What do nurses experience in communication when assisting in robotic surgery: an integrative literature review.

BACKGROUND: Communication in surgery is integral to the fundamentals of perioperative nursing practice and patient safety. Research exploring team communication in robotic-assisted surgery (RAS) is evident in the literature but little attention has been focused on how the experiences of operating room nurses' communication affect safety, practice and patient care outcomes. OBJECTIVE: To synthesise current evidence regarding communication during robotic-assisted surgery as experienced by registered nurses. DESIGN: An integrative literature review informed by Whittemore and Knafl's (2005) methodology was used to conduct a rigorous analysis and synthesis of evidence. METHODS: A comprehensive database search was conducted using PRISMA guidelines. CINAHL, Pubmed, PsychINFO and British Nursing Web of Science databases were searched using a Boolean strategy. RESULTS: Twenty-five relevant papers were included in this literature review. Thematic analysis revealed two main themes with four related subthemes. The two main themes are: 'Adaptive operating room nursing in RAS' and 'RAS alters team dynamics'. The four subthemes are: 'Navigating disruptions in RAS', 'RAS heightens interdependence on team working', 'Augmented communicative workflow in RAS', and 'Professional empowerment to speak up'. CONCLUSIONS: This integrative review identifies how current research largely focuses on communication in the wider OR team. However, current evidence lacks the input of nurses. Therefore, further evidence is needed to explore nurses' experiences to highlight their perspectives. CLINICAL RELEVANCE: Robotics significantly benefit patients, and this review identifies different challenges that robotic-assisted surgery nurses encounter. A better understanding of the communication from the perspective of nurses is needed to guide future research, practice education, policy development and leadership/management.

Bereaved Caregivers' Experiences of End of Life Care For People With Advanced Heart Failure: A Narrative Synthesis.

BACKGROUND: Heart Failure is a life-limiting condition with a poor and uniquely unpredictable prognosis. The aim of this review is to present and synthesise the current evidence around bereaved caregivers' experiences of end of life care for people with Heart Failure. METHODS: A systematic review of the literature was conducted using four electronic databases (CINHAL, Medline, BND, PsycINFO). Data was analysed and presented using a narrative synthesis approach. RESULTS: Eight articles were included within this review. Themes included: Limited and inadequate communication around the condition (including prognosis, preparations for death and the aim of palliative care), the burden of caregiving, and the limited provision of services and formal support. CONCLUSION: Bereaved caregivers experience unique and significant challenges when caring for someone dying from Heart Failure. However, further research is required to greater understand the experiences of bereaved caregivers of people with Heart Failure.

Patient and clinician experiences of remote consultation during the SARS-CoV-2 pandemic: A service evaluation.

Objectives: During the SARS-CoV-2 pandemic, clinicians were instructed to move all but emergency consultations to remote means to reduce the spread of the virus. The aim of this study was to evaluate patients' and clinicians' experiences of moving to remote means of consultation with their health care professionals during the SARS-CoV-2 pandemic. Methods: The study design was a qualitative service evaluation. Twenty-six clinicians and forty-eight patients who met the inclusion criteria consented to be interviewed. Clinician participants were from either medical, nursing, or allied health professional backgrounds. Patients were recruited from diabetes, acute care, and haematology and cancer areas. Data analysis was conducted using a thematic analysis framework. Results: Following coding and thematic analysis of the data collected from clinicians, five themes were identified: personal and professional well-being; providing a safe and high-quality experience; adapting to a new way of working; making remote consultations fit for purpose and an awareness of altered dynamics during consultation. Patient data was coded into 3 themes: remote consultation adds value; remote consultation brings challenges and concerns about remote consultation. Conclusions: Clinician and patient experiences reported here are reflected in the literature. The study indicates that remote consultation is not suitable for all patients and in all contexts. Whilst maintaining the benefits to patients, remote means of consultation needs organisational support and preparation. A way forward that maintains the benefits whilst addressing concerns seems urgent.

Patients' and clinicians' experiences of remote consultation? A narrative synthesis.

AIMS: To identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in-person consultations. DESIGN: Narrative synthesis. DATA SOURCES: Medline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020. REVIEW METHODS: Papers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute. RESULTS: Seven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non-face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges. CONCLUSION: This narrative synthesis presents the existing evidence on clinician and patient experience of participating in non-face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self-manage with support from clinicians who are not in-person. More high-quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post-SARS-CoV-2 pandemic to identify any learning and education opportunities. IMPACT: Health care staff can provide high-quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.

Bearing witness to the challenges of breathlessness.

The community respiratory nurse specialist (CRNS) supports patients at different stages of lung disease, witnessing the challenge of living with chronic obstructive pulmonary disease (COPD), a progressive illness for which there is no cure. Breathlessness is the most prominent and debilitating symptom experienced; it is frightening, distressing and very difficult to manage. Little is known about the experience of CRNSs in witnessing the distress of patients, specifically those experiencing breathlessness. The nurse may have cared for such patients over many months or years. In witnessing this distress, CRNSs engage in emotional labour, which is associated with burnout and poor-quality care. This paper seeks to identify bearing witness to suffering and vulnerability as components of emotional labour in the context of the CRNS role. It highlights the need for research to explore the experience of CRNSs and insights into supporting people with long-term breathlessness. It is more likely that well-supported staff can provide sustained, supportive care to patients living with breathlessness.

Learning from nursing students' experiences and perceptions of their clinical placements in nursing homes: An integrative literature review.

OBJECTIVES: This paper aims to investigate pre-registration nursing students' experiences and perceptions of their clinical placements in nursing homes in order to develop recommendations for nurse educators. Evidence indicates that nursing students do not view nursing home placements as favourably as acute hospital placements. Therefore, nurse educators are challenged to facilitate a change in students' perceptions towards working in the nursing home environment. DESIGN: An integrative literature review allowed for the analysis and synthesis of the data relating to students' experiences and perceptions of nursing home practice, from studies with diverse research designs. METHODS: An electronic database search of CINAHL (Ebsco), Pubmed, British Nursing Database (BND), ERIC and social service abstracts, published from 2008 to April 2020 in English was completed. Papers were included using pre-allocated criteria and 649 qualified for closer examination. After exclusion, 21 papers underwent final analysis and synthesis using NIVIO 12. RESULTS: Five main themes were derived from the literature; i) the importance of effective supervision; ii) students' experiences and perceptions of the learning environment; iii) understanding the roles of care staff, iv) comprehensive orientation to the learning environment, and v) curriculum preparation. From these five categories, two synthesised themes were developed: nursing home placement encounters and enhancing learning opportunities. CONCLUSIONS: Increasing the visibility of caring for older people in the curriculum is urgent in order to address nursing students' perceived misconceptions about placements in nursing homes. The development of standalone older people pathways, delivered by experienced and knowledgeable faculty, as well as the provision of compulsory clinical placements in settings exclusive to nursing older people and supervised by registered nurses are recommended. Failing to resolve this immediate problem will result in a further shortage of nurses who are adequately prepared to meet future nursing needs.

Patients' experiences of attending an adapted cardiac rehabilitation programme for heart failure in a day hospice.

BACKGROUND: Heart failure is highly prevalent with poor outcomes, yet only a small proportion of patients receive specialist palliative care services. AIM: To explore if a programme focusing on support and symptom management of people with heart failure in a hospice environment would be acceptable and of benefit to patients. METHODS: A pre/post intervention study design using mixed methods was used to evaluate the programme. The programme was delivered in 2-hour time slots over a period of 8 weeks. Participants completed three questionnaires pre- and post- and were interviewed within 1 week of completion. The study was conducted between June 2014 and January 2015. FINDINGS: A response rate of 51.7% (n=15) was narrowed to a final sample size of 12 patients. The questionnaire results showed a positive impact on participants' wellbeing and views regarding the use of a hospice, but a desire for greater focus on emotional support. Four key themes emerged from inductive qualitative analysis: demystifying perceptions about hospice care; positivity about wellbeing; learning together; and consideration of end-of-life preparation. CONCLUSION: This adapted programme provides a useful model for the increased integration of palliative care into provision for those living with advancing heart failure.

Reflection and reflective practice.

Reflection is an approach to the generation of understanding about practice that has become a largely accepted part of nursing education at both undergraduate and post-qualifying levels. It is also increasingly common now for healthcare professionals to use reflection in their practice communities as a part of their daily professional work. The literature is replete with accounts of the possible benefits to practitioners and clients of using reflection in practice, yet this amounts to a rather scant evidence base. For community nurses there are several challenges in the practical application of reflective practice, but these are not insurmountable. Issues such as lone-working and geographical distance may be a challenge. There are some key skills that will help public health and community practitioners get started in reflection and some important issues that should be addressed before beginning. Reflective practice has, however, the potential to help practitioners in all fields unlock the tacit knowledge and understanding that they have of their practice and use this to generate knowledge for future practice.