Aim
To analyze personal and organizational strategies described in the literature for dealing with the second victim phenomenon among healthcare providers.
Background
The second victim phenomenon ...involves many associated signs and symptoms, which can be physical, psychological, emotional, or behavioral. Personal and organizational strategies have been developed to deal with this phenomenon.
Materials and methods
A systematic review was carried out in PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO, Science Direct, and Cumulative Index to Nursing and Allied Health Literature databases, searching for evidence published between 2010 and 2019 in Spanish, English, German, and Portuguese.
Results
Seven hundred and eighty‐three articles were identified. After eliminating duplicates, applying inclusion and exclusion criteria and critical analysis tools of the Joanna Briggs Institute, 16 research articles were included: 10 quantitative studies (design: descriptive, correlational, systematic, or integrative review) and six qualitative studies (descriptive, systematic review). There are several different personal and organizational strategies for dealing with the second victim phenomenon. Among these, peer support and learning from adverse events are highly valued. In personal strategies stands out the internal analysis of the adverse event that the professional performs to deal with the generated negative feelings. In organizational strategies, the most valued are second victim support programs with rapid response teams and made up of peers.
Conclusions
The main organizational coping strategies for tackling this phenomenon are online programs in countries such as the United States, Spain, and other European countries. Formal evaluation of these programs and research is required in Latin America.
Implications for nursing and health policies
Adequately coping with the second victim phenomenon allows health professionals and organizations to learn from adverse events. Furthermore, by supporting health professionals who suffer from the second victim phenomenon, the organization takes care of its most valuable resource, its human capital. This contributes toward building a culture of healthcare quality in organizations, which will reduce adverse events in the future.
Aims and objectives
To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units.
Background
In mental health units, the therapeutic relationship is ...especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care.
Design
Action and observation stages of a participatory action research project.
Methods
Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used.
Results
The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice.
Conclusions
This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse–patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice.
Relevance to clinical practice
These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day‐to‐day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.
Health professionals can be 'second victims' of adverse patient events. Second victimhood involves a series of physical and psychological signs and symptoms of varying severity and is most prevalent ...among nurses and women and in intensive care units (ICUs). Previous research has described personal and organizational coping strategies.
The objective of this research is to determine the prevalence of second victimhood, focusing on psychological distress, among Chilean adult intensive care nurses and its relationship with the support provided by their organizations.
A descriptive, correlational and cross-sectional study was conducted in seven intensive care units of Chilean hospitals.
Of a sample of 326 nurses, 90.18% reported having been involved in an adverse event and 67% reported psychological distress resulting from the adverse event. Embarrassment was the most prevalent psychological symptom (69%). Only 2.8% reported that their organization had an action plan for professionals in the event of a serious adverse event. Participants who had spent longer working in an ICU reported more support from their organization around adverse events.
Two-thirds of Chilean adult intensive care unit nurses report psychological stress following an adverse event. These results should be assessed internationally because second victims have major implications for the well-being of health professionals and, therefore, for retention and the quality of care.
Critical care leaders must actively promote a safe environment for learning from adverse events, and hospitals must establish a culture of quality that includes support programmes for second victims.
Aims
To develop and psychometrically test a Theory of Planned Behaviour (TPB) questionnaire to assess nurses’ intention to use physical restraints (PRs) in intubated patients.
Design
A psychometric ...instrument validation study conducted in three phases.
Methods
A theory‐driven questionnaire was developed. Eight experts validated the content of the preliminary 58‐item questionnaire. A pilot study was conducted including 101 critical care nurses to test the reliability of the items. Construct validity and reliability were tested in a cross‐sectional study of 12 units from eight hospitals in Spain (N = 354) from October ‐ December 2017. Participants completed the questions based on the TPB, and socio‐demographic and professional variables.
Results
The instrument comprised 48 items. All the direct and indirect constructs exhibited acceptable reliability. Confirmatory factor analysis indicated satisfactory fit indices for factorial structure according to the TPB. Nurses showed favourable attitudes, low perception of social pressure and modest perception of behaviour control. Perceived behavioural control and attitude were moderately positively correlated with the intention to use restraints, whereas subjective norm revealed the lowest correlation. Overall, the model explained 33% of the variance in intention.
Conclusions
The Physical Restraint TPB questionnaire is a 48‐item self‐reporting theoretically based instrument with acceptable reliability and construct validity to identify nurses’ intentions to use PRs in intubated patients.
Impact
Unravelling the key determinants of nurses’ intentions to use PRs should be examined to tailor quality improvement projects aimed at de‐implementing restraints use in practice and to promote safer care.
Aims and Objectives
To explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse–patient ...therapeutic relationship.
Design
Participatory Action Research.
Methods
Ninety‐six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used.
Results
The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change.
Conclusions
This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar.
Relevance to Clinical Practice
The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units.
No Patient or Public Contribution
Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice.
Aims and objectives
To produce changes in the therapeutic relationship between clinical practice nurses and patients in psychiatric units by implementing evidence‐based practices through ...participatory action research.
Background
The therapeutic relationship is the cornerstone of nursing care in psychiatric units. The literature suggests that theoretical knowledge alone is insufficient to establish the therapeutic relationship in practice. Therefore, strategies are needed to adequately establish the therapeutic relationship in psychiatric units.
Design
Participatory action research.
Methods
Participants consisted of nurses from two psychiatric units of a university hospital. Data were collected through focus groups and reflective diaries, which were analysed using the content analysis method. The COREQ guidelines were followed to ensure rigour.
Results
Nurses conceptualised the therapeutic relationship in their practice, identifying facilitating elements and limitations. They were able to compare their clinical practice with the recommendations of scientific evidence and constructed three evidence‐based proposals to improve the therapeutic relationship: (a) a customised nurse intervention space, (b) knowledge updating and (c) reflective groups, which they subsequently implemented and evaluated.
Conclusions
This study shows that nurses in psychiatric units can generate changes and improvements in the therapeutic relationship. The process of implementing evidence‐based practice enhanced participants’ awareness of their clinical practice and allowed them to make changes and improvements.
Relevance to clinical practice
The process confirmed that the implementation of evidence‐based practice through participatory methods, such as participatory action research, is valid and produces lasting changes. This study also reveals the need to rethink nurses’ functions and competencies in current psychiatric units.
Background
Intensive care unit (ICU) patients can experience emotional distress and post‐traumatic stress disorder when they leave the ICU, also referred to as post‐intensive care syndrome. A deeper ...understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient‐centred care and, ultimately, contribute to a positive experience.
Aim
To describe the patients' experience while transitioning from the ICU to a general ward.
Design
A descriptive qualitative study.
Method
Data were gathered through in‐depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.
Findings
Forty‐eight interviews were conducted. Impact on emotional well‐being emerged as a main theme, comprising four categories with six subcategories.
Conclusion
Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well‐being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward.
Relevance to clinical practice
It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow‐up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge.
The concept of leadership has been studied in various disciplines and from different theoretical approaches. It is a dynamic concept that evolves over time. There are few studies in our field on ...managers' self-perception of their leadership style. There are no pure styles, but one or another style is generally favoured to a greater or lesser degree. In the primary health care (PHC) setting, managers' leadership style is defined as a set of attitudes, behaviours, beliefs and values. The objectives of this study were to describe and learn about the self-perception of behaviours and leadership styles among PHC managers; to determine the influence of the leadership style on job satisfaction, efficiency, and willingness to work in a team; and to determine the relationship between transformational and transactional styles according age, gender, profession, type of manager years of management experience, and the type of organization.
To describe leadership styles as perceived by PHC managers, a cross sectional study was performed using an 82 items-self-administered Multifactor Leadership Questionnaire (MLQ). This questionnaire measures leadership styles, attitudes and behaviour of managers. The items are grouped into three first order variables (transformational, transactional and laissez-faire) and ten second order variables (which discriminate leader behaviours). Additionally, the questionnaire evaluates organizational consequences such as extra-effort, efficiency and satisfaction.
One hundred forty responses from 258 managers of 133 PHC teams in the Barcelona Health Area (response rate: 54.26 %). Most participants were nurses (61.4 %), average age was 49 years and the gender predominantly female (75 %). Globally, managers assessed themselves as equally transactional and transformational leaders (average: 3.30 points). Grouped by profession, nurses (28.57 % of participants) showed a higher transactional leadership style, over transformational leadership style, compared to physicians (3.38 points, p < 0.003). Considering gender, men obtained the lowest results in transactional style (p < 0.015). Both transactional and transformational styles correlate with efficiency and job satisfaction (r = 0.724 and r = 0.710, respectively).
PHC managers' self-perception of their leadership style was transactional, focused on the maintenance of the status quo, although there was a trend in some scores towards the transformational style, mainly among nurse managers. Both styles correlate with satisfaction and willingness to strive to work better.
Objective
To identify and classify the barriers and facilitators of the individualisation process of the standardised care plan in hospitalisation wards.
Background
The administration of ...individualised care is one of the features of the nursing process. Care plans are the structured record of the diagnosis, planning and evaluation stages of the nursing process. Although the creation of standardised care plan has made recording easier, it is still necessary to record the individualisation of the care. It is important to study the elements that influence the individualisation process from the nurses' perspective.
Design
Qualitative study with the grounded theory approach developed by Strauss and Corbin.
Methods
Thirty‐nine nurses from three hospitals participated by way of theoretical sampling. In‐depth interviews were conducted, as well as participant observation, document analysis and focus group discussion. The analysis consisted of open, axial and selective coding until data saturation was reached. EQUATOR guidelines for qualitative research (COREQ) were applied.
Results
For both barriers and facilitators, three thematic categories emerged related to organisational, professional and individual aspects. The identified barriers included routines acquired in the wards, the tradition of narrative records, lack of knowledge and limited interest in individualisation. The identified facilitators included holding clinical care sessions, use of standardised care plan and an interface terminology, the nurse's expertise and willingness to individualise.
Conclusion
The individualisation process of the standardised care plan involves multiple barriers and facilitators, which influence its degree of accuracy.
Relevance to clinical practice
Implementing strategies at an organisational level, professional level and individual level to improve the way the process is carried out would encourage individualising the standardised care plan in a manner that is consistent with the needs of the patient and family; it would improve the quality of care and patient satisfaction.
Aim
To understand the individualization process of the standardized care plan (SCP) that nurses design for hospitalized patients.
Background
To apply the nursing process, it is advisable to use SCP ...to standardize the diagnosis, planning and evaluation stages. However, the fundamental element of this methodology is the individualization of the care plan.
Design
A qualitative study, framed within the constructivist paradigm and applying the Grounded Theory method, in accordance with Strauss and Corbin's approach.
Methods
Multicentre study. Theoretical sampling with maximum variation will be used. The data collection will consist of: in‐depth individual interviews, participant observation, document analysis, focus group, and the questionnaires for Critical Thinking Assessment in relation to clinical practice and Nursing Competency Assessment for hospital nurses. The qualitative data will be analysed according to the constant comparative method of Strauss and Corbin's Grounded Theory, which involves performing open, axial and selective coding. The questionnaire results will be used to make a qualitative analysis that will consist of a triangulation between the level of critical thinking, level of expertise and record of the individualization process performed by the nurses. This protocol was approved in July 2015.
Discussion
By knowing the possible stages used in the individualization of a SCP, together with the elements that facilitate or hinder said individualization and nurses’ attitudes and experiences regarding this phenomenon, it could help direct improvement strategies in the standardization and individualization process. In addition to recommendations for teaching and research.
目的
了解护理人员为住院患者设计的标准化护理计划(SCP)的个体化程序。
背景
为了适应护理过程,建议使用标准化护理计划来规范诊断、规划和评价阶段。然而,本方法的基本要素是护理计划的个体化。
设计
根据施特劳斯和科尔宾方法,在建构主义范式框架下,应用扎根理论方法进行定性研究。
方法
多中心研究。将采用最大变化的理论抽样。资料收集将包括:深度个人访谈、参与观察、文献分析、焦点小组以及针对临床实践的批判性思维评估问卷调查和医院护士的护理能力评估。定性数据将根据施特劳斯和科尔宾扎根理论的常量比较法,进行分析,其中包括执行开放、轴向和选择性的编码。问卷调查结果将用来进行定性分析,其中包括评判性思维水平、专业知识水平与护士负责的个体化程序记录之间的三角测量。本方案于2015年7月获得批准。
讨论
通过了解标准化护理计划之个体化的潜在阶段,以及促进或阻碍个体化的因素和护士对这种现象的态度和经验,除了可为教学和研究提供建议,还有助于对标准化和个性化过程中的改进策略提供指导。
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