Dr Kathleen Greenway

Aim: This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth.

Background: Telehealth is a modality of care that has gained popularity due to digital technology development and the COVID-19 pandemic. It is recognised that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood.

Design: A systematic integrative review.

Data Sources: Databases include CINAHL, APA PsycInfo, Academic Search Complete, Pubmed, Web of Science, and Google Scholar.

Review Methods: This systematic integrative review method was informed by Whittemore and Knafl (2005).  The databases were searched with keywords initially in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesise the data.

Results: The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included.  5 studies were qualitative, 1 quantitative and 4 were mixed method.  Five main themes that are relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor, and external influencing factor.

Conclusions:  The decision-making process in telehealth is a complicated cognitive process that is influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors.

Impact: Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalised and made transparent, to prepare junior clinicians with skills to minimise risks associated with telehealth. 

Patient or Public Contribution: Not Applicable

Keywords: Decision-making, patient management plan, telehealth

Background
Communication in surgery is integral to the fundamentals of perioperative nursing practice andpatient safety. Research exploring team communication in robotic-assisted surgery (RAS) is evident in the literaturebut little attention has been focused on how the experiences of operating room nurses' communication affect safety,practice and patient care outcomes.

Objective
To synthesise current evidence regarding communication during robotic-assisted surgery asexperienced by reg-istered nurses.

Design
An integrative literature review informed by Whittemore and Knafl's (2005) methodology was used toconduct a rigorous analysis and synthesis of evidence.

Methods
A comprehensive database search was conducted using PRISMA guidelines. CINAHL, Pubmed,PsychINFO and British Nursing Web of Science databases were searched using a Boolean strategy.

Results
Twenty-five relevant papers were included in this literature review. Thematic analysis revealed two mainthemes with four related subthemes. The two main themes are: ‘Adaptive operating room nursing in RAS’ and ‘RASalters team dynamics’. The four subthemes are: ‘Navigating disruptions in RAS’, ‘RAS heightens interdependenceon team working’, ‘Augmented communicative workflow in RAS’, and ‘Professional empowerment to speak up’.

Conclusions
This integrative review identifies how current research largely focuses on communication in thewider OR team. However, current evidence lacks the input of nurses. Therefore, further evidence is needed toexplore nurses' experiences to highlight their perspectives.

Clinical Relevance
Robotics significantly benefit patients, and this review identifies different challenges thatrobotic-assisted surgery nurses encounter. A better understanding of the communication from the perspective ofnurses is needed to guide future research, practice education, policy development and leadership/management.

Background

A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives.

Objective

To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice.

Design

A descriptive qualitative design informed by the Fundamentals of Care framework.

Setting(s).

The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019.

Participants

A total sample of 53 registered nurses working at the bedside participated. Participants had a wide variety of clinical experience and represented a range of different nursing practice areas.

Methods

Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach.

Purpose. 
Head and neck cancer patients can face debilitating treatment related side-effects, resulting in requirement for support and negatively impacting on care outcomes. This study aimed to develop a digital recovery support package and assess its acceptability with head and neck cancer patients to support their information needs and assist with their self-management. It provided additional support through development of a WebXR platform ‘recovery’ package, which allowed patients to live a ‘virtual reality’ experience, entering and moving inside a ‘virtual room’, accessing targeted resources and specific learning materials related to their cancer.

Method. 
A qualitative intervention development study consisting of three phases. This study followed the COREQ checklist for qualitative research. Phase 1- Focus groups with seven head and neck cancer patients and six healthcare professionals. Phase 2- Development of ‘recovery’ package based on the focus group data which informed the content and design of the WebXR recovery platform. Phase 3- Technology acceptance study. Once developed, the platform's acceptability of the experience lived inside the virtual room was assessed via qualitative interviews with six different patient participants.

Results. 
Most participants felt comfortable using the virtual reality platform, finding it a realistic and useful support for identifying resources and signposting to relevant materials. Participants agreed the WebXR platform was a feasible tool for the head and neck cancer setting and helped reduce anxiety.

Conclusions. 
Head and neck cancer patients welcome specific targeted, information and advice to support their ability to self-manage their rehabilitation and thus focus their nursing care. The platform was implemented during the Covid-19 pandemic, demonstrating its versatility and accessibility in providing complementary support to head and neck cancer patients, to empower them to adjust to their ‘new’ normal as part of their ongoing cancer journeys.

Objectives. This paper aims to investigate pre-registration nursing students' experiences and perceptions of their clinical placements in nursing homes in order to develop recommendations for nurse educators. Evidence indicates that nursing students do not view nursing home placements as favourably as acute hospital placements. Therefore, nurse educators are challenged to facilitate a change in students' perceptions towards working in the nursing home environment.

Design. An integrative literature review allowed for the analysis and synthesis of the data relating to students' experiences and perceptions of nursing home practice, from studies with diverse research designs.

Methods. An electronic database search of CINAHL (Ebsco), Pubmed, British Nursing Database (BND), ERIC and social service abstracts, published from 2008 to April 2020 in English was completed. Papers were included using pre-allocated criteria and 649 qualified for closer examination. After exclusion, 21 papers underwent final analysis and synthesis using NIVIO 12.

Results. Five main themes were derived from the literature; i) the importance of effective supervision; ii) students' experiences and perceptions of the learning environment; iii) understanding the roles of care staff, iv) comprehensive orientation to the learning environment, and v) curriculum preparation. From these five categories, two synthesised themes were developed: nursing home placement encounters and enhancing learning opportunities.

Conclusions. Increasing the visibility of caring for older people in the curriculum is urgent in order to address nursing students' perceived misconceptions about placements in nursing homes. The development of standalone older people pathways, delivered by experienced and knowledgeable faculty, as well as the provision of compulsory clinical placements in settings exclusive to nursing older people and supervised by registered nurses are recommended. Failing to resolve this immediate problem will result in a further shortage of nurses who are adequately prepared to meet future nursing needs.

In nursing literature, the phrase ‘theory-practice gap’ is widely used without common definition or description of its underlying concept. This review paper presents a concept analysis using Rodgers (2000) evolutionary process to define and clarify the concept of the theory-practice gap as part of a doctoral study. In so doing it provides a deeper understanding of the concept to enable its consistent application within nurse education. A theoretical definition is developed, the data search that was undertaken is described and a discussion of the attributes, antecedents and consequences is provided. We conclude by offering, a model case, which is employed to illustrate the concept.

Aims and objectives: This discursive paper will consider to what extent Intramuscular injection (IM) technique can be described to remain entrenched in ritualistic practice and how evidence based practice should be considered and applied to the nursing practice of this essential skill.

Background: The notion of rituals within nursing and the value or futile impact they afford to this essential nursing skill will be critically reviewed.

Design: discursive paper

Method: Literature review from 2002 to 2013 to review the current position of IM injections

Results: Within the literature review it became clear that there are several actions within the administration of an IM injection that could be perceived as ritualistic and require consideration for contemporary nursing practice.

Conclusions: The essential nursing skill of intramuscular injection often appears to fit into the description of a ritualised practice. By providing evidence based care nurses will find themselves empowered to make informed decisions based on clinical need and using their clinical judgment.

Relevance to clinical practice: For key learning, it will outline with rationale, how site selection, needle selection, insertion technique and aspiration can be cited as examples of routinised or ritualistic practice and why these should be rejected in favour of an evidence based approach. The effect on some student nurses of experiencing differing practices between what is taught at university compared to what is often seen in clinical practice will also be discussed.

Aims and objectives. To consider to what extent intramuscular injection tech-

nique can be described to remain entrenched in ritualistic practice and how evi-

dence-based practice should be considered and applied to the nursing practice of

this essential skill.

Background. The notion of rituals within nursing and the value or futile impact

they afford to this essential nursing skill will be critically reviewed.

Design. Discursive paper.

Method. Literature review from 2002–2013 to review the current position of

intramuscular injection injections.

Results. Within the literature review, it became clear that there are several actions

within the administration of an intramuscular injection that could be perceived as

ritualistic and require consideration for contemporary nursing practice.

Conclusions. The essential nursing skill of intramuscular injection often appears

to fit into the description of a ritualised practice. By providing evidence-based

care, nurses will find themselves empowered to make informed decisions based on

clinical need and using their clinical judgement.

Relevance to clinical practice. For key learning, it will outline with rationale how

site selection, needle selection, insertion technique and aspiration can be cited as

examples of routinised or ritualistic practice and why these should be rejected in

favour of an evidence-based approach. The effect on some student nurses of expe-

riencing differing practices between what is taught at university and what is often

seen in clinical practice will also be d

Aims and objectives. To consider to what extent intramuscular injection tech-

nique can be described to remain entrenched in ritualistic practice and how evi-

dence-based practice should be considered and applied to the nursing practice of

this essential skill.

Background. The notion of rituals within nursing and the value or futile impact

they afford to this essential nursing skill will be critically reviewed.

Design. Discursive paper.

Method. Literature review from 2002–2013 to review the current position of

intramuscular injection injections.

Results. Within the literature review, it became clear that there are several actions

within the administration of an intramuscular injection that could be perceived as

ritualistic and require consideration for contemporary nursing practice.

Conclusions. The essential nursing skill of intramuscular injection often appears

to fit into the description of a ritualised practice. By providing evidence-based

care, nurses will find themselves empowered to make informed decisions based on

clinical need and using their clinical judgement.

Relevance to clinical practice. For key learning, it will outline with rationale how

site selection, needle selection, insertion technique and aspiration can be cited as

examples of routinised or ritualistic practice and why these should be rejected in

favour of an evidence-based approach. The effect on some student nurses of expe-

riencing differing practices between what is taught at university and what is often

seen in clinical practice will also be d