A cross-sectional survey of nursing students' patient safety knowledge
- Authors: Levett-Jones, Tracy , Andersen, Patrea , Bogossian, Fiona , Cooper, Simon J. , Guinea, Stephen , Hopmans, Ruben , McKenna, Lisa , Pich, Jacqui , Reid-Searl, Kerry , Seaton, Philippa
- Date: 2020
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 88, no. (2020), p.
- Full Text: false
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- Description: Background: Knowledge provides a foundation for safe and effective nursing practice. However, most previous studies have focused on exploring nursing students' self-reported perceptions of, or confidence in, their level of patient safety knowledge, rather than examining their actual levels of knowledge. Objective: The overarching objective of this study was to examine final year nursing students' levels of knowledge about key patient safety concepts. Design: A cross-sectional design was used for this study. Data collection was undertaken during 2018 using a web-based patient safety quiz with 45 multiple choice questions informed by the Patient Safety Competency Framework for Nursing Students. A Modified Angoff approach was used to establish a pass mark or ‘cut score’ for the quiz. Setting and participants: Nursing students enrolled in the final year of a pre-registration nursing program in Australia or New Zealand were invited to participate in the study. Results: In total, 2011 final year nursing students from 23 educational institutions completed the quiz. Mean quiz scores were 29.35/45 or 65.23% (SD 5.63). Participants achieved highest scores in the domains of person-centred care and therapeutic communication, and lowest scores for infection prevention and control and medication safety. Based on the pass mark of 67.3% determined by the Modified Angoff procedure, 44.7% of students (n = 899) demonstrated passing performance on the quiz. For eight of the institutions, less than half of their students achieved a passing mark. Conclusions: Given the pivotal role that nurses play in maintaining patient safety, the results from this quiz raise important questions about the preparation of nursing students for safe and effective clinical practice. The institutional results also suggest the need for increased curricula attention to patient safety. © 2020 Elsevier Ltd
The academic experiences of transitioning to blended online and digital nursing curriculum
- Authors: Porter, Joanne , Barbagallo, Michael , Peck, Blake , Allen, Louise , Tanti, Erin , Churchill, Anne
- Date: 2020
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 87, no. (2020), p.
- Full Text: false
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- Description: Background: The blended online digital (BOLD) approach to teaching is popular within many universities. However, much of the research conducted in this area focusses on the student perspective. Aim The aim of this study is to explore the experiences and perspectives of academics involved in the development and implementation of an inaugural BOLD Bachelor of Nursing curriculum at a regional multi-campus institution in Victoria, Australia. Methods: Eleven academics across two regional campuses participated in one of five focus groups. Creswell's (2003) six step approach to thematic analysis was used to analyse the semi-structured interview data in order to capture the meaning of the transition experience. Findings: Three significant themes emerged from the focus group data: ‘Get Ready’, ‘Get Set’, and ‘Go’. Discussion: Three significant themes emerged, ‘Get Ready’, embodies insight from academic staff preparing to make the transition to a BOLD delivery model acknowledging the need for staff to be genuinely prepared, educated, guided and supported to understand the pedagogy of BOLD. Secondly, ‘Get Set’, acknowledges the period immediately after the preparatory phase and preparedness of academic staff to manage content and delivery for both face-to-face and online student cohorts within the learning platform. Thirdly, the theme ‘Go’ recognises the culmination of the previous two phases and is a recognition of the need for ongoing evaluation across the implementation phase. Conclusion: This qualitative exploration of nursing academics' experience contributes to contemporary pedagogical insights in relation to the blended approaches to teaching and learning. © 2020
Implementing an intervention to promote normal labour and birth : A study of clinicians' perceptions
- Authors: Shee, Anna , Nagle, Cate , Corboy, Denise , Versace, Vincent , Robertson, Carolyn , Frawley, Natasha , McKenzie, AnneMarie , Lodge, Julie
- Date: 2019
- Type: Text , Journal article
- Relation: Midwifery Vol. 70, no. (2019), p. 46-53
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- Description: Objective: Prior to implementation of a Normal Labour and Birth Bundle (NLBB) at a regional maternity service in Victoria, Australia, this study aimed to understand clinician factors that may influence the uptake, acceptance and use of the NLBB. Design: This was a mixed methods study in which The Theory of Planned Behaviour (TPB) provided the framework for the conduct and analysis of the staff survey and focus groups. Descriptive and multiple regression were used to analyse the survey data and thematic analysis was used for the focus group data. Participants: Participants for the survey and focus groups included clinicians providing publicly funded care and management of labour for women birthing at the health service. Maternity care clinicians were invited to participate in both the survey and the focus groups. Findings: Seventy-six clinicians (88.8%) responded to the survey. Mean scores for TPB constructs were well above the mid-scale score of 4, indicating strong positive attitudes, high levels of self-efficacy and positive social pressure to use the NLBB and strong intentions to use it in the future. Self-efficacy was the strongest independent predictor (beta=0.45, p < 0.001) of intention to use the NLBB (overall model R2 = 0.38). A valued consequence of implementing standardised and objective guidelines, highlighted in the focus groups, was the positive impact on clinicians' confidence in their decision-making. Key conclusions: This study found that midwives and obstetricians were in favour of using a normal labour and birth care bundle and perceived the bundle to align with the expectations of work colleagues and the women they care for. The findings of this study show that clinicians at the health service had strong intentions to use the normal labour and birth care bundle in the future. Implications for practice: Implementation science is important in embedding and sustaining practice change. Understanding staff perceptions is an essential first step of this process. (c) 2018 Elsevier Ltd. All rights reserved.
Informing the development midwifery standards for practice : A literature review for policy development
- Authors: Nagle, Cate , McDonald, Susan , Morrow, Jane , Kruger, Gina , Cramer, Rhian , Couch, Sara , Hartney, Nicole , Bryce, Julianne , Birks, Melanie , Heartfield, Marie
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Midwifery Vol. 76, no. (2019), p. 8-20
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- Description: Aim: To critically appraise and synthesise the literature regarding the role and scope of midwifery practice, specifically to inform the evidence based development of standards for practice for all midwives in Australia. Design: A structured scoping review of the literature Data sources: CINAHL Complete, MEDLINE Complete and Cochrane Libraries databases, online and grey literature databases Review methods: Comprehensive searches of databases used key words and controlled vocabulary for each database to search for publications 2006-2016. Studies were not restricted by research method. Findings: There is no substantive body of literature on midwifery competency standards or standards for practice. From 1648 papers screened, twenty-eight papers were identified to inform this review. Eight studies including systematic reviews were annotated with three research papers further assessed as having direct application to this review. To inform the development of Midwife standards for practice, the comprehensive role of the midwife across multiple settings was seen to include: woman centred and primary health care; safe supportive and collaborative practice; clinical knowledge and skills with interpersonal and cultural competence. Key conclusions: Midwifery practice is not restricted to the provision of direct clinical care and extends to any role where the midwife uses midwifery skills and knowledge. This practice includes working in clinical and non-clinical relationships with the woman and other clients as well as working in management, administration, education, research, advisory, regulatory, and policy development roles. Implications for practice: This review articulates the definition, role and scope of midwifery practice to inform the development of contemporary standards for practice for the Australian midwife. (C) 2019 Elsevier Ltd. All rights reserved.
Key factors deterring women's engagement with skilled birth attendants in three districts of Timor-Leste. A qualitative descriptive study
- Authors: King, Rosemary , Jones, Linda
- Date: 2019
- Type: Text , Journal article
- Relation: Midwifery Vol. 79, no. (Dec 2019), p. 8
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- Description: Objective: To describe the barriers to women's access to maternity services in three districts of Timor-Leste. Research design/setting: Focused ethnography with data collection methods commensurate with a qualitative research design. Setting and participants: Data was collected in three districts in Timor-Leste. Participants included seventeen stakeholders, health professionals and managers providing skilled birth attendance (SBA) in Timor-Leste and thirty women who have given birth and are competent to give consent. Findings: Access to SBA services is seriously impeded by poor roads and lack of transportation, the poor condition and amenity of services, restricted hours of opening, the lack of availability of skilled SBA professionals and medical resources. Participants also commented upon the lack of privacy and multiple caregivers. Timorese patriarchal family structures, intergenerational decision-making and cultural attitudes towards reproductive health information and services potentially reduce women's access to reproductive health services. Conclusion: This data provides a comprehensive record of the multiple structural barriers to women's access to SBA services. The modified AAAQA framework provides categories and an organisational structure to these barriers to SBA services. Implications for practice: Maternity care in Timor-Leste is extremely poorly resourced. Midwives and other SBA will need to provide innovative low cost solutions if they are to consistently provide respectful culturally safe midwifery care. This includes the provision of privacy and a one to one midwifery relationship 'with woman'. In addition, many women are unable to access SBA, where possible the MoH can consider strategies to improve the provision of SBA services to women birthing in community. Crown Copyright (C) 2019 Published by Elsevier Ltd. All rights reserved.
What factors influence midwives to provide obstetric high dependency care on the delivery suite or request care be escalated away from the obstetric unit? Findings of a focus group study
- Authors: James, Alison , Cooper, Simon J. , Stenhouse, Elizabeth , Endacott, Ruth
- Date: 2019
- Type: Text , Journal article
- Relation: Bmc Pregnancy and Childbirth Vol. 19, no. 1 (2019), p. 1-15
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- Description: Background In the United Kingdom, midwives will engage in discussions with the multidisciplinary team as to whether they can provide Obstetric High Dependency Care (OHDC) on the Delivery Suite or whether a woman's care should be escalated to the critical care team. This study aimed to explore the question: What factors influence midwives to provide OHDC or request care be escalated away from the obstetric unit in hospitals remote from tertiary referral centres? Methods Focus groups were undertaken with midwives (n = 34) across three obstetric units in England, with annual birth rates ranging from 1500 to 5000 per annum, in District General Hospitals. Three scenarios in the form of video vignettes of handover were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission of woman with chest pain receiving facial oxygen and requiring continuous electrocardiogram (ECG) monitoring. Two focus groups were conducted in each of the obstetric units with experienced midwives. Data were analysed using a qualitative framework approach. Results Factors influencing midwives' care escalation decisions included the care environment, a woman's diagnosis and fetal or neonatal factors. The overall plan of care including the need for ECG and invasive monitoring were also influential factors. Midwives in the smallest obstetric unit did not have access to the facilities for OHDC provision. Midwives in the larger obstetric units provided OHDC but identified varying degrees of skill and sometimes used 'workarounds' to facilitate care provision. Midwifery staffing levels, skill mix and workload were also influential. Some differences of opinion were evident between midwives working in the same obstetric units as to whether OHDC could be provided and the support they would enlist to help them provide it. Reliance on clinical guidelines appeared variable. Conclusions Findings indicate that there may be inequitable OHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable OHDC care including skills development for midwives and precise escalation guidelines to minimise workarounds. Training for midwives must include strategies that prevent skills fade.
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
- Full Text: false
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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.
Health guides for unattended births and aftercare in New Zealand and Australia, 1900-1950
- Authors: Wood, Pamela , Jones, Jan
- Date: 2015
- Type: Text , Journal article
- Relation: New Zealand College of Midwives Journal Vol. , no. 51 (2015), p. 44-49
- Full Text: false
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- Description: Background: In the early twentieth century, most women in Australia and New Zealand gave birth at home. As in colonial times, women living in the isolated New Zealand backblocks or Australian bush without access to a midwife, nurse or doctor, or women in towns who could not afford their service, gave birth with only a neighbouring woman, husband or older child to help. Most households had a domestic health guide as a source of health information and support in caring for themselves and others. This guide might therefore be the only assistance available to women and their lay attendants during childbirth. Aim: This research aimed to identify the information domestic health guides provided on childbirth, particularly if addressed to a person assisting the woman in the absence of a midwife, nurse or doctor, and to compare it with information midwives were expected to know. Methods: Using historical methodology, the researchers analysed the childbirth information in a range of domestic health guides available in Australia and New Zealand, 1900-1950. The information was also compared with midwifery textbooks and considered within the context of the increasing professionalisation of midwifery to discover how it reflected boundaries between lay and professional knowledge and practice. Findings: Some domestic health guides provided as detailed information as midwifery texts but without their scientific rationale that was a mark of professional knowledge and practice. Conclusion: By providing clear information, domestic health guides could have been a significant part of the culture of self-reliance and mutual aid, and of the cultures of health in both rural and urban environments in New Zealand and Australia in this time period.