Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study.

BACKGROUND: Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana. AIM: To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers. STUDY DESIGN: The study employed a descriptive qualitative design. The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist. RESULTS: Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes. CONCLUSION: The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice. RELEVANCE TO CLINICAL PRACTICE: Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.

Concepts of family-centered care at the neonatal and paediatric intensive care unit: A scoping review.

BACKGROUND: Understanding family-centred care (FCC) concepts is critical for its implementation in any context. The researchers synthesised studies on FCC in neonatal and paediatric critical care units in order to present its concepts and gaps in the literature to guide further research in the area. METHOD: The study used the JBI methodology, and the PRISMA-ScR guidelines confirmed the final report. The search for material, with the use of library sources, used Medline via PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Google Scholar, and Wiley Library online for papers published in English from 2015 to 2019 and updated to 2023. RESULTS: From 904 references, 61 studies were identified for inclusion. The majority of the studies (29; 55.77%) were qualitative ethnography and phenomenology. Four themes and ten subthemes emerged from the data to support the main concepts of FCC. CONCLUSION: To guide its useful integration and implementation, more research on family-centred care in neonatal and paediatric intensive care units, involving families, staff, and managers, should be undertaken. PRACTICE IMPLICATION: Findings presented in this review may provide a guide for nurses to adjust nursing interventions for critically ill neonates and children in intensive care units.

Does improved postgraduate capacity shift the balance of power for nurse specialists in a low-income country: A mixed methods study.

AIM: To explore nurse specialists' experiences of change and influence on practice two years after graduating with a postgraduate degree. BACKGROUND: In the absence of further study opportunities for nurses in their own country, a master's degree was introduced to train the first group of nurse specialists in Mozambique. DESIGN: Within a hybrid evaluation framework an exploratory, sequential mixed methods design was followed. METHODS: Qualitative data from focus group interviews with nurse specialists (N = 12) led to five thematic data sets from which survey questions were formulated for the sequential quantitative component. FINDINGS: "Change expectations", "Ambiguous practice environments", "Feeling powerless", "Having some influence" and "Workplace support" were emergent themes from interview data. Areas of positive change occurred in research (100%) and the use of evidence (88.9%) and involvement in decision-making (77.8%). For some change did not happen as anticipated-reasons included lack of nurse mentors to support new graduates (55.6%); lesser respect compared with doctors (44.4%) and poor understanding of the value of a master's degree (44.4%). Improvements in service quality and elevating the status of nursing were areas of greatest influence (77.8%). CONCLUSION: Several enabling and limiting factors were identified in the experiences of change and influence on practice of newly qualified nurse specialists. Tacit change with respect to the value of the degree in improving the status of nursing seems not to have affected nurse specialists' own ability and power to influence practice. Improved postgraduate capacity on its own does not empower nurses in their role as specialists. IMPACT: The findings point to a two-tiered strategy to be developed to dismantle barriers to the empowerment and advancement of nurse specialists. The identification of designated nurse mentors is essential to induct and sustain newly graduated nurse specialists. A clear research policy should be developed that supports the conduct of relevant research and the use of evidence in specialist practice.

South African critical care nurses' views on end-of-life decision-making and practices.

BACKGROUND: Care of patients at the end-of-life (EOL) may be influenced by the experiences, attitudes and beliefs of nurses involved in their direct care. AIM: To investigate South African critical care nurses' experiences and perceptions of EOL care. DESIGN: Cross-sectional survey. METHODS: South African critical care nurses completed a modified version of the 'VENICE' survey tool. Data were collected concerning: attitudes towards EOL care; involvement in EOL decision-making; and beliefs about EOL practices. RESULTS: Of 149 surveys distributed, 100 were returned (response rate 67%). Seventy-six percent stated that they had had direct involvement in EOL care of patients, but a minority (29%) had participated in EOL decision-making processes. Whilst most nurses (86%) were committed to family involvement in EOL decisions, less than two thirds (62%) reported this as routine practice. When withdrawing treatment, around half (54%) of the respondents indicated they would decrease the inspired oxygen level to room air, and the majority (84%) recommended giving effective pain relief. Continued nutritional support (84%) and hydration (85%) were advocated, with most nurses (62%) indicating that they were against keeping patients deeply sedated. Most respondents (68%) felt patients should remain in intensive care at the end of life, with the majority (72%) supporting open-visiting, no restriction on number of family members visiting (70%), and the practising of religious or traditional cultural EOL rituals (93%). CONCLUSIONS: The involvement of Johannesburg critical nurses in EOL care discussions and decisions is infrequent despite their participation in care delivery and definite views about the process. RELEVANCE TO CLINICAL PRACTICE: Use of formal guidelines and education is recommended to increase the nurses' involvement in and their confidence in participating in EOL decisions. Educators, managers, senior nurses and other members of the multi-disciplinary team should collaborate to enable critical care nurses to become more involved in EOL care.

Effectiveness of handover practices between emergency department and intensive care unit nurses.

Background: Nurses from the emergency department (ED) and the intensive care unit (ICU) must interact during the handover procedure. Factors such as unit boundaries, the interaction between different specialities, patient acuities, and treatment adjustments generate specific negotiating and teamwork problems during the transition of patients from ED to ICU. Objective: This study aimed to describe the opinions of nurses regarding the effectiveness of handover practices between nurses in the ED and ICU in a major academic hospital in Gauteng province, South Africa. Method: An analytical cross-sectional survey design was used. Data were collected using a 16-item handover evaluation tool. It comprises two sections (1) biographical details and (2) 16 statements about handover quality divided into five constructs, namely information transfer, shared understanding, working atmosphere, overall handover quality, and circumstances of handover. Data analysis was done utilising descriptive and non-parametric statistics. Results: The majority (51.8%; n = 115) of the handovers occurred during the day. Out of 171 nurses, there were specialist practice emergency (19.2%; n = 33) and intensive care (28.0%; n = 48) nurses. There was statistical significance in information transfer between the ED and ICU nurses. (Me = 4.0, p < 0.05), compared to ICU nurses (Me = 3.0). Nurse specialist and non-specialist nurses' handovers differed statistically significantly on 12 of the 16 items on the rating scale, compared to 10 for non-specialist nurses' handovers. Conclusion: The study showed that ED and ICU nurses have significantly different requirements and expectations for handover procedures. In addition to completed documentation, subtle interpretations of the information provided and received also impact the need. The ED and ICU nurses would need to agree on the contents of a structured handover framework because different specialities and departments have varied expectations to achieve an effective handover.

Advancing nursing scholarship: the Mozambique model.

BACKGROUND: Despite the importance of Human Resources for Health for the development and functioning of health systems worldwide, many countries continue to be plagued by poor health systems and a lack of adequate health care. Health systems failures may be attributed to both quantitative and qualitative nursing shortages including the lack of advanced skills to lead health initiatives, to conduct research and to educate other nurses. The response by development partners is usually framed around the production of skilled nurses through the processes of up-skilling and scaling-up. The outcome is expanded practice but with scant attention to the professional advancement of nurses. OBJECTIVES: In this paper we present a two-phased capacity development model that adopted professionalization strategies to advance nursing scholarship and consequent postgraduate specialization of the first cohort of nurses in Mozambique. The main objectives were to: develop and implement a clinical course work master's degree in nursing; and ensure sustainability by capacitating the host institution to continue with the master's programme following graduation. METHODS: Rigorous processes for project discussions, negotiations and monitoring were necessary amid limited resources and a challenging political climate. Forging in-country partnerships, sustaining alliances and government investment are thus key to the success of the Mozambique model. OUTCOMES: Notwithstanding some difficulties, the process unfolded over a five-year period, graduating the first cohort of 11 senior nurses with a master's degree, specializing either in critical care and trauma nursing, or maternal and neonatal health. CONCLUSIONS: Bridging the skills gap between generalist and specialist nurses is essential for them to manage complex and high acuity cases and to reverse associated morbidity and mortality. We conclude that this model serves as a professionalization strategy to advance nurses' scholarship of clinical practice, research and teaching.

Consensus forum: worldwide guidelines on the critical care nursing workforce and education standards.

This article explores the key themes, evidence, and arguments that inform the current position statements. It is acknowledged that future research, evidence, and practice experience may create the need to review and change these guidelines. Reform and refinement of the guidelines are inevitable; however, the current guidelines represent the best attempt yet to reach international consensus on what are appropriate standards to guide critical care nursing education and workforce requirements.

An integrative review of South African cancer nursing research published from 2002-2012.

BACKGROUND: This integrative review aimed to quantify the publication output of South African cancer nursing research conducted between 2002 and 2012 and to identify key trends relevant to cancer nurse researchers. OBJECTIVES: To describe the publication output of cancer nursing research in terms of the journals of publication, authors, focus, participants and methods used, to explore whether the published work was funded and to assess the quality of the studies published. METHODS: An integrative review was conducted using the key words South Africa in combination with cancer nursing and oncology nursing to search the databases Pubmed, PsycINFO, CINAHL, Sabinet, Web of Science, Medline and OvidSP. A data extraction sheet was developed to document the required information from each paper and all publications were reviewed independently by the authors. RESULTS: A total of 181 publications for potential inclusion were identified and 26 papers were included in this review. Cervical cancer, specifically the prevention of this disease, was the most popular diagnostic focus and theme of investigation. Most of the studies were descriptive and none of the studies met the criteria of the highest quality. CONCLUSION: Nursing added to the body of knowledge regarding the primary and secondary prevention of cancer. There is a need for work on both men and women diagnosed withthe most common cancers, as well as the family and care giver. There is also a need for multidisciplinary work using complex interventions focusing on symptom management to improve patient outcomes.

Restraints in intensive care units--a mixed method study.

UNLABELLED: The use of mechanical restraints is a controversial practice internationally but is common in South African Intensive Care Units (ICUs). Their use was studied in the ICUs of an academic, public hospital in Johannesburg, South Africa. RESEARCH METHODOLOGY: Quantitative data were collected over two months by means of a checklist and analysed by means of descriptive statistics. The patients' length of stay, type of restraint used and duration thereof, the daily nurse patient ratios, as well as information regarding sedation and analgesia were detailed. Individual interviews with twenty medical and nursing ICU clinicians elicited their stated rationale for restraint, their experiences and perceptions of the practice and recommendations for restraint. FINDINGS: Of a total of 219 patients in the three ICUs, 106 (48.4%) were restrained. The average number of days restrained was nine with a range of days from 1 to 53 (in one case only). In only six cases were restraints other than wrist ties used. Forty seven of the restrained patients had sedation and analgesic medication prescribed and 59 not. All participants conceded a place for physical restraint in the ICU, primarily to ensure the safety of patients but were divided as to the reason for restraining patients and disputed the benefits of restraint. CONCLUSION: Poor communication between the team, patients and families and diminished collaboration within the multi-disciplinary team emerged as central concepts in this study and influenced care decisions and practises regarding the use of mechanical restraints in the clinical area.