Patients' experiences of shared decision-making in nursing care: A qualitative study.

AIM: To explore patients' experiences of shared decision-making, in nursing care during their stay in a healthcare institution. DESIGN: This study employed a qualitative descriptive design. METHODS: Twenty participants were interviewed from two rehabilitation centres, a nephrology ward of a hospital, and a rehabilitation ward of a long-term care facility. A constant comparative method was used for the inductive analysis. RESULTS: The main theme was 'feeling seen and understood', in the context of person-centred care, which served as the unifying thread across five themes. The five themes included the importance of a positive nurse-patient relationship as a foundation for shared decision-making. Next, patients experienced collaboration, and this was influenced by verbal and non-verbal communication. Another theme was that patients often felt overwhelmed during their stay, affecting shared decision-making. The fourth theme was that many decisions were not made through the shared decision-making process but were still perceived as satisfactory. The final theme highlighted patients' perspectives on their role in decision-making and influencing factors. CONCLUSION: Patients describe how feeling seen and understood is a prerequisite for shared decision-making as a part of person-centred care. For nurses, this implies that they should focus on aspects such as building a good relationship and acknowledgement of patients' feelings and circumstances, next to empowering patients to feel knowledgeable and valued. This way patient's motivation to participate in shared decision-making will be enhanced. REPORTING METHOD: Following the EQUATOR guidelines, reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in the study through interviews during the research process and member checks during analysis. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Before initiating shared decision-making processes, prioritise making the patient feel seen and understood. Be mindful that patients often feel overwhelmed during their stay. Use a person-centred approach to make patients feel knowledgeable-this empowers them for shared decision-making. IMPACT: Research on patients' experiences of shared decision-making in nursing care is limited, yet crucial for understanding patients' needs in shared decision-making. This study highlights patients' perceptions that shared decision-making is best facilitated within the nurse-patient relationship by nurses who primarily focus on ensuring that patients feel acknowledged and understood.

Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review.

AIM: To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies. DESIGN: Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). DATA SOURCES: PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022. REVIEW METHODS: Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group. RESULTS: Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only. CONCLUSIONS: A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies. IMPACT: Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated. NO PATIENT OR PUBLIC CONTRIBUTION: Prospero ID CRD42021292290.

Teamwork, clinical leadership skills and environmental factors that influence missed nursing care - A qualitative study on hospital wards.

AIM: To explore how nursing teams in clinical inpatient nursing hospital wards perform teamwork to prevent or reduce missed nursing care and how teamwork is influenced by clinical leadership skills and environmental factors. BACKGROUND: Earlier studies on missed nursing care identified teamwork and leadership skills as promising factors in inpatient care that can positively influence quality of care and reduce missed nursing care. The effective use of teamwork in hospitals requires understanding what it is, how it is performed by nursing teams and how it is influenced by clinical leadership skills and environmental factors. DESIGN: A qualitative exploratory study was undertaken between January and March 2021. METHODS: A total of 16 registered nurses who worked on various hospital wards, participated in three online focus groups. Data were analyzed with thematic analysis according to Braun and Clarke. RESULTS: Thematic analysis revealed four themes. First, nurses perform teamwork and clinical leadership skills in various ways. Some nurses work in pairs and have common goals, while other nurses work individually. This influences teamwork. Second, nurses are informal teachers, visible in teaching and learning from each other, contributing in constructive teamwork. Third, senior nurses are seen as informal leaders, forming connection between nursing wards and formal leaders, resulting in awareness of each other and the progress of patientcare. Finally, environmental factors influence the performance of teamwork. CONCLUSIONS: Results of this study show how knowledge regarding missed nursing care can be increased. Results can be used for developing training programs and embedding education in practice aimed at constructive teamwork, clinical leadership skills and missed nursing care.

What makes a nurse today? A debate on the nursing professional identity and its need for change.

In 2020, due to the Nightingale year and COVID-19 crisis, nursing is in the public eye more than ever. Nurses often are being seen as compassionate helpers. The public image of nursing, however, also consists of stereotypes such as nursing being a 'doing' profession and care being a 'female' characteristic. Next to that, nursing is associated with images from the past, such as 'the lady with the lamp'. Therefore, in the public eye at least, the nursing identity seems a simple and straightforward enough construct, but nothing less is true. Looking at what a professional identity consists of, historic and social developments influence a group identity as a construct. In addition, individual, professional and contemporary societal moralities, including stereotypes, play its role. Nurses themselves reinforce stereotypes in order to fit into what is expected, even when they believe professional behaviour encompasses other features. They may do so individually as well as in a group context. But nursing actually seems to be better off when viewed upon as a diverse, autonomous profession. Moral values such as compassion motivate nurses to enter the profession. Research shows that if such values are addressed in daily practice, nursing could perhaps be saved from nurses leaving the profession because of feeling unfulfilled. Another aspect concerns the huge nursing body of knowledge. If seen as the ground on which nursing behaviour is standing, it would contribute to a different image of nursing than simplified stereotypes, which do not acknowledge the complex nature of the profession. This paper challenges the idea that the nursing identity is unchangeable and the notion that 'a nurse will always be a nurse'. By doing so, the paper contributes to a debate on the supposed 'true' nature of the nursing identity and opens a discussion on the need for it to change.

Compassion: Use it or lose it?: A study into the perceptions of novice nurses on compassion: A qualitative approach.

BACKGROUND: Nurses and patients believe compassion to be one of the most important professional values. However, it is not known which factors influence compassionate behaviour in practice. There is a need for insight whether or not compassion in nursing practice flourishes or falters. OBJECTIVES: This study aims to explore how Dutch novice nurses perceive compassion within nursing care and gain insight in their strategies of sustaining and developing compassionate care. DESIGN: This study used an exploratory design, employing a qualitative approach. DATA SOURCES: 14 in depth interviews with Dutch bachelor novice nurses with 0-5 years of practical experience took place. REVIEW METHODS: Thematic analysis and inductive coding was used. RESULTS: Four themes emerged from the data. First, participants perceive compassion to be a part of their professional identity. Balancing between positive and negative environmental influences and their own perceptions was shown as a second theme. Thirdly, various strategies such as rebellion and conforming to the ideas on the workplace helped nurses to do so in daily practice. If nurses succeeded in dealing positively with various influences, a professional development was perceived over time. The fourth theme described the increased awareness of compassion and professional identity if strategies were successful. If not; insecurity, job dissatisfaction and ultimately consideration of job-retention was described. CONCLUSION: Compassion is an essential value during the development of the professional identity of novice nurses. Dealing with meaningful emotions and experiences broadened nurses' personal awareness of compassionate care and stimulated a growth in their professional identity. Novices need support during their internships that builds empowerment and resilience in sustaining compassion. Furthermore, there is a need for role models and a corporative team spirit in order to coach novice nurses in compassionate behaviour.

Factors facilitating nurses to deliver compassionate care: a qualitative study.

BACKGROUND: Compassion is an important ethical foundation of all healthcare professionals especially for nursing. However, there is little understanding of factors which could help and motivate nurses to deliver compassionate care in modern healthcare practices today. Moreover, a cultural context may affect the way compassionate care is delivered by healthcare professionals. AIMS AND OBJECTIVES: This study aimed to explore what facilitates compassionate care in daily practice from the unique perspective of Iranian nurses. RESEARCH METHODS: This qualitative exploratory study was conducted in four hospitals. In this study, 16 nurses were selected from various wards. Data were collected by in-depth, face-to-face interviews. For data analysis, a conventional content analysis approach was used. RESULTS: As the most important theme, the theme 'deepening individual's capacity for compassionate care' emerged, which consisted of three categories: the personal system of values and beliefs, patient experience and positive role models of compassion. CONCLUSIONS: Addressing and developing nurses' capacity for compassion is possible by providing organisational support and professional education, next to recruiting nurses with a high motivation to relieve patient suffering. These recommendations would help to provide high-quality compassionate care in healthcare practices. Moreover, nurses could improve their individual capacity for compassion by following their value and belief system and by considering their colleagues as a role model of compassionate practice.

Compassion: the missing link in quality of care.

This article discusses the impact of selected findings from a PhD-study that focuses on compassion as a guiding principle for contemporary nursing education and practice. The study, of which the literature review and empirical findings have already been published, looked at compassion as perceived within the relationship of nurses and older persons with a chronic disease. The patient group was chosen because daily life for them is characterized by long-term dependency on care. The literature review resulted in a theoretical framework of compassion that also explores other closely related concepts such as suffering and empathy. The empirical part of the study, in which 61 in-depth interviews and 6 group interviews with patients and nurses took place, showed that compassion is a mirroring process in response to grief. Compassion consists of seven dimensions such as attentiveness and presence, in which saliency, so as to anticipate patients' needs, is of major importance. Compassion is perceived by participants as an indispensable aspect of care, which helps to reveal relevant information in order to establish appropriate outcomes of care. This article focuses on the aspects of the PhD-study in which an analysis of compassion in the context of both modern as well as the history of nursing took place. Currently evidence based practice is regarded as the standard for good quality care. Nevertheless there is an on-going debate about what constitutes good quality care. Within this debate two opposing views are apparent. One view defines good care as care supported by the best scientific evidence. The other view states that good care takes place within the nurse-patient relationship in which the nurse performs professional care based on intuitive knowing. It is suggested that compassion is the (missing) link between these views.

Compassion in care: a qualitative study of older people with a chronic disease and nurses.

This article describes compassion as perceived within the relationship between nurses and older persons with a chronic disease. The aim of the study is to understand the benefit of compassion for nursing practice within the context of long-term care. The design of the study involves a qualitative analysis of in-depth interviews with nurses and patients in three different care-settings. Results show the nature of compassion in seven dimensions: attentiveness, listening, confronting, involvement, helping, presence and understanding. Analysis of the data also shows in what way opinions of participants relate to issues raised in a previous literature study, for example the difference between pity and compassion. The conclusion states that compassion is a valuable process which motivates patients as well as nurses to cooperate in achieving relevant outcomes of care. The discussion involves some methodological issues. For one thing, further confirmation of the dimensions found is recommended.

Compassion and professional care: exploring the domain.

Compassion unites people during times of suffering and distress. Unfortunately, compassion cannot take away suffering. Why then, is compassion important for people who suffer? Nurses work in a domain where human suffering is evidently present. In order to give meaning to compassion in the domain of professional care, it is necessary to describe what compassion is. The purpose of this paper is to explore questions and contradictions in the debate on compassion related to nursing care. The paper reviews classical philosophers as well as contemporary scientists' main arguments on compassion. First, I will examine the relationship between compassion and suffering. Second, how does one recognize serious suffering? This issue raises questions about the role of imagination and the need for identification. Third, literature describes compassion as an emotion. Some philosophers consider emotions uncontrollable feelings; others see a clear rational dimension in emotions. In order to determine what compassion is, it is necessary to weigh these contradictional arguments. Fourth, I will discuss motives for compassion. Is compassion an act of altruism or egoism? In this debate Nietzsche and Schopenhauer are well-known opponents. Today, analysis of their arguments leads to some surprising conclusions. Fifth, there is the issue of fault and compassion. Can we only feel compassionate when people who suffer are not to blame for their own suffering? Such a condition faces professional caretakers with a dilemma which needs a thorough analysis if compassion is to be of use in the field of professional care. Finally, I will explore the moral meaning of compassion. Compassion, described as a concept with cognitive as well as affective dimensions, also has volitional and behavioural aspects. These aspects specifically are of importance to nursing care and further research of compassion in the nursing domain.