Description:
Aims and objectives To review communication interventions that aim to improve regular care interactions between people with dementia and their carers in various settings; and to examine the impact of such interventions on both carer and care-receiver outcomes. Background Effective communication is imperative to ensure quality of care for people living with dementia. Due to neurodegenerative changes, people with dementia encounter ongoing and progressive difficulties in both understanding and expressing themselves. This in turn creates challenges for carers, which highlights the need for equipping them with necessary communication skills to respond to the specific communication needs of people with dementia. Design Systematic review and meta-analysis. Method Medline, Embase, CINAHL, ProQuest and PsycINFO databases were searched for eligible interventions with any date of the publication. Hand searching was also conducted through reviewing the reference lists of relevant articles. The screening and selection of studies were based on the inclusion/exclusion criteria for eligibility and the methodological quality assessment checklist. Random-effects meta-analyses were conducted on comparable quantitative data. The review is reported following the PRISMA reporting guidelines. Results Seventeen studies were included in the final review, including 12 randomised controlled trials (RCTs), three nonrandomised controlled trials (NRCTs) and two controlled before-after interventions. The intervention designs, settings and outcome measures were varied. The findings suggest that the communication training had a positive impact on both carer and care-receiver outcomes, albeit to different degrees. The intervention effects were found to be strongest on carer communication skills and knowledge. Conclusion There is solid evidence for the positive impact of communication training on the skills and knowledge of carers. More research is needed regarding the effects of such educational interventions on carer physio-psychological outcomes and care-receiver neuropsychiatric symptoms. It is important to establish best practices in training design, develop validated outcome measures and adopt consistent reporting approaches. Relevance to clinical practice The increasing global prevalence of people with dementia manifests across clinical and community contexts. The profound impact of dementia on communication and associated care raises the imperative for enhanced health worker and carer communication skills to meet the needs of this particular client group. The findings of this review indicate that educational interventions incorporating face-to-face and diverse instructional delivery methods in dementia communication showed positive outcomes for communication skills in all carer groups and warrant inclusion as strategies in dementia training.
Description:
Aims and objectives To review communication interventions that aim to improve regular care interactions between people with dementia and their carers in various settings; and to examine the impact of such interventions on both carer and care-receiver outcomes. Background Effective communication is imperative to ensure quality of care for people living with dementia. Due to neurodegenerative changes, people with dementia encounter ongoing and progressive difficulties in both understanding and expressing themselves. This in turn creates challenges for carers, which highlights the need for equipping them with necessary communication skills to respond to the specific communication needs of people with dementia. Design Systematic review and meta-analysis. Method Medline, Embase, CINAHL, ProQuest and PsycINFO databases were searched for eligible interventions with any date of the publication. Hand searching was also conducted through reviewing the reference lists of relevant articles. The screening and selection of studies were based on the inclusion/exclusion criteria for eligibility and the methodological quality assessment checklist. Random-effects meta-analyses were conducted on comparable quantitative data. The review is reported following the PRISMA reporting guidelines. Results Seventeen studies were included in the final review, including 12 randomised controlled trials (RCTs), three nonrandomised controlled trials (NRCTs) and two controlled before-after interventions. The intervention designs, settings and outcome measures were varied. The findings suggest that the communication training had a positive impact on both carer and care-receiver outcomes, albeit to different degrees. The intervention effects were found to be strongest on carer communication skills and knowledge. Conclusion There is solid evidence for the positive impact of communication training on the skills and knowledge of carers. More research is needed regarding the effects of such educational interventions on carer physio-psychological outcomes and care-receiver neuropsychiatric symptoms. It is important to establish best practices in training design, develop validated outcome measures and adopt consistent reporting approaches. Relevance to clinical practice The increasing global prevalence of people with dementia manifests across clinical and community contexts. The profound impact of dementia on communication and associated care raises the imperative for enhanced health worker and carer communication skills to meet the needs of this particular client group. The findings of this review indicate that educational interventions incorporating face-to-face and diverse instructional delivery methods in dementia communication showed positive outcomes for communication skills in all carer groups and warrant inclusion as strategies in dementia training.
Description:
Reflective practice post clinical placement in nursing education is essential to integrate knowledge, skills, attitudes, and experiences. Many nursing programs in-cooperate reflective practice to permit the integration of core nursing education with clinical experiences to develop safe and component nurses. The purpose of this literature review is to examine the current trends in nursing education around reflective practice post clinical practice experiences.
Description:
Reflective practice post clinical placement in nursing education is essential to integrate knowledge, skills, attitudes, and experiences. Many nursing programs in-cooperate reflective practice to permit the integration of core nursing education with clinical experiences to develop safe and component nurses. The purpose of this literature review is to examine the current trends in nursing education around reflective practice post clinical practice experiences.
Description:
The cornerstone of contemporary nursing practice is the provision of individualised nursing care. Sustaining and nourishing the stream of research frameworks that inform individualised care are the findings from qualitative research. At the centre of much qualitative research practice, however, is an assumption that experiential understanding can be delivered through a thematisation of meaning which, it will be argued, can lead the researcher to make unsustainable assumptions about the relations of language and meaning-making to experience. We will show that an uncritical subscription to such assumptions can undermine the researcher's capacity to represent experience at the high level of abstraction consistent with experience itself and to thus inform genuinely individualised care. Instead, using qualia as a touchstone for the possibilities of understanding and representing experience, we trace the ‘designative’ and ‘expressive’ distinction to language in order to raise critical questions concerning both these assumptions and common practices within qualitative research. Following the ‘expressive’ account of language, we foreground in particular the hermeneutic work of Gadamer through which we explore the possibilities for a qualitative research approach that would better seek the mot juste of individual experience and illuminate qualia in order to better inform genuinely individualised care.
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.
Description:
Registered Nurses (RNs) are regulated health professionals who are educated and accountable for safe medication administration (MA). Binding their practice are standards, policies, procedure and legislation. MA competence is taught and assessed during professional pre-registration education programs. However, different philosophies, theories and models are used by education providers making curriculum content disparate and competency frameworks diverse. Additionally, healthcare contexts are increasingly complex and clinical environments unpredictable. Competency models must respect contemporary practice. This paper focusses on the outcomes of Australian PhD research that combined Appreciative Inquiry (AI) principles with a qualitative study to identify MA safety strategies. In this 2-phase descriptive study, twenty RNs were observed then interviewed about their MA experiences. This paper discusses the interview findings. The participants explained how they assessed patient's needs and implemented strategies to administer medications safely. They presented their actions as being underpinned by a desire to do ‘the right thing for the patient’ despite their practice going beyond traditional procedural frameworks and not reflecting organisational protocols. Instead, they developed common strategies to enhance safe MA. The participants’ described using clinical reasoning and patient-centredness during MA. This study contributes to the knowledge needed for future practice development by highlighting what works.
Description:
Aims and objectives: To investigate burnout among nurses from Australia and China and explore the effects of resilience and turnover intention on nurse burnout between the two countries. Background: Nursing shortages and burnout have become serious problems worldwide in recent years. In both developed and developing countries, such as Australia and China, nurse burnout levels are high and therefore attract concern from nurse managers, hospital administrators, nurse educators and researchers. However, few studies have been conducted exploring the differences in burnout and its predictors between Australian and Chinese nurses, particularly investigating the differences in the effect sizes of the predictors. Design: A comparative cross-sectional design was employed. Methods: A total of 100 Australian nurses and 197 Chinese nurses participated in the study. Australian participants completed an online questionnaire, while Chinese participants completed a hardcopy questionnaire. Burnout, resilience and turnover intention were measured. Results: Burnout was worse for Australian participants than Chinese participants. Only having turnover intention significantly predicted burnout in Australian participants, while low resilience, having turnover intention and low level of regular exercise strongly predicted burnout in Chinese participants. The effect size of turnover intention on burnout in the Australian group was almost twice that of the Chinese group. Conclusion: The findings of this study show that there are differences in burnout between Australian and Chinese nurses. The effects of resilience and turnover intention on burnout between the two groups are also identified. Relevance to clinical practice: The differences in nurse burnout and the effects of resilience and turnover intention on burnout should be better understood by nurse managers from Australia and China. Moreover, developing effective strategies relevant to their own country to reduce nurse burnout is recommended.
Description:
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.
Description:
Little is known about why nurses escalate a Medical Emergency Team (MET) response based on ‘worried’ criteria or what clinical findings define a ‘worried’ MET call. Limited clarity exists in nursing literature regarding the clinical definition of ‘worried’ in medical emergencies. Commonly ‘worried’ terminology is associated with nursing intuition about a patient's condition before signs of decline in clinical condition. This research has identified the exact clinical cause of ‘worried’ escalations, with evidence to support that clinical reasoning and patient deterioration are the main cause of ‘worried’ activation. This research has also highlighted areas for further professional development to enhance levels of patient safety and quality care within a regional hospital setting.
Description:
Clinical simulation is an essential component of health professional education. Digital technologies can provide students with near-reality, interactive virtual simulation learning experiences on static and mobile appliances. Clarification is needed, however, regarding the various types of virtual simulation and the different program components. We drew on published literature to define virtual simulation modalities and to offer definitive terminology to clarify the nomenclature and composition of virtual simulation. Reporting should include description of ‘Fidelity’ ‘Immersion’ and ‘Patient’ to add clarity and utility to research in the field.
Description:
Background: Papers continue to be cited by authors even after they have been retracted. Retraction notices provide readers with information about retracted papers and may help minimise post-retraction citation. To date, a review of the quality of retraction notices in nursing science has not been reported. Design: An audit of retraction notices associated with 29 retracted manuscripts published in nursing science journals. Methods: Retraction notices were reviewed again using the Committee on Publication Ethics (COPE) guidelines. Results: In total, 28 retraction notices were retrieved and reviewed (one retracted paper did not have a retraction notice). Details of the retracted manuscripts were included in all reviewed notices and, in all but two, author names were reported. Details of the time between a paper being published and retracted were not reported and generally there was a little information in notices about how the retraction decisions were made. All retraction notices were freely available. Seven notices stated who had made the decision to retract. Twenty-two (77%) notices stated the reason for retraction. Notices were brief and contained factual information. The webpages of three retracted articles did not clearly indicate that the paper had been retracted. Conclusion: More detailed and informative retraction notices will inform readers and may help reduce post- retraction citation.
Description:
Aims: To evaluate the impact of Acute Deterioration Detection System (ADDS) charts introduced to a regional healthcare service. Background: To assist health professionals in identifying essential elements for recognizing patient clinical deterioration, a national initiative introduced track and trigger observation charts, to hospitals in Australia. This study investigated whether the introduction of ADDS charts had an impact on the number of Medical Emergency Team (MET) and Code Blue activations at one regional healthcare service, according to their incident recording database. Method: A retrospective study of all Code Blue and MET activations was undertaken at a regional hospital, pre and post the introduction of ADDS charts in a two year period, June 2012 to June 2014. Results: There was a significant increase in MET activations from 5.91 to 11.27 per 1000 admissions (p < 0.01) after the implementation of ADDS charts. There was also an unexplained non-significant increase from 0.50 to 0.88 per 1000 admissions in the activations of Code Blue during this period (p = 0.05). It was also found that ADDS charts did not overly influence the activation criteria for calling a MET/Code Blue, except for an increase in reports of high heart rate and a decrease in the use of the criteria ‘worried’. Conclusion: The introduction of ADDS charts has provided health professionals with a clear track and trigger set of criteria, improving the detection of early signs of deterioration in patients. This study demonstrated an increase in activations as a result of the introduction of ADDS charts in one regional healthcare service.
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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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Simulation-based education has become a ubiquitous teaching approach in nursing. However, ensuring the quality of simulation research is critical. We reviewed the methodological quality of 26 quantitative studies published in Clinical Simulation in Nursing, 2017. The Medical Education Research Study Quality Instrument and Simulation Research Evaluation Rubric showed that nearly all studies were of moderate to high quality (rated ≥50%). Correlation coefficients showed that interrater agreement was high overall (≥0.94). In conclusion, this was a valid approach for examining simulation study quality. Although most included studies were of high quality, some elements of study reporting can be improved upon.
Description:
Simulation-based education has become a ubiquitous teaching approach in nursing. However, ensuring the quality of simulation research is critical. We reviewed the methodological quality of 26 quantitative studies published in Clinical Simulation in Nursing, 2017. The Medical Education Research Study Quality Instrument and Simulation Research Evaluation Rubric showed that nearly all studies were of moderate to high quality (rated ≥50%). Correlation coefficients showed that interrater agreement was high overall (≥0.94). In conclusion, this was a valid approach for examining simulation study quality. Although most included studies were of high quality, some elements of study reporting can be improved upon.
Description:
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.