Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework

Jangland, Eva; Teodorsson, Therese; Molander, Karin; Athlin, Åsa Muntlin

doi:10.1111/jocn.14095

Cited by 55 publications

(67 citation statements)

References 28 publications

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“…This gap between different managers and the solely medical perspective are worrying. Nurse managers in all leading positions need to seize the initiative and take on the responsibility to ensure that nursing perspectives come to be as prioritised as the medical perspective (Jangland, Teodorsson, Molander, & Muntlin Athlin, ; Kitson et al, ). Nurse managers need to take more initiative in promoting a holistic and high‐quality evidence‐based fundamental care.…”

Section: Discussionmentioning

confidence: 99%

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Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain

Tegelberg

Jangland

Juhlin

et al. 2019

Journal of Clinical Nursing

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Aim and objectives To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care. Background Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high‐quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high‐quality fundamental care across the acute care chain. Design Qualitative descriptive semi‐structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used. Methods Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro‐ and macrolevels across the acute care chain. Results The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models. Conclusions The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal. Relevance to clinical practice Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence‐based and high‐quality care.

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Section: Discussionmentioning

confidence: 99%

“…Nurse managers in all leading positions need to seize the initiative and take on the responsibility to ensure that nursing perspectives come to be as prioritised as the medical perspective (Jangland, Teodorsson, Molander, & Muntlin Athlin, 2018;Kitson et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain

Tegelberg

Jangland

Juhlin

et al. 2019

Journal of Clinical Nursing

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“…Recent studies revealed an individual's awareness and management of diseases are affected by family habits with regard to seeking treatment consultation, availability of healthcare resources, access to subsidised health care and traditional treatment culture. Additionally, these studies emphasised that, in the patients' opinion, personal factors cannot overcome illnesses attributed to environmental factors, such as the lack of sports facilities in the working environment (Bhandari & Kim, ), health care providers' attitudes (Lee et al, ), linguistic barriers (Lee et al, ; Stanford, Biba, Khubchandani, Webb, & Rathore, ) and the lack of a supportive care environment for different cultures (Jangland, Teodorsson, Molander, & Muntlin, ).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, these studies emphasised that, in the patients' opinion, personal factors cannot overcome illnesses attributed to environmental factors, such as the lack of sports facilities in the working environment (Bhandari & Kim, 2016), health care providers' attitudes (Lee et al, 2017), linguistic barriers (Lee et al, 2017;Stanford, Biba, Khubchandani, Webb, & Rathore, 2016) and the lack of a supportive care environment for different cultures (Jangland, Teodorsson, Molander, & Muntlin, 2018).…”

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confidence: 99%

Environmental factors affecting self‐management of chronic hepatitis B from the patients’ perspective

Lin

Lee²,

Yang

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To explore factors affecting self‐management experiences of patients with chronic hepatitis B within their social and cultural environments. Background Many cases of hepatitis B are not detected until they are in end‐stage liver disease. Despite an increasing trend of indicating a lack of health awareness as the reason, studies have rarely referred to the personal, social and cultural environmental constraints from patients' perspectives. Design A descriptive qualitative study. Methods Forty‐seven adults diagnosed with chronic hepatitis B were interviewed in a private area of a hospital clinic in Taiwan in 2018. Four open‐ended questions relating to care self‐management included the following: disease detection; disease control; preventive care; and perceptions of screening and follow‐ups. Data were examined using content analysis. This study also adhered to the consolidated COREQ guidelines. Results Five main themes emerged: personal experiences, awareness of occupational health, the availability of conventional treatment, cultural beliefs about health care and family roles. Findings of note were that some participants became aware that they had never known the difference between follow‐up for hepatitis B and regular adult/labourer health checks due to a lack of information within their living environment. Many participants added alternative treatments to their self‐management strategies and others frequently ignored follow‐up appointments because of different cultural health beliefs. Conclusions Patients’ disease self‐management perceptions are driven by dynamic influences suggesting that development of policies integrating personal, family, social and cultural environmental factors could enhance individual screening and subsequent health behaviours of patients with chronic hepatitis B. Relevance to practice Adding person‐centred case management of hepatitis B could enhance patients’ adherence to follow‐up. Attention should be given to increasing provider awareness of the influence of their own attitude and communication on patients’ participation in self‐management.

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“…Negative sequelae are also exerted on nurses and include decreased job satisfaction, increased desire to leave and absenteeism (Gibbon & Crane, ; Papastavrou, Andreou, & Efstathiou, ; Verrall et al., ). Several contributing factors to this phenomenon including time, resource and staffing shortages, skill mix issues, increasing patient acuity and unsafe case‐ and workloads have been identified (Blackman et al., ; Jangland, Teodorsson, Molander, & Muntlin Athlin, ; Jones et al., ; Kalisch, Landstrom, & Hinshaw, ; Schubert et al., ). Working in such constrained conditions and with such constrained resources, renders missed care a veritable inevitability, resulting in inescapable adverse events, for which, Willis et al.…”

Section: Nursing Care – Are We Missing Something?mentioning

confidence: 99%

Missed Nursing Care: A Symptom of Missing Evidence

Cleary‐Holdforth

2019

Worldviews Ev Based Nurs

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Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework

Cited by 55 publications

References 28 publications

Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain

Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain

Environmental factors affecting self‐management of chronic hepatitis B from the patients’ perspective

Missed Nursing Care: A Symptom of Missing Evidence

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