Inattentional blindness and pattern-matching failure : The case of failure to recognize clinical cues
- Authors: Al-Moteri, Modi , Symmons, Mark , Cooper, Simon J. , Plummer, Virginia
- Date: 2018
- Type: Text , Journal article
- Relation: Applied Ergonomics Vol. 73, no. (2018), p. 174-182
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- Description: Eye-tracking methodology was used to investigate lapses in the appropriate treatment of ward patients due to not noticing critical cues of deterioration. Forty nursing participants with different levels of experience participated in an interactive screen-based simulation of hypovolemic shock. The results show that 65% of the participants exhibited at least one episode of non-fixation on clinically relevant, fully visible cues that were in plain sight. Thirty-five percent of participants dwelt for sufficient time (>200 ms) on important cues for perception to take place, but no action followed, indicating they had pattern-matching failure. When participants fail to notice what, they should notice in patient status until it is too late, this can have serious consequences. Much work needs to be done, since these human perceptual limitations can affect patient safety in general wards.
Enhancing alcohol and other drug (AOD) screening by emergency nurses
- Authors: Kelly, David , Chan, Raymond , Plummer, Virginia
- Date: 2015
- Type: Text , Journal article
- Relation: Australian Nursing and Midwifery Journal Vol. 22, no. 10 (2015), p. 49
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- Description: Within Australia it is culturally acceptable to consume alcohol and it is an integral part of the Australian way of life (Australian Government 2013). The National Drug Household Survey stated that about fourfifths of Australians aged 14 or older reported they had consumed alcohol in the past year and 6.5% drank on a daily basis (2013).
Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia
- Authors: Al Thobaity, Abdulellah , Plummer, Virginia , Innes, Kelli , Copnell, Beverley
- Date: 2015
- Type: Text , Journal article
- Relation: Australasian Emergency Nursing Journal Vol. 18, no. 3 (2015), p. 156-164
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- Description: Summary Background It is generally accepted that nurses have insufficient knowledge about disaster preparedness due to a lack of acceptance of core competencies and the absence of disaster preparedness in nursing curricula.1 This study explored nurses’ knowledge and sources of knowledge, and skills as they relate to disaster management in Saudi Arabia, where more than 4660 people have died, 32,000 people have been affected, and US$4.65 billion in damage has been caused by disaster since 1980.2 Methods A quantitative, non-experimental, descriptive research design. Results Nurses in Saudi Arabia have moderate knowledge concerning disaster preparedness. However, nurses in military hospitals possess more knowledge than those who work in government hospitals. The majority of nurses gained their knowledge and skills from disaster drills. Conclusions Nurses need more education in all areas of disaster management, most importantly in their roles during response to disasters. Nurses perceive themselves as not well-prepared but they are willing to improve their skills in disaster preparedness if educational opportunities are provided.
ICU nurses feel unprepared to care for patients with mental illness : A survey of nurses' attitudes, knowledge, and skills
- Authors: Weare, Reuben , Green, Cameron , Olasoji, Michael , Plummer, Virginia
- Date: 2019
- Type: Text , Journal article
- Relation: Intensive and Critical Care Nursing Vol. 53, no. (2019), p. 37-42
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- Description: 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.
Perceptions of shared decision-making in severe mental illness : an integrative review
- Authors: Huang, Chongmei , Plummer, Virginia , Lam, Louisa , Cross, Wendy
- Date: 2020
- Type: Text , Journal article , Review
- Relation: Journal of Psychiatric and Mental Health Nursing Vol. 27, no. 2 (Apr 2020), p. 103-127
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- Description: 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
Validation of the distress thermometer for caregivers of children and adolescents with schizophrenia
- Authors: Bai, Xiaoling , Wang, Anni , Cross, Wendy , Lam, Louisa , Plummer, Virginia , Guan, Ziyao , Sun, Mei , Tang, Siyuan
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 76, no. 2 (Feb 2020), p. 687-698
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- 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.
A wechat-based “three good things” positive psychotherapy for the improvement of job performance and self-efficacy in nurses with burnout symptoms : a randomized controlled trial
- Authors: Guo, Yu-Fang , Lam, Louisa , Plummer, Virginia , Cross, Wendy , Zhang, Jing-Ping
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Nursing Management Vol. 28, no. 3 (2020), p. 480-487
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- Description: Aim: To evaluate the effects of a WeChat-based “Three Good Things” on job performance and self-efficacy of clinical nurses with burnout symptoms. Background: Few studies have valued the impact of nurses' personal strengths and positive work environment on job performance, particularly in developing countries. Methods: A randomized controlled trial. The intervention group (n = 33) participated in WeChat-based Three Good Things, while the control group (n = 40) did not. Data were collected prior to and immediately after the intervention. WeChat, a popular social software, provides several communicating and recording functions. Results: The main intervention effects and interactions between time and intervention on job performance and self-efficacy were significant (each p < .05). The main time effects on self-efficacy were also significant (p < .05). The post-intervention scores for job performance and self-efficacy between the two groups were statistically different (each p < .05). The scores for job performance and self-efficacy of the intervention group were statistically different before and after the intervention (each p < .05). Conclusion: Three Good Things could significantly improve job performance and self-efficacy of nurses with burnout. Implications for Nursing Management: Nurse managers are recommended to include Three Good Things into their management systems to improve nurses' physical and mental health and work outcomes over the long term. © 2019 John Wiley & Sons Ltd.
Nurses' cognitive and perceptual bias in the identification of clinical deterioration cues
- Authors: Al-Moteri, Modi , Cooper, Simon J. , Symmons, Mark , Plummer, Virginia
- Date: 2020
- Type: Text , Journal article
- Relation: Australian Critical Care Vol. 33, no. 4 (2020), p. 333-342
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- Description: Background: Perception and processing of clinical cues have rarely been investigated in the nursing literature despite their relevance to the early identification and management of clinical deterioration. Aim: This study used a hypovolemic shock scenario from the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACT) virtual simulation program, equipped with an eye tracker, to investigate cue processing during the management of patient deterioration. Result: The study revealed that attention deviation distorted interpretation of subsequent cues, causing 63% of participants to exhibit a cognitive bias (heightened sensitivity to specific but noncritical cues) and 65% to exhibit at least one episode of nonfixation on clinically relevant cues. Attention deviation and distorted interpretations of clinical cues will have an impact on patient safety. Conclusion: The findings are likely to have important implications for understanding error and associated training implications. © 2019 Australian College of Critical Care Nurses Ltd
Clinical deterioration of ward patients in the presence of antecedents : A systematic review and narrative synthesis
- Authors: Al-Moteri, Modi , Plummer, Virginia , Cooper, Simon J. , Symmons, Mark
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Australian Critical Care Vol. 32, no. 5 (2019), p. 411-420
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- Description: Aim: The aim of this review was to identify and synthesise published accounts of recognising and responding to patient deterioration in the presence of deterioration antecedents. Design: The systematic review canvassed four electronic databases/ search engines for studies of adult ward patients who had altered physiological parameters before developing major adverse events. Synthesis Methods: The findings were synthesised using a narrative approach. Results: Clinical deterioration can be missed by nurses, even with adequate charting. Delays in recognising and responding to patient deterioration remains an international patient safety concern, and strategies to enhance recognition of patient deterioration have not achieved consistent improvements. The lack of significant and sustained improvement through targeted training suggests the problem may be rooted in human behaviour and local ward culture. Nurses play a pivotal role in recognising and responding to patient deterioration; however, patient records do not facilitate tracking of all nurse decisions and actions, and any undocumented care cannot be easily captured by auditing processes. Conclusion: Failure to recognise clinical deterioration was evident even with adequate charting. It is not clear if nurses do not recognise clinical deterioration because they failed to interpret the signs of deterioration or they made a conscious decision not to escalate based on their clinical judgement or they lacked attention at the time of the event. Whatever the reason, focus is warranted for nurses' decisionmaking after the recording of clinical deterioration signs and the role of human factors in delayed recognition, before maximum benefit of any strategy can be achieved.
Nursing perspectives on reducing sedentary behaviour in sub-acute hospital settings : a mixed methods study
- Authors: Hills, Danny , Ekegren, Christina , Plummer, Virginia , Freene, Nicole , Kunstler, Breanne , Robinson, Tracy , Healy, Ellen , Vo, Jennifer , Gasevic, Danijela , Crabtree, Amelia
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 31, no. 9-10 (2022), p. 1348-1361
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- Description: Aim and objectives: To determine the factors influencing nurses’ decisions and capacity to reduce sedentary behaviour in hospital inpatients in sub-acute hospital settings. Background: Sedentary behaviour in hospital inpatients is a complex issue that can be resistant to resolution. There is little research investigating factors influencing nurses’ promotion of reduced levels of sedentary behaviour in sub-acute hospital settings. Design: An explanatory sequential design was employed, comprising quantitative and qualitative phases. Methods: An online survey was conducted with a convenience sample of 138 nurses from five Australian states. Logistic regression modelling identified demographic and behavioural characteristics of nurses who often encouraged patients to reduce their sedentary behaviour. In-depth interviews were conducted with 11 ward nurses and nurse managers, with the content subjected to thematic analysis. STROBE and GRAMMS checklists were employed. Results: Nurses recognised their role in promoting reduced sedentary behaviour but faced a range of personal and organisational barriers in achieving this outcome for patients. Few nurses were aware of national physical activity and sedentary behaviour guidelines. Five themes emerged from interviews (nursing role, care challenges, expectations of advocates, teamwork and improving the experience). Overall, many nurses experienced a lack of agency in promoting reduced sedentary behaviour and cognitive dissonance in feeling unable to undertake this role. Conclusions: The results of this study are significant in confirming that reducing sedentary behaviour in hospital inpatients is influenced by a range of complex and multi-level factors. There is a fundamental need for organisational and clinical leadership in building a culture and climate in which staff feel empowered to promote reduced sedentary behaviour in their patients. Relevance to clinical practice: The results of this study highlight the importance of taking action to reduce sedentary behaviour in sub-acute hospital settings. A co-design approach to developing interventions in local health services is warranted. © 2021 John Wiley & Sons Ltd.
Decision-making errors during recognizing and responding to clinical deterioration : gaze path-cued retrospective think-aloud
- Authors: Al-Moteri, Modi , Plummer, Virginia , Cooper, Simon
- Date: 2022
- Type: Text , Journal article
- Relation: Clinical Simulation in Nursing Vol. 73, no. (2022), p. 29-36
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- Description: Background: Using individuals. own eye gaze path and mouse click tracks has proven to be a valuable technique for identifying a broad range of underlying cognitive processes and lapses of decision-making. Aim: The study aims to investigate nurses. decision-making errors in clinical deterioration. Method: Tobii eye tracker(R) was used to collect eye movements and mouse clicks of eighteen participants followed by gaze path retrospective interview. Finding: Thematic analysis revealed several forms of cognitive bias including anchoring, availability and confirmation bias, commission error and Yin-yang out. A distraction effect was apparent in nurses' ability to perceive, process data and to intervene. © 2022
Evaluation of resource allocation for undergraduate nursing professional experience placements coordination in Australian Higher Education; a cross-sectional study with descriptive qualitative thematic analysis
- Authors: Osman, Abdi , Bradley, Leah , Plummer, Virginia
- Date: 2023
- Type: Text , Journal article
- Relation: Nurse Education in Practice Vol. 67, no. (2023), p.
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- Description: Aims and objective: To assess the implementation of standards by Australian Nursing higher education providers as set by accrediting and regulating bodies and to identify any barriers or enablers to optimizing Professional Experience Placement. To recommend strategies for safeguarding and improving any identified enablers as well as mitigating factors for any identified barriers. Background: Professional Experience Placement is an essential element of all accredited Nursing Programs in Australia. The Australian Nursing and Midwifery Accreditation Council is responsible for developing accreditation standards and mandates minimum of 800 h of Professional Experience Placement scaffolded across curriculum which some Higher Education Providers set as their exact baseline for clinical placement duration. Design: Descriptive study using; questionnaire survey with qualitative thematic analysis and CROSS checklist. Method: Quantitative method with descriptive qualitative thematic analysis and purposive sampling was used to target 37 higher education institutions that offer BN and BN/BM programs, 33 of these institutions were randomly selected for inclusion. Data was collected over a six-week period from 24th May to 4th July 2022 using Qualtrics online survey. Results: Out of the 33 Higher Education providers who were invited to participate, 51.5 % (n = 17) responded. The respondent's demographics were: 94 % Bachelor of Nursing only placements coordinators while one respondent reported covering both Bachelor of Nursing and Bachelor of Midwifery; Most of the respondents (65 %) were in 40–55 years age group. The respondents reported to have overall responsibility across one to 6 campuses (Mean = 2.2) and having support/administrative staffs ranging from 0 to 15 (Mean = 4.11). Student population among the institutions ranged from 500 to 7500 with a mean of 2365.38. The number of campuses covered had statistically significant relationship with the student population (p < 0.001; 0.392–0.929 confidence interval) however no statistically significant relationship with the number of administrative staff allocated (p = 0.319;