Physical restraint in mental health nursing: A concept analysis

Objective: Physical restraint is frequently used in medical services,such as in mental health settings,intensive care units and nursing homes,but its nature varies in different institutions.By reviewing related literature,this study aims to clarify the concept of physical restraint in mental health nursing.Method: Three databases (PubMed,PsyclNFO and CINAHL) were retrieved,and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing.Results: Physical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement.It should be the last option used by qualified personnel.Antecedents of physical restraint are improper behavior (violence and disturbance) of patients,medical assessment prior to implementation and legislation governing clinical usage.Consequences of physical restraint are alleviation of conflict,physical injury,mental trauma and invisible impact on the institution.Discussion: This study defined the characteristics of physical restraint in mental health nursing.The proposed concept analysis provided theoretical foundation for future studies.

Advancing the quality of care and nursing practice through emancipatory reflection

Reflection is a fundamental skill of health-care professionals and plays an important role in ensuring the quality of care in health-care practice. It is believed that undertaking reflection in practice can help nurses develop an awareness of a sense of personal power and agency, cultivate their critical thinking ability and help them promote their professional development. However, reflection has not been introduced widely as a nursing curriculum in China, and literature shows that some clinical nurses lack critical thinking skills and critical reflective practice skills by reason of not receiving systematic education on reflection when they were at nursing college.Therefore, we present a series of seven articles focused on prevalent and interesting practice-based events to reflect on in this special issue. The main aim is to disseminate reflective methodology and techniques and present examples of reflective writing for nurses.It is expected that these articles will help to lead Chinese nurses to adopt critical emancipatory reflective processes to bring about transformative actions.

Using action research to evaluate a nursing orientation program in a multicultural acute healthcare setting

Objectives:Competence motivates newly employed nurses to provide high-quality care,which leads to appropriate patient care and satisfaction.A nursing orientation program can have a positive impact on new nurses who are joining healthcare organizations.The research examined the orientation program for new nurses in a multicultural setting to redesign the program.Methods:The study was carried out in a multicultural tertiary setting.Action research was used as a research strategy with qualitative content analysis and quantitative evaluation.Seventy nurses were part of the orientation program.The competence of the nurses was assessed using the Nurse Competence Scale.Focus-group discussions were also conducted to find the views of the beneficiaries about the program.Results:The study revealed that the overall competence was high,and there was an overall gain in the competence score(5.48%)among the nurses.Among their competence in different dimensions,new nurses had a maximum gain in competence for the dimension of ensuring quality.However,they showed low competence gain in teaching coaching.The results show that the difference in the overall pre-and post-test scores was statistically significant(P<0.05)in all dimensions except teaching coaching and managing situations,and the program was effective.However,a few challenges were identified in the program.Conclusions:New nurses were found to be competent,and the orientation program had a significant impact on the competence of the nurses.The findings emphasized the need for modification of some content and strategy for future programs.The strategies developed from the findings were presented.This helps hospitals to consider examining specific aspects of the orientation program and redesigning it so it can enrich the experiences of new nurses.

Prevalence of social media addiction among nursing students

Objective:The objective of this study was to assess the prevalence and level of social media addiction among nursing students in the Faculty of Nursing,Cairo University.Materials and Methods:A descriptive cross‑sectional research design was conducted on samples of 340 students at the Faculty of Nursing,Cairo University.Data were collected through demographic background information sheet and Social Networking Addiction Scale.Results:All the students were addicted as 6.76%were severely addicted and 60.59%and 32.65%were moderately and mildly addicted,respectively.Significant relations were found between social media addiction and students’age(χ^(2)=11.331,P=0.003),educational level(χ^(2)=20.239,P=0.003),and grade point average(χ^(2)=19.378,P=0.013).Conclusion:Internet addiction was prevalent among all students but at different levels,so early screening of students for Internet addiction using the Internet Addiction Scale is important to provide early treatment and prevent hazards to health.

The Progress of Case Teaching Method for Postgraduate Nursing Education

The development of postgraduate nursing education is a major tendency of the nursing industry in the future.Cultivation method is closely related to the progress of nursing postgraduate talents.In order to provide proper education support,this article reviews the progress of the development of case teaching method in postgraduate nursing education,the concept of case teaching,the development status around the world.Moreover,this review specially reviewed the application process of case teaching method.

Emancipatory reflection on a nursing practice-based ethical issue about nurses' paternalistic decision-making for patients

Objective: This study aimed to demonstrate and promote the skill of critical emancipatory reflection through reflecting on a nursing practice-based ethical issue about nurses' paternalistic decision-making for patients. Meanwhile, critical awareness will be developed and the underlying issues of paternalism in nursing decision-making will be analyzed. Then, by applying the procedure, improvement in nursing decision-making practice will be expected.Methods: Taylor's model of emancipatory reflection with four steps, including construction, deconstruction, confrontation, and reconstruction, is utilized to guide the author's reflection.Results: Guided by the socialization theory, the author's personal and professional socialization is seen to be associated with the formation of the value of paternalism. The theory of reflexivity is applied to unearth the related issues, including deeper personal value,work environment, as well as historical and cultural contexts. Moreover, the power derived from policy, work relationship, and nursing administration, which could induce paternalism in the author's nursing decision-making practice, was critically debated using the hegemony theory. Finally, new insights into paternalism will be achieved, which enable change in terms of how to facilitate patients' autonomous decision-making.Conclusions: The process of refection makes it clear that respecting patients' right and performing patient-centered caring are the bases to change the paternalism existing in the nursing decision-making practice currently. The reconstruction step assists the author in terms of how to value the patients' autonomy and balance patients' safety and choice, rather than being overprotective; carry out risk assessment, and search for strong evidence to counterbalance the positive and negative aspects of risk-taking; communicate with patients appropriately in a manner that they can comprehend; spend more time to explore patients' preference and choice; make every effort to elevate the patients' decision-making capacity; implement patient-centered care and shared decision-making in nursing practice; consult with other colleagues and obtain the required support when limitations or challenges exist; try to justify and avoid hidden paternalism behind policy or guidelines; deal with the power in hand well and fairly; and also positively face the powers that constrain the author.

Physical restraint using,autonomy,ethics among psychiatric patients in nursing practice in China

The application of physical restraint for patients represents ethical dilemmas for psychiatric nurses in terms of maintaining the safety of all(clients and staff)while at the same time curtailing the individual’s autonomy.This article aimed to provide a sound knowledge of ethical positions and strategies for psychiatric nurses to address ethical issues of physical restraint according to the ethical principles of autonomy,beneficence,nonmaleficence,and ethical theories.Given that nursing workforce was limited and workload among psychiatric nurses was heavy,physical restraint was one of the coercive interventions managing aggressive behavior.In relation to address ethical dilemmas,it was proposed to acquire informed consent of physical restraint from the individuals and provide person‑centered care.Effective communication and negotiation with patients could help to strike a balance between patients’autonomy and nurses’accountability when using physical restraint.In addition,guidelines and targeted intervention strategies need to be developed to regulate and reduce the implementation of restraint.Finally,a collaboration among nurses,psychiatrists,and families is essential to protect patients’autonomy concerning physical restraint use.

Johns Hopkins循证护理实践模式的研究进展

系统介绍了Johns Hopkins循证护理实践模式,包括3大关键要素,即实践、教育和研究;其核心是证据,分为研究型证据和非研究型证据;以及众多内因和外因。阐述了循证实践的3阶段流程即实践问题、证据生成和证据转化以及国内外应用进展,旨在为我国护理人员开展循证护理实践、教育和研究提供思路和方法指导。另一方面,在实践过程中加强该模式与其他循证护理实践模式的相互比较,并根据我国国情对该模式进行不断地测试和修订,加强该模式理解、应用和实践项目成效报道,并根据不同研究目的和临床情景来发展其概念框架是未来发展方向。

Telehealth utilization among Egyptian population and health institutional readiness:An exploratory study

Objective:This study aimed to assess the public’s perspectives and the health institutions’readiness for telehealth utilization in Egypt.Methods:A cross-sectional study design was employed,and data were collected from a convenient sample of 800 Egyptian citizens and 26 nursing administrators and information technology personnel from 16 governmental hospitals and 10 private hospitals between January and March 2022.The Egyptian community utilization of telehealth questionnaire and the telemedicine hospital readiness assessment were used to collect the data.Results:The results revealed that 35.1%of the general Egyptian population used telehealth services and 43%expressed willingness to use them in future.As perceived by the general Egyptian population,the most prevalent barriers to telehealth utilization were communication barriers(97.6%),lack of confidence in health professionals(77.6%),technological limitations(72.5%),the need for physical examination(25%),and privacy concerns(10%).Regarding hospital readiness,42%of governmental hospitals were not taking any initiative to implement telehealth services,and 15.4%were at the beginner level,meaning that some steps had been taken.However,the hospital was still far from being able to implement telehealth services.In contrast,private hospitals were either at the beginner or advanced level.Conclusion:Although the use of telehealth services in Egypt has increased,there is a need to address the barriers to public utilization and improve hospitals’readiness to implement telehealth services to enhance public usage.

A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas:A cross-sectional study

Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.

Nurse trainees' perception of effective clinical instructor characteristics

Objectives:Clinical education and experience in the clinical environment play an important role in shaping the clinical experience.Effective clinical teaching improves the clinical practice of the nursing trainees which in turn improves the quality of patient care.It mandates for the clinical instructor with desired qualities,to have a positive influence in clinical education.This study examined nurse trainees'perceptions of clinical instructor characteristics.Methods:The current study was conducted in a multi-cultural tertiary setting using a cross-sectional descriptive design.Using convenience sampling,302 trainees were chosen as participants for the study,and there were 296 respondents.The data were collected from the participants using the Nursing Clinical Teacher Effectiveness Inventory(NCTEI)tool.Results:The findings of the study revealed that the clinical instructors have scored high in personality(scoring percentage=84.0%)and relatively low in teaching ability(scoring percentage=81.3%).Also,the overall perception was almost the same among all the trainees though there was a slight variation in their rating of each dimension.Conclusions:Nursing trainees indicated the instructors as having good personality and relatively low teaching ability.This mandates the clinical instructors in the clinical environment to empower themselves in this area of improvement.This helps the teaching institutions to consider all the domains of effective clinical instructor characteristics while recruitment and also organize programs giving emphasis on building and developing these characteristics to create effective instructors.

Critical emancipatory reflection on a practice-based issue in relation to the working relationship between doctors and nurses in China

Objective: Reflection is viewed as the most significant skill and should be advocated for lifelong learning. In order to grasp the process of reflection and embrace the reflective skill, one of the authors of this paper reflects on a practice-based issue in relation to the communication between doctors and nurses, to gain new understanding and thus improve the authors' clinical practice.Methods: Smyth's framework with four stages is utilized as an ideal framework to guide the author's reflection on the practice-based issue to free the author from her entrenched assumptions and the oppressive forces that limit her practice.Results: The espoused and enacted theory, together with the critical reflection theory, are used to explore the values and beliefs that essentially govern the author's practice and how these are distinct from the author's worldviews. Following this, critical emancipatory reflection is undertaken to explore the dominant power structures within the author's workplace. Furthermore, given the hegemonic and chaotic working context of this issue, hegemony and symbolic interaction theory are applied to unearth the various hidden constraining and oppressive forces. Additionally, socialization theory is utilized to help the author achieve professional identity.Conclusions: Reconstructing the practice-based issue empowers the author to realize that in the future, she should act as a reflective practitioner, creating a daily habit, staying alert to practice, seeing things freshly, finding support systems, improving communication skills, conducting reflective research, and reifying reflective practice. Ultimately, the author will be sufficiently equipped to be able to transform her practice and change its outcomes.

Physical restraints:An ethical dilemma in mental health services in China

Given that physical restraints cause adverse effects to patients and nurses,their wide and frequent use has resulted in various clinical and ethical controversies in mental health services.The rate of physical restraints is significantly higher in China than in other countries.Some western and domestic media blamed relevant institutions for compromising the basic rights of psychiatric patients.Therefore,this study aims to collect and synthesize the relevant ethical evidence and to provide corresponding guidance for the nursing practice based on the current situation of the mainland of China.This study synthesized the ethical issue according to the ethical principle of autonomy,justice,beneficence,and nonmaleficence.Given the current situation where the nursing workforce is limited and the mental health service is under-developed in China,applying physical restraints in the psychiatric inpatients to guarantee the safety of patients and nurses is crucial.In regard to respect the basic rights of psychiatric patients,it is recommended to protect the their autonomy,and eliminate the adverse effects of physical restraint.This goal would be achieved by ensuring the informed consent,providing humane care,and regulating the implementation of physical restraints.

Critical Thinking Disposition among Nurses Working in Puplic Hospitals at Port-Said Governorate

Aim: This study aimed to investigate critical thinking disposition among nurses working in Public Hospitals in Port-Said Governorate.Methods: A descriptive research design was conducted in this study. Totally 196 respondents were chosen by systemic random sampling, to take part in the study as the sample. Data was collected from April to September in 2015. Tools of data collection: A personal and job characteristics data sheet and California Critical Thinking Disposition Inventory(CCTDI) were used. Results: The results revealed that the total critical thinking disposition score mean was 257.05 ± 20.16 and the highest score mean was 48.67 ± 6.28 for inquisitiveness subscale, while the lowest score mean was 21.36 ± 7.19 for the truth-seeking subscale. Also, none of the personal&job characteristics showed statistically significant relations with the total critical thinking disposition. Conclusion: More than three quarters of the nurses had an ambivalent disposition toward critical thinking, and most nurses' scores indicated a negative tendency towards truth-seeking. So the findings pointed for upgrading nurses' critical thinking through educational programs and a need for more problem-based learning with advanced teaching strategies in clinical areas.

Critical emancipatory reflection on a practice-based issue in relation to nurses' communicative role with unsatisfied clients in Chinese hospitals

Objective: This study aims to use reflective theory and critical emancipatory theory to explore nurses' communicative role with unsatisfied clients.Methods: This paper begins with the broad issue, and the analysis will engage Smyth's cycle, which includes describing, analyzing,exploring, and reconstructing.Results: Critical emancipatory reflection is essential to make changes in the professional practice of nursing, because it is of primary importance for the professional learning and development of a nurse.Conclusions: Critical emancipatory reflection helps a nurse to analyze the constraints, including historical, sociocultural, political, and personal aspects.

Clinical leadership behaviors among critical care nurses in private and governmental hospital:A cross-sectional survey

Objectives This study aimed to investigate clinical leadership behaviors among critical care nurses and compare the differences between nurses in private and public hospitals.Methods A cross-sectional survey including 365 critical care nurses with a bachelor’s degree in nursing science were recruited in two Egyptian hospitals(a government teaching hospital and one private hospital from January to March 2019.A socio-demographic characteristics form and the Clinical Leadership Behaviors Questionnaire(CLB-Q)were used to collect data.For comparison and analysis,the mean score was calculated and converted to a percentage value.Results Results showed that the overall mean score of nurses’clinical leadership behaviors was 77.11±11.87,the level was higher,and the highest score of the communication dimension was 91.84±7.38.The mean score of nurses at a private hospital(90.48±5.53)was higher than that at a government teaching hospital(68.29±4.21)(P<0.001).On nursing experience,nurses with 5–10 years had higher mean score in self-awareness,advocacy and empowerment,decision making,quality and safety,teamwork,and clinical excellence dimension of clinical leadership behavior than those who worked less than 5 years or more than 10 years(P<0.01).Single nurses had higher mean score in advocacy and empowerment,decision making,quality and safety,and clinical excellence dimension of clinical leadership behavior than those who married(P<0.01).Conclusions Nurse managers should foster clinical leadership by enabling critical care nurses to practice clinical excellence and encouraging their attendance in training programs on quality and safety.Nurses in government hospitals need improvement in clinical leadership behaviors regarding all dimensions.

Occupational burnout in nurses:a concept analysis

Objective:This paper aims to clarify the concept of occupational burnout(OB)as well as develop appropriate methods to relieve or prevent OB in the nursing profession.Methods:Walker and Avant's eight-step approach of concept analysis was applied.Results:OB was defined as a chronic form of work-related stress.Accurately,it was characterized by emotional exhaustion,depersonalization/cynicism,and reduced personal accomplishment/inefficacy.Antecedents of burnout included(a)demographic characteristics;(b)chronic exposure to work-related stressors;(c)quantitative and qualitative job demands;(d)lack of job resources;and(e)personality traits.Consequences involved(a)individual’s unfavorable quality of life;(b)negative impact on the organization;and(c)poor services quality.Although the Maslach Burnout Inventory(MBI)is perceived as an ideal tool to measure burnout and hence,it is used worldwide,whether this instrument fits to measure this concept for nurses has still not yet been verified and thus further research is needed.Conclusions:By proposing a comprehensive definition of the concept,this analysis contributes to recognition of the process of OB of nurses.All nurses are vulnerable to OB.Hence,burnout in nursing needs to be recognized as a critical factor in the delivery of safe patient care.It proposes that the prevention of OB would be achieved through team communication training,mindfulness group,education,etc.

Safety and Quality of Care Evaluation in Japanese Long-Term Facilities Focused on the Activity Condition and Cognitive Function of Residents

Objective: Currently, standards for evaluating long-term care facilities do not exist in Japan. This study aimed to evaluate the quality of healthcare services in Japan’s long-term care facilities and identify the structural and process indicators associated with the facilities’ outcome indicators. Methods: This retrospective study assessed changes in residents’ abilities to participate in physical activities, their cognitive function, and their vulnerability to injuries. From 2012 to 2013, we collected information on the healthcare services at 1067 long-term care facilities registered with Japan’s Welfare, Health and Medical Care Information Network in the Welfare and Medical Service Agency. We examined 12 structural indicators, 26 process indicators, and 7 outcome indicators. We used multivariate linear regression models adjusted to analyze relationships between outcome indicators and structural or process indicators. Results: Residents’ activity and cognitive function indicators either improved by 80% - 90% or were maintained for one year. The Geriatric Functional Independence Measures, the Barthel Index, and holding conferences related to care were all considered activities of daily living. Three adverse events—tumbles and falls, behavioral problems, and aimless wandering or leaving the facility without permission—were factors that restricted residents’ behavior and number of residents per care staff member. Conclusions: Maintaining or improving levels of independence and cognition in daily living requires a care process system that enables ongoing monitoring of residents’ activities of daily living and cognitive functioning. Ensuring the safety of residents and improving the quality of care in long-term care facilities without securing adequate care staff are not possible.

Relationship of Job Satisfaction with Perceived Organizational Support and Quality of Care among Saudi Nurses

Background: Both, job satisfaction with quality of provided health care is considered the main issue which directly influences the health care field because if nurses do not give the quality care to their patients then the patient dissatisfaction increased. Job satisfaction is defined as the extent of workers’ contentedness with their job, either they like the job or individual aspects or facets of jobs, such as type of work or regulation. Objective: To assess nurses’ job satisfaction and perceived organizational support with their effect on quality of provided health care in Saudi Arabia. Methods: Nurses in Saudi Arabia governmental hospitals during the period from 1st March to 30th April 2020 were invited and consecutively included. Data were collected using online questionnaire. Results: The study included 355 nurses with their ages ranged from 25 to 55 years old. Females were 216 (60.8%) of the total participants. Exact of 267 (75.2%) nurses reported that they like the type of work they do, 245 (69%) provided with satisfactory equipment to accomplish my task. There was a significant relation between organizational support and job satisfaction with their effect on quality of care. Conclusion: Organizational support positively affected nonsatisfaction which in turn positively affected quality of delivered care.

The impact of sleep quality on reported anxiety and fatigue among shift nurses: The mediating role of resilience

Aims:The aim of this article is to explore the relation of sleep quality,anxiety status,fatigue level and psychological resilience among rotating‑shift nurses,thus,to propose solutions and promote physical and psychological health of shift nurses.Methods:The cross‑sectional survey was performed on 263 clinical nurses recruited from three tertiary hospitals of Xinxiang City,Henan Province,China from October 2017 to June 2018.The questionnaire survey was conducted using Pittsburgh Sleep Quality Index(PSQI)for measuring nurses’sleep quality,connor‑davidson resilience scale(CD‑RISC)for measuring their psychological resilience,self‑rating anxiety scale(SAS)for measuring their anxiety status,and Fatigue‑14 Scale for measuring their fatigue.The relationship among above indicators were analysed using Pearson correlation analysis.The mediating effect of psychological resilience on the process of sleep quality impacting anxiety and fatigue was analyzed using Wen’s causual steps method and linear regression.Results:The mean CD‑RISC score of shift nurses was 57.76±11.90,which indicated that resilience level was at a medium level.The mean of PSQI,SAS and total fatigue score was(7.53±2.83),(50.56±9.57)and(7.81±9.42),respectively.Resilience could negatively predict the anxiety state(β=−0.366,P<0.01)and fatigue(β=−0.197,P<0.01).Sleep quality could positively predict anxiety(β=0.395,P<0.01)and fatigue level(β=0.495,P<0.01)for shift nurses.The mediating effects of resilience upon sleep quality and anxiety or fatigue was 0.044 and 0.026,respectively.Conclusion:The resilience could fuel sleep quality and reduce the occurrence of negative emotion and fatigue among shift nurses.