Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain

Intrahospital transport of critically ill patients: Nurse anaesthetists' and specialist ICU nurses' experiences

BACKGROUND

Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice.

AIM

This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses.

STUDY DESIGN

This study adopted a mixed-methods approach.

METHODS

Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics.

RESULTS

Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training).

CONCLUSION

IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care.

RELEVANCE FOR CLINICAL PRACTICE

The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team. Written guidelines about IHT are of utmost importance, and everyone in the team should be aware of and follow the guidelines. It is important to make careful preparations before IHT and to be aware of the possible risks to patient safety. Clinical training and discussions about IHT where patient safety has been impaired are important to increase the whole team's awareness of patient safety during IHT.

Testing a model for person-centred pain management: A systematic review and synthesis guided by the Fundamentals of Care framework

AIMS

To test a model for person-centred pain management using qualitative evidence in the literature and refine it based on the results.

DESIGN

A qualitative systematic review with thematic synthesis using the Fundamentals of Care framework.

METHODS AND DATA SOURCES

A literature search in February 2021 in six scientific databases: CINAHL, PsycInfo, Pubmed, Scopus, Social Science Premium Collection and Web of Science, reported using ENTREQ and PRISMA. Quality assessment was performed for the individual studies. Thematic analysis and the GRADE-CERQual approach were used in the synthesis including the assessment of confidence in the evidence.

RESULTS

The model was tested against the evidence in 15 studies appraised with moderate or high quality and found represented in the literature but needed to be expanded. A refined model with a moderate/high confidence level of evidence presents elements to be used in a holistic care process; The nurse is guided to establish a trusting relationship with the patient and enable communication to identify and meet pain management needs using pharmacological and non-pharmacological management. Nurse leaders are guided to support this process by providing the right contextual conditions.

CONCLUSIONS

The strengths of the confidence level in the refined model, and that it is represented from the nurse and patient perspectives in nursing research across countries and cultures, support our recommendation for empirical evaluation.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The model links the knowledge of pain management elements from individual studies together into actions to be performed in clinical practice. It also outlines the organizational support needed to make this happen. Nurses and nursing leaders are suggested to test the model to implement person-centred pain management in clinical practice.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT

What Problem Did the Study Address? There is a need to transfer available evidence of person-centred pain management into practice to relieve the patient from pain. What Were the Main Findings? Person-centred pain management is of high priority for patients and nurses around the world and can be performed in a holistic care process including patient-nurse trust and communication, supported by contextual conditions to deliver timely pharmacological and non-pharmacological pain management addressing the patient's physical, psychosocial and relational care needs. Where and on Whom will the Research Have an Impact? The model is to be tested and evaluated in clinical practice to guide the providers to relieve the patient from pain.

REPORTING METHOD

Relevant EQUATOR guidelines were used to report the study: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.

Translation and cultural adaptation of the fundamentals of care framework: Are we there yet?

AIM

This paper aims to explore and describe the translation and cultural adaptation of the Fundamentals of Care framework to a Swedish context, and highlight the need for a translated version.

DESIGN

An exploratory, descriptive approach was adopted.

METHODS

A structured forward-backward translation process and cultural adaptation were used, considering situation and recipient as recommended for such process. Data such as literature and documents were collected during 2019-2021. The authors took systematic steps in collaboration with a strategic sample of experts: professional language service providers, clinicians, educators and a linguist.

RESULTS

The framework was mainly translated verbatim. A few fundamental care elements were adjusted to the Swedish language, context and clinical practice. Also, this work clarified the relational elements to be coherently seen as nursing actions. Addressing the need for a translated version was illustrated in activities in research, education and clinical practice.

CONCLUSION

This paper highlights the importance of translating the Fundamentals of Care framework into a country's native language to gain acceptance and application there. Sharing the framework's translated version impacts nursing science, generating a consistent language in the development and conducting of research for the comparison and transferability or generalizability of findings. Together with a cultural adaptation, the translated framework can support and guide researchers, educators and nursing leaders in articulating fundamental nursing care for enacting change. By disseminating the first Swedish version of the framework we encourage a global discussion and sharing of examples of translation and cultural adaptation by others.

IMPACT

The framework's English version has limitations in various context. This paper shows a systematic translation and cultural adaptation process of the framework. We proclaim that this is necessary for nursing leaders and nurses to be able to apply it in guiding nursing practice and leading change.

Perceptions of managers regarding prerequisites for the development of professional competence of newly graduated nurses: A qualitative study

AIM AND OBJECTIVES

To describe perceptions of managers regarding prerequisites for professional competence development of newly graduated nurses following a 1-year residency programme.

BACKGROUND

In general, managers are unsatisfied with the professional competence of newly graduated nurses. Therefore, they have been involved in residency programmes to support the nurses' transition from being nursing students to professional nurses. However, perceptions of managers regarding the professional competence development of nurses have been sparingly studied.

DESIGN/METHODS

Qualitative, descriptive study with a data-driven inductive approach with content analysis to obtain an understanding of the perceptions of nine managers through interviews. EQUATOR checklist COREQ is used (see File S1).

RESULTS

Three themes emerged: (a) the nurses' relationships with their teams and patients, (b) expectations regarding the development of practical skills and leadership skills and (c) prerequisites for continuing learning by supportive structures and a mutual responsibility between the manager and the nurse. Reflection was perceived by the managers as a cornerstone in the learning and development of professional competence. Learning theory was important, but learning practical clinical skills was essential for the nurses to develop competence and be able to perform their work, including being a leader of the team. Some structures discouraged continued learning in the development of professional competence, indicating a gap between the healthcare settings and the basic nursing programme.

CONCLUSIONS

There is a gap between the university and the healthcare settings in maintaining a structure for continued learning, which requires cooperation. This gap and tension can be a driving force for the learning process of competence development. Relationships with team members and patients are considered fundamental for developing professional competence.

RELEVANCE TO CLINICAL PRACTICE

To overcome the gap between the university and the healthcare settings, the managers can facilitate nurses' continued learning by creating structures for reflection.

Engagement under difficult conditions: Caring for patients with acute abdominal pain across the acute-care chain: A qualitative study

BACKGROUND

Studies report that patients with acute abdominal pain do not always receive optimal care and can experience poor pain management, safety failures, and emotional harm. Deeper understanding of how health professionals experience care delivery is needed to improve care to patients with acute abdominal pain.

AIM

To explore, from the perspective of registered nurses and physicians, how care is provided for patients with acute abdominal pain in the acute care chain, and to identify barriers that they describe in the delivery of care.

METHOD

Registered nurses and physicians (n = 19) working in ambulance services, emergency departments, and surgical departments at five hospitals in Sweden were interviewed. A content analysis was performed.

RESULTS

Five categories were identified; interaction: a decisive moment, competence and resources: not always available, guidelines: limited use, medical care: a main focus, and feedback and collaboration: limited across acute care chain.

CONCLUSION

This study adds new insights relating to how health professionals reflect on patient needs and obstacles to satisfying them. To deliver high quality care and meet patients' fundamental needs, there is a need of general guidelines and close collaboration in the acute care chain.

Using communication to manage missed care: A case study applying the Fundamentals of Care framework

AIM

To explore, through the patient's perspective, how patient-provider communication is linked to missed nursing care vs. meeting patients' fundamental care needs.

BACKGROUND

Missed nursing care causes severe consequences for patients. Person-centred fundamental care, in which communication is central, provides an approach to manage this challenge. However, the specific patient-provider communications linked to care outcomes are unknown.

METHODS

Case study using secondary analysis of observations and interviews. A purposeful sample of 20 patients with acute abdominal pain collected using ethnographic methodology at one emergency department and two surgical wards. The Fundamentals of Care framework guided the analysis.

RESULTS

Communications that included the patient as an equal member of the care team were observed to make a difference between adequate and missed nursing care. Four categories were identified: interpersonal respect, humanized context of care, available and accessible communication channels, and mutual holistic understanding of the care needs and care plan.

CONCLUSION

Communication can be an essential tool to avoid missed nursing care and address the critical need for nursing managers to restore the fundamentals of care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers can use this new knowledge of communication to facilitate person-centred fundamental care and thereby avoid missed nursing care.

"We are already person-centred in our practice"-A Qualitative Study of Ambulance Clinicians' Experiences of Person-Centred Care

The concept of person-centred care (PCC) is considered one of the core competencies in Swedish healthcare. It has increasingly spread and involves treating the patient as a person who is decision-competent and part of the team. The PCC concept has been introduced in the Swedish Ambulance Service setting, but as there has been no previous research on PCC in this context, the aim of the present study was to illuminate ambulance clinicians’ experiences of the introduction of PCC in a Swedish Ambulance Service setting. Data collection took the form of interviews with 15 ambulance clinicians in the southernmost part of Sweden. Qualitative content analysis was employed to analyse the interviews, wherein two categories emerged: organisational perspective and contextual culture. The latent meaning was interpreted as the theme: Seeing the individual in need of care as a person instead of a patient. In conclusion, the concept of PCC was considered a barrier and there was some resistance to its introduction. While PCC enhanced the ambulance clinicians’ stance, e.g., when initiating a caring relationship and encouraging the patient to participate in her/his care, it was also described as a catchphrase that is not applicable to the Ambulance Service as it contributes nothing new to the standard of treatment.