Nurses' experiences of hospital-acquired pressure injury prevention in acute healthcare services in Victoria, Australia: A qualitative study using the Theoretical Domains Framework.

We investigated nurses' experiences of hospital-acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence-based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital-acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self-blame related to PI identification, and exacerbating impacts of the COVID-19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital-acquired PI.

Caring for children and families during the COVID-19 pandemic: innovations and changes experienced by nurses.

OBJECTIVE: To understand the experience of nurses working in pediatric units in the face of innovations and changes in the process of caring for children and families during the COVID-19 pandemic. Also, the objective is to understand the typical experience of nurses in this care. METHOD: Qualitative research, which involved the participation of 16 nurses from pediatric units of a public teaching hospital. The data were analyzed according to the theoretical-methodological framework of Alfred Schütz's social phenomenology. RESULTS: The participants' reports generated the categories: the challenge of experiencing changes amid fear, the team's adaptation to innovations and changes caused by the COVID-19 pandemic and the expectation for care and the work process. CONCLUSION: The understanding of the nurses' experience highlighted changes, team adaptations and expectations for the care of children and families, which, although permeated by learning, were experienced by ethical dilemmas and moral suffering for these professionals.

Knowledge Domain of Professional Identity in Nursing.

The knowledge domain of professional identity in nursing is the analysis and application of information derived from experiences, critical reflection, and scientific discovery from nursing and other disciplines. Knowledge guides role clarity, decision-making, and advocacy. Key concepts described in this column include mindset, innovation, clinical judgment, and reflection. [J Contin Educ Nurs. 2024;55(7):328-330].

My Magical Day in the Trauma ICU.

Healing is a difficult concept to describe, quantify, or replicate. It is a complex mixture of personal contributions from the professional providing care, including competence, compassion, and empathy, that conjoins with the needs, sensitivities, and receptivity of the one who is receiving the care. Although it may be difficult to predict all the elements that come together to initiate sustained healing, as well as the long-term impact, it is important to observe the moments that make a difference. For those who study the nature of healing, a patient's reflections can surface the kinds of elements that are present when healing is sustained. [J Contin Educ Nurs. 2024;55(7):326-327.].

Discharging older patients from hospital to homecare: conflicts in collaborative practices among nurses across sectors.

BACKGROUND: Collaboration is a key factor influencing the quality and safety in patients transition between sectors. However, specific collaborative practices may give rise to conflict between hospital nurses and community nurses. AIMS: To gain a deeper understanding of collaborative practices which have the potential to fuel tension in collaboration between hospital nurses and community nurses during discharge of older patients from hospital to homecare. METHODS: A meta-ethnography approach was used in this study and a systematic literature search was conducted in 2022. RESULTS: Five themes were identified in the analysis. These themes revealed how uncertainty, limited confidence in information and personal attitude in communication may fuel tension between hospital nurses and community nurses. Tensions arising from a negative loop emerged because of uncertainty, causing a growing rift between hospital nurses and community nurses, leaving them as opponents rather than collaborators. The authors suggest that policy makers and managers can break this loop by underpinning shared policies and awareness of common objectives.

Registered general nurses' health assessment practices in a tertiary hospital: A focused ethnography study.

AIM: To explore the assumptions and values that influence nursing health assessment practices among registered general nurses in general medical and surgical wards. DESIGN: The study was designed as a focused ethnography. METHODS: A semi-structured interview guide was used to explore prevailing nursing health assessment practices of 13 registered general nurses in an attempt to explore the assumptions and values influencing health assessment practices in the study setting. Data were analysed inductively using an interpretive qualitative content analysis method. RESULTS: Nursing health assessment practices, and underlying assumptions and values were underpinned by a central theme of a culture of low expectation relating to nursing health assessment. The culture of low expectation was highlighted in five themes: (1) Unsystematic Assessment of Health Status, (2) Purpose of Nursing Health Assessment, (3) The Role of Nursing Educational and Regulatory Institutions, (4) Ward Ethos and (5) The Role of Organizational and Ward Leadership. IMPLICATION: The adoption of a holistic nursing health assessment framework with a clearly defined purpose of aiding nursing diagnoses can guide patient-centred care delivery and facilitate early recognition of physiological deterioration. PATIENT OR PUBLIC CONTRIBUTION: Thirteen registered general nurses were interviewed, and the initial findings returned to them for validation. CONCLUSION: The potential contribution of nursing health assessment to nursing practice and patient outcomes may not be fully realized if nursing health assessment is not situated within a holistic health assessment model with a clearly defined purpose for nursing practice.

Hepatitis B immunisation and immune status of nurses in a regional hospital in central South Africa.

BACKGROUND:  The hepatitis B virus (HBV) is one of the most important biological occupational hazards for healthcare workers. A high percentage of HBV infections are attributable to percutaneous occupational exposure. This study aimed to describe the HBV immunisation and current immune status of all the nurses employed in a regional hospital in central South Africa. METHODS:  A descriptive record review included all the nurses (N = 388) employed in a regional hospital in central South Africa from 01 January 2018 to 31 January 2020. A total of 289 health records were included in the study. Data were analysed using descriptive statistics. Logistic regression analysis was used to establish factors associated with full immunisation. RESULTS:  Most nurses were females (87.9%), working in medical (27.0%) wards. Only 20.4% of nurses received one dose of vaccine, while 51.2% received the three prescribed doses. However, 91.2% of nurses did not receive the vaccine at the correct intervals. Most of the tested nurses (71.0%) were immune. Immunisation status was significantly associated with religion (p  0.001) and schedule (p = 0.003). Nurses who were non-Christians were 35.9% less likely to be fully vaccinated compared to Christians. CONCLUSION:  Half of the nursing staff received three doses as prescribed. All nurses should receive the vaccine against HBV and their immune status monitored to minimise the risk of an infection. It is therefore recommended that proof of immunity should be a requirement.Contribution: This study found a high percentage of nurses with HBV antibodies, which will ensure workplace safety.

The Art of Delegation.

The nurse staffing crisis requires nurses and administrators to think differently about how to get things done. Delegation is key to doing more work with fewer registered nurses (RNs) and retaining current RN staff. Responsibility for effective delegation does not rest solely with the RN but begins with the institution, and includes both the delegator and delegatee. While effective delegation has often been referred to as an art, knowing the science behind delegation can aid in honing a skill necessary for top of license practice.

Developing an ethical attitude scale for pain management in nursing.

OBJECTIVES: The aim of this study is to develop the 'Developing an Ethical Attitude Scale for Pain Management in Nursing' to assign the ethical attitudes of nurses in pain management. METHODS: The population of the study comprised nurses (n=411) working in a university hospital in Izmir. The Ethical Attitude Scale in Nursing Pain Management was developed in five sub-dimensions: 'Care and Dignity,' 'Ethical Values,' 'Attitude,' 'Rights,' and 'Pain Management.' This scale was created by examining many research studies related to pain management in nursing in the literature and taking expert opinions. 'The Ethical Attitude Scale in Nursing Pain Management' initially consisted of 36 items. After expert opinions and validity analyses, the draft scale was reduced to 34 items, and then reliability analysis further reduced the scale to 23 items. RESULTS: In the validity and reliability study of 'The Ethical Attitude Scale in Nursing Pain Management,' the total Cronbach's alpha value of the scale was 0.86. The Cronbach's alpha value for the 'Care and Dignity' sub-dimension was 0.88; for the 'Ethical Values' sub-dimension, it was 0.83; for the 'Attitude' sub-dimension, it was 0.86; for the 'Rights' sub-dimension, it was 0.79; and for the 'Pain Management' sub-dimension, it was 0.72. CONCLUSION: According to these data, it was determined that 'The Ethical Attitude Scale in Nursing Pain Management' is a valid and reliable scale.

Low back pain frequency and the related risk factors in nurses and caregivers.

OBJECTIVES: The objective of this study is to investigate the frequency of low back pain and the relationship between low back pain and personal and occupational risk factors in hospital employees. METHODS: The study sample consisted of 270 nurses and 189 caregivers working in a university hospital. Demographic characteristics, low back pain history, and low back pain risk factors were queried by self-report questionnaires. The Biering-Sorensen Test was used to evaluate the endurance of trunk extensor muscles. Also, the Oswestry Disability Index (ODI) and Hospital Anxiety and Depression Scale (HADS) were used. RESULTS: Of the hospital employees included in the study, 56.5% had low back pain in the last month, and 81.9% had a his-tory of low back pain. The frequency of low back pain was significantly higher among those who work in a stressful working environment, stand for extended periods, lift patients or heavy subjects without using a lifting device, and transfer patients alone. In addition, it was determined that those who exercise regularly and are satisfied with their job had significantly less low back pain (p<0.05). The mean Biering-Sorensen test difference between the two groups was statistically significant (p<0.001). There was a significant difference between the groups with and without low back pain in terms of HADS-Anxiety and HADS-Depression subscale scores. CONCLUSION: The study findings indicated that being a hospital worker is a risk factor for low back pain, and the decrease in the strength and endurance of the lower back muscles increases the risk of low back pain.

Development of management indicators of nursing for minimizing physical restraints focused on older adult patients hospitalized in acute care settings: A Delphi consensus study.

Nursing management activities are important in influencing staff nurses' action to prevent or withdraw physical restraints. However, limited studies have been conducted empirically to determine the nursing management activities required for minimizing physical restraints. Therefore, there is a need for basic standards of nursing management activities to minimize physical restraints in acute care settings. This study aimed to develop nursing management indicators to minimize physical restraint (MaIN-PR) in hospitalized older adult patients in an acute care setting. It was conducted between June and October 2021 in Japan using a Delphi consensus approach. Fifty nurses working at top or middle management levels or as certified nurse specialists in gerontological nursing enrolled as participants. The potential indicators obtained from the literature review and interviews were organized inductively to develop two types of draft indicators: (1) 35 items for top management and (2) 33 items for middle management. We asked the nursing managers and certified nurse specialists in gerontological nursing to assess the validity of each indicator in three rounds. Of the 50 initial panelists, 12 from top management and 13 from middle management continued till the third round. MaIN-PR contained 35 indicators for top management and 28 indicators for middle management and were classified into the following six metrics: planning, motivating, training, commanding, organizing, and controlling. To the best of our knowledge, the current MaIN-PR are the first set of nursing management indicators for minimizing physical restraint, including perspectives on geriatric nursing in acute care settings. These indicators could guide both top and middle nursing management, thus supporting staff nurses' judgment in minimizing physical restraints to enhance the quality of older adult patient care.

Effect of occupational stress and resilience on insomnia among nurses during COVID-19 in China: a structural equation modelling analysis.

OBJECTIVES: To explore the effects of occupational stress and resilience on insomnia among Chinese nurses during the COVID-19 pandemic. DESIGN, SETTINGS AND PARTICIPANTS: A quantitative description study. The data were collected via a cross-sectional survey. A total of 725 front-line nurses at three tertiary hospitals in western China were included from December 2022 to January 2023. The Connor-Davidson Resilience Scale, Job Content Questionnaire, and Athens Insomnia Scale were used to collect data from a self-reported online questionnaire. OUTCOME MEASURES: The outcome variable was insomnia, and structural equation modelling was used to assess the associations among resilience, occupational stress and insomnia. RESULTS: The prevalence of insomnia among the participants was 58.76%. The structural equation model showed that resilience had a negative direct effect on insomnia and occupational stress, and occupational stress had a positive direct effect on insomnia. Involvement in COVID-19-related work has a positive effect on insomnia through occupational stress. In contrast, higher education levels improved insomnia through increased resilience. CONCLUSION: A significantly higher prevalence of insomnia has been observed among Chinese nurses during the COVID-19 pandemic. Our study suggests that better resilience may improve insomnia by relieving occupational stress, and implementing measures to promote resilience is essential to reduce occupational stress in nurses and improve their sleep quality.

Association between patient safety culture and professional quality of life among nursing professionals.

OBJECTIVE: To analyze the association between patient safety culture and professional quality of life in nursing professionals. METHOD: Correlational study carried out in a hospital in Salvador, Bahia, Brazil, with 180 participants. The data were collected through the Hospital Survey on Patient Safety Culture and Professional Quality of Life Scale and analyzed with correlation tests. RESULTS: The use of the Quality of Professional Life model, which encompasses Compassion Satisfaction, Burnout and Traumatic Stress, showed that a better assessment of the safety culture was negatively associated with Burnout. Regarding the dimensions of culture, better evaluations of the general perception of safety, teamwork and staffing were negatively associated with Burnout and Traumatic Stress. Higher Burnout was negatively associated with better handoffs and greater Traumatic Stress was positively associated with error communication. CONCLUSION: Higher levels of Burnout were associated with worse perception of safety culture and worse teamwork evaluations; staffing and general perception of safety were associated to a higher level of Burnout and Traumatic Stress, which emphasizes the importance of investment in these areas.

Evidence-based practice knowledge, attitude, practice and barriers as predictors of stay intent among Jordanian registered nurses: a cross-sectional study.

AIM: This study aimed to identify factors influencing stay intent among Jordanian registered nurses, with a specific focus on the role of evidence-based practice (EBP) knowledge, attitudes, practices and barriers. METHODS: A descriptive cross-sectional study of 311 nurses from 5 hospitals was conducted from January 2022 to June 2022. Participants completed data about stay intent and knowledge, attitude, practice and barriers of EBP. Data were analysed using SPSS program V.24. FINDINGS: EBP attitudes, practices, knowledge and barriers significantly predicted stay intent, controlling for participants and workplace characteristics. Private hospitals (t=-4.681, Β=-0.287, p<0.001), having a library in the healthcare institution (t=-2.018, Β=-0.118, p<0.001) and adopter barriers (t=-1.940, Β=-0.105, p=0.05) were significantly associated with stay intent. CONCLUSION: Our findings show that EBP influences Jordanian nurses' intent to stay. It highlights the importance of addressing EBP barriers, especially in private hospitals as well as library access issues, in enhancing nurse retention and healthcare outcomes in Jordan.

Personal Protective Equipment Use and Surface Contamination With Antineoplastic Drugs: The Impact of the COVID-19 Pandemic.

BACKGROUND: Surface contamination with antineoplastic drugs (ADs) is persistent. The use of personal protective equipment (PPE) is recommended to reduce exposure to ADs. OBJECTIVES: This study explored the impact of the COVID-19 pandemic on nurses' PPE use and surface contamination with ADs. METHODS: Demographic characteristics, PPE use, and associated factors were assessed on two inpatient oncology units where etoposide and cyclophosphamide were administered before (N = 26) and during the COVID-19 pandemic (N = 31). FINDINGS: PPE use when handling contaminated excreta was significantly higher during the pandemic. Perceived risk of chemotherapy exposure was significantly associated with greater PPE use when handling AD-contaminated excreta, and conflict of interest was related to less PPE use during AD administration and handling of AD-contaminated excreta. During the pandemic, surface contamination with etoposide increased in shared areas and decreased in patient rooms.

Do inexperienced nurses in the lactation period experience workplace violence? A qualitative study.

Introduction: Among clinical healthcare personnel, nurses face the highest proportion of workplace violence, which has a significant impact on their physical and mental well-being as well as their personal and professional lives. However, little is known about the effects of workplace violence on inexperienced breastfeeding nurses and their experiences during and after breastfeeding when they return to work. This study aimed to explore the experiences of inexperienced breastfeeding nurses who encountered workplace violence and its resulting impacts. Methods: This study employed a descriptive qualitative design. Semi-structured in-depth interviews were conducted with 20 nurses working in various positions and departments at three tertiary hospitals. Purposive and maximum variation sampling techniques were employed. The interview data were analyzed using Colaizzi's method, and the research findings were reported according to Consolidated Criteria for Reporting Qualitative Studies (COREQ)standards. Results: Inferences regarding workplace violence and risks for inexperienced breastfeeding nurses included physical labor (such as lifting heavy objects and performing cardiopulmonary resuscitation), conflicts, inadequate job skills, role confusion, occupational exposure risks, patient violence, and pressure from older adults. An inductive thematic investigation revealed the "Challenges faced during breastfeeding," "Conflicting professional and family roles," "Out of balance," and "Coping strategies." Conclusion: Inexperienced breastfeeding nurses experience several negative consequences due to workplace violence. Therefore, it is essential to plan and implement preventive strategies and management programs that specifically target workplace violence among inexperienced breastfeeding nurses.

Indicators of technostress, their association with burnout and the moderating role of support offers among nurses in German hospitals: a cross-sectional study.

OBJECTIVES: To examine the level of indicators of technostress among nurses with and without a leadership position, the relationship between indicators of technostress and burnout and the moderating role of support offered by employers. The availability of support offers and further needs of nurses were also explored. DESIGN: Cross-sectional online survey. SETTING: Acute care hospitals in Germany. PARTICIPANTS: 303 nurses (73.3% female) who have worked at the hospital for at least 1 year and a minimum of 10 hours per week. PRIMARY AND SECONDARY OUTCOME MEASURES: Indicators of technostress (complexity, overload, usefulness, lack of technical support and unreliability) served as predictors in multiple linear regression analyses to examine their association with the primary outcome burnout. Support of employers was included as a moderator variable. Validated subscales from the Digital Stressors Scale and Copenhagen Burnout Inventory as well as open-ended questions were applied. RESULTS: There were no differences in the level of indicators of technostress found between nurses with and without a leadership position. Techno-overload (ß=0.259, p=0.004) and techno-complexity (ß=0.161, p=0.043) were significantly associated with burnout. Support by the employer moderated the relationship between lack of technical support and burnout significantly (R² change=0.026, F(1,292)=7.41, p=0.007). Support offers such as training, IT service and contact persons on the ward helped nurses to be more confident in the use of information and communication technologies. However, they expressed further needs with regard to these and new offers. CONCLUSIONS: There was an association between two indicators of technostress and burnout. Therefore, particular attention should be paid to supporting nurses in terms of techno-overload and techno-complexity. Furthermore, there is still a need for customised support and further offers from employers in the use of digital technologies.

The DAISY Award: Meaningful Recognition's Impact on Patients, Nurses, and Organizations.

This review demonstrates the impact of The DAISY Award and how meaningful recognition (MR) through gratitude affects nurse engagement, healthy work environments (HWEs), and patient/families' (PFs) experiences. MR has mutual benefits for nurses and PFs, promoting therapeutic healing and resiliency. MR in HWEs can impact organizations' care quality, fiscal health and influence public perceptions. Nurse leaders should create an environment where MR is a core strategic imperative that impacts nurse, patient, and organizational outcomes.