‘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:	Signe Eekholm, Karin Samuelson, Gerd Ahlström, Tove Lindhardt
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	evidence-based practice fundamental care nurse manager nursing care nursing practice organisational behaviour Medicine R
Acceso en línea:	https://doaj.org/article/09ac515575874ddcbcca260bdd8bbe9f
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spelling	oai:doaj.org-article:09ac515575874ddcbcca260bdd8bbe9f2021-11-25T17:45:32Z‘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 Pneumonia10.3390/healthcare91115242227-9032https://doaj.org/article/09ac515575874ddcbcca260bdd8bbe9f2021-11-01T00:00:00Zhttps://www.mdpi.com/2227-9032/9/11/1524https://doaj.org/toc/2227-9032The 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 (<i>n</i> = 2), field observations (<i>n</i> = 14), and individual follow-up interviews (<i>n</i> = 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.Signe EekholmKarin SamuelsonGerd AhlströmTove LindhardtMDPI AGarticleevidence-based practicefundamental carenurse managernursing carenursing practiceorganisational behaviourMedicineRENHealthcare, Vol 9, Iss 1524, p 1524 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	evidence-based practice fundamental care nurse manager nursing care nursing practice organisational behaviour Medicine R
spellingShingle	evidence-based practice fundamental care nurse manager nursing care nursing practice organisational behaviour Medicine R Signe Eekholm Karin Samuelson Gerd Ahlström Tove Lindhardt ‘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
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 (<i>n</i> = 2), field observations (<i>n</i> = 14), and individual follow-up interviews (<i>n</i> = 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.
format	article
author	Signe Eekholm Karin Samuelson Gerd Ahlström Tove Lindhardt
author_facet	Signe Eekholm Karin Samuelson Gerd Ahlström Tove Lindhardt
author_sort	Signe Eekholm
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_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_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_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
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/09ac515575874ddcbcca260bdd8bbe9f
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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

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