Aims and Objectives
To explore moral distress empirically and conceptually, to understand the factors that mitigate and exacerbate moral distress and construct a model that represents how moral ...distress relates to its constituent parts and related concepts.
Background
There is ongoing debate about how to understand and respond to moral distress in nursing practice.
Design
The overarching design was feminist empirical bioethics in which feminist interpretive phenomenology provided the tools for data collection and analysis, reported following the COREQ guidelines. Using reflexive balancing, the empirical data were combined with feminist theory to produce normative recommendations about how to respond to moral distress. The Moral Distress Model presented in this paper is a culmination of the empirical data and theory.
Methods
Using feminist interpretive phenomenology, critical care nurses in the United Kingdom (n = 21) were interviewed and data analysed. Reflexive Balancing was used to integrate the data with feminist theory to provide normative recommendations about how to understand moral distress.
Results
There are five compounding factors that exacerbate/ mitigate nurses' experiences of moral distress: epistemic injustice; the roster lottery; conflict between one's professional and personal responsibilities; ability to advocate and team dynamics. In addition to the causal connection and responses to moral distress, these factors make up the moral distress model which can guide approaches to mitigate moral distress.
Conclusions
The Moral Distress Model is the culmination of these data and theorising formulated into a construct to explain how each element interacts. We propose that this model can be used to inform the design of interventions to address moral distress.
Aims and Objectives
This scoping review aims to identify whether transition programmes support new graduate nurses and nursing students in terms of dealing with workplace violence, bullying and ...stress and enhance new graduate nurses' resilience during the transition from education to clinical practice.
Background
Many new graduate nurses in their first year of employment experience issues at work such as violence, bullying and stress, which forces them to leave their jobs. Nursing students also experienced these issues during their clinical rotation. However, some hospitals and universities have developed transition programmes to help nursing students and new graduate nurses and ease their transition from education to clinical practice. Although transition programmes have been successful in increasing the retention rate for new graduate nurses, their impact on supporting new graduate nurses and nursing students in dealing with workplace violence, bullying and stress and in enhancing their resilience is unknown.
Design
A scoping review of the current literature (with no date limit) using the PRISMA‐ScR checklist for reporting scoping reviews was utilised.
Method
Following the scoping review framework of Arksey and O'Malley, a broad search (with no date limit) was performed in CINAHL, Scopus, Medline, Web of Science, ASSIA, PsycINFO, Embase, PROSPERO and ProQuest Dissertation databases. Reference lists of the included studies were searched.
Results
This review found that most transition programmes provide support for new graduate nurses when dealing with workplace violence, bullying and stress. Transition programmes varied in length, content and implementation. Preceptors' support, educational sessions and safe work environments are the most beneficial elements of transition programmes for supporting new graduate nurses. Education sessions about resilience provide new graduate nurses with knowledge about how to deal and cope with stressful situations in the work environment. We found no studies that focused on nursing students.
Conclusion
The paucity of research on transition programmes' impact on workplace violence and bullying means that further research is recommended. This to determine which strategies support nursing students and new graduate nurses in clinical practice and to explore the effect of these programmes on experiences of workplace violence and bullying.
Relevance to Clinical Practice
Evidence indicates that there is a worldwide gap in how universities and colleges prepare nursing students for transitioning from the education system to clinical practice. New graduate nurses and nurse managers regularly report that their education did not fully provide them with the skills required for their transition to clinical practice. Transition programmes support new graduate nurses to deal with workplace violence and bullying and need to have structured implementation. Ongoing evaluation is required to ensure that the programmes meet the needs of nursing students and new graduate nurses and health organisations, improve new graduate nurses' transition to clinical practice safely, enhance their resilience to overcome issues in the workplace (such as violence, bullying and stress) and reduce their turnover.
Aims
To determine the barriers and enablers to regular, women‐oriented screening programmes for women with cerebral palsy (CP); and to discuss the participants’ suggestions for change.
Design
...Qualitative life course approach.
Methods
Twenty‐five life course interviews were conducted with women in 2020 who identified as having a diagnosis of CP. Interviews were conducted in person or using electronic platforms. Framework analysis was used to interpret the data.
Findings
Access and utilization of regular screening programmes for women with CP across the life course are determined by multiple socioecological factors. Three themes are discussed focusing particularly on cervical and breast screening: 1. barriers, 2. enablers and 3. women's suggestions for change. Some women chose to opt out of sexual health checks for fear they would be too uncomfortable or the procedure would be too difficult. Practitioner attitudes towards disability in general, as well as the extent to which they understood the effects of CP for women, was highlighted as a barrier. Accessibility and adaptability of the environment also influenced women's uptake of screening.
Conclusion
Women with CP face many challenges to their sexual and reproductive healthcare. These can deter them from participating in regular women‐oriented screening programmes, which puts them at higher risk of preventable diseases. Understanding the lifelong effects of CP for women, and the interaction with their reproductive health could help to reduce unmet needs and increase participation in relevant screening across the life course.
Impact
Knowledge of the challenges to regular screening programmes experienced by women with CP across the life course is crucial to provide appropriate preventative healthcare for women with CP across different stages of life. Elements of this knowledge could have benefits for the care of all disabled women.
When the world went into lockdown in early 2020 in response to the COVID‐19 pandemic, the pervasive message from governments and authorities was to stay safe at home. The problem is, however, that ...home for many people is far from a safe haven (Bradbury‐Jones & Isham, 2020). While it may well have provided a protective factor against the virus, home was a dangerous place for many people (especially women). Being shut‐off from family, friends, social circles and work colleagues played directly into the hands of perpetrators. Lockdown created a fertile breeding ground for coercion, control and isolation tactics. Calls to domestic abuse helplines rose exponentially at that time and there has been a plethora of literature and research reports that have captured the impacts on IPV as a result of restrictive, COVID‐related measures. We know then, that the pandemic and different phases of lockdown have had a direct, negative impact on IPV because of victims being literally trapped with their perpetrator, with limited avenues for accessing help and support. Early in the pandemic when the risks associated with lockdown on IPV were beginning to be reported, Bradbury‐Jones and Isham (2020) referred to the ‘protection paradox’, whereby measures to control the virus had the unintended consequence of increasing the control of many perpetrators. Since then, we have come to understand far more about the problem and yet more paradoxes have unfolded. We take the case of stalking and explore technology abuse, paper abuse and the ‘old normal’.
Aims
To explore the palliative care experiences of forced migrant children, families, and healthcare professionals (HCPs) highlighting successes, challenges, and associated practice implications.
...Design
Systematic literature review.
Data Sources
The following search engines were searched from 2008 ‐ 2018: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, Embase, ProQuest, Scopus, Psycinfo, and Web of Science. Extensive reference and citation checking were also conducted.
Review Methods
Systematic review followed PRISMA guidelines with prepared PROSPERO registered protocol #CRD42019129200. English language qualitative, quantitative, or mixed methods studies were eligible for inclusion. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT).
Results
Eighteen studies (reported in 20 articles) met the final inclusion criteria. Most focused on challenges to care provision. Thematic analysis following methods proposed by Braun and Clarke was undertaken. Five themes were identified: (a) divergence of beliefs and expectations; (b) communication; (c) navigating healthcare systems; (d) burdens and coping strategies; and (e) training and knowledge. A compassionate, collaborative approach with mutual respect crossed themes and was linked to high‐quality care.
Conclusion
Forced migrant families have multiple needs including physical and emotional support and help in navigating complex systems. Professional interpreters can ease communication barriers when resourced appropriately. Individualized care is crucial to addressing the intricate mosaic of culture such families present. A cultural sensitivity/insensitivity framework is presented that may help guide future interactions and priorities for those working in children's palliative care.
Impact
This systematic review explored the international experiences of palliative care for forced migrant families. The findings highlight the plight of families who experience multiple traumas and increased levels of grief and loss through their migration experiences and when caring for a child with a life‐limiting condition. This research has potential to have an impact on professionals working with culturally diverse families in all palliative care settings.
摘要
目标
探讨被迫移民儿童、家庭和医疗专业人员(HCP)的姑息治疗经验,强调成功、挑战和相关实践意义。
设计
系统文献回顾。
数据来源
搜索2008年至2018年以下搜索引擎中的内容:英国联合补充医学数据库、CINAHL护理学全文权威数据库、联机医学文献分析和检索系统(MEDLINE),荷兰医学文摘数据库(Embase)、ProQuest学位论文文摘索引数据库、Scopus电子数据库、心理学文摘(PsycINFO)和科学网。此外,还进行了广泛的参考文献和引文检查。
评审方法
系统回顾遵循PRISMA指南,编制PROSPERO注册协议编号是CRD42019129200。入选标准为英语类的定性、定量或混合方法研究。采用混合方法评价工具(MMAT)评价研究的质量。
结果
18篇研究(报告的有20篇)符合最终入选标准。最关注的是护理法规方面的挑战。采用布劳恩和克拉克提出的方法进行专题分析。确定了五大主题:(a) 信念和期望的分歧;(b)沟通;(c)医疗体系导航;(d)负担和应对策略;以及(e)培训和知识。依托跨主题的相互尊重的富有同情心的协作方式,与高质量的护理相联系。
结论
被迫移民家庭有多种需求,包括身体和精神上的支持,以及对于复杂体系导航的帮助。如果资源充足,专业口译员可以缓解沟通上存在的障碍。个性化护理对于解决这些家庭所呈现的复杂多元文化至关重要。提出一个文化敏感性/不敏感性的框架,可能有助于对从事儿童姑息治疗人员在其今后互动和工作要务方面给予指导。
影响
本系统回顾探讨了国际上对被迫移民家庭进行姑息治疗的经验。研究发现强调那些经历了多重创伤的家庭困境,在他们移民的经历中,以及在照顾重症患者儿童时,他们的悲伤和失落程度有所增加。该研究有可能对在所有姑息治疗环境中与多样文化家庭合作的专业人士产生影响。
This special issue has highlighted the many different approaches and methods for doing a literature review. These have included the established methods for undertaking a systematic review with ...meta-analysis as developed by the Cochrane Collaboration (Higgins et al., 2019) to more recent innovations involving the synthesis of both qualitative and quantitative data, alongside scoping reviews which map out the scope of existing research, telling us what is known about a particular topic. We argue that no review method is better than another; what is important is that the method used is appropriate to the focus of the review and is comprehensively undertaken. For example, a scoping review is used when we want to scope or map out the existing literature and to identify research gaps. It does not undertake an in-depth synthesis of the literature and is therefore unlikely to be the method of choice for those reviewing the literature to justify an empirical project. Where a deeper level of synthesis is required and where the nuances of the research really matter in order to justify a potential research question, a method of reviewing the literature which requires synthesis and analysis is required.
PDF
