The Exercise of Nurses' Clinical Leadership in Hospital Care Units: A Qualitative Multiple Case Study.

AIMS: This study aims to describe the exercise of clinical leadership by nurses within hospital care units, identify the factors influencing it and explore how nurses perceive its impact. DESIGN: Qualitative multiple case study. METHOD: The study involved 36 interviews, 120 h of observation and documentary analyses with nurses across various roles within three nursing teams to capture collective leadership. Thematic and cross-case analyses were also conducted. RESULTS: Nurses' clinical leadership was manifested in five distinct forms, irrespective of their role: (1) initiating actions involving reflective thinking and intervention, (2) influencing others through coaching, (3) actively participating in and mobilising efforts to enhance the quality of care, (4) fostering optimal synergy and team cohesion, and (5) leveraging personal and collaborative capacities. Factors influencing this leadership included clinical, human and material resources, time, a work environment that promotes autonomy and a positive work climate. Nurses perceived their leadership as having a positive impact on patients, themselves, the interdisciplinary team and the organisation. These findings were integrated into a modellisation of the exercise of nurses' clinical leadership based on Le Moigne's (La Théorie du Système Général. Théorie de la Modélisation. Paris: Presses Universitaires de France, 2006) philosophical approach. CONCLUSION: This study provides a perspective on nurses' collective clinical leadership in hospital care units, emphasising its leverage effect and the achievement of positive impacts. The proposed model serves as a valuable tool for nurse managers to better understand and support the exercise of clinical leadership. IMPLICATIONS FOR THE PROFESSION: The model can guide nurse managers in supporting clinical leadership within teams, assist individual nurses in associating clinical leadership with their practice and assist with mobilising their leadership skills. IMPACT: This study explores how nurses across various roles within a hospital care unit exercise clinical leadership. The findings reveal five active forms of nurses' clinical leadership, perceived by nurses to positively impact patients, the interdisciplinary team and the organisation. Nurses and managers can use these five forms to foster a collective approach to clinical leadership. PATIENT OR PUBLIC CONTRIBUTION: None. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER COMMUNITY?: This study introduces an innovative model for understanding and promoting nurses' clinical leadership. It provides insights into the positive impact of this leadership approach and the significance of promoting it. REPORTING METHOD: Standards for Reporting Qualitative Research [SRQR] (O'Brien et al. Academic Medicine, 89, 2014 and 1245). TRIAL AND PROTOCOL REGISTRATION: Not registered.

Experiences and perceptions of nurses participating in an interprofessional, videoconference-based educational programme on concurrent mental health and substance use disorders: a qualitative study.

BACKGROUND: Individuals with co-occurring mental health and substance use disorders (i.e., concurrent disorders) have complex healthcare needs, which can be challenging for nurses to manage. Providing optimal care for this subpopulation requires nurses to develop high-level competencies despite limited resources at their disposal and the isolated settings in which many of them work. The Extension for Healthcare Community Outcomes (ECHO®) is a promising collaborative learning and capacity building model that uses videoconference technology to support and train healthcare professionals in the management of complex and chronic health conditions. The aim of this study was to explore the experiences and perceptions of nurses participating in a Canadian ECHO programme on concurrent disorders about the competencies they developed and used in their clinical practice, and which factors have influenced this process. METHODS: The study was qualitative, guided by an interpretive description approach. Individual semi-structured interviews were held with ten nurses who had participated in the programme between 2018 and 2020. A thematic analysis was conducted iteratively using an inductive approach to progressive data coding and organization. RESULTS: Four themes and eighteen sub-themes were identified. During their participation in ECHO, the nurses perceived as having further developed eight clinical nursing competencies. Nurses viewed ECHO as a unique opportunity to open themselves to their peers' experiences and reflect on their own knowledge. Learning from experts in the field of concurrent disorders helped them to build their confidence in managing complex clinical situations. The nurses' sense of belonging to a community further enhanced their engagement in the programme, and learning was facilitated through the programme's interprofessional environment. Nevertheless, the lack of contextualized educative content linked to local realities, the limited resources in concurrent disorders, and time constraints were experienced as factors limiting competency development. CONCLUSIONS: ECHO is a promising alternative to conventional, in-person continuing education programmes to improve the development of advanced competencies among nurses providing care to individuals with chronic and complex health conditions. These findings can inform clinicians, educators, researchers, and decision makers who are developing, implementing, evaluating, and escalating future educational interventions in the field of CDs.

Learning through the experience of cancer survivorship: differences across age groups.

OBJECTIVE: To identify and describe challenges that contribute to experiential learning among cancer survivors across different age groups. RESEARCH APPROACH: Qualitative collaborative study. PARTICIPANTS: 27 cancer survivors. METHODOLOGICAL APPROACH: Participants were invited to explain the after-cancer challenges they learned from during six focus groups. Five were organized by age-group (15-18, 19-34, 35-44, 45-59, ≥ 60) and a mixed group was held to ensure the co-construction of findings with participants. Inductive content analysis was performed. FINDINGS: While learning to live with a chronic disease, participant's experiential learning appeared through four challenges: Searching for one's identity, Autonomy, Disruption of social roles and responsibilities, Reclaiming one's life. Particular aspects of challenges were identified across ages-groups and life courses. INTERPRETATION: Results indicate that psychosocial and health professionals should be sensitive to the fact that life courses are now diverse and not always associated with biological age. This has the potential to improve care by informing how these challenges affect the experience of cancer survivorship over time.

Understanding the expanded nursing role in indigenous communities: A qualitative study.

AIM: By studying an extreme context, we aim to provide an in-depth understanding of the expanded nursing role in remote aboriginal communities, its dynamics and the main barriers to its full expansion. BACKGROUND: While it is recognized that nurses play a major role in remote or rural areas, little is known about the dynamics of the expanded role and the nurses' daily practice and routines. METHODS: We conducted 49 in-depth interviews with nurses and key informants and more than 14 days of observation: two days of pre-departure training and 12 days in dispensaries and a hospital in Hudson Bay, Québec, Canada. RESULTS: We identified four sub-roles within the nurses' expanded role: administrative, nursing, medical and community sub-roles. This typology allowed us to document the evolving and dynamic nature of the role as well as the individual, organisational and community barriers that limit its expansion. CONCLUSION: This typology represents the first attempt to gain an in-depth understanding of the enlarged nursing role in northern Québec and of the complexity of the daily nursing routines and dynamics. We believe it to be relevant for other contexts, such as rural areas, even if nurses there do not always take on all four sub-roles during their nursing experience. IMPLICATIONS FOR NURSING MANAGEMENT: Our paper has significant practical implications for different stakeholders-educators, directors of nursing, recruiters, regulators and policymakers-as it may help with identifying the education and training requirements for developing specific sub-roles, overcoming obstacles to widening the expanded role or better allocating the resources needed based on the predominant sub-role in different contexts. More broadly, this study shows that, when properly regulated, extending professional nursing boundaries does not put the patient at risk and enables professionals to develop their practice. It represents a textbook case for rethinking our contemporary health care systems.

The strategic leadership of nursing directorates in the context of healthcare system reform.

In Quebec, the strategic leadership of nursing directorates remains poorly documented despite its importance for the performance of their organizations. Using three focus groups and 31 individual semistructured interviews, a qualitative descriptive study was conducted, including 35 participants from 18 of the Quebec 34 health institutions created in 2015 by the last reform. Seven themes emerged: (1) taking ownership of the strategic positioning, (2) developing and communicating a vision, (3) making strategic, systematic, and measured choices, (4) reframing roles, (5) getting involved in the strategic decision-making processes, (6) developing the political capacity, and (7) building alliances. Four professional and organizational components influenced the nursing directorates' leadership capacity: clinical credibility, a sufficient number of people educated at the graduate level, organizational culture, and size of the institution. It is expected that these results regarding nursing directorates' exercise of strategic leadership will lead to better governance and quality of nursing care.

A conceptual framework of student professionalization for health professional education and research.

OBJECTIVES: To present a conceptual framework of student professionalization for health professional education and research. METHODS: Synthesis and discussion of a program of research on competency-based education. RESULTS: Competency-based education relies on active, situation-based group learning strategies to prepare students to become health professionals who are connected to patient and population needs. Professionalization is understood as a dynamic process of imagining, becoming, and being a member of a health profession. It rests on the evolution of three interrelated dimensions: professional competencies, professional culture, and professional identity. Professionalization occurs throughout students' encounters with meaningful learning experiences that involve three core components: the roles students experience in situations bounded within specific contexts. Educational practices conducive to professionalization include active learning, reflection, and feedback. CONCLUSIONS: This conceptual framework drives a research agenda aimed at understanding how students become health professional and how learning experiences involving action, reflection, and feedback foster that process and the advancement of professional practices.

Learning theories and tools for the assessment of core nursing competencies in simulation: A theoretical review.

AIM: To identify the theories used to explain learning in simulation and to examine how these theories guided the assessment of learning outcomes related to core competencies in undergraduate nursing students. BACKGROUND: Nurse educators face the challenge of making explicit the outcomes of competency-based education, especially when competencies are conceptualized as holistic and context dependent. DESIGN: Theoretical review. DATA SOURCES: Research papers (N = 182) published between 1999-2015 describing simulation in nursing education. REVIEW METHODS: Two members of the research team extracted data from the papers, including theories used to explain how simulation could engender learning and tools used to assess simulation outcomes. Contingency tables were created to examine the associations between theories, outcomes and tools. RESULTS: Some papers (N = 79) did not provide an explicit theory. The 103 remaining papers identified one or more learning or teaching theories; the most frequent were the National League for Nursing/Jeffries Simulation Framework, Kolb's theory of experiential learning and Bandura's social cognitive theory and concept of self-efficacy. Students' perceptions of simulation, knowledge and self-confidence were the most frequently assessed, mainly via scales designed for the study where they were used. Core competencies were mostly assessed with an observational approach. CONCLUSION: This review highlighted the fact that few studies examined the use of simulation in nursing education through learning theories and via assessment of core competencies. It also identified observational tools used to assess competencies in action, as holistic and context-dependent constructs.

Nurse-Environment Interactions in the Development of Cultural Competence.

Studies on the development of cultural competence among healthcare providers tend to focus on the clinical encounter, with little attention paid to the environment. In this paper, results from a grounded theory study conducted with nurses and students to understand cultural competence development are presented; with a focus on findings that call particular attention to nurse-environment interactions. Two concurrent processes, as students and nurses develop cultural competence through interactions with their environment, were identified: "dealing with structural constraints" and "mobilizing social resources". These dynamic interactions between healthcare providers and the larger structures of healthcare systems raise critical questions about the power of healthcare providers to influence the structures that shape their practice. The intersection of nursing theory with social and critical theories is essential to gain a comprehensive understanding of cultural competence development and to transform healthcare providers' education in the service of social justice and health equity.

Defining patient deterioration through acute care and intensive care nurses' perspectives.

AIM: To explore the variations between acute care and intensive care nurses' understanding of patient deterioration according to their use of this term in published literature. BACKGROUND: Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses' help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains. DESIGN: Dimensional analysis was used as a framework to analyze papers retrieved in a nursing-focused database. METHOD: A thematic analysis of 34 papers (2002-2012) depicting acute care and intensive care unit nurses' perspectives on patient deterioration was conducted. FINDINGS: No explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses' accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored. CONCLUSIONS: From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology towards critical illness. Contextual factors relating to acute care units (ACU) appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modelling the concept of patient deterioration, which could be specific to ACU. RELEVANCE TO CLINICAL PRACTICE: The findings suggest that it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issue.

Interprofessional patient-centred practice in oncology teams: utopia or reality?

Studies on interprofessional practice usually report professionals' viewpoints and document organizational, procedural and relational factors influencing that practice. Considering the importance of interprofessional patient-centred (IPPC) practice, it seems necessary to describe it in detail in an actual context of care, from the perspective of patients, their families and health-care professionals. The goal of this study was to describe IPPC practice throughout the continuum of cancer care. A qualitative multiple case study was completed with two interprofessional teams from a Canadian teaching hospital. Interviews were conducted with patients, their families and professionals, and observation was carried out. Three themes were illustrated by current team practice: welcoming the person as a unique individual, but still requiring the patient to comply; the paradoxical coexistence of patient-centred discourse and professional-centred practice; and triggering team collaboration with the culmination of the patient's situation. Several influential factors were described, including the way the team works; the physical environment; professionals' and patients'/family members' stance on the collaboration; professionals' stance on patients and their families; and patients' stance on professionals. Finally, themes describing the desired IPPC practice reflect the wish of most participants to be more involved. They were: providing support in line with the patient's experience and involvement; respecting patients by not imposing professionals' values and goals; and consistency and regularity in the collaboration of all members.

The care continuum with interprofessional oncology teams: Perspectives of patients and family.

To accompany the individual diagnosed with cancer along the care continuum, teams of professionals have been created based on integrating an interprofessional patient-centred (IPPC) practice. The goal of this article is to present some of the results of a case study documenting IPPC practice carried on by teams within the oncology care continuum. Observations and interviews with patients and their family were conducted. The results suggest that IPPC practice is variable within teams, but optimal at the beginning of treatments or cancer recurrence. However, patients can experience breakdowns in the continuity of care and more difficult transitions between oncology continuum periods (diagnosis, treatment, follow-up).

[The nurse's thought for a significant social contribution by the production and use of scientific knowledge]. / La pensée infirmière pour une production et utilisation de connaissances scientifiques pertinentes à la pratique.

The social contribution of nurses to the health of the population is mainly defined by the knowledge supporting their actions. Conceptualization in nursing guides the production and utilisation of scientific knowledge within the discipline. The purpose of this paper is to present the recent thoughts on nursing theory and to provide some strategies to integrate them within the activities of knowledge mobilization, in practice, research, and education. When nurses are engaged in mobilizing theoretical and empirical knowledge in answering nursing practice questions and in discussing social health issues, they participate in persons, families, and communities health improvement, while affirming their disciplinary and social identity. Called to be change agents in health care systems, with other professional team members, it is important that nurses be prepared to mobilize knowledge and to engage in critical reasoning, and ethical conduct. Their social contribution will be as strong as the value they assign to nursing knowledge and their participation in producing it.

Learning to provide humanistic care and support in the context of chronic illness: Insights from the narratives of healthcare professionals in hemato-oncology.

PURPOSE: To document the process by which healthcare professionals (HCPs) support people living with and beyond hematological cancer and detail how they learned from their personal and clinical experience. METHOD: Using a narrative approach, we conducted nine semi-structured interviews with HCPs, including nurses, from a specialized care centre who support patients with hematological cancer. Interviews aimed to capture experiential learning gained from their practice. We performed a hybrid inductive/deductive content analysis on data using a framework based on sociological and educational models of experiential learning. RESULTS: Among healthcare professionals, analysis revealed the need to provide care and support that is 'humane' and adapted to each patient. Learning to provide this type of care proved to be challenging. Over the course of their clinical experience, healthcare professionals learned to adapt the support they provided by straddling a boundary between sympathy and empathy. Learning outcomes were associated with personal-professional development among participants. CONCLUSION: Our findings bring to light an overlooked facet of patient support in the context of cancer care, which is the acquisition of the soft skills required to deliver humanistic care and support. This learning process requires time and involves navigating between the realms of sympathy and empathy. Experiential learning is intertwined with the complexity of the often long-term patient-professional relationship that characterizes hemato-oncology. This unique relationship offers rewards for healthcare professionals on both personal and professional fronts.

Reflective debriefing to promote novice nurses' clinical judgment after high-fidelity clinical simulation: a pilot test.

BACKGROUND: Novice nurses are increasingly beginning their career paths in critical care areas, where they are expected to care for patients whose lives are potentially threatened. They are unable to benefit from years of experience to facilitate their clinical decisions. Reflection after simulation could possibly improve nurses' clinical judgment in complex situations. DESIGN: An educational project was conducted to pilot-test a teaching intervention, which combined reflective debriefing with a simulated critical care experience. METHOD: Five nurses beginning in an intensive care unit participated in the pilot test. Their perception of their learning and satisfaction with the reflective debriefing and the simulation were collected using open-ended questionnaires. A clinical nurse educator, a faculty member and the first author participated in a group discussion to review the time plan and the affective components of the teaching intervention. RESULTS: Participants reported that the reflective debriefing helped them understand their cognitive processes during the simulation and contributed to clinical judgment development and to their care prioritization and assessment capacities. Observers reported the time plan was adequate and that attention to participants' negative feelings was necessary. CONCLUSION: The results of this pilot test provide preliminary information that reflective debriefing may be a safe and potentially effective way for novice critical care nurses to learn from a clinical experience and enhance clinical judgment.

[The contribution of nursing science to interprofessional knowledge development]. / Contribution des sciences infirmières au développement des savoirs interprofessionnels.

Health professionals have to work together to ensure quality patient care.There are many studies exploring interprofessional education and practice. However, interprofessional knowledge is related to teamwork and organizational context. Some frameworks include "patient-centered" concepts to highlight the contribution of the patient but descriptions of the patient's contribution to the interprofessional practice are limited. Nursing professionals develop extensive expertise as a patient-centered professional practice and their experience can inspire new collaborative approaches.This article aims to summarize the state of knowledge regarding interprofessional practice and patient-centered nursing expertise.We also highlight the contribution of nursing in developing this approach and the ways in which nursing contributes to the development of interprofessional knowledge that is consistent with its values.

Key conditions for the successful implementation of evidence-based practice in concurrent disorder nursing care with the ECHO® model: Insights from a mixed-methods study.

Background: People with concurrent mental health and substance use disorders have complex biopsychosocial problems but risk not having their healthcare needs met. Nurses are positioned to meet these needs but often lack training in concurrent disorder management. Extension for Community Healthcare Outcomes (ECHO®, University of New Mexico Health Sciences Center, 2003) is a promising technology-enabled collaborative learning model used to implement evidence-based practice and build capacity among healthcare professionals in managing complex, chronic, health conditions. Objective: To understand how an ECHO program for concurrent disorder management impacts nurses' competency development and clinical practice and uncover key conditions for successful uptake and implementation. Design: A convergent mixed-methods design comprising a quantitative, uncontrolled before-and-after study and a qualitative study using interpretive description methodology. Setting and participants: An ECHO program for concurrent disorder management was implemented in 2018 at a quaternary academic hospital centre in metropolitan Western Canada. All 65 nurses who registered in the program between 2018 and 2020 were invited to participate in the study. Methods: Online surveys completed by the participating nurses (N = 28) were administered at baseline and six and 12 months following entry-to-program to measure changes in nurse-related outcomes. The survey data were analyzed using descriptive statistics and repeated measures analysis. Semi-structured interviews were conducted with a nurse subgroup (n = 10) to explore how they developed and implemented competencies and what factors influenced this process. Interview transcripts were analyzed using inductive thematic analysis. Using the Pillar Integration Process, we analyzed results from both methods to provide a richer understanding of the phenomena. Results: We identified six interrelated key conditions for successful uptake and implementation of evidence-based practice in concurrent disorder nursing care with ECHO: (1) Practice and validation opportunities; (2) Reciprocal and trusting relationships in an interprofessional education context; (3) Peer-to-peer experience sharing; (4) Collaboration with experts; (5) Reinforcement of positive attitudes towards one's professional role; and (6) Organizational support. Conclusions: Outcome measures, perspectives, and experiences collected over 12 months indicated that ECHO contributed to nurses' competency development and, under some conditions, to effective nursing practice changes. Given the challenges in implementing clinical guidelines in concurrent disorder nursing care, our results highlight the importance of understanding the key conditions for successful uptake and implementation. This informs approaches to optimally adapt implementation strategies to the needs and specificities of nurses to obtain impactful and sustainable results.

Improving the self-efficacy, knowledge, and attitude of nurses regarding concurrent disorder care: Results from a prospective cohort study of an interprofessional, videoconference-based programme using the ECHO model.

Several challenges have been identified for patients with concurrent disorders to access adequate services and for nurses to care for them. These challenges contribute to a pressing need for continuing educational interventions, particularly within the mental health nursing workforce. To address this issue, an innovative interprofessional videoconferencing programme based on the ECHO® model (Extension for Community Healthcare Outcomes) was implemented in Quebec, Canada to support and build capacity among healthcare professionals for CD management. The aim of this prospective cohort study was to examine nurses' self-efficacy, knowledge, and attitude scores over a 12-month period. All nurses who registered in the programme between 2018 and 2020 were invited to participate in the study (N = 65). The data were collected online using a self-administered survey at baseline, after 6 months, and then 12 months following entry-to-programme. Twenty-eight nurses participated in the study (96.4% women), with a mean age of 39.1 (SD = 6.2). Compared to other professions (n = 146/174), the group of nurses also showed significant improvements in their knowledge and attitude scores, with respective effect sizes of 0.72 and -0.44 at 6 months, and 0.94 and -0.59 at 12 months. However, significant changes in self-efficacy were only found at the 12-month follow-up (P = 0.0213), among the nurses who attended more than 25% of the 20-session curriculum. ECHO is a promising intervention to improve the accessibility of evidence-based practice and to support nurses in suitably managing concurrent disorders. Further research is needed to establish the effectiveness of this educational intervention on clinical nursing practice and patient outcomes.

Multicentre implementation of a nursing competency framework at a provincial scale: A qualitative description of facilitators and barriers.

RATIONALE: Nurses are responsible for engaging in continuing professional development throughout their careers. This implies that they use tools such as competency frameworks to assess their level of development, identify their learning needs, and plan actions to achieve their learning goals. Although multiple competency frameworks and guidelines for their development have been proposed, the literature on their implementation in clinical settings is sparser. If the complexity of practice creates a need for context-sensitive competency frameworks, their implementation may also be subject to various facilitators and barriers. AIMS AND OBJECTIVES: To document the facilitators and barriers to implementing a nursing competency framework on a provincial scale. METHODS: This multicentre study was part of a provincial project to implement a nursing competency framework in Quebec, Canada, using a three-step process based on evidence from implementation science. Nurses' participation consisted in the self-assessment of their competencies using the framework. For this qualitative descriptive study, 58 stakeholders from 12 organizations involved in the first wave of implementation participated in group interviews to discuss their experience with the implementation process and their perceptions of facilitators and barriers. Data were subjected to thematic analysis. RESULTS: Analysis of the data yielded five themes: finding the 'right unit' despite an unfavourable context; taking and protecting time for self-assessment; creating value around competency assessment; bringing the project as close to the nurses as possible; making the framework accessible. CONCLUSION: This study was one of the first to document the large-scale, multi-site implementation of a nursing competency framework in clinical settings. This project represented a unique challenge because it involved two crucial changes: adopting a competency-based approach focused on educational outcomes and accountability to the public and valorizing a learning culture where nurses become active stakeholders in their continuing professional development.

Journal club in a critical care unit: an innovative design triggering learning through reading and dialogue.

Journal club has been used for decades to incorporate reading clinical and research articles into professional practice of numerous health care providers to disseminate knowledge and to bridge the gap between research and clinical practice. In this article, the authors describe how such activity was implemented by and for the nursing team of an intensive care unit. This journal club was designed to trigger dialogue among the nurses related to cardiac surgery topics, while providing an organizational support for them aimed to facilitate the incorporation of reading in their professional habits. More specifically, the design of this journal club was intended to create an opportunity for these nurses to keep their practice updated, to review physiological or pathological processes related to the cardiac surgery population, and to explore if how and why the results described in those research reports should be implemented in their own intensive care unit. The authors describe the phases of this project: the co-development of the journal club, the implementation of the activity and its results. The authors detail how this journal club format incorporated additional teaching aids during each session and used narrative pedagogy as a conceptual framework.

[Cultural safety: a concept analysis]. / La sécurité culturelle culturelle analyse du concept.

Cultural safety is a concept that is getting more attention in scientific literature related to the cultural dimension of care. Difficulty to grasp the meaning and implications for research, education and practice is frequently raised by the authors. A concept analysis inspired by the evolutionary method of Rodgers was performed to better understand its meaning and its utility to the various fields of nursing. A systematic review of the literature was conducted in the databases CINAHL, PsycINFO, MEDLINE, EMBASE, ERIC, and Sociological Abstracts to identify literature published between 1988 and 2012 and containing the expression "cultural safety". 68 documents were analyzed. Findings included attributes, antecedents and consequences of cultural safety. The evolution of cultural safety through the various sociocultural and political contexts and application domains is also addressed. Issues related to the definition and operationalization of the concept, as well as the ability to export it out of its context of emergence, are discussed. The concept of cultural safety needs further development and a theoretical integration before reaching a conceptual clarity and effective operationalization.