Experiences of parents visiting an adult family member in the intensive care unit accompanied by their underaged children: A qualitative study.

OBJECTIVES: The objective of this study was to explore experiences and needs of parents visiting critically ill family members in intensive care units (ICUs) accompanied by their underaged children (<18 years). METHODS: Six semistructured interviews with parents were conducted in a qualitative design. Data analysis and synthesis were performed using Braun and Clarke's thematic analysis. This study was conducted in five adult ICUs in Switzerland. FINDINGS: Parents opted for early and truthful involvement of their children, and the majority initiated the visits themselves. Five themes were identified: feeling of shock by the entire family; crying in front of the children; feeling welcome with the children; knowing that the children can cope with it; and holding the family together. Parents felt only partially welcomed in the ICU when accompanied by their children. In one case, the parents withdrew the child from the visit. CONCLUSIONS: Parents experienced the visit to a critically ill family member in the ICU with their underaged children as challenging. They were emotionally vulnerable and yet took the initiative to keep the family together. Parents had to mediate between their children, the critically ill family member, and the treatment team. Awareness of the needs of the parents visiting with underaged children is important in clinical practice. There is a need for family-centred structures and processes, including adequate visiting times and rooms suitable for children with books, pictures, and toys.

Protecting Personhood: A Classic Grounded Theory.

The importance of perceiving and considering patients as healthcare partners has been increasingly promoted. Healthcare systems around the world are now highly interested in patient engagement, participation, collaboration, and partnership. Healthcare professionals are advised that patients, as autonomous beings, should be active in and responsible for a portion of their own care. The study presented here focused on patients' perceptions of interprofessional collaboration. It was conducted using the classic grounded theory methodology. The theory of protecting personhood emerged as the core concept of hospitalized patients, cared for by interprofessional healthcare teams. This theory encapsulates the process hospitalized patients go through to find balance in their sense of self, oscillating between personhood and patienthood in the unfamiliar hospital environment. The process consists of four stages: the stage of introspection, during which hospitalized patients become aware of their self as a person and as a patient; the stage of preservation, when patients find a balance between the sense of personhood and patienthood; the stage of rupture, wherein patients experience an imbalance between their sense of personhood and patienthood; and the stage of reconciliation, in which personhood is restored. The theory of protecting personhood offers insights into a better understanding of hospitalized patients' experiences and strategies, revealing the importance of relationships, and the driving force of empowerment. This study is about patients' perspectives of interprofessional healthcare teams. A grounded theory process allowed the emergence of patients' concerns and expectations, leading to a substantive theory grounded in the patients' data.

Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries.

To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross-disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care.

[The contribution of advanced practice nurses in Swiss family practices: Multiple case study design]. / Der Beitrag von Advanced Practice Nurses in Schweizer Hausarztpraxen.

The contribution of advanced practice nurses in Swiss family practices: Multiple case study design Abstract. Background: The increase in chronic diseases, multimorbidity and shortage of health professionals make it essential to adapt primary health care. New models of care are needed which are oriented towards patient needs and thus ensure comprehensive care for chronically ill people. In this context, there is great potential for the use of advanced practice nurses in Swiss family practices. Aims: In this study we investigated the contribution of advanced practice nurses in the interprofessional context in two family practices. Methods: We conducted a multiple case study design. We investigated two advanced practice nurses, located in family practices in rural and in mountainous regions. We used qualitative and quantitative methods. As an intermediate step, within-case analyses were performed and we summarized data inductively to create case vignettes. Results: The cases showed that advanced practice nurses contribute to self-management, prevention and health promotion in complex, stable and unstable patients. These areas have not been covered adequately by other health professionals in family practices. They strengthened interface management through hybrid employment and flexible, addressee-appropriate communication. Conclusions: Similarities and differences between family practices with and without new professional roles should be elicited to specifically identify gaps in care for the chronically ill.

Competencies of nurse practitioners in family practices: A scoping review.

AIMS AND OBJECTIVE: To explore the existing literature related to nurse practitioner (NP) competencies in family practices and to examine the evidence and develop a list of competencies. BACKGROUND: The integration of NPs into the healthcare system is at different stages of progress around the world. Therefore, an overview and clarification of competencies are important to ensure successful implementation of new roles in existing healthcare systems. However, detailed knowledge is lacking about the competencies of NPs in adult care in family practices. DESIGN AND METHODS: We conducted a scoping review in accordance with the JBI methodology for scoping reviews and the PRISMA-ScR guidelines. We considered studies published in English, German or French from 1965 to the present. Databases searched included MEDLINE, CINAHL, Web of Science and PsycINFO. Sources of grey literature that were searched included ProQuest Dissertations and Theses, OpenGrey and websites of national NP organisations. Two reviewers retrieved full-text studies and extracted data independently. We described the competencies using Hamric's model of advanced practice nursing. RESULTS: We included 23 publications. Competencies in direct clinical practice were described most often particularly pertaining to nursing or medical tasks. Indirect care activities were frequently mentioned. Less information was found regarding competencies in leadership, ethical decision-making and evidence-based practice. We found elementary and extended competencies required to perform the role in family practices. Depending on the country, the role was either emerging or already well-established. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: This review provides insight into current knowledge about competencies of NP in family practices. The identified competencies can be used to develop job descriptions or to conceptualise professional development programmes in countries where such roles are just recently emerging. A list of competencies will promote a common understanding of the NP role and to help clarify interprofessional collaboration in clinical practice.

The perspective of spirituality of patients with new hematological cancer and their families. An exploratory qualitative study / La spiritualité : perspective de patients atteints d'un cancer hématologique nouvellement diagnostiqués et de leurs proches. Une étude qualitative exploratoire

Introduction: For patients with newly diagnosed hematological cancer spirituality constitutes an important aspect. Spirituality refers to a person's attachment to what inspires and grounds him/her as well as to associated beliefs, values, and existential experiences, be they religious or not. However, these aspects are not systematically and regularly determined and integrated into the care of patients with hematological cancer. Objective: To describe the perception of spirituality among patients with newly diagnosed hematological malignancies and their loved ones. Method: This qualitative descriptive study employed semi-structured individual interviews with patients and their loved ones and the completion of three questionnaires concerning spiritual well-being, quality of life and symptom burden. Results: A total of 10 patients and six family members were included in our study. Three types of spirituality emerged from the interviews: religious, connecting, and non-religious spirituality. These perceptions are part of the backdrop of this disease whose sudden onset requires the mobilization of resources such as family support, coping strategies, resilience, and hope. Discussion: Beyond the physical consequences, hematological malignancies induce profound changes in patients and their loved-ones regarding their values and beliefs. Encouraging moments of self-expression such as addressing notions of spirituality and supporting patients in their personal cultural practices are important supportive measures that nurses can adopt into their practice.

Introduction: La prise en compte de la spiritualité auprès des patients atteints de cancer est importante. Elle désigne l'attachement de la personne à ce qui l'inspire et donne du sens à son existence, les convictions, les valeurs, les expériences associées, qu'elles soient de nature religieuse ou non. Cependant, ces aspects ne sont pas dépistés et utilisés d'une manière systématique et régulière dans la prise en soins des patients atteints d'hémopathie maligne. Objectif: Décrire le point de vue des patients ayant un diagnostic de cancer hématologique récent et de leurs proches envers la spiritualité. Méthode: Cette étude qualitative descriptive comprenait la réalisation d'entretiens semi-directifs auprès du patient et de son proche, et le remplissage de trois questionnaires concernant le bien-être spirituel, la qualité de vie et la charge en symptômes. Résultats: Dix patients et six de leurs proches ont été inclus dans notre étude. Trois types de spiritualité sont identifiés : religieuse, de connexion et non religieuse. Ces perceptions s'inscrivent en toile de fond d'une pathologie dont la survenue soudaine nécessite la mobilisation de ressources telles que la famille, les stratégies de coping, une résilience rapide et la manifestation d'espoir. Discussion: Le cancer hématologique, au-delà de l'impact physique, engage des changements profonds chez les patients et leurs proches concernant leurs valeurs et croyances. Favoriser des moments d'expressions de soi, comme aborder les notions de spiritualité, soutenir les patients dans leurs pratiques culturelles personnelles semble être favorable à l'intégration du soin spirituel en pratique par les infirmiers.

Competencies and scope of practice of nurse practitioners in primary health care: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to explore existing literature about nurse practitioners' competencies and scope of practice in primary health care in order to examine and conceptually map the evidence and identify gaps in the literature. INTRODUCTION: To meet growing health care needs, current primary health care models have expanded to include nurse practitioners. The integration of nurse practitioners in primary health care is challenging. This is mainly due to the lack of a unified definition of the role, competencies, or clear criteria to determine scope of practice. INCLUSION CRITERIA: This scoping review will consider studies addressing nurse practitioner practice in primary health care. The focus lies on nurse practitioner competencies (eg, core competencies or practice activities) and scope of practice (eg, areas of responsibility or legally defined professional boundaries). Studies that were conducted in primary health care settings in rural, urban, and suburban regions where nurse practitioners are employed will be included. METHODS: Studies published in English, German, or French from 1965 to present will be considered. The databases to be searched include PubMed, CINAHL, Web of Science, and PsycINFO. Sources of unpublished studies and gray literature to be searched will include ProQuest Dissertations and Theses, OpenGrey, and websites of national nurse practitioner organizations. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. The extracted data will be presented in tables or graphs, with an accompanying narrative summary.

Facilitators and barriers in implementing clinical nursing assessment in mental health care for older people: A multimethod approach.

With the aging of the population and the growing prevalence of dementia, specialized and collaborative nursing care is paramount in this area. To ensure better quality care, it is necessary to use effective and context-specific processes to implement evidence-based practices and more specifically clinical nursing assessment. This study aimed to identify and describe factors that may influence the implementation of clinical nursing assessment in mental health care for older people. The Consolidated Framework for Implementation Research was employed to guide evaluation in the pre-implementation phase in the specific context of mental health care for older people. Using a multimethod approach, interviews, focus groups, and a quantitative survey were conducted with a non-probability convenience sample. A total of 39 hospital nurses (registered nurses and head nurses) were interviewed. Analysis yielded five main factors, notably three barriers and two facilitators. Barriers include a lack of general nursing culture, deficiencies in leadership, and difficulties in communication and collaboration. Facilitators comprise team cohesion and the perceived benefits of the study.

Nurses' response to spiritual needs of cancer patients.

PURPOSE: In this qualitative study, nurses from the United States of America (USA) and Switzerland were asked to recount their spiritual care experiences with cancer patients and their own responses to their patients' spiritual needs. Recent advances in cancer care have highlighted the importance of spirituality and spiritual care as part of quality palliative care from the time of a patient's diagnosis through end of life. Nurses who play an important role in supporting patients, describe their own discomfort when confronting their patients' spiritual needs. METHODS: A qualitative survey was used to collect narratives of nurses' experiences in responding to spiritual care needs (n = 62). The accounts were analyzed using thematic analysis. RESULTS: Nurses identified patients as having spiritual needs and their own experiences in addressing spirituality or religion. Patients sought meaning in their illness, which, they believed, led to disease acceptance. Nurses reported their patients' struggles with challenging disease situations and their own challenges in addressing patients' spirituality/religion. With experience, nurses developed ways of talking with patients about spirituality/religion, which profoundly impacted their own lives and resulted in personal growth. CONCLUSION: Patients' spirituality was identified by nurses who tried to address patients' spiritual needs drawing on existing resources. For nurses, supporting patients in their spirituality and finding meaning in the disease situation eventually led to disease acceptance.

Interprofessional Collaboration and Involvement of Parents in the Management of Painful Procedures in Newborns.

Introduction: Newborns are subject to many painful procedures. Pharmacological and non-pharmacological approaches alone are not enough, and it is necessary to consider other contributing elements such as the environment, interprofessional collaboration and parental involvement. The aim of this feasibility study was to explore interprofessionality and the role of parents in improving the management of painful procedures in newborns and pain management strategies. Materials and Methods: a pre-post feasibility study using a mixed method approach was conducted. Questionnaires, interviews and focus groups were used to describe the parents' views on their child's pain management and involvement in care as well as to explore the level of interprofessionality and feasibility. Results: Collaboration between physicians and nurses improved following the implementation of a complex interprofessional intervention involving professionals, parents and newborns. In spite of improving professional collaboration in procedural pain management, parents were attributed a passive role or only marginally involved in in the infant's pain management. However, parents stated-as elicited by the questionnaires and interviews-that they wished to receive more information and be included in painful procedures executed on their infant. Discussion: Management of painful procedures in neonates needs to be changed. Interprofessional collaboration contributes to improved procedural pain management in neonates. It is essential to include parents as active members in the interprofessional healthcare team.

A Multidisciplinary Approach for Improving Quality of Life and Self-Management in Diabetic Kidney Disease: A Crossover Study.

Individuals with diabetic kidney disease are at high risk of complications and challenged to self-manage. Previous research suggested that multidisciplinary approaches would improve health outcomes. This study investigated the effect of a multidisciplinary self-management approach of diabetic kidney disease on quality of life, and self-management, glycemic control, and renal function. A uniform balanced crossover design was used because it attains a high level of statistical power with a lower sample size. A total of 32 participants (aged 67.8 ± 10.8) were randomized into four study arms. In differing sequences, each participant was treated twice with three months of usual care alternated with three months of multidisciplinary management. The intervention improved the present dimension of quality of life demonstrating higher mean rank as compared to usual care (52.49 vs. 41.01; p = 0.026, 95% CI) and three self-care activities, general diet habits, diabetes diet habits, and blood sugar testing (respectively: 55.43 vs. 38.31; p = 0.002, 56.84 vs. 37.02; p = 0.000, 53.84 vs. 39.77; p = 0.008; 95% CI). Antihypertensive medication engagement was high across the study period (Mean = 95.38%, Min = 69%, Max = 100%). Glycemic control and renal function indicators were similar for the intervention and the usual care. Studies are needed to determine how the new recommended therapies for diabetic kidney disease such as SGLT2 inhibitors and GLP-1 receptor agonists impact on self-management and quality of life.

The Omnipresence of Cancer: Two Perspectives.

This article aimed at describing the development of a theory of the experience of living with cancer. Secondary analysis of data from a series of studies yielded the concepts and propositions of the theory of the omnipresence of cancer. Theory construction was guided by Heidegger's ontology of dasein, whereas Newman's grand theory of health as expanding consciousness guided theory evolution. The theory includes 4 concepts-influencing factors, toward authentic dasein, mapping out the future, and living with cancer-each of which has several dimensions. Based on this theory, nursing interventions can be developed and tested to support persons with cancer.

A Systematic Review of Clinical Practice Guidelines for Acute Procedural Pain on Neonates.

OBJECTIVES: During hospitalization in neonatal intensive care units, neonates are exposed to many painful procedures within a stressful environment. To date, many evidence-based guidelines are available. However, the quality of these guidelines and their clinical application remain unclear. This systematic review aimed to determinie the quality of existing guidelines on the management of procedural pain in neonates and to summarize the recommendations provided by these guidelines. MATERIALS AND METHODS: A structured search was conducted in Embase, PubMed, CINAHL, JBI database, and gray literature resources in November 2018 to identify relevant guidelines published from 2007 onward. Published guidelines and guidelines from complementary searches were included in the treating assessment or management of procedural pain in neonates. The methodological quality was analyzed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. RESULTS: A total of 1154 records were identified. After screening for eligibility, 17 guidelines were included in this review. Among these, 11 were identified to be high-quality guidelines. Besides the usual recommendations for pharmacological and nonpharmacological treatments, the inclusion of parents, improving interprofessional collaboration, and considering the setting were identified as important elements. DISCUSSION: The results of this review show that there is a need to improve the methodological quality of guidelines for procedural pain in newborns. The set of recommendations for procedural pain prevention needs to involve not only pharmacological and nonpharmacological pain treatment but also parents and interprofessional collaboration. It is also essential to take into account facilitators, barriers, and the context to improve pain management.

A complex interprofessional intervention to improve the management of painful procedures in neonates.

During hospitalization, neonates are exposed to a stressful environment and a high number of painful procedures. If pain is not treated adequately, short- and long-term complications may develop. Despite evidence about neonatal pain and available guidelines, procedural pain remains undertreated. This gap between research and practice is mostly due to limited implementation of evidence-based knowledge and time constraints. This study describes in detail the development process of a complex interprofessional intervention to improve the management of procedural pain in neonates called NEODOL© (NEOnato DOLore). The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used as a methodological guide for the design of the NEODOL© intervention. The development of the intervention is based on several steps and multiple methods. To report this process, we used the Criteria for Reporting the Development of Complex Interventions in Healthcare (CReDECI 2). Additionally, we evaluated the content of the intervention using a Delphi method to obtain consensus from experts, stakeholders, and parents. The complex interprofessional intervention, NEODOL©, is developed and designed for three groups: healthcare professionals, parents, and neonates for a level IIb neonatal unit at a regional hospital in southern Switzerland. A total of 16 panelists participated in the Delphi process. At the end of the Delphi process, the panelists endorsed the NEODOL© intervention as important and feasible. Following the MRC guidelines, a multimethod process was used to develop a complex interprofessional intervention to improve the management of painful procedures in newborns. Complex interprofessional interventions need theoretical bases, careful development, and integration of stakeholders to provide a comprehensive approach. The NEODOL intervention consists of promising components and has the potential to improve the management of painful procedures and should facilitate the knowledge translation into practice.

Using Ockham's razor to redefine "nursing science".

Confusion remains about the concept "nursing science." Definitions vary, depending on country, context and setting. Even among nurse scholars and scientists there is disagreement about the content and boundaries of nursing science. There is an urgent need for an acceptable definition that can guide nursing knowledge development, education, and practice. In this article, we highlight the problems for the profession of this sort of conceptual ambiguity, arguing that it is an ethical responsibility for the profession to gain clarity about the meaning and apt focus of our knowledge development initiatives. We parse out nursing and science as separate concepts and synthesize from this analysis a simple yet comprehensive definition of nursing science. We propose that this definition is capable of unifying ongoing nursing endeavors and should serve as the basis for evaluating nursing's knowledge development and educational initiatives.

Revie ⊕: An intervention promoting the dignity of individuals with advanced cancer: A feasibility study.

PURPOSE: The dignity of patients is a major concern among health professionals engaged in the care of individuals with advanced cancer. Although several dignity promoting interventions have been developed, none of them have focused on a positive, resource-based approach. The aim of our study, entitled Revie ⊕, was to assess the feasibility and acceptability of a theory-guided life-review intervention, focusing on strength and resources, for patients with advanced cancer and for nurses delivering the intervention. METHOD: Our 2015-2016 study was conducted with patients with advanced cancer in an ambulatory and an inpatient setting of a Swiss university hospital. An embedded concurrent mixed method design was used. The feasibility and acceptability of Revie ⊕ was explored, as were changes in the sense of dignity, posttraumatic growth, and satisfaction with life. RESULTS: A total of 41 patients received the intervention. The level of attrition was low (26%). Administering the Revie ⊕ intervention proved to be feasible. Participants (patients and nurses) considered the intervention helpful with a high level of satisfaction. A merged data analysis highlighted the need to address the patients' existential concerns. The majority of the participants found that the intervention helped them, and they recommend it for other patients. CONCLUSIONS: This study indicates that the Revie ⊕ intervention, which focuses on a resource-based approach, was perceived favorably by all of the participants. A change in the nurse-patient relationship was noted and it was deemed to be beneficial.

Experiences of newly diagnosed cancer patients in confronting the finitudes of life: a qualitative systematic review protocol.

REVIEW QUESTION: What is the experience of newly diagnosed patients with cancer when facing the finitude of life and undergoing initial anti-cancer treatment?

The Impact of motivational interviewing on illness perception in patients with stable coronary artery disease. A randomised controlled study / Auswirkung motivierender Gesprächsführung auf die Krankheitswahrnehmung bei stabiler koronarer Herzkrankheit. Eine randomisiert-kontrollierte Studie

Background: Coronary heart disease (CHD) constitutes one of the most frequent causes of death for individuals > 60 years. Lifestyle dependent risk factors are key. Hence, cardiac rehabilitation is essential for optimal CHD treatment. However, individuals rarely comprehend their illness. Motivational interviewing promotes illness perception. Aim/Methods: A randomised-controlled study was conducted to determine the effect of motivational interviewing on illness perception. Patients with stable coronary heart disease were consecutively recruited after elective percutaneous transluminal coronary angioplasty (PTCA). The intervention group received a short motivational interview (MI) about the disease and related risk factors as an intervention. The control group had usual treatment. Illness perception was assessed (Illness Perception Questionnaire-Revised) prior to the intervention and six months afterwards. Results: A total of 312 patients (intervention group: n = 148, control group: n = 164) were recruited into the study (mean age: 66.2 years). After the intervention, a significant change was observed in the domain of emotional reactions regarding the disease. Conclusion: To improve illness perception in patients with stable CHD, one short intervention with MI may have an effect. Whether intensifying the MI-intervention is more effective, requires further research.

Focused development of advanced practice nurse roles for specific patient groups in a Swiss university hospital / Gezielte Entwicklung von Advanced Practice Nurse-Rollen für spezifische Patient(inn)engruppen in einem Schweizer Universitätsspital.

Background: To cover future health care needs of the population, new care models are necessary. The development of advanced nursing practice (ANP) offers the opportunity to meet these challenges with novel services. At the Inselspital, Bern University Hospital, ANP services and corresponding advanced practice nurse (APN) roles have been developed since 2011. Purpose: The aim is to develop innovative and evidence based ANP services to supplement health care for specific patient groups and their family members with the goal to improve safety and achieve better outcomes. Methods: Project-based ANP services are developed in close collaboration of clinical departments and the Nursing Development Unit (NDU) of the Directorate of Nursing. Structure, process and outcome data are collected for evaluation. Findings: Currently, five ANP services are established and running, eight more are in the developmental phase. Most services address the long term care of patients with chronic illnesses and their family members. Ten APNs work between 10 % and 80 %, three are leading an ANP-team. APNs work over 50 % in direct clinical practice, primarily in counselling. An ANP network connects APNs and NDU, promoting synergy and exchange. Conclusions: The available resources often constitute a challenge for the development of ANP services. Vital for the long-term success are an adequate extent of the position, the support by department directorate, the conceptual framework that is implemented across the whole hospital, and the development within project structures.