Project description:BackgroundCultivating a positive research culture is considered the key to facilitating the utilization of research findings. In the realm of clinical nursing research, nurses conducting research may find the utilization of findings challenging due to the lack of a positive research culture.ObjectiveThis study aims to identify and describe the sociocultural context of nursing research in a clinical setting at a Korean tertiary hospital.MethodsWe included participant observation and ethnographic interviews with 6 registered nurses working in a medical-surgical unit in a Korean tertiary hospital who had experience conducting nursing research in clinical settings in this qualitative ethnographic study. The study was conducted from April 2022 to May 2022. Data analysis was conducted using Spradley's ethnographic approach, which includes domain analysis, taxonomic analysis, componential analysis, and theme analysis, and occurred concurrently with data collection.ResultsThe overarching theme identified for nursing research culture in clinical practice was the development of a driving force for growth within the clinical environment. This theme encompasses (1) balancing positive and negative influences in the research process, (2) fostering transformational change for both nurses and patients, and (3) promoting complementary communication among nurses.ConclusionsClinical research plays a vital role in nursing practice that requires a balance of supportive elements, such as patient-driven research questions and hospital research support, with practical challenges such as shift work and high work intensity. This study found that a positive clinical nursing research culture can serve as a unifying bridge, connecting researchers, patients, who serve as both the origin and ultimate beneficiaries of research, and hospitals that facilitate research endeavors. Future research should explore whether the themes derived from this study fully reflect a clinical nursing research culture comprising patients, nurses, and the hospital environment and determine what requirements are needed to establish such a nursing research culture.

Project description:BackgroundCommunication about managing medications during transitions of care can be a challenging process for older patients since they often have complex medication regimens. Previous studies highlighted that links between communication breakdowns and medication incidents in older patients occur mainly at discharge or in the post-discharge period. Little attention has been paid to exploring communication strategies facilitating patient-centred medication communication at transitions of care from a discourse-analytic perspective.ObjectivesTo explore, through a discursive lens, strategies that enable patient-centred medication communication at transitions of care.DesignA focused ethnographic study was employed for this study. The study was reported according to the COREQ checklist.MethodsInterviews, observations and focus groups were analysed utilising Critical Discourse Analysis and the Medication Communication Model following thematic analysis. Data collection was undertaken in eight wards across two metropolitan hospitals in Australia.ResultsPatient preferences and beliefs about medications were identified as important characteristics of patient-centred communication. Strategies included empathetic talk prioritising patients' medication needs and preferences for medications; informative talk clarifying patients' concerns; and encouraging talk for enhancing shared decision-making with older patients. Challenges relating to the use of these strategies included patients' hearing, speech or cognitive impairments, language barriers and absence of interpreters or family members during care transitions.Relevance to clinical practiceTo enhance medication communication, nurses, doctors and pharmacists should incorporate older patients' preferences, previous experiences and beliefs, and consider the challenges faced by patients across transitions. Strategies encouraging patients' contribution to decision-making processes are crucial to patient-centeredness in medication communication. Nurses need to engage in informative talk more frequently when administering the medications to ensure older patients' understanding of medications prescribed or altered in hospital settings.

Project description:Aims and objectivesTo describe prehospital nursing students' experiences of patient safety culture in emergency medical services during their internship.BackgroundPatient safety culture in the emergency medical services is a complex phenomenon including more than organisational policies and practices and professionals' technical skills.DesignThe descriptive qualitative approach used the Sharing Learning from Practice to improve Patient Safety Learning Event Recording Tool, which includes both open-ended and structured questions.MethodsPurposeful sampling was used, and data were collected from graduating prehospital nursing students (n = 17) from three Finnish Universities of Applied Sciences. Open-ended questions were reviewed using thematic analysis, and frequencies and percentages were derived from structured questions. COREQ guidelines were used to guide this study.ResultsFour themes were identified during the thematic analysis: environmental and other unexpected factors in emergency medical services, working practices and professionalism in emergency medical services, teamwork in emergency medical services and feelings related to patient safety events in emergency medical services. Patient safety events described by students were seldom reported in the healthcare system or patient files. According to the students, such events were most likely related to communication, checking/verification and/or teamwork.ConclusionsThis study shows that prehospital nursing students can produce important information about patient safety events and the reasons that contributed to those events. Therefore, emergency medical services organisations and managers should use students' observations to develop a patient safety culture in emergency medical services.Relevance to clinical practiceUnderstanding how prehospital nursing students have experienced patient safety culture during their internships on ambulances can support educational institutions, together with emergency medical services organisations and managers, to improve policies for students to express patient safety concerns as well as patient safety successes.

Project description:BackgroundThe definition of feedback in clinical education has shifted from information delivery to student-teacher dialogue. However, based on Hofstede's theory, countries with large power distance or a robust social hierarchy and collectivistic cultural dimensions can reduce the feedback dialogue to a minimum. Indonesia is classified in this group, with some Asian, African, Mediterranean, and Latin American countries. This study explores the interactional communication of feedback during clinical education in a hierarchical and collectivistic context.MethodsThe focused ethnographic approach was applied to the clinical rotation program in an Indonesian teaching hospital. Data sources included observations of feedback episodes during workplace-based assessments followed by interviews with clinical supervisors and students. The data were compiled within 16 weeks of observation in 7 groups of clinical departments, consisting of 28 field notes, audiotaped interviews including nine focus group discussions of students (N = 42), and seven in-depth interviews with clinical supervisors. Data were analyzed through transcription, coding, categorization, and thematic analysis using the symbolic interactionist perspective.ResultsWe identified four themes representing actual interactional communication and its 'meaning' or interpretation. The interactional communication in feedback is described in the first and second themes, such as 1) Students play the subordinate roles in a feedback dialogue; 2) The feedback content is focused on explanation and students' limitations. The third and fourth themes represent the clinical supervisors' and students' interpretation of their feedback experience, such as 3) Clinical supervisors' perspectives are mostly on dissatisfaction and teaching authority; 4) Students' acceptance of reality and negative affection.ConclusionsThis study shows that the social gap between students and clinical supervisors in Indonesia, and other countries in the same cultural classification, potentially causes communication barriers in the feedback dialogue. The adaptation of 'feedback as a dialogue' requires further effort and research to develop communication strategies in feedback that consider the national culture and context.

Project description:Clinical practice is a pivotal part of nursing education. It provides students with the opportunity to put the knowledge and skills they have acquired from lectures into practice with real patients, under the guidance of registered nurses. Clinical experience is also essential for shaping the nursing students' identity as future professional nurses. There is a lack of knowledge and understanding of the ways in which students learn practical skills and apply knowledge within and across different contexts, i.e. how they apply clinical skills, learnt in the laboratory in university settings, in the clinical setting. The aim of this study was therefore to explore how nursing students describe, and use, their prior experiences related to practical skills during their clinical practice.An ethnographic case study design was used. Fieldwork included participant observations (82 h), informal conversations, and interviews (n = 7) that were conducted during nursing students' (n = 17) clinical practice at an emergency department at a university hospital in Sweden.The overarching theme identified was "Learning about professional identities with respect to situated power". This encompasses tensions in students' learning when they are socialized into practical skills in the nursing profession. This overarching theme consists of three sub-themes: "Embodied knowledge", "Divergent ways of assessing and evaluating knowledge" and "Balancing approaches".Nursing students do not automatically possess the ability to transfer knowledge from one setting to another; rather, their development is shaped by their experiences and interactions with others when they meet real patients. The study revealed different ways in which students navigated tensions related to power differentials. Reflecting on actions is a prerequisite for developing and learning practical skills and professional identities. This highlights the importance of both educators' and the preceptors' roles for socializing students in this process.

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Culture of patient care among international nursing students: a focused ethnographic study

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