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Paquette L, Kilpatrick K. L’autonomie décisionnelle d’infirmières de soins intensifs lors du sevrage de la ventilation mécanique : une analyse de concept. Rech Soins Infirm 2021:76-91. [PMID: 33485287 DOI: 10.3917/rsi.143.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Nurses have a leading role in weaning patients from mechanical ventilation (WMV) given their constant presence and their continuous monitoring. To promote proper WMV, nurses must exercise autonomy and be involved in decision-making. However, in certain care contexts, there is little involvement of nurses. The purpose of this text is to establish the characteristics of the concept of autonomous decision-making applied to nursing during WMV. An analysis of this concept was carried out according to the evolutionary method of Rodgers. The identification of the attributes, antecedents, and consequences made it possible to note ambiguity in the definition of this concept. Nurses use autonomous decision-making for the execution of assigned tasks and when they make decisions according to a pre-prescribed decision-making algorithm. Significant foundations for the decision-making autonomy of critical care nurses during WMV emerged from this analysis : scope of practice, in-depth knowledge of the patient, and commitment to the success of WMV. Participation in interdependent decision-making allows nurses to bring the patient’s perspective into decisions. Avenues of reflection have also emerged, including decisions based on evidence to provide new avenues for autonomous decision-making.
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Hossny EK, Sabra HE. The attitudes of healthcare professionals towards nurse-physician collaboration. Nurs Open 2020; 8:1406-1416. [PMID: 33378598 PMCID: PMC8046133 DOI: 10.1002/nop2.756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/13/2020] [Accepted: 10/19/2020] [Indexed: 11/09/2022] Open
Abstract
Aims The current study aims to examine the attitudes of healthcare professionals towards nurse–physician collaboration and to explore the level of satisfaction concerning the quality of collaboration among them. Design A descriptive comparative study design was used to demonstrate attitudes of 338 participants (158 internship nurses, 139 nurses and 41 physicians) working in intensive care units, surgical department and medical department. Methods Two instruments were used, socio‐demographic data sheet and Jefferson scale of attitude towards nurse–physician collaboration (JSANPC), it consisted of 15 items under 4 dimensions. Results The internship nurses have the high score (38.6%) in poor level of satisfaction regarding quality of collaboration between nurses and physicians comparing to staff nurses and physicians. Physicians are satisfied (61%) with the level of collaboration between them and nurses. Staff nurses have the high positive attitude (48.45 (4.03)) towards collaboration between nurses and physicians comparing to physicians and internship nurses. Conclusion Internship nurses were not satisfied with the level of collaboration between nurses and physicians.
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Affiliation(s)
- Eman Kamel Hossny
- Nursing Administration Department, Faculty of Nursing, Assiut University, Assiut, Egypt
| | - Hanaa Esmail Sabra
- Nursing Administration Department, Faculty of Nursing, South Valley University, Quena, Egypt
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Alastalo M, Salminen L, Vahlberg T, Leino-Kilpi H. Knowledge of patient observation among critical care nurses. Nurs Crit Care 2020; 26:341-351. [PMID: 33150722 DOI: 10.1111/nicc.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The clinical observations made by critical care nurses are vital for maintaining patient safety and making appropriate decisions in the care of patients who are critically ill. Evaluating the reliability of observations and applying analytical thinking are essential elements of patient observation. Previous studies of critical care nurses' knowledge have focused either on specific aspects of patient observation or on critical care nursing in general; therefore, the findings are not comprehensive. AIM The aim of this study was to evaluate critical care nurses' level of knowledge in patient observation and to explore the factors that are associated with it. STUDY DESIGN A cross-sectional knowledge test survey with critical care nurses in Finland was used. METHODS Data were collected in seven adult intensive care units in all five university hospitals in Finland between September 2017 and January 2018 by using a knowledge test (20 items) developed for this study. All critical care nurses were eligible to participate. The data were analysed using descriptive and inferential statistics. RESULTS Altogether, 372 nurses responded (response rate 49%). Their average scores in the knowledge test were 77% (mean 15.29/20, SD 2.41) for correct answers, 75% (mean 8.2/11, SD 1.54) in the sum-variable "Evaluating the reliability of observation" and 79% (mean 7.08, SD 1.45) for "Analytical thinking." A higher knowledge level was associated with education in special tasks in an intensive care unit. CONCLUSION The critical care nurses' knowledge level was considered to be suboptimal. There is a need for improving knowledge of patient observation among Finnish critical care nurses to ensure safe and good quality care. RELEVANCE TO CLINICAL PRACTICE Finnish critical care nurses' knowledge of patient observation could be improved by providing specific continuing education for new nurses entering intensive care units and for experienced critical care nurses throughout their career.
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Affiliation(s)
- Mika Alastalo
- The Department of Nursing Science, University of Turku, Turku, Finland
| | - Leena Salminen
- The Department of Nursing Science, University of Turku, Turku, Finland
| | - Tero Vahlberg
- The Department of Biostatistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- The Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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Alastalo M, Salminen L, Jeon Y, Vahlberg T, Leino-Kilpi H. Critical care nurses' self-assessed patient observation skills: a cross-sectional survey study. Nurs Crit Care 2019; 24:268-275. [PMID: 30637884 DOI: 10.1111/nicc.12412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/05/2018] [Accepted: 12/07/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Observing a patient's clinical condition is an important responsibility of critical care nurses and an essential component of their competence. Critical care nurses' patient observation skills contribute to patient safety and quality of care. These observation skills have not been assessed or measured previously. AIM The aim of this study was to measure the self-assessed level of critical care nurses' patient observation skills and to explore the factors associated with these skills. STUDY DESIGN This was a multicentre cross-sectional survey conducted in Finland. METHODS The sample consisted of critical care nurses working at Finnish university hospitals. The data were collected between September 2017 and January 2018 using an instrument developed for the study - Patient Observation Skills in Critical Care Nursing (visual analogue scale 0-100). Descriptive and inferential statistics were used to analyse the data. RESULTS A total of 372 critical care nurses (49%) responded. Finnish critical care nurses assessed their patient observation skills overall as excellent. The bio-physiological foundation was assessed as good, whereas skills in using observation methods and skills in recognizing changing clinical condition were assessed as excellent. Education for special tasks in intensive care units, information searching in scientific journals, working experience in critical care nursing and critical care nurses' perception of critical care as a preferred field of nursing were factors promoting patient observation skills. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE The study provided a novel instrument for measuring critical care nurses' patient observation skills. The instrument may be used as an assessment tool in clinical practice and education. Developing orientation and on-the-job training in intensive care units are essential in assuring critical care nurses' adequate patient observation skills. Patient observation skills could be developed during nursing education by providing students with opportunities for clinical training and applying patient cases in virtual learning environments.
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Affiliation(s)
- Mika Alastalo
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Leena Salminen
- Professor, Department of Nursing Science, University of Turku, Turku, Finland
| | - Yunsuk Jeon
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Biostatistician, Department of Biostatistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Professor, Department of Nursing Science and Nurse Director, Turku University Hospital, University of Turku, Turku, Finland
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Aghamohammadi D, Dadkhah B, Aghamohammadi M. Nurse-Physician Collaboration and the Professional Autonomy of Intensive Care Units Nurses. Indian J Crit Care Med 2019; 23:178-181. [PMID: 31130789 PMCID: PMC6521826 DOI: 10.5005/jp-journals-10071-23149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and aims Poor collaboration between the physicians and the nurses may interfere with nursing performance in patient care. This study aimed to determine the nurse–physician collaboration and professional autonomy of intensive care nurses. Subjects and methods This descriptive correlational study was performed on 126 nurses working in the intensive care units (ICUs) of Ardabil, Iran. The data were collected using the Jefferson scale of attitudes toward physician–nurse collaboration’ (JSAPNC) and the Dempster Practice Behavior Scale (DPBS). The results were analyzed using descriptive statistics (mean, standard deviation, and frequency) and inferential statistics (t-test, ANOVA, and Pearson). Results The mean score of the nurse–physician collaboration was found to be 47.83 ± 3.9, which indicates good collaboration between physicians and nurses in the ICUs. The results showed that 73% of the nurses reported a moderate autonomy and 27% of them considered their autonomy to be high. There was no significant relationship between the nurse–physician collaboration and the professional autonomy of the nurses (p >0.05). Conclusion The nurses who participated in this study had a positive attitude toward collaboration with the physicians and a moderate level of professional autonomy. Interventions may be required to further enhance the level of nurse–physician collaboration and the professional autonomy of nurses. How to cite this article Aghamohammadi D, Dadkhah B, et al. Nurse-Physician Collaboration and the Professional Autonomy of Intensive Care Units Nurses. Indian J Crit Care Med 2019;23(4):178-181.
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Affiliation(s)
- Delshad Aghamohammadi
- Department of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Behrouz Dadkhah
- Department of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Masoumeh Aghamohammadi
- Department of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
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Abstract
Purpose
The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost containment. The authors wanted to find out what professional, personal and organisational factors contribute to that decision-making process. This work follows previous international research that explored missed nursing care using Kalisch and Williams’ MISSCARE survey.
Design/methodology/approach
The authors drew on the care elements used by Kalisch and Williams, asking nurses to tell us how they decided what care to leave out, the conduits for which could include delaying care during a shift, delegating care to another health professional on the same shift, handing care over to staff on the next shift or leaving care undone.
Findings
The findings suggest that nurses do not readily consider their accountability when deciding what care to leave or delay, instead their priorities focus on the patient and the organisation, the outcomes for which are frequently achieved by completing work after a shift.
Originality/value
The actions of nurses implicitly rationing care is largely hidden from view, the consequences for which potentially have far reaching effects to the nurses and the patients. This paper raised awareness to hidden issues facing nurses within a cycle of implicitly rationing care, caught between wanting to provide care to their patients, meeting the organisation’s directives and ensuring professional safety. Rethinking how care is measured to reflect its unpredictable nature is essential.
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Karanikola MN, Giannakopoulou M, Mpouzika M, Nicolaou C, Tsiaousis G, Vouzavali F, Koutroubas A, Papathanassoglou EDE. Perceptions of critical and emergency department nurses regarding changes in their professional role. Rev Esc Enferm USP 2018; 51:e03287. [PMID: 29562039 DOI: 10.1590/s1980-220x2017014403287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Preliminary investigation of the way Greek critical and emergency department nurses conceptualize changes in their professional role. Method A qualitative focus-group methodology was applied. Following purposeful sampling and informed consent of participants. Results Participated eight individuals. The need for enhancement of nurses' participation in decision-making in order for an actual change in their professional role to be achieved was the central theme of participants' narratives. Perceived advancements in professional role performance regarded: evidence-based practice; technology; education, knowledge; clinical skills; research; heightened nurse-physician collaboration. Perceived reasons why these advancements failed to enhance nurses' professional role were lack of meritocracy; competitive relationships; lack of support among nurses; insufficient managerial support; budget limitations. Conclusion Despite advancements in clinical practice, participants did not deem that their professional role was enhanced significantly, as participation in decision-making and control over practice remain limited. Interventions targeted to enhance nurses' participation in clinical decision-making, and overall professional autonomy are recommended.
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Affiliation(s)
- Maria Nk Karanikola
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | - Meropi Mpouzika
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Christiana Nicolaou
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - George Tsiaousis
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Foteini Vouzavali
- Nursing Department, Technological Educational Institute of Athens, Athens, Greece
| | - Anna Koutroubas
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Alastalo M, Salminen L, Lakanmaa RL, Leino-Kilpi H. Seeing beyond monitors-Critical care nurses' multiple skills in patient observation: Descriptive qualitative study. Intensive Crit Care Nurs 2017; 42:80-87. [PMID: 28363593 DOI: 10.1016/j.iccn.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/25/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to provide a comprehensive description of multiple skills in patient observation in critical care nursing. RESEARCH METHODOLOGY Data from semi-structured interviews were analysed using thematic analysis. SETTING Experienced critical care nurses (n=20) from three intensive care units in two university hospitals in Finland. FINDINGS Patient observation skills consist of: information gaining skills, information processing skills, decision-making skills and co-operation skills. The first three skills are integrated in the patient observation process, in which gaining information is a prerequisite for processing information that precedes making decisions. Co-operation has a special role as it occurs throughout the process. CONCLUSION This study provided a comprehensive description of patient observation skills related to the three-phased patient observation process. The findings contribute to clarifying this part of the competence. The description of patient observation skills may be applied in both clinical practice and education as it may serve as a framework for orientation, ensuring clinical skills and designing learning environments. Based on this study, patient observation skills can be recommended to be included in critical care nursing education, orientation and as a part of critical care nurses' competence evaluation.
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Affiliation(s)
- Mika Alastalo
- University of Turku, Department of Nursing Science, 20014 Turun yliopisto, Finland; Laurea University of Applied Sciences, Ratatie 22, 01300 Vantaa, Finland.
| | - Leena Salminen
- University of Turku, Department of Nursing Science, 20014 Turun yliopisto, Finland.
| | - Riitta-Liisa Lakanmaa
- University of Turku, Department of Nursing Science, 20014 Turun yliopisto, Finland; Turku University of Applied Sciences, Joukahaisenkatu 3, 20520 Turku, Finland.
| | - Helena Leino-Kilpi
- University of Turku, Department of Nursing Science, 20014 Turun yliopisto, Finland; Turku University Hospital, PL 52, 20521 Turku, Finland.
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Abstract
OBJECTIVE To identify and prioritize research questions of concern to the practice of pediatric critical care nursing practice. DESIGN One-day consensus conference. By using a conceptual framework by Benner et al describing domains of practice in critical care nursing, nine international nurse researchers presented state-of-the-art lectures. Each identified knowledge gaps in their assigned practice domain and then poised three research questions to fill that gap. Then, meeting participants prioritized the proposed research questions using an interactive multivoting process. SETTING Seventh World Congress on Pediatric Intensive and Critical Care in Istanbul, Turkey. PARTICIPANTS Pediatric critical care nurses and nurse scientists attending the open consensus meeting. INTERVENTIONS Systematic review, gap analysis, and interactive multivoting. MEASUREMENTS AND MAIN RESULTS The participants prioritized 27 nursing research questions in nine content domains. The top four research questions were 1) identifying nursing interventions that directly impact the child and family's experience during the withdrawal of life support, 2) evaluating the long-term psychosocial impact of a child's critical illness on family outcomes, 3) articulating core nursing competencies that prevent unstable situations from deteriorating into crises, and 4) describing the level of nursing education and experience in pediatric critical care that has a protective effect on the mortality and morbidity of critically ill children. CONCLUSIONS The consensus meeting was effective in organizing pediatric critical care nursing knowledge, identifying knowledge gaps and in prioritizing nursing research initiatives that could be used to advance nursing science across world regions.
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Scholes J. What's in this issue? Nurs Crit Care 2015; 19:57-8. [PMID: 24529103 DOI: 10.1111/nicc.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Julie Scholes
- Professor of Nursing and Co-Editor, Nursing in Critical Care
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Georgiou E, Papathanassoglou EDE, Pavlakis A. Nurse-physician collaboration and associations with perceived autonomy in Cypriot critical care nurses. Nurs Crit Care 2015; 22:29-39. [PMID: 25598391 DOI: 10.1111/nicc.12126] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 06/09/2014] [Accepted: 07/22/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Increased nurse-physician collaboration is a factor in improved patient outcomes. Limited autonomy of nurses has been proposed as a barrier to collaboration. This study aims to explore nurse-physician collaboration and potential associations with nurses' autonomy and pertinent nurses' characteristics in adult intensive care units (ICUs) in Cyprus. DESIGN AND METHODS Descriptive correlational study with sampling of the entire adult ICU nurses' population in Cyprus (five ICUs in four public hospitals, n = 163, response rate 88·58%). Nurse-physician collaboration was assessed by the Collaboration and Satisfaction About Care Decisions Scale (CSACD), and autonomy by the Varjus et al. scale. RESULTS The average CSACD score was 36·36 ± 13·30 (range: 7-70), implying low levels of collaboration and satisfaction with care decisions. Male participants reported significantly lower CSACD scores (t = 2·056, p = 0·04). CSACD correlated positively with years of ICU nursing experience (r = 0·332, p < 0·0001) and professional satisfaction (r = 0·455, p < 0·0001). The mean autonomy score was 76·15 ± 16·84 (range: 18-108). Higher degree of perceived collaboration (CSACD scores) associated with higher autonomy scores (r = 0·508, p <0·0001). CONCLUSIONS Our findings imply low levels of nurse-physician collaboration and satisfaction with care decisions and moderate levels of autonomy in ICU nurses in Cyprus. RELEVANCE TO CLINICAL PRACTICE The results provide insight into the association between nurse-physician collaboration and nurses' autonomy and the correlating factors.
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Affiliation(s)
- Evanthia Georgiou
- Education Sector, Nursing Services, Ministry of Health, Nicosia, Cyprus
| | | | - Andreas Pavlakis
- Open University of Cyprus, Health Care Management, Strovolos, Cyprus
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