Neglected Concerns of Nurses and Their Unheard Voices; A Blind Spot in our Health System

The current scenario of nursing in India forces us to introspect if the nurses are equipped enough to bring out their best contribution towards the health of our country and if their voices are well heard in the healthcare system. Despite being highly skilled professionals, nurses are neither facilitated nor rewarded enough to sustain their motivation and inputs. To understand the struggles faced by nurses in India, we reviewed literature that addresses Indian nurses’ concerns and brainstormed about the major challenges that nurses encounter with key nursing personnel from nursing education, clinical services and administration from selected hospitals of India. The major challenges that negatively affect the contribution of nurses are shortage of nurses, poor working conditions and career opportunity, ineffective leadership roles, poor educational quality, low salary and state neglect. The COVID-19 pandemic has proven the vast contribution and sacrifice of nurses. The competency of nurses has gone up with specialization, and advanced nursing degrees. Enhancing nurses’ involvement in collaborative healthcare research would be a hallmark in improving the quality patient care. To efficiently utilize the contribution of the nurses in healthcare system, the society and state have to recognize the potentials and vulnerabilities of nurses, appreciate their strengths and reciprocate responsibilities to their neglected concerns.

A realist review protocol of the role and contribution of the advanced nurse practitioner (ANP) in gastroenterology nursing

Background: The role and contribution of advanced nurse practitioners (ANP) has been well researched and found to be of great value for improving quality patient care and enhancing patient outcomes through education and health promotion. However, the role and the contribution of the ANP to gastroenterology nursing have not been evaluated either nationally or internationally. A review to determine the role and contribution of the ANP in gastroenterology nursing will inform on the contribution of the role and whether the role makes a difference to patient outcomes and cost effectiveness of patient care. Objective: This review aims to investigate the nursing role and contribution of the advanced nurse practitioner in gastroenterology. Furthermore, improved understanding of the underlying causal mechanisms explaining how the ANP role in gastroenterology nursing works, will provide a deeper understanding of how, why, for whom and in what contexts the role and contribution of the ANP to gastroenterology nursing are most successful. Methods: A realist review will consolidate evidence on how, when why and where the ANP role in gastroenterology works or fails through identifying programme theories underlying to the role’s introduction. The following steps will be operationalised; locating existing theories, searching the literature, documenting literature selection, engaging in data extraction and synthesis and refining programme theory. As an iterative approach, review cycles will uncover explanatory and contingent theories through context-mechanism-outcome configurations (CMOCc). Due to the variation in context and mechanisms, different outcomes will be likely across different clinical settings although similar patterns may be identified. Conclusions: Due to the theory-oriented approach of realist reviews, the pragmatic consequences of the review, will lend itself to deeper understanding of how the role and contribution of the ANP in gastroenterology nursing works in practice.

Defining the Critical Components of Informed Consent for Genetic Testing

Purpose: Informed consent for genetic testing has historically been acquired during pretest genetic counseling, without specific guidance defining which core concepts are required. Methods: The Clinical Genome Resource (ClinGen) Consent and Disclosure Recommendations Workgroup (CADRe) used an expert consensus process to identify the core concepts essential to consent for clinical genetic testing. A literature review identified 77 concepts that are included in informed consent for genetic tests. Twenty-five experts (9 medical geneticists, 8 genetic counselors, and 9 bioethicists) completed two rounds of surveys ranking concepts’ importance to informed consent. Results: The most highly ranked concepts included: (1) genetic testing is voluntary; (2) why is the test recommended and what does it test for?; (3) what results will be returned and to whom?; (4) are there other types of potential results, and what choices exist?; (5) how will the prognosis and management be impacted by results?; (6) what is the potential family impact?; (7) what are the test limitations and next steps?; and (8) potential risk of genetic discrimination and legal protections. Conclusion: Defining the core concepts necessary for informed consent for genetic testing provides a foundation for quality patient care across a variety of healthcare providers and clinical indications.

Clinical Oncology Workload in Sri Lanka: Infrastructure, Supports, and Delivery of Clinical Care

PURPOSE Sri Lanka is a lower middle-income country undergoing a demographic transition with an increasing aging population. This has given rise to a higher burden of noncommunicable diseases including cancer. A well-trained oncology workforce is essential to address this growing public health challenge. Understanding the baseline status of the clinical oncology workforce is an essential step to improving cancer care delivery in Sri Lanka. METHODS In this cross-sectional study, we distributed a web-based survey to all clinical oncologists in Sri Lanka. The survey captured data regarding clinical workload, demographic details, practice setting, and perceived barriers to quality patient care. RESULTS A total of 41 of 54 oncologists responded to the survey, and all participants had training in clinical oncology. Thirty-seven (90%) of 41 oncologists treated both solid and hematologic malignancies, and the median duration of independent practice was 5 years. Almost two thirds of the oncologists (26 of 41, 63%) work at an academic center, and two thirds of the oncologists (27 of 41, 66%) work in both public and private sectors. A majority of the oncologists (26 of 41, 63%) were on-call 7 days per week. More than half of the oncologists saw over 400 new patient consults per year. With regard to barriers to quality patient care, most of the concerns relate to the scarcity of resources. CONCLUSION This study sheds significant light about the clinical oncology workload landscape in Sri Lanka. Compared with other low- and middle-income countries, Sri Lankan clinical oncologists are faced with a very high workload, which may affect delivery or care.

Task shifting of intravitreal injections from physicians to nurses: a qualitative study

Background Intravitreal injections of anti-vascular endothelial growth factor are high-volume procedures and represent a considerable workload on ophthalmology departments. Several departments have tried to meet this increase by shifting the task to nurses. To maintain high-quality patient care, we developed a training program for nurses that certifies them to administer injections. This qualitative study aimed to evaluate whether the nurses were confident and in control after participating in the training program and whether they were satisfied with the training and the new task. Methods Between 2014 and 2018, 12 registered nurses were trained in a tertiary hospital in central Norway. All the nurses were interviewed, either individually (n = 7) or in a group (n = 5). We analysed the interviews using Graneheim and Lundman’s qualitative content analysis. Results Eight subthemes were clustered within four main themes: 1) procedure and challenges, 2) motivation, 3) cooperation and confidence, and 4) evaluation. The nurses felt confident and in control when administering injections but experienced moments of insecurity. The new task gave the nurses a sense of achievement, and they highlighted improvement of patients’ lives as positive. A greater level of responsibility gave the nurses pride in their profession. They had suggestions that could improve training efficiency but were overall satisfied with the training program. Conclusions Our study showed that the nurses were satisfied with the training and that learning a new task led to higher self-esteem and increased respect from patients and colleagues. Suggestions to improve the training were identified; these should be considered before implementation by other departments.

Tele-U to Tele-ICU: Telehealth Nursing Education

Background The use of telehealth technology in various health care settings continues to expand. Such technology allows intensive care units to monitor patients living in remote locations and to intervene early when a patient’s condition declines or a critical event occurs. The use of telehealth can also support nurses and help meet staffing challenges, which have increased in intensive care units during the COVID-19 pandemic. Currently, however, there are no formal requirements for telehealth education in nursing education or for telehealth orientation in nursing practice. Objective To develop a telehealth curriculum based on telehealth competencies that would be broad enough to encompass all educational levels of nursing students and to support the current nursing workforce. Intervention A telehealth curriculum was designed that included an overview of telehealth, camera considerations, equipment, troubleshooting, reimbursement, legislation, and quality measures. These topics were then organized and developed into 6 online interactive video modules and simulation experiences. The curriculum topics pertinent to the tele–intensive care unit are discussed in this article. Conclusions Completion of the telehealth curriculum or a formal telehealth orientation session may provide nurses with an understanding of the principles of telehealth and the skills needed to provide high-quality patient care using telehealth best practices. As the use of telehealth continues to expand, nursing education and practice should work together to address the needs of the nursing workforce and staffing challenges, specifically in the intensive care unit setting.

Improving the effectiveness of the referral process in a tertiary NICU using lean methodology concepts

Aim: To reduce the administrative time trainees spent when completing a patient referral to specialist teams in a tertiary Neonatal Intensive care setting. Methods: We designed a pre intervention and post intervention questionnaire completed prospectively by trainees describing the tasks they needed to undertake to complete a referral, the time perceived as ‘wasted’ and suggest potential solutions over a 2 month period between 1st June 2020 and 1st August 2020. We used Lean methodology to identify waste as steps that did not add value to quality patient care. We designed a NICU referral directory containing the standard operating steps, the appropriate proformas and contact details of receiving unit, a process algorithm and a collective consultant email address. Results: Our project achieved a reduction in the median time to complete a referral from 27.5 minutes to 6 minutes (p = 0.0087). The time perceived ‘wasted’ by trainees was reduced from 20 minutes to 0 minutes (p=0.006). Conclusion: Our project is a simple intervention and supports using Lean methodologies to identify waste and bring about quick improvements without significant capital investments. We demonstrate how front line staff can be engaged in identifying inefficiencies, suggest solutions which help in the successful adoption and sustainability of quality improvements.

Association of Continuity of General Practitioner Care with Utilisation of General Practitioner and Specialist Services in China: A Mixed-Method Study

Background: Continuity of general practitioner (GP) care, widely known as the core value of high-quality patient care, has a positive association with health outcomes. Evidence about the relationship between continuity and health service utilisation has so far been lacking in China. This study aimed to analyse the association of continuity of GP care with utilisation of general practitioner and specialist services in China. Method: A cross-sectional mixed methods study was conducted in 10 urban communities in Hangzhou. Quantitative data were collected from a random sample of 624 residents adopting the self-developed questionnaire. Measurement of continuity of GP care included informational continuity (IC), managerial continuity (MC) and relational continuity (RC). With adjustment for characteristics of residents, multivariate regression models were established to examine the association of continuity of GP care with the intention to visit GP, frequency of GP and specialist visitations. Qualitative data were collected from 26 respondents using an in-depth interview, and thematic content analysis for qualitative data was conducted. Results: Quantitative analysis showed that the IC was positively associated with the intention to visit GP and frequency of GP visitations. Those people who gave a high rating for RC also used GP services more frequently than their counterparts. MC was negatively associated with frequency of specialist visitations. Qualitative analysis indicated that service capabilities, doctor–patient interaction and time provision were regarded as three important reasons why patients chose GPs or specialists. Conclusions: Overall, high IC and RC are independently associated with more GP service utilisation, but a high MC might reduce specialist visitations. Continuity of GP care should be highlighted in designing a Chinese GP system.