Enhancing the management of deteriorating patients with Australian on line e-simulation software : Acceptability, transferability, and impact in Hong Kong
- Authors: Sparkes, Louise , Chan, Maggie , Cooper, Simon J. , Pang, Michelle , Tiwari, Agnes
- Date: 2016
- Type: Text , Journal article
- Relation: Nursing and Health Sciences Vol. 18, no. 3 (2016), p. 393-399
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- Description: International concerns relating to healthcare professionals’ failure to rescue deteriorating patients exist. Web-based training programs have been developed and evaluated in Western settings but further testing is required before application in non-Western countries, as traditional modalities of learning may differ between cultures. We trialed an Australian English language online simulation program for the management of deteriorating patients, Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTWeb), to test cultural acceptability, transferability, and educational impact. The study was designed as a quasi-experimental evaluation of the FIRST2ACTWeb program with final year nursing students from a Bachelor of Nursing program at the University of Hong Kong. Participants completed pre-course and post-course tests, three interactive scenarios, and program evaluations. The program was positively evaluated, with significant improvements in knowledge, skills, self-rating of performance, confidence, and competence. Outcomes were comparable to earlier evaluations with Australian students, demonstrating that an interactive simulation-based program of patient deterioration management has cultural and language acceptability and transferability across communities with significant educational impact. © 2016 John Wiley & Sons Australia, Ltd.
Exploration of nursing degree students’ content expectations of a dedicated Indigenous health unit
- Authors: Jacob, Elisabeth , Raymond, Anita , Jones, Janet , Jacob, Alycia , Drysdale, Marlene , Isaacs, Anton
- Date: 2016
- Type: Text , Journal article
- Relation: Collegian Vol. 23, no. 3 (2016), p. 313-319
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- Description: Mandatory Aboriginal and Torres Strait Islander health units are included in all nursing education programmes in Australia to improve students’ knowledge, skills and attitudes towards Indigenous people in order to help address health inequities. This research explores content expectations of nursing students required to undertake Aboriginal and Torres Strait Islander health studies as part of a Bachelor of Nursing Degree at a rural university campus. A cross-sectional survey was undertaken to examine students’ opinions of course content of an Aboriginal health and wellbeing unit. Two hundred and ninety-four students across the three years of the degree were asked to complete the anonymous survey. Two hundred and forty-six students (83.6%) completed the survey. One hundred and thirty-nine students had completed, and 107 students were yet to undertake the unit. Qualitative content analysis of an open-ended survey question was used to interrogate the data. Four themes emerged from the data: cultural competence, disease implications and management, nursing care and other issues. Content expectations were consistent for students who were yet to undertake (pre) or had completed (post) the unit. Content expectations included Aboriginal and Torres Strait Islander culture (pre 30.4%–post 29.8%), Aboriginal and Torres Strait Islander health issues (pre 20.0%–post 23.7%) and understanding nursing care related issues (pre 15.7%–post 17.1%). Data findings were significant for enhancing the current unit. Students express the need for a safe learning environment in which to challenge beliefs and opinions. Course facilitators need to be sensitive to student populations and include content relevant to the programme being studied. Cultural immersion experiences may improve confidence in nursing Aboriginal and Torres Strait Islander people. © 2015 Australian College of Nursing Ltd
Facilitators and barriers to evidence-based practice : Perceptions of nurse educators, clinical coaches and nurse specialists from a descriptive study
- Authors: Malik, Gulzar , McKenna, Lisa , Plummer, Virginia
- Date: 2016
- Type: Text , Journal article
- Relation: Contemporary Nurse Vol. 52, no. 5 (2016), p. 544-554
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- Description: Background: Implementation of evidence-based practice (EBP) is a major initiative within health care settings to ensure clinical and policy decisions incorporate best available evidence. Aims: This paper reports findings from a descriptive study exploring nurse educators’, clinical coaches’ and nurse specialists’ perceptions of factors associated with using EBP. Methods: Data was collected from a senior group of nurses working in a tertiary health care network in Victoria, Australia by employing a questionnaire that was distributed to a total of 435 people, of whom 135 responded. Data Analysis:Descriptive statistics for each questionnaire item were determined using SPSS (Statistical Package for Social Sciences version 17). Thematic analysis was performed for the qualitative part of the questionnaire. Results Findings revealed that organisational support, sufficient resources, and access to continuing education were perceived as factors promoting acceptance of EBP. Barriers to such acceptance in health care settings were identified as lack of knowledge and skills, poor time allowance, limited support, and insufficient resources. Conclusion: The reported findings create evidence-based information for organisational strategic planning. Organisations need to develop educational programs to promote EBP and employ strategies to overcome barriers to implementation. © 2016 Informa UK Limited, trading as Taylor & Francis Group.
Factors influencing community nursing roles and health service provision in rural areas : a review of literature
- Authors: Barrett, Annette , Terry, Daniel , Lê, Quynh , Hoang, Ha
- Date: 2016
- Type: Text , Journal article
- Relation: Contemporary Nurse Vol. 52, no. 1 (2016), p. 119-135
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- Description: Aims: This review sought to better understand the issues and challenges experienced by community nurses working in rural areas and how these factors shape their role. Methods: Databases were searched to identify relevant studies, published between 1990 and 2015, that focussed on issues and challenges experienced by rural community nurses. Generic and grey literature relating to the subject was also searched. The search was systematically conducted multiple times to assure accuracy. Results: A total of 14 articles met the inclusion criteria. This critical review identified common issues impacting community nursing and included role definition, organisational change, human resource, workplace and geographic challenges. Conclusion: Community nurses are flexible, autonomous, able to adapt care to the service delivery setting, and have a diversity of knowledge and skills. Considerably more research is essential to identify factors that impact rural community nursing practice. In addition, greater advocacy is required to develop the role. © 2016 Informa UK Limited, trading as Taylor & Francis Group.
Factors that affect the job satisfaction of Saudi Arabian nurses
- Authors: Alotaibi, Jazi , Paliadelis, Penny , Valenzuela, Fredy‐Roberto
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Nursing Management Vol. 24, no. 3 (2016), p. 275-282
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- Description: Background Saudi Arabia has a chronic shortage of Saudi national nurses. This research contributes to a greater understanding of how job satisfaction influences the recruitment and retention of Saudi nationals within the nursing profession. Methods Qualitative data were gathered from Saudi nurses and content analysis was used to identify themes in the written responses. Results Four main themes emerged from the data: lack of educational opportunities and support and the poor image of the nursing profession, perceptions of favouritism, high workloads and stressful work environment and the effect of religion on job satisfaction. Conclusions Saudi nurses would be more satisfied with their jobs if they had greater access to educational opportunities and if there was a reduction in workload and the perceived favouritism in the workplace was addressed. Religion was also found to play a significant role in supporting job satisfaction. Implications for nursing management These findings suggest the development of educational scholarships, as well as policies that better support equity in the workplace, to address Saudi nurses’ level of job satisfaction. The generally positive impact of cultural and religious beliefs is also highlighted in this study.
Graduate nurse program coordinators' perspectives on graduate nurse programs in Victoria, Australia : A descriptive qualitative approach
- Authors: Missen, Karen , McKenna, Lisa , Beauchamp, Alison
- Date: 2016
- Type: Text , Journal article
- Relation: Collegian Vol. 23, no. 2 (2016), p. 201-208
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- Description: Aims: The purpose of this study was to describe the formal preparation nursing graduates are given throughout their first year of nursing in terms of educational structure and content of work-based year-long graduate nurse programs, from the perspectives of Graduate Nurse Program Coordinators. Background: In Australia, graduate nurse programs aim to provide a supportive learning environment, assisting nursing graduates in applying their theory to practice and supporting them in becoming safe, competent and responsible professionals. Internationally, research has demonstrated an increase in the job satisfaction and more importantly retention rates of newly qualified nurses who are supported in their first year of employment in some type of transition program. Method: Using a descriptive qualitative approach, individual semi-structured interviews were used. These interviews were audio recorded, transcribed verbatim and thematically analysed to reveal themes and sub-themes. Results: The interviews provided an insight into the various aspects of preparation that nursing graduates are given in their first year of practice with the main theme to emerge from analysis, nature of transition programs. The three subthemes associated with nature of transition programs consisted of composition of rotations and study days and supernumerary strategies. Findings indicate variation in pedagogical models underpinning graduate nurse programs across Victoria. Clinical rotations varied between three to twelve months, the number of study days offered were between four and thirteen days and there was variation in supernumerary time and strategies within the programs investigated. © 2015 Australian College of Nursing Ltd.
Learning from clinical placement experience : Analysing nursing students' final reflections in a digital storytelling activity
- Authors: Paliadelis, Penny , Wood, Pamela
- Date: 2016
- Type: Text , Journal article
- Relation: Nurse Education in Practice Vol. 20, no. (2016), p. 39-44
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- Description: This paper reports on the learning potential of a reflective activity undertaken by final year nursing students, in which they were asked to recount two meaningful events that occurred during their clinical placements over the duration of their 3-year nursing degree program and reflect on how these events contributed to their learning to become beginning level Registered Nurses (RNs). This descriptive qualitative study gathered narratives from 92 students as individual postings in an online forum created within the University's learning management system. An analysis of the students' reflections are the focus of this paper particularly in relation to the value of reflecting on the identified events. Four themes emerged that clearly highlight the way in which these students interpreted and learned from both positive and negative clinical experiences, their strong desire to fit into their new role and their ability to re-imagine how they might respond to clinical events when they become Registered Nurses. The findings of this study may contribute to developing nursing curricula that better prepares final year students for the realities of practice. © 2016 Elsevier Ltd.
Nursing assessment of older people who are in hospital : Exploring registered nurses' understanding of their assessment skills
- Authors: Penney, Wendy , Poulter, Nola , Cole, Clare , Wellard, Sally
- Date: 2016
- Type: Text , Journal article
- Relation: Contemporary Nurse Vol. 52, no. 2-3 (2016), p. 313-325
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- Description: Background: Nurses worldwide are expected to take a leading role in caring for older people. Considerable literature dedicated to the range and application of assessment skills used by nurses vary. There is limited knowledge of registered nurses' (RNs) views of their assessment of older adults.Aim: The aim of this project was to explore RNs current perceptions of nursing assessment, and the core skills they identified as necessary.Design: A qualitative descriptive design study was conducted in three inpatient units in one regional hospital in Victoria.Method: Date were collected through participant observation of RNs (n = 13) followed by 1:1 semi-structured interviews. Data were analysed thematically.Conclusion: This research has illuminated that an ill-defined repertoire of skills was used by RNs when assessing older persons. Skills identified appeared to be based on years of personal-professional experience. Differences were noted between the descriptions nurses gave and what was observed during interactions with older persons.
Perceptions of NP Roles in Australia: Nurse Practitioners, managers, and policy Advisors
- Authors: Lowe, Grainne , Plummer, Virginia , Boyd, Leanne
- Date: 2016
- Type: Text , Journal article
- Relation: The Journal for Nurse Practitioners Vol. 12, no. 7 (2016), p. e303-e310
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- Description: The aim of this study was to explore perceptions of nurse practitioner (NP) roles from NP, nurse manager, and nurse policy adviser perspectives in Australia. A questionnaire formed phase 1 of a mixed methods study with 171 responses (36% response rate). Results show that, although there was a generally positive regard for NPs, there is evidence of a difference in perception between the stakeholder groups. The finding that nurse policy participants had a lower overall perception rating score is significant given this is the group that drives policy at the state and territory levels.
Qualified nurses' perceptions of nursing graduates' abilities vary according to specific demographic and clinical characteristics. A descriptive quantitative study
- Authors: Missen, Karen , McKenna, Lisa , Beauchamp, Alison , Larkins, Jo-Ann
- Date: 2016
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 45, no. (2016), p. 108-113
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- Description: Background: Evidence from the literature and anecdotally from clinical settings suggests that newly graduated nurses are not fully prepared to be independent practitioners in healthcare settings. Aims and Objectives: The aim of this studywas to explore perceptions of qualified nurses in relation to the practice readiness of newly registered nursing graduates and determine whether these views differ according to specific demographic characteristics, clinical settings, and geographical locations. Design: A descriptive quantitative design was used. Methods: An online survey tool was used to assess how qualified nurses (n = 201) in Victoria, Australia, rated newly graduated nurses' abilities on 51 individual clinical skills/competencies in eight key skill areas. A composite score was calculated for each skill area and a comparative analysis was undertaken on the various cohorts of participants according to their demographic and clinical characteristics using one-way ANOVA and post hoc tests. Results: Newly graduated nurses were found to be lacking competence in two key skill areas and were rated as performing adequately in the remaining six skill areas assessed. Significant differences (p ≤ 0.05) in performance were found according to the age of the nurse, number of years registered, the educational setting in which they undertook their nurse education, their role, and the clinical area inwhich theyworked. There were no significant differences according to whether the nurse worked in the private or public healthcare sector. Few differences were found between nurses working in a metropolitan vs. regional/rural healthcare setting. Conclusion: This is the first study to quantify the scale of this problem. Our findings serve as a reference for both nurse education providers and healthcare settings in better preparing nursing graduates to be competent, safe practitioners in all clinical areas.
Qualified nurses' rate new nursing graduates as lacking skills in key clinical areas
- Authors: Missen, Karen , McKenna, Lisa , Beauchamp, Alison , Larkins, Jo-Ann
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 25, no. 15-16 (2016), p. 2134-2143
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- Description: Aims and objectives: The aim of this study was to explore perceptions of qualified nurses on the abilities of newly registered nursing graduates to perform a variety of clinical skills. Background: Evidence from the literature suggests that undergraduate nursing programmes do not adequately prepare nursing students to be practice-ready on completion of their nursing courses. Design: A descriptive quantitative design was used. Methods: Participants were recruited through the Australian Nursing and Midwifery Federation, Victorian branch. A brief explanation of the study and a link to the survey were promoted in their monthly e-newsletter. A total of 245 qualified nurses in the state of Victoria, Australia participated in this study. A survey tool of 51 clinical skills and open-ended questions was used, whereby participants were asked to rate new nursing graduates' abilities using a 5-point Likert scale. Results: Overall participants rated new nursing graduates' abilities for undertaking clinical skills as good or very good in 35·3% of skills, 33·3% were rated as adequate and 31·4% rated as being performed poorly or very poorly. Of concern, essential clinical skills, such as critical thinking and problem solving, working independently and assessment procedures, were found to be poorly executed and affecting new registered nurses graduates' competence. Conclusion: The findings from this study can further serve as a reference for nursing education providers to enhance nursing curricula and work collaboratively with healthcare settings in preparing nurses to be competent, safe practitioners on completion of their studies. Relevance to clinical practice: Identifying key areas in which new nursing graduates are not yet competent means that educational providers and educators from healthcare settings can focus on these skills in better preparing our nurses to be work ready.
Registered nurses' perceptions of new nursing graduates' clinical competence : A systematic integrative review
- Authors: Missen, Karen , McKenna, Lisa , Beauchamp, Alison
- Date: 2016
- Type: Text , Journal article
- Relation: Nursing and Health Sciences Vol. 18, no. 2 (2016), p. 143-153
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- Description: Over the past decade, many questions have been raised about graduates' clinical competence and fitness for practice upon completion of their undergraduate education. Despite the significance of this issue, the perspectives of registered nurses have rarely been examined. This systematic review explores the perceptions of experienced registered nurses regarding the clinical competence of new nursing graduates. Original research studies published between 2004-2014 were identified using electronic databases, reference lists, and by searching "grey literature." Papers were critically reviewed and relevant data extracted and synthesized using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis. From 153 studies initially identified, 15 original research papers were included. Four main research themes were identified: clinical/technical skills, critical thinking, interaction/communication, and overall readiness for practice. Areas of concern in relation to the clinical competence of new nursing graduates specifically related to two themes: critical thinking and clinical/technical skills. Further research is required on strategies identified within the literature with the ultimate aim of ensuring new nursing graduates are safe and competent practitioners.
Sharing overdose data across state agencies to inform public health strategies : A case study
- Authors: Cherico-Hsii, Sara , Bankoski, Andrea , Singal, Pooja , Horon, Isabelle , Beane, Eric , Casey, Meghan , Rebbert-Franklin, Kathleen , Sharfstein, Joshua
- Date: 2016
- Type: Text , Journal article
- Relation: Public Health Reports Vol. 131, no. 2 (2016), p. 258-263
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- Description: Data sharing and analysis are important components of coordinated and cost-effective public health strategies. However, legal and policy barriers have made data from different agencies difficult to share and analyze for policy development. To address a rise in overdose deaths, Maryland used an innovative and focused approach to bring together data on overdose decedents across multiple agencies. The effort was focused on developing discrete intervention points based on information yielded on decedents' lives, such as vulnerability upon release from incarceration. Key aspects of this approach included gubernatorial leadership, a unified commitment to data sharing across agencies with memoranda of understanding, and designation of a data management team. Preliminary results have yielded valuable insights and have helped inform policy. This process of navigating legal and privacy concerns in data sharing across multiple agencies may be applied to a variety of public health problems challenging health departments across the country.
Stigma and developmental disabilities in nursing practice and education
- Authors: Whiteley, Annette , Kurtz, Donna , Cash, Penelope
- Date: 2016
- Type: Text , Journal article
- Relation: Issues in Mental Health Nursing Vol. 37, no. 1 (2016), p. 26-33
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- Description: Individuals with developmental disabilities (DD) experience stigma, discrimination, and barriers, including access to appropriate health care, that restrict their ability to be equal participants in society. In this study, underlying contexts, assumptions, and ways of acting are investigated that perpetuate inequalities and pejorative treatment toward those with disabilities. Several nurse researchers and educators suggest specific content for, or approaches to, education about DD. Critical pedagogy that employs cultural competency and a disability studies' framework to guide curriculum and course development will allow assumptions underlying common health care practices that oppress and other people with disabilities to be exposed and changed.
The first year : the support needs of parents caring for a child with an intellectual disability
- Authors: Douglas, Tracy , Redley, Bernice , Ottmann, Goetz
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 72, no. 11 (Nov 2016), p. 2738-2749
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A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB
- Authors: Bogossian, Fiona , Cooper, Simon J. , Cant, Robyn , Porter, Joanne , Forbes, Helen , McKenna, Lisa , Kinsman, Leigh , Endacott, Ruth , Devries, Brett , Philips, Nicole , Bucknall, Tracey , Young, Susan , Kain, Victoria
- Date: 2015
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 35, no. 10 (2015), p. e36-e42
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- Description: Background: High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students. Objectives: To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance. Design and setting: Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses. Participants: A population of 489 final-year nursing students in programs of study leading to license to practice. Methods: Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation.Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis. Results: Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation.Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R2=0.090, F(7, 352)=4.962, p<0.001. Discussion: The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning. Conclusion: The web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students. © 2015 Elsevier Ltd.
Attitude to the subject of chemistry in undergraduate nursing students at Fiji National University and Federation University, Australia
- Authors: Brown, Stephen , Wakeling, Lara , Peck, Blake , Naiker, Mani , Hill, Dolores , Naidu, Keshni
- Date: 2015
- Type: Text , Journal article
- Relation: Collegian Vol. 22, no. 4 (2015), p. 369-375
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- Description: Attitude to the subject of chemistry was quantified in first-year undergraduate nursing students, at two geographically distinct universities. A purpose-designed diagnostic instrument (ASCI) was given to students at Federation University, Australia (. n=. 114), and at Fiji National University, Fiji (. n=. 160). Affective and cognitive sub-scales within ASCI showed reasonable internal consistency. Cronbach's α for the cognitive sub-scale was 0.786 and 0.630, and 0.787 and 0.788 for affective sub-scale for the Federation University and Fiji National University students, respectively. Mean (SD) score for the cognitive sub-scale was 10.5 (5.6) and 15.2 (4.1) for students at Federation University and Fiji National University, respectively (. P<. 0.001, t-test). Mean (SD) score for the affective sub-scale was 13.1 (5.1) and 20.7 (4.3) for students at Federation University and Fiji National University, respectively (. P<. 0.001, t-test). An exploratory factor analysis (. n=. 274) confirmed a two-factor solution consistent with affective and cognitive sub-scales, each with good internal consistency. Quantifying attitude to chemistry in undergraduate nursing students using ASCI may have utility in assessing the impact of novel teaching strategies used in the education of nursing students in areas of bioscience and chemistry. However, geographically distinct populations of undergraduate nurses may show very different attitudes to chemistry. © 2014 Australian College of Nursing Ltd.
Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review
- Authors: Ghareeb, Amal , Cooper, Simon J.
- Date: 2015
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. In Press, no. (2015), p.
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- Description: Objective This integrative review identified, critically appraised and synthesised the existing evidence on the barriers and enablers to using high-fidelity Human Patient Simulator Manikins (HPSMs) in undergraduate nursing education. Background In nursing education, specifically at the undergraduate level, a range of low to high-fidelity simulations have been used as teaching aids. However, nursing educators encounter challenges when introducing new teaching methods or technology, despite the prevalence of high-fidelity HPSMs in nursing education. Design An integrative review adapted a systematic approach Data source Medline, CINAHL plus, ERIC, PsychINFO, EMBASE, SCOPUS, Science Direct, Cochrane database, Joanna Brigge Institute, ProQuest, California Simulation Alliance, Simulation Innovative Recourses Center and the search engine Google Scholar. Keywords were selected and specific inclusion/exclusion criteria applied. Inclusion criteria The review included all research designs for papers published between 2000 and 2015 that identified the barriers and enablers to using high-fidelity HPSMs in undergraduate nursing education. Review methods Studies were appraised using the Critical Appraisal Skills Programme criteria. Thematic analysis was undertaken and emergent themes were extracted. Results Twenty-one studies were included in the review. These studies adopted quasi-experimental, prospective non-experimental and descriptive designs. Ten barriers were identified, including ‘lack of time’, ‘fear of technology’ and ‘workload issues’. Seven enablers were identified, including ‘faculty training’, ‘administrative support’ and a ‘dedicated simulation coordinator’. Conclusion Barriers to simulation relate specifically to the complex technologies inherent in high-fidelity HPSMs approaches. Strategic approaches that support up-skilling and provide dedicated technological support may overcome these barriers.
Barriers and facilitators to accessing skilled birth attendants in Afar region, Ethiopia
- Authors: King, Rosemary , Jackson, Ruth , Dietsch, Elaine , Hailemariam, Asseffa
- Date: 2015
- Type: Text , Journal article
- Relation: Midwifery Vol. 31, no. 5 (2015), p. 540-546
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- Description: Objective: to explore barriers and facilitators that enable women to access skilled birth attendance in Afar Region, Ethiopia. Design: researchers used a Key Informant Research approach (KIR), whereby Health Extension Workers participated in an intensive training workshop and conducted interviews with Afar women in their communities. Data was also collected from health-care workers through questionnaires, interviews and focus groups. Participants: fourteen health extension workers were key informants and interviewers; 33 women and eight other health-care workers with a range of experience in caring for Afar childbearing women provided data as individuals and in focus groups. Findings: participants identified friendly service, female skilled birth attendants (SBA) and the introduction of the ambulance service as facilitators to SBA. There are many barriers to accessing SBA, including women's low status and restricted opportunities for decision making, lack of confidence in health-care facilities, long distances, cost, domestic workload, and traditional practices which include a preference for birthing at home with a traditional birth attendant. Key conclusions: many Afar men and women expressed a lack of confidence in the services provided at health-care facilities which impacts on skilled birth attendance utilisation. Implications for practice: ambulance services that are free of charge to women are effective as a means to transfer women to a hospital for emergency care if required and expansion of ambulance services would be a powerful facilitator to increasing institutional birth. Skilled birth attendants working in institutions need to ensure their practice is culturally, physically and emotionally safe if more Afar women are to accept their midwifery care. Adequate equipping and staffing of institutions providing emergency obstetric and newborn care will assist in improving community perceptions of these services. Most importantly, mutual respect and collaboration between traditional birth attendants (Afar women's preferred caregiver), health extension workers and skilled birth attendants will help ensure timely consultation and referral and reduce delay for women if they require emergency maternity care. © 2015 Elsevier Ltd.
Care of patients in emergency department waiting rooms - an integrative review
- Authors: Innes, Kelli , Jackson, Debra , Plummer, Virginia , Elliott, Doug
- Date: 2015
- Type: Text , Journal article , Review
- Relation: Journal of Advanced Nursing Vol. 71, no. 12 (2015), p. 2702-2714
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- Description: Aim: To conduct an integrative review of primary research examining patient care roles introduced into emergency department waiting rooms. Background: Internationally, emergency departments are under pressure to meet increasing patient demand with limited resources. Several initiatives have been developed that incorporate a healthcare role in waiting rooms, to assess and initiate early interventions to decrease waiting times, detect patient deterioration and improve communication. The literature reporting these roles has not been systematically evaluated. Design: Integrative review. Data sources: Published English-language peer reviewed articles in CINAHL, Scopus, Medline and Web of Knowledge between 2003-2014. Review methods: Identified literature was evaluated using an integrative review framework, incorporating methodological critique and narrative synthesis of findings. Results: Six papers were included, with three waiting room roles identified internationally - clinical initiative nurse, Physician-Nurse Supplementary Assessment Team and clinical assistants. All roles varied in terms of definitions, scope, responsibilities and skill sets of individuals in the position. There was limited evidence that the roles decreased waiting times or improved patient care, especially during busy periods. Of note, staff members performing these roles require high-level therapeutic relationship and effective interpersonal skills with patients, family and staff. The role requires support from other staff, particularly during periods of high workload, for optimal functioning and effective patient care. Conclusion: Generalisations and practice recommendations are limited due to the lack of available literature. Further research is required to evaluate the impact emergency department waiting room roles have on patient outcomes and staff perspectives. © 2015 John Wiley & Sons Ltd.