Nursing expertise: a course of ambiguity and evolution in a concept

Maximization delays decision-making in acute care nursing

The maximization personality trait refers to the tendency to face decision-making situations along a continuum from exhaustively analysing all the options (maximize) to choosing the one that exceeds a subjective threshold of acceptability (satisfy). Research has revealed the influence of maximizing on decision making, although little is known about its possible role in high risk and high uncertainty situations. A sample of 153 active Spanish nurses, with an average experience of 11 years, completed a maximization questionnaire and responded to written vignettes depicting time-demanding decision making in which three options were offered, representing delayed action, non-action, and immediate action. Two vignettes presented critical situations related to acute care during the COVID-19 pandemic, whilst two vignettes presented non-nursing scenarios. People high in maximization took longer to choose and were more likely to choose non-action. No relationship was found between maximization score and the subjective experience of the person making the choice. Maximization had no significant correlation with years of experience nor perceived expertise. Greater perceived expertise was associated with lower indecision and greater confidence. When participants answered nursing vignettes, they took longer to respond, but chose less delayed action and more immediate action. Our results suggest that maximization plays only a relative role in acute care decision-making in nursing, as compared to contextual variables and expertise. They also support a domain general approach to this personality trait. Findings are consistent with Nibbelink and Reed's Practice-Primed Decision Model for nursing.

An Exploration of Nurses' Experience Following a Face-to-Face or Web-Based Intervention on Patient Deterioration

A web-based clinical simulation program, known as FIRST2ACT (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends), was designed to increase the efficacy of clinicians' actions in the recognition and immediate response to a patient's deterioration. This study, which was nested in a larger mixed method project, used ten focus groups (n = 65) of graduate, enrolled, registered nurses, associate nurse unit managers, and general managers/educators/coordinators from four different institutions to investigate whether nurses felt their practice was influenced by participating in either a face-to-face or web-based simulation educational programme about patient deterioration. The results indicate that individuals who were less "tech-savvy" appreciated the flexibility of web-based learning, which increased their confidence. Face-to-face students appreciated self-reflection through performance evaluation. While face-to-face simulations were unable to completely duplicate symptoms, they showed nurses' adaptability. Both interventions enhanced clinical practice by improving documentation and replies while also boosting confidence and competence. Web learners initially experienced tech-related anxiety, which gradually subsided, demonstrating healthcare professionals' resilience to new learning approaches. Overall, the study highlighted the advantages and challenges of web-based and face-to-face education in clinical practice, emphasising the importance of adaptability and reflective learning for healthcare professionals. Further exploration of specific topics is required to improve practice, encourage knowledge sharing among colleagues, and improve early detection of patient deterioration.

Nurse Leader Expertise for Pandemic Management: Highlighting the Essentials

The COVID-19 pandemic requires military nurse leaders in various patient care settings to engage in disaster response. Evidence supports essential leadership attributes for nurses that include skilled communication, organizational influence, and personnel management. Yet, nursing expertise that shapes nurse leader responsibilities during disaster management remains unclear. A description of how military nurse leaders contributed their nursing expertise during the COVID-19 pandemic response at one U.S. Military health care facility is provided to begin to delineate disaster management responsibilities.

Embedded researchers in Australia: Survey of profile and experience across medical, nursing and midwifery and allied health disciplines

AIMS AND OBJECTIVES

This study explores embedded researcher's age, qualifications, research environment and experience in healthcare and academic organisations in Australia and makes comparisons across three core professional disciplines of nursing and midwifery, medicine and allied health.

BACKGROUND

The embedded researcher model, where a researcher is embedded as a core member of the clinical team, offers promise to support the implementation of research evidence into practice. Currently, there is a lack of clarity about how the model has been adopted across the three largest professional disciplines in Australian health care.

DESIGN

A cross-sectional survey was designed and reported, using the STROBE Statement.

METHODS

A purposive sample of embedded researchers was invited to participate in an exploratory online survey. Embedded researchers worked, or had worked, for a minimum of 30% of their time, in a healthcare organisation doing research or building research capacity. Participant responses were extracted from the survey and imported into SPSS for analysis.

RESULTS

Perspectives of 100 Australian embedded researchers were compared across nursing and midwifery (36%, n = 37), allied health (35%, n = 36) and medicine (26%, n = 27). Professional differences are reported in respondents' qualifications and experience, employment conditions and their research cultures and environments. Comparatively, most nursing and midwifery embedded researchers were older, more clinically experienced than allied health respondents, who were more research qualified. Medical-embedded researchers are typically older, more clinically experienced and focussed on producing personally relevant clinical research. Nursing and midwifery embedded researchers reported doing clinical research within their teams, as well as research capacity building, management and clinical practice roles.

CONCLUSIONS

Embedded researchers describe different career trajectories across the three largest professional disciplines in Australian health care.

RELEVANCE TO CLINICAL PRACTICE

Embedded researchers from different professional disciplines enact their work differently. It appears that when they engage in research capacity building via a range of management and networking roles, embedded researchers contribute to their organisation's research culture and receive greater recognition for their achievements.

Exploring the thinking, reasoning and clinical approach of expert child psychiatric nurses

BACKGROUND

Expert nurses are characterized by their deep knowledge of patient situations and understanding of patients in the context of their total situation. We know of no studies that have focused on the expert practice of child/adolescent (C/A) psychiatric mental health (PMH) advanced practice nurse.

OBJECTIVE

The purpose of this study was to gather information on how expert C/A advanced practice psychiatric nurses (APPNs) view their role and assess/treat children and adolescents with complex mental health issues.

METHOD

Expert C/A APPNs were interviewed by one of the two investigators using a semi-structured interview guide. All interviews were audiotaped and transcribed. This was a qualitative descriptive study and in line with that method, interview content was open-coded and examined for themes that were collapsed into categories.

RESULTS

Fifteen C/A PMH APPNs were interviewed. Initial categories that were distilled included descriptions of their commitment to the population, development of families as partners, an expanded approach to medication management, and how they demonstrate expertise.

CONCLUSION

Expert nurses adopt an invaluable approach to children and families-inherently patient and family-centered. They view the child/teen in terms of the multiple contexts of their lives.

A Phenomenographic Approach to Understanding the Expertise of Perioperative Nurses

Understanding the ways that perioperative nurses view the acquisition of expertise may provide foundational information for perioperative nurse educators. Our study aimed to evaluate specific types of expertise exhibited by experienced perioperative nurses and identify how nurses perceived these areas of expertise. We interviewed 20 perioperative nurses working in a university hospital in Korea. We extracted six themes regarding perioperative nursing expertise: sticking to principles, using available resources in complex situations, paying close attention to details, seeing the whole picture, prioritizing actions according to patients' conditions, and organizing a team to maximize efficiency. These findings may help perioperative educators develop practical educational strategies for novice perioperative nurses by providing a common language regarding the areas of expertise exhibited by experienced perioperative nurses.

Expertise among critical care nurses: A grounded theory study

OBJECTIVES

Explore critical care nurses' personal perceptions of expertise, expert performance and transition from novice to expert performer in clinical practice.

DESIGN

Following constructivist approach to grounded theory this investigation used qualitative open-ended interviews focused on the social construction of expertise in critical care nursing and the experiences of clinical practice that define that process.

SETTING

A multi-site urban area in the southeastern United States.

PARTICIPANTS

10 certified critical care nurses, three males and seven females, with 10-30+ years of critical care experience.

FINDINGS

Experience and knowledge are the foundation of expertise and expert performance. The higher the acuity the more frequent the experience the greater the nurses' aptitude and opportunity for learning and professional growth. It was also noted that self-actualisation was a major determinant in the development of expertise in critical care.

CONCLUSION

Key findings suggested that clinical experience and personal motivation combined with self-actualisation, the drive to maximise personal potential, determine critical care nurse's trajectory towards professional excellence. Expert performance evolves over time. Knowledge acquisition and experience have an interdependent reciprocal relationship inferring that you cannot have one without the other. Social expectations and experiences have a direct impact on professional aptitude and development if expertise.

INTENSIVE CARE IN NON-CRITICAL UNITS: REPRESENTATIONS AND PRACTICES OF NOVICE GRADUATE NURSES

ABSTRACT Objective: to analyze the practices of novice graduated nurses in view of their social representations on intensive care to the critical patient provided in non-critical patient units. Method: a qualitative research, based on social representations, with 26 novice graduated nurses at a private university in Rio de Janeiro (Brazil). Data collection made between 2016 and 2017 by a semi-structured interview and lexical analysis by Alceste software. Results: the context of the Intensive Care Unit influences social representations, which mobilizes identity aspects of this environment that stereotype the ward as a disorganized place and that does not have material resources and trained professionals. Thus, when novice undergraduates act and despite the effort and dedication fail to transfer the patient, fear and lack of confidence are exacerbated, resulting in actions that can bring risks to the patient. Conclusion: there are stereotypes in relation to the clinic that limit the care actions of the novice undergraduates in relation to the critical patient, and should be re-signified in generalist education. It is recommended to develop follow-up programs for novice graduated nurses.

The factors influencing the effective early career and rapid transition to a nursing specialty in differing contexts of practice: a modified Delphi consensus study

OBJECTIVES

This study aimed to test and further develop the 'Early Career and Rapid Transition to a Nursing Specialty' (TRANSPEC) model to a nursing specialty developed from a systematic review. Semi-structured interviews of specialist clinically based nurses and a consensus Delphi study with an expert panel were used to expand and achieve consensus, agreement, reliability and stability of the model.

DESIGN

A modified Delphi, two rounds (64 and 52 Likert items) of reiterative online questionnaires and one round as a nominal group technique, was informed by qualitative thematic analysis of semi-structured interviews.

SETTING AND PARTICIPANTS

Interviews with 14 specialists clinical practicing registered nurses and a panel of 25 national experts participated in the Delphi study.

RESULTS

The interview participants experienced 14 rapid transitions and three were early career transition. The overarching themes from the preliminary model were confirmed and further expanded. These were the self (personal and professional); the transition processes (final and informal); a sense of belonging; and the overarching context of practice over a time continuum. In the Delphi, the highest rating item was 'Specialty work colleagues respect, include, support, and accept specialist nurse on completion of transition processes'. Pre-entry was highlighted as an important time point prior to transition. All items reaching consensus were included in the final model. Cronbach α increased from 0.725 to 0.875 for the final model.

CONCLUSIONS

The TRANSPEC model is a valid and reliable evidence-based tool for use in the career pathway and development of nursing specialists. Using the Benner model 'Novice to Expert' after the novice incomer phase is achieved, further lifelong learning development will transform the novice specialist over time continuum.

Patient readiness for hospital discharge and its relationship to discharge preparation and structural factors: A cross-sectional study

BACKGROUND

Nursing discharge preparation is vital to successful hospital-to-home transitions. However, despite a wealth of evidence on its effectiveness, little is known of the structure- and process-related factors that facilitate or impede its use in clinical practice. Specifically, the associations between unit size and type, leadership support, skill mix, staffing, nurse and patient characteristics, discharge teaching and patient readiness for discharge have rarely been studied.

OBJECTIVES

This study aimed to explore the associations between structure-individual characteristics (i.e., unit, nurse and patient characteristics) and process-related (i.e., teaching of self-care and symptom management) factors and patient readiness for hospital discharge.

DESIGN

A secondary data analysis of the multicentre observational "Matching Registered Nurse services with changing care demands (Match^RN)" study.

SETTING AND PERIOD

Data were collected between September 2015 and January 2016 on 123 surgical, medical and mixed units in 23 Swiss acute care hospitals.

PARTICIPANTS

A total of 1833 registered nurses and 1755 patients were included in the analyses.

METHODS

Structure-, process- and patient readiness-related hospital discharge variables were assessed using validated items either from existing instruments or self-developed. Multilevel mixed-effects logistic regression was used to test associations.

RESULTS

Fewer than half of the patients hospitalized (47.8%) reported readiness for hospital discharge. Fifty-eight percent reported receiving discharge preparation interventions for self-care and 30% for symptom management. Patients' readiness for hospital discharge was significantly lower in larger units (β = -0.001; 95% confidence interval (CI) = -0.002 to -0.001) and on medical units (β = -0.44; 95% CI = -0.70 to -0.19). Higher nurses' experience (β = .004; 95% CI = 0.001 to 0.01), better patient self-reported health (β = -0.11; 95% CI = -0.17 to -0.05), higher patient ratings of self-care teaching (β = 1.33; 95% CI = 1.07-1.59) and symptom management teaching (β = 0.79; 95% CI = 0.52-1.06) were significantly associated with greater patient readiness for hospital discharge.

CONCLUSIONS

Patient readiness for hospital discharge is associated with process- and structure-related factors. Our findings suggest that, for successful uptake in clinical practice, the development and implementation of effective discharge preparation programs should consider the structural context, i.e., patient population, unit size, and experience of nurses within the team. Further research, using a more accurate measure of patient readiness for hospital discharge, is needed to test associations with the nurse work environment and staffing.

Factors that impact on emergency nurses’ ethical decision-making ability

Background:

Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered.

Research purpose:

Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability.

Research design and context:

A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions.

Participants:

A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected.

Ethical considerations:

Approval to conduct this study was obtained by the Adelphi University Institutional Review Board.

Findings:

A relationship between intuition and perceived ethical decision-making ability ( r = .252, p = .001) was a significant finding in this study.

Discussion:

This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability.

Conclusion:

This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.