Dr Dan Butcher

Aim

Professional Doctorate Programmes (PDP) in nursing continue to develop across many countries. However, there is a lack of evidence demonstrating the impact on nurses who graduate from these programmes and the outcomes they deliver. This exploratory study aims to identify graduate outcome domains that can be applied internationally to evaluate professional doctorate programmes in nursing.

Design and Methods

Underpinned by Kim's theory of knowledge development in nursing, this innovative exploratory study was carried out in three phases: (1) a scoping review of literature published between 1 January 2000 and 1 July 2023, guided by the methodology developed by Arksey and O'Malley; (2) a document analysis of the graduate outcomes of three different universities' Professional Doctorate Programmes in Nursing and (3) a thematic analysis and coalescence of the findings from the initial two study phases.

Results

A scoping review revealed three patterns in the literature related to graduate outcomes: personal transformation, critical self-awareness and bridging the theory–practice divide. An analysis of three universities' Professional Doctorate Programmes revealed insights into documented graduate outcomes. The third and final research phase identified five graduate outcome domains: Personal achievement, critical self-awareness and professional identity, professional citizenship, discipline, research and information literacy and community-based academic practice.

Conclusions

The impact of Professional Doctorate Programmes in nursing has traditionally lacked consensus and clarity. However, this research has led to the identification of graduate outcome domains that offer valuable insights for establishing new professional doctoral programmes and conducting meaningful evaluations of the outcomes of existing PDP and their graduates globally.

Impact

This exploratory study establishes five graduate outcome domains for evaluating the effectiveness of PDP in nursing internationally. These domains offer valuable benchmarks for the development and assessment of such nursing programmes globally.

Introduction

High-quality pre-registration student nurse training and development is integral to developing a sustainable and competent global nursing workforce. Internationally, student nurse recruitment rates have increased since the onset of the COVID-19 pandemic; however, attrition rates for student nurses are high. During the pandemic, many student nurses considered leaving the programme due to academic concerns, feeling overwhelmed, and doubting their clinical skills. Little was known about the extent to which nursing education prior to COVID-19 had prepared students for their role in managing the healthcare crisis or the impact on their resilience. Thus, this study aimed to explore how the COVID-19 pandemic impacted on the resilience levels of student nurses across the United Kingdom.

Methods

Data were collected as part of a multi-site qualitative study named ‘COV-ED Nurse’ and involved pre-placement surveys, placement diaries, and post-placement interviews with nursing students. Student nurse participants were recruited from across the United Kingdom, from all years of study, and from all four nursing branches: children, adult, mental health, and learning disabilities. Participants were asked to complete a pre-placement survey that collected demographic details and information about their placement expectations. They were also asked to record a weekly audio-visual or written diary to describe their placement experiences, and, on completion of their placements, students were interviewed to explore their experiences of this time. Data were thematically analysed using the Framework Approach. Ethical approvals were obtained.

Results

Two hundred and sixteen students took part in the wider study. The current study involved a subset of 59 students’ data. Four main themes were identified: ‘coping with increased levels of acuity’, ‘perceived risks of the pandemic’, ‘resilience when facing uncertainty and isolation’, and ‘the importance of coping mechanisms and support structures.’

Discussion

From this study, we have generated insights that can be applied to nursing research, education, policy, and practice and identified the wide-ranging impact that the COVID-19 pandemic had on student nurses and their abilities to remain resilient in an unstable environment. The value of communication and support networks from a wide range of sources was highlighted as key to navigating many uncertainties. In addition, the extent to which students were able to navigate their personal and professional roles and identities influenced their ability to cope with and continue along their training pathways.

Background: Global workforce challenges faced by health care providers are linked to low levels of job satisfaction, recruitment, retention, and well-being, with detrimental impacts on patient care outcomes. Resilience-building programs can provide support for staff who endure highly stressful environments, enhance resilience, and support recruitment and retention, with web-based formats being key to increasing accessibility.

Objective: We aimed to examine participants’ engagement with a newly developed Resilience Enhancement Online Training for Nurses (REsOluTioN), explore its acceptability, and compare levels of resilience and psychological well-being in nurses who completed REsOluTioN with those who did not.

Methods: We carried out a pilot randomized trial (1:1), conducted at a single site (mental health and community trust in South England) between August 2021 and May 2022. Local research ethics approvals were obtained. Nurses were invited to participate and were randomly assigned to a waitlist group or REsOluTioN group. Training lasted for 4 weeks, consisting of prereading, web-based facilitated sessions, and mentorship support. We evaluated trial engagement, acceptability of training, and pre-post changes in resilience, measured by the Brief Resilience Scale, and psychological well-being, measured by the Warwick Edinburgh Mental Wellbeing Scale. Qualitative participant feedback was collected. Consolidated Standards of Reporting Trials 2010 extension guidelines for reporting pilot and feasibility trials were used.

Results: Of 108 participants recruited, 93 completed the study. Participants’ mean age was 44 (SD 10.85) years. Most participants were female (n=95, 88.8%), White (n=95, 88.8%), and worked in community settings (n=91, 85.0%). Sixteen facilitated and 150 mentoring sessions took place. Most REsOluTioN program participants reported the sessions helped improve their resilience (n=24, 72.8%), self-confidence (n=24, 72.7%), ability to provide good patient care (n=25, 75.8%), relationships with colleagues (n=24, 72.7%), and communication skills (n=25, 75.8%). No statistically significant differences between training and control groups and time on well-being (F1,91=1.44, P=.23, partial η2=0.02) and resilience scores (F1,91=0.33, P=.57, partial η2=0.004) were revealed; however, there were positive trends toward improvement in both. Nurse participants engaged with the REsOluTioN program and found it acceptable. Most found web-based training and mentoring useful and enjoyed learning, reflection, networking, and participatory sessions.

Conclusions: The REsOluTioN program was acceptable, engaging, perceived as useful, and nurses were keen for it to be implemented to optimize resilience, psychological health, communication, and workplace environments. The study has evidenced that it is acceptable to implement web-based resilience programs with similar design features within busy health care settings, indicating a need for similar programs to be carefully evaluated. Mentorship support may also be a key in optimizing resilience. Trial limitations include small sample size and reduced statistical power; a multicenter randomized controlled trial could test effectiveness of the training on a larger scale.

Aim. 
To explore how nurses' use of electronic health records impacts on the quality of nurse–patient interactions and communication.

Design. 
An integrative review.

Data sources. 
MEDLINE®, CINAHL®, PscyINFO, PubMed, BNI and Cochrane Library databases were searched for papers published between January 2005 and April 2022.

Review methods. 
Following a comprehensive search, the studies were appraised using a tool appropriate to the study design. Data were extracted from the studies that met the inclusion criteria relating to sample characteristics, methods and the strength of evidence. Included empirical studies had to examine interactions or communication between a nurse and patient while electronic health records were being used in any healthcare setting. Findings were synthesized using a thematic approach.

Results. 
One thousand nine hundred and twenty articles were initially identified but only eight met the inclusion criteria of this review. Thematic analysis revealed four key themes, indicating that EHR: impedes on face-to-face communication, promotes task-orientated and formulaic communication and impacts on types of communication patterns.

Conclusion. 
Research examining nurse–patient interactions and communication when nurses' use electronic health records is limited but evidence suggests that closed nurse–patient communications, reflecting a task-driven approach, were predominantly used when nurses used electronic health records, although some nurses were able to overcome logistical barriers and communicate more openly. Nurses' use of electronic health records impacts on the flow, nature and quality of communication between a nurse and patient.

Impact. 
The move to electronic health records has taken place largely without consideration of the impact that this might have on nurse–patient interaction and communication. There is evidence of impact but also evidence of how this might be mitigated. Nurses must focus future research on examining the impact that these systems have, and to develop strategies and practice that continue to promote the importance of nurse–patient interactions and communication.

Patient or Public contribution. 
Studies examined within this review included patient participants that informed the analysis and interpretation of data.

Background

Heart Failure is a life-limiting condition with a poor and uniquely unpredictable prognosis. The aim of this review is to present and synthesise the current evidence around bereaved caregivers’ experiences of end of life care for people with Heart Failure.

Methods

A systematic review of the literature was conducted using four electronic databases (CINHAL, Medline, BND, PsycINFO). Data was analysed and presented using a narrative synthesis approach.

Results

Eight articles were included within this review. Themes included: Limited and inadequate communication around the condition (including prognosis, preparations for death and the aim of palliative care), the burden of caregiving, and the limited provision of services and formal support.

Conclusion

Bereaved caregivers experience unique and significant challenges when caring for someone dying from Heart Failure. However, further research is required to greater understand the experiences of bereaved caregivers of people with Heart Failure.

Background/Aims

Living with advanced heart failure places a considerable burden on patients and their caregivers. Improving the education and support given to patients and caregivers, with the input of palliative care services, could support them to live well with heart failure. This study evaluated an 8-week programme of education and support delivered in a day hospice for patients diagnosed with heart failure and their informal caregivers.

Methods

An 8-week programme was delivered five times between January 2018 and March 2019, with a total of 39 participants (24 patients and 15 caregivers). Two focus groups were conducted at the end of each programme (one with patients and one with caregivers). Groups were recorded and transcribed verbatim, and inductive thematic analysis was performed.

Results

Most patient participants were male (92%) and aged >70 years, while most caregiver participants were female (93%) and aged >50 years. The main themes from the patient participants' focus groups regarding the programme were the importance of knowledge; support and communication; having a gateway to resources; and the concept of living with heart failure. The main themes from the caregiver participant focus groups were becoming stronger; altered outcomes for the future; and connection through knowledge. All participants gave positive feedback about the programme, with increased knowledge about heart failure and access to peer support being highlighted as particularly valuable.

Conclusions

This hospice-based model of support and education, involving patients and their caregivers, has considerable potential as a means of helping these individuals to live well with heart failure. Greater integration between cardiac services and palliative care is needed to support this growing patient group.

The community respiratory nurse specialist (CRNS) supports patients at different stages of lung disease, witnessing the challenge of living with chronic obstructive pulmonary disease (COPD), a progressive illness for which there is no cure. Breathlessness is the most prominent and debilitating symptom experienced; it is frightening, distressing and very difficult to manage. Little is known about the experience of CRNSs in witnessing the distress of patients, specifically those experiencing breathlessness. The nurse may have cared for such patients over many months or years. In witnessing this distress, CRNSs engage in emotional labour, which is associated with burnout and poor-quality care. This paper seeks to identify bearing witness to suffering and vulnerability as components of emotional labour in the context of the CRNS role. It highlights the need for research to explore the experience of CRNSs and insights into supporting people with long-term breathlessness. It is more likely that wellsupported staff can provide sustained, supportive care to patients living with breathlessness.

Background. Heart Failure is highly prevalent with poor outcomes yet only a small proportion of patients receive specialist palliative care services.
Aim. To explore if a programme focussing on support and symptom management of people with heart failure in a hospice environment would be acceptable and of benefit to patients. Methods: A pre/post intervention study design using mixed methods was used to evaluate the programme. The programme was delivered in two-hour time slots over a period of 8 weeks. Participants completed 3 questionnaires pre and post and were interviewed within one week of completion. The study was conducted between June 2014 and January 2015.
Findings. A response rate of 51.7% gave a final sample size of 12 patients. The questionnaire results showed a positive impact on participants’ well-being and views regarding the use of a hospice, but a desire for greater focus on emotional support. Four key themes emerged from inductive qualitative analysis: demystifying perceptions about hospice; positivity about well-being; learning together and consideration of end of life preparation.
Conclusion. This adapted programme provides a useful model for the increased integration of palliative care into the provisions for those living with advancing heart failure.

While the numbers of male nursing staff are growing in both the UK and the USA, there remains a significant imbalance both in terms of the total number and the specialities in which male staff choose to work. Management, education and technology-dominated roles, characterised as ‘high-tech, low-touch’ specialities attract disproportionately larger numbers of male nursing staff.

Aim:

The aim of this narrative literature review was to explore and critically review the factors that influence the perception and use of touch by male nursing staff in contemporary healthcare settings.

Method:

A comprehensive review of the literature was undertaken using significant online databases focusing on evidence from peer-reviewed journals published in English.

Results:

Key influential factors arising from 11 selected studies included male nurses' definitions of touch; fear of touch misinterpretation; coping strategies employed; the assessment of certain groups of patients; gender-derived stressors; the emotional experiences of male staff; and the limited consideration of these issues in the pre-registration nursing curriculum.

Conclusion:

A range of factors regarding touch impact on the way male nurses use touch when caring for patients. A lack of research-based education in the preparation of male students leads to the development of various protective strategies. There is a need for the particular challenges facing male students and staff to be explicitly addressed within undergraduate and post-qualifying education and training programmes.