Factors contributing to the fostering of resilience among final-year nursing students in challenging situations: Lessons from the COVID-19 pandemic.

BACKGROUND: During the first wave of the COVID-19 pandemic, final-year nursing students in our country volunteered to join the healthcare workforce, and the challenges they faced were considerable. AIM: To explore the factors that foster resilience among final-year nursing students that joined the healthcare workforce during the first wave of the COVID-19 pandemic. DESIGN: Descriptive qualitative study with thematic analysis. PARTICIPANTS: Newly graduated nurses who had volunteered to join the health workforce during the first wave of the COVID-19 pandemic as final-year bachelor of nursing students. METHODS: Twenty-two semi-structured interviews were conducted during January and February 2021. Interviews were conducted by nursing students as part of their final-year dissertation with the supervision of a researcher with experience on qualitative data collection methods. Thematic analysis of interview transcripts was performed using Weft QDA 1.0.1. RESULTS: The analysis revealed two main themes that described newly graduated nurses views regarding the factors that had enabled them to develop resilience when working on the frontline as final-year nursing students: (1) factors that helped them cope with adversity related with the identification and use of personal resources, feeling supported from others and professional recognition; and (2) factors that promoted learning such as guided reflection and the opportunity to share peer experiences. CONCLUSION: The identification and use of personal resources, recognition and support from others, guided reflection and sharing peer experiences appear to be the key factors in helping nursing students develop resilience in the face of challenging situations. Promoting these factors in the context of nurse education programmes will help to ensure that future professionals are better prepared to deal with the challenges that nurses face in clinical practice in their early career.

Effectiveness and safety of a simple catheter securement device aimed at preventing catheter-associated urinary tract infection in intensive care unit patients: A randomized controlled trial.

BACKGROUND: Clinical practice guidelines for the prevention of catheter associated urinary tract infection (CAUTI) recommend urinary catheter securement in critical patients although there is scant research on its effectiveness. AIM: To analyse whether securement of an indwelling urinary catheter (IUC) reduces the risk of CAUTI and meatal pressure injury among intensive care unit (ICU) patients and assess medical adhesive-related skin injury (MARSI) associated with the securement device. STUDY DESIGN: Open randomized controlled trial involving patients admitted to two ICUs in Spain. In the intervention group (n = 169 patients), the IUC was secured to the thigh using an in-house device piloted as part of this trial. Controls (n = 181) received standard care, including non-securement of the IUC. Barrier film spray was applied to the securement site with the aim of preventing MARSI. The definitions of the main outcomes were: CAUTI was diagnosed according to the criteria of the European Centre for Disease Prevention and Control, meatal pressure injury was categorized into four grades and MARSI was classified as either erythema or skin tears. Bivariate analysis and multivariate logistic regression were performed. Log-rank and Cox regressions were used to compare risk over time to CAUTI and meatal pressure injury in the two groups. RESULTS: Data from 350 patients were analysed, 169 (48.29%) from IG and 181 (51.71%) from CG. In the multiple logistic regression analysis, IUC securement was an independent protective factor against both CAUTI (RR = 0.2, 95% CI [0.05, 0.67]) and meatal pressure injury (RR = 0.31, 95% CI [0.15, 0.58]). The incidence of MARSI was 7.1%. CONCLUSION: Effective IUC securement significantly reduces the risk of CAUTI and meatal pressure injury among ICU patients. The in-house device piloted in the present trial is simple for nurses to use, and the incidence of MARSI was low. These results underline the benefits of IUC securement. RELEVANCE TO CLINICAL PRACTICE: Indwelling urinary catheter (IUC) securement reduces the risk of urinary tract infection. IUC securement helps prevent meatal pressure injury. IUC securement with in-house devices is safe and effective.

Knowledge and beliefs of intensive care nurses about urinary catheter securement: Results of a national survey.

OBJECTIVE: To explore the knowledge and beliefs of intensive care nurses about urinary catheter securement. METHOD AND SETTING: A self-report survey tool comprising 19 questions (15 closed, 4 open-ended) was developed through consultation with a panel of experts and then disseminated electronically to nurse members of two societies for critical care medicine and nursing in Spain. Responses were analysed by calculating descriptive statistics and through qualitative analysis. MAIN OUTCOME MEASURES: Nurses' self-reported knowledge and beliefs about urinary catheter securement in the intensive care patient. RESULTS: Responses of 333 nurses were analysed. Most respondents considered that urinary catheter securement was beneficial for patients (n = 261, 78.4 %) and that it reduced the risk of both meatal pressure injury (n = 266, 79.9 %) and accidental tugging (n = 304, 91.3 %). Regarding the securement procedure, less than a quarter of nurses mentioned the use of barrier film to protect the skin at the securement site (n = 62, 18.6 %) or the need to leave slack in the tube to avoid tugging (n = 45, 13.5 %). Qualitative analysis of responses to open-ended questions revealed that some nurses believed that catheter securement was contraindicated due to the risk of skin injury, or that it interfered with some aspects of basic care, thus increasing their workload. CONCLUSIONS: There appears to be a lack of knowledge among Spanish intensive care nurses about recommended procedures for securing a urinary catheter. Clear and concise guidelines for the intensive care setting are required to ensure safe and standardised practice without creating additional burden for nurses. IMPLICATIONS FOR CLINICAL PRACTICE: Lack of knowledge among intensive care nurses about how to secure urinary catheters may pose certain risks to patients, therefore specific training in how to secure a urinary catheter is needed.

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.

Where do nursing students make mistakes when calculating drug doses? A retrospective study.

BACKGROUND: Research internationally shows that nursing students find dosage calculation difficult. Identifying the specific aspects of dose calculation procedures that are most commonly associated with errors would enable teaching to be targeted where it is most needed, thus improving students' calculation skills. The aim of this study was to analyze where specifically nursing students make mistakes when calculating drug doses. METHOD: Retrospective analysis of written examination papers including dosage calculation exercises from years 1, 2, and 3 of a nursing degree program. Exercises were analyzed for errors in relation to 23 agreed categories reflecting different kinds of calculation or steps in the calculation process. We conducted a descriptive and bivariate analysis of results, examining the relationship between the presence of errors and the proportion of correct and incorrect final answers. RESULTS: A total of 285 exam papers including 1034 calculation exercises were reviewed. After excluding those that had been left blank, a total of 863 exercises were analyzed in detail. A correct answer was given in 455 exercises (52.7%), although this varied enormously depending on the type of exercise: 89.2% of basic dose calculations were correct, compared with just 2.9% of those involving consideration of maximum concentration. The most common errors were related to unit conversion, more complex concepts such as maximum concentration and minimum dilution, or failure to contextualize the answer to the clinical case. Other frequent errors involved not extracting the key information from the question, not including the units when giving their answer, and not understanding the question. In general, fewer errors in basic dose calculations were made by students at later stages of the degree program. CONCLUSIONS: Students struggle with more complex dose calculations. The main errors detected were related to understanding the task and the key concepts involved, as well as not following the correct steps when solving the problem.

Challenges for hospital management in supporting nurses to deliver humanized care.

Hospitals are paying increasing attention to the delivery of humanized care. The purpose of this study was to explore from the nursing perspective what hospital managers might do to facilitate this. A secondary analysis from a primary ethnographic study regarding dignity in nursing practice was conducted. Twenty interviews of internal medicine nurses from four hospitals were analyzed, and three main themes were identified: Management of nursing teams, Management of ethical values, and Management of the context. It is important for institutional values to be closely aligned with those of the nursing profession, and nurse managers play a key role in ensuring that the latter are applied in practice. The proposed actions offer a cost-effective framework through which nurses and managers may promote the delivery of humanized care.

Feeling Informed Versus Being Informed: Mixed-Methods Analysis of Family Perceptions and Behavior Following a Pediatric Emergency Department Visit.

PURPOSE: To examine perceptions of family-centered care, satisfaction, and quality of communication with health professionals during a pediatric emergency department visit, and to evaluate the perceived usefulness of the information received and whether provider treatment recommendations were followed after discharge. DESIGN: Embedded mixed methods design with two concurrent phases. Participants in phase 1 were 385 adult relatives of children (age 6 days-17 years, mean 5.0 years, SD 4.5) seen in a pediatric emergency department. On the day of the visit, relatives completed questionnaires exploring perceptions of family-centered care, satisfaction (CSQ-8), and quality of communication with professionals (ad hoc instrument). For phase 2, we conducted daily structured telephone interviews with 37 of these parents over the six consecutive days following the emergency visit. RESULTS: Satisfaction with the visit was significantly related to the perception of family-centered care (B = 0.25; 95% CI [0.20, 0.29]; p < .001). Follow-up interviews revealed that 45.9% (n = 17) of families did not follow the prescribed treatment and 32.4% (n = 12) made a further appointment with their primary care pediatrician. Qualitative analysis suggested that families lacked certain information from care providers. CONCLUSIONS: Elements of a family-centered approach were rated positively and families believed that the information they received was useful. Importantly, more than half of the families who were followed up by telephone had doubts about provider treatment recommendations. PRACTICE IMPLICATIONS: Family-centered care in the pediatric emergency department could enhance communication and help to ensure that treatment recommendations are followed at home.

Dimensions of leadership in undergraduate nursing students. Validation of a tool.

BACKGROUND: Nurses require leadership skills in order to fulfil their clinical role in an ever-changing healthcare environment. The acquisition of such skills should therefore begin during their professional training. OBJECTIVES: To identify the dimensions of leadership present among nursing undergraduates in the original Self-Assessment Leadership Instrument (SALI). DESIGN: This was a validation study involving the translation and cultural adaptation of the Self-Assessment Leadership Instrument (SALI) for use with nursing undergraduates in the Spanish context. SETTING: Faculty of Medicine and Health Sciences in Spain. PARTICIPANTS AND METHODS: Participants were 280 nursing undergraduates (years 1-4) from a Spanish university. The SALI was adapted following the back-translation procedure, and its psychometric properties (validity and reliability) were analyzed. RESULTS: The Spanish version of the SALI maintains the 40 items of the original scale. Scores on the Spanish SALI were positively and significantly correlated (0.542, p = .000) with scores on the General Self-Efficacy Scale (convergent scale) and negatively and significantly correlated (-0.348, p = .000) with the total score on the Lille Apathy Rating Scale (divergent scale). Factor analysis indicated that scores on the Spanish SALI loaded on four dimensions: Strategic thinking, Emotional intelligence, Impact and influence, and Teamwork skills, which together accounted for 43.42% of the total variance. Cronbach's alpha for the total scale was 0.870 (range 0.688-0.781 for the four dimensions). Test-retest reliability over a 15-day interval was high (ICC = 0.929, p = .000). CONCLUSIONS: The study has identified four key dimensions of leadership that nursing students need to acquire and provides a valid and reliable tool for assessing them. This will enable nurse educators to evaluate the effectiveness of teaching initiatives aimed at developing these competences.