Moral Distress: A Qualitative Study of Experiences Among Oncology Team Members.

BACKGROUND: Oncology healthcare professionals (HCPs), particularly nurses, experience moral distress. However, little is known about the impact of moral distress on oncology teams. OBJECTIVES: The purpose of this study was to describe moral distress as it is experienced by oncology teams in practice. METHODS: 32 oncology team members participated in eight focus groups. Content analysis was used to identify key themes. Two investigators collaboratively analyzed the data, and findings were independently reviewed by two additional investigators. FINDINGS: The following six themes emerged.

Advance directives and intensity of care delivered to hospitalized older adults at the end-of-life.

BACKGROUND: Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). OBJECTIVES: This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults. METHODS: A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care. RESULTS: Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late. CONCLUSION: The ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves.

Moral distress in critical care nursing: The state of the science.

BACKGROUND: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. OBJECTIVES: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. REVIEW METHODS: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. RESULTS: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. CONCLUSION: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended.

Addressing Traumatic Stress in the Acute Traumatically Injured Patient.

Psychological injuries after an acute traumatic event are commonly overlooked. Currently within United States, there is no consistently utilized screening process that addresses traumatic stress within the acute trauma population. Roy's Adaptation Model guided this project, focusing on the idea that bedside nurses are at the frontline of providing early identification through nursing assessment. The purpose of this pilot study was to evaluate whether the implementation of the Primary Care-Posttraumatic Stress Disorder (PC-PTSD) screening tool by bedside nurses would result in identifying more patients at risk for traumatic stress after an acute trauma as compared with the use of no screening method. This descriptive survey study took place over a 6-week period at a Midwest Level 1 trauma hospital. The results revealed that the tool did not increase the number of health psychology consults when compared with the same 6-week period a year prior when no tool was used. Nonetheless, use of the PC-PTSD tool did trigger 28% of the patients to receive a health psychology consult. Forty-five percent of patients who received a health psychology consult were recommended outpatient therapy. Utilization of this tool by bedside nurses did not adversely increase a number of inappropriate health psychology consults. These results agree with the literature and further suggest that there are a clinically significant number of acute trauma patients who are at risk for traumatic stress. With this screening tool, nurses accurately assessed patients and connected them with timely psychological treatment.

Bridges and Barriers: Patients' Perceptions of the Discharge Process Including Multidisciplinary Rounds on a Trauma Unit.

Discharge planning is a complex process and ideally begins early in the patient stay. Despite evidence about the importance of discharge readiness, there is limited literature about the patient's view during this transition. The goal of this study was to explore patient perspectives about the discharge process, including multidisciplinary rounds. Multidisciplinary rounding is a process where care providers from various specialties meet to communicate, coordinate patient care, make decisions, and manage responsibilities. The theme found was "bridges and barriers to discharge." Participants identified timelines and tasks, communication, social support, and motivation as helpful and medical setbacks, insurance limitations, and infrequent communication as hindrances to the discharge. Future research is recommended examining efficacy of various discharge models and examination of communication and support throughout hospitalization.

Preferences for photographic art among hospitalized patients with cancer.

PURPOSE/OBJECTIVES: To determine the preferences of patients with cancer for viewing photographic art in an inpatient hospital setting and to evaluate the impact of viewing photographic art. DESIGN: Quantitative, exploratory, single-group, post-test descriptive design incorporating qualitative survey questions. SETTING: An academic medical center in the midwestern United States. SAMPLE: 80 men (n = 44) and women (n = 36) aged 19-85 years (X = 49) and hospitalized for cancer treatment. METHODS: Participants viewed photographs via computers and then completed a five-instrument electronic survey. MAIN RESEARCH VARIABLES: Fatigue, quality of life, performance status, perceptions of distraction and restoration, and content categories of photographs. FINDINGS: Ninety-six percent of participants enjoyed looking at the study photographs. The photographs they preferred most often were lake sunset (76%), rocky river (66%), and autumn waterfall (66%). The most rejected photographs were amusement park (54%), farmer's market vegetable table (51%), and kayakers (49%). The qualitative categories selected were landscape (28%), animals (15%), people (14%), entertainment (10%), imagery (10%), water (7%), spiritual (7%), flowers (6%), and landmark (3%). Some discrepancy between the quantitative and qualitative sections may be related to participants considering water to be a landscape. CONCLUSIONS: The hypothesis that patients' preferences for a category of photographic art are affected by the psychophysical and psychological qualities of the photographs, as well as the patients' moods and characteristics, was supported. IMPLICATIONS FOR NURSING: Nurses can play an active role in helping patients deal with the challenges of long hospital stays and life-threatening diagnoses through distraction and restoration interventions such as viewing photographic images of nature. KNOWLEDGE TRANSLATION: Nurses can use photographic imagery to provide a restorative intervention during the hospital experience. Photographic art can be used as a distraction from the hospital stay and the uncertainty of a cancer diagnosis. Having patients view photographs of nature is congruent with the core nursing values of promoting health, healing, and hope.

The impact of certification on certified perioperative nurses: a qualitative descriptive survey.

As the practice of healthcare becomes more technologically advanced, specialized and complex, there is an increasing demand for accountability. Certification demonstrates that an individual practitioner has maintained an acceptable, or perhaps more advanced level of qualifications, knowledge, and skills in a specialty practice area. Although certification for nurses has been available for decades a detailed evaluation of its meaning and implications for practice seems to be unavailable. The purpose of this qualitative study, conducted in Chicago, Illinois and also online, was to describe the perceptions of perioperative nurses as related to the impact that certification has had on both their professional practice and on a personal level. A qualitative survey design was used for this study. A purposive sample (N = 149) was obtained from board certified perioperative specialty nurses. Thematic analysis was used to explain the nurses' perceptions. Thematic analysis involves searching through data, in this case the narrative responses to the survey, to identify any recurrent patterns. A theme is a cluster of linked categories conveying similar meanings and usually emerges through the inductive analytic process. Themes that emerged from the data were categorized into two groups--impact on professional practice and personal impact. The primary theme that emerged related to respondents' personal perspectives was pride in accomplishment or achievement and increased confidence. The theme that described professional impact was credibility. Some themes, such as knowledge, confidence, and opportunity, overlapped both groups. The nurses' perceptions, as shared in this study, revealed positive aspects related to their achievement of certification in perioperative practice. The findings of this research expand knowledge about how certification impacts on the nurses' personal and professional experiences.

The professional portfolio: an evidence-based assessment method.

Competency assessment is critical for a myriad of disciplines, including medicine, law, education, and nursing. Many nurse managers and educators are responsible for nursing competency assessment, and assessment results are often used for annual reviews, promotions, and satisfying accrediting agencies' requirements. Credentialing bodies continually seek methods to measure and document the continuing competence of licensees or certificants. Many methods and frameworks for continued competency assessment exist. The portfolio process is one method to validate personal and professional accomplishments in an interactive, multidimensional manner. This article illustrates how portfolios can be used to assess competence. One specialty nursing certification board's process of creating an evidence-based portfolio for recertification or reactivation of a credential is used as an example. The theoretical background, development process, implementation, and future implications may serve as a template for other organizations in developing their own portfolio models.