Evaluation of Malnutrition Knowledge among Nursing Staff in the Czech Republic: A Cross-Sectional Psychometric Study

Construct: The Knowledge of Malnutrition - Geriatric 2.0' (KoM-G 2.0) instrument was designed to quantify nursing staff malnutrition knowledge in inpatient medical and rehabilitation care facilities, as well as home health care. It has been used to assess grasp of current clinical practice guidelines and proficiency in addressing issues related to malnutrition. It provides insight into familiarity with and capacity to tackle issues pertaining to malnutrition in clinical practice. Furthermore, it has been used assess the effectiveness of educational interventions aimed at improving nursing professionals knowledge and awareness of malnutrition. Background: The quality of nursing education affects malnutrition risk assessment, monitoring of food intake, and effectiveness of nutrition care. Improvements in malnutrition education require determining the current level of knowledge and benchmarking with other countries. In the Czech Republic, no nationwide assessment of nursing staff malnutrition knowledge has ever been conducted. Approach: The purpose of the study was to translate the KoM-G 2.0 instrument, gather initial validity evidence, and evaluate nursing staff knowledge of malnutrition in inpatient medical, rehabilitation care facilities, and home care in the Czech Republic. All inpatient healthcare facilities and home healthcare facilities in the Czech Republic were invited to participate. The Czech version of the internationally standardized KoM-G 2.0 (KoM-G 2.0 CZ) was used to assess nursing staff malnutrition knowledge between 3 February 2021 and 31 May 2021. A total of 728 nurses began the questionnaire, and 465 (63.9%) of respondents completed it and were included in the study. Data analyses examined instrument difficulty, discriminability, and reliability, as well as sources of variation in knowledge scores. Findings: The psychometric characteristics of the KoM-G 2.0 CZ instrument included the difficulty index Q (0.61), the discriminant index (ULI 0.29, RIT 0.38, upper-lower 30% 0.67), and Cronbach alpha (0.619). The overall mean of correct answers was 6.24 (SD 2.8). There was a significant impact of educational attainment and nutrition training on KoM-G 2.0 CZ scores. Conclusions: Our findings provide initial validity evidence that KoM-G 2.0 CZ is useful and appropriate for assessing malnutrition knowledge among Czech nursing staff. Our research identified gaps in knowledge and examples of good practice in understanding malnutrition that can be applied internationally. The knowledge of academic nurses was greater; therefore, we suggest they play a key role in nutritional care. We recommend continuous education to improve understanding of malnutrition in this setting.

Registered nurses' knowledge and practice of preoperative fasting and medication administration

Background

Knowledge of fasting or Nil Per Os (NPO) guidelines is an essential component of nursing care in the preoperative period.

Aim

To describe registered nurses' (RNs) knowledge and management of the preoperative NPO period.

Setting

Selected surgical wards in a tertiary hospital in the Western Cape, South Africa.

Methods

Quantitative descriptive, cross-sectional study utilising a structured questionnaire. The population consisted of RNs working in selected surgical wards. Convenience sampling was used and adequate knowledge was determined as ≥ 90%.

Results

The response rate was 100%. Of the 68 participants, 48 (70.6%) held a diploma and 20 (29.4%) held a degree as the highest academic qualification achieved. Sixty-one (89.7%) participants knew the correct reason for keeping patients NPO. Sixty-five (95.6%) knew the correct answer for the NPO time for solids while only 27 (39.7%) knew the correct answer for clear fluids. Only 30 (44.1%), 26 (38.2%) and 33 (48.5%) participants, respectively, answered the questions about oral analgesia, oral antibiotics and chronic medication administration during the NPO period correctly. Significantly more degree participants knew the correct answer for the fasting time for non-human milk (p = 0.005) and more diploma participants would administer chronic medication during the NPO period (p = 0.037).

Conclusion

Inadequate knowledge of NPO times for various fluids and unsatisfactory practice of medication administration for oral and chronic medication require attention.

Contribution

This study highlights the importance that ongoing education is needed to ensure that patients receive the most up-to-date evidence-based care during the NPO period.

Dialectical Pluralism for Nursing Knowledge Development

The purpose of this paper is to explore the potential of dialectical pluralism (DP) for nursing knowledge development. Nursing scholars have discussed ways of developing nursing knowledge, exploring the fit and relevance of various worldviews for knowledge development and examining the dynamic and perpetual processes of knowledge development. Scholars have argued that knowledge development occurs under a certain worldview to which the researcher adheres. Many nurses employ various worldviews, which can give rise to ontological and epistemological conflicts. DP can help nurses appreciate the diversity of worldviews and recognize the importance of implicit worldviews to generate more practical nursing knowledge. DP as a philosophical approach can enable nurses to communicate between diverse worldviews, become tolerant of conflicting differences, and develop an array of nursing knowledge.

A New Nursing Aesthetic

Conceptions of the art and aesthetics of nursing traditionally focus on the nurse and nursing practice. My purpose here is to propose a shift in thinking from this traditional focus that dominates the "art of nursing" literature, to consider a new nursing aesthetic that focuses on human beings proper: health as wellbecoming. I present a framework based on everyday aesthetics, feminist aesthetics, and Deweyan perspectives, along with attention to the nursing disciplinary perspective of health and well-being. I conclude with a look ahead to philosophical questions and scientific issues regarding theorizing and scientific inquiry about the health as wellbecoming aesthetic to advance nursing knowledge.

"Their tenacity to just keep going": Nurses' experiences in medical hotel quarantine during the COVID-19 pandemic

AIM

To explore how nurses and nursing knowledge contributed to the success of an Australian nurse-led medical hotel quarantine facility during the COVID-19 pandemic. The facility was established to accommodate returning travellers who were COVID-19 positive or at risk of becoming positive, to travellers requiring complex care and expanded to community members who could not quarantine at home.

DESIGN

This descriptive qualitative study explored how nurses and nursing knowledge in the quarantine facility contributed to the low transmission incidence of COVID-19 infection.

METHOD

Twelve semi-structured interviews were conducted via ZOOM from February to May 2022 with all levels of nursing staff (nurse managers to assistants in nursing) who had worked in the facility for 3 months or more. The nurses were asked to describe their experiences, the challenges they faced and how they overcame them. The data were rich and were analysed using Braun and Clarke's six-step thematic analysis.

RESULTS

Four broad themes were generated demonstrating how nurses played a pivotal role in the success of the facility. First: nursing knowledge was evident through the development of policies, which minimized risks to nurses and patients. Second: a community of learning was developed as nurses supported upskilling and capacity building of staff, particularly new graduates with the facility. Third: a supportive management structure promoted teamwork and a positive workplace culture. And finally: the nurses were encouraged to develop techniques that promoted self-care which enabled them to develop resilience.

CONCLUSION

This was a nurse-led service that developed strategies to manage care delivery and overcame unanticipated difficulties in a unique clinical setting.

REPORTING METHOD

The quality of the research design was ensured by using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Construction of nursing knowledge in commodified contexts: Views and experiences of nurses regarding primary care

The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed-methods study was conducted that included a closed-question survey and in-depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in-depth interviews. The main findings of the survey were related to workload and limited time for nursing care. Six themes emerged from the in-depth interviews: (1) limited time for nursing, (2) feelings of burnout, (3) awareness of patient and family satisfaction, (4) organizational factors that favor nurses' needs, (5) organizational factors that hinder nurses' needs, and finally (6) public administration requirements. Participants perceive excessive workload and time constraints and feel that this affects their nursing care and their physical and mental health. However, nurses purposefully use knowledge patterns to cope with the problems associated with commodification. Nurses have multidimensional, contextualized, and integrated knowledge that allows them to optimize their care based on the needs of their patients. This research examines many challenges related to nursing practice and the nursing discipline and opens the door for further research that encompasses all areas of nursing.

A Dialogue with Dr. Marilyn A. Ray: Nurse Scholar and USAF Veteran

Dr. Marilyn A. Ray, nurse scholar and retired United States Air Force (USAF) veteran and former flight nurse, began her nursing scholarship in Canada. She was influenced by the experiences and interprofessional scholarly ideas that she encountered along her career trajectory. Her early love of the air and space led her to the United States Air Force Nurse Corps, where she served as a flight nurse during the Vietnam war era, followed by leadership positions in nursing education, administration, practice, and research. Dr. Ray's contributions to nursing knowledge includes two nursing theories and a caring inquiry methodology. Dr. Ray is helping to create a new caring science certificate program at Florida Atlantic University, Christine E. Lynn College of Nursing. In this column, Dr. Ray shares the story of her scholarly influences and how they helped her care for her husband and gain insight into her contributions to nursing knowledge development.

Nursing students' perception of nursing knowledge: A qualitative study

AIM

To explore nursing students' perception of nursing knowledge.

DESIGN

Qualitative interview study.

METHODS

Semistructured individual interviews with nine nursing students in their third year were conducted via a cloud-based video communication app. Transcriptions were analysed based on Braun and Clarke's thematic analysis. The Consolidated Criteria for Reporting Qualitative Research checklist for qualitative research was used.

RESULTS

The findings show that the participants emphasised that values are the prerequisites of and basis for performing professional nursing. The students found it difficult to define nursing knowledge and to distinguish nursing knowledge from other subjects. The thematic analysis resulted in two themes: values-a prerequisite of nursing knowledge, and nursing knowledge-an umbrella of knowledge.

CONCLUSION

Nursing knowledge seems to be difficult both to clarify and to demarcate for the students. However, the participants considered values to be important and vital to becoming a professional nurse.

IMPLICATIONS FOR THE PROFESSION

This study addresses students' perceptions of values, nursing knowledge and what it consists of, and how this is experienced. An understanding of the nursing students' perceptions of what they consider to be important values and how they understand nursing knowledge is important in making the profession clearer and more distinguishable.

IMPACT

The impact of this study means that nurse education needs to emphasise a more argumentative and visible education where nursing knowledge and values are more prominent than today.

REPORTING METHOD

COREQ.

PUBLIC CONTRIBUTION

No patient or public contribution.

A response to Michael Clinton's On Bender's orientation to models: Towards a philosophical debate on covering laws, theory, emergence and mechanisms in nursing science

My purpose in this short response to Clinton's interesting article On Bender's orientation to models: Towards a philosophical debate on covering laws, theory, emergence and mechanisms in nursing science, which is published in this issue, is not to provide any counterargument to Clinton's interpretation of my own argument; readers are welcome to interrogate both articles at their leisure and make their own conclusions. What I will do instead is provide a brief critical assessment of my own (il)logic re bringing in the notion of mechanism as conceived by Machamer, Darden and Craver into an argument for models versus theories as a carrier of nursing knowledge.

Nurses' knowledge and attitudes regarding children's pain assessment and management in Nepal

Pain is frequently experienced by children in hospital, and international guidelines for appropriate pain assessment and management are available. Optimal management of paediatric pain has important long-term health, psychosocial, and economic benefits. However, evidence indicates that globally there are deficits in nurses' understanding of paediatric pain assessment and management. This study explored knowledge and attitudes regarding paediatric pain assessment and management among nurses at a tertiary children's hospital in Nepal. In this cross-sectional study all 140 nurses at a tertiary children's hospital in Nepal, were invited to complete the validated Paediatric Nurses Knowledge and Attitudes Survey. Findings revealed substantial deficits in nurse's knowledge and erroneous attitudes towards pain assessment and management in children. Test scores ranged from 14% to 56%, with mean scores of 38%, with no nurses achieving a recommended pass score of 80% regarding knowledge and attitudes in paediatric pain management. Consistent with previous research, nurses had insufficient knowledge and attitudes that did not reflect best practice regarding pain assessment and management in children. Education programmes targeting both trainees and registered nurses are essential to enable nurses to deliver evidence-based care and improve outcomes for children and their families.

[Holism at the heart of nursing knowledge: a proposed model for teaching it in nursing]

The concept of holism remains difficult to grasp and to teach because of its polysemous nature. In the current reflections on the construction of nursing curricula, it seems necessary to propose some reference points in the meaning given to this widely used but little conceptualized notion. Nursing shares a unique and holistic view of patients, yet nursing education, rooted in the substance of nursing, remains undefined. Drawing on the work of English-language theorist Hesook Suzie Kim, this article explains part of her model of nursing practice analysis. This model is composed of four distinct domains that address the need to identify the holistic dimension of nursing knowledge to be taught.

Managing delirium in acute inpatient units: A cross-sectional study of nursing teams' knowledge and perceived limitations

AIM

The aim of the study was to describe nursing teams' theoretical knowledge of delirium and their perceptions of the way in which it is handled in acute inpatient units.

DESIGN

This is a descriptive cross-sectional study using a questionnaire comprising ten questions on knowledge and seven on perception.

METHODS

The sample consisted of 216 professionals working at a hospital complex in Madrid, Spain. Descriptive and non-parametric bivariate analyses were performed for a p < .05.

RESULTS

Fifty-three point two per cent of staff possessed sufficient theoretical knowledge, and this figure rose significantly among professionals with more years of experience. Areas for improvement in theoretical knowledge included the use of therapeutic immobilization, screening scale, subtypes of delirium and precipitating factors. Sixty-eight point five per cent of staff perceived their knowledge as fair, 50% agreed that delirium was underdiagnosed and 48.1% agreed that preventive measures were only occasionally taken. Perceived barriers included lack of training, work overload, ineffective coordination and lack of standardized protocols.

A Book Review of Knowledge Development in Nursing: Theory and Process by Peggy L. Chinn, Maeona K. Kramer, and Kathleen Sitzman (2022). Elsevier

This is a review of the 11^th edition of Knowledge Development in Nursing: Theory and Process by Chinn and colleagues (2022). This book is divided into 11 chapters and each chapter provides comprehensive details with thorough material and adherence to the purpose of this book, offering the readers a broad understanding of nursing knowledge and knowing within the discipline and practice of nursing.

Breaking the chains: Decolonizing the language of Nursology

In this article, I discuss the concept of 'Decolonizing Nursing', answering what this process is about, and how and when it should be done. I introduce the idea of epistemological dominance and the concepts of colonization and decolonization of nursing knowledge. I describe my experiences of coming from Latin America and facing Anglo-Saxon academy to discuss core disciplinary nursing knowledge and provide reflections around the decolonization of nursing language.

A reflection on the decolonization discourse in nursing

Colonialism, in its many forms and stages is often imposed as being central to the narratives of colonizedpeople and their cultures, as well as the genesis of their knowledge. In colonial discourse, lands and the occupants of these lands were 'discovered', further implying that colonized people did not have their own ways of knowing (nor even existence) before colonization. This narrative has been embedded within Euro-American fields of study, including nursing, in which caring and healing practices that exist outside of a colonial lens are dismissed and complicity with colonialism is downplayed or sanitized. This paper is a reflection on the current discourse on decolonizing nursing shaped by postcolonial, critical and Black feminist philosophies. After examining the decolonization discourse in nursing, I argue that current calls to decolonize nursing lack a clear description of the goals and process of doing so, making it unfeasible to hold those in the process of decolonizing accountable. In addition, the lack of intentionality in reckoning with past and current forms of colonialism embedded in nursing hinders the ability to engage with lessons that could shape the future. I conclude this discourse by discussing practical steps toward centrering diverse ways of knowing, and ensuring this process prioritizes communities and nurse scholars who have historically been silenced.

Revisiting the nursing metaparadigm: Acknowledging technology as foundational to progressing nursing knowledge

The nursing metaparadigm, as described by Fawcett in 1984, includes human, health, nursing, and the environment, all of which support theory development by giving direction to our focus as a scientific body. Nursing scientists make their mark in biotechnological applications, mobile health, informatics, and human factors research. We give voice to the patient through design feedback and incorporating technological advancements in our evolving nursing knowledge; however, we have not formally acknowledged technology in our metaparadigm. To continue patient-centered care in this age where machines are enmeshed in daily human life, we propose technology must be a domain of the metaparadigm to continue advancing nursing science and knowledge. In this paper, we propose a separate domain of technology within the metaparadigm to challenge nurses to consider approaches within their research and practice of how technology will impact patient care and their personal development within the profession. A technology-specific domain within the metaparadigm also is a signal to other bodies of science of our willingness and ability to run at pace with novel, exciting new discoveries while adding our perspective. Nurses may become active agents in novel developments rather than passive adopters, continuing our legacy of patient advocacy through new knowledge generation. Emerging and continuing nurse leadership has set the stage for the next era of nurse-led innovation and technology development, which provides an opportunity to embed technology as a core aspect of the nursing metaparadigm.

Decolonizing nursing knowledge

This dialogue introduces the concepts of colonization and decolonization of nursing knowledge, the harms that have come from colonization, and the importance of engaging in the processes of decolonization as a means of achieving social justice and humanization for all. Specific options to decolonize nursing knowledge are discussed.

Development and psychometric evaluation of nurses' perception towards the gap between knowledge and practice

AIM

The aim of the study was to develop a survey instrument and psychometrically evaluate nurses' perceptions of the gap between knowledge and practice. Although the nursing literature has widely documented a gap between knowledge and practice, no instrument has been developed to measure this gap.

DESIGN

Psychometric analysis was done on 513 nurses working in different positions at two large hospitals in Jeddah City.

METHODS

Cronbach's alpha was used to determine the internal consistency and reliability of the research instrument, and a panel of experts evaluated the validity of the tool's content.

RESULT

The content validity index computed from expert rankings was 0.89. Factor analysis yielded four major components: knowledge, practice, environment and learning. Cronbach's alpha indicated a high level of internal consistency and reliability for the component items. The newly developed scale will facilitate measuring nurses' perceptions of the knowledge-practice gap in clinical settings.

Patterns of Knowing and Being in the COVIDicene: An Epistemological and Ontological Reckoning for Posthumans

The crucible of the COVIDicene distills critical issues for nursing knowledge as we navigate our dystopian present while unpacking our oppressive past and reimagining a radical future. Using Barbara Carper's patterns of knowing as a jumping-off point, the authors instigate provocations around traditional disciplinary theorizing for how to value, ground, develop, and position knowledge as nurses. The pandemic has presented nurses with opportunities to shift toward creating a more inclusive and just epistemology. Moving forward, we propose an unfettering of the patterns of knowing, centering emancipatory knowing, ultimately resulting in liberating the patterns from siloization, cocreating justice for praxis.

Identifying areas of improvement in nursing knowledge regarding hepatic encephalopathy management

Hepatic encephalopathy (HE) is a reversible brain dysfunction caused by liver insufficiency and portosystemic shunting. Hepatic encephalopathy is a common complication of advanced liver disease and is on a rise with the increasing incidence of non-alcoholic steatohepatitis (NASH). Since partnership with nursing staff is a critical part of successful management of these complex patients, we conducted a survey assessing their knowledge regarding HE.169 nurses participated in the survey. We found that more than 30% of the nurses did not know that ammonia is one of the toxins responsible for causing hepatic encephalopathy. We also found that 20% of the nurses had difficulty answering questions regarding titration of lactulose to bowel movements. Dietary education is a significant area for improvement as 80% of the nurses wanted to restrict fat and carbohydrate intake in these patients. With this simple survey, we identified important knowledge gaps among experienced nurses at our institution. We believe that by improving knowledge through focused lectures, we can improve patient care and reduce the length of hospitalizations in patients with HE.

Community Change Concepts and Health Policy Implications

Nursing knowledge is housed in its paradigms, philosophies, models, and theories. This knowledge must be utilized to demark nursing's unique contributions within healthcare, regardless of the setting. The purpose of this paper is to explore the ways in which Parse's community model may serve as a way to think about health policies and the unique ways policies may connect to nursing knowledge. Within this paper, there is a discussion about health policy, Parse's humanbecoming paradigm, and policy development reflected upon with change concepts within the humanbecoming community model. This exploration is important because "disciplinary knowledge is the foundation for transforming health policy and health care delivery systems" (American Academy of Nursing, 2020, para. 1).

Nursing Knowledge in the Doctor of Nursing Practice Curriculum

The goal of Doctor of Nursing Practice (DNP) education is to prepare advanced practice nurse leaders for the practice setting. Accordingly, it is imperative that DNP education is grounded in nursing theoretical knowledge. The purpose of this project was to examine the presence of nursing theoretical knowledge within DNP programs across the United States. A retrospective approach was used to review publicly available information on the webpages of a sample of DNP programs accredited by the Commission on Collegiate Nursing Education (CCNE) to determine if nursing theoretical knowledge guided DNP programs. Demographic information was also collected. A sample of 100 CCNE accredited programs revealed a lack of nursing theoretical knowledge visible within DNP programs. It is unclear how DNPs are being prepared to be practice leaders guided by nursing theoretical knowledge. Nursing leaders must develop policies to assure that nursing knowledge is core in DNP programs.

The Knowledge, Practice and Attitudes of Nurses Regarding Physical Restraint: Survey Results from Psychiatric Inpatient Settings

There is a considerable amount of literature describing how nurses’ knowledge contributes to their attitudes and practices related to patient physical restraint. However, whether or not there have been any improvements in nurses’ knowledge levels, attitudes or practices regarding physical restraint during the past few years is unknown. A survey was conducted on nurses (n = 133) in one psychiatric hospital in Hong Kong (n = 98, response rate = 74%). The data were analyzed using independent t-tests, ANOVA, a Mann–Whitney U test, a Kruskal–Wallis test and Spearman’s rho. In general, nurses had good restraint-related knowledge with satisfactory attitudes and practices, although their knowledge levels, attitudes, and practices regarding restraint varied. Having a higher age, seniority, and education level contributed to a higher restraint-related knowledge level. Male nurses demonstrated more desirable practices (i.e., care of restrained patients), while nurses with a higher education level were more likely to avoid restraint. Nurses’ restraint-related knowledge positively correlated with restraint practices. Although nurses’ knowledge levels, attitudes, and practices regarding restraint were found to be satisfactory, more training efforts should focus on young nurses working in psychiatric settings with less work experience and lower education levels. As some nurses seem to favor the use of restraint with limited reflection, more studies are needed to verify nurses’ emotions and how their emotions influence the use of restrictive practices.

Integrity of Databases for Literature Searches in Nursing: Avoiding Predatory Journals

The quality of literature used as the foundation to any research or scholarly project is critical. The purpose of this study was to analyze the extent to which predatory nursing journals were included in credible databases, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, commonly used by nurse scholars when searching for information. Findings indicated that no predatory nursing journals were currently indexed in MEDLINE or CINAHL, and only one journal was in Scopus. Citations to articles published in predatory nursing journals are not likely found in a search using these curated databases but rather through Google or Google Scholar search engines.

Knowledge for Nursing Practice: Beyond Evidence Alone

OBJECTIVE

For the past 30 years there has been a growing emphasis on evidence as the primary or exclusive basis for nursing practice.

METHODS

Critical examination of literature related to evidence-based practice from the 1990s to the present.

RESULTS

This review of the nursing literature from the 1990s to the present reveals that in the midst of the movement to promote evidence-based practice as the gold standard, there have been persistent expressions of concern. These concerns are (a) lack of alignment of evidence-based practice with nursing's disciplinary perspective; (b) wrongful privileging of empirical knowledge over other sources of knowledge; (c) underappreciation of the complexity of practice and practice wisdom;(d) possibilities of evidence-based practice thwarting innovation and creativity;(e) vulnerabilities of empirical evidence to be flawed, inconsistent, and influenced by competing interests; (f) situational realities that limit access to and critical appraisal of evidence that access to and critical appraisal of evidence is not feasible or practical; and (g) lack of relationship of evidence-based practice to theory.

CONCLUSIONS

We call for a recalibrated practice epistemology that promotes a greater appreciation for the myriad sources of knowledge for nursing practice, and offer recommendations for international change in education, literature, scholarship, and public media.

[Temporality in nursing research: a metronome for the benefit of quality?]

Time is a key element of the nursing research process, notably because it is lacking in daily life and is subject to strict regulations. Engage in a nursing research project thereby forces the researcher to review the time available, to rethink nursing practice. It can therefore prove to be a useful tool in the organisation of are and the improvement of practices.

Examining progression and degeneration of nursing science using Imre Lakatos's methodology of scientific research programs

Over the years, nursing research and practice have been through remarkable transformations in response to evolving and emerging healthcare systems and practices. Regarding research, nurses moved beyond merely using the quantitative methodology to combining qualitative, quantitative and mixed methods. In practice, nurses have transitioned from the delivery of medical-based care to nursing theory-guided practice, evidence-based practice, knowledge translation and transformative practice. Some domains of nursing research and practice became progressive, while others degenerated. This paper aims to examine how different domains of nursing research and practice progress and degenerate using Imre Lakatos's methodology of scientific research programs. Lakatos differentiated scientific and pseudoscientific knowledge and coined the idea of scientific research programs. He believed that science in any discipline develops so that some programs are more progressive and others' degenerative. The degeneration and progression of programs occur steadily and rationally and are determined based on the extent of development and programs' potential to predict new solutions to old problems. Adopting this idea could enable nurses to critically analyse research programs in everyday knowledge development to use valid and legitimate programs for informing nursing practice.

Reliability and Validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD Test

BACKGROUND AND PURPOSE

The purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis.

METHODS

This study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial.

RESULTS

A total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions.

CONCLUSIONS

Future use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.

Nursing: Forever Changed by a Pandemic

The paper consists of reflections on the corona pandemic and nursing knowledge as practice. Nurses have been so appreciated by the public during this time that they are referred to as heroes. The moral injustice of taking nurses who come so willing to serve and not provide protective gear for their practice is addressed.

Operationalist and inferentialist pragmatism: Implications for nursing knowledge development and practice

Philosophical inquiries in nursing are useful for analysing and critiquing existing practices, exploring contextual factors affecting practice, adapting to and sustaining ongoing changes in knowledge development, and facilitating the linkages between theory, research and practice. Nurse scholars used several philosophical schools of thought to guide knowledge development and practice. Pragmatism has been described as essential for bridging the theory-practice gap, for engaging in the inquiry-based practice and for translating knowledge into practice. The existing descriptions of pragmatism rely on rudimentary descriptions of "what works" and "inquiry-based action" aspects. However, the operationalist and inferentialist aspects of pragmatism and their worth for nursing knowledge development and practice are yet to be discussed. This paper explores the operationalist and inferentialist pragmatism and highlights the implications of these aspects for nursing knowledge development and practice. It has been argued that the dual aspect of pragmatism offers an approach to develop practical lines of action, evaluate actions in terms of their usefulness and assimilate already learned actions with the new actions. I suggested that moving beyond the rudimentary understanding of pragmatism and embracing and utilizing the dual aspect of pragmatism can bring more significant benefits for nursing. Embracing the dual aspect of pragmatism can enable nurses in developing philosophical reflexivity, emphasizing the experiential context of nursing, generating actionable and ready to use knowledge, and utilizing nursing theories to their fullest potential.

Superstition in health beliefs: Concept exploration and development

Concept exploration and development of superstition is the aim of this research. Superstition is a complex concept, needs to be clarity, removes it from its mundane state, and gives it a scientific richness. To use a list of questions extracted from a review of the literature to analyze, develop, and explore superstition. It was assessed according to studies conducted in three fields sociology, psychology, and nursing. The maturity of the concept was determined in four areas, epistemology, practicability, semantics, and deduction/logic. Nurses must discover people's beliefs and superstitions. Although the concept of superstition is commonly used, many of its features and aspects were still unclear.

Construction of nursing knowledge in commodified contexts: A discussion paper

This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse-patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge.

Relationships between the Advanced Nursing Process quality and nurses' and patient' characteristics: A cross-sectional study

Aim

This study aimed to assess (a) nurses' knowledge and their attitude towards the Advanced Nursing Process-nursing assessment, diagnoses, interventions, outcomes, (b) the quality of the Advanced Nursing Process and (c) relationships with patient characteristics.

Design

A cross-sectional, descriptive correlational study was performed.

Methods

Ninety-two registered nurses and ninety nursing records of six hospital wards were included. In January 2016, a knowledge test, a self-assessment tool for measuring nurses' attitude (PND) and the Quality of Diagnoses, Interventions and Outcomes Revised instrument (Q-DIO R) were applied. The correlations between nurses' knowledge, attitude, patient characteristics, organizational factors and the Advanced Nursing Process quality were investigated.

Results

Nurses demonstrated low levels of knowledge, positive attitudes and an average Advanced Nursing Process quality. Accurate nursing diagnoses were strong and highly significantly related to effective nursing interventions and better nursing-sensitive patient outcomes. A higher proportion of registered nurses was related to better nursing outcomes.

The Prismatic Midparadigm of Nursing

The disciplinary perspective of nursing is guided in part by its metaparadigm, which includes the concepts of human beings, environment, health, and nursing. While relevant to the discipline as a whole, these abstract concepts are not meant for operationalization into the practice environment. The authors in this paper introduce a midparadigm of nursing-namely, the prismatic midparadigm-for applications in research, practice, policy, and education. It is a framework of concepts that are less abstract, but congruent with, the metaparadigm and more specific to the practice environment with the context of vulnerability as central.

Fuzzy cognitive mapping: An old tool with new uses in nursing research

AIMS

Describe the implementation and uses of fuzzy cognitive mapping (FCM) as a constructive method for meeting the unique and rapidly evolving needs of nursing inquiry and practice.

DESIGN

Discussion paper.

DATA SOURCES

Drawing on published scholarship of cognitive mapping from the fields of ecological management, information technology, economics, organizational behaviour and health development, we consider how FCM can contribute to contemporary challenges and aspirations of nursing research.

IMPLICATIONS FOR NURSING

Fuzzy cognitive mapping can generate theory, describe knowledge systems in comparable terms and inform questionnaire design and dialogue. It can help build participant-researcher partnerships, elevate marginalized voices and facilitate intercultural dialogue. As a relatively culturally safe and foundational approach in participatory research, we suggest that FCM should be used in settings of transcultural nursing, patient engagement, person- and family-centred care and research with marginalized populations. FCM is amenable to rigorous analysis and simultaneously allows for greater participation of stakeholders.

CONCLUSION

In highly complex healthcare contexts, FCM can act as a common language for defining challenges and articulating solutions identified within the nursing discipline.

IMPACT

There is a need to reconcile diverse sources of knowledge to meeting the needs of nursing inquiry. FCM can generate theory, describe knowledge systems, facilitate dialogue and support questionnaire design. In its capacity to engage multiple perspectives in defining problems and identifying solutions, FCM can contribute to advancing nursing research and practice.

Philosophical Theories of Truth and Nursing: Exploring the Tensions

In this paper, the authors explore three philosophical theories of truth and offer a critique of this foundational area of scholarship for nursing. A brief summary of key ideas related to the three substantial philosophical theories of truth-that is, correspondence, pragmatism, and coherence-serves to highlight various convictions and commitments that facilitate or discourage the growth of nursing knowledge in particular ways. The authors conclude that the coherence theory of truth offers a more inclusive view of truth and best captures and supports the diversity that exists within nursing knowledge and the regulative ideal to which nursing aspires.

Nursing knowledge of essential maternal and newborn care in a high-mortality urban African setting: A cross-sectional study

Aims

To assess the knowledge of nurses of national guidelines for emergency maternity, routine newborn and small and sick newborn care in Nairobi County, Kenya.

Background

The vast majority of women deliver in a health facility in Nairobi. Yet, maternal and neonatal mortality remain high. Ensuring competency of health workers, in providing essential maternal and newborn interventions in health facilities will be key if further progress is to be made in reducing maternal and neonatal mortality in low‐resource settings.

Design

Cross‐sectional survey.

Methods

Questionnaires comprised of clinical vignettes and direct questions and were administered in 2015–2016 to nurses (n = 125 in 31 facilities) on duty in maternity and newborn units in public and private facilities providing 24/7 inpatient neonatal services. Composite knowledge scores were calculated and presented as weighted means. Associations were explored using regression. STROBE guidelines were followed.

Results

Nurses scored best for knowledge on active management of the mother after birth and immediate routine newborn care. Performance was worst for questions on infant resuscitation, checking signs and symptoms of sick newborns, and managing hypertension in pregnancy. Overall knowledge of care for sick newborns was particularly low (score 0.62 of 1). Across all areas assessed, nurses who had received training since qualifying performed better than those who had not. Poorly resourced and low case‐load facilities had lower average knowledge scores compared with better‐resourced and busier facilities.

Conclusion

Overall, we estimate that 31% of maternity patients, 3% of newborns and 39% of small and sick newborns are being cared for in an environment where nursing knowledge is very low (score <0.6).

Relevance to clinical practice

Focus on periodic training, ensuring retention of knowledge and skills among health workers in low‐case load setting, and bridging the know‐do gap may help to improve the quality of care delivered to mothers and newborns in Kenya.

The learning history: A research method to advance the science and practice of organizational learning in healthcare

AIMS

This paper presents a discussion of the learning history research method, including a description of how to conduct a learning history. Suggested applications of the method in research and clinical practice are also provided.

BACKGROUND

Organizational learning has been linked to improved clinical performance and other positive outcomes in healthcare. Yet, the theoretical guidance available to researchers and clinical leaders who study and strive to foster organizational learning is sparse. Studying how organizational learning occurs in the healthcare context is a critical step toward addressing this knowledge gap. The learning history, a participatory research method, is specifically designed for studying the organizational learning process. Thus, it is precisely suited for the work of developing a theoretical foundation for organizational learning in healthcare.

DESIGN

Discussion paper.

DATA SOURCES

This discussion paper is based on relevant literature and the authors' experiences conducting learning histories.

IMPLICATIONS FOR NURSING

Researchers can use learning histories to develop a better understanding of and a theoretical foundation for organizational learning in healthcare. Leaders in clinical practice can use learning histories to foster learning and improvement in their organizations.

CONCLUSION

Learning histories are a promising approach to advancing the science and practice of organizational learning.

Implementing an Obstetrics-Specific Triage Acuity Tool to Increase Nurses' Knowledge and Improve Timeliness of Care

OBJECTIVE

To implement an obstetrics-specific triage acuity tool called the Maternal Fetal Triage Index (MFTI) in two maternity units, test the change in nurses' knowledge of triage assessment, and improve timeliness of care.

DESIGN

A quality improvement project that included pre- and posttesting of nursing knowledge using the MFTI and measuring the difference in time based on time stamps from pregnant women's intake sheets.

SETTING/LOCAL PROBLEM

Two hospitals that are part of a large multi-campus hospital system in the Southeastern United States.

PARTICIPANTS

Obstetric triage nurses who have worked in obstetrics for more than 2 years.

INTERVENTION/MEASUREMENTS

Participants watched a clinical module about the MFTI and took a pretest; then, 2 months after implementation of the MFTI, they took a posttest. Comparisons of means of the tests were analyzed for a knowledge increase. A retrospective analysis of pre-implementation triage times was conducted using chart reviews from the previous year. This time was then compared with the weekly mean times on the patient flow sheets to assess for timeliness of care.

RESULTS

Participants received the educational session, took a pretest, and followed up with completion of a posttest 2 months later. There was an increase in nursing knowledge from a pretest mean score of 79% to a posttest mean score of 95%. Once the MFTI was implemented, timeliness of care improved; the result was a pre-implementation mean time of 19 minutes compared with a post-implementation mean time of 10.4 minutes.

CONCLUSION

The educational sessions effectively increased nursing knowledge, and the timeliness of care component showed an improvement from pre- to post-implementation time.

Embracing the wild profusion: A Foucauldian analysis of the impact of healthcare standardization on nursing knowledge and practice

Standardization has emerged as the dominant principle guiding the organization and provision of healthcare, with standards resultantly shaping how nurses conceptualize and deliver patient care. Standardization has been critiqued as homogenizing diverse patient experiences and diminishing nurses' skills and critical thinking; however, there has been limited examination of the philosophical implications of standardization for nursing knowledge and practice. In this manuscript, I draw on Foucault's philosophy of order and categorization to inform an analysis of the consequences of healthcare standardization for the profession of nursing. I utilize three exemplars to illustrate the impact of the primacy of standardized thinking and practices on nurses, patients and families: pain assessments using the 0-10 pain scale; patient triage emergency departments through the Canadian Triage and Acuity Scale; and determination of cause of death within the context of the current opioid crisis. Through each exemplar, I demonstrate that standardization reductively constrains nursing knowledge and the health and healthcare experiences of patients and populations. I argue that the centrality of standardization must be re-envisioned to embrace the complexity of health and more effectively and meaningfully frame nursing knowledge and practice within healthcare systems.

Thoughts About Advancement of the Discipline: Dark Clouds and Bright Lights

In this essay, several nurse scholars who are particularly concerned about the contemporary state of nursing science present their specific concerns (dark clouds) about the advancement of our discipline and the ways in which the concerns have been addressed (bright lights). This essay is the first of two essays that were catalyzed by Barrett's paper, "Again, What Is Nursing Science?" The second essay will be published in the next issue Nursing Science Quarterly.

Nursing as concrete philosophy, Part I: Risjord on nursing knowledge

This essay addresses the problem of the essentiality of nursing knowledge and what kind of theory, if any, is essential to nursing practice. The overarching aim of the essay was to argue for the thesis that nursing may be described as a kind of philosophical activity, and, consequently, that philosophy is the kind of "theory" that is essential to nursing practice and to the nursing discipline at large. The essay consists of two papers. The present paper, Part I, is a critical examination of Mark Risjord's discussion of the problem of the theory-practice gap in his Nursing Knowledge: Practice, Science, Philosophy, from 2010. According to Risjord, the cause of the theory-practice gap originates in an erroneous conception of science (logical positivism) which had a decisive influence upon the way nursing scholars appropriated theoretical frameworks for the nursing discipline. This philosophical influence is considered in effect to have generated the theory-practice gap. In order to bridge the gap, Risjord suggests, the nursing discipline needs to adopt a standpoint epistemology conjoined with a postpositivist conception of scientific theory. In this way, a legitimate brand of nursing science may be developed and the theory-practice gap overcome. I will argue that neither Risjord's diagnosis of the problem, nor his recommended cure, may succeed in rescuing the nursing discipline from the theory-practice gap. Rather, the real cause of the theory-practice gap, I will claim, derives from an erroneous conception of nursing (not of science), namely the conception of nursing as a kind of science (roughly speaking). On my view, to overcome the gap, the nursing discipline needs to make salient the inherently philosophical character of nursing. In the second paper (Part II), I will continue the discussion of nursing knowledge and delineate the thesis of nursing as a kind of concrete philosophy.

Big Data and Perioperative Nursing

Big data are large volumes of digital data that can be collected from disparate sources and are challenging to analyze. These data are often described with the five "Vs": volume, velocity, variety, veracity, and value. Perioperative nurses contribute to big data through documentation in the electronic health record during routine surgical care, and these data have implications for clinical decision making, administrative decisions, quality improvement, and big data science. This article explores methods to improve the quality of perioperative nursing data and provides examples of how these data can be combined with broader nursing data for quality improvement. We also discuss a national action plan for nursing knowledge and big data science and how perioperative nurses can engage in collaborative actions to transform health care. Standardized perioperative nursing data has the potential to affect care far beyond the original patient.

Using Evidence-Based Practice and an Educational Intervention to Improve Vascular Access Management: A Pilot Project

Abstract.

The Impact of a Neonatal Sleep Care Training Program on Nurses' Knowledge and Performance in Neonatal Intensive Care Units

BACKGROUND

Sleep is essential for organizing and maturation of the brain in premature infants; it also plays a role in maintaining the natural balance between different nervous centers. Given the role of nurses in neonatal sleep care, this study aimed at assessing the impact of a training program on the nurses' knowledge and performance in a Neonatal Intensive Care Unit (NICU).

MATERIALS AND METHODS

In this quasi-experimental study which structured into three stages, 35 nurses working in an NICU in Isfahan, Iran, were included. The neonatal sleep training program was in the form of a lecture with questions and answers and then placing posters and booklets in the NICU. The data were collected by a questionnaire for nurses' knowledge and performance assessment which its validity and reliability were determined through content validity and internal consistency, respectively. The nurses' knowledge was assessed via 40 multiple-choice questions before, immediately after, and 1 month after the training program, and their performance was evaluated before and 1 month after intervention using 15 multiple-choice questions. The data were analyzed by descriptive and inferential statistics using the SPSS software version 16.

RESULTS

The results showed that the mean score of nurses' knowledge after training has significantly increased as compared to before training (33.33 (4.4) vs. 19.33 (4.1)) (P < 0.001); however, the score of performance was slightly improved although it did not reveal any significant differences (P = 0.07, 42.6 (7.6) vs. 45.1 (7.8)).

CONCLUSIONS

The results indicated that this method of training program could lead to an increase in nurses' knowledge, but it did not significantly improve their performance. It may be due to a low number of training sessions; therefore, it is recommended to implement long-term training programs in this field.

Nurses' shift reports: a systematic literature search and critical review of qualitative field studies

AIMS AND OBJECTIVES

To identify reporting practices that feature in studies of nurses' shift reports across diverse nursing specialities. The objectives were to perform an exhaustive systematic literature search and to critically review the quality and findings of qualitative field studies of nurses' shift reports.

BACKGROUND

Nurses' shift reports are routine occurrences in healthcare organisations that are viewed as crucial for patient outcomes, patient safety and continuity of care. Studies of communication between nurses attend primarily to 1:1 communication and analyse the adequacy and accuracy of patient information and feature handovers at the bedside. Still, verbal reports between groups of nurses about patients are commonplace. Shift reports are obvious sites for studying the situated accomplishment of professional nursing at the group level. This review is focused exclusively on qualitative field research for nuanced and contextualised insights into nurses' everyday shift reporting practices.

DESIGN

The study is a systematic literature search and critical review of qualitative field analyses of nurses' shift reports. We searched in the databases CIHAHL, PubMed and PsycINFO and identified and reviewed 19 articles published 1992-2014. Data were systematically extracted using criteria for the evaluation of qualitative research reports.

RESULTS

The studies described shift report practices and identified several factors contributing to distribution of clinical knowledge. Shift report practices were described as highly conventionalised and locally situated, but with occasional opportunities for improvisation and negotiation between nurses. Finally, shift reports were described as multifunctional meetings, with individual and social effects for nurses and teams.

CONCLUSION

Innovations in between-shift communications can benefit from this analysis, by providing for the many functions of handovers that are revealed in field studies.

RELEVANCE TO CLINICAL PRACTICE

Leaders and practising nurses may consider what are the best opportunities for nurses to work up clinical knowledge and negotiate care.

Intersections of the arts and nursing knowledge

The arts and nursing are profoundly connected. While the relationship between nursing and art has persisted over time, the majority of nursing scholarship on the arts has historically centered upon the art of nursing practice and the cultivation and application of aesthetic knowing. However, there is a burgeoning use of arts-based strategies is nursing education, research, and practice. Correspondingly, there is a need to understand how such approaches can uniquely contribute knowledge to the nursing discipline in order to support arts-integration for nursing scholars. We structure our inquiry into arts' contributions according to two dominant methods of engaging with arts-based strategies: knowing about (e.g., phenomena) vis-à-vis art-viewing, and knowing through (e.g., embodied knowing) vis-à-vis art-making. In doing so, we explore critical contributions of art to nursing research and educational practices, including arts' capacity to augment traditional research and communication approaches, democratize the research space, challenge issues of representation, and facilitate education, dissemination, and reflexivity.

What we're trying to solve: the back and forth of engaged interdisciplinary inquiry

Interdisciplinary research assumes that teams of highly specialized scientists develop new knowledge by bridging their respective horizons. Nurse educators preparing nursing doctoral students to conduct interdisciplinary research need insight into how members of interdisciplinary research teams experience knowledge horizons in these complex contexts. Based on the work of the philosopher Bernard Lonergan, this pilot study uses Transcendental Method for Research with Human Subjects to explore interdisciplinary researchers' experiences with and attitudes toward interdisciplinary research. Results reveal the overarching conceptual category of "engaged interdisciplinary inquiry" which includes six themes: (i) valuing interdisciplinary engagement; (ii) direct engagement; (iii) interior engagement; (iv) disengagement; (v) facilitated engagement and (vi) engaged researcher development. Results also suggest engagement depends on vigorous "back and forth", or dialogue, with self and others, and demonstrate the study method is fruitful for cognitive inquiry. This pilot supports expanded study to inform preparation for and conduct of interdisciplinary research involving nurses and raises important questions about how the trend toward interdisciplinary research affects nursing science.