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Introduction: Professional isolation, feelings of being isolated from one's professional peers and lacking mentoring and opportunities for professional interaction, collaboration, and development, is a challenge for workers across the labor market. The notion of professional isolation is particularly prevalent in low-resource health care settings and is common among emergency nurses., Methods: This study explored the perceptions of professional isolation among emergency nurses working in a low-resource environment using individual interviews with 13 participants in 5 settings in Lesotho., Results: The data were analyzed using qualitative content analysis and revealed an overarching theme of "feeling like an island" containing 3 categories, namely lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness., Discussion: This study suggests that lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness have influenced feelings of professional isolation among emergency nurses working in low-resource environments. The findings of this research lend support to the idea that communities of practice may have a potential impact in addressing professional isolation., (Copyright © 2023 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background: Family engagement positively impacts patient and family members' experiences of care and health outcomes. While partnering with families denotes best practice in intensive care units (ICUs), its full adoption requires improvement. A better understanding of the factors that influence the implementation of family engagement practices is necessary., Aim: To investigate the factors that enable or hinder adult ICU nurse-family engagement and to explore potential international variations., Study Design: Descriptive, cross-sectional survey. Nurses from 10 countries completed the 'Questionnaire on Factors that Influence Family Engagement' (QFIFE), including five open-ended questions. We performed descriptive statistics on quantitative data and content analysis for open-ended questions, and then integrated the findings according to influencing factors and geographical patterns. This was part of a larger qualitative study where 65 nurses participated from adult intensive care units., Results: Sixty-one nurses completed the questionnaire, making a response rate of 94%. Overall, patient acuity (Md = 5.0) and nurses' attitudes (Md = 4.6) seemed to be the most influential facilitator, followed by nurse workflow (Md = 4.0) and ICU environment (Md = 3.1) (score 1-6 most influential). The open-ended question data showed a more nuanced picture of the complexity of family engagement in care around these four determinants. Adding a fifth determinant, namely Families are complex structures that respond uniquely to the ICU and patient, revealed that difficult family dynamics, miscommunication and family having difficulty in understanding the situation or health literacy, hindered family engagement. Exploring geographical variations, Africa/Middle East consistently differed from others on three of the four QFIFE subscales, showing lower median levels., Conclusions: Some determinants are perceived to be more influential than others, becoming barriers or enablers to nurse-family engagement in adult ICU. Research that investigates contextual determinants and which compares implementation and improvement initiatives tailored to address family engagement practices barriers and enablers are needed., Relevance to Clinical Practice: Knowledge of this international study expands our understanding of enablers and barriers in family engagement that may inform family engagement practice improvement efforts around the world., (© 2022 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: The use of social media platforms to convey public opinions and attitudes has exponentially increased over the last decade on topics related to health. In all these social media postings related to the pandemic, specific attention has been focused on healthcare professionals, specifically nurses., Objective: This study aimed to explore how the keyword 'nurse' is located in COVID-19 pandemic-related tweets during a selected period of the pandemic in order to assess public perception., Methods: Tweets related to COVID-19 were downloaded from Twitter for the period January 1st, 2020, to November 11th, 2021. Sentiment analysis was used to identify opinions, emotions, and approaches expressed in tweet which included 'nurse', 'COVID-19', and 'pandemic' as either keyword or hashtags., Results: A total of 2,440,696 most used unique words in the downloaded 582,399 tweets were included and the sentiment analysis indicated that 24.4% ( n  = 595,530) of the tweets demonstrated positive sentiment while 14.1% ( n  = 343,433) of the tweets demonstrated negative sentiment during COVID-19. Within these results, 17% ( n  = 416,366) of the tweets included positive basic emotion words of trust and 4.9% ( n  = 120,654) of joy. In terms of negative basic emotion words, 9.9% ( n  = 241,758) of the tweets included the word fear, 8.3% ( n  = 202,179) anticipation, 7.9% ( n  = 193,145) sadness, 5.7% ( n  = 139,791) anger, 4.2% ( n  = 103,936) disgust, and 3.6% ( n  = 88,338) of the tweets included the word surprised., Conclusions: It is encouraging to note that with the advent of major health crises, public perceptions on social media, appears to portray an image of nurses which reflects the professionalism and values of the profession.

Background: Critical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood., Objectives: To describe nurses' perceptions and practices of family engagement in adult intensive care units from a global perspective., Design: A qualitative-descriptive multi-site design using content analysis., Settings: The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents., Participants: A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU., Methods: Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis., Results: We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses' practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses' attitudes and perceptions of family, the patient's condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses' ability to engage with families., Conclusions: This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

A violent death is the sudden and unexpected loss of life due to a violent means, and in South Africa, violent death due to interpersonal violence appears to be a huge problem with the majority of these clients being young adults in the prime of their life (Trauma Rev. 5(1) (1997) 1).The objective of the study was to explore the influence that the confrontation of violent death of their clients had on the emergency nurses' daily personal and professional lives. The participants described a number of physical and emotional ways in which their lives had been affected.

This exploratory study investigates how a typically disadvantaged user group of older, female learners from rural, low-tech settings used and perceived a Facebook group as a research supervision and distance learning tool over time. The within-stage mixed-model research was carried out in a module of a part-time, advanced midwifery education course in rural South Africa. To address the research questions, three quantitative and qualitative surveys were repeated, pre, post, and three months post evaluation. The findings indicate that using the social media space lowered learners' threshold to accessing educational resources. The increased ease of communication was afforded in particular by using mobile phones to access the space. The analysis also suggests that the social networking site became a more integral part of students' learning environments. The learners' use of the site to discuss further course and work-related issues increased during the intervention and also remained significantly higher in the three-month, post evaluation survey, indicating the routinisation and habitualisation of this learning space. The practical implications and constraints of using social networking spaces to enhance disadvantaged groups of learners' access to educational resources are discussed.

This study analyses the use of a group space on the social networking site Facebook as a way to facilitate research supervision for teams of learners. Borrowing Lee's framework for research supervision, the goal was to understand how supervision and learning was achieved in, and shaped by, the properties of a social networking space. For this purpose, the discourse between supervisor and learners was analysed along with the structural properties afforded by the space. Using the empirical findings and further literature, a conceptual framework was developed that illustrates the ways in which functional supervision, enculturation, emancipation, critical thinking and relationship development are achieved and formed by the interplay of the technological, functional, multimodal and the wider sociocultural, political and sociolinguistic structures associated with social media space.

Background. Antimicrobial stewardship (AMS) is a proactive healthcare intervention to improve patient outcomes by optimising antimicrobial use. Although nursing involvement is a recognised necessity, bedside nurses may not yet possess competencies to fulfil this role. Objectives. To identify recommendations for AMS education for the bedside nurse in key global AMS guidelines. Methods. Scoping review methodology was used to systematically search published and 'grey' literature in PubMed, EBSCOhost, Google Scholar, government websites and websites of professional societies and organisations. Search dates were from 1990 to 2020. Inclusion criteria were English language AMS guidelines for hospitals. Results. Literature searches retrieved 1 824 articles, with 43 meeting the review inclusion criteria. Reference was made to AMS nursing education in 23 (53.4%) of the articles. Educational opportunities for nurses were recommended: inclusion of AMS concepts/content into undergraduate and postgraduate nursing curricula (n=12; 27.9%), in-hospital training (n=14; 32.5%) and continuing professional development (n=6; 13.9%). Recommendations for nursing education were as follows: role of AMS in preventing antimicrobial resistance (n=7; 16.2%), infection prevention and control (n=3; 6.9%), diagnostics in AMS (n=5; 11.6%), pharmacology (n=11; 25.5%) and collaboration (n=2; 4.6%). Identified nursing educational gaps were: nurses not recognising their role within AMS (n=5; 11.6%), inadequate nursing resources and expertise for dosing, pharmacokinetic/pharmacodynamic strategies and managing possible drug incompatibilities with extended/prolonged infusions (n=3; 6.9%), and inappropriate nurse disposal of antibiotic waste (n=1; 2.3%). Conclusions. Although recommendations for nursing education were found in many key AMS guidelines, few guidelines provided detailed descriptions of the nursing competencies that were required for this role. [ABSTRACT FROM AUTHOR]

Background. Antimicrobial stewardship aims to optimise the use of antimicrobial medicines to preserve the efficacy of these medicines and to contain antimicrobial resistance where possible. Nurses constitute the largest group of healthcare workers; however, the role played by nurses within current antimicrobial stewardship strategies is largely unacknowledged despite nurses being at point-of-care at the hospital bedside. Objective. To identify recommendations for the antimicrobial stewardship role of the bedside nurse in key global antimicrobial stewardship guidelines. Methods. Scoping review methodology was used to systematically search published and 'grey' literature in PubMed, EBSCOhost, Google Scholar, government websites, and websites of professional societies and organisations. Search dates were 1990 to 2020. Inclusion criteria were English language antimicrobial stewardship guidelines for hospitals. Screening was conducted in two stages for title and abstract and then full text relevancy and documented according to the PRISMA Extension for Scoping Reviews. Results. Of the 1 824 articles that were retrieved, only 43 met the inclusion criteria. Inclusion of the bedside nurse on the antimicrobial stewardship team occurred in 13.9% (n=6) of the papers. A role for the bedside nurse was recommended in antibiotic stewardship (32.5%; n=14), infection prevention and control (23.2%; n=10), and administration of antimicrobial medicines (20.9%; n=9) of reviewed documents. Other recommendations included the use of evidence-based antimicrobial stewardship (20.9%; n=9), collaboration with other healthcare staff (11.6%; n=5), facilitation of transition of care (18.6%; n=8), and nurse prescription of antibiotics (4.6%; n=2). Conclusion. This scoping review highlights a slow but incremental increase in recognition of the role of the bedside nurse within the operational hub of antimicrobial stewardship strategies. [ABSTRACT FROM AUTHOR]

Background. Antimicrobial stewardship has become an important initiative within intensive care units in the global fight against antimicrobial resistance. Support for nurses to participate in and actively direct antimicrobial stewardship interventions is growing however, there may be barriers that impede the development of this nursing role. Objectives. To explore the views of healthcare professionals regarding barriers to the antimicrobial stewardship role of the nurse in intensive care in a private hospital in KwaZulu-Natal, South Africa. Methods. Using a qualitative research approach, purposive sampling was used to identify fifteen participants from the disciplines of nursing, surgery, anaesthetics, internal medicine, microbiology, and pharmacy in a general intensive care unit. Content analysis was used to code data obtained from each individual interview. Results. The following categories and subcategories were derived: regarding barriers to the role of the nurse in antimicrobial stewardship: (i) lack of collaboration (subcategories: not participating in the antimicrobial stewardship programme, no feedback about antimicrobial resistance in the unit, and not part of decision-making); (ii) inadequate knowledge (subcategories: not understanding infection prevention and control, missing the link between laboratory results and start of treatment, and poor knowledge of antibiotics and their administration); and (iii) inexperienced nurses (subcategories: shortage of intensive care nurses, lack of experienced nurses, and inadequate nursing staff to provide in-service training). Conclusion. The nursing role within antimicrobial stewardship was negatively affected by both staffing and collaborative difficulties, which impacted on the implementation of antimicrobial stewardship within the unit. [ABSTRACT FROM AUTHOR]

Antimicrobial stewardship (AMS) has developed over the past decade as a critical tool to promote the appropriate use of antimicrobials in order to contain antimicrobial resistance (AMR) and conserve antimicrobial medicines. Current literature supports the role of the nurse in AMR, with a strong focus on the responsibilities of the nurse in infection prevention and control (IPC), both in the formal role of the IPC nurse specialist, and the more general IPC role of the bedside nurse. There is also growing support for the collaborative role of the nurse in the multidisciplinary AMS team. There is, however, very little literature examining the clinical practice role of the nurse in AMS. In this discussion, we contend that nursing practice may unknowingly contribute to AMR owing to varying methods of administration of intermittent intravenous infusions, resulting in under-dosing of antimicrobial medicines. [ABSTRACT FROM AUTHOR]

Nursing literature indicates that the involvement of nurses in research has the potential to inform practice, improve quality care, and enhance positive patient outcomes, but the number of nurses engaging in research appears low. This deficit involves conducting and utilising research which may be associated with limited or lack of research knowledge, training, funding, incentives and poor motivation for nurses to conduct research. Although there is a growing demand for nurses in the clinical service areas to conduct research independently and collaboratively, many nurses find it difficult to start the process. In this article, we suggest ways by which nurses working in the clinical service area can start to plan to become actively engaged in research. [ABSTRACT FROM AUTHOR]

Background. Care of the critically ill patient has become increasingly challenging, with a rising incidence of resistant pathogens resulting in the ineffectiveness of many antibiotics. Severe infection is associated with prolonged intensive care unit (ICU) length of stay, and increased morbidity, mortality, and healthcare costs. Antimicrobial stewardship (AMS) aims to prevent resistance and protect patients and the wider community by promoting correct antimicrobial use. The current AMS literature has failed to describe the role of the ICU nurse in this important initiative. Objective. To explore the perceptions of AMS team members regarding the role of the ICU nurse in the AMS team. Methods. Using a qualitative research approach, purposive sampling was used to identify participants in an ICU. Semi-structured interviews were conducted with 15 participants, including ICU shift-leader nurses, nursing management, surgeons, anaesthetists, physicians, microbiologists and pharmacists. Data were analysed and categorised using content analysis. The study was conducted in a general ICU in the private healthcare sector in KwaZulu-Natal, South Africa. Results. Participants representing various disciplines of the AMS team felt that the role of the ICU nurse within the team was an important part of the AMS programme. Four categories that emerged from the data are discussed: organisational, advocacy, clinical and collaborative roles. Conclusion. The role of the ICU nurse was found to be essential to the success of AMS in the ICU. These findings provide implications for practice, which, if recognised and supported by all healthcare stakeholders from ICU and hospital management, could improve AMS in this acute care area. [ABSTRACT FROM AUTHOR]

Background. Do not resuscitate (DNR) is the policy and practice of deliberately not attempting to resuscitate a person whose heart has stopped beating. Research on nursing care for patients designated with DNR orders has been conducted since the late 1980s; however, no study appears to have been carried out in the Rwandan setting. Purpose. The purpose of this study was to explore the lived experiences of nurses caring for a patient with a DNR order in an intensive care unit (ICU) in Kigali, Rwanda, in order to suggest nursing recommendations. Methods. Using a phenomenological approach, two semi-structured interviews were conducted with each participant to explore their lived experiences of caring for patients with DNR orders. The sample comprised six nurses from an ICU in a large tertiary-level hospital in Kigali, Rwanda. Results. The data were organised into categories based on a review of the data from the interviews of the six participants. The categories were: feeling emotional distress; barrier to optimal care; and not part of decision-making. Conclusion. DNR orders are a fairly new concept in Rwanda and the practice of DNR orders in ICU is very demanding for the staff, especially the ICU nurses. Additional education about DNR orders as well as policies to guide its implementation could assist ICU nurses in their difficult work. [ABSTRACT FROM AUTHOR]

Background. The unexpected admission of a loved one to an intensive care unit (ICU) may have a negative effect on the everyday lives of family members, as they have had little time to adjust. Hence, it is imperative for healthcare professionals to promote optimal outcomes for both the patient and family members during admission for critical illness. Objective. To explore and describe the needs of families during critical illness and to develop methods to provide family care during a critical illness of a loved one. Methods. The Strauss and Corbin grounded theory approach was used. In-depth interviews with 16 intensive care nurses, 6 doctors and 9 family members in private and public settings were completed. Results. Five codes emerged using the characteristic coding in grounded theory. These were identified as information sharing; reassurance; striving for consolation; garnering of resources; and cultural and religious co-operation. Conclusion. This study elicited the needs of family members of ICU patients. Methods tailored around these needs were presented to support family members during a critical illness. [ABSTRACT FROM AUTHOR]

The South African Nursing Council promulgated the compulsory community service (CCS) policy, in regulation R765 of 2007, for nurses of the four-year diploma or degree in nursing. The implementation of the CCS policy takes place at public health institutions. There have been no studies to date on how nurse managers experience this process of the CCS policy implementation. The findings of the study will inform future changes to the policy, such as guidelines for nurse managers on how to handle community nurse practitioners (CNPs) that are placed in their institutions. This study explores the experiences of nurse managers with nurses who are placed at their institutions to carry out compulsory community service. Descriptive qualitative design was used to gather data from nurse managers using individual interviews and data were analysed using Tesch's content analysis. The main categories that were identified were: valuing the CNPs, role modelling behaviours, benefiting from mentoring, dealing with challenges and following the process. The community nurse practitioners were valued by two groups of nurse managers. Support and professional development were provided on an ad hoc basis, leading to inconsistencies in their management. The following are recommended: the guidelines of the CCS policy to provide structured guidelines for the development of the CNPs during the CCS year; mentorship for the CNPs that is evaluated at regular intervals through formalised reports; and a scope of practice for the CNPs. [ABSTRACT FROM AUTHOR]

Introduction: South Africa has unenviable rates of violent crime and low rates of conviction and prosecution. Contributing to this is the poor collection of medical evidence by health workers. Methods: A quantitative exploratory descriptive survey using a questionnaire was carried out with nurses, either registered or enrolled with the South African Nursing Council, who had a minimum of 6 months experience in the Emergency Department. The Emergency Departments of two provincial (state) and two private hospitals, as well as two comprehensive care clinics (state) were used. Results: The findings revealed that most of the forensic tasks to be performed by the Emergency Department nurses were rated as never or seldom done and this was due to a lack of training and knowledge in the field of forensic nursing. The respondents did however indicate that forensic nursing was very important to their daily activities in the Emergency Departments. Discussion: Emergency nurses in South Africa are facing new challenges in acquiring the skills to effectively care for crime victims. It is becoming extremely important for these nurses to correctly manage the forensic evidence, as failure to do so can have far reaching legal consequences. [Copyright &y& Elsevier]