Understanding the process of people with hypersensitivity pneumonitis implementing continuous antigen avoidance and their affecting situations: A grounded theory study.

AIMS AND OBJECTIVES: To explore the process by which people with hypersensitivity pneumonitis implement continuous antigen avoidance, alongside the situations that influence this process. BACKGROUND: Antigen avoidance is the primary treatment for people with hypersensitivity pneumonitis. However, the best method to support antigen avoidance has not yet been established. DESIGN: The present qualitative study used a constructivist grounded theory approach. METHODS: The participants were inpatients or outpatients with hypersensitivity pneumonitis diagnosed at a Japanese urban university hospital. In parallel with semi-structured interviews and a medical record survey from 2016 to 2021, we conducted coding, categorising, writing memos, theoretical sampling and continuous comparisons of experiences from finding physical abnormalities to implementing antigen avoidance. The COREQ checklist was followed for reporting. RESULTS: Interpreting the experiences leading to the implementation of continuous antigen avoidance by 28 participants provided a process consisting of a core category: trying to maintain one's desired life under uncertain situations, and four phases: (1) searching for a convincing cause of the illness, (2) gradually understanding the disease, (3) realising the need for behaviour change and (4) seeking a good balance between behaviour change and one's desired life. The situations that influenced the process were also revealed. CONCLUSIONS: Being convinced of the cause of one's illness and realising its severity led to the participants' realisation of the need for a behavioural change to avoid antigens. The uncertainty of the cause of illness and measures taken, a lack of clear advice from healthcare providers and one's desired life influenced participants' implementation of continuous antigen avoidance. RELEVANCE TO CLINICAL PRACTICE: This study provides important insights regarding how healthcare providers should better understand and support people with hypersensitivity pneumonitis in avoiding antigens.

Effects of the project on enhancement of teaching skills in gerontic nursing practice of Indonesian nursing lecturer and clinical nurse preceptor.

The Indonesia health care services require knowledgeable and skilled nurses as professional service providers, especially in a gerontic nursing area. Moreover, widening the gap between academic and clinical practice is also an issue, which affects the care service quality. In these circumstances, the project to enhance the educational skills of nursing lecturers and clinical nurse preceptors in gerontic nursing practice was started in 2020. Japanese nursing education experts provided guidance on the principle theory of nursing practice in basic nursing education and conducted workshops to develop nursing practice materials for 10 Indonesian trainees. The project provided 3 webinars for more than 100 Indonesian nursing lecturers and preceptors each time, 18 workshops and developed 2 virtual reality (VR) materials, 8 supervisions of the trial class and 5 lectures onsite and online. This study aimed to clarify the effects of the project evaluated in the process and its impact using a questionnaire survey and interviews conducted. The results of the questionnaire survey for students showed that 20% of their knowledge and skills in gerontic nursing, increased and the extent of understanding and satisfaction was high. Lecurers and preceptors perceived improvement in their teaching skills, especially in theoretical thinking and evidence-based teaching methods. Notably, "the evaluation from others" would be a facilitating factor of the project. The project effects were clarified and achieved the goal and objectives of the project.

Development of the Nurses' Care Coordination Competency Scale for mechanically ventilated patients in critical care settings in Japan: Part 1 Development of a measuring instrument.

OBJECTIVES: To develop a draft scale measuring nurses' care coordination competency for care of mechanically ventilated patients in critical care settings. METHOD: The scale items and concepts were derived from semi-structured interviews with 28 professionals (14 nurses, eight physicians, three physical therapists, three clinical engineers) who are managing mechanically ventilated critical care patients. A grounded theory approach was used. After content validation by experts, two pilot tests were used to identify and correct non-discriminating items and vague items. After expert approval, the final draft scale was completed. SETTING: Intensive care units of acute care hospitals in Japan. FINDINGS: A scale was drafted with the following six concepts including 51 items of nurses' care coordination competency: (1) understanding care coordination needs (2) devising and clearly articulating the care vision (3) aggregating and disseminating information (4) employing resources (5) promoting team cohesion (6) engaging in situation-based negotiating. The interviewed participants argued that these competencies clearly reflect the inter-professional activities required for well-coordinated and individualised care and improved patient outcomes. CONCLUSIONS: These findings could be utilised to educate and train nursesand establish the awareness that coordinating care is the nurses' responsibility. Future research focusing on its validity and reliability are needed.

Development of the Nurses' Care Coordination Competency Scale for mechanically ventilated patients in critical care settings in Japan: Part 2　Validation of the scale.

OBJECTIVES: To confirm the validity and reliability of the nurses' care coordination competency draft scale for mechanically ventilated patients in Japan. DESIGN/METHOD: In this cross sectional observational study, a draft scale measuring care coordination was distributed to 2189 nurses from 73 intensive care units in Japan from February-March 2016. Based on the valid 887 responses, we examined construct validity including structural validity (exploratory and confirmatory factor analysis), convergent and discriminant validity and internal consistency reliability. SETTINGS: 73 Intensive care units. RESULTS: Exploratory factor analyses yielded four factors with 22 items: 1) promoting team cohesion, 2) understanding care coordination needs, 3) aggregating and disseminating information, 4) devising and clearly articulating the care vision. The four-factor model was confirmed using a confirmatory factor analysis (confirmatory fit index=0.942, root mean square error of approximation=0.062). Scale scores positively correlated with team leadership and clearly identified and discriminated nurses' attributes. Cronbach's alpha coefficient for each subscale was between 0.812 and 0.890, and 0.947 for the total scale. CONCLUSIONS: The Nurses' Care Coordination Competency Scale with four factors and 22 items had sufficient validity and reliability. The scale could make care coordination visible in nursing practice. Future research on the relationship between this scale and patient outcomes is needed.