Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
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Item Listen to me, I really am sick! Patient and family narratives of clinical deterioration before and during rapid response system intervention(2024-05-31) Bucknall, Tracey K.; Guinane, Jessica; McCormack, Brendan; Jones, Daryl; Buist, Michael; Hutchinson, Alison M.Aim: To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital. Background: Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability. Design: A narrative inquiry. Methods: Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data. Results: The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation. Conclusion: Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians. Implications for the Profession and/or Patient Care: Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly. Reporting Method: The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting. Patient or Public Contribution: The consumer researcher was involved in design, data analysis and publication preparation.Item Improving person-centred leadership: A qualitative study of ward managers' experiences during the COVID-19 crisis(Dove Press, 2021-04-07) Hølge-Hazelton, Bibi; Kjerholt, Mette; Rosted, Elizabeth; Thestrup Hansen, Stine; Zacho Borre, Line; McCormack, BrendanIn order to provide guidance and prepare ward managers for future crisis situations similar to the COVID-19 pandemic, the aim of this study was to reflect and learn how person-centred nursing leadership may be strengthened in such situations. The pandemic has forced nurse leaders to face new challenges. Knowledge about their experiences may contribute to advancing leadership practices in times of future crises. A qualitative directed content analysis was chosen. The theoretical perspective was person-centred leadership. Thirteen ward managers from a Danish university hospital were included and interviewed using telephone interviews three months after the first national COVID-19 case was confirmed. The main findings of the study revealed that the ward managers often experienced a lack of timely, relevant information, involvement in decision-making and acknowledgement from the head nurse of department and the executive management. This was caused by the existing organizational cultures and the traditional hierarchy of communication. This meant that the ward managers' sense of own competences and leadership values and beliefs came under high pressure when they had to balance different stakeholders' needs. When the experience of ward managers results in them being unable to lead authentically and competently in a crisis like the COVID-19 pandemic, lack of engagement can occur, with serious consequences for patients, staff and the ward managers themselves. Traditional organizational cultures that are hierarchical and controlling needs to be challenged and reoriented towards collaborative, inclusive and participative practices of engagement and involvement. Leadership development must be an established and integrated component of organizations, so that ward managers are able to sustain person-centred ways of being and doing in times of crisis.Item Collaboration between home care staff, leaders and care partners of older people with mental health problems: A focus on personhood(Wiley, 2019-05-20) Anker-Hansen, Camilla; Skovdahl, Kirsti; McCormack, Brendan; Tønnessen, SiriAim: To explore home care staff and leaders’ experiences of collaborating with care partners of older people with mental health problems through a personhood perspective.Item Nurses' perceptions of early person-centred palliative care: A cross-sectional descriptive study(Wiley, 2019-05-20) Kmetec, Sergej; Štiglic, Gregor; Lorber, Mateja; Mikkonen, Irma; McCormack, Brendan; Pajnkihar, Majda; Fekonja, ZvonkaPalliative care is aimed at improving the quality of life of an individual with chronic noncommunicable disease and their care partners. Limitations in the provision of palliative care are mainly lack of knowledge and experience by nurses, fear of treating palliative persons, loss of control over treatment and fear of providing poor-quality palliative care to persons and care partners. The aim of this study was to investigate the perception, knowledge and attitudes of palliative care by nurses who use palliative care approaches in practice, as well as the difference in perception, knowledge and attitudes of palliative care between nurses in Slovenia and Finland. We conducted a cross-sectional descriptive study. The survey included 440 nurses in clinical environments in Slovenia and Finland with a completed bachelor, master or doctoral level of education. We found statistically significant differences between both countries in the perception of palliative care. Differences between the two countries in the knowledge of palliative care were not confirmed. We confirmed statistically significant differences between both countries in the attitudes of palliative nursing care. Early person-centred palliative care is an important part of the holistic and integrative treatment of a person who has a disease with disturbing symptoms. For such an approach, it is important to educate nurses about knowledge, expectations, values and beliefs in developing a concept of person-centred palliative care to improve quality of life. The better perception, knowledge and attitudes of palliative care by nurses may help persons to improve and raise their quality of life, as well as diminish stress in their care partners and improve quality of life.Item Invisible cornerstones. A hermeneutic study of the experience of care partners of older people with mental health problems in home care services.(Wiley, 2018-11-16) Anker-Hansen, Camilla; Skovdahl, Kirsti; McCormack, Brendan; Tønnessen, SiriTo explore the lived experiences and support needs of the care partners of older people with mental health problems living at home with assistance from home care services. Care partners face significant challenges in their care role and they often feel unsupported. An understanding of their experiences may help improve home care to support their needs. An exploratory qualitative approach was used. The study is based on the SRQR and COREQ reporting guidelines. In-depth interviews were conducted with six Norwegian care partners from two municipalities. Data were collected during 2012-2013 and 2016. The data were analysed using Gadamer's hermeneutics. Three themes were identified: "invisible cornerstones," "dimensions of collaboration" and "unwanted roles." Few or no routines for collaboration exist between care partners and home care, and the care partners seem to have little knowledge of legal rights. They request more information, spare time and the opportunity to remain in their original family role. However, their main focus is for the patient to receive the necessary help from home care. Home care have restricted resources for meeting these needs and share a sense of powerlessness and lack of influence over their own everyday life with the care partners. There is a need for a systematic, person-centred approach to collaboration. A correlation is necessary between what is communicated at the system level and the means of realising this in practice for home care to meet care partners' needs. [Abstract copyright: © 2018 John Wiley & Sons Ltd.]Item Danish translation and adaptation of the Context Assessment Index (CAI) with implications for evidence-based practice(Wiley, 2019-01-28) Hølge-Hazelton, Bibi; Bucknall, Tracey; Bruun, Line Zacho; Slater, Paul F.; McCormack, Brendan; Klausen, Susanne Hwiid; Thomsen, Thora SkodshøjBackground: Healthcare contexts are rapidly changing with growing demand for health services to accommodate an ageing population and financial pressures. Assessment of context in healthcare set-tings has been the subject of increasing debate. The Context Assessment Index (CAI) examines three interconnected contextual elements derived from the PARIHS-Framework with the purpose of providing practitioners with an understanding of the context in which they work. Aims: 1: To describe the translation of the CAI into Danish and adapt the instrument for use in Danish hospitals. 2: To evaluate the psychometric properties of the Danish version of the CAI. Methods: Translation and adaption included an expert panel and a translation/back-translation pro-cess. The CAI was then sent to 4416 nurses in the Region Zealand, Denmark. There are two alternative measurement models to explain the factor structure of the CAI, the five-factor model and the three-factor model. In order to provide the best explanation for the data both measurement models were examined using confirmatory factor analysis. Results: The CAI was translated and modified based on expert review and usability testing. 2261 nurses completed the CAI. For both models, factor loadings and fit statistics were acceptable, appropriate and statistically significant, and the measurement models were confirmed (5-factor model RMSEA 0.07, CFI=0.923; 3-factor model RMSEA 0.07, CFI=0.924). Cronbach alpha scores showed the models to have broadly acceptable scores (5-factor 0.64 – 0.89; 3-factor model 0.72 – 0.89). Linking Evidence to Action: The three-factor model can advantageously be used when the PARIHS framework is part of the project. In a translation process, differences in cultural specificity, language, and working environment have to be considered. By understanding the context of practice, nurses may enable person-centered care and improve patient outcomes.Item Third-generation professional doctorates in nursing: the move to clarity in learning product differentiation(Foundation of Nursing Studies (FoNS), 2017-11-15) Cashin, Andrew; Casey, Mary; Fairbrother, Greg; Graham, Iain; Irvine, Lindesay; McCormack, Brendan; Thoms, DebraContext: Professional doctorates have been a part of the academic landscape for many years. Over this time, their focus, structure and mode of delivery have changed significantly as the terrain of professional practice has developed. In this paper we articulate this development over time through discussion of the evolution of first- and second-generation professional doctorates, and argue that there is a need for a third-generation doctorate with greater clarity regarding focus, structure and mode of delivery, in the context of advanced professional practice. Aims: A scoping review was undertaken of the development of professional doctorates in the discipline of nursing to inform thinking with regard to future design work for a post-masters (nurse practitioner endorsement) professional doctorate. Conclusion: In the context of the absence of any identified published outcome-based evidence of the value of first- or second-generation professional doctorates in general, and specifically in nursing, a third-generation evolution is proposed. This is based on the conclusion that the lack of identified outcomes is based not only on the axiomatic absence of research, but also that this may be symptomatic of a prevailing lack of clarity in programme design. A third-generation professional doctorate for nursing offers an opportunity to focus on congruence and internal consistency between the aims of the programme, learning outcomes, learning content and design, and the assessment. Implications for practice development: - The third-generation professional doctorate would no longer need to be distinguished from other degrees via an expression of what it is not, but rather would set out what it is - The educational product, with clear processes and content that are congruent with the course aims, could be clearly described as a self-contained entity more capable of producing measurable outcomes - Practice development is an integral part of the learning product through being a prescribed method in the research component of the course