Types of nursing knowledge used to guide care of hospitalized patients

With and for the Patient: The Knowledges Embodied in Nurses' Practices-of-Work in Acute Care

While understanding of what nurses do is most commonly framed as using clinical decision-making in completing a range of tasks to meet the care needs of patients, other perspectives show nurses as experiential carers and/or utilising a body of professional knowledge to do this. Taking data from an ethnographic study framed in Bourdieu's theory of practice, this paper aims to extend understanding of how nurses in acute care accomplish nursing-in-practice by utilising reconnaissance, a conceptualisation of nursing practice knowledges, as a vocabulary to further analyse these data. In this new way of thinking about what nurses do, nursing-as-it-happens is shown to be not about nurses making decisions as such, but about how nurses use contextualised knowledge to activate practices that respond to what needs to be done for patient care in the context of each practice situation. Focusing attention on what nurses accomplish in their daily practices-of-work reveals nurse agency as working with and for the patient. This enables recognition of how nurses working with multiple patients on a shift can make adjustments to their practices in light of unfolding situations and, when necessary, bring each of those patients as persons to the centre of their practice.

Coping after the COVID-19 pandemic: nurses' learning intent and implications for the workforce and education

BACKGROUND/AIM

Addressing the critical global shortage of nurses requires an understanding of how a global pandemic reshaped nurses' motivations and intentions toward education. This study aimed to describe COVID-19's impact on nurses' intent to pursue additional education.

METHOD

This descriptive study, based in North Carolina in the USA, used content analysis with an inductive approach to examine the responses of nurses to one open-ended question in a large quantitative workforce survey: how has COVID-19 influenced your plans for future education? Responses were coded with counts and organised into themes and subthemes.

FINDINGS

Primary themes identified from the data included: stressors, appraisals and coping. There were 10 subthemes, which supported primary themes with direct quotes from nurses. The implications of the themes aligns with concepts from the self-determination theory: autonomy, competence and relatedness.

CONCLUSION

Nurse responses to the pandemic can guide organisations and academic institutions in supporting nurses in times of stress and design programmes that align with their goals. Nursing leaders and educators must support nurses' autonomy, competence and relatedness, addressing issues such as burnout, financial strain, work-life balance and evolving professional demands. Academic institutions should adopt flexible, resilience-focused curricula and invest in skilled nurse educators to support the growing need for advanced education and online learning.

Análise de particularidades da participação lusófona em uma Rede de Conhecimentos em Enfermagem

Resumo Objetivo Descrever o exercício conceitual de reflexão sobre as possibilidades e particularidades da participação das Escolas de Enfermagem e Faculdades de Enfermagem lusófonas na Rede de Conhecimentos em Enfermagem. Método Análise das informações obtidas em um levantamento de recursos institucionais de acordo com o marco conceitual proposto por Prug e Prusak sobre rede de conhecimentos. A ponderação de aspectos positivos e negativos - analisando o aprendizado com as informações - levou em consideração as possíveis soluções para um plano de ação. Resultados Tanto nas ações institucionais para suportar a pesquisa em Enfermagem como nos benefícios almejados com a participação na Rede existe o interesse na internacionalização da pesquisa e no trabalho colaborativo. Com a ampliação dos horizontes da ciência da Enfermagem lusófona, este trabalho visa aumentar o impacto da pesquisa e agilizar a divulgação e a utilização dos resultados, tanto na educação como na clínica. Conclusão e Implicações para a prática A participação das referidas instituições oferece inúmeras possibilidades de demonstrar originalidade, criatividade e perícia de sua prática docente e de pesquisa, favorecendo o compartilhamento de ideias e práticas. A prática de produção científica, por docentes e discentes, pode ser aprimorada pelo refinamento de modos de pensar, criar, produzir e disseminar.

Analysis of the particularities of Lusophone participation in a Nursing Knowledge Network

Abstract Objective To describe the conceptual exercise of reflecting on the possibilities and particularities of the participation of Lusophone schools of nursing in the Nursing Knowledge Network. Method An analysis was conducted using information obtained from an environmental scan of institutional resources following the conceptual framework by Prug and Prusak on the knowledge networks. The learnings reported in the analysis are based on the collected information and reflections on the positive and negative aspects of participation, while proposing possible solutions for an action plan. Results There is interest in the internationalization of research and collaborative work both as institutional actions to support nursing research and potential benefits due to participation in the Network. The collaborative work has potential to increase the impact of research, expedite dissemination and use of results both in education and in clinical practice, broadening the horizons of Lusophone nursing science. Conclusion and Implications for practice Participation of these institutions in the Network offers numerous possibilities to demonstrate the originality, creativity and expertise of their teaching and research practice, encouraging the sharing of ideas and practices. The practice of scientific production in all its scenarios by educators and students can be improved through refined ways of thinking, creating, producing, and disseminating knowledge.

Taking into account patient preferences in personalised care: Blending types of nursing knowledge in evidence-based practice

AIMS AND OBJECTIVES

To explore how excellent nurses in hospitals take into account patient preferences in nursing decision-making in the evidence-based practice towards personalised care.

BACKGROUND

In evidence-based practice, nursing decision-making is based on scientific evidence, evidence of best practice and individual patient preferences. Little is known about how nurses in hospitals take into account patient preferences in nursing decision-making.

DESIGN

Qualitative grounded theory.

METHODS

Data collection entailed 27 semi-structured interviews with nurses designated by their colleagues as excellent caregivers, followed by 57 hours of participant observation. Data analysis was conducted using three-level coding with constant comparison and theoretical sampling. The COREQ checklist for qualitative research was followed.

RESULTS

A main finding was that participants used three implicit tools to discover patient preferences: establishing a connection, using antennae and asking empathic questions, thus instantly reassuring patients from the very first contact. Their starting point in care was the patient's perception of quality of life wherein they shifted towards their patient's perspective: "Teach me to provide the best care for you in this situation." During the observations, it was confirmed that the excellent nurses behaved as they had described before.

CONCLUSION

Excellent nurses actively turn towards patients' expectations and experienced quality of life by carefully blending individual sensitive and situation specific patient preferences with scientific evidence and evidence of best practice. In doing so, they are able to balancing more equally patient preferences in to the equation called evidence-based practice, thus leading to wise decision-making in personalised nursing care.

RELEVANCE TO CLINICAL PRACTICE

Patient preferences become a fully fledged part of nursing decision-making in EBP when in education and practice, the implicit knowledge of excellent nurses about how to take into account patient preferences to provide personalised care is more valued and taught.

New Directions in Pediatric Palliative Care Education for Preclinical Medical and Nursing Students

OBJECTIVES

Since insufficient education has partially contributed to challenges in providing pediatric palliative care (PPC), a cross-sectional questionnaire study was conducted to explore the knowledge, attitudes, and educational needs of preclinical medical and nursing students in Hong Kong.

METHODS

Pretested self-administered 44-item questionnaires with written informed consent were distributed to 241 medical and nursing students at Li Ka Shing Faculty of Medicine, the University of Hong Kong, between February and March 2019. This questionnaire covered eleven categories related to participants' knowledge of and attitudes towards PPC. A convenience sampling method was used. Data analysis was performed with descriptive statistics, chi-squared, and Fisher's exact test.

RESULTS

Only 38.3% of participants had heard of PPC before, but 73.5% advocated for its local commencement. A large number, with more in nursing, misunderstood fundamental palliative concepts and pain assessment methods. Many reported that undergraduate curricula should include PPC since they were not prepared to deal and cope with dying children. More medical students identified multidisciplinary approaches in PPC while less believed that they were mentally prepared to discuss death and dying. The majority indicated family as the final decision maker, even for teenage patients. Although a large proportion agreed that PPC should be delivered at home since the diagnosis of a life-limiting illness, only a few were aware of the suggested referral structure.

CONCLUSIONS

Most healthcare students were supportive of PPC despite their limited exposure. PPC education on palliative principles, pain management, multidisciplinary approaches, and emotional coping skills is needed and welcomed among students.

Implementation of the evidence for the improvement of nursing care to the critical patient's family: a Participatory Action Research

BACKGROUND

There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Therefore, the purpose of the study is to understand the change process aimed at improving care to critical patient's families, and to explore the evolution of patterns of knowing that nurses use in this process.

METHODS

Qualitative study with a Participatory Action Research method, in accordance with the Kemmis and McTaggart model. In this model, nurses can observe their practice, reflect upon it and compare it with scientific evidence, as well as define, deploy and evaluate improvement strategies adapted to the context. Simultaneously, the process of empowerment derived from the Participatory Action Research allows for the identification of patterns of knowing and their development over time. The research will take place in the Intensive Care Units of a tertiary hospital. The participants will be nurses who are part of the regular workforce of these units, with more than five years of experience in critical patients, and who are motivated to consider and critique their practice. Data collection will take place through participant observation, multi-level discussion group meetings and documentary analysis. A content analysis will be carried out, following a process of codification and categorisation, with the help of Nvivo10. The approval date and the beginning of the funding were December 2012 and 2013, respectively.

DISCUSSION

The definition, introduction and evaluation of care strategies for family members will allow for their real and immediate implementation in practice. The study of the patterns of knowing in the Participatory Action Research will be part of the theoretical and practical feedback process of a professional discipline. Also, the identification of the construction and evolution of knowledge will provide decision elements to managers and academics when choosing strategies for increased quality.

Nursing students' perceptions of knowledge: an international perspective

Introduction: Nursing education in Europe is undergoing the development toward greater comparability under the Bologna process. Based on our mutual experiences from teaching in Slovenia and Sweden, the students' perspectives on knowledge and nursing practice became an issue. The aim was to explore Slovenian and Swedish undergraduate nursing students' perceptions of knowledge needed for future practice. Methods: A qualitative study design was applied. A questionnaire with open ended questions was used to collect opinions of 174 nursing students from the University of Ljubljana, Slovenia, and 109 nursing students from the University of Umea, Sweden. Textual data were analysed using qualitative content analysis. Results: Four subcategories were identified, related to the content of knowledge: knowledge about 'bodies and diseases', about 'people and communication'; and to its purpose: 'to do nursing' and 'to be a nurse'. The main theme, 'integration', indicated the students' awareness of the complexity of their future work and the need for a wide integrated knowledge. Discussion and conclusion: There were more similarities than differences between the Slovenian and Swedish students included in the study. The students were aware of the complex responsibilities and expressed the need for integrating various competences. Interprofessional education should become a constitutive part of nursing education programmes.

Exploring sources of knowledge utilized in practice among Jordanian registered nurses

RATIONALE, AIMS AND OBJECTIVES

Understanding sources of knowledge used in everyday practice is very helpful in improving the quality of health care services. There is a consensus in the literature that nurses mostly relied in their practice on experiential knowledge gained through their interactions with other members of health care professionals and patients. The general aim of this study is to explore the sources of knowledge Jordanian registered nurses use during their practice.

METHOD

A descriptive correlational design was used to collect data from 539 Jordanian registered nurses from 10 hospitals using a self-administered questionnaire.

RESULTS

The mean year of experience of the sample was 7.08 years. Of the 615 questionnaires distributed, 555 were returned. This yields a response rate of 87.6%. Results revealed that the top five ranked sources used by Jordanian registered nurses include: the information that nurses learned during nursing education, personal experience in nursing over time, what was learned through providing care to patients, information gained through discussion between physicians and nurses about patients, and information from policy and procedure manuals.

CONCLUSION

Jordanian registered nurses recognize the value of research and that research utilization (RU) is an important issue and must not be ignored. The study has many implications for practice, education and research. Health care managers and decision makers need to play a more visible and instrumental role in encouraging RU to improve patients' quality of life.

Malaysian nurses' skin care practices of preterm infants: experience vs. knowledge

This study sought to explore the impact of Malaysian nurses' perceptions, knowledge and experiences in preterm infant skin care practices using a descriptive approach. Questionnaires were distributed to Neonatal Intensive Care Unit (NICU) nurses in one teaching hospital in Malaysia. A knowledge gap was revealed among nurses in both theoretical and practical knowledge of preterm infant skin. Nurses working for more than 5 years in NICU or having a Neonatal Nursing Certificate (NNC) were not predictors of having adequate knowledge of preterm infants' skin care. The results highlight the complex issue of providing effective skin care to preterm infants. However, a specific finding related to nurses' confidence provides some direction for future practice and research initiatives. Clear clinical evidence-based guidelines and Continuing Nursing Education on relevant topics of preterm infants' care may provide the required knowledge for the nurses.

Tinkering and tailoring individual consultations: how practice nurses try to make cardiovascular risk communication meaningful

AIMS AND OBJECTIVES

To explore the perspectives of practice nurses in their role of communicating cardiovascular risk to patients.

BACKGROUND

Nurses in primary care have for some time been engaged in cardiovascular risk discussions with patients. With the recent introduction of the NHS Health Checks, the focus on this work is set to increase.

DESIGN

Qualitative using a framework approach.

METHODS

Two focus groups and 16 semi-structured interviews were conducted with nurses purposively sampled from those working in primary care.

RESULTS

The nurses' accounts revealed the need to develop a relationship of trust and establish a level of relevance with each individual patient whilst discussing cardiovascular risk. Potential aspects of these discussions were as follows: working within a highly structured data-collecting task; time constraints and consideration of the individual's context. We used the idea of tailoring to describe how nurses navigate and constantly modify and pitch their approach for each patient they see in response to these constraints.

CONCLUSION

We suggest that in order for risk to be made meaningful to patients, practice nurses recognise the need for such information to be embedded in the more reciprocal dynamics of nurse-patient consultations. From their perspective, success is often as much about not saying something, or saying it in a particular way, as saying anything accurately or consistently.

RELEVANCE TO CLINICAL PRACTICE

For practice nurses to be instrumental in the successful delivery of health prevention policy initiatives such as the NHS Health Checks, it is important to acknowledge their views and perspectives in undertaking this work. This study suggests that the nurses recognised the need for further skills and a refinement of approach for those health professionals involved.

Knowledge use in nursing practice: the importance of practical understanding and personal involvement

Understanding knowledge use in everyday nursing practice is important to the improvement of educational preparation and quality in health care. This paper reports registered nurses' experiences in different parts of the Norwegian health care system. The aim of the study was to elucidate nurses' experiences of knowledge use in work situations. Eleven nurses, each with two to three years of experiences after graduation, participated in both in-depth interviews and focus group interviews in 2006. A qualitative hermeneutic approach, inspired by Gadamer's philosophy, guided the research process and the analysis and interpretation of the transcribed interview-texts. Experiences related to coping with frequent changes and complexity in work situations were captured in this study. The participants emphasised that knowledge use is connected to their ability to get involved in and assess particular situations, and so is their skill in integrating situational experiences into their existing knowledge framework. A challenge in nursing education is as follows: for students to understand these interpretive modes of knowledge use and to develop personal abilities, they should have access to and be active participants in certain health care situations, and they should have the opportunity to reflect on acting personally in professional relationships.

The meaning of autonomy in nursing practice

AIM

To illuminate the meaning of nurses' experiences of autonomy in work situations.

BACKGROUND

Professional autonomy means having the authority to make decisions and the freedom to act in accordance with one's professional knowledge base. An understanding of autonomy is needed to clarify and develop the nursing profession in rapidly changing health care environments and internationally there is a concern about how the core elements of nursing are taken care of when focusing on expansion and extension of specialist nursing roles.

DESIGN

Qualitative study.

METHODS

This paper reports part of a project aimed at exploring the education and work qualifications required by the nursing profession. Eleven Norwegian nurses, each with 2-3 years of work experience since graduation, participated in both in-depth interviews and focus group interviews in 2006. A qualitative hermeneutic approach, inspired by Gadamer's philosophy, guided the research process and the analysis and interpretation of the transcribed interview-texts.

RESULTS

The nurses' descriptions of their experiences of autonomy in work situations emerged as four themes: 'to have a holistic view', 'to know the patient', 'to know that you know' and 'to dare'. To be knowledgeable and confident was found to be the coherent meaning of autonomy in nursing practice.

CONCLUSIONS

Authority of total patient care, the power to make decisions in a relationship with the patient and next of kin and the freedom to make clinical judgements, choices and actions seem to be connected to the meaning of autonomy in nursing practice.

RELEVANCE TO CLINICAL PRACTICE

To gain autonomous practice, nurses must be competent and have the courage to take charge in situations where they are responsible. This study shows the challenges in handling this autonomous practice.

The research evidence published in high impact nursing journals between 2000 and 2006: a quantitative content analysis

BACKGROUND

Evidence-based practice has become an imperative for efficient, effective and safe practice. Furthermore, evidences emerging from published research are considered as valid knowledge sources to guiding practice.

OBJECTIVES

The aim of this paper is to review all research articles published in the top 10 general nursing journals for the years 2000-2006 to identify the methodologies used, the types of evidence these studies produced and the issues upon which they endeavored.

DESIGN

Quantitative content analysis was implemented to study all published research papers of the top 10 general nursing journals for the years 2000-2006.

METHODS

The top 10 general nursing journals were included in the study. The abstracts of all research articles were analysed with regards the methodologies of enquiry, the types of evidence produced and the issues of study they endeavored upon. Percentages were developed as to enable conclusions to be drawn.

RESULTS

The results for the category methodologies used were 7% experimental, 6% quasi-experimental, 39% non-experimental, 2% ethnographical studies, 7% phenomenological, 4% grounded theory, 1% action research, 1% case study, 15% unspecified, 5.5% other, 0.5% meta-synthesis, 2% meta-analysis, 5% literature reviews and 3% secondary analysis. For the category types of evidence were 4% hypothesis/theory testing, 11% evaluative, 5% comparative, 2% correlational, 46% descriptive, 5% interpretative and 27% exploratory. For the category issues of study were 45% practice/clinical, 8% educational, 11% professional, 3% spiritual/ethical/metaphysical, 26% health promotion and 7% managerial/policy.

CONCLUSIONS

Published studies can provide adequate evidences for practice if nursing journals conceptualise evidence emerging from non-experimental and qualitative studies as relevant types of evidences for practice and develop appropriate mechanisms for assessing their validity. Also, nursing journals need to increase and encourage the publication of studies that implement RCT methodology, systematic reviews, meta-synthesis and meta-analysis methodologies. Finally, nursing journals need to encourage more high quality research evidence that derive from interpretative, theory testing and evaluative types of studies that are practice relevant.