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‘Stolen Time’—Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia

The research has reported a high prevalence of low-quality and missed care for patients with community-acquired pneumonia (CAP). Optimised nursing treatment and care will benefit CAP patients. The aim of this study was to describe the barriers and facilitators influencing registered nurses’ (RNs’) a...

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Autores principales: Eekholm, Signe, Samuelson, Karin, Ahlström, Gerd, Lindhardt, Tove
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8620708/
https://www.ncbi.nlm.nih.gov/pubmed/34828571
http://dx.doi.org/10.3390/healthcare9111524
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author Eekholm, Signe
Samuelson, Karin
Ahlström, Gerd
Lindhardt, Tove
author_facet Eekholm, Signe
Samuelson, Karin
Ahlström, Gerd
Lindhardt, Tove
author_sort Eekholm, Signe
collection PubMed
description The research has reported a high prevalence of low-quality and missed care for patients with community-acquired pneumonia (CAP). Optimised nursing treatment and care will benefit CAP patients. The aim of this study was to describe the barriers and facilitators influencing registered nurses’ (RNs’) adherence to evidence-based guideline (EBG) recommendations for nursing care (NC) for older patients admitted with CAP. Semi-structured focus group interviews (n = 2), field observations (n = 14), and individual follow-up interviews (n = 10) were conducted in three medical units and analysed by a qualitative content analysis. We found a main theme: ‘‘stolen time’—delivering nursing at the bottom of a hierarchy’, and three themes: (1) ‘under the dominance of stronger paradigms’, (2) ‘the loss of professional identity’, and (3) ‘the power of leadership’. These themes, each comprising two to three subthemes, illustrated that RNs’ adherence to EBG recommendations was strongly influenced by the individual RN’s professionalism and professional identity; contextual barriers, including the interdisciplinary team, organisational structure, culture, and evaluation of the NC; and the nurse manager’s leadership skills. This study identified central factors that may help RNs to understand the underlying dynamics in a healthcare setting hindering and facilitating the performance of NC and make them better equipped for changing practices.
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spelling pubmed-86207082021-11-27 ‘Stolen Time’—Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia Eekholm, Signe Samuelson, Karin Ahlström, Gerd Lindhardt, Tove Healthcare (Basel) Article The research has reported a high prevalence of low-quality and missed care for patients with community-acquired pneumonia (CAP). Optimised nursing treatment and care will benefit CAP patients. The aim of this study was to describe the barriers and facilitators influencing registered nurses’ (RNs’) adherence to evidence-based guideline (EBG) recommendations for nursing care (NC) for older patients admitted with CAP. Semi-structured focus group interviews (n = 2), field observations (n = 14), and individual follow-up interviews (n = 10) were conducted in three medical units and analysed by a qualitative content analysis. We found a main theme: ‘‘stolen time’—delivering nursing at the bottom of a hierarchy’, and three themes: (1) ‘under the dominance of stronger paradigms’, (2) ‘the loss of professional identity’, and (3) ‘the power of leadership’. These themes, each comprising two to three subthemes, illustrated that RNs’ adherence to EBG recommendations was strongly influenced by the individual RN’s professionalism and professional identity; contextual barriers, including the interdisciplinary team, organisational structure, culture, and evaluation of the NC; and the nurse manager’s leadership skills. This study identified central factors that may help RNs to understand the underlying dynamics in a healthcare setting hindering and facilitating the performance of NC and make them better equipped for changing practices. MDPI 2021-11-09 /pmc/articles/PMC8620708/ /pubmed/34828571 http://dx.doi.org/10.3390/healthcare9111524 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Eekholm, Signe
Samuelson, Karin
Ahlström, Gerd
Lindhardt, Tove
‘Stolen Time’—Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia
title ‘Stolen Time’—Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia
title_full ‘Stolen Time’—Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia
title_fullStr ‘Stolen Time’—Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia
title_full_unstemmed ‘Stolen Time’—Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia
title_short ‘Stolen Time’—Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia
title_sort ‘stolen time’—delivering nursing at the bottom of a hierarchy: an ethnographic study of barriers and facilitators for evidence-based nursing for patients with community-acquired pneumonia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8620708/
https://www.ncbi.nlm.nih.gov/pubmed/34828571
http://dx.doi.org/10.3390/healthcare9111524
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