Critical care nursing role in low and lower middle-income settings: a scoping review

ObjectivesA scoping review was conducted to answer the question: How is critical care nursing (CCN) performed in low-income countries and lower middle-income countries (LICs/LMICs)?DesignScoping review guided by the JBI Manual for Evidence Synthesis.Data sourcesSix electronic databases and five web-based resources were systematically searched to identify relevant literature published between 2010 and April 2021.Review methodsThe search results received two-stage screening: (1) title and abstract (2) full-text screening. For sources of evidence to progress, agreement needed to be reached by two reviewers. Data were extracted and cross-checked. Data were analysed, sorted by themes and mapped to region and country.ResultsLiterature was reported across five georegions. Nurses with a range formal and informal training were identified as providing critical care. Availability of staff was frequently reported as a problem. No reports provided a comprehensive description of CCN in LICs/LMICs. However, a variety of nursing practices and non-clinical responsibilities were highlighted. Availability of equipment to fulfil the nursing role was widely discussed. Perceptions of inadequate resourcing were common. Undergraduate and postgraduate-level preparation was poorly described but frequently reported. The delivery of short format critical care courses was more fully described. There were reports of educational evaluation, especially regarding internationally supported initiatives.ConclusionsDespite commonalities, CCN is unique to regional and socioeconomic contexts. Nurses work within a complex team, yet the structure and skill levels of such teams will vary according to patient population, resources and treatments available. Therefore, a universal definition of the CCN role in LIC/LMIC health systems is likely unhelpful. Research to elucidate current assets, capacity and needs of nurses providing critical care in specific LIC/LMIC contexts is needed. Outputs from such research would be invaluable in supporting contextually appropriate capacity development programmes.

The plant and the management of the PICC/MIDLINE. The priority nursing role in the appropriate care

The interaction between the individual and the environment has a strategic significance for welfare purposes and shows the importance of the bilateral nature of the relationship. It highlights how promoting health means acting on the environment and on the individual. In terms of health education, for health workers it is no longer a question of intervening from the outside on behavior, but of inserting themselves into situations, in the processes of interaction, as active protagonists of a complex system. This orientation of the health system requires a reinterpretation of the role of operators, through the adoption of the participatory planning method, which requires interpreting one's work as a problem solving process. To get to the solution of the problems it is necessary to identify the elements of difficulty that the patient encounters, thus adopting methodologies that allow for an exchange relationship. Nurses, in all health systems, have a privileged position due to the capillarity of their action, inherent in the “to care” of nursing care, and of their contacts with citizens and clients. In particular towards the patient he teaches the correct assistance maneuvers and the most appropriate attitudes to be adopted to favor the change of behaviors and the achievement of awareness of a new state of health and a new degree of autonomy. The most suitable educational method that should be used by the nurse in the path of therapeutic education, is to link learning to action, in clinical practice, alongside the patient, promoting healthy lifestyles and the dissemination of a culture of health. Educational intervention aims at personalizing care and can improve health status and reduce healthcare costs. Alongside the ethical value and professional duty, it is necessary to use methodologies, techniques and methods to provide a structured set of specific information, with a simple and understandable language, speaking.

Patient needs and resource intensity weighting in the ambulatory care unit

Across British Columbia Cancer (BC Cancer), oncology nurses work as part of an interdisciplinary team in the outpatient ambulatory care unit (ACU) and support patients across the trajectory of their cancer journey. Previous initiatives, which focused on identifying patient needs and nursing role optimization work, have enhanced role clarity, enabling nurses to articulate their scope of practice and specialty competencies required to best meet the needs of patients and families. However, while the patient needs and fundamental practice elements have been identified to optimize the ACU nursing role, a gap still exists in quantifying the staffing resources required to operationalize the current model of care. To address this gap, a quality improvement project was initiated to develop an internally validated ACU Nursing Resource Intensity Weighting (RIW) tool for projecting baseline staffing requirements. The tool can be utilized to inform strategic and operational planning discussions focused on improving the outpatient model of care in oncology.

Interreligious Nursing: A conceptual framework

Religion, which is one of fundamental element that affects and changes culture. One of the most important functions of religions is to unite their members around a common belief. People who share the same belief look at the world from the same window and think that they see the same things through that window. It is stated that, thanks to religious belief, people are relieved significantly by means of emotional comfort and calmness, coping with death anxiety and seeking wisdom in their illnesses. In order for nurses to know how the individual's religious beliefs will affect their care; they are expected the relationship between religion, culture and health. Westbeerg proposed an innovative nursing role for faith communities in the mid-1980s, and interest in this area has grown exponentially over the past 25 years.In this review, it is proposed to develop the field by creating a conceptual framework for the field of "Interreligious Nursing", which is based on religion integrated care. Özet Din, kültürü etkileyen, değiştiren ona süreklilik kazandıran temel unsurlarından birisidir. Dinlerin en önemli işlevlerinden birisi mensuplarını ortak bir inanç etrafında birleştirmeleridir. Aynı inancı paylaşan insanlar dünyaya aynı pencereden bakar ve o pencereden aynı şeyleri gördüklerini düşünürler. Dini inanç sayesinde insanların duygusal bir rahatlık ve sakinlik yaşadıkları, ölüm kaygısıyla başaçıktıkları ve hatta geçirdikleri hastalıklarda bir hikmet olduğunu düşünerek rahatladıkları belirtilmektedir. Hemşirelerin, bireyin dini inançlarının bakım sürecini nasıl etkileyeceğini bilmek için; din, kültür ve sağlık ilişkisini bilmeleri beklenmektedir. Westbeerg'in 1980'lerin ortasında iman (inanç) toplulukları için yenilikçi bir hemşirelik rolü önermiş ve son 25 yılda bu alana ilgi katlanarak artmıştır. Bu derlemede dinin entegre adildiği bakımı esas alan “Dinlerarası hemşirelik” alanına yönelik kavramsal çatı oluşturularak, alanın geliştirilmesi önerilmektedir.

Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice

Background Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice. Methods A qualitative study was conducted in four wards (neurology, oncology, pneumatology and surgery) of a Dutch teaching hospital. Various ethnographic methods were used: shadowing nurses in daily practice (65h), observations and participation in relevant meetings (n=56), informal conversations (up to 15 h), 22 semi-structured interviews and member-checking with four focus groups (19 nurses in total). Data was analyzed using thematic analysis. Results Hospital nurses developed new role distinctions in a series of small-change experiments, based on action and appraisal. Our findings show that: (1) this developmental approach incorporated the nurses’ invisible work; (2) nurses’ roles evolved through the accumulation of small changes that included embedding the new routines in organizational structures; (3) the experimental approach supported the professionalization of nurses, enabling them to translate national legislation into hospital policies and supporting the nurses’ (bottom-up) evolution of practices. The new roles required the special knowledge and skills of Bachelor-trained nurses to support healthcare quality improvement and connect the patients’ needs to organizational capacity. Conclusions Conducting small-change experiments, anchored by action and appraisal rather than by design, clarified the distinctions between vocational and Bachelor-trained nurses. The process stimulated personal leadership and boosted the responsibility nurses feel for their own development and the nursing profession in general. This study indicates that experimental nursing role development provides opportunities for nursing professionalization and gives nurses, managers and policymakers the opportunity of a ‘two-way-window’ in nursing role development, aligning policy initiatives with daily nursing practices.