A hermeneutic-phenomenological study of paediatric intensive care unit nurses' professional identity following hospital redesign: Lessons learned for managers

Voice of the nurse in paediatric intensive care: a scoping review

OBJECTIVES

The objective was to explore how the voice of the nurse in paediatric intensive care units (PICU) is portrayed in the literature.

DESIGN

Scoping review using the six-step scoping review framework outlined by Arksey and O'Malley.

DATA SOURCES

PubMed, Nursing (OVID), Medline (OVID), CINHAL (EBSCO), SCOPUS and Web of Science online databases. The initial search was conducted in June 2020 and was repeated in January 2023.

ELIGIBILITY CRITERIA

The review included publications in English; published since 2010 in peer-reviewed journals; papers identified nurses in the population studied and conducted in PICU.

DATA EXTRACTION AND SYNTHESIS

The papers were screened by abstract and subsequently by reading the full text by two independent reviewers. The literature was imported into the software program NVivo V.12 for thematic analysis.

RESULTS

The scoping review identified 53 articles for inclusion. While the value of seeking the voice of the nurse has been identified explicitly in other healthcare contexts, it has only been identified indirectly in PICU. Four main themes emerged from the data: the voice of the nurse in the organisation of PICU, caring for children in PICU, as a healthcare professional, and communication in PICU.

CONCLUSION

While this literature suggests many facets of the complex role of the nurse, including partnership with families and advocating for patients, the limited literature on care delivery reduces the capacity to fully understand the voice of the nurse at key junctions of care. Further research is needed on the voice of the nurse in PICU to illuminate the barriers and enablers for nurses using their voices during decision-making.

Humanisation in paediatric intensive care units: A narrative review

OBJECTIVE

To identify findings in the scientific literature relevant to the strategic lines proposed by the Humanising Intensive Care Project in the context of paediatric intensive care units.

DESIGN

Narrative review.

METHODS

A literature search was conducted in the databases PubMed, Scopus, CINHAL, and Cochrane Library. Specific indexing terms and search strategies adapted to each database were designed. The inclusion of publications was based on two criteria: 1) related to the paediatric intensive care unit and 2) addresses at least one of the topics related to the strategic lines of the Humanising Intensive Care Project. Study selection was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the quality of the included studies was assessed using the Mixed Method Appraisal tool.

RESULTS

A total of 100 articles from 19 different countries were included, covering the period between 2019 and 2021. Nineteen different design types were identified. Thirty-two studies were cross-sectional observational studies, while 15 had an experimental approach. The articles were distributed among the seven strategic lines of the Humanising Intensive Care Project.

CONCLUSIONS

Synthesising the knowledge related to humanisation in paediatric intensive care units will allow progress to be made in improving quality in these units. However, there is disparity in the amount of experimental research overall.

IMPLICATIONS FOR CLINICAL PRACTICE

There is a disparity in the available research related to the different strategic lines, and it is necessary to carry out more exhaustive research on topics such as the presence and participation of the family in care or the management of post-paediatric intensive care syndrome.

Professional identity research in the health professions-a scoping review

Professional identity impacts the workforce at personal, interpersonal and profession levels however there is a lack of reviews of professional identity research across practising health professionals. To summarise professional identity research in the health professions literature and explore how professional identity is described a scoping review was conducted by searching Medline, Psycinfo, Embase, Scopus, CINAHL, and Business Source Complete using "professional identity" and related terms for 32 health professions. Empirical studies of professional identity in post-registration health professionals were examined with health profession, career stage, background to research, theoretical underpinnings and constructs of professional identity being extracted, charted and analysed using content analysis where relevant. From 9941 studies, 160 studies across 17 health professions were identified, with nursing and medicine most common. Twenty studies focussed on professional identity in the five years post-entry to the workforce and 56 studies did not state career stage. The most common background for the research was the impact of political, social and healthcare reforms and advances. Thirty five percent of studies (n = 57) stated the use of a theory or framework of identity, the most common being classified as social theories. Individual constructs of professional identity across the research were categorised into five themes-The Lived Experience of Professional Identity; The World Around Me; Belonging; Me; and Learning and Qualifications. Descriptions of professional identity are broad, varied, rich and multi-layered however the literature is under theorised with current theories potentially inadequate to capture its complexity and make meaningful contributions to the allied health professions.

Status Quo of Occupational Identity of Nursing Staff in Rehabilitation Department and Its Relationship with Work Stressors

Due to the continuous progress of social economy, medical and health technology and the development of disciplines have shown a trend of rapid development. In the current medical environment, quality nursing services are constantly promoted. Nursing staff are dedicated to their work to the best of their ability. Meanwhile, they should be rewarded with corresponding happiness and joy in their work. This study starts from the perspective of nursing management and psychology. On this basis, it investigates the occupational identity and work stress status of nursing staff. At the same time, the data are analyzed, and the relationship between occupational identity and work pressure is analyzed. This article provides a certain theoretical basis and support for the decision-making of relevant nursing managers, and also makes efforts to improve the professional identity and work happiness of nursing staff. In this study, which surveyed 596 rehabilitation nurses, the nurses' total occupational stress score was 74.52, with an average score of 2.12 points. The overall score for professional identity was 102.00, with an average score of 3.40 points. This belonged to the medium level. It showed that the occupational pressure of nurses should be paid attention to by relevant managers. Two of the five dimensions with the highest scores were occupational social support and occupational self-reflection. A negative correlation was found between occupational stress and its dimensions and occupational identity and its dimensions (P < 0.01).

Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods

OBJECTIVE

To provide a taxonomy of spatial observation methods that are commonly used in healthcare environments research and to describe their relative success.

BACKGROUND

Spatial observation is a valuable but resource intensive research method that is often used in healthcare environments research, but which frequently fails to deliver conclusive results. There is no existing catalog of the different spatial and behavioral observation methods that are used in healthcare design research and their benefits or limitations.

METHODS

The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ten key databases were searched, and articles were screened by both authors.

RESULTS

Across 67 included studies, 79 observation methods were reported. We categorized those into four, distinct methodological approaches, outlining the benefits, limitations, and suitability of each for obtaining different types of results. Common limitations included difficulty generalizing to other contexts and a lack of detailed description during data collection which led to key environment variables not being recorded. More concrete conclusions were drawn when observation methods were combined with complimentary methods such as interview.

CONCLUSIONS

The relative success of spatial observation studies is dependent on the fit of the method selected relative to the research question, approach, and healthcare setting; any complimentary methods delivered alongside it; and the analysis model employed. This article provides researchers with practical advice to guide the appropriate selection of spatial observation methods.

Supporting the Professional Identity Development of Nursing Alumni: A Phenomenology Study

BACKGROUND: Professional identity is the expected outcome of nursing educational institutions reflected in the values, beliefs, attitudes, and behavior of nursing alumni as professional nurses. Nursing alumni’s experiences at the Bachelor nursing program in Universitas Muhammadiyah Yogyakarta (UMY) related to professional identity development (PID) at various nursing careers need to be explored. AIM: This study aims to describe Ners alumni in PID at Universitas Muhammadiyah Yogyakarta (UMY). METHODS: This study was a phenomenological approach with a maximum variation sampling technique. Seventeen nursing alumni who have been working as professional nurses for a minimum of two years and worked in various nursing careers were recruited. A semi-structured interview between 60-90 minutes was conducted. Data analysis used Colaizzi’s methods and Nvivo 12TM Plus. RESULTS: There were two themes emerged from data; 1) Internal motivation to enhancing nursing career, with two sub-themes: having a great personal motivation and developing expertise, 2) External support driving nursing career, with five sub-themes: family encouragement, supports from a leader, accreditation and credential, exemplary role model and positive nursing image. CONCLUSION: Nursing alumni engaged in a variety of professional roles that contributed to the nursing workforce. The supporting of PID impacts personal and professional capability and strengthens nurses’ careers.

“I Internalize Islamic Values”: Bachelor Nursing Students’ Perception and Experience of Professional Identity in Indonesia

BACKGROUND: Professional identity is the primary goal of nursing education institutions that shaped professional nurse’s identity. However, final-year bachelor nursing students’ perception and experience of professional identity remain limited to explore. AIM: This study aims to analyze final-year bachelor nursing students’ perception and experience toward professional identity in Indonesia. METHODS: A descriptive qualitative study with a drawing exercise was conducted with a convenience sample of final-year bachelor nursing students to explore how they viewed the nursing profession. Thirteen nursing students were recruited from four academic hospitals of Universitas Muhammadiyah Yogyakarta. Data were analyzed thematically using Colaizzi methods and NVivo 12 Plus. RESULTS: The analysis showed five themes identified, namely, “Islamic nurse is my identity,” “I follow Islamic sharia,” “I internalize Islamic values,” “I practice professional roles,” and “I obey professional regulation.” CONCLUSION: Nursing students perceived the identity of Islamic nurses into their identity. Developing a strong professional identity is essential for the students to enhance a sense of belonging and career choice in the nursing profession.

Towards abandoning the master's tools: The politics of a universal nursing identity

Healthcare environments continue to prove discriminatory and marginalizing towards patients and healthcare workers themselves, which contributes to inequitable health outcomes across lines of socially constructed difference. This content and discourse analysis of nursing identity scholarship asks whether there is a connection between nursing identity and oppressive behaviour by examining the construction of nursing identity and the foundational discourses, sometimes in absentia, that support such a construction. Bourdieu's concepts of social fields and Audre Lorde's concept of the master's house are applied as a framework towards understanding the constructs of power and status in healthcare. The analysis identifies a gap in nursing identity literature where social constructs of difference are not considered. In the reviewed literature, nursing identity has been co-opted by the professionalization project in effort to stabilize a conceptualization of nursing's contribution to healthcare towards gaining professional and societal status. This leads to a monolithic, apolitical representation of nursing identity that erases difference, denies historical influence, universalizes nursing work and further marginalizes marginalized identities. The oppressive and hegemonic nature of a universal nursing identity may contribute to a lack of disciplinary reflexivity about the ongoing influences of foundational discursive constructs of gender, epistemology, power and professional status.