Occupational factors contributing to low self-esteem in registered nurses and licensed practical nurses: a multivariate analysis.

Registered nurses (RNs) work closely with nurse practitioners (NPs) in all facets of patient care and often have a direct influence on the patient's perception of the professional who is directing the care, and a patient's perceptions may affect clinical outcomes. However, few studies have been conducted to measure RN acceptance of the NP. The authors surveyed RNs in southern Illinois to assess their attitudes concerning the level of care provided by NPs. Southern Illinois was chosen because of the limited number of NPs in the area and because of concerns that limited exposure might negatively influence RN attitudes about the NP role. A 26-item research questionnaire, previously used with school nurses, was modified to reflect RNs in general. Seven items related to demographic information, and 19 items created a five-response Likert-formatted scale (r = .93). The questionnaire was mailed to 500 randomly selected RNs from the 11 southernmost counties of Illinois. The results showed support of the NP role. RNs believed that NPs were knowledgeable, competent health care providers. RNs were also comfortable working with NPs and often consulted them for advice and information. They saw the role of the NP as a positive addition to the health care team. One identified concern was that scores indicated RNs felt that they received limited respect from NPs. Although the scores were high in this category, some RNs had concerns that NPs might not respect or understand the difficulty of the RN role in providing patient care. NPs need to recognize their collegial and professional ties to RNs and should take time to provide positive feedback to RNs as they collaborate to provide health care. Such behavior would only solidify the health team approach.

Difference in Work-Related Violence by Nurse License Type

Older people are at risk of experiencing functional decline and related complications during hospitalization. In countries with projected increases in age demographics, preventing these adverse consequences is a priority. Because most Canadian nurses have received little geriatrics content in their basic education, understanding their learning needs is fundamental to preparing them to respond to this priority. This two-phased multi-method study identified the geriatrics learning needs and strategies to address the learning needs of acute care registered nurses (RNs) and registered practical nurses (RPNs) in the province of Ontario, Canada. In Phase I, a survey that included a geriatric nursing knowledge scale was completed by a random sample of 2005 Ontario RNs and RPNs. Average scores on the geriatric nursing knowledge scale were in the "neither good nor bad" range, with RNs demonstrating slightly higher scores than RPNs. In Phase II, 33 RN and 24 RPN survey respondents participated in 13 focus group interviews to help confirm and expand survey findings. In thematic analysis, three major themes were identified that were the same in RNs and RPNs: (a) geriatric nursing is generally regarded as simple and custodial, (b) older people's care is more complex than is generally appreciated, and (c) in the current context, older people's care is best learned experientially and in brief on-site educational sessions. Healthcare providers, policy-makers, and educators can use the findings to develop educational initiatives to prepare RNs and RPNs to respond to the needs of an aging hospital population.

To create data-driven typologies of licensed nurse staffing and health services in residential care and assisted living (RC/AL). Cluster analysis was used to describe the patterns of licensed nurse staffing and 47 services and the extent to which these clusters were related. RC/AL communities in the United States. A convenience sample of administrators and healthcare supervisors from 89 RC/AL communities in 22 states. RC/AL characteristics, licensed nurse staffing (total number of hours that registered nurses (RNs) and licensed practical nurses (LPNs) worked), number of hours that contract nurses worked, and availability of 47 services. Analysis revealed four licensed nurse staffing clusters defined according to total number of hours and the type of nurse providing the hours (RN, LPN, or a mix of both). They ranged from no or minimal RN and LPN hours to high nursing hours with a mix of RNs and LPNs. The 47 services clustered into five clusters: basic services; technically complex services; assessments, wound care, and therapies; testing and specialty services; and gastrostomy and intravenous medications. The availability of services was related to the presence of nurses (RNs and LPNs) except for the gastrostomy and intravenous medication services, which were not readily available. The amount and skill mix of licensed nurse staffing varies in RC/AL and is related to the types of services available. These findings may have implications for resident care and outcomes. Future work in this area, including extension to include nonnurse direct care workers, is needed.

Nursing Programs Could Sharpen LTC Focus

Multiple jobholding and part-time work among nurses in long-term care homes compared to other healthcare sectors: Evidence from Ontario

Working conditions of nurses and absenteeism: Is there a relationship? An empirical analysis using National Survey of the Work and Health of Nurses

Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) communication is critical for ensuring patient safety, improving the quality of care, and fostering cohesive healthcare teams. This study evaluated the impact of a collaborative simulation experience on nursing students' confidence in working together. As healthcare systems newly integrate LPNs into acute care settings, the need for RNs and LPNs to collaborate effectively has become important. However, communication gaps and misunderstandings about the scope of practice often affect teamwork that could lead to potential medical errors. To address this concern, a community college in Northeastern Pennsylvania implemented a simulation to improve communication, collaboration, and delegation between RN and LPN students. The study assessed pre- and post-simulation confidence levels related to communication, delegation, and teamwork through surveys. Surveys revealed that both RNs and LPNs identified increased comfort and confidence in communication and collaboration after the simulation. However, both groups also reported concerns during emergent situations such as feeling hesitant to delegate, possess poor communication skills, and overall lack a sense of urgency. Fortunately, all participants voiced the value of the experience and hoped for future similar simulation experiences. The students verbalized an appreciation for teamwork and areas for further improvement. This study suggests that simulation experiences can be an effective tool in enhancing communication and increase confidence in collaboration and delegation, but continued education and feedback are essential to ensure that these skills translate to realworld clinical settings.

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Nursing Home Staff Palliative Care Knowledge and Practices: Results of a Large Survey of Frontline Workers

Background: In the Netherlands, the majority (80%) of the older people (age>65) do use prescribed drugs. 82% of the patients who receive home healthcare are 65 years of age or older. Because of natural changes in age-related drug metabolism, these older home healthcare patients are particularly vulnerable to drug - related problems. Purpose: To describe how home healthcare Nurse Assistants (NA), home healthcare Licensed Practical Nurses (LPN) and home healthcare Registered Nurses (RN) rate their knowledge, monitoring skills and ability to recognize adverse drug reactions and drug interactions of the most commonly used medication in older people, aged 75 or older, in the Netherlands. Methods: A survey design was conducted with the use of a questionnaire in a home care organization in the Netherlands. Results: Home healthcare workers most easily recognize side-effects of confusion, drowsiness and fatigue more easily than gastrointestinal disorders and dizziness. In addition, home healthcare Registered Nurses and home healthcare Licensed Practical Nurses were more likely than home healthcare assistants to recognize and report symptoms due to side- effects. Conclusion: There are differences between RN, LPN and NA in the knowledge and their skills to recognize adverse drug reactions and interactions in home care. Consequently, the allocation of clients to RNs, LPNs or NAs should be arranged well. Home healthcare workers are well positioned to act preventatively and alertly to potential drug related problems, if they have adequate access to information on side effects and interactions of medication.

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

<p dir="ltr">Background: Undergoing an Allogeneic haematopoietic cell transplant (allo-HCT) can have a long-term physical, psychological, social and existential impact on the patient. First, the patient's life is threatened by a serious diagnosis that allo- HCT may cure; then the patient's life is challenged by a wide range of symptoms, sometimes lifelong if chronic conditions develop. The majority of patients adapt to life following allo-HCT but should know what to expect in terms of symptoms and limitations in everyday life. Post allo-HCT challenges can be of a physical, psychological, social and existential nature for which patients should be prepared and confident in their own ability to cope after allo-HCT. Registered nurses (RNs) play a key role through dialogue and education to prepare patients for life after allo-HCT. There is little research on patients' preparedness for allo- HCT and their confidence in their ability to manage their health through self- management after treatment. In addition, there is little research on how preparedness and self-care are incorporated in the nursing care in allo-HCT.</p><p dir="ltr">Aim: The overall aim of this thesis was to describe symptom burden, nursing, preparedness, self-efficacy and self-care in the trajectory of allo-HCT.</p><p dir="ltr">Methods: Both quantitative and qualitative methods were used and included patients and RNs. Patients undergoing allo-HCT were recruited at the time of enrolment for allo-HCT (study I & IV) or by advertisement at the outpatient clinic (study III). Participating RNs worked in allo-HCT (study II & IV). Descriptive statistics and logistic regression analyses was used to analyse patients (n= 189) self-reported questionnaire data from 4 different time points (baseline, 4, 7 months and 1 year) (study I). Thematic analyse was used in study II, to analyse qualitative data from 6 workshops performed with RNs (n=12), working at the largest centre performing allo-HCT in Sweden. Descriptive content analysis was used in study III, to analyse qualitative data from individual interviews with patients (n=9), 3-12 months post allo-HCT. Study IV has a convergent parallel mixed methods design, where data were collected during a predefined time period. Patients completed questionnaires on 2 occasions and participated in an individual interview (n=12) 6-8 weeks after allo-HCT. RNs (n=9) from 2 clinics performing allo-HCT in Sweden were included in the study and participated in focus group interviews held on one occasion/clinic.</p><p dir="ltr">Results: Study I showed that high symptom burden, old age and low physical activity at 4 months were factors that had a statistically significant association with perceived poor general health one year after allo-HCT. A high symptom burden, presence of chronic immune reaction (cGvHD), and low physical activity at 4 months were factors statistically significant with sick leave at 1 year post allo-HCT. The most commonly reported symptoms were fatigue, physical weak- ness, and disinterest in sex, which were reported at all measurement points. Distressing symptoms varied more than symptom prevalence during the first year after allo-HCT. The symptoms reported as most distressing were difficulty eating, discomfort during sex and physical weakness. In Study II, an overarching theme was defined that described nursing in allo-HCT as a balancing act, illu- strating the conditions for performing nursing in a highly medical-technical en- vironment. The overall theme was followed by three sub-themes: Fragmented care vs. holistic care, describing how the holistic view of care was lost when care became fragmented: Proximity vs. distance, highlighting the balance between seeing the patient as an independent person despite illness and need for sup- port: Teamwork vs. stand-alone, showing the difficulties of adapting to both teamwork and independence in nursing. As a result of the content analysis in Study III, an overarching theme developed that illustrated the situation described by patients in the interviews: Life is taken apart, then you have to know how to put the pieces together, and four sub-themes: Convert information into some- thing understandable; Taking responsibility, maintaining and preparing for an uncertain time in life; Balancing vigilance with independence and Reorientating in an altered body places new demands on self-care. This highlights the dis- mantling of life during treatment and how measures and approaches can build a new life, as described by patients. In study IV, patients reported overall high self- care scores, with no statistically significant change from baseline to 4 month follow up. Patients expressed that the Assessment of Rehabilitation Needs Checklist (ARNC) with a subsequent conversation with a RN contributed to preparedness. RNs felt that through the use of the ARNC and the conversation, care became more person-centered, as patients were able to raise issues important to them. The tool was therefore mainly used to highlight problems on admission, while preparedness and self-care issues were not addressed either at this time or later in the course of care.</p><p dir="ltr">Conclusion: The aim of this thesis was to describe symptom burden, nursing care, preparedness, self-efficacy and self-care in the context of allo-HCT. The results show that systematic symptom assessment is important to detect symptoms at an early stage after allo-HCT, as symptoms can affect recovery at a later stage of the allo-HCT course. RNs have a key role in educating and preparing patients through person-centered nursing interventions, such as dialogue and teaching. Nursing has partly moved towards more person-centered care by using a structured conversation tool. However, the conversation tool was used on only one occasion during the care period, which may be perceived as too infrequent in terms of capturing the symptoms and concerns that patients may experience. From a medical point of view, patients' needs are met down to the cellular level, but to meet the individual needs of patients, person-centred care needs to be further developed to include preparedness and self-care. RNs therefore need to become more aware of their important role in continuously educating and informing patients, as part of the nursing associated with allo- HCT. This can help to bridge the knowledge gap that may arise for the patient when transitioning from the safe environment of a care unit to independent self- care at home.</p><h3>List of scientific papers</h3><p dir="ltr">I. * Eriksson, L, V., <b>Holmberg, K.</b>, Lundh Hagelin, C., Wengström, Y., Bergkvist, K., & Winterling, J. (2023). Symptom burden and recovery the first year after allogeneic hematopoietic stem cell transplantation. Cancer Nursing, 46 (1), 77-85. <a href="https://doi.org/10.1097/NCC.0000000000001077" rel="noreferrer" target="_blank">https://doi.org/10.1097/NCC.0000000000001077</a>. * L.V.E and K.H contributed equally to this work</p><p dir="ltr">II. <b>Holmberg, K.</b>, Bergkvist, K., Adalsteinsdóttir, S., Wengström, Y., & Lundh Hagelin, C. (2023). Nursing as a balancing act in allogeneic hematopoietic cell transplantation-nurses 'experiences through participation in workshops. European Journal of Oncology Nursing, 63, 1-6. <a href="https://doi.org/10.1016/j.ejon.2023.102300">https://doi.org/10.1016/j.ejon.2023.102300</a><br><br></p><p dir="ltr">III. <b>Holmberg, K.</b>, Bergkvist, K., Wengström, Y., & Lundh Hagelin, C. (2024). Dismantle and rebuild: The importance of preparedness and self-efficacy before, during and after allogeneic haematopoietic cell transplantation. Journal of Cancer Survivorship. <a href="https://doi.org/10.1007/s11764-024-01622-2">https://doi.org/10.1007/s11764-024-01622-2</a><br><br></p><p dir="ltr">IV. <b>Holmberg, K.</b>, Bergkvist, K., Wengström, Y., & Lundh Hagelin, C. (2024). Preparedness, self-efficacy and self-care in allogeneic hematopoietic cell transplantation - a mixed methods study of patients' and nurses' perceptions. [Manuscript]</p>

SUMMARY Objective. To determine the relationship among 11 types of home health care services for patients with HIV/AIDS and to develop a terminal-care, service-usage profile of persons receiving such services. Services include the number of psychiatric nurse visits, Medical Social Work (MSW) visits, evaluation visits, physical therapy visits, occupational therapy visits, homemaker visits, home health aide visits, public health nurse visits, registered nurse (RN) visits, Licensed Vocational Nurse (LVN) visits, and Intravenous (IV) nurse visits. Data Sources and Study Setting. Data were collected on 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). The service utilization data were collected from the VNA-LA's computerized data system. Study Design. The relationship among the service types was evaluated with principal component analysis. A service-usage profile was developed for patients using cluster analysis. To control for the variability in the amount of time that patients were on service, the number of days that patients were in the VNA-LA program and were actually receiving services was included as a factor that yielded a variable reflecting the number of each type of service that a patient received per day. Principal Findings. Five components were found to best describe the relationships among the service-type variables. These were identified as being: the Number of Evaluation Visits, the Number of Intensive Nursing Visits, the Number of Physical Therapy Visits, the Number of Psychosocial Visits, and the Number of Attendant Visits. Patients were found to cluster into 1 of 5 groups based on the type of service utilization profile that they received. The variables that appeared to have the most influence on this profile were the number of home health aide visits per day that the patient received, the number of RN visits that were made, the number of IV nurse visits that were provided, and the number of LVN visits that were made. Conclusions. Terminally ill AIDS patients receiving home health care services can be identified as having a service utilization profile. This profile can be used to evaluate more precisely the service areas in which costs for patient services differ. Individuals assigned to an experimental Transprofessional Model of care had a different service utilization profile than those assigned to a Traditional Model of care.

The aim of the study is to introduce an innovative use of bar code medication administration (BCMA) data, medication pass analysis, that allows for the examination of nurse staffing and workload using data generated during regular nursing workflow. Using 1 year (October 1, 2014-September 30, 2015) of BCMA data for 11 acute care units in one Veterans Affairs Medical Center, we determined the peak time for scheduled medications and included medications scheduled for and administered within 2 hours of that time in analyses. We established for each staff member their daily peak-time medication pass characteristics (number of patients, number of peak-time scheduled medications, duration, start time), generated unit-level descriptive statistics, examined staffing trends, and estimated linear mixed-effects models of duration and start time. As the most frequent (39.7%) scheduled medication time, 9:00 was the peak-time medication pass; 98.3% of patients (87.3% of patient-days) had a 9:00 medication. Use of nursing roles and number of patients per staff varied across units and over time. Number of patients, number of medications, and unit-level factors explained significant variability in registered nurse (RN) medication pass duration (conditional R2 = 0.237; marginal R2 = 0.199; intraclass correlation = 0.05). On average, an RN and a licensed practical nurse (LPN) with four patients, each with six medications, would be expected to take 70 and 74 minutes, respectively, to complete the medication pass. On a unit with median 10 patients per LPN, the median duration (127 minutes) represents untimely medication administration on more than half of staff days. With each additional patient assigned to a nurse, average start time was earlier by 4.2 minutes for RNs and 1.4 minutes for LPNs. Medication pass analysis of BCMA data can provide health systems a means for assessing variations in staffing, workload, and nursing practice using data generated during routine patient care activities.