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Background: Anxiety has a powerful impact on learning due to activation of anxiety hormones, which target related receptors in the working memory. Experiential learning requires some degree of challenge and anxiety. Patient simulation, as a form of experiential learning, has been an integrated component of health professional education internationally over the last two decades, especially in undergraduate nursing education. Little information is available to determine if and how anxiety impacts nursing students’ clinical performance during simulation. Objectives: To investigate physiological and psychological anxiety during emergency scenarios in high-fidelity simulation and understand the effect of anxiety on clinical performance. Design: First2Act was the model for the simulation intervention. Second and third year undergraduate nursing students attended a two-hour simulation session and completed a demographic questionnaire plus pre-simulation self-reported psychological anxiety scale. A heart rate variability monitor was attached to each student's chest to measure heart rate variability (as a sign of anxiety) before engaging in two video-recorded simulated emergency scenarios (cardiac and respiratory) with a professional actor playing the patient. Performance was rated by a clinician followed by video-assisted debriefing. Finally, heart monitors were removed and students repeated self-reports of psychological anxiety. Results: Students’ psychological anxiety was high pre-simulation and remained high post-simulation. With regard to physiological anxiety, students were anxious at the start of the simulation but became more relaxed toward the end as they gained familiarly with the simulation environment (p < .007). Clinical performance increased significantly in the second scenario (p < .001). Factors found to positively affect clinical performance were length of enrolment in the nursing degree (p = .001), current employment in a nursing or allied healthcare field (p = .030), and previous emergency experience (p = .047). The relationship between physiological anxiety and clinical performance was statistically not significant, although there was an indication that low level anxiety led to optimal performance. Conclusion: High-fidelity patient simulation has the capacity to arouse novice nurses psychologically and physiologically while managing emergency situations. Indicative outcomes suggest that optimal performance was apparent when anxiety levels were low, indicating that they had received insufficient training to deal with situations that induced moderate to high anxiety levels.
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Background This paper reports on one aspect of a larger doctoral project which investigated the perceptions of qualified nurses on the abilities of newly registered nursing graduates. Aims To explore qualified nurses’ perceptions on national examinations for registration in Australia.
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Evidence-based practice (EBP) in the clinical setting is recognized as an approach that leads to improved patient outcomes. Nurse educators (NEs), clinical coaches (CCs) and nurse specialists are in key positions to promote and facilitate EBP within clinical settings and have opportunities to advance practice. Therefore, it is important to understand their perceptions of factors promoting EBP and perceived barriers in facilitating EBP in clinical settings, before developing educational programmes. This paper reports findings from a study that aimed to explore NEs' , CCs' and nurse specialists' knowledge, skills and attitudes associated with EBP. This study used a questionnaire containing quantitative and a small number of qualitative questions to capture data collected from NEs, CCs and nurse specialists working at a tertiary health-care facility in Victoria, Australia. The questionnaire was distributed to a total of 435 people, of whom 135 responded (31%). Findings revealed that the three senior nurse groups relied heavily on personal experience, organizational policies and protocols as formal sources of knowledge. Furthermore, they had positive attitudes towards EBP. However, participants demonstrated lack of knowledge and skills in appraising and utilizing evidence into practice. They indicated a desire to seek educational opportunities to upskill themselves in the process of EBP.
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Nursing students are required to develop clinical knowledge, skills and attitudes for professional practice. However, objectivity and parity of students' clinical assessments has been questioned. In the last decade, more objective techniques have been developed, with increased use of Objective Structured Clinical Examinations. We reviewed objective clinical assessment measures used in preregistration nursing courses to determine utilization and the validity and reliability of assessment techniques. A systematic search was made of quantitative research publications between 2000 and May 2011, identifying 16 studies that were subsequently reviewed. The validity and reliability of studies varied, with six studies judged as high quality, using various methodologies. This paper describes methods of instrument development and reports on their application in preregistration nursing programs.
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Objectives: To examine the knowledge, skills, and attitudes of a cohort of Australian nurses towards caring for patients with mental illness in the intensive care unit. Research design: A questionnaire was developed and distributed via internal email to all nurses working in the study intensive care unit. Responses were anonymous. Setting: A metropolitan intensive care unit located in Melbourne, Australia. Main outcome measures: Intenisve care nurses completed a 76-question self-administered questionnaire. Results: Forty intensive care nurses completed the survey, a response rate of 35.7% (n = 40/112). Respondents were predominantly female (82.5%) and held a post-graduate qualification (62.5%). ICU nurses felt that they needed further training and education to care for patients with mental illness in the intensive care unit. While respondents were empathetic to this patient group, negative stereotypes and stigma were reported by some participants. The pressures of the environment were perceived barriers to delivering optimal person-centred care for patients with mental illness. Conclusion: This sample of nurses felt they require education and support in order to care for patients with mental illness in the intenisve care unit. Further education may also help to reduce negative perceptions of this patient group.
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In Australia, the emerging use of technology in higher education has brought about significant change in the delivery of undergraduate nursing programs. Universities are now tasked with delivering a blend of online and face-to-face education, while students face new and sometimes challenging online learning environments with little technical support. This article explores the attitudes held by Bachelor of Nursing students toward the blended educational mode at a rural university in Victoria, Australia. A total of 109 participants constituted a convenience sample from a Bachelor of Nursing program across all 3-year levels. Responses provided by participants who completed an online self-report questionnaire were analyzed via descriptive and inferential statistics. The results indicated that participants struggled with inaccurate expectations of workload and the technical difficulties presented by online modules. Although this area requires further research, to an extent autonomy and flexibility were identified as two prominent traits exhibited by students who flourished in the blended modes. All in all, the results of this study strongly reflect the challenges faced by undergraduate nursing students navigating newly introduced online systems in a blended mode of study.
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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.
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In the UK there is a drive to develop referral pathways for a ‘seamless service’ which for ambulance services has led to a series of reports advising on emergency care networks and collaborative practice (DH, 1997, 2000, 2004) aiming for the ‘right response, first time, in time’ (DH, 2005). In addition changes in doctors’ working hours and their out of hours practice have led to the emergence of the emergency care practitioner (ECP) role (JRCALC, 2000). ECPs are defined as an ‘‘advanced practitioner (paramedic or nurse) capable of assessing, treating and discharging/referring patients at the scene’’ (DH, 2005 p. 51). As part of a larger study on inter-professional collaboration (Cooper et al., 2007a,b) (which has been granted full NHS ethics approval) we undertook a review of West country ECPs’ practice in a regional patient survey. Of the 25 ECPs that responded the majority were paramedics, but 3 were qualified nurses and 2 were dual qualified (paramedic/nurse). All were employed by West country Ambulance Service NHS Trust (WAST) (UK), and were either completing or had completed a full time 3 month Certificate level programme or a part time Bachelors level programme in emergency care. ECPs shifts were based in response cars or in treatment centres from where they responded to emergency calls. Our objectives were to identify contemporary practice and performance in this unique and emerging role.
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People have tattooed themselves for thousands of years, and it remains popular with various groups across mainstream society. Although many people choose tattoos that express their life philosophy, epic events in their life, or their personal mantra, the use of tattooing in medicine such as a "do not resuscitate" tattoo is increasingly becoming more common (Drew, 2017; Islam et al., 2016). As these tattoos do not meet the legal requirements for an advance health directive, they are at best a guide to the person's wishes and at worst a useless, painful exercise. New technology such as "talking tattoos" or implantable microchips could conceivably be used to record either an audible advance health directive or directions for emergency responders to access an individual's advance health directive. This article discusses the ethical and legal implications of nonstandard advance health directive tattoos in emergency treatment situations.
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The aim of the present paper was to review the opportunities currently available to health service planners to advance sustainable development in their future-facing roles within health service organisation. Critical challenges and enablers to facilitate health services planners in adopting a pro-environmental lens are discussed. What is known about the topic? Despite its harmful effect on the environment, health has been slower than other industries to embrace the sustainable development agenda. The attitudes and knowledge base of health service planners with regard to environmental sustainability has not been widely studied. For health service planners, embracing pro-environmental considerations in sustainable model of care development is a powerful opportunity to review care paradigms and prepare for the implementation of meaningful, improved health and system efficiency. What does this paper add? This paper advances the case for health service planners to embrace a pro-environmental stance and guides health service leaders in the preparation and implementation of sustainable and improved health and system efficiency. What are the implications for practitioners? Health service planers are in an ideal position to champion the sustainable development agenda as they explore what care is delivered, how care is delivered and where care is delivered. External policy, health service leadership and carbon literacy are advanced as critical contextual factors to facilitate the key role that health service planners can play in building sustainable healthcare organisations.
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Aim To develop a valid, reliable and feasible teamwork assessment measure for emergency resuscitation team performance. Background Generic and profession specific team performance assessment measures are available (e.g. anaesthetics) but there are no specific measures for the assessment of emergency resuscitation team performance. Methods (1) An extensive review of the literature for teamwork instruments, and (2) development of a draft instrument with an expert clinical team. (3) Review by an international team of seven independent experts for face and content validity. (4) Instrument testing on 56 video-recorded hospital and simulated resuscitation events for construct, consistency, concurrent validity and reliability and (5) a final set of ratings for feasibility on fifteen simulated ‘real time’ events. Results Following expert review, selected items were found to have a high total content validity index of 0.96. A single ‘teamwork’ construct was identified with an internal consistency of 0.89. Correlation between the total item score and global rating (rho 0.95; p < 0.01) indicated concurrent validity. Inter-rater (k 0.55) and retest reliability (k 0.53) were ‘fair’, with positive feasibility ratings following ‘real time’ testing. The final 12 item (11 specific and 1 global rating) are rated using a five-point scale and cover three categories leadership, teamwork and task management. Conclusion In this primary study TEAM was found to be a valid and reliable instrument and should be a useful addition to clinicians’ tool set for the measurement of teamwork during medical emergencies. Further evaluation of the instrument is warranted to fully determine its psychometric properties.
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Objective: To evaluate the effect of a workplace health intervention designed to reduce prolonged occupational sitting on the mean arterial pressure (MAP) of desk-based employees. Methods: This randomized controlled trial involved an experimental group who received an e-health intervention and a control group who did not. The 13-week intervention passively prompted participants to stand and engage in short bouts of office-based physical activity by interrupting prolonged occupational sitting time periodically throughout the workday. Mean arterial pressure was measured at pretest and posttest. Results: Between pretest and posttest the experimental group significantly reduced their MAP, whereas MAP in the control group did not. Conclusions: A workplace e-health intervention designed to reduce prolonged occupational sitting was effective in decreasing MAP in desk-based employees.
Description:
Objective: To evaluate the effect of a workplace health intervention designed to reduce prolonged occupational sitting on the mean arterial pressure (MAP) of desk-based employees. Methods: This randomized controlled trial involved an experimental group who received an e-health intervention and a control group who did not. The 13-week intervention passively prompted participants to stand and engage in short bouts of office-based physical activity by interrupting prolonged occupational sitting time periodically throughout the workday. Mean arterial pressure was measured at pretest and posttest. Results: Between pretest and posttest the experimental group significantly reduced their MAP, whereas MAP in the control group did not. Conclusions: A workplace e-health intervention designed to reduce prolonged occupational sitting was effective in decreasing MAP in desk-based employees.
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Objective To explore the family’s experience of end-of-life care for their dying family member during the last few days of life in an acute rural hospital. Design Interpretive design using qualitative methods, including 1: 1 semi- structured interviews. Setting The study was undertaken in a large regional health service in Victoria. Subjects Twelve relatives who were next of kin of people who died between 1 January 2012 and 30 June 2013 in an acute ward at the health service agreed to participate in the study. Main outcome measure Families’ perceptions of end-of-life care for their dying family member. Results Data analysis identified five themes that were grouped into two general dimensions - communication (guidance for family member’s role in end of life care, the family’s preparation for death, the dying experience) and care and support (the hospital care experience, follow-up after death). Conclusion A lack of open and candid communication hindered family members’ engagement in decision-making and involvement in their loved ones’ last days of life. The absence of formal processes for end of life (EOL) care planning resulted in families being unprepared for what they perceived as their family member’s ‘sudden death’.