The Function of Ritualized Acts of Memory Making after Death in the Neonatal Intensive Care Unit

(1) Background: Some infants die shortly after birth, leaving both parents and nurses in grief. In the specific setting where the data were collected, the bereaved parents receive a scrapbook made by the nursing staff in the NICU, and a box made by a local parent support group. Making a scrapbook and a box when an infant dies in the NICU can be regarded as ritualized acts. The aim of this study is to explore the functions of these ritualized acts of making a scrapbook and memory box when an infant dies in the NICU. (2) Methods: Focus group interviews were performed with experienced nurses in the NICU, and with members of a parent support group. Reflexive thematic analysis was used to interpret the data. (3) Three main themes were constructed: “Making memories”, “showing evidence of the infant’s life and of the parenthood”, and “controlling chaos”. (4) Conclusions: Through the ritualized acts of making scrapbooks and boxes, nurses and members of the parent support group collect and create memories and ascribe the infant with personhood, and the parents with the status of parenthood. In addition, the ritualizing functions to construct meaning, repair loss, relieve sorrow, and offer a sense of closure for the makers of these items.

Dynamic Surgery Scheduling Based on an Improved Genetic Algorithm

We formulated a new stochastic programming formulation to solve the dynamic scheduling problem in a given set of elective surgeries in the day of operation. The problem is complicated by the fact that the exact surgery durations are not known in advance. Elective surgeries could be performed in parallel in a subset of operating rooms. The appointment times and assignments of surgeries were planned by an experienced nurses in advance. We present a mathematical model to capture the nature of dynamic scheduling problem. We propose an efficient solution based on an improved genetic algorithm (IGA). Our numerical results showed that dynamic scheduling with the IGA improves the resource utilization as measured by surgeon waiting time and operation room idle time.

Hospitals’ and Nurses’ Preparedness to COVID-19 Pandemic

Background: Human corona virus disease (COVID-19) is a contagious disease that has been suggested to have a negative impact on both health care system and health care providers, and this was mainly attributed to the rapid and unexpected spread of this pandemic. Purpose: This study was conducted to assess the level of preparedness of Jordanian nurses and hospitals to COVID-19 pandemic. Method: cross-sectional, descriptive design was used. Data were collected through electronic survey questionnaires from 306 nurses from seven Jordanian hospitals. A modified version of tool developed by Elhadi and colleagues (2020) was used to collect data regarding the preparedness of nurses and hospitals to COVID-19 pandemic. Results: The majority of nurses (84.3%) have participated in care provision for clients with COVID-19. Findings of this study revealed that male, older, more experienced nurses scored significantly higher on nurses’ preparedness scale. About 60% of nurse participants perceived their hospitals to be well-prepared to COVID-19 pandemic. Conclusion: The level of preparedness among nurse was found to be good, but not optimal. Greater emphasis should be placed on younger and less experienced nurses. Urgent actions should be taken to enhance the health institutes’ preparedness, particularly in terms of infection control domain. Keywords: COVID-19, Preparedness, Nurses, Hospitals, Pandemic.

An Exploration of the Transition of Patients From Intensive Care to the Ward Environment: a Ward Nursing Perspective

<p>Background: The transition of patients from intensive care to the ward environment is a regular occurrence in intensive care. Today patients are often transferred earlier and sicker due to the demands for intensive care beds. This results in patients with higher acuity being cared for in the wards. Here ward nurses have to meet the ongoing complex demands of caring for higher acuity patients, alongside managing high patient-to-nurse ratios, staffing concerns, and varying levels of experienced nurses. Objective: This research explored the experiences of ward nurses receiving patients transferred from intensive care. The aims were to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent to ward nurses when receiving patients from intensive care. Methodology: A qualitative descriptive methodology using focus groups was utilised to gather information about these experiences. Three focus groups were held with ward nurses from various wards within the study setting hospital. All participants had considerable contact with intensive care and were familiar with the processes of transferring patients. Findings: Five themes emerged from the focus groups – Patients as intensive care staff say they are; Time to prepare the biggest thing; Documentation as a continuation of patient care; They forget what its like; and Families, a need to know about them. The theme Patients as intensive care staff say they are relates to reliable information sharing focused on the patient, their needs and condition. Participants expressed their concern that patients were not always in the condition that the intensive care staff stated they were on the referral. Having adequate time to prepare was considered important for the majority of ward nurses receiving patients from intensive care. Documentation was highlighted in the theme Documentation as a continuation of patient care particularly in relation to fluid balances and vital sign history. The theme They forget what its like suggests there is a perception that intensive care nurses have a lack of understanding of what the ward staff can actually manage. Decreased staffing levels during certain shift patterns and a lack of appropriately experienced staff on the wards is a common concern for ward nurses. Ward nurses also recognised that caring for families was part of their role. Patients and families may respond differently to the transfer process and their inclusion in transfer planning was seen as essential. Communication was a reoccurring element throughout all themes. Conclusion: Communication is the paramount factor that impacts on a ‘smooth transition’ for ward nurses. A ‘smooth transition’ refers to the transfer of patients from intensive care to the next level of care. Subsequently, nurses’ perceptions need to change, whereby transfer planning from ICU should be the focus rather than discharge planning. Transfer planning and education for all nursing staff is vital if the transfer process is to be improved. Consequently, transitional care within the context of ICU aims to ensure minimal disruption and optimal continuity of care for the patient. The knowledge gained from this research may provide better understanding of the multifaceted issues linked with transitional care that may be adapted for a wider range of patients in various clinical environments.</p>

An Exploration of the Transition of Patients From Intensive Care to the Ward Environment: a Ward Nursing Perspective

<p>Background: The transition of patients from intensive care to the ward environment is a regular occurrence in intensive care. Today patients are often transferred earlier and sicker due to the demands for intensive care beds. This results in patients with higher acuity being cared for in the wards. Here ward nurses have to meet the ongoing complex demands of caring for higher acuity patients, alongside managing high patient-to-nurse ratios, staffing concerns, and varying levels of experienced nurses. Objective: This research explored the experiences of ward nurses receiving patients transferred from intensive care. The aims were to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent to ward nurses when receiving patients from intensive care. Methodology: A qualitative descriptive methodology using focus groups was utilised to gather information about these experiences. Three focus groups were held with ward nurses from various wards within the study setting hospital. All participants had considerable contact with intensive care and were familiar with the processes of transferring patients. Findings: Five themes emerged from the focus groups – Patients as intensive care staff say they are; Time to prepare the biggest thing; Documentation as a continuation of patient care; They forget what its like; and Families, a need to know about them. The theme Patients as intensive care staff say they are relates to reliable information sharing focused on the patient, their needs and condition. Participants expressed their concern that patients were not always in the condition that the intensive care staff stated they were on the referral. Having adequate time to prepare was considered important for the majority of ward nurses receiving patients from intensive care. Documentation was highlighted in the theme Documentation as a continuation of patient care particularly in relation to fluid balances and vital sign history. The theme They forget what its like suggests there is a perception that intensive care nurses have a lack of understanding of what the ward staff can actually manage. Decreased staffing levels during certain shift patterns and a lack of appropriately experienced staff on the wards is a common concern for ward nurses. Ward nurses also recognised that caring for families was part of their role. Patients and families may respond differently to the transfer process and their inclusion in transfer planning was seen as essential. Communication was a reoccurring element throughout all themes. Conclusion: Communication is the paramount factor that impacts on a ‘smooth transition’ for ward nurses. A ‘smooth transition’ refers to the transfer of patients from intensive care to the next level of care. Subsequently, nurses’ perceptions need to change, whereby transfer planning from ICU should be the focus rather than discharge planning. Transfer planning and education for all nursing staff is vital if the transfer process is to be improved. Consequently, transitional care within the context of ICU aims to ensure minimal disruption and optimal continuity of care for the patient. The knowledge gained from this research may provide better understanding of the multifaceted issues linked with transitional care that may be adapted for a wider range of patients in various clinical environments.</p>

Nurses as Patients: the Stories of Two Woman Nurse Educators as Recipients of Nursing Care

<p><b>In this research two nurse-patients have engaged in a conversation about theirexperience of ‘being nursed’. The project sets out to address the following questions:How might our experiences as nurses who have been hospitalised be drawn upon toinfluence positive changes in nursing practice? What effect might our experiences ofhospitalisation have on us as nurses and on our nursing practice?</b></p> <p>The study utilises narrative as inquiry and the method of story telling andauto/biography to tell the stories of Maria (a pseudonym) and myself, the researcher.</p> <p>This interpretive research has been informed by the feminist process and sits within apostmodern framework. Maria’s stories were audio taped and transcribed beforebeing prepared for analysis using ‘core story creation’, and the process of'emplotment' (Emden, 1998b). My reflective topical autobiographical narrative wasconstructed through the processes described by Johnstone (1999).</p> <p>Three distinct qualities emerged from both of our experiences. The first,‘knowing as nurse-patient’ contains the three sub themes of ‘having knowledge’,‘expectations of being nursed’, and ‘knowledge gained’. The second distinct quality‘being nursed’ contains the two sub themes of ‘feeling safe and cared for’ and‘presencing’; and the third ‘not being nursed’ contains the four sub themes ‘feelingvulnerable’, ‘invisibility of nurses’, ‘getting out’ and ‘feeling let down’. The subtheme ‘getting out’ includes three additional sub themes of ‘wanting to get out andnot wanting to be there’, ‘leaving and the need for closure’ and ‘not wanting to goback’,This study on nurse-patients receiving nursing care will be useful for nurseeducators, students of nursing, and nurse clinicians. Nursing does make a differenceto patient care. For patients to receive therapeutic care new graduate nurses must bepreceptored/mentored by experienced nurses in supportive programmes. Suggestionsfor further research have been identified.</p>

Nurses as Patients: the Stories of Two Woman Nurse Educators as Recipients of Nursing Care

<p><b>In this research two nurse-patients have engaged in a conversation about theirexperience of ‘being nursed’. The project sets out to address the following questions:How might our experiences as nurses who have been hospitalised be drawn upon toinfluence positive changes in nursing practice? What effect might our experiences ofhospitalisation have on us as nurses and on our nursing practice?</b></p> <p>The study utilises narrative as inquiry and the method of story telling andauto/biography to tell the stories of Maria (a pseudonym) and myself, the researcher.</p> <p>This interpretive research has been informed by the feminist process and sits within apostmodern framework. Maria’s stories were audio taped and transcribed beforebeing prepared for analysis using ‘core story creation’, and the process of'emplotment' (Emden, 1998b). My reflective topical autobiographical narrative wasconstructed through the processes described by Johnstone (1999).</p> <p>Three distinct qualities emerged from both of our experiences. The first,‘knowing as nurse-patient’ contains the three sub themes of ‘having knowledge’,‘expectations of being nursed’, and ‘knowledge gained’. The second distinct quality‘being nursed’ contains the two sub themes of ‘feeling safe and cared for’ and‘presencing’; and the third ‘not being nursed’ contains the four sub themes ‘feelingvulnerable’, ‘invisibility of nurses’, ‘getting out’ and ‘feeling let down’. The subtheme ‘getting out’ includes three additional sub themes of ‘wanting to get out andnot wanting to be there’, ‘leaving and the need for closure’ and ‘not wanting to goback’,This study on nurse-patients receiving nursing care will be useful for nurseeducators, students of nursing, and nurse clinicians. Nursing does make a differenceto patient care. For patients to receive therapeutic care new graduate nurses must bepreceptored/mentored by experienced nurses in supportive programmes. Suggestionsfor further research have been identified.</p>

The information system stress, informatics competence and well-being of newly graduated and experienced nurses: a cross-sectional study

Background The use of information systems takes up a significant amount of nurses’ daily working time. Increased use of the systems requires nurses to have adequate competence in nursing informatics and is known to be a potential source of stress. However, little is known about the role of nursing informatics competence and stress related to information systems (SRIS) in the well-being of nurses. Moreover, the potential impact of nurses’ career stage on this matter is unknown. This study examined whether SRIS and nursing informatics competence are associated with stress and psychological distress in newly graduated nurses (NGNs) and experienced nurses. Methods A cross-sectional study was conducted in Finland between October and December 2018. The participants were NGNs (n = 712) with less than two years of work experience and experienced nurses (n = 1226) with more than two years of work experience. The associations of nursing informatics and SRIS with nurses’ stress and psychological distress were analyzed with linear regression analysis. Analyses were conducted separately for NGNs and experienced nurses. Models were adjusted for age, gender, and work environment. Results SRIS was associated with stress / psychological distress for both NGNs (β = 0.26 p < 0.001 / β = 0.22 p < 0.001) and experienced nurses (β = 0.21 p < 0.001/ β = 0.12 p < 0.001). Higher nursing informatics competence was associated with lower stress (β = 0.20 p < 0.001) and psychological distress (β = 0.16 p < 0.001) in NGNs, but not among experienced nurses. Conclusions SRIS appears to be an equal source of stress and distress for nurses who are starting their careers and for more experienced nurses, who are also likely to be more experienced users of information systems. However, informatics competence played a more important role among NGNs and a lack of adequate competence seems to add to the strain that is already known to be high in the early stages of a career. It would be important for educational institutions to invest in nursing informatics so that new nurses entering the workforce have sufficient skills to work in increasingly digital health care.

Working in a minefield; Nurses’ strategies for handling medicine administration interruptions in hospitals, -a qualtiative interview study

Background Administering medicines is one of the most high-risk tasks in health care. However, nurses are frequently interrupted during medicine administration, which jeopardises patient safety. Few studies have examined nurses’ experiences and the strategies they adopt to cope with interruptions during medicine rounds. This paper identifies nurses’ strategies for handling and reducing interruptions and ensuring safety during medicine rounds, within the confines of the hospitals’ organisational systems. Methods This descriptive and exploratory research study was undertaken with experienced nurses in Norwegian hospitals in 2015 using semi-structured interviews. Interviews were designed to elicit experiences and strategies used for handling interruptions to medicine rounds. Data were analysed using qualitative content analysis based on inductive reasoning to identify meaningful subjects and reach an interpretive level of understanding regarding nurses’ experiences. Results All 19 senior nurses who were approached were interviewed. From 644 condensed meaning units, we identified eight interpretative units and three themes: ‘working in environments of interruptions’, ‘personal coping strategies’, and ‘management-related strategies’. Nurses’ working environments were characterised by interruptions and distractions, which often threatened patient safety. To handle this unpredictability and maintain ward organisation, nurses developed their own personal strategies to overcome inherent problems with their working conditions, the absence of effective management, and colleagues’ reluctance to assume responsibility for minimising interruptions. Conclusions Administration of medicines in hospitals can be described as ‘working in a minefield’. Our findings indicate that the hospital management, in cooperation with nurses and other healthcare professionals, should take responsibility for improving the routine process of medicine administration by minimising avoidable interruptions. Patient safety can be improved when the hospital management takes steps to protect nurses’ work environments and assumes responsibility for resolving these challenges.

Moral distress among nurses working in Covid-19 wards: a cross-sectional study in 2021

Background Covid-19 is an emerging disease, which has confronted nurses with new moral distress. This study aims to determine the moral distress and its related factors among nurses working in the covid-19 wards of Ardabil city in Iran. Methods This cross-sectional descriptive study evaluated 159 nurses working in the covid-19 wards of Imam Khomeini hospital -as the only hospitalization center for the patients with covid-19 in Ardabil, 2021. The instruments used included a personal-occupational information form and Corley's moral distress scale. Data analysis was performed using descriptive and inferential statistics (Pearson correlation coefficient, independent t-test and one-way analysis of variance) in SPSS v22. Results The mean and standard deviation of the frequency and intensity of the nurses' moral distress were estimated 52.28 ± 5.24 and 51.54 ± 5.86, respectively, which indicated the moderate level of moral distress in the both dimensions. The item "I hesitate to tell the patient or the patient's family about his condition and treatment" (4.74 ± 0.75) showed the most moral distress based on the intensity and the phrase "too much work reduces the quality of my work” (4.81 ± 0.55) caused the most moral distress in the frequency dimension. The results indicated a significant relationship between the intensity and frequency of moral distress with the type of nurses' employment (P < 0.05). Moreover, a significant relationship was observed between the nurses’ position and the frequency (P = 0.04), and the nurses’ work experience and the intensity of moral distress (P = 0.02). Conclusions It seems that providing the necessary training for how to deal with the moral distress in new waves of the disease and using the experiences of the experienced nurses in this field are essential due to observing the moderate level of moral distress among nurses working in covid-19 wards.