Therapeutic relationships within child and adolescent mental health inpatient services: A qualitative exploration of the experiences of young people, family members and nursing staff

Child and adolescent mental health services (CAMHS), especially inpatient units, have arguably never been more in demand and yet more in need of reform. Progress in psychotherapy and more broadly in mental health care is strongly predicted by the therapeutic relationship between professional and service user. This link is particularly pertinent in child and adolescent mental health inpatient services where relationships are especially complex and difficult to develop and maintain. This article describes a qualitative exploration of the lived experienced of 24 participants (8 young people, 8 family members/carers and 8 nursing staff) within inpatient CAMHS across four sites in the UK. We interviewed participants individually and analysed the transcripts using thematic analysis within a critical realist framework. We synthesised data across groups and present six themes, encapsulating the intricacies and impact of therapeutic relationships; their development and maintenance: Therapeutic relationships are the treatment, Cultivating connection, Knowledge is power, Being human, The dance, and It’s tough for all of us in here. We hope these findings can be used to improve quality of care by providing a blueprint for policy, training, systemic structures and staff support.

Practice variations in antibiotic administration for the management of peritonitis in patients on automated peritoneal dialysis in Australia and New Zealand

In the absence of guidelines on the management of peritoneal dialysis (PD)-associated peritonitis in patients on automated peritoneal dialysis (APD), variations in clinical practice potentially exist between PD units that could affect clinical outcomes. This study aimed to document the current practices of treating PD-associated peritonitis in patients on APD across Australia and New Zealand and the reasons for practice variations using a cross-sectional online survey. Of the 62 PD units, 34 medical leads (55%) responded to the survey. When treating APD-associated peritonitis, 21 units (62%) continued patients on APD and administered intraperitoneal (IP) antibiotics in manual daytime exchanges; of these, 17 (81%) considered allowing at least 6 h dwell time for adequate absorption of the IP antibiotics as an important reason for adding manual daytime exchange. Nine units (26%) temporarily switched patients from APD to continuous ambulatory peritoneal dialysis (CAPD); of these, five (55%) reported a lack of pharmacokinetic (PK) data for IP antibiotics in APD, four (44%) reported a shortage of APD-trained nursing staff to perform APD exchanges during hospitalisation and three (33%) reported inadequate time for absorption of IP antibiotics on APD as important reasons for their practice. Four units (12%) continued patients on APD and administered IP antibiotics during APD exchanges; of these, three (75%) believed that PK data available in CAPD could be extrapolated to APD. This study demonstrates wide variations in the management of APD-associated peritonitis in Australia and New Zealand; it points towards the lack of PK on antibiotics used to treat peritonitis as an important reason underpinning practice variations.

“Just because people are old, just because they're ill…” dignity matters in district nursing

Purpose This paper aims to explore the concept and practice, of dignity as understood and experienced by older adults and district nursing staff. The paper adds a new, nuanced, understanding of safeguarding possibilities in the context of district nursing care delivered in the home. Design/methodology/approach The research used an ethnographic methodology involving observations of care between community district nursing clinicians and patients (n = 62) and semi-structured interviews with nursing staff (n = 11) and older adult recipients of district nursing care (n = 11) in England. Findings Abuse is less likely to occur when clinicians are maintaining the dignity of their patients. The themes of time and space are used to demonstrate some fundamental ways in which dignity manifests. The absence of dignity offers opportunities for abuse and neglect to thrive; therefore, both time and space are essential safeguarding considerations. Dignity is influenced by time and how it is experienced temporally, but nurses are not allocated time to “do dignity”, an arguably essential component of the caregiving role, yet one that can become marginalised. The home-clinic exists as a clinical space requiring careful management to ensure it is also an environment of dignity that can safeguard older adults. Practical implications District nurses have both a proactive and reactive role in ensuring their patients remain safeguarded. By ensuring care is delivered with dignity and taking appropriate action if they suspect abuse or neglect, district nurses can safeguard their patients. Originality/value This paper begins to address an omission in existing empirical research regarding the role of district nursing teams in delivering dignified care and how this can safeguard older adults.

To see, meet and adapt – an interview study about physiotherapists’ pedagogical approach to dementia

Background Physiotherapists need to use pedagogical approaches and strategies in their work. However, there is no previous definition of what a pedagogical approach in physiotherapy means neither in general nor specifically to dementia. The purpose of this study was therefore to gain greater insight into physiotherapists’ pedagogical approach to dementia by investigating physiotherapists’ views and working methods in contact with older people with dementia, relatives, and nursing staff in elderly care. Methods This was a qualitative study with an inductive approach. Semi-structured individual interviews were conducted with 15 physiotherapists with experience of working with older people with dementia in elderly care. The interviews were analyzed with qualitative content analysis. Results The term “pedagogical approach” could sometimes be experienced as “vague” or “hard to grasp”. Our research nonetheless identified one overarching theme To see, meet and adapt which is based on insights from the interviews grouped in to five categories. This theme can be seen as an expression of the physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff. It captures the participants’ desire to always see the person in front of them, meet them where they are and adapt their own way of working accordingly. Creating a trusting relationship was described as important and made it easier for the participants to adapt their working methods. The participants’ adaptations could apply to the way they communicated with people with dementia, and how they organized tutoring/education of relatives and nursing staff to maximize learning. Learning through experience and reflection was described as a key to advancing the pedagogical approach and the participants experienced their own learning as constantly ongoing. Conclusions This study provides increased understanding into physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff in elderly care and shows that learning through experience and reflection can contribute to the development of the pedagogical approach. Thus, opportunity for reflection should be accommodated in the physiotherapists’ work. The importance of more pedagogical education for physiotherapists both in bachelor and master level were also highlighted. Increasing mobility and physical activity in older people with dementia is important since physical inactivity and sedentary behavior is common. Future research may be directed at further exploring physiotherapists’ pedagogical approach in tutoring/education of nursing staff, with the aim of increasing physical activity among older people with dementia.

Converting threats from COVID-19 in long term care into opportunities for improvement

The effects of the COVID-19 pandemic on long term care (LTC) have been published in the literature and experienced by residents, their support persons and nursing staff. The morbidity and mortality, as well as the threats of isolation and psychosocial distress continue. Both LTC residents and staff experience physiological and psychological impacts. Nurses can use the current threats produced by the pandemic to advocate for alternate models of care and reduced isolation for residents. The pandemic is an opportunity for nursing advocacy in LTC for shared governance and empowerment, involvement in policy development, and oversight in policy implementation. Nurses are presented with the opportunities for advocacy related to resources and reshaping the paradigm of residential care for older adults.

influences of job satisfaction and organizational commitment on turnover intention

This study aimed to find out partially and simultaneously the influences of job satisfaction and organizational commitment on turnover intention of nursing staff at Bunda General Hospital Palembang. This study used qualitative data through questionnaire statements quantified using a Likert scale of 1-5 points to measure the attitudes, opinions, and perceptions. The total population was 144 people of which 20 of them were used in the survey before starting this study. Therefore, the number of samples was 124 people using the population sampling technique. The data were collected by using a questionnaire that had been tested for its validity and reliability with the result that it was reliable and usable. Multiple Regression Analysis Technique was used to analyze the collected data. The results of the study showed that partially the job satisfaction and organizational commitment had a significant influence on turnover intention; and simultaneously, had a negative and significant effect on turnover intention. The findings are expected to be used to improve the performance of nursing staff by providing authority according to task performance, recognition as appreciation for success in completing work well, and increasing organizational commitment to reduce the intention to quit or leave the company.

Nursing Care of Low-Risk Newborns in Low Resource Setting: Nurses' Aides May Bridge the Gap at Community Hospitals

Objective: To study the role of a nurses' aide in the care for newborns weighing between 1500 and 2000 g at birth in a low resource setting. Study Design: Observational. Setting: The General hospital in 1994-95, in a public sector, located in a remote area in India Intervention: A female ward assistant with seven years of schooling trained, on-the-job, to keep babies warm, initiate maternal breastfeeding, and to detect rapid breathing. The nursing staff from the pediatric ward supervised her performance. A separate "warm room" appropriately heated for preterm and sick babies became a makeshift nursery. The nursing staff administered enteral feeding, oxygen, and antibiotics. Services of the resident doctors or general duty medical officers were not available. Results: The survival rate was nearly 100% for babies with birthweights between 1,500 and 2,000 g (none referred out). Conclusions: A nurses' aide may facilitate the delivery of special care for newborns where nursing personnel are grossly inadequate and saving babies weighing between 1,500 and 2,000 g may need minimal inputs. It may be worthwhile to target 1,500 and 2,000 g birthweight categories even when resources are meager. What is already known about this subject? Low resource settings face staff shortages, especially nursing staff. Health workers with midwifery skills can deliver nearly 90% of essential care services for maternal and neonatal health. A substantial proportion of neonatal deaths occur among moderately low birth weight babies. What does this study add? It is possible to train a semi-literate person to facilitate early breastfeeding and to keep a baby warm. A large proportion of deaths among babies with birthweight ranging from 1500 to 2000 g are preventable with meager resources. How might this impact on clinical practice or future developments? The facilities facing shortage of nursing staff in low resource settings, may employ nurses’ aide to deliver basic newborn care.

EL ROL DEL PERSONAL DE ENFERMERÍA EN LA PROMOCIÓN DEL BIENESTAR BIOPSICOSOCIAL DURANTE LA EXPERIENCIA DE HOSPITALIZACIÓN PEDIÁTRICA.

La estancia en el hospital de niños y niñas es desafortunadamente común y está asociada a regresión en los comportamientos, agresión, falta de cooperación, retraimiento, dificultad para recuperarse, llanto excesivo, y disminución de la comunicación y/o actividad, por lo que el proceso atención enfermero necesita no solo una perspectiva biológica, sino también incluir a las esferas psicológicas y sociales. El rol del personal de enfermería, al ser los principales referentes de cuidado dentro del contexto sanitario, resulta esencial pues son percibidos como la mayor fuente de apoyo e información de los padres, madres y pacientes. En el documento se proporcionan algunas pautas, dirigidas al personal de salud, para aumentar el bienestar integral a través de acciones concretas y de fácil ejecución. Palabras clave: hospitalización, personal de enfermería, humanización de la atención. ABSTRACT The hospital stay of children is unfortunately common and is associated with regression in behaviors, aggression, lack of cooperation, withdrawal, difficulty in recovering, excessive crying, and decreased communication and / or activity, so The nursing care process needs not only a biological perspective, but also includes the psychological and social spheres. The role of the nursing staff, being the main care references within the healthcare context, is essential since they are perceived as the greatest source of support and information from parents and patients. The document provides some guidelines, aimed at health personnel, to increase comprehensive well-being through concrete and easy-to-implement actions. Keywords: hospitalization, nursing staff, humanization of care.

Experiences of nursing professionals involved in the care of COVID-19 patients

The outbreak of SARS-COV-2 has become an opportunity for nursing professionals of North Eastern states of India to experience handling patients during pandemics with limited resources. To explore the experiences of nursing staff in the care of COVID-19 patients. Descriptive phenomenological design was adopted to describe the experiences of nursing professionals involved in the care of COVID-19 patients in selected hospitals/COVID centers of Assam, India. The experiences of nurses caring for COVID-19 patients were summarized into 4 themes and various sub-themes. The themes include: Perspectives about COVID-19 duty, Experience on PPE kit, Conflicts & disagreements and Swab test & the final stage of isolation. Nurses reported changing patterns of nursing care, anxiety regarding COVID-19 duty, professional growth amidst risks and pressure. The nurses had to work under certain conflicts and disagreements in relation to patient care, their personal and career related decisions and interprofessional role distribution. At the final stage of isolation, most nurses were prepared to handle the situation even if they test COVID-19 positive. During this COVID-19 outbreak, positive and negative emotions of the front-line nurses interweaved and coexisted. The experience was new and challenging, the nurses had contributed in the management of COVID-19.