Change fatigue in nursing: An integrative review.

AIMS: To synthesize the empirical and theoretical literature on change fatigue in nursing, including how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. BACKGROUND: Change fatigue refers to the overwhelming feelings of stress, exhaustion and burnout associated with rapid and continuous change across healthcare organizations. Change fatigue can affect nurses' wellbeing, yet there is a distinct lack of literature which synthesizes the relationship between cumulative organizational change and nurses' wellbeing. DESIGN: Integrative review following Toronto and Remington and Whittemore and Knafl methodology. DATA SOURCES: Searches were conducted in CINAHL, Embase, Medline, APA PsycInfo, Scopus, Business Source Complete and ProQuest Dissertations & Theses Global in January 2022. REVIEW METHODS: A comprehensive search was conducted to identify literature on change fatigue in nursing. Included literature were critically appraised for methodological quality. Data from each article were abstracted and thematically analysed. RESULTS: Twenty-six articles were included in this review, including 14 empirical studies, 10 theoretical papers and two literature reviews. Five main themes described in the literature included: definitions, preceding factors, associated behaviours, consequences and mitigation strategies for change fatigue. CONCLUSION: This review highlights the impact of rapid and continuous change on nurses and nursing practice. Further research is needed to explore the relationship between change fatigue and burnout, understand how and why nurses withdraw or avoid change, and to develop a metric to measure change fatigue when considering new change initiatives. IMPACT: Findings from this review generated an improved understanding of how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. This paper provides practical recommendations for future research, direction for nursing educators and leaders, and encourages nurses to practice political agency with change management. PATIENT OR PUBLIC CONTRIBUTION: This project was an integrative review of the literature therefore no patient or public contribution was necessary.

Nursing student and faculty attitudes about a potential genomics-informed undergraduate curriculum.

OBJECTIVES: To explore attitudes about adding genomic content to an undergraduate nursing curriculum. Genomic knowledge is essential to nursing education, but challenges exist for curriculum innovation. Few countries have guiding documents from national nursing organizations on genomic competencies for practice or education. Information on attitudes about genomics may provide guidance for curriculum development. METHODS: Nineteen undergraduate nursing students and two faculty from a school of nursing with two sites in western Canada participated. Five focus groups and four interviews were conducted using a semi-structured focus group guide. Data were analysed using thematic analysis. Coding was inductive. RESULTS: Characteristics of participants, eight key themes, and four future focal areas were identified to guide future research and curriculum development. CONCLUSIONS: Global development of genomics-informed curricula will require a focus on increasing knowledge, defining scope and role, increasing visibility of role models, and preparing to implement precision health.

Assessing knowledge of genomic concepts among Canadian nursing students and faculty.

Objectives Contemporary nurses require genomic literacy to engage in genomics-informed health care. Little is known about the genomic literacy of undergraduate nursing students and faculty in many countries. Concept inventories can be used to assess levels of knowledge and inform curriculum development. Methods The 31-item Genomic Nursing Concept Inventory (GNCI) was administered to undergraduate nursing students (n=207) and faculty (n=13) in a school of nursing with two sites in western Canada. Results Scores on the GNCI were low and comparable to those of US students and faculty. Six student characteristics were associated with total score on the GNCI. Conclusions Both students and faculty need to increase their knowledge of genomics. Mandates from national nursing organizations and international collaboration are needed to develop and implement foundational genomics content for undergraduate curricula to enable graduates to engage in genomics-informed health care.

Sex Differences in Stroke Rehabilitation Care in Alberta.

BACKGROUND: Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation. METHODS: Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), length of stay (LOS), and discharge destination; (2) if sex was related to age at the time of stroke, stroke severity, and living arrangement at discharge from rehabilitation; and (3) whether patients' age and preadmission living arrangement had an influence on LOS in rehabilitation or discharge destination. RESULTS: Two thousand two hundred sixty-six adult stroke patients (1283 males and 983 females) were subcategorized as mild (FIM >80; n = 1155), moderate (FIM 40-80; n = 994), or severe (FIM <40; n = 117). Fifty-five percent of males (45.7% females) had mild stroke; 39.5% of males (49.5% females) had moderate stroke; and 5.5% of males (4.8% females) had severe stroke. Females were significantly older than males (p = 2.4 × 10-4). No sex difference existed in time from acute care to rehabilitation admission (p = 0.73) or in mean FIM change (p = 0.294). Mean LOS was longer for females than males (p=0.018). Males were more likely than females to be discharged home (p = 1.8 × 10-13). Further, male patients (p = 6.4 × 10-7) and those < 65 years (p = 1.4 × 10-23) were more likely to be discharged home without homecare. CONCLUSION: There are significant sex and age differences in LOS in rehabilitation and discharge destination of stroke patients. These differences may suggest that sex and age of the patient need to be considered in care planning.

Inpatient Rehabilitation Care in Alberta: How Much Does Stroke Severity and Timing Matter?

BACKGROUND: We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination. METHODS: Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Further, we examined whether timing to inpatient rehabilitation impacted the latter three factors. RESULTS: The 2404 adults were subcategorized as mild (1237), moderate (1031), or severe (136) based on FIM at inpatient rehabilitation admission. Length of time to rehabilitation admission was not significantly (p = 0.232) different between stroke severities. Mean length of time (days) to rehabilitation admission was 19.79 (20.3 SD) for mild, 27.7 (35.7 SD) for moderate, and 37.70 (56.8 SD) for severe stroke. Mean FIM change for mild (M = 16.3, 9.9 SD) differed significantly (p = 5.1 × 10-9) from moderate (M = 30.4, 16.4 SD) and severe (M = 31.0, 25.7 SD) stroke. The mean LOS for mild stroke (M = 41.3, 31.9 SD) was significantly (p = 5.1 × 10-9) different from moderate stroke (M = 86.8, 76.4 SD) and severe stroke (M = 126.1, 104.2 SD). Time to inpatient rehabilitation admission showed a small, significant impact on FIM change (p = 1.4 × 10-9, partial η2 0.022) and LOS (p = 1.1 × 10-19, partial η2 0.042). Shorter times to rehabilitation admission and mild stroke were associated with discharging home without needing homecare. CONCLUSION: Stroke severity has a significant impact on the conduct of inpatient rehabilitation. Yet, despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small.

Les soins de réadaptation prodigués à des patients albertains hospitalisés: quelle est l'importance de la gravité des AVC et des délais d'admission en matière de réadaptation? Contexte: Nous nous sommes penchés sur l'impact que la gravité des AVC et les délais d'admission à des soins de réadaptation peuvent avoir sur la durée de séjour de patients hospitalisés, sur leurs gains fonctionnels et sur leur lieu de destination à la suite de leur congé. Méthodes: Nous avons analysé les données portant sur la réadaptation de patients albertains hospitalisés à la suite d'un AVC. Ces données couvraient la période allant d'avril 2013 à mars 2017. À l'aide de la mesure de l'indépendance fonctionnelle (MIF), nous avons ainsi évalué l'impact de la gravité des AVC sur les délais d'admission de patients hospitalisés à des soins de réadaptation, sur leurs gains fonctionnels, sur la durée de leur séjour et sur leur lieu de destination à la suite de leur congé. De plus, nous avons examiné dans quelle mesure les délais d'admission à des soins de réadaptation avaient un impact sur ces trois dernières variables. Résultats: Au total, 2 404 adultes ont été répartis en trois catégories en fonction de leur résultat à la MIF: AVC légers (1237), modérés (1031) ou graves (136). Mentionnons que les délais avant d'être admis à des soins de réadaptation ne se sont pas révélés notablement différents (p = 0,232) selon les niveaux de gravité des AVC. Les délais moyens (en jours) avant d'être admis à des soins de réadaptation ont été de 19,79 (σ 20,3) pour les AVC légers; de 27,7 (σ 35,7) pour les AVC modérés; et de 37,70 (σ 56,8) pour les AVC graves. En se basant sur la MIF, les changements moyens pour les AVC légers (M = 16,3; σ 9,9) ont différé de façon notable (p = 5,1 x 10-9) par rapport à ceux des AVC modérés (M = 30,4; σ 16,4) et des AVC graves (M = 31,0; σ 25,7). La durée moyenne de séjour dans le cas des AVC légers (M = 41,3; σ 31,9) s'est par ailleurs révélée significativement (p = 5,1 x 10-9) différente si on la compare aux autres catégories (AVC modérés M = 86,8; σ 76,4 ou AVC graves M = 126,1; σ 104,2). Les délais d'admission à des soins de réadaptation ont donné à voir un faible, quoique notable, impact sur les changements révélés par la MIF (p = 1,4 x 10-9, eta-carré partiel 0,022) et sur la durée des séjours (p = 1,1 x 10-19, eta-carré partiel 0,042). Enfin, des délais d'admission plus courts à des soins de réadaptation et des AVC légers ont été associés, à la suite d'un congé, à un retour à la maison sans devoir recourir à des soins à domicile. Conclusion: La gravité des AVC a un impact considérable sur la réadaptation de patients ayant été hospitalisés. Bien qu'il ait été suggéré que la réduction des délais d'admission à des soins de réadaptation devrait améliorer l'évolution de leur état de santé, l'impact quant à leurs gains fonctionnels et leur durée de séjour en réadaptation a toutefois été mineur.

From apprehension to advocacy: a qualitative study of undergraduate nursing student experience in clinical placement in residential aged care.

BACKGROUND: Undergraduate nursing placement in aged care is forecast to grow in importance with the increasing aging population, and to help to reverse trends in student lack of interest in gerontology careers. However, there is a need to better understand undergraduate nursing students' experiences on placement with older adults, as well as key features of quality learning within residential aged care. The aim of this study was to explore how nursing students understand learning within residential aged care. METHODS: This qualitative study used a participatory action research approach, and this paper reports on the thematic analysis of data from one cycle of undergraduate nursing placement in a Canadian residential aged care setting, with two groups of 7-8 students and two university instructors. Staff and residents at the research site were also included. Researchers interviewed both groups of students prior to and after placement. Instructors, staff and residents were interviewed post placement. RESULTS: Students commenced placement full of apprehension, and progressed in their learning by taking initiative and through self-directed learning pathways. Engagement with residents was key to student learning on person-centred care and increased understanding of older adults. Students faced challenges to their learning through limited exposure to professional nursing roles and healthcare aide/student relationship issues. By placement end, students had gained unique insights on resident care and began to step into advocacy roles. CONCLUSIONS: In learning on placement within residential aged care, students moved from feelings of apprehension to taking on advocacy roles for residents. Better formalizing routes for students to feedback their unique understandings on resident care could ensure their contributions are better integrated and not lost when placements end.

Factors influencing orthopedic nurses' pain management: A focused ethnography.

Aim: The aim of this study was to explore the factors influencing orthopedic surgery nurses' decisions to administer pro re nata (PRN) opioid analgesia for postoperative pain. Background: Fast-track surgery programs reduce length of stay by identifying and addressing factors causing patients to remain in hospital, including pain (H. Kehlet, Lancet. 2013;381:9878(9878)). The management of acute pain is an important component of quality care for patients after total knee arthroplasty. Methods: The study used a qualitative design of focused ethnography. Ten nurses working on an orthopedic surgery unit at a large urban hospital in western Canada participated in semistructured interviews that used a patient vignette to examine factors that influenced participants' pain management in the context of fast-track surgery. Interviews were transcribed and analyzed using thematic analysis and constant comparison. Findings: Nurses described a complex clinical environment where the interplay of several factors informed decisions to administer PRN opioid analgesia. The unit's culture and physical space influenced nurses' assessments of pain and their decisions whether to treat pain with PRN opioids. Each nurse's self-concept affected pain management decisions because of perceived importance of pain control and perceived duty to provide analgesics. The subjectivity of pain added another layer of complexity as nurses responded to the patient's expression of pain from within the milieu of the unit culture and their unique self-concept. Conclusion: Understanding the complexity of factors that influence nurses' postoperative pain management provides clinical nurses and nursing leaders with directions for future education and research, guided by the goal of continued improvement in pain management in the challenging setting of fast-track surgeries.

But: Étudier les facteurs qui influencent la décision des infirmières en chirurgie orthopédique d'administrer des analgésiques opiacés pro re nata pour la douleur postopératoire.Contexte: Les programmes de chirurgie accélérée réduisent la durée du séjour en cernant les facteurs qui font en sorte que les patients restent à l'hôpital, dont la douleur, et en y apportant des réponses (Kehlet, 2013). La gestion de la douleur aigue est une composante importante de la qualité des soins pour les patients après une arthroplastie totale du genou.Méthodes: L'étude a eu recours à un devis qualitatif d'ethnographie focalisée. Dix infirmières travaillant dans l'unité de chirurgie orthopédique d'un grand hôpital urbain de l'Ouest du Canada ont participé à des entrevues semi-structurées qui avaient recours à une vignette de patient pour examiner les facteurs influençant la gestion de la douleur dans le contexte d'une chirurgie accélérée. Les entrevues ont été transcrites et analysées au moyen d'une analyse thématique et de la méthode de comparaison constante.Résultats: Les infirmières ont décrit un environnement clinique complexe où l'interaction de plusieurs facteurs était à l'origine de la décision d'administrer un analgésique opiacé pro re nata (prn). La culture de l'unité, de même que l'espace physique, influençait l'évaluation des infirmières et leur décision de traiter la douleur avec des opiacés pro re nata. L'image de soi de chaque infirmière affectait ses décisions en matière de gestion de la douleur en fonction de l'importance qu'elle accordait au contrôle de la douleur et de sa perception de l'obligation de donner des analgésiques. La subjectivité de la douleur a ajouté une autre couche de complexité car les infirmières ont répondu à l'expression de la douleur par le patient dans le contexte de la culture de l'unité et de leur propre image de soi.Conclusion: La compréhension de la complexité des facteurs qui influencent la gestion de la douleur post-opératoire par les infirmières donnent des orientations aux infirmières cliniciennes et aux infirmières-cadres en ce qui concerne l'enseignement et la recherche dans l'avenir, dans le but de constamment améliorer la gestion de la douleur dans le contexte difficile des chirurgies accélérées.

South Asians' cardiac medication adherence.

AIM: This paper is a report of a narrative review examining the current state of knowledge regarding adherence with cardiac medication among South Asian cardiac patients. BACKGROUND: South Asians experience higher rates of cardiovascular disease than any other ethnic group. South Asians may be less adherent with a cardiac medication regimen than Caucasians. The factors contributing to adherence are important to discover to assist South Asians to optimize their cardiac health. DATA SOURCES: CINAHL, Medline (Ovid), PsychINFO, EMB Reviews-(Cochrane), and EMBASE were accessed using the key words: 'South Asian', 'Asia', 'East India', 'India', 'Pakistan', 'Bangladesh', 'Sri Lanka', 'medication compliance', 'medication noncompliance' and 'medication adherence'. English language papers published from January 1980 to January 2013 were eligible for inclusion. REVIEW METHODS: Abstracts were reviewed for redundancy and eligibility by the primary author. Manuscripts were then retrieved and reviewed for eligibility and validity by the first and last authors. Content analysis strategies were used for the synthesis. RESULTS: Thirteen papers were in the final data set; most were conducted in India and Pakistan. Medication side-effects, cost, forgetfulness and higher frequency of dosing contributed to non-adherence. South Asian immigrants also faced language barriers, which contributed to non-adherence. Knowledge regarding the medications prescribed was a factor that increased adherence. CONCLUSION: South Asians' non-adherence to cardiac medications is multifaceted. How South Asians who newly immigrate to Western countries make decisions regarding their cardiac medication adherence ought to be explored in greater detail.

Weight and patients' decision to undergo cardiac surgery.

Obese patients are less likely to have cardiac surgery than normal weight patients. This could be due to physician or patient decision-making. We undertook a qualitative descriptive study to explore the influence of obesity on patients' decision-making to have cardiac surgery. Forty-seven people referred for coronary artery bypass graft (CABG) surgery were theoretically sampled. Twelve people had declined cardiac surgery. Participants underwent in-depth interviews aimed at exploring their decision-making process. Data were analyzed using conventional content analysis. Though patients' weight did not play a role in their decision, their relationship with their cardiologist/surgeon, the rapidity and orchestration of the diagnosis and treatment, appraisal of risks and benefits, previous experience with other illness or others who had cardiac surgery, and openness to other alternatives had an impact. It is possible that there is a lack of comfort or acknowledgment by all parties in discussing the influence of weight on CABG surgery risks.

Achieving interprofessional practice in cardiac rehabilitation.

PURPOSE: Cardiac rehabilitation staff members consider interprofessional practice to be the standard for delivering effective care. However, it is not known how interprofessional teams collaborate or what they consider to be important elements of collaboration. Thus, it is important to investigate how healthcare professionals plan and communicate care, work together, and define their roles as members of the cardiac rehabilitation teams. The purpose of this report was to provide an analysis of current literature related to interprofessional practice in cardiac rehabilitation, with a particular focus on examining the terms interprofessional practice and collaboration. METHODS: For this review, published articles in peer-reviewed journals for the preceding 20-year period were included from online databases (CINAHL, MEDLINE, EBM Reviews, PubMed, and Google Scholar). Key words used in the search included "cardiac rehabilitation," "cardiac recovery," and "interprofessional and interdisciplinary practice and collaboration." Of the 67 articles reviewed, 7 met inclusion criteria specifically addressing interprofessional practice in cardiac rehabilitation. RESULTS: Analysis revealed that (1) the terms interprofessional and multidisciplinary are commonly used interchangeably in healthcare, revealing a lack of clarity regarding interprofessional practices and approaches, and (2) there are few articles that clearly describe, define, or discuss interprofessional practice or collaboration in cardiac rehabilitation settings, rendering it difficult for practitioners to adhere to published practice guidelines. CONCLUSION: It is unclear why and how professional team members practice in specific ways to form cardiac teams. Further research is required to increase an understanding of these issues and to develop possibilities for the enhancement of cardiac rehabilitation practice.

Understanding nursing on an acute stroke unit: perceptions of space, time and interprofessional practice.

AIM: This paper is a report of a study conducted to uncover nurses' perceptions of the contexts of caring for acute stroke survivors. BACKGROUND: Nurses coordinate and organize care and continue the rehabilitative role of physiotherapists, occupational therapists and social workers during evenings and at weekends. Healthcare professionals view the nursing role as essential, but are uncertain about its nature. METHOD: Ethnographic fieldwork was carried out in 2006 on a stroke unit in Canada. Interviews with nine healthcare professionals, including nurses, complemented observations of 20 healthcare professionals during patient care, team meetings and daily interactions. Analysis methods included ethnographic coding of field notes and interview transcripts. FINDINGS: Three local domains frame how nurses understand challenges in organizing stroke care: 1) space, 2) time and 3) interprofessional practice. Structural factors force nurses to work in exceptionally close quarters. Time constraints compel them to find novel ways of providing care. Moreover, sharing of information with other members of the team enhances relationships and improves 'interprofessional collaboration'. The nurses believed that an interprofessional atmosphere is fundamental for collaborative stroke practice, despite working in a multiprofessional environment. CONCLUSION: Understanding how care providers conceive of and respond to space, time and interprofessionalism has the potential to improve acute stroke care. Future research focusing on nurses and other professionals as members of interprofessional teams could help inform stroke care to enhance poststroke outcomes.

The inevitable pull of the river's current: interpretations derived from a single text using multiple research traditions.

The purpose of this article is to make visible the multiple ways in which doctoral students from various qualitative research traditions learned to think, read, and write interpretively as they completed an assignment requiring the interpretive analysis of a common interview transcript. Students were asked to offer a convincing account of the text and to demonstrate an understanding of what it means to interpret within their selected research tradition. Shared and disputed meanings arising from the interpretive process are presented and discussed. This description of their collective experience might be useful to novice researchers and their mentors.

Post-stroke shoulder subluxation: a concern for neuroscience nurses.

Approximately 84% of all stroke patients with hemiplegia will experience shoulder injury and pain. The importance of maintaining proper posture while positioning and transferring a stroke patient is key to decreasing risk for shoulder injury. Shoulder subluxation injury post-stroke is a consequence of sustained hemiplegia and spasticity. Current research evidence suggests that using therapies such as gentle range of motion and functional electrical stimulation may reduce and prevent shoulder subluxation and hemiplegic shoulder pain. However, physiotherapists are currently the only professionals who can implement such therapies. Considering that stroke care provided by neuroscience nurses includes transferring, positioning and assisting in activities of daily living, it is clear that nurses are an important part of the therapy process. Therefore, the question is: "What is the role of the neuroscience nurse in the reduction and prevention of shoulder pain post-stroke?" The purposes of this paper are to i) discuss the causes of shoulder subluxation and related pain post-stroke, ii) review current best practice in prevention and treatment of shoulder subluxation, and iii) explore ways in which the acute neuroscience nurse can prevent or reduce shoulder subluxation in the hemiplegic stroke patient.

Neurodevelopmental treatment stroke rehabilitation: a critique and extension for neuroscience nursing practice.

The aim of this article is to review neurodevelopmental treatment (NDT) literature and existing stroke NDT nursing research, as well as explore issues related to professional collaboration in stroke rehabilitation and implications for neuroscience nursing practice. NDT or the Bobath approach is used to encourage stroke patients to use the affected side of their body in order to promote and relearn normal movement and to reduce muscle spasticity. Neuroscience nurses have an important role in facilitating stroke patients to practise transferring out of bed and performing activities of daily living outside of physiotherapy and occupational therapy sessions. Neuroscience nurses also care for stroke patients over a 24-hour perio. Therefore, it is important that nurses understand physiotherapy and occupational therapy strategies in stroke rehabilitation.