Nurses' encounters with patients having end-of-life dreams and visions in an acute care setting - A cross-sectional survey study

AIM

This study aimed to estimate the proportion of acute care nurses witnessing end-of-life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs.

DESIGN

A cross-sectional survey study was conducted from February 2023 to May 2023.

SETTING/PARTICIPANTS

Participants were medical and surgical nurses from a 200-bed acute care hospital in metropolitan Australia.

RESULTS

Fifty-seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end-of-life dreams and visions. The nature of end-of-life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end-of-life dreams and visions but identified an unmet need for education and training on this aspect of end-of-life care.

CONCLUSION

Our results suggest that nurses in acute care encounter end-of-life dreams and visions in a similar proportion to oncology and long-term care but lower than in palliative care settings. Education and training regarding end-of-life dreams and visions are needed to ensure the provision of comprehensive, patient-centred end-of-life care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT

Research in sub-acute and long-term care settings suggests that end-of-life dreams and visions are a common accompaniment to the dying process. No research has yet focused on the acute care setting, despite this being the place of death for the majority of people in most high-income countries. This study demonstrates that acute care nurses encounter end-of-life dreams and visions in similar proportions to oncology and long-term care nurses but lower than palliative care nurses. Acute care nurses would benefit from education and training regarding end-of-life dreams and visions to enable the provision of holistic person-centred end-of-life care.

REPORTING METHOD

This study was reported using the STROBE Checklist for cross-sectional studies.

Suboptimal Knowledge and Care of Patients with Acute Coronary Syndrome Among Nurses Working in Selected Hospitals in Addis Ababa, Ethiopia 2021

Background

Acute Coronary Syndrome is the leading cause of morbidity and mortality in developing nations including Ethiopia. As frontline healthcare providers, nurses need to be prudent in handling cases of acute coronary syndrome. However, nurses' knowledge and practice of acute coronary syndrome are not well-known across Ethiopia. Thus, this study aimed to assess knowledge, practice, and associated factors regarding the care of acute coronary syndrome among acute care nurses working at selected hospitals in Addis Ababa, Ethiopia.

Methods

Institution-based descriptive cross-sectional study design was conducted from February to March among 252 purposively selected nurses working in tertiary hospitals of Addis Ababa, Ethiopia. A pretested and structured questionnaire was used for data collection. Data were entered into Epi-Data 4.6 and exported to SPSS version 25. Both descriptive and inferential statistics were used to describe and test the association between selected variables. P-values < 0.05 were declared as significant factors for the outcome variable.

Results

Out of 252 nurses, (52%) had good knowledge, and (44.4%) had good practice towards care of Acute Coronary Syndrome. Being a master's degree [AOR=3.801, (95% CI:1.314-10.996), P =0.014] and having guidelines [AOR= 10.998, (95% CI:2.478-48.805), P =0.002] were significantly associated with nurse's good knowledge of ACS. While having a master's degree [AOR=4.258, (95% CI:1.676-10.820), P=0.002] and getting in-service training [AOR= 1.902, (95% CI:1.022-3.539), P = 0.042] were significantly associated with nurse's good level of practice.

Conclusion

In this study, nurses had inadequate knowledge and practice regarding the care of Acute Coronary Syndrome. Nurses' educational level, presence of clinical practice guidelines, and getting training were determinant factors associated with good knowledge and practice. Therefore, organizational and nursing educational support are needed to improve this gap by providing short- and long-term training, and updated evidence-based clinical practice guidelines should be available for all acute care nurses.

Development and Testing of an Acute Care Nurses' Job Satisfaction Scale

BACKGROUND AND PURPOSE

Factors affecting nurses' job satisfaction in the acute care setting may differ from nurses working in other settings. The aim of this study was to develop a new tool that measure the job satisfaction of acute care nurses who provide direct patient care.

METHODS

Content validity then exploratory factor analysis (EFA) were used for validation of the new tool using a random sample of 349 acute care nurses.

RESULTS

The EFA resulted in 31 items suggesting 6 factors were present in the instrument. The identified factors were: achievement/job interest/responsibility, hospital policy, quality of supervision, peer support/work condition, growth/advancement, and benefits/job security.

CONCLUSION

A new tool for measuring acute care nurses' job satisfaction was developed based on a robust theoretical foundation and demonstrated sound psychometric properties.

Attitudes towards the dying and death anxiety in acute care nurses - can a workshop make any difference? A mixed-methods evaluation

OBJECTIVES

In Singapore, the core curriculum for end-of-life (EOL) care used in nurse training courses is limited. Only 45% of nurses indicated familiarity with inpatient palliative care. Nurses who lack skills in palliative care may develop anxiety and negative attitudes towards caring for dying patients. We explored whether a two-day, multimodal EOL care workshop could reduce nurses' death anxiety and improve nurses' skills, knowledge, and attitude towards palliative care.

METHODS

Forty-five nurses participated in the workshop. At baseline before and at six weeks after, a 20-item knowledge-based questionnaire and the Death Attitude Profile-Revised (DAP-R) were administered. Six weeks post-workshop, in-depth interviews were conducted. We employed descriptive statistics, student paired samples t-test and inductive thematic analysis.

RESULTS

There was a significant improvement in nurses' knowledge score (p < 0.01) and reduction in their death anxiety score (p < 0.01). Fear of Death (p = 0.025) and Death Avoidance (p = 0.047) sub-scores decreased significantly. However, the remaining domains such as Neutral Acceptance, Approach Acceptance, and Escape Acceptance did not show any significant difference, although Escape Acceptance showed a trend towards a reduced score (p = 0.063). After the workshop, more nurses adopted the Neutral Acceptance stance (76.2%), and none of them fell into the Fear of Death subdomain. Most nurses interviewed reported a positive change in their knowledge, attitudes, and practice even after the workshop.

SIGNIFICANCE OF RESULTS

The multimodal palliative care workshop was useful in improving nurses' EOL knowledge and reducing their anxiety towards death. The positive change in nurses' attitudes and practices were noted to be sustained for at least six weeks after the intervention.

"You only have time for so much in 12 hours" unmet social needs of hospitalised patients: A qualitative study of acute care nurses

AIMS AND OBJECTIVES

To explore the experiences of nurses caring for socially at-risk patients and gain an understanding of the challenges nurses face when providing care.

BACKGROUND

Nurses play a pivotal role in caring for hospitalised patients with social risk factors and preparing them for discharge. Few studies have explored whether acute care nurses are adequately supported in their practice environments to address the unique needs of socially at-risk patients as they transition back into community settings.

DESIGN

A qualitative descriptive study of nurses working in a large urban academic medical centre.

METHODS

We conducted six semi-structured focus groups of nurses (n = 21). Thematic content analysis was performed to analyse the transcripts from the focus groups. We adhered to COREQ guidelines for reporting this qualitative study.

RESULTS

Six key themes emerged: (a) nurses' assessments of social risk factors, (b) experiences providing care, (c) barriers to care, (d) fear of "labelling" socially at-risk patients, (e) unmet social care needs and (f) recommendations to improve care.

CONCLUSIONS

Our findings suggest that nurses are able to identify social risk factors. However, prioritisation of medical needs during acute care hospitalisation and lack of organisational supports may deter nurses from fully addressing social concerns.

RELEVANCE TO CLINICAL PRACTICE

Acute care nurses should be involved in the development of future efforts to address the needs of socially at-risk patients and be provided with additional supports in their practice environments. This could include continuing education to build nursing competencies in community-based care and social vulnerability.

What do caregivers value and is there agreement in perception of met needs between nurses and caregivers?

INTRODUCTION

There is an increasing reliance on informal caregivers to continue the care of patients after discharge. This is a huge responsibility for caregivers and some may feel unprepared for the role. Without adequate support and understanding regarding their needs, patient care may be impeded. This study aimed to identify the needs valued by caregivers and if there was agreement between acute care nurses and caregivers in the perception of whether caregiver needs were being met.

METHODS

We conducted face-to-face interviews with 100 pairs of acute care nurses and caregivers. Participants were recruited from inpatient wards through convenience sampling. Questionnaires included demographic data of nurses and caregivers, patients' activities of daily living, and perception of caregiver needs being met in six domains of care. Independent t-test was used to compare mean values in each domain, and intraclass correlation coefficient was used to compare agreement in perception.

RESULTS

Caregivers valued reassurance the most. Three domains of care needs showed significant differences in perception of caregiver needs being met:reassurance (p = 0.002), honesty and timeliness (p = 0.008), and kindness and genuine care (p = 0.026). There was poor agreement in all six domains of caregiver needs being met between nurses and caregivers.

CONCLUSION

Although caregivers valued reassurance the most, there was poor agreement between acute care nurses and caregivers in the perception of caregiver needs being met. Hence, more attention should be paid to the caregiver's needs. Further studies can examine reasons for unmet caregiver needs and interventions to improve support for them.

A cross-hospital exploration of nurses' experiences with horizontal violence

AIM

To explore nurses' experiences of horizontal violence (HV) in three diverse non-affiliated organisations within a single city in the USA.

BACKGROUND

Horizontal violence, also called workplace bullying or lateral violence, is a long-standing nursing issue.

METHOD

Content analysis was used to analyse open-format textual responses from 126 registered nurses.

RESULTS

A powerful collective story emerged from nurses' shared experiences with HV, describing the characters and the setting in which HV and its consequences exist. Nurses' depictions of HV were consistent despite the different organisational structures of their workplaces suggesting that hospital type is not the explanation for HV, rather the culture of acute care nursing. Nurses want change and asked for tactics to resolve HV within their institutions; some provided specific solutions.

CONCLUSION

Nurse managers must continue to address HV by using a variety of known tactics, as well as adopting new evidence-based interventions as they are identified. The anti-bullying message should be disseminated through professional nursing organisations as well as in local health-care establishments.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to be the culture champions who hold individuals accountable for HV and foster professionalism through their leadership.