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Objectives This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients. Design Mixed-method multi-centre study. Setting High fidelity simulated acute clinical environment in three Australian universities. Participants A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study. Method In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance. Results Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p = .034), overall situation awareness (p = .05) and clinical performance in two of the three scenarios (p = .032 cardiac and p = .006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%. Conclusions Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.
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Aims: This research explores the challenges that new nursing graduates experience whilst adapting to their new role in their first year of practice. These challenges are presented from the perspectives of Graduate Nurse Program Coordinators in the state of Victoria, Australia, previously not described in the literature. Background: Each year, thousands of new nursing graduates join the workforce in Australia, with many suffering major stressors and dissatisfaction in their first year of practice. Much has been written about challenges faced by this group from their own perspectives, yet nothing has been heard from the perspectives of those who support them; that is, the coordinators of year-long graduate nurse transition programs. Methods: This descriptive qualitative study used individual, semi-structured interviews to access information and perceptions from sixteen Graduate Nurse Program Coordinators about the challenges experienced by nursing graduates in their first year of practice. Transcripts were thematically analysed to reveal reoccurring themes and sub-themes. Results: The interviews provided an insight into various challenges that nursing graduates experience in relation to role adaptation in their first year of practice. Nursing graduates found difficulties with reality shock, work-life balancing and having unrealistic assumptions in their capacity to work, assuming they should be at a higher level despite being a beginner practitioner. Conclusions: This study reinforces the need for education providers to maintain currency in their undergraduate nursing programs and to work closely with health care services in providing a quality clinical experience to all nursing students. It also provides evidence that graduate transition programs are essential, with Graduate Nurse Program Coordinators performing a crucial role in providing appropriately planned strategies to support graduates through this vulnerable time.
Description:
Aims: This research explores the challenges that new nursing graduates experience whilst adapting to their new role in their first year of practice. These challenges are presented from the perspectives of Graduate Nurse Program Coordinators in the state of Victoria, Australia, previously not described in the literature. Background: Each year, thousands of new nursing graduates join the workforce in Australia, with many suffering major stressors and dissatisfaction in their first year of practice. Much has been written about challenges faced by this group from their own perspectives, yet nothing has been heard from the perspectives of those who support them; that is, the coordinators of year-long graduate nurse transition programs. Methods: This descriptive qualitative study used individual, semi-structured interviews to access information and perceptions from sixteen Graduate Nurse Program Coordinators about the challenges experienced by nursing graduates in their first year of practice. Transcripts were thematically analysed to reveal reoccurring themes and sub-themes. Results: The interviews provided an insight into various challenges that nursing graduates experience in relation to role adaptation in their first year of practice. Nursing graduates found difficulties with reality shock, work-life balancing and having unrealistic assumptions in their capacity to work, assuming they should be at a higher level despite being a beginner practitioner. Conclusions: This study reinforces the need for education providers to maintain currency in their undergraduate nursing programs and to work closely with health care services in providing a quality clinical experience to all nursing students. It also provides evidence that graduate transition programs are essential, with Graduate Nurse Program Coordinators performing a crucial role in providing appropriately planned strategies to support graduates through this vulnerable time.
Description:
Background: Workplace aggression is a major work health and safety, and public health concern. To date, there has been limited investigation of population level exposure and responses to workplace aggression from all sources, and little evidence on the experiences, reporting and support-seeking behaviour of nurses, midwives and care personnel in Australian settings. Aim: To determine the 12-month prevalence of aggression experienced by nurses, midwives and care personnel from sources external and internal to the organisation, and the reporting behaviours and support sought from employers, health services, Trade Unions, work health and safety agencies, police and legal services. Methods: An online survey of the membership of the Australian Nursing and Midwifery Federation – Victorian Branch was conducted between 1 st May and 30th June 2017. Findings: In the previous 12 months, 96.5% of respondents experienced workplace aggression, with 90.9% experiencing aggression from external sources and 72.3% from internal sources. A majority indicated they just accepted incidents of aggression, and most rarely or never took time off work, sought medical or psychological treatment, or sought organisational or other institutional support, advice or action. Levels of satisfaction with institutional services were mostly neutral to poor. Discussion: Victorian nurses, midwives and care personnel work in aggressive and violent workplaces. The incivility endemic in health care likely sets the climate for the generation of and exposure to so much explicit aggression and violence. It appears that any systems or processes instituted to protect health care personnel from harm are failing. Conclusion: More targeted and effectively operationalised legislation, incentives and penalties are likely required. Further research may elaborate the extent of the impact of exposure to workplace aggression over time.
Description:
Background: Workplace aggression is a major work health and safety, and public health concern. To date, there has been limited investigation of population level exposure and responses to workplace aggression from all sources, and little evidence on the experiences, reporting and support-seeking behaviour of nurses, midwives and care personnel in Australian settings. Aim: To determine the 12-month prevalence of aggression experienced by nurses, midwives and care personnel from sources external and internal to the organisation, and the reporting behaviours and support sought from employers, health services, Trade Unions, work health and safety agencies, police and legal services. Methods: An online survey of the membership of the Australian Nursing and Midwifery Federation – Victorian Branch was conducted between 1 st May and 30th June 2017. Findings: In the previous 12 months, 96.5% of respondents experienced workplace aggression, with 90.9% experiencing aggression from external sources and 72.3% from internal sources. A majority indicated they just accepted incidents of aggression, and most rarely or never took time off work, sought medical or psychological treatment, or sought organisational or other institutional support, advice or action. Levels of satisfaction with institutional services were mostly neutral to poor. Discussion: Victorian nurses, midwives and care personnel work in aggressive and violent workplaces. The incivility endemic in health care likely sets the climate for the generation of and exposure to so much explicit aggression and violence. It appears that any systems or processes instituted to protect health care personnel from harm are failing. Conclusion: More targeted and effectively operationalised legislation, incentives and penalties are likely required. Further research may elaborate the extent of the impact of exposure to workplace aggression over time.
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The traditional stereotypical image of a nurse is closely linked to that of Florence Nightingale, the founder of modern nursing, who established a training system for nurses to teach them how to be completely dedicated to the taskes of care regardless of personal needs; dependent on and deferential to authorities such as medical doctors and matron supervisors; and modest and feminine. Of course, contemporary nursing is no longer a profession exclusive to females, and nor does nursing work predominantly involve dependent actions. However, these old ideas remain strong in the minds of the public and are often repeated in popular culture.
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Background Simulation-based education is one strategy that may be used to teach nursing students to recognize and manage patient deterioration. Method Final-year preregistration nursing students (n = 97) completed three face-to-face laboratory-based team simulations with a simulated patient (actor) and 330 students individually completed a three-scenario Web-based simulation program: FIRST2ACTWeb™. Results Both groups achieved moderate performance scores (means: face to face, 49%; e-simulation, 69%). Course evaluations were positive, skill gain showing a greater effect size in the face-to-face program than for e-simulation, and higher satisfaction and more positive appraisal. Conclusion Face-to-face simulation and e-simulation are effective educational strategies with e-simulation offering greater feasibility. Either strategy is likely to add value to the learning experience.
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Accessible SummaryWhat is known about shared decision-making? There is increasing evidence of the positive impact of shared decision-making on health outcomes. There has been little exploration of shared decision-making regarding people diagnosed with serious mental illness from the perspectives of key stakeholders including consumers, families and mental health professionals. What this paper adds to existing knowledge? Consumers show variability in the preference for their involvement. Most stakeholders acknowledge the importance of family involvement. MHPs should share the responsibility and right to facilitate consumer involvement. There is bidirectional association between shared decision-making and therapeutic relationships. The practice of shared decision-making is related to multiple factors, and one main perceived barrier is time. The majority of studies are from Western countries. What are the implications for practice? Elicit consumer preferences and establish a collaborative therapeutic relationship. Encourage and engage families in treatment decision-making. Inter-professional collaboration should be integrated into shared decision-making. It might require lengthier consultation time. Studies in non-Western countries are needed to fully understand the impact of culture on shared decision-making. Shared decision-making (SDM) has been broadly advocated in health services and constitutes an important component of patient-centred care and relationship-based care. To review available literature related to perceptions of key stakeholders about shared decision-making in serious mental illness. An integrative review was conducted through a search of four online databases from January 2012 to June 2019. Forty-six articles were included. Six themes were generated from the data analysis: (a) dynamic preferences for SDM, (b) various stakeholders are rarely involved, (c) SDM is not routinely implemented, (d) multiple facilitators and barriers to SDM, (e) SDM and therapeutic relationships interact, (f) SDM has a promising impact on health outcomes. Overall, most stakeholders have recognized the importance and flexibility of SDM in serious mental illness, although it is not routine in mental health service. Consumer preferences show variability in their involvement. Most stakeholders acknowledged the importance of family involvement to treatment decision-making. There are several significant challenges to practice SDM. It may require extended consultation times and increasing empirical evidence regarding the SDM outcomes, as well as integrating inter-professional collaboration into SDM. Most studies were conducted in Western culture. Mental health nurses should elicit consumer preferences and establish a collaborative therapeutic relationship. Encourage and engage families in treatment decision-making when consumers prefer their families to be involved. Inter-professional collaboration should be integrated into shared decision-making. The practice of shared decision-making might need extended consultation time and more robust evidence about the outcome of shared decision-making. Studies in non-Western cultures are needed to fully understand cultural issues of shared decision-making. IntroductionAimMethodResultsDiscussionImplications for practice
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Grit is the capacity to persevere, to have passion, and be committed to achieve goals long-term regardless of adversity or challenge. Grit provides an insight into why some nursing students succeed academically or clinically, while others do not. This quantitative cross-sectional correlational study measured levels of grit among nursing students undertaking a three-year bachelor's degree program. All students (n = 2349) within the program were invited to complete a questionnaire which included the short grit scale (Grit-S) which measured each student's level of perseverance and passion. Overall, it was highlighted that increased levels of grit correlated with an increase in the student's year of study, greater perceived clinical and academic performance, not using television as a motivator for entry to nursing, being lower on the socio-economic spectrum, and being older in age. Grit was found to develop exponentially as students entered second and third years, suggesting that a balance of constant academic and clinical challenge was an impetus for many to achieve in the face of adversity, and is reminiscent of the journey of the koi fish. This paper culminates in a call for educators to consider the inclusion of creative grit forming challenges that focus on developing a student's sense of open-mindedness within first year of undergraduate nursing programs.
Description:
Grit is the capacity to persevere, to have passion, and be committed to achieve goals long-term regardless of adversity or challenge. Grit provides an insight into why some nursing students succeed academically or clinically, while others do not. This quantitative cross-sectional correlational study measured levels of grit among nursing students undertaking a three-year bachelor's degree program. All students (n = 2349) within the program were invited to complete a questionnaire which included the short grit scale (Grit-S) which measured each student's level of perseverance and passion. Overall, it was highlighted that increased levels of grit correlated with an increase in the student's year of study, greater perceived clinical and academic performance, not using television as a motivator for entry to nursing, being lower on the socio-economic spectrum, and being older in age. Grit was found to develop exponentially as students entered second and third years, suggesting that a balance of constant academic and clinical challenge was an impetus for many to achieve in the face of adversity, and is reminiscent of the journey of the koi fish. This paper culminates in a call for educators to consider the inclusion of creative grit forming challenges that focus on developing a student's sense of open-mindedness within first year of undergraduate nursing programs.
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Although the idealisation of nurses as advocates is popularised in nursing literature and supported within nursing frameworks, codes and standards, there has been little critical examination of these ideas within contemporary Australian healthcare settings and nursing practice. The Australian Healthcare system is a complicated system of interacting service providers and consumers. Institutions that regulate healthcare professionals and organisations normalise understandings of nursing and nursing practice, including conceptualisations of the importance of autonomy and advocacy and how each is to be supported and/or practised. This study used the perceptions of practising Registered Nurses (RNs) to examine the actualities of advocacy and support for autonomy as they are carried out within clinical practice, and to highlight, problematise and then analyse differences between the rhetoric and realities of practice. Firstly, a phenomenological lens, including an ethnographic model of observation, was used to thematically map and examine the RNs’ lived experience of their practice, paying particular attention to their conceptions of and responsibilities toward advocacy and autonomy. This thematic analysis brought to the fore a range of assumptions that, although clearly normative within nursing practice, are in evident tension with one other. These were then re-examined using a range of Michel Foucault’s concepts concerning the construction and maintenance of regimes of truth. Designed to unpack the operations of power and knowledge, and to make visible the techniques of disciplinarity and governmentality that inform and support them, an engagement of these concepts has allowed this thesis to critically examine the normative constructions and enactments of nursing practice with regards to ideas and practices concerning advocacy and autonomy. What this thesis provides is a detailed examination of the contrasting constructions of power and knowledge within nursing practice in relation to advocacy and autonomy, how and why these concepts have been operationalised within nursing practice, and how they could be re-visioned into the future.
Description:
Although the idealisation of nurses as advocates is popularised in nursing literature and supported within nursing frameworks, codes and standards, there has been little critical examination of these ideas within contemporary Australian healthcare settings and nursing practice. The Australian Healthcare system is a complicated system of interacting service providers and consumers. Institutions that regulate healthcare professionals and organisations normalise understandings of nursing and nursing practice, including conceptualisations of the importance of autonomy and advocacy and how each is to be supported and/or practised. This study used the perceptions of practising Registered Nurses (RNs) to examine the actualities of advocacy and support for autonomy as they are carried out within clinical practice, and to highlight, problematise and then analyse differences between the rhetoric and realities of practice. Firstly, a phenomenological lens, including an ethnographic model of observation, was used to thematically map and examine the RNs’ lived experience of their practice, paying particular attention to their conceptions of and responsibilities toward advocacy and autonomy. This thematic analysis brought to the fore a range of assumptions that, although clearly normative within nursing practice, are in evident tension with one other. These were then re-examined using a range of Michel Foucault’s concepts concerning the construction and maintenance of regimes of truth. Designed to unpack the operations of power and knowledge, and to make visible the techniques of disciplinarity and governmentality that inform and support them, an engagement of these concepts has allowed this thesis to critically examine the normative constructions and enactments of nursing practice with regards to ideas and practices concerning advocacy and autonomy. What this thesis provides is a detailed examination of the contrasting constructions of power and knowledge within nursing practice in relation to advocacy and autonomy, how and why these concepts have been operationalised within nursing practice, and how they could be re-visioned into the future.
Description:
Aim To develop and psychometrically test the distress thermometer for caregivers (DT-C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia. Design A validation diagnostic accuracy study and descriptive cross-sectional survey. Methods DT-C was adopted based on Harverman's distress thermometer for parents. The cut-off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale-21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018. Results One-item DT of DT-C indicated a good retest reliability (r = 0.86) and one-item DT and the Problem List (PL) indicated good convergent validity (r = 0.67-0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70-0.90). Setting seven as the cut-off score, the values of sensitivity (0.72-0.81), specificity (0.86-0.90), Youden's index (0.61-0.70), positive predictive value (0.67-0.74), and negative predictive value (0.84-0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88-0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut-off. Caregivers above the cut-off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains. Conclusion The DT-C, with six domains containing 35 items in Problem List and with the cut-off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers' distress. Impact This study adapted a reliable DT-C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals.
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Ongoing challenges for nurses working in the primary care/community setting include professional development external policy which esteems productivity greater than the quality of care and changes in the economy which have shaped the community at large.
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Ongoing challenges for nurses working in the primary care/community setting include professional development external policy which esteems productivity greater than the quality of care and changes in the economy which have shaped the community at large.
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Problem Based Learning (PBL) using minimal guided instruction is used as an educational strategy across a broad variety of disciplines in the tertiary sector. This paper includes some of the strengths and weaknesses of PBL, both in general and in relation to the health care setting, encompassing some of its philosophical underpinnings and its methodological approach. In an effort to explore some of the benefits and problems with PBL in the work setting, this account will comprise a realistic rather than idealistic focus and will include a range of perspectives from both a facilitator and student standpoint. We suggest that PBL is a useful strategy across a comprehensive nursing degree programme (as the ideal) provided the learning programme is supported financially and that its ideal creed which supports a small group approach are adhered to. What we find is that reality is often different, with individual facilitators condensing their PBL programmes to incorporate a modified PBL approach with this personalised approach often taking strength away from the original conceptions of PBL. What we suggest here is that these circumstances constitute a conundrum.
Description:
Problem Based Learning (PBL) using minimal guided instruction is used as an educational strategy across a broad variety of disciplines in the tertiary sector. This paper includes some of the strengths and weaknesses of PBL, both in general and in relation to the health care setting, encompassing some of its philosophical underpinnings and its methodological approach. In an effort to explore some of the benefits and problems with PBL in the work setting, this account will comprise a realistic rather than idealistic focus and will include a range of perspectives from both a facilitator and student standpoint. We suggest that PBL is a useful strategy across a comprehensive nursing degree programme (as the ideal) provided the learning programme is supported financially and that its ideal creed which supports a small group approach are adhered to. What we find is that reality is often different, with individual facilitators condensing their PBL programmes to incorporate a modified PBL approach with this personalised approach often taking strength away from the original conceptions of PBL. What we suggest here is that these circumstances constitute a conundrum.
Occupational self-efficacy and psychological capital amongst nursing students : a cross sectional study understanding the malleable attributes for success
Description:
With a predicted shortfall in the worldwide nursing workforce, efforts to understand attributes that influence attrition and workforce longevity remain fundamental. Self-efficacy and the broader construct of psychological capital have been linked to positive workplace-based attributes in occupations. The aim of the study was to examine the relationship between general self-efficacy, occupational (nursing) self-efficacy, and psychological capital and their predictive factors among nursing students. A cross sectional design was used to address the aims of the study where all nursing students studying a three-year bachelor's degree were invited to complete a questionnaire examining traits that might assist in the preparation for, and longevity in, a nursing career. Although the participating nursing students demonstrated high levels of general self-efficacy, their reported levels of nursing-specific self-efficacy were significantly lower. Psychological capital measures indicated that students had high levels of belief, hope, and resilience concerning their capacity to commit to and achieve goals, succeed now and into the future, and overcome obstacles. The findings suggest an opportunity exists for education providers to nurture the malleable aspects of self-e fficacy and psychological capital, while developing greater capacity to bounce back and overcome the challenges that nursing students may encounter in their undergraduate academic training, and to reduce attrition as they prepare to enter the workplace.
Description:
With a predicted shortfall in the worldwide nursing workforce, efforts to understand attributes that influence attrition and workforce longevity remain fundamental. Self-efficacy and the broader construct of psychological capital have been linked to positive workplace-based attributes in occupations. The aim of the study was to examine the relationship between general self-efficacy, occupational (nursing) self-efficacy, and psychological capital and their predictive factors among nursing students. A cross sectional design was used to address the aims of the study where all nursing students studying a three-year bachelor's degree were invited to complete a questionnaire examining traits that might assist in the preparation for, and longevity in, a nursing career. Although the participating nursing students demonstrated high levels of general self-efficacy, their reported levels of nursing-specific self-efficacy were significantly lower. Psychological capital measures indicated that students had high levels of belief, hope, and resilience concerning their capacity to commit to and achieve goals, succeed now and into the future, and overcome obstacles. The findings suggest an opportunity exists for education providers to nurture the malleable aspects of self-e fficacy and psychological capital, while developing greater capacity to bounce back and overcome the challenges that nursing students may encounter in their undergraduate academic training, and to reduce attrition as they prepare to enter the workplace.