Annotated Bibliography

Bakar, N. A. H., Isahak, F. H., Saiful, F. M., & Zolkefli, Y. (2020). Shift Handover Practices Among Nurses in Medical Wards: A Qualitative Interview Study. INTERNATIONAL JOURNAL OF CARE SCHOLARS, 3(2), 41-49.

This article explains the shift handover practices in between shifts and at end of shifts by nurses, errors in communication can cause harm to patients. The purpose of this study is to identify the effectiveness of handover and barriers to effective handover. The authors are doctors and research teachers in nursing universities who have been teaching several student nurses and doctors for a long time. They used a descriptive qualitative interview study technique and performed a number of interviews among nurses recruited from different wards of a hospital in Brunei. This article highlighted the importance of an effective handover and its direct impact on a patient’s health recovery and outcome. After analysing the data, the result revealed three main themes: multiple handover styles, the use of handover tools, and handover distractions. The first theme described the handovers given by the bay in charge (who covers 6-9 patients) and nurses’ handovers that happen three times a day after every shift change. The nurses also explained the importance of bay-in-charge handover that it helps them to reduce error and divide the workload. The second theme focused on the use of the ISBAR tool to give handover and according to nurses this tool has a positive effect and helps them to exchange information concisely and accurately. The third theme shed light on situations that lead to errors in documentation and missing things from handover due to interruptions of calls from patients or family concerns or workload. One statement was made by a nurse in this article that it is the duty of every shift-changing nurse to double-check the notes and records of patients before making rounds in the ward. This ensures that nothing is missed and the patient is not harmed by any means of miscommunication, whether verbally or as charted. The authors argued about the effectiveness of handover given at the bedside of the patient, which is more strengthening and encouraging patient-centred care, further helping to maintain patients’ dignity and autonomy. A contradictory statement was made by nurses stating, bedside handover is more time-consuming and more distracting due to family members’ query interruptions and it usually results in errors in the exchange of information. Another prospect discussed in this article was related to updating the records of patient transfer by using standardized resources to help nurses to provide coordinated information and have less chance of missing information, protecting patients from getting any harm in terms of treatment, care, and medication. This article illustrated handover practices are inconsistent according to each ward even in one organization. The limitation in this article was the usage of a single language to collect data, while few nurses were bilingual and translators were used for recording answers, which might result in a slight change in the information conveyed. However, this article has shown that maintaining records and exchanging patient information during any time of handover ( linking to case study supporting errors made in documentation during the transfer of patient), should be accurate and considered of utmost importance to protect the patient from getting any harm, instead helping in the easy recovery.

Barroso Gaspar, R., Miranda da Silva, M., Moraes Zepeda, K. G., & Silva, Í. R. (2019). Nurses defending the autonomy of the elderly at the end of life. Revista Brasileira de Enfermagem, 72(6), 1639–1645. https://doi-org.ezproxy.ecu.edu.au/10.1590/0034-7167-2018-0768

The authors of this article described how nurses deal with elder patients’ autonomy at end-of-life. This article put emphasis on reserving patients’ right to make their own choice for life, despite the fact, that they are dependent on care or not. The data was collected using a qualitative, exploratory study, guided by the Grounded Theory. At a university hospital in Brazil, 8 doctors, 10 nurses, and 15 nursing technicians were interviewed. The authors have worked in other research and have the reliable experience to share this knowledge. Data was collected by semi-structured interviews and non-participant observation and data was analysed in subcategories under the main category entitled “Establishing actions and interactions to defend the elderly’s autonomy in palliative care at the end of life”. The outcomes revealed that patients, families, and healthcare providers need to establish a relationship of trust. Along with this, it is the responsibility of the nurse to understand the elderly’s desires and reasons for denial, advocating on their behalf and creating conditions for the elderly to participate in decision-making. The study highlighted the importance of teamwork in the decision-making process, seeking help from physicians and other healthcare professionals to provide the best outcome for their patients. An argument was made regarding leadership nurses to defend the elderly’s autonomy, it explains that nurses should have openness to listening to the elderly because they trust them and can express more about their thoughts if provided with openness to dialogue. Apart from this, the study revealed that conflicts and disagreements commonly occur, when a patient or family member is not informed or is poorly informed. This article also states the importance of national health policy, which states that full rights of the elderly’s autonomy should be preserved and they should be asked, informed, and given the opportunity to participate in decision-making, instead of relying on family members’ decisions. It can be observed from the study that the author is compelling to emphasize that there are few barriers in healthcare facilities to promote the elder patient’s autonomy, which relates to the case study scenario, in which false expectations were generated and this study found the reason behind this, professional paternalism and unpreparedness to define diagnosis and prognosis. This article is limited to one form of validation method for research and a small group of participants. However, this study is useful for every healthcare member in terms of respecting the elderly’s autonomy during end-of-life care and the key responsibility is of the nurse to advocate and involve the patient, and family to take decisions rather than concentrating on the doctor.

Tia, M. B., Aziato, L., & Dzansi, G. (2022). Exploring Ghanaian nurses knowledge and application of bio-ethical principles in postoperative pain management. PLOS ONE, 17(10), 1-13. https://doi.org/10.1371/journal.pone.0276422

The authors of this article explored the understanding and knowledge of Ghanaian nurses related to bio-ethical principles (autonomy, justice, beneficence, and non-maleficence) and how to apply them in the nursing care setting. The researchers developed a qualitative exploratory descriptive design and recruited nurses as their participants from the surgical ward and collected data related to ethics. This study described how nurses apply these principles to manage the pain of post-operative patients. The authors and researchers are experts in this field as they are affiliated with the University of Ghana and have educated several nursing students. The special feature of this research article is an interview guide, which was designed using the open-end question format. This allowed nurses to openly express their views regarding ethical principles. To collect data, nurses were interviewed and their answers were categorized under three main categories, which are: autonomy, justice, and beneficence. The nurses responded that patients should always be given opportunities to choose and make decisions on their own. In the article, a statement was made by a nurse that patients should be explained everything and involved in whatever is done to them so that they can participate in decision-making and choose the right thing for them. This is how the study describes about the implementation of nurses’ knowledge related to ethical principles. Another answer was related to justice and no discrimination among patients. Amongst the participants, one nurse stated that patients should be treated equally and fairly despite their ethnicity, race, and religion, implementing knowledge about justice. Another statement was highlighted by another nurse that patients should be treated without any discrimination and medications should be administered timely, which relates to the case study of Mrs. Miller, where a nurse breached the principle of justice for her patient by not doing observations and medication. Apart from this, researchers also found that nurses whom they interview are applying their best knowledge to advocate for their patients and do benefit them to get the best outcomes for their health. Along with these principles, nurses sometimes go as far as their limits to provide beneficence to their patients. The uniqueness of this article is that researchers have interviewed the nurses and elaborated answers were taken, which broadens the aspect of exploring. However, it is only limited to the post-operative ward, while nurses in other sectors may not have the same level of knowledge. According to the analysis, it is clear that general nurses in Ghana have a higher level of understanding as compared to clinical nurses. The information and knowledge about these principles as described by participants show that nurses should always prioritize their patients. This article is useful to inform nurses of the case study about the lack of knowledge about ethical principles and showing unethical behaviour. These wrong implementations of knowledge can cause greater harm to patients and the nurse can lose the registration.

Wang, S., Jiang, Z., Zhang, Z., Chen, L., Zhao, X., Wang, F., Chen, Y., & Yang, X. (2022). The status of ethical behaviour in clinical nursing in three Chinese hospitals: A qualitative interview study. Journal of Nursing Management, 30(7), 2424–2433. https://doi.org/10.1111/jonm.13810

This article discusses the different behaviours of nurses in a clinical setting and what factors lead them to show ethical and unethical behaviours. The purpose of this research was to find contributing factors to the unethical behaviour of nurses and to do so, researchers conducted an in-depth semi-structured interview, and a focus group was recruited including 21 head nurses and 9 nurses. The authors are reliable experts in their field as they have been working as professors or lecturers in the faculty of nursing in medical colleges and hospitals for a long time. This article is unique as researchers have tried to conduct interviews face to face for 120-150 minutes and telephone interviews for 15-16 minutes, the outline was developed on the basis of basic principles of ethics for nurses: care, justice, non-maleficence, and respect. After analysing data, results revealed data under seven themes. Firstly, “the lack of awareness of the protection of patients’ privacy”, needs to be improved by nurses according to this study, as many nurses don’t shield the ill patients properly and sometimes their private parts are exposed, and sometimes clinical nurses share chats about their patient’s exposure, which needs to be considered strictly to protect the privacy and maintain the confidentiality of their patients. The second theme revealed “violation of patients’ autonomy”, this study found that nurses choose patients’ outcomes over patients’ autonomy, as explained by a few participant nurses that despite patients’ objection, they restrain them because of the concern for patients’ extubation. Along with this comes the next theme that is divided into two parts: “negligence at work causes harm to patients” and “improper communication”. The researchers found that nurses do harm patients due to their carelessness, one of the nurses stated that she observed one patient, whose skin was necrotic due to drug extravasation because the nurse didn’t observe the patient timely and no rounds were made, which teaches other nurses as well as healthcare professionals to consider their sense of responsibility and never neglect patient. Moreover, the result revealed that one of the most important causative factors for the unethical behaviour of nurses is workload. Nurses usually ignore the emotional status and other factors related to care for patients and show unethical behaviour because of a greater number of patients or the number of treatments to perform, consequently, this will cause harm to patients and they will not recover or might worsen the situation. This study is only limited to nurses recruited from one hospital in China, whereas this research needs to be followed up further to test the extent to which these findings can be applied to similar groups. This study is useful for all nurses, and other researchers and can be linked to case studies in terms of negligence and communication errors.