Exploring psychological safety as a component of facilitation within the Promoting Action on Research Implementation in Health Services framework

Donna Brown, Brendan McCormack

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims and objectives. To use holistic facilitation to create psychologically safe spaces to enable the nursing team to critically analyse practice and consider ways to enhance patient care.Background. Internationally the challenge and complexity of changing healthcare practices for enhanced patient care is the focus of much attention. Facilitation is emerging as an important approach to assist nursing teams to explore their practice, if they are to improve the care. Within the Promoting Action on Research Implementation in Health Services (PARIHS) framework, facilitation is a key element of operationalising collaborative changes in practice. This paper uses the framework to explore holistic facilitation and the concept of psychological safety. Design. An Emancipatory Action Research approach was used to open critical dialogue and enable the nursing team to explore their practice .Methods. Individual and group facilitated critical reflective sessions were undertaken with the nursing team working in a surgical unit that conducted complex abdominal surgery. In addition, the researcher maintained a reflexive journal. Data was analysed using thematic analysis. Eighty-five percent (n = 48) of nursing staff participated in the two-year project. Results. Holistic facilitation encompasses working with practitioners to support and enable them to improve practice and take action. In environments where weak leadership, deficient support mechanisms and oppressed behaviours are evident, there is a need to create psychologically safe spaces. Psychological safety helps to cultivate a climate in which individuals and groups feel safe to engage in the difficult conversations and challenges required to explore practice. This in turn can enable the nursing team to more effectively undertake appropriate actions to enhance person-centred practices with older people. Conclusions. The additional element of psychological safety needs to be incorporated into facilitation models, in particular the PARIHS framework, to more accurately reflect the complexities of working with practitioners in practice.
LanguageEnglish
Pages2921-2932
JournalJournal of Clinical Nursing
Volume25
Issue number19-20
Early online date15 Aug 2016
DOIs
Publication statusE-pub ahead of print - 15 Aug 2016

Fingerprint

Team Nursing
Health Services Research
Health Services
Psychology
Safety
Patient Care
Nursing Staff
Climate
Research Personnel
Delivery of Health Care

Keywords

  • Key words. PARIHS framework
  • psychological safety
  • holistic facilitation
  • leadership
  • oppression
  • culture

Cite this

@article{2da330268c7246ee8fb1e84c4f158caa,
title = "Exploring psychological safety as a component of facilitation within the Promoting Action on Research Implementation in Health Services framework",
abstract = "Aims and objectives. To use holistic facilitation to create psychologically safe spaces to enable the nursing team to critically analyse practice and consider ways to enhance patient care.Background. Internationally the challenge and complexity of changing healthcare practices for enhanced patient care is the focus of much attention. Facilitation is emerging as an important approach to assist nursing teams to explore their practice, if they are to improve the care. Within the Promoting Action on Research Implementation in Health Services (PARIHS) framework, facilitation is a key element of operationalising collaborative changes in practice. This paper uses the framework to explore holistic facilitation and the concept of psychological safety. Design. An Emancipatory Action Research approach was used to open critical dialogue and enable the nursing team to explore their practice .Methods. Individual and group facilitated critical reflective sessions were undertaken with the nursing team working in a surgical unit that conducted complex abdominal surgery. In addition, the researcher maintained a reflexive journal. Data was analysed using thematic analysis. Eighty-five percent (n = 48) of nursing staff participated in the two-year project. Results. Holistic facilitation encompasses working with practitioners to support and enable them to improve practice and take action. In environments where weak leadership, deficient support mechanisms and oppressed behaviours are evident, there is a need to create psychologically safe spaces. Psychological safety helps to cultivate a climate in which individuals and groups feel safe to engage in the difficult conversations and challenges required to explore practice. This in turn can enable the nursing team to more effectively undertake appropriate actions to enhance person-centred practices with older people. Conclusions. The additional element of psychological safety needs to be incorporated into facilitation models, in particular the PARIHS framework, to more accurately reflect the complexities of working with practitioners in practice.",
keywords = "Key words. PARIHS framework, psychological safety, holistic facilitation, leadership, oppression, culture",
author = "Donna Brown and Brendan McCormack",
note = "Reference text: REFERENCES Apekey TA, McSorley G, Tilling M, & Siriwardena AN (2011) Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice. Journal of Evaluation in Clinical Practice 17, 311–318. Brown D & McCormack B (2011) Developing the practice context to enable more effective pain management with older people: an action research approach. Implementation Science 6:9 Doi:10.1186/1748-5908-6-9 Botti M, Kent B, Bucknall T, Duke M, Johnstone MJ, Considine J, Redley B, Hunter S, de Steiger R, Holcombe M, & Cohen E (2014) Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee or total hip replacement: Study rationale and design. Implementation Science 9: 110 Doi:10.1186/s13012-014-0110-3 Carmeli A, Brueller D & Dutton, JE (2008) Learning Behaviours in the Workplace: The Role of High-quality Interpersonal Relationships and Psychological. Safety Systems Research and Behavioural Science 26, 81-98. Cohen L, Manion L & Morrison K (2011) Research Methods in Education. 7th edn. Routledge, New York. Dogherty EJ, Harrison NB & Graham ID (2010) Facilitation as a Role and Process in Achieving Evidence-Based Practice in Nursing: A Focused Review of Concept and Meaning. Worldviews on Evidence-Based Nursing 7, 76–89. Dubois C, D’Amour D, Pomey M, Girard F & Brault, I. (2013) Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review. BioMed Central Nursing 12:7 Doi: 10.1186/1472-6955-12-7 Dixon-Woods M, Baker R, Charles K, Dawson J, Jerzembek G, Martin G, McCarthy I, McKee L, Minion J, Ozieranski P, Willars J, Wilkie P & West M. (2013) Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. BMJ Quality and Safety 0:1–10. Doi:10.1136/bmjqs-2013-001947 Edmondson A. (2012) Teaming: How Organisations learn, innovate and compete in the knowledge economy. Jossey Bass, San Francisco. Edmondson A C (1999) Psychological safety and learning behaviour in work teams. Administrative Science Quarterly 44, 350–383. Francis R.(2013) Report of the Mid- Staffordshire NHS Foundation Trust Public Inquiry: Analysis of evidence and lessons learned. The Stationary Office, London. Guba EG & Lincoln Y S (1981) Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches. Jossey-Bass, San Francisco. CA. Harvey J & Kitson, A (2015) Implementing Evidence-Based Practice in Healthcare: A facilitation guide. Routledge, Oxon. Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B, & Seers K. (2002). Getting evidence into practice: The role and function of facilitation. Journal of Advanced Nursing 37, 577-588. Huang C & Jiang P (2012) Exploring the psychological safety of R&D teams: An empirical analysis in Taiwan. Journal of Management & Organization 18, 175–192. Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich PM & Stetler CB (2010) A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implementation Science 2, 5:82 Doi:10.1186/1748-5908-5-82 Heslop, L. and Lu, S. 2014. Nursing-sensitive indicators: a concept analysis. Journal of Advanced Nursing, 70 (11), 2469-2482. Janes N, Fox M, Lowe M, McGilton K & Schindel-Martin L (2009) Facilitating best practice in aged care: exploring influential factors through critical incident technique. International Journal of Older People Nursing 4, 166–176. Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K & Titchen A (2008) Evaluating the successful implementation of evidence into practice using the PARIHS framework: theoretical and practical challenges Implementation Science 3:1 Doi:10.1186/1748-5908-3-1 Kitson A. (2007) Guest Editorial: What influences the use of research in clinical practice. Nursing Research 56, S1-S3 (Supplement). Kitson A, Harvey G, & McCormack B. (1998) Enabling the implementation of evidence based practice: A conceptual framework. Quality in Health Care 7, 149-158. Law R, Dollard MF, Tuckey MR & Dormann C (2011) Psychological safety climate moderated harassment and bullying behaviours and negative relationships between harassment and bullying and engagement. Accident Analysis and Prevention 43, 1782-1793. Maben J, Adams M, Peccei M, Murrells T & Robert G. (2012) ‘Poppets and parcels’: the links between staff experience of work and acutely ill older peoples’ experience of hospital care. International Journal of Older People Nursing 7, 83–94 Doi:10.1111/j.1748-3743.2012.00326 Manias E, Gerdtz M, Williams A, & Dooley M (2014) Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards. Journal of Clinical Nursing 24, 69–80. Manley K, Sanders K, Cardiff S & Webster J (2011) Effective workplace culture: the attributes, enabling factors and consequences of a new concept. International Practice Development Journal 1, 1-29 Available at: http://www.fons.org/library/journal.aspx Manley K, Titchen A & Hardy S. (2009) Work-based learning in the context of contemporary health care education and practice: a concept analysis. Practice Development in Health Care 8, 87-127. Meyer J, Spilsbury K & Prieto J. (2000) Comparison of findings from a single case in relation to those from a systematic review of action research. Nurse Researcher 7, 37-53. McCance T, McCormack, B & Dewing J. (2011) An exploration of person-centredness in practice. The Online Journal of Issues in Nursing 16, Manuscript 1. McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, & Seers K (2002) Getting evidence into practice: The meaning of ‘context.’ Journal of Advanced Nursing 38, 94-104. Powell A & Davies H (2012) The struggle to improve patient care in the face of professional boundaries. Social Science and Medicine 75, 807- 814. Rycroft-Malone J, Seers K, Chandler J, Hawkes CA, Crichton N, Allen C, Bullock I & Strunin L.= (2013) The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implementation Science 8:28 Doi:10.1186/1748-5908-8-28 Rycroft-Malone J, Harvey J, Kitson A, McCormack B, Seers K, & Titchen A (2002) Getting evidence into practice: Ingredients for change. Nursing Standard 16, 38-43. Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A, & McCormack B. (2004). What counts as evidence in evidence-based practice? Journal of Advanced Nursing 47, 81-90. Schein EH (2010) Organisational Culture and Leadership. 4th edn. Jossey Bass, San Francisco. Schepers J, Jong A, Wetzels, M & Ruyter K (2008) Psychological safety and social support in groupware adoption: A multi-level assessment in education. Computers & Education 51, 757–775. Siemsen E, Roth AV, Balasubramanian S & Anand G (2009) The Influence of Psychological Safety and Confidence in Knowledge on Employee Knowledge Sharing. Manufacturing and Service Operations Management 11, 429–447. Senge P, Scharmer CO, Jaworski J & Flowers BS (2005). Presence: Exploring profound change in people, organisations and society. Nicholas Brealey Publishing, London. Shian M, Arnold I & Germ, AK (2012) The Road to psychological safety: legal, scientific and social functions for a Canadian National Standard on psychological safety in the workplace. Bulletin of Science, Technology and Society 32, 142-162. Stetler CB, Damschroder LJ, Helfrich CD & Hagedorn HJ (2011) A Guide for applying a revised version of the PARIHS framework for implementation. Implementation Science 6:99 Doi:10.1186/1748-5908-6-99. Ward V, House A & Hamer S. (2009) Developing a framework for transferring knowledge into action: a thematic analysis of the literature. Journal Health Service Research Policy 14, 156–164. Weaver Moore L, Leahy C, Sublett C & Lanig H (2013) Understanding Nurse-to-Nurse Relationships and Their Impact on Work Environments. Medical Surgical Nursing 22, 172-179. West M, Eckert R, Stewart K & Pasmore B. (2014) Developing collective leadership for healthcare. The Kings Fund. London. Wilson V, McCormack B, & Ives G.(2005) Understanding the workplace culture of a special care nursery. Journal of Advanced Nursing 50, 27-38.",
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Exploring psychological safety as a component of facilitation within the Promoting Action on Research Implementation in Health Services framework. / Brown, Donna; McCormack, Brendan.

In: Journal of Clinical Nursing, Vol. 25, No. 19-20, 15.08.2016, p. 2921-2932.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Exploring psychological safety as a component of facilitation within the Promoting Action on Research Implementation in Health Services framework

AU - Brown, Donna

AU - McCormack, Brendan

N1 - Reference text: REFERENCES Apekey TA, McSorley G, Tilling M, & Siriwardena AN (2011) Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice. Journal of Evaluation in Clinical Practice 17, 311–318. Brown D & McCormack B (2011) Developing the practice context to enable more effective pain management with older people: an action research approach. Implementation Science 6:9 Doi:10.1186/1748-5908-6-9 Botti M, Kent B, Bucknall T, Duke M, Johnstone MJ, Considine J, Redley B, Hunter S, de Steiger R, Holcombe M, & Cohen E (2014) Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee or total hip replacement: Study rationale and design. Implementation Science 9: 110 Doi:10.1186/s13012-014-0110-3 Carmeli A, Brueller D & Dutton, JE (2008) Learning Behaviours in the Workplace: The Role of High-quality Interpersonal Relationships and Psychological. Safety Systems Research and Behavioural Science 26, 81-98. Cohen L, Manion L & Morrison K (2011) Research Methods in Education. 7th edn. Routledge, New York. Dogherty EJ, Harrison NB & Graham ID (2010) Facilitation as a Role and Process in Achieving Evidence-Based Practice in Nursing: A Focused Review of Concept and Meaning. Worldviews on Evidence-Based Nursing 7, 76–89. Dubois C, D’Amour D, Pomey M, Girard F & Brault, I. (2013) Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review. BioMed Central Nursing 12:7 Doi: 10.1186/1472-6955-12-7 Dixon-Woods M, Baker R, Charles K, Dawson J, Jerzembek G, Martin G, McCarthy I, McKee L, Minion J, Ozieranski P, Willars J, Wilkie P & West M. (2013) Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. BMJ Quality and Safety 0:1–10. Doi:10.1136/bmjqs-2013-001947 Edmondson A. (2012) Teaming: How Organisations learn, innovate and compete in the knowledge economy. Jossey Bass, San Francisco. Edmondson A C (1999) Psychological safety and learning behaviour in work teams. Administrative Science Quarterly 44, 350–383. Francis R.(2013) Report of the Mid- Staffordshire NHS Foundation Trust Public Inquiry: Analysis of evidence and lessons learned. The Stationary Office, London. Guba EG & Lincoln Y S (1981) Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches. Jossey-Bass, San Francisco. CA. Harvey J & Kitson, A (2015) Implementing Evidence-Based Practice in Healthcare: A facilitation guide. Routledge, Oxon. Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B, & Seers K. (2002). Getting evidence into practice: The role and function of facilitation. Journal of Advanced Nursing 37, 577-588. Huang C & Jiang P (2012) Exploring the psychological safety of R&D teams: An empirical analysis in Taiwan. Journal of Management & Organization 18, 175–192. Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich PM & Stetler CB (2010) A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implementation Science 2, 5:82 Doi:10.1186/1748-5908-5-82 Heslop, L. and Lu, S. 2014. Nursing-sensitive indicators: a concept analysis. Journal of Advanced Nursing, 70 (11), 2469-2482. Janes N, Fox M, Lowe M, McGilton K & Schindel-Martin L (2009) Facilitating best practice in aged care: exploring influential factors through critical incident technique. International Journal of Older People Nursing 4, 166–176. Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K & Titchen A (2008) Evaluating the successful implementation of evidence into practice using the PARIHS framework: theoretical and practical challenges Implementation Science 3:1 Doi:10.1186/1748-5908-3-1 Kitson A. (2007) Guest Editorial: What influences the use of research in clinical practice. Nursing Research 56, S1-S3 (Supplement). Kitson A, Harvey G, & McCormack B. (1998) Enabling the implementation of evidence based practice: A conceptual framework. Quality in Health Care 7, 149-158. Law R, Dollard MF, Tuckey MR & Dormann C (2011) Psychological safety climate moderated harassment and bullying behaviours and negative relationships between harassment and bullying and engagement. Accident Analysis and Prevention 43, 1782-1793. Maben J, Adams M, Peccei M, Murrells T & Robert G. (2012) ‘Poppets and parcels’: the links between staff experience of work and acutely ill older peoples’ experience of hospital care. International Journal of Older People Nursing 7, 83–94 Doi:10.1111/j.1748-3743.2012.00326 Manias E, Gerdtz M, Williams A, & Dooley M (2014) Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards. Journal of Clinical Nursing 24, 69–80. Manley K, Sanders K, Cardiff S & Webster J (2011) Effective workplace culture: the attributes, enabling factors and consequences of a new concept. International Practice Development Journal 1, 1-29 Available at: http://www.fons.org/library/journal.aspx Manley K, Titchen A & Hardy S. (2009) Work-based learning in the context of contemporary health care education and practice: a concept analysis. Practice Development in Health Care 8, 87-127. Meyer J, Spilsbury K & Prieto J. (2000) Comparison of findings from a single case in relation to those from a systematic review of action research. Nurse Researcher 7, 37-53. McCance T, McCormack, B & Dewing J. (2011) An exploration of person-centredness in practice. The Online Journal of Issues in Nursing 16, Manuscript 1. McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, & Seers K (2002) Getting evidence into practice: The meaning of ‘context.’ Journal of Advanced Nursing 38, 94-104. Powell A & Davies H (2012) The struggle to improve patient care in the face of professional boundaries. Social Science and Medicine 75, 807- 814. Rycroft-Malone J, Seers K, Chandler J, Hawkes CA, Crichton N, Allen C, Bullock I & Strunin L.= (2013) The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implementation Science 8:28 Doi:10.1186/1748-5908-8-28 Rycroft-Malone J, Harvey J, Kitson A, McCormack B, Seers K, & Titchen A (2002) Getting evidence into practice: Ingredients for change. Nursing Standard 16, 38-43. Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A, & McCormack B. (2004). What counts as evidence in evidence-based practice? Journal of Advanced Nursing 47, 81-90. Schein EH (2010) Organisational Culture and Leadership. 4th edn. Jossey Bass, San Francisco. Schepers J, Jong A, Wetzels, M & Ruyter K (2008) Psychological safety and social support in groupware adoption: A multi-level assessment in education. Computers & Education 51, 757–775. Siemsen E, Roth AV, Balasubramanian S & Anand G (2009) The Influence of Psychological Safety and Confidence in Knowledge on Employee Knowledge Sharing. Manufacturing and Service Operations Management 11, 429–447. Senge P, Scharmer CO, Jaworski J & Flowers BS (2005). Presence: Exploring profound change in people, organisations and society. Nicholas Brealey Publishing, London. Shian M, Arnold I & Germ, AK (2012) The Road to psychological safety: legal, scientific and social functions for a Canadian National Standard on psychological safety in the workplace. Bulletin of Science, Technology and Society 32, 142-162. Stetler CB, Damschroder LJ, Helfrich CD & Hagedorn HJ (2011) A Guide for applying a revised version of the PARIHS framework for implementation. Implementation Science 6:99 Doi:10.1186/1748-5908-6-99. Ward V, House A & Hamer S. (2009) Developing a framework for transferring knowledge into action: a thematic analysis of the literature. Journal Health Service Research Policy 14, 156–164. Weaver Moore L, Leahy C, Sublett C & Lanig H (2013) Understanding Nurse-to-Nurse Relationships and Their Impact on Work Environments. Medical Surgical Nursing 22, 172-179. West M, Eckert R, Stewart K & Pasmore B. (2014) Developing collective leadership for healthcare. The Kings Fund. London. Wilson V, McCormack B, & Ives G.(2005) Understanding the workplace culture of a special care nursery. Journal of Advanced Nursing 50, 27-38.

PY - 2016/8/15

Y1 - 2016/8/15

N2 - Aims and objectives. To use holistic facilitation to create psychologically safe spaces to enable the nursing team to critically analyse practice and consider ways to enhance patient care.Background. Internationally the challenge and complexity of changing healthcare practices for enhanced patient care is the focus of much attention. Facilitation is emerging as an important approach to assist nursing teams to explore their practice, if they are to improve the care. Within the Promoting Action on Research Implementation in Health Services (PARIHS) framework, facilitation is a key element of operationalising collaborative changes in practice. This paper uses the framework to explore holistic facilitation and the concept of psychological safety. Design. An Emancipatory Action Research approach was used to open critical dialogue and enable the nursing team to explore their practice .Methods. Individual and group facilitated critical reflective sessions were undertaken with the nursing team working in a surgical unit that conducted complex abdominal surgery. In addition, the researcher maintained a reflexive journal. Data was analysed using thematic analysis. Eighty-five percent (n = 48) of nursing staff participated in the two-year project. Results. Holistic facilitation encompasses working with practitioners to support and enable them to improve practice and take action. In environments where weak leadership, deficient support mechanisms and oppressed behaviours are evident, there is a need to create psychologically safe spaces. Psychological safety helps to cultivate a climate in which individuals and groups feel safe to engage in the difficult conversations and challenges required to explore practice. This in turn can enable the nursing team to more effectively undertake appropriate actions to enhance person-centred practices with older people. Conclusions. The additional element of psychological safety needs to be incorporated into facilitation models, in particular the PARIHS framework, to more accurately reflect the complexities of working with practitioners in practice.

AB - Aims and objectives. To use holistic facilitation to create psychologically safe spaces to enable the nursing team to critically analyse practice and consider ways to enhance patient care.Background. Internationally the challenge and complexity of changing healthcare practices for enhanced patient care is the focus of much attention. Facilitation is emerging as an important approach to assist nursing teams to explore their practice, if they are to improve the care. Within the Promoting Action on Research Implementation in Health Services (PARIHS) framework, facilitation is a key element of operationalising collaborative changes in practice. This paper uses the framework to explore holistic facilitation and the concept of psychological safety. Design. An Emancipatory Action Research approach was used to open critical dialogue and enable the nursing team to explore their practice .Methods. Individual and group facilitated critical reflective sessions were undertaken with the nursing team working in a surgical unit that conducted complex abdominal surgery. In addition, the researcher maintained a reflexive journal. Data was analysed using thematic analysis. Eighty-five percent (n = 48) of nursing staff participated in the two-year project. Results. Holistic facilitation encompasses working with practitioners to support and enable them to improve practice and take action. In environments where weak leadership, deficient support mechanisms and oppressed behaviours are evident, there is a need to create psychologically safe spaces. Psychological safety helps to cultivate a climate in which individuals and groups feel safe to engage in the difficult conversations and challenges required to explore practice. This in turn can enable the nursing team to more effectively undertake appropriate actions to enhance person-centred practices with older people. Conclusions. The additional element of psychological safety needs to be incorporated into facilitation models, in particular the PARIHS framework, to more accurately reflect the complexities of working with practitioners in practice.

KW - Key words. PARIHS framework

KW - psychological safety

KW - holistic facilitation

KW - leadership

KW - oppression

KW - culture

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DO - 10.1111/jocn.13348

M3 - Article

VL - 25

SP - 2921

EP - 2932

JO - Journal of Clinical Nursing

T2 - Journal of Clinical Nursing

JF - Journal of Clinical Nursing

SN - 0962-1067

IS - 19-20

ER -