followed by physical and sexual harassment. In general, when faced with aggression, they choose to do nothing[AU]

Descrever as situações de violência por pacientes percebidas pela equipe de enfermagem em uma instituição pública de saúde da capital Corrientes durante o ano de 2021. Metodologia: Estudo observacional, descritivo, transversal. Amostragem do tipo consecutivo. A população da equipe de enfermagem de um hospital. Variáveis: idade, sexo, escolaridade, tempo de serviço, área de atuação, turno, identifcação de abuso físico, verbal e sexual, principal forma de atuação e impacto em situações de violência. Coleta de dados por meio de questionário Google Forms com consentimento informado anônimo, que foi validado por teste piloto. Análise com Microsof Excel e Epidat 4.1. Resultados: População estudada 115 trabalhadores de enfermagem; 69,57% mulheres; faixa etária de 22 a 56 anos, média de 35,5 anos. Formação: 58,26% enfermeiros, 22,61% graduados em enfermagem e 19,13% auxiliares de enfermagem. Turno: 37,39% matutino, 30,43% tarde, 17,39% noturno e 14,78% rotativo. Área de atuação: terapia intensiva 27,83%, clínica médica 21,74%, clínica cirúrgica 15,65%, emergências 15,65%, clínicas 10,43%, coronariana 8,70%. Dos entrevistados, 89,56% já perceberam algum tipo de violência, destes 61,17% tinham entre 22 e 38 anos. A percepção da violência mostrou que 92,53% eram enfermeiros, 88,46% licenciados e 81,81% auxiliares de enfermagem. Os tipos de violência identifcados foram abuso verbal em 86,09%, abuso físico em 72,17% e assédio sexual em 24,35%. O principal gênero acometido por atos violentos foi o feminino, e o turno de trabalho com maior identifcação de situações de violência foi o turno da manhã. Em relação às formas de proceder para comunicar as situações vivenciadas à instituição, 66,96% relataram a um superior Os atos de violência por área de trabalho foram relatados por 80% daqueles na unidade coronariana, 84,38% na unidade de terapia intensiva, 88,89% emergências, 92% clínica médica, 94,44% clínica cirúrgica e 100% ambulatório. Conclusão: A violência contra a enfermagem está presente no hospital e atinge mais as mulheres. A forma mais frequente é a verbal, seguida do assédio físico e sexual. Em geral, diante da agressão, optam por não fazer nada[AU]

Reframing nurses' time to enhance interpersonal interactions in dementia care.

Spending time with a person with dementia to develop a rapport is vitally important for nurses who are attempting to deliver high-quality care. However, finding opportunities to spend meaningful time with a person with dementia can be challenging due to the nature of busy clinical environments. Further, spending time with people may be considered a non-essential use of a nurse's time by some colleagues. These factors can result in inadequate outcomes for both the person with dementia and the nurse providing the care. This article outlines a rationale for reframing the time nurses have available to spend with people with dementia. The author explains the concepts of 'ways of being' and 'mentalising' and how these can assist nurses to provide a more authentic presence during their interactions with people with dementia.

'Owning the space'-person-centred practice in a 100% single-room acute-care environment: an ethnographic study.

AIMS AND OBJECTIVES: Exploring the influence of the 100% single-room environment on staff and patient experience of person-centred practice in an acute-care setting. BACKGROUND: Current building guidance for the NHS advocates increasing the single-room inpatient environment. There is little evidence of the impact of this design in adult acute-care settings on the experience and delivery of person-centred care. DESIGN: Ethnography, underpinned by McCormack and McCance's Person-centred Practice Framework. METHODS: Data collection took place between March and June 2018. Staff and patients in a National Health Service hospital in the United Kingdom took part in observations of practice (n = 108 hours); face to face inpatient interviews (n = 9); and participatory reflective staff groups (n = 3). A reflexive journal was kept by the researcher throughout the study. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS: Themes relating to care delivery and interactions were identified. Staff and patients' views converged around visibility and isolation. Patients appreciated the privacy afforded by the single rooms, while staff experienced a psychological shift, being viewed (and viewing themselves) as 'visitors'. There was space for more sympathetic presencing, encouraging patients to speak more openly, to facilitate knowing and authentic engagement. However, time remained an issue resulting in more task-focused care. CONCLUSION: Changes to the physical environment have an impact on the delivery and experience of person-centred practice. While the facilities enhance patient experience, the interweaving of engagement, emotional support and the development of therapeutic relationships remain challenging.

Efeito da escuta terapêutica na ansiedade de pessoas no período pré-operatório imediato / Effect of therapeutic listening on people's anxiety in the immediate preoperative period / Efecto de la escucha terapéutica sobre la ansiedad de las personas en el preoperatorio inmediato

RESUMO Objetivo: avaliar o efeito da escuta terapêutica na ansiedade de pessoas no período pré-operatório imediato. Método: pesquisa quase-experimental e de intervenção realizada com 150 pessoas em um Hospital de Minas Gerais/Brasil, de julho a outubro de 2018. Foi avaliada a ansiedade pela Escala Hospitalar de Ansiedade e Depressão e as medidas fisiológicas. Realizou-se análise estatística descritiva e inferencial e testes Qui-quadrado, Spearman e Wilcoxon. Resultados: das 31 pessoas com ansiedade, 10 tiveram redução da ansiedade e das médias das medidas fisiológicas após a intervenção. Foi verificada relação significativa entre as variáveis sexo, renda familiar mensal, complicações cirúrgicas anteriores e eventos marcantes na vida com a medida de ansiedade. Foi constatada correlação positiva fraca entre ansiedade e frequência respiratória e correlação negativa fraca entre ansiedade e faixa etária. Conclusão: ao identificar pacientes com ansiedade, intervenções como a escuta terapêutica podem ser implementadas para tornar o perioperatório mais saudável.

ABSTRACT Objective: to evaluate the effect of therapeutic listening on people's anxiety in the immediate preoperative period. Method: a quasi-experimental and intervention research study carried out from July to October 2018 with 150 people in a Hospital from Minas Gerais/Brazil. Anxiety was assessed using the Hospital Anxiety and Depression Scale and the physiological measures. Descriptive and inferential statistical analysis and Chi-square, Spearman and Wilcoxon tests were performed. Results: of the 31 people with anxiety, 20 had a reduction in the anxiety levels and in the physiological measures mean values after the intervention. A significant relationship was found between the gender, monthly family income, previous surgical complications and significant life events variables and the anxiety measure. A weak positive correlation was found between anxiety and respiratory rate and a weak negative correlation between anxiety and age group. Conclusion: when identifying patients with anxiety, interventions such as therapeutic listening can be implemented to make the perioperative period healthier.

RESUMEN Objetivo: evaluar el efecto de la escucha terapéutica sobre la ansiedad de las personas en el preoperatorio inmediato. Método: investigación cuasiexperimental y de intervención realizada con 150 personas en un Hospital de Minas Gerais, Brasil, de julio a octubre de 2018. La ansiedad fue evaluada por la Escala Hospitalaria de Ansiedad y Depresión y por medidas fisiológicas. Se realizaron análisis estadísticos descriptivos e inferenciales y pruebas de Chi-cuadrado, Spearman y Wilcoxon. Resultados: de las 31 personas con ansiedad, 20 presentaron reducción de la ansiedad y de las medias de las medidas fisiológicas después de la intervención. Se verificó que había una relación significativa entre la medida de ansiedad y las variables sexo, ingreso familiar mensual, complicaciones quirúrgicas previas y acontecimientos significativos vividos. Se observó una correlación positiva débil entre la ansiedad y la frecuencia respiratoria y una correlación negativa débil entre la ansiedad y la franja etaria. Conclusión: al identificar pacientes con ansiedad, se pueden implementar intervenciones como la escucha terapéutica para que el perioperatorio sea más saludable.

NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention.

BACKGROUND: Nursing homes are likely to become increasingly important as end-of-life care facilities. Previous studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing homes in the country. METHODS: A descriptive study of a complex intervention procedure was developed. The study consisted of three phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the completion of a basic palliative care training program. In the second phase, objectives were selected using the Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility, and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through two focus group sessions involving nursing home, primary care, and palliative care professionals. RESULTS: As a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information in a clear and accessible way; to request and record advance care directives; to provide early care with respect to loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22 interventions that make up the program. CONCLUSIONS: The objectives and interventions of the NUHELP program constitute an end-of-life care program which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by modifying their clinical practice, organization, and relationship with the health system as well as serving as an example of an effective health intervention program.

The impact of a participatory intervention on the therapeutic relationship in mental health nurses: A multicentre study.

AIMS: To evaluate the effects of an intervention aimed at improving the therapeutic relationship, using the participatory-action research method, in terms of improving the quality of the nurse-patient therapeutic relationship. DESIGN: A single-group pre-post research design. METHODS: Quantitative data were collected between January 2018 and June 2019 using an online form completed by nurses from 18 mental health units (N = 95). Data were collected before and after the intervention, which consisted of the design, implementation and evaluation of strategies to improve the therapeutic relationship through participatory-action research involving nurses. The Working Alliance Inventory-Short, Interpersonal Reactivity Index, Evidence-Based Practice Questionnaire and Practice Environment Scale of the Nursing Work Index were used. The Wilcoxon rank-sum test was used together with the Spearman's correlation coefficient. Two multiple linear regressions models were constructed. RESULTS: Overall, the intervention improved the nurse-patient therapeutic relationship. In addition, the results revealed that, above all, the improvement in evidence-based practice along with a decrease in nurses' personal distress were the factors associated with the improvement of the nurse-patient therapeutic relationship. CONCLUSION: In mental health units, the therapeutic nurse-patient relationship can be improved through participatory interventions that include the implementation of evidence-based practices. IMPACT: This research examined the effects of an intervention aimed at improving the therapeutic relationship among nurses working at mental health units using participatory action research. The results show that the therapeutic relationship can be improved through participatory methods where evidence-based practice is implemented and enhanced among nurses, since a better therapeutic relationship along with reduced staff discomfort are determining factors that influence the quality of the therapeutic relationship. Institutional managers should promote participatory group interventions to enable nurses to develop evidence-based aspects of the therapeutic relationship together with expanding personal aspects and self-knowledge.

A qualitative study exploring the patients' perspective from the 'Reserved Therapeutic Space' nursing intervention in acute mental health units.

This study aimed to explore the perspective of people who had experienced treatment as patients at acute mental health units, regarding an intervention model to improve therapeutic relationships in the units, which had been previously designed by the nurses. The study participants were people linked to collectives for social activism in mental health. Six focus groups were held. The results were classified into three themes: (a) the meaning of a space to enable the establishment of a therapeutic relationship, (b) the procedures to implement the space, and (c) the difficulties to overcome to establish the space. For the participants, the Reserved Therapeutic Space intervention was perceived as a space where they could share expectations and needs with the nurses, considering it as both valid and useful to improve the therapeutic relationship in acute units. For the participants, the intervention should be structured in three stages: orientation, follow-up, and discharge. The content of the intervention should be proposed by the patients based on their needs and concerns. The barriers identified for carrying out the intervention were the lack of relational competence, the violation of rights, and the lack of accessibility of nurses. The facilitating elements were the availability of nurses, active listening, and empathy. The resulting intervention model includes realities of both groups, providing insights for nurses to initiate a space with patients and improve their therapeutic relationship. This intervention model could be used by managers to test its effectiveness.

Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways.

AIMS: To provide insight into patient experiences of a general hospital-based alcohol specialist nurse intervention during alcohol detoxification, experiences of alcohol specialist nurse hospital-based follow-up appointments (Pathway A) as well as the experiences of patients who did not have access to this additional help post detoxification (Pathway B). DESIGN: A longitudinal qualitative study. METHODS: A thematic analysis of semi-structured interviews (2016-2017) with 24 patient participants (N = 12 in each pathway; purposive selection) 1-4 weeks post-detoxification and at 3 and 6 months, to identify patient experiences of these interventions. RESULTS: Participants gave accounts of how 'empathic' and 'straight talking' interactions with alcohol specialist nurses during detoxification helped them to 'open up' and orient towards change. After detoxification follow-up, outpatient appointments in the hospital setting were seen as supporting change in early recovery and engagement with a wider range of services. Those with no access to nurse follow-up described experiencing a 'void' in available help. Participants in both groups described barriers to engagement with community alcohol services, peer groups and access to help for mild-moderate mental health problems. CONCLUSION: Patient accounts indicate alcohol specialist nurse interventions during and after unplanned detoxification in a hospital setting can help orient patients towards change and support early recovery. IMPACT: Providing alcohol specialist nurse interventions in general hospitals offers one route to initiating recovery in alcohol-dependent patients. This has potential to improve the lives of those affected and to reduce related demands on hospital services, but further research is needed.

Suicide care from the nursing perspective: A meta-synthesis of qualitative studies.

AIMS: To explore nurses' experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective. DESIGN: Qualitative meta-synthesis. DATA SOURCES: Comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019. REVIEW METHODS: The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method. RESULTS: Seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: 'Understanding suicidal behaviour as a consequence of suffering', 'Nurses' personal distress in suicide care', 'The presence of the nurse as the axis of suicide care' and, 'Improving nurses' relational competences for a better therapeutic environment'. CONCLUSION: Further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care. IMPACT: This review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour.

The influence of engaging authentically on nurse-patient relationships: A scoping review.

The current international healthcare focus on ensuring the perspectives and needs of individual persons, families or communities are met has led to the core tenet of person-centred care for all. The nurse-patient relationship is central to the provision of care, and enhancing this relationship to ensure trust and respect supports optimal care outcomes for those accessing healthcare services. Engaging authentically is one of the recognised key approaches in person-centred practice, and this scoping review of the literature aims to gain an understanding of the role this process plays in developing effective relationships between nurses and the people they care for. A systematic search of databases and grey literature was undertaken, and twenty-one research papers met the inclusion criteria. A thematic analysis revealed four themes: 'getting to know the patient as a person', 'the complexity of relationship building-it takes time', 'the nurse: characteristics and behaviours that support the nurse-patient relationship' and 'the patient voice'. Nurses and patients both benefit from effective relationships, feeling valued and experiencing greater satisfaction with care. Key elements of engaging authentically were revealed as a nurse-patient relational process through this literature review; however, further research is needed to gain a greater understanding of this concept.

Examining the association between evidence-based practice and the nurse-patient therapeutic relationship in mental health units: A cross-sectional study.

AIMS: To examine the relationship between the dimensions of evidence-based practice and the therapeutic relationship and to predict the quality of the therapeutic relationship from these dimensions among nurses working in mental health units. DESIGN: A cross-sectional design. METHODS: Data were collected between February-April 2018 via an online form completed by nurses working at 18 mental health units. Multiple linear regressions were used to examine the relationship between the dimensions of evidence-based practice and therapeutic relationship. Questionnaires were completed by 198 nurses. RESULTS: Higher levels of evidence-based practice were a significant predictor of a higher-quality therapeutic relationship (ß: 2.276; 95% CI: 1.30-3.25). The evidence-based practice factor which most influenced an improved therapeutic relationship was the nurses' attitude (ß: 2.047; 95% CI: 0.88-3.21). The therapeutic relationship dimension which was most conditioned by evidence-based practice dimensions was agreement on tasks, which was most favourable with a better attitude (ß: 0.625; 95% CI: 0.09-1.16) and greater knowledge and skills for evidence-based practice (ß: 0.500; 95% CI: 0.08-0.93). CONCLUSION: In mental health settings, the therapeutic nurse-patient relationship is positively enhanced by evidenced-based practice and the nurse's level of experience, with a great influence on shared decision-making. IMPACT: This research sought to examine the relationship between the evidence-based practice and the therapeutic relationship in mental health nursing. This study demonstrates that an improved attitude and knowledge of evidence-based practices of mental health nurses increases shared decision-making with patients, which is a basic requirement for person-centred care. Because the therapeutic relationship is considered the backbone of nursing practice in mental health units, this research will have an impact on both mental health nurses and mental health unit managers.

Evaluación de los comportamientos de cuidado otorgados a partir de la percepción del profesional de enfermería / Evaluation of the Care Behaviors Granted from the Perception of the Nursing Professional / Avaliação dos comportamentos de cuidado concedidos a partir da percepção do profissional de enfermagem

Introducción: los profesionales de enfermería son los cuidadores que prestan la mayor parte de la atención directa que reciben los pacientes. Comprender lo que los pacientes perciben como comportamientos de cuidado es esencial para adaptar las intervenciones de enfermería de tal manera que se llegue a satisfacer las necesidades del paciente. Objetivo: describir la percepción de los comportamientos de cuidado otorgados por enfermería que tienen los profesionales del área en una clínica de alta complejidad de la ciudad de Medellín (Colombia). Método: estudio descriptivo, transversal. Se incluyeron 81 profesionales de enfermería que laboraban en la institución para el 2018. Se utilizó un instrumento que mide la percepción del cuidado otorgado por el profesional, el cual se denomina: evaluación de los comportamientos de cuidado otorgado por enfermería (ECCOE). Resultados: de los 81 profesionales de enfermería que participaron en el estudio, la percepción de cuidado otorgado por enfermería tuvo una valoración global de 89,4%. En la relación de las puntuaciones promedio obtenidas en cada subescala, se observó mayores promedios para el soporte/protección/ambiente con 92,3%, asistencia en las necesidades humanas con 92,0%, humanismo/fe-esperanza/sensibilidad con 91,8%, y promedios menores en fuerzas existenciales/fenomenológica/espiritual con 88,6% ayuda/confianza con 86,5%, expresión de sentimientos positivos/negativos con 85,5% y enseñanza/aprendizaje con 84,7%. Conclusión:los profesionales perciben los comportamientos de cuidado de manera positiva. Fue posible establecer aspectos como ayudar al paciente a fijarse metas para su salud, planificar cómo lograrlas y no abandonarlo ni alejarse cuando esté triste. Los hallazgos permiten orientar los comportamientos de cuidado para adaptar las intervenciones de enfermería y satisfacer las necesidades del paciente.

Nurse practitioners are the caregivers who provide most of the direct care received by patients. Understanding what patients perceive as caring behaviors is essential to tailor nursing interventions and meet the patient's needs. Objective: To describe the perception of nursing care behaviors that professionals in the area have in a high complexity clinic in the city of Medellín (Colombia). Method: a descriptive, cross-sectional study. Eighty-one nursing professionals who worked in the institution for 2018 were included. An instrument that measures the perception of the care provided by the professional called Assessment of Nursing Care Behaviors (ECCOE by its Spanish acronym) was used. Results: of the 81 nurse practitioners who participated in the study, the perception of care provided by nursing had a global assessment of 89.4%. Regarding the average scores obtained in each subscale, higher averages were observed for support / protection / environment with 92.3%; assistance in human needs with 92.0%; humanism / faith-hope / sensitivity with 91.8%; and lower averages in existential / phenomenological / spiritual forces with 88.6%; help / trust with 86.5%, expression of positive / negative feelings with 85.5%; and teaching / learning with 84.7%. Conclusion: professionals perceive care behaviors positively. It was possible to establish aspects such as helping the patient set goals for his health, planning how to achieve them, and not abandoning him or walking away when he is sad. The findings allow guiding care behaviors to adapt nursing interventions and meet the needs of the patient.

Introdução: os prossionais de enfermagem são os cuidadores que prestam a maior parte dos cuidados diretos recebidos pelospacientes. Compreender o que os pacientes percebem como comportamentos de cuidado é essencial para adequar as intervenções de enfermagem de forma a atender às necessidades do paciente. Objetivo: descrever a percepção dos comportamentos assistenciais de enfermagem que os profissionais da área têm em uma clínica de alta complexidade na cidade de Medellín (Colômbia). Método: estudo descritivo, transversal. Foram incluídos 81 profissionais de enfermagem que atuavam na instituição em 2018. Foi utilizado um instrumento que mede a percepção do cuidado prestado pelo profissional, nomeado: avaliação dos comportamentos de cuidado de enfermagem (ACCOE). Resultados: dos 81 profissionais de enfermagem que participaram do estudo, a percepção do cuidado prestado pela enfermagem teve uma avaliação global de 89,4%. Na relação dos escores médios obtidos em cada subescala, foram observadas médias superiores para suporte / proteção / meio ambiente com 92,3%, atendimento às necessidades humanas com 92,0%, humanismo / fé-esperança / sensibilidade com 91,8% e médias inferiores nas forças existenciais / fenomenológicas /espirituais com 88,6% ajuda / confiança com 86,5%, expressão de sentimentos positivos / negativos com 85,5% e ensino /aprendizagem com 84,7%. Conclusão: os profissionais percebem os comportamentos de cuidado de forma positiva. Foi possível estabelecer aspectos como ajudar o paciente a traçar metas para sua saúde, planejar como alcançá-las e não abandoná-lo ou ir embora quando está triste. Os achados permitem nortear comportamentos de cuidado para adequar as intervenções de enfermagem e atender às necessidades do paciente