Hospital Discharge Process: Context-Sensitive Care.

The transition from hospital to home after surgery is a vulnerable time for all cardiac surgical patients, particularly older adults. This postoperative phase presents multiple physical, physiological, emotional, and socioeconomic challenges, not only for patients but also for their families and informal caregivers, who often describe this period as stressful and overwhelming. Health-care professionals, particularly nurses, play an integral role in a patient's discharge process; the challenges can be ameliorated through timely discharge planning and effective discharge education. The context-sensitive solutions shared in this paper propose enhancing nurses' discharge practices to provide individualized care and to facilitate the hospital-to-home transition.

Medication administration error prevention among nurses working in intensive care units: A secondary analysis.

BACKGROUND: The intensive care unit (ICU) brings together high-risk patients and interventions in a complex environment. Based on this consideration, medication administration error is the most common type of error that occurs in ICUs. Literature confirms that human factors (lack of knowledge, poor practices and negative attitudes) of nurses are the main contributors to the occurrence of medication administration errors in ICUs. AIM: To examine and compare the knowledge, attitudes and behaviour scores on medication administration error according to nurses' sociodemographic and professional variables. STUDY DESIGN: This is a secondary analysis of data from a cross-sectional international study based on a survey. Descriptive statistics were computed for all items of the questionnaire. Non-parametric tests (Kruskal Wallis and Mann Whitney U tests) were used to carry out the comparison between groups. RESULTS: The international sample consisted of 1383 nurses in 12 different countries. Statistically significant changes were seen in knowledge, attitudes and behaviour scores among several subgroups of the international population. Eastern nurses were more likely to show adequate knowledge about medication administration error prevention than Western nurses; concurrently, Western nurses were significantly more likely to show positive attitudes than Eastern nurses. No statistically significant differences in the behaviour scale were found in this study. CONCLUSIONS: The findings show a difference between knowledge and attitudes in relation to cultural background. RELEVANCE TO CLINICAL PRACTICE: Decision makers in ICUs should consider cultural background when planning and implementing prevention strategies for medication administration errors. Further research is needed to investigate the effectiveness of educational systems on the decrease of the incidence of medication administration errors in ICU.

Professional competence, personal occupational well-being, and mental workload of nurse educators - A cross-sectional study in four European countries.

BACKGROUND: Nurse educators need a high level of professional competence to educate future health care professionals. Professional competence supports occupational well-being whilst high mental workload can undermine it. There is little existing research into nurse educators' professional competence, occupational well-being, mental workload, and the relationships between them, particularly in the European context. OBJECTIVES: To describe the professional competence, personal occupational well-being, and mental workload of nurse educators in four European countries, and to explore how the professional competence and mental workload of nurse educators relate to their personal occupational well-being. DESIGN: Cross-sectional study design with quantitative survey data. SETTING: Nurse educators from Finland, Spain, Slovakia, and Malta. METHODS: The data were collected from 302 nurse educators through an online questionnaire which used the Health and Social Care Educator's Competence (HeSoEduCo) instrument. This contains 43 items which measure areas of professional competence. Statistical analysis involved descriptive and multivariate analysis. RESULTS: Nurse educators self-assessed their overall professional competence as high. Competence in evidence-based practice was assessed as the highest whilst cultural competence was perceived to be the lowest of the six competence areas. Nurse educators perceived their levels of personal occupational well-being and the balance of mental workload as moderate. However, these levels varied between the four countries. Professional competence, more specifically administrative and curriculum competence, and a balanced mental workload were positively related to personal occupational well-being. CONCLUSIONS: The educators who perceive themselves to have very good professional competence and a balanced mental workload are more likely to report high occupational well-being. The findings suggest that nurse educators' cultural competence needs to be strengthened and intervention research is needed to determine ways of reducing mental workload and increasing the occupational well-being of nurse educators.

The health literacy and patient discharge experience dyad after cardiac surgery: an exploratory study.

Health literacy concerns the ability to access, appraise and use information to maintain good health. The purpose of this study was to explore the health literacy of older adults and their experiences after cardiac surgery. A purposive sample of eight patients (aged ≥65 years) who had undergone cardiac surgery participated in this qualitative study. A validated health literacy assessment instrument was used to gather data on their health literacy levels. Two semi-structured interviews were conducted with each participant to explore the experiences of recovery in the immediate and medium-term post-discharge period. The data from the assessment instrument and the interviews were analysed and collated. Data analysis gave rise to seven themes: aftermath of cardiac surgery; settling in; whirlwind of emotions; shifting perspective; faith and hope; sense of community; and COVID-19 experience. The findings suggest health literacy plays a part in a patient's cardiac surgical discharge experience, along with other factors. As patients' responses and experiences vary, health professionals need to adopt a context-sensitive approach when discharging patients after surgery.

Nurse educator competence in four European countries-A comparative cross-sectional study.

AIM: The aim of this article is to describe and compare the nurse educator competences in four European countries using three different evaluators: nurse educators (n = 329), heads of a nursing subject (n = 60) and student nurses (n = 1058). DESIGN: The study was conducted as a comparative cross-sectional survey in Finland, Malta, Slovakia and Spain between May 2021 and February 2022. METHODS: The data were collected with an online survey. The instrument used was a 20-item Tool for Evaluation of Requirements of Nurse Teachers, utilizing a 5-point Likert-type scale. The data were analysed statistically and reported according to STROBE guidelines. RESULTS: Nurse educators' competence evaluated positively in all the groups of evaluators, with a mean of >3.5. The self-evaluation of nurse educators' competence was higher than the other evaluators' evaluations. Having a degree in nursing, having completed some pedagogical studies and longer work experience as a nurse educator had a positive association with higher self-evaluated competence among nurse educators. CONCLUSIONS: Nurse educator competence is at a good level in the selected European countries, but further studies are required to find the reasons behind the differences in evaluations. PUBLIC CONTRIBUTION: Each participating educational institution named a contact person who distributed the surveys to the participants and returned the study's metadata to the researchers.

An integrative review of the continuing professional development needs for nurse educators.

OBJECTIVES: The study aimed at describing the field of research in continuing professional development for nurse educators and the continuous education and development needs of nurse educators by asking: What research has been done in the field of continuing professional development of nurse educators? What are the continuing education and development needs and requirements reported for and by nurse educators? DESIGN: An integrative review of peer-reviewed academic literature following a systematic search design. DATA SOURCES: Qualitative, quantitative, and mixed methods publications in CINAHL, Cochrane Library, Web of Science, Embase, ERIC, and PubMed. REVIEW METHODS: Search results were screened for full text and assessed for quality using the Mixed Methods Assessment Tool. Full texts were then thematic analysed using an inductive and reflective process. RESULTS: The number of published academic articles about the continuing professional development for nurse educators is small (n = 13). The themes produced from the articles identify heterogenous development needs for nurse educators, clustered around four themes: (1) professional competencies (2) management and resources, (3) communication and collaboration, and (4) agency. The findings of this review show that nurse educators have multiple roles which have specific and multiple personal and institutional needs. CONCLUSIONS: The results of this review show that the continuing professional development needs are heterogenous between nurse educators, yet share commonalities across departmental teams as a whole, and across different countries. This raises the issue of how these needs can or should be, focused on the sustainable development of nurse educators.

3Cs: the experiences of informal caregivers of patients undergoing thoracic surgery.

The informal caregiver is pivotal to the postoperative experience of patients. The purpose of this study was to explore the informal caregivers' experience while accompanying patients through thoracotomy surgery. Specifically, and exclusively, the informal carers' personal reactions, needs and views regarding their experience in the patients' surgery trajectory were explored. A convenience sample of eight informal caregivers of patients who had undergone thoracotomy were interviewed approximately 2 weeks following discharge from a general hospital in Malta. The findings revealed knowledge regarding participants' experiences of demands and fears associated with the 3Cs: cancer, challenges and coping. The impact of timely information-sharing and support on the informal caregiver's experience was highlighted. These findings suggest that careful consideration of both a patient's and informal caregiver's needs promotes an enhanced hospitalisation experience, and creates opportunity for a better transition back home. Implications for research and practice are discussed.

A review of literature on risk prediction tools for hospital readmissions in older adults.

PURPOSE: The purpose of this paper is to identify and analyse the readmission risk prediction tools reported in the literature and their benefits when it comes to healthcare organisations and management. DESIGN/METHODOLOGY/APPROACH: Readmission risk prediction is a growing topic of interest with the aim of identifying patients in particular those suffering from chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease and diabetes, who are at risk of readmission. Several models have been developed with different levels of predictive ability. A structured and extensive literature search of several databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis strategy, and this yielded a total of 48,984 records. FINDINGS: Forty-three articles were selected for full-text and extensive review after following the screening process and according to the eligibility criteria. About 34 unique readmission risk prediction models were identified, in which their predictive ability ranged from poor to good (c statistic 0.5-0.86). Readmission rates ranged between 3.1 and 74.1% depending on the risk category. This review shows that readmission risk prediction is a complex process and is still relatively new as a concept and poorly understood. It confirms that readmission prediction models hold significant accuracy at identifying patients at higher risk for such an event within specific context. RESEARCH LIMITATIONS/IMPLICATIONS: Since most prediction models were developed for specific populations, conditions or hospital settings, the generalisability and transferability of the predictions across wider or other contexts may be difficult to achieve. Therefore, the value of prediction models remains limited to hospital management. Future research is indicated in this regard. ORIGINALITY/VALUE: This review is the first to cover readmission risk prediction tools that have been published in the literature since 2011, thereby providing an assessment of the relevance of this crucial KPI to health organisations and managers.

Intended and Actual Outcomes of Study Abroad Programs: Nursing Students' Experiences.

BACKGROUND: Many nursing students participate in study abroad opportunities; yet, few studies explore their experiences. Given the increasing emphasis on evaluating the quality of higher education internationalization, this study explored the motivations for, and outcomes of, Maltese nursing students' Erasmus+ exchanges against the program's intended outcomes. METHOD: Sixty-five Erasmus+ mobility participants completed an online questionnaire (response rate = 44.8%), and 16 participated in a 2-hour focus group. RESULTS: Participants overwhelmingly agreed that intended outcomes of the Erasmus+ program were achieved. Thematic analysis revealed five themes: Enhanced Employability as a Nurse; Exposure to Nursing Beyond the National Shores; Personal Growth; Context-Sensitivity of Nursing Care Delivery; Language and Citizenship. CONCLUSION: These positive experiences confirm that nurse educators should continue encouraging and facilitating study abroad experiences, and that such opportunities should be offered to even more students. However, more research is required to explore any negative outcomes of student mobility and whether the participants' perceptions change over time. [J Nurs Educ. 2020;59(9):501-505.].

Person-Centered Care From a Relational Ethics Perspective for the Delivery of High Quality and Safe Healthcare: A Scoping Review.

Background: The aim of this scoping review is to explore whether or not person-centered care (PCC), in its quest to deliver high quality and safe health care, has a relational-ethics perspective. To do so, we first need to relate the extant literature pertaining to PCC and relational ethics. To this extent, the specific features that define PCC and relational ethics were identified. PCC dimensions include: patient and provider concordance, improved health outcomes, improved patient safety, individual expectations, patients' integration within the environment, patient as a person, patient as an active part of society, dialogue and interaction, sharing experience, and documentation of patient's (person's) narrative. Relational ethics framework includes the following actions: mutual respect, engagement, embodied knowledge, environment, and uncertainty. Methods: Data were retrieved through multiple keywords search on PubMed, Medline, and Scopus. Inclusion/exclusion criteria were set, and these were based on year of publication (2008-2018), language, paper focus, research method and document types. A total of 23 articles (N = 23) were selected and reviewed. Content analysis was conducted in order to identify and compare the main features of PCC and relational ethics. Results: The most important relational ethics action referred to in conjunction with PCC features is environment (referred to as person's integration within a social environment/community). This is followed by mutual respect, engagement and embodied knowledge. These were the salient relational ethics actions both directly and indirectly linked to PCC. Uncertainty was the less recurrent relational ethical action mentioned. Conclusions: This paper revealed that while PCC features embrace most of the relational ethics approaches, these are not exploited in their entirety and therefore PCC emerges as a unique ethical stance in healthcare. PCC's ethical approach goes beyond what is explained within provider-patient relational ethics and emphasizes that the patient is an active person and a partner in care with capabilities and resources. This distinction enables us to explain the paradigm shift from "patient-centered" to "person-centered" care. The healthcare provider partnership and co-creation of the healthcare plan contributes to the delivery of high quality, safe and cost-contained healthcare.

Nurse Leadership Development in Malta.

INTRODUCTION: Leadership development has been studied extensively in many of the larger countries around the world, but there has been very limited research on nursing leadership development within small island countries. PURPOSE: Explorative semistructured interviews underpinned by a phenomenological philosophy were conducted to seek understanding of the meaning attributed to the nursing leadership development within the Maltese culture. METHOD: Six nurse leaders from administration, advanced practice, and academic backgrounds participated in semistructured interviews. Thematic data analysis was conducted with a focus on the competencies of nurse leadership within the context of authentic leadership theory. RESULTS: Themes moved from a general discussion of the wider cultural setting (Cultural Integration) to a more focused observation of practical factors that contribute to leadership growth (Developing as a Leader), to a personal reflection on their own experiences and journeys (Self-Reflection in Leadership). Indeed, 15 subthemes supported the broad themes addressed in the present study, providing additional context and detail. DISCUSSION: Nurse leadership strategies identified during this study may be effective in similar small island cultures.

Can virtual learning environments be used as research platforms?

BACKGROUND: Many higher education institutions use virtual learning environments (VLEs), with one in seven students learning exclusively online. The use of online research methods and approaches has also gained momentum over the past decade. AIM: To explore the use of VLEs for qualitative research. DISCUSSION: Using VLEs for purposes beyond teaching and learning functions offers various opportunities, providing a method of collecting data that has minimal costs, requires few resources, offers maximum flexibility, has apt technical support and engages participants. However, it also has several challenges. CONCLUSION: This study supports the proposed potential value and appropriateness of using VLEs to collect data. The function of VLEs may be significantly widened at reasonable cost and challenge. Work in this regard is encouraged. IMPLICATION FOR PRACTICE: VLEs may be used in nurse education research, which stands to benefit from this opportunity at reasonable cost and challenge.

Dual agency in critical care nursing: Balancing responsibilities towards colleagues and patients.

AIM: To explore critical care nurses' decisions to seek help from doctors. BACKGROUND: Despite their well-documented role in improving critically ill patients' outcomes, research indicates that nurses rarely take decisions about patients' treatment modalities on their own and constantly need to seek advice or authorization for their clinical decisions, even for protocol-guided actions. However, research around the factors related to, and the actual process of, such referrals is limited. DESIGN: A grounded theory study, underpinned by a symbolic interactionist perspective. METHODS: Data collection took place in a general intensive care unit between 2010 - 2012 and involved: 20 hours of non-participant and 50 hours of participant observation; ten informal and ten formal interviews; and two focus groups with ten nurses, selected by purposive and theoretical sampling. Data analysis was guided by the dimensional analysis approach to generating grounded theory. FINDINGS: Nurses' decisions to seek help from doctors involve weighing up several occasionally conflicting motivators. A central consideration is that of balancing their moral obligation to safeguard patients' interests with their duty to respect doctors' authority. Subsequently, nurses end up in a position of dual agency as they need to concurrently act as an agent to medical practitioners and patients. CONCLUSION: Nurses' dual agency relationship with patients and doctors may deter their moral obligation of keeping patients' interest as their utmost concern. Nurse leaders and educators should, therefore, enhance nurses' assertiveness, courage and skills to place patients' interest at the forefront of all their actions and interactions.

Nurse staffing levels on the NPICU in the island of Malta.

Purpose. Nurse staffing levels in neonatal paediatric intensive care units (NPICU) are often inadequate. Malta is a small Island in the centre of the Mediterranean (total population around 400,000) with a birth rate of just under 4000/annum, with one NPICU. This study analysed nurse staffing levels for a 1 year period in order to ascertain whether said levels are adequate or not. Methods. Daily ward occupancies were classified by level of dependency, and ideal nursing requirements were estimated using internationally approved standards, on a daily basis, for the period 12 month period from 01/04/2008 to 31/03/2009. These were compared with the actual daily morning nursing levels to estimate deficit/s. Results. There were a total of 373 admissions to the unit resulting in a total of 5464 patient days (daily census at 0700 hrs) and 1471 free bed days (occupancy 78.8%). Occupancy varied between 8 and 23 patients (mean 15). Staffing levels ranged between 7 and 17 nurses (mean 11). The overall mean deficit was of 3.3 nurses, but this ranged from a maximum of 11 to a rare surplus of 7 nurses. Conclusions. This study only focused on a daily morning snapshot where the nursing staff is at its peak number - the nocturnal deficit is naturally worse. Furthermore, experience levels vary due to short rotations through the unit of inexperienced midwifery staff. Moreover, there are no staff designated as responsible for further education and training, extra staff for unpredictable high dependency situations, to compensate for leave, sickness, maternity leave, study leave, staff training and attendance at meetings. Clearly, the Maltese NPICU is overall understaffed.