Adult deterioration detection system (ADDS) : An evaluation of the impact on met and code blue activations in a regional healthcare service
- Authors: Missen, Karen , Porter, Joanne , Raymond, Anita , de Vent, Kerry , Larkins, Jo-Ann
- Date: 2018
- Type: Text , Journal article
- Relation: Collegian Vol. 25, no. 2 (2018), p. 157-161
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- 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.
The meaning of ‘worried’ in MET call activations : A regional hospital examination of the clinical indicator
- Authors: Raymond, Anita , Porter, Joanne , Missen, Karen , Larkins, Jo-Ann , de Vent, Kerry , Redpath, Simone
- Date: 2019
- Type: Text , Journal article
- Relation: Collegian Vol. 26, no. 3 (2019), p. 378-382
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- 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.
Addressing information needs of vulnerable communities about incontinence: a survey of ten CALD communities
- Authors: Cross, Wendy , Cant, Robyn , Manning, Deborah , McCarthy, Susan
- Date: 2014
- Type: Text , Journal article
- Relation: Collegian (Royal College of Nursing, Australia) Vol. 21, no. 3 (2014), p. 209-216
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- Description: Urinary incontinence is a common and distressing condition. Using focus groups, we explored the views of ten ethnic language groups in Melbourne about knowledge and awareness of incontinence. The 218 participants (with or without incontinence) spoke with trained interpreters. Twenty focus group discussions of single and mixed sex groups were audio-recorded and transcribed into English. Narratives were analyzed using thematic analysis with open coding and also incorporated themes from literature. Participants' knowledge of incontinence was low and incontinence was thought to be an inevitable consequence of ageing. There was little understanding of treatments or assistance available under government-funded programmes. No group was aware of the national continence programme or phone helpline. Sensitivities of the topic plus language barriers in immigrant culturally and linguistically diverse communities may impose barriers to accessing help. Several groups thought they would cope with incontinence by themselves, while all groups suggested they would be able to discuss the condition with a doctor. Various preferences voiced about social limitations and permissible communications with others are described. Nurses should be aware of the needs and communication preferences of ethnic language groups regarding continence information and continence service delivery.
Attitude to the subject of chemistry in undergraduate nursing students at Fiji National University and Federation University, Australia
- Authors: Brown, Stephen , Wakeling, Lara , Peck, Blake , Naiker, Mani , Hill, Dolores , Naidu, Keshni
- Date: 2015
- Type: Text , Journal article
- Relation: Collegian Vol. 22, no. 4 (2015), p. 369-375
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- Description: Attitude to the subject of chemistry was quantified in first-year undergraduate nursing students, at two geographically distinct universities. A purpose-designed diagnostic instrument (ASCI) was given to students at Federation University, Australia (. n=. 114), and at Fiji National University, Fiji (. n=. 160). Affective and cognitive sub-scales within ASCI showed reasonable internal consistency. Cronbach's α for the cognitive sub-scale was 0.786 and 0.630, and 0.787 and 0.788 for affective sub-scale for the Federation University and Fiji National University students, respectively. Mean (SD) score for the cognitive sub-scale was 10.5 (5.6) and 15.2 (4.1) for students at Federation University and Fiji National University, respectively (. P<. 0.001, t-test). Mean (SD) score for the affective sub-scale was 13.1 (5.1) and 20.7 (4.3) for students at Federation University and Fiji National University, respectively (. P<. 0.001, t-test). An exploratory factor analysis (. n=. 274) confirmed a two-factor solution consistent with affective and cognitive sub-scales, each with good internal consistency. Quantifying attitude to chemistry in undergraduate nursing students using ASCI may have utility in assessing the impact of novel teaching strategies used in the education of nursing students in areas of bioscience and chemistry. However, geographically distinct populations of undergraduate nurses may show very different attitudes to chemistry. © 2014 Australian College of Nursing Ltd.
Graduate nurse program coordinators' perspectives on graduate nurse programs in Victoria, Australia : A descriptive qualitative approach
- Authors: Missen, Karen , McKenna, Lisa , Beauchamp, Alison
- Date: 2016
- Type: Text , Journal article
- Relation: Collegian Vol. 23, no. 2 (2016), p. 201-208
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- Description: Aims: The purpose of this study was to describe the formal preparation nursing graduates are given throughout their first year of nursing in terms of educational structure and content of work-based year-long graduate nurse programs, from the perspectives of Graduate Nurse Program Coordinators. Background: In Australia, graduate nurse programs aim to provide a supportive learning environment, assisting nursing graduates in applying their theory to practice and supporting them in becoming safe, competent and responsible professionals. Internationally, research has demonstrated an increase in the job satisfaction and more importantly retention rates of newly qualified nurses who are supported in their first year of employment in some type of transition program. Method: Using a descriptive qualitative approach, individual semi-structured interviews were used. These interviews were audio recorded, transcribed verbatim and thematically analysed to reveal themes and sub-themes. Results: The interviews provided an insight into the various aspects of preparation that nursing graduates are given in their first year of practice with the main theme to emerge from analysis, nature of transition programs. The three subthemes associated with nature of transition programs consisted of composition of rotations and study days and supernumerary strategies. Findings indicate variation in pedagogical models underpinning graduate nurse programs across Victoria. Clinical rotations varied between three to twelve months, the number of study days offered were between four and thirteen days and there was variation in supernumerary time and strategies within the programs investigated. © 2015 Australian College of Nursing Ltd.
Australian nursing students’ experience of bullying and/or harassment during clinical placement
- Authors: Budden, Lea , Birks, Melanie , Cant, Robyn , Bagley, Tracy , Park, Tanya
- Date: 2017
- Type: Text , Journal article
- Relation: Collegian Vol. 24, no. 2 (2017), p. 125-133
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- Description: Bullying and harassment in nursing are unacceptable behaviours in the workplace. There is a large body of evidence relating this problem, however little of it focuses on the experiences of nursing students. This prospective cross-sectional survey investigated Australian undergraduate nursing students’ (N = 888) experiences of bullying and/or harassment during clinical placement. Half (50.1%) of the students indicated they had experienced this behaviour in the previous 12 months. Younger students were more likely to be bullied/harassed than older students (p = 0.05). Participants identified perpetrators of bullying/harassment as registered nurses (56.6%), patients (37.4%), enrolled nurse's (36.4%), clinical facilitators (25.9%), preceptors (24.6%), nurse managers (22.8%) and other student nurses (11.8%). The majority of students reported that the experience of being bullied/harassed made them feel anxious (71.5%) and depressed (53.6%). Almost a third of students (32.8%) indicated that these experiences negatively affected the standard of care they provided to patients with many (46.9%) reconsidering nursing as their intended career. In the face of workforce attrition in nursing, the findings of this study have implications for education providers, clinical institutions and the profession at large. © 2015 Australian College of Nursing Ltd
Are we there yet? Graduate readiness for practice, assessment and final examinations
- Authors: Missen, Karen , McKenna, Lisa , Beauchamp, Alison
- Date: 2018
- Type: Text , Journal article
- Relation: Collegian Vol. 25, no. 2 (2018), p. 227-230
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- Description: 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.
Newly qualified graduate nurses’ experiences of workplace incivility in Australian hospital settings
- Authors: Mammen, Bindu , Hills, Danny , Lam, Louisa
- Date: 2018
- Type: Text , Journal article
- Relation: Collegian Vol. 25, no. 6 (2018), p. 591-599
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- Description: Background: Workplace incivility is a well-documented issue of concern known to negatively impact on new graduate nurses’ confidence, which in turn may affect the quality of patient care. However, there is lack of qualitative research that solely focuses on workplace incivility experiences of new graduate registered nurses enrolled in graduate nurse programs. Aim: This paper aims to explore new graduate nurses’ experiences of workplace incivility while enrolled in graduate nurse programs Method: A descriptive-qualitative method was used to discover the ‘who, what, and where’ of events and experiences, and assist in understanding the perceptions of newly qualified nurses, through face-to-face, in-depth interviews. After transcription, the interviews were analysed by thematic analysis. Findings: Four major themes emerged: ‘realising vulnerability’ ‘sensing self actualisation’ ‘changing expectations’ and ‘yearning for respect, support & information’. Discussion: Our interpretations of what participants said suggest that workplace incivility is an extant issue in nurses’ supportive graduate year, with the temporary employment status offered by the graduate nurse program being identified as a major contributing factor. Paradoxically, the relatively short duration of clinical rotation was also found to be a morale booster, as the new graduate nurses knew that any conflict experienced would cease, which therefore acted as a decisive factor for their continuation in nursing. Conclusion: This study has provided more depth and insight into the experiences of incivility experienced by new graduate nurses, highlighting that the role of temporary employment as a major causative element for exposure to workplace incivility. Graduate nurse programs could be strengthened, with additional support provided for each rotation and throughout the graduate year.
Workplace aggression experiences and responses of Victorian nurses, midwives and care personnel
- Authors: Hills, Danny , Lam, Louisa , Hills, Sharon
- Date: 2018
- Type: Text , Journal article
- Relation: Collegian Vol. 25, no. 6 (2018), p. 575-582
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- 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.
Best practice in clinical simulation education − are we there yet? A cross-sectional survey of simulation in Australian and New Zealand pre-registration nursing education
- Authors: Bogossian, Fiona , Cooper, Simon J. , Kelly, Michelle , Levett-Jones, Tracy , McKenna, Lisa , Slark, Julia , Seaton, Philippa
- Date: 2018
- Type: Text , Journal article
- Relation: Collegian Vol. 25, no. 3 (2018), p. 327-334
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- Description: Background: Simulation is potentially a means of increasing clinical education capacity. Significant investments have been made in simulation but the extent to which this has improved uptake, quality and diversity of simulation use is unclear. Aim: To describe the current use of simulation in tertiary nursing education programs leading to nurse registration Australia and New Zealand, and determine whether investments in simulation have improved uptake, quality and diversity of simulation experiences. Methods: A cross sectional electronic survey distributed to lead nursing academics in programs leading to nurse registration in Australia and New Zealand. Findings: 51.6% of institutions responded and reported wide variation in allocation of program hours to clinical and simulation learning. Simulation was embedded in curricula and positively valued as an adjunct or substitute for clinical placement. While simulation environments were adequate, staff time, training and resource development were barriers to increasing the quality, amount and range of simulation experiences. Quality assurance and robust evaluation were weak. Discussion: Simulation program hours are inconsistently reported and underutilized in terms of potential contribution to clinical learning. Benefits of capital investment in simulation physical resources have been realised, but barriers persist for increasing high quality simulation in nursing programs. Conclusion: Transitioning components of clinical education from the clinical to tertiary sectors has resource implications. Establishment of sustainable, high quality simulation experiences requires staff training, shared resources, best practice and robust evaluation of simulation experiences in nursing curricula. © 2017 Australian College of Nursing Ltd
Using the lens of enablement to explore patients’ experiences of Nurse Practitioner care in the Primary Health Care setting
- Authors: Frost, Jane , Currie, Marian , Cruickshank, Mary , Northam, Holly
- Date: 2018
- Type: Text , Journal article
- Relation: Collegian Vol. 25, no. 2 (2018), p. 193-199
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- Description: Background: Patient enablement is a patient-centred concept reflecting a patient's ability to cope, understand and manage their own health. It can be used as a measure of the quality of care and has been linked with improved patient outcomes. While there have been studies into patient enablement following consultations with General Practitioners (GPs) and practice nurses, Nurse Practitioners’ (NPs) role in enabling patients remains unexplored. Aim: To use the lens of enablement to explore patients’ lived experience of NP care in a Primary Health Care (PHC) setting in Australia. Methods: Using a qualitative approach, 12 patients who had consulted an NP in PHC participated in unstructured interviews. An interpretative phenomenological approach was used to inform the study. A secondary analysis was conducted to explore possible synergies and resonance between the data and the constructs of the Patient Enablement Instrument (PEI). Findings: This small qualitative study found that, following consultations with NPs in PHC, patients reported personal approaches and behaviours consistent with enablement. Three key existential themes appeared to contribute to patient enablement: the way NPs used consultation time (temporality), the building of partnerships between NPs and patients (relationality) and through NPs’ holistic and hands-on consultation approach (corporality). The effective use of time in the consultation was seen as particularly important. Conclusion: The findings from this study suggest consultations with NPs do enable patients. This is a previously undocumented strength of NP care. Further research, using a variety of settings, methods and patient and health care provider populations, is recommended. © 2017 Australian College of Nursing Ltd
Defining and classifying aggression and violence in health care work
- Authors: Hills, Danny
- Date: 2018
- Type: Text , Journal article
- Relation: Collegian Vol. 25, no. 6 (2018), p. 607-612
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- Description: Background: There is considerable contention in defining workplace aggression, especially in health care. This can lead to challenges in effectively researching workplace aggression, and ensuring a sound basis for developing strategies to prevent and minimise its likelihood and consequences. Aim: The aim of this discussion paper is to provide a pragmatic definition of workplace aggression, based on a contemporary conceptualisation of human aggression, followed by a discussion on key classifications of workplace aggression. Methods: The argument presented draws on theoretical and applied literature to develop a case for adopting a pragmatic definition of aggression, with key classification components. Findings and Discussion: A highly practical conceptualisation of workplace aggression differentiates two main forms – verbal or written and physical aggression – and two main source groups – internal (co-workers) and external (patients, their relatives or carers and others external to the workplace). Conclusion: Clarity and consensus on defining and classifying workplace aggression, should provide a sound and coherent basis for researchers, policy makers, clinicians and health care organisations to successfully prevent and minimise this challenging and serious work health and safety concern. © 2018 Australian College of Nursing Ltd
Exploration of nursing degree students’ content expectations of a dedicated Indigenous health unit
- Authors: Jacob, Elisabeth , Raymond, Anita , Jones, Janet , Jacob, Alycia , Drysdale, Marlene , Isaacs, Anton
- Date: 2016
- Type: Text , Journal article
- Relation: Collegian Vol. 23, no. 3 (2016), p. 313-319
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- Description: Mandatory Aboriginal and Torres Strait Islander health units are included in all nursing education programmes in Australia to improve students’ knowledge, skills and attitudes towards Indigenous people in order to help address health inequities. This research explores content expectations of nursing students required to undertake Aboriginal and Torres Strait Islander health studies as part of a Bachelor of Nursing Degree at a rural university campus. A cross-sectional survey was undertaken to examine students’ opinions of course content of an Aboriginal health and wellbeing unit. Two hundred and ninety-four students across the three years of the degree were asked to complete the anonymous survey. Two hundred and forty-six students (83.6%) completed the survey. One hundred and thirty-nine students had completed, and 107 students were yet to undertake the unit. Qualitative content analysis of an open-ended survey question was used to interrogate the data. Four themes emerged from the data: cultural competence, disease implications and management, nursing care and other issues. Content expectations were consistent for students who were yet to undertake (pre) or had completed (post) the unit. Content expectations included Aboriginal and Torres Strait Islander culture (pre 30.4%–post 29.8%), Aboriginal and Torres Strait Islander health issues (pre 20.0%–post 23.7%) and understanding nursing care related issues (pre 15.7%–post 17.1%). Data findings were significant for enhancing the current unit. Students express the need for a safe learning environment in which to challenge beliefs and opinions. Course facilitators need to be sensitive to student populations and include content relevant to the programme being studied. Cultural immersion experiences may improve confidence in nursing Aboriginal and Torres Strait Islander people. © 2015 Australian College of Nursing Ltd