Judith Butler's theoretical perspectives within a nursing context-a scoping review.

Philosopher Judith Butler has influenced how people talk about vulnerable bodies and sees vulnerability as universal, existential, and relational. Being vulnerable is part of the human condition. The main theoretical areas that run across Butler's work; power, knowledge and subjectivity, performativity, and ethics-are of particular relevance to nursing practice. This review aims to explore how Butler's theoretical work is reflected in research literature within a nursing context. We conducted a scoping review guided by Arksey and O'Malley's methodological framework. A systematic literature search of CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science identified 15 papers. Butler's theoretical work was applied at an individual and social level in research literature within a nursing context. Nurses need to reflect on their clinical practice and role as health professionals in relation to power and performativity in encounters with patients who are marginalized. Nurses' working conditions, recognition, and understanding are strongly influenced by society, and calling nurses heroes undermines their capacity to challenge and resist the hero identity. The healthcare system's impact on patient-nurse encounters challenges patients' and nurses' subjectivity, performativity, and power relations. The review allowed us to describe how Butler's theoretical work can facilitate a reflection on nursing practice which is a prerequisite for caring, ethical relationships, and working conditions within a nursing context. Butler's concepts can provide useful perspectives on how nurses understand, communicate with, and care for patients, as well as a nuanced understanding of the nursing role and power relations and structures.

The Norwegian version of the nursing student mentors' competence instrument (MCI): A psychometric validation study.

Background: Nurse mentors require competence to mentor nursing students in clinical practice, including specific knowledge and skills. Evaluating mentor competence is crucial in developing and ensuring the high-quality mentoring of nursing students. The nursing student mentors' competence instrument is one of the few valid instruments for assessing the competence of nurses as mentors. Objectives: To translate the nursing student mentors' competence instrument into Norwegian and evaluate its psychometric properties. Design: The research employed a cross-sectional study design. Settings: Data were collected from nurse mentors at nursing homes, hospitals, home nursing care and mental health care units in Norway from 2021 to 2022. Participants: A total of 458 registered nurses with experience of mentoring nursing students participated in the study, of which data was used to conduct psychometric testing. Methods: The nursing student mentors' competence instrument was translated and evaluated in six steps: Forward translation, forward translation synthesis, backward translation, backward translation synthesis, cognitive debriefing and psychometric testing. The validity and reliability of the translated instrument were investigated using confirmatory factor analysis (CFA) and Cronbach's alpha. Results: The translated instrument showed acceptability. The CFA goodness-of-fit indices showed acceptable model fit (χ2/df = 2.547, SRMR = 0.051, CFI = 0.919, RMSEA = 0.058), and the Cronbach's alpha values for the instrument's subscales ranged from 0.77 to 0.95. Conclusions: The Norwegian version of the nursing student mentors' competence instrument shows potential as a useful instrument for assessing current and required competencies of nurse mentors in clinical practice in nursing education.

Critical care nurses' assessment of writing diaries for adult patients in the intensive care unit - A qualitative study.

BACKGROUND: Patients describe surreal experiences, hallucinations, loss of control, fear, pain, and other discomforts during their stay in intensive care units. Diaries written by critical care nurses can help patients fill-in memory gaps, gain an understanding of their illness after returning home, and enhance recovery. However, critical care nurses have difficulty deciding which patients in the intensive care unit should receive diaries and how to conduct and prioritise this nursing intervention. OBJECTIVES: The objective of this study was to explore critical care nurses' assessments regarding starting and writing diaries for adult patients in the intensive care unit. METHODS: A qualitative study with an exploratory descriptive design was utilised. Interviews were conducted with 14 critical care nurses from four hospitals. The data were analysed using systematic text condensation and were reported according to the consolidated criteria for reporting qualitative research checklist. FINDINGS: Three categories emerged: patients' disease trajectories and prognoses, tailoring the content and language and balancing time, and resources to create diaries that benefit patients. CONCLUSIONS: Whilst critical care nurses' assessments of the need for diaries are based on patients' disease trajectories and prognoses, patients' conditions can shift rapidly, which makes these assessments challenging. To ensure diary quality, the language and content should be personal and address the individual patient. The time and resources required for diaries are weighed against the benefits to patients. Contributions from colleagues and a common recognition in the intensive care unit of the value of the diaries influence nurses' judgements and are essential for successful diary practices.

Critical care nurses' experiences of caring for patients with iatrogenic opioid withdrawal in the intensive care unit: A qualitative study.

OBJECTIVES: To explore critical care nurses' experiences of caring for adult patients experiencing iatrogenic opioid withdrawal in the intensive care unit. RESEARCH METHODOLOGY/DESIGN: A qualitative study with an explorative and descriptive design was conducted. Data were collected through semi-structured interviews and systematic text condensation was used to analyse the data. The study was reported according to the consolidated criteria for reporting qualitative research checklist. SETTING AND PARTICIPANTS: Ten critical care nurses, working at three different intensive care units in two university hospitals in Norway. FINDINGS: Three categories were identified in the data analysis. "Subtle signs and symptoms of opioid withdrawal", lack of a systematic approach to opioid withdrawal, and the prerequisites for appropriate management of opioid withdrawal. Critical care nurses experienced challenges in identifying opioid withdrawal due to subtle and vague signs and symptoms, especially when not knowing their patient or when difficulties were encountered with patient communication. A systematic approach to opioid withdrawal and increased knowledge, definitive plans for weaning, as well as interdisciplinary unity and collaboration, could improve the management of opioid withdrawal. CONCLUSION: Validated assessment tools, systematic strategies, and guidelines are essential for the management of opioid withdrawal in opioid naïve patients in intensive care units. The prerequisites for an appropriate management of opioid withdrawal are an accurate and effective communication among critical care nurses and other healthcare professionals involved in patient care. IMPLICATIONS FOR CLINICAL PRACTICE: There is a need for a validated assessment tool, systematic strategies, and guidelines for the management of opioid withdrawal in opioid naïve patients in intensive care units. Increased emphasis needs to be placed on the process of identifying iatrogenic opioid withdrawal and improving opioid withdrawal management in the education system and clinical practice.

Facilitating a safe and caring atmosphere in everyday life in forensic mental health wards - a qualitative study.

PURPOSE: To explore healthcare professionals' experiences with facilitating a safe and caring atmosphere in patients' everyday lives in forensic mental health wards. METHODS: This qualitative study employed interviews with 16 healthcare professionals working shifts in two forensic mental healthcare wards in Norway. Data were analysed using phenomenological hermeneutic analysis. RESULTS: The findings are presented in terms of two themes. The first theme is "Creating a calming atmosphere" and includes the subthemes "Creating caring surroundings with safety, comfort and trust" and "Balancing everyday life activities". The second theme is "Facilitating risk assessments and care" and includes the subthemes "Acting as a team", "Becoming aware of the meaning in signs" and "Becoming aware of vulnerability and the window of tolerance". CONCLUSIONS: Involvement in patients' history and lived lives is important both for understanding general social behaviour as well as for assessing signs, symptoms, and changes in patients' conditions; furthermore, it provides valuable information that allows healthcare professionals to become aware of the underlying meanings in signs, which can facilitate examinations and treatment. Acting as a team is essential to solve issues in a calm and safe way when signs of violence occur. In addition, our participants highlighted the need to be aware of individual patients' vulnerability and windows of tolerance to obtain a deeper understanding of patients' lived lives as a whole in the context of providing therapy and care to patients.

Carers' experience of everyday life impacted by people with dementia who attended a cognitive stimulation therapy (CST) group intervention: a qualitative systematic review.

ObjectivesTo explore carers' experiences of everyday life impacted by people with dementia who attended a seven-week cognitive stimulation therapy (CST) group intervention.MethodsA systematic review of qualitative studies and qualitative mixed method studies was conducted. Eight databases were searched. The selected studies were screened and assessed for methodological quality using the Rayyan Qatar Computing Research Institute (QCRI) and Critical Appraisal Skills Programme Qualitative Checklist (CASP-QC). Three studies were included following an inductive content analysis.ResultsTwo themes were identified: 'Enrichment by enhanced communication' and 'Growth through positive emotional interaction'.ConclusionQualitative research on the impact of the CST group intervention on carers' everyday life with a person with dementia is scarce. Carers experienced feelings of enrichment due to improvement and equality in communication and a possible source of happiness. There was a sense of togetherness and reconnection through music and singing together as well as a sense of mutual growth, increased positive interaction, increased ability to socialize, and feelings of fondness when experiencing glimpses of the previous personality of the person with dementia. Nevertheless, knowledge about the impact of the CST group intervention on carers' personal everyday life is lacking and requires further research.

Communication with mechanically ventilated patients in intensive care units: A concept analysis.

AIMS: The aim of this study was to perform a concept analysis of communication with mechanically ventilated patients in intensive care units and present a preliminary model for communication practice with these patients. DESIGN: The Im & Meleis approach for concept analysis guided the study. SEARCH METHODS: A literature search was performed in January 2022 in MEDLINE, Embase, CINAHL, psycINFO and Scopus, limited to 1998-2022. The main medical subject headings search terms used were artificial respiration, communication and critical care. The search resulted in 10,698 unique references. REVIEW METHODS: After a blinded review by two authors, 108 references were included. Core concepts and terminology related to communication with mechanically ventilated patients were defined by content analytic methods. The concepts were then grouped into main categories after proposing relationships between them. As a final step, a preliminary model for communication with mechanically ventilated patients was developed. RESULTS: We identified 39 different phrases to describe the mechanically ventilated patient. A total of 60 relevant concepts describing the communication with mechanically ventilated patients in intensive care were identified. The concepts were categorized into five main categories in a conceptual map. The preliminary model encompasses the unique communication practice when interacting with mechanically ventilated patients in intensive care units. CONCLUSION: Highlighting different perspectives of the communication between mechanically ventilated patients and providers through concept analysis has contributed to a deeper understanding of the phenomena and the complexity of communication when the patients have limited possibilities to express themselves. IMPACT: A clear definition of concepts is needed in the further development of guidelines and recommendations for patient care in intensive care, as well as in future research. The preliminary model will be tested further. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution, as this is a concept analysis of previous research.

Haematological nurses' experiences about palliative care trajectories of patients with life-threatening haematological malignancies: A qualitative study.

AIMS: To explore haematological nurses' experiences about the palliative care trajectories of patients with life-threatening haematological malignancies. DESIGN: A qualitative study with a descriptive and explorative design. METHODS: Data were collected through 12 individual semi-structured interviews of nurses who work with patients with haematological malignancies from four hospitals in Norway. The data were analysed using systematic text condensation. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. RESULTS: Three categories emerged from the data analysis: focus on a cure delays integration of palliative care, dialogue with patients facilitates palliative care and the need for enhanced interdisciplinary understanding. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution since nurses' experiences were explored.

Humanizing and dehumanizing intensive care: Thematic synthesis (HumanIC).

BACKGROUND: Critical illness and the intensive care unit can be a terrifying experience to patients and relatives and they may experience the extreme life-saving measures as dehumanizing. Humanizing intensive care is often described as holism or dignity, but these abstract concepts provide little bodily resonance to what a humanized attitude is in concrete situations. OBJECTIVE: To explore what contributes to patients' and relatives' experience of intensive care as humanized or dehumanized. DESIGN: Thematic synthesis. MATERIALS: Findings from 15 qualitative papers describing patients' and/or relatives' perceptions of humanizing or dehumanizing care. METHODS: A systematic literature search of PubMed, CINAHL, Scopus and EMBASE from 1 January 1999 to 20 August 2022 identified 16 qualitative, empirical papers describing patients' and relatives' experiences of humanizing or dehumanizing intensive care, which were assessed using Critical Appraisal Skills Programme Qualitative Checklist, 15 papers were included and analysed using Thematic Synthesis and Ricoeur's model of the text. FINDINGS: Intensive care was humanized when patients felt connected with healthcare professionals, with themselves by experiencing safety and well-being and with their loved ones. Intensive care was humanized to relatives when the patient was cared for as a unique person, when they were allowed to stay connected to the patient and when they felt cared for in the critical situation. CONCLUSION: Patients and relatives experienced intensive care as humanized when healthcare professionals expressed genuine attention and supported them through their caring actions and when healthcare professionals supported patients' and relatives' opportunities to stay connected in the disrupted situation of critical illness. When healthcare professionals offered a connection to the patients and relatives, this helped them hold on and find meaning. PATIENT OR PUBLIC CONTRIBUTION: No patient and public contribution.

Collaboration between nurses and doctors in the decision-making process when considering ending the life-prolonging treatment of intensive care patients.

AIMS: The aim of the study was to explore intensive care nurses' collaboration with doctors' when considering ending the life-prolonging treatment of patients in the intensive care unit. DESIGN: A qualitative method with an explorative descriptive design was employed. METHODS: Data were collected through semi-structured interviews with four intensive care nurses and four doctors working in three intensive care units at two university hospitals and one local hospital. The data were analysed using systematic text condensation. This study was reported according to the consolidated criteria for reporting qualitative research checklist. RESULTS: Two categories were identified in the data analysis: listening to each other during the decision-making process and continuity and having time to facilitate regular discussions of prognosis and treatment plans.

Exploring the Impact of Virtual Reflection Groups on Advanced Practice Nurse Students During the COVID-19 Pandemic: Focus Group Study With Master's Students.

BACKGROUND: In the master's program of advanced practice nursing at a Norwegian university college, the learning activity reflection groups were converted into virtual reflection group (VRG) meetings during the COVID-19 pandemic. Regardless of the students' clinical practices in different hospitals, they could participate in the same VRG meeting on the web together with the educator from the university college, and the clinical supervisors were invited to participate. The students were in the process of developing the core competence required in their role as advanced practice nurses (APNs), and they had increased responsibility in the implementation of the VRG meetings. OBJECTIVE: In this study, we aimed to explore how master's students of advanced practice nursing experienced VRG meetings during the COVID-19 pandemic. METHODS: A qualitative exploratory design was adopted using focus group interviews. A group of students in the master's program of advanced practice nursing participated in an interview that lasted for 60 minutes. They had experienced participating in the VRG meetings following a rigorous guide during their clinical practice. The data from the focus group were analyzed using qualitative content analysis. RESULTS: The main findings of this study highlighted the importance of structure in VRG meetings, the role of increased responsibility in students' learning processes, the development of APN students' competencies, and increased professional collaboration with clinical supervisors. The APN students and clinical supervisors also continued their discussions in the clinical setting afterward, which strengthened the collaboration between students' education in the master's program and their clinical practice. CONCLUSIONS: VRG meetings gave the students the opportunity to lead professional discussions while reflecting thoroughly on the chosen patient cases from clinical practice. They experienced receiving feedback from fellow students, supervisors, and educators as stimulating their critical thinking development.

"Humanizing intensive care: A scoping review (HumanIC)".

Significant scientific and technological advances in intensive care have been made. However, patients in the intensive care unit may experience discomfort, loss of control, and surreal experiences. This has generated relevant debates about how to humanize the intensive care units and whether humanization is necessary at all. This paper aimed to explore how humanizing intensive care is described in the literature. A scoping review was performed. Studies published between 01.01.1999 and 02.03.2020 were identified in the CINAHL, Embase, PubMed, and Scopus databases. After removing 185 duplicates, 363 papers were screened by title and abstract. Full-text screening of 116 papers led to the inclusion of 68 papers in the review based on the inclusion criteria; these papers mentioned humanizing or dehumanizing intensive care in the title or abstract. Humanizing care was defined as holistic care, as a general attitude of professionals toward patients and relatives and an organizational ideal encompassing all subjects of the healthcare system. Technology was considered an integral component of intensive care that must be balanced with caring for the patient as a whole and autonomous person. This holistic view of patients and relatives could ameliorate the negative effects of technology. There were geographical differences and the large number of studies from Spain and Brazil reflect the growing interest in humanizing intensive care in these particular countries. In conclusion, a more holistic approach with a greater emphasis on the individual patient, relatives, and social context is the foundation for humanizing intensive care, as reflected in the attitudes of nurses and other healthcare professionals. Demands for mastering technology may dominate nurses' attention toward patients and relatives; therefore, humanized intensive care requires a holistic attitude from health professionals and organizations toward patients and relatives. Healthcare organizations, society, and regulatory frameworks demanding humanized intensive care may enforce humanized intensive care.

Ethical dilemmas embedded in performing fieldwork with nurses in the ICU.

BACKGROUND: Background: In general, qualitative research design often involves merging together various data collection strategies, and researcher's may need to be prepared to spend longer periods in the field to pursue data collection opportunities that were not foreseen. Furthermore, nurse researchers performing qualitative research among patients and their relatives often experience unforeseen ethical dilemmas. AIM: This paper aimed to explore aspects of ethical dilemmas related to qualitative nursing research among patients and their relatives in the intensive care unit (ICU). RESEARCH DESIGN: This paper is based on a qualitative researcher's personal experience during a hermeneutic phenomenological study involving close observation and in-depth interviews with 11 intensive care nurses. Data were collected at two ICUs in two Norwegian university hospitals. ETHICAL CONSIDERATIONS: The study was approved by the Norwegian Social Science Data Services (NSD). The Regional Committee for Medical and Health Research Ethics (REK) granted dispensation to the project regarding health personnels confidentiality of the patients who were present during the observation (2012/622-4). FINDINGS: Close observation with nurses in the ICU requires the researcher to balance being a qualitative researcher, an ICU nurse and a sensitive fellow human being open to the suffering of the other-that is, being embodied, engaged and affected by sensitive situations and simultaneously constantly stepping back and reflecting on the meaning of those situations. CONCLUSIONS: The qualitative researcher's ethical awareness also entails knowing and acknowledging his or her own vulnerability, which becomes apparent in the researcher-participant relationship and settings in which being a fellow human always overrules the researcher's role in ethical dilemmas.