Falls risk score removal does not impact inpatient falls : a stepped-wedge, cluster-randomised trial
- Jellett, Joanna, Williams, Cylie, Clayton, Diana, Plummer, Virginia, Haines, Terry
- Authors: Jellett, Joanna , Williams, Cylie , Clayton, Diana , Plummer, Virginia , Haines, Terry
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 29, no. 23-24 (2020), p. 4505-4513
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- Description: Aims and objectives: To investigate the impact of removing a falls risk screening tool from an overall falls risk assessment programme on the rate of falls, injurious falls and completion of falls prevention activities by staff. Background: Falls in older patients are common adverse events in hospital settings. Screening and assessing individual patients for risk of falls are a common, but controversial element of falls prevention strategies in hospitals. Design: A stepped-wedge, cluster-randomised controlled trial using a disinvestment approach. Methods: This trial was carried out according to the Consolidated Standards of Reporting Trials (CONSORT). All patients were admitted to 20 health service wards (9 units) over the 10-month study period. The control condition contained a falls risk screening tool element, a full falls risk factor assessment and intervention provision section. In the intervention condition, only the full falls risk factor assessment and intervention provision section was applied, and the falls risk screening tool element was removed. Fall rates were extracted from hospital level data, files were audited for tool completion, and nurses surveyed about tool use. Results: There did not appear to be an impact on the falls rate per month when the risk screening tool component was removed (incidence rate ratio (IRR) = 0.84—favours intervention, 95%CI = 0.67 to 1.05, p =.14) nor on the falls rate with serious injury (IRR = 0.90, 95%CI = 0.26 to 3.09, p =.87). There was a thirty-six second reduction of time per patient reported by staff to complete paperwork (p <.001). There was no difference in the proportion of patients for whom the tool was completed, nor the number of falls prevention interventions identified for implementation. Conclusion: Removing the falls risk screening tool section did not negatively impact falls and reduced time spent completing falls prevention paperwork. Relevance to clinical practice: Falls prevention is an important issue in health services. Removal of a screening risk tool is unlikely to impact falls. This has the potential to reduce nursing administration time that may be otherwise redirected to individual approaches to falls prevention. © 2020 John Wiley & Sons Ltd
Nursing perspectives on reducing sedentary behaviour in sub-acute hospital settings : a mixed methods study
- Hills, Danny, Ekegren, Christina, Plummer, Virginia, Freene, Nicole, Kunstler, Breanne, Robinson, Tracy, Healy, Ellen, Vo, Jennifer, Gasevic, Danijela, Crabtree, Amelia
- 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.
- 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.
Practice priorities for acute care nursing : a Delphi study
- Connell, Clifford, Plummer, Virginia, Crawford, Kimberley, Endacott, Ruth, Foley, Pieternella, Griffiths, Debra, Innes, Kelli, Schwerdtle, Patricia, Walker, Lorraine, Morphet, Julia
- Authors: Connell, Clifford , Plummer, Virginia , Crawford, Kimberley , Endacott, Ruth , Foley, Pieternella , Griffiths, Debra , Innes, Kelli , Schwerdtle, Patricia , Walker, Lorraine , Morphet, Julia
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 29, no. 13-14 (2020), p. 2615-2625
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- Description: Aims and objectives: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. Background: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. Design: Delphi Method. Method: A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. Results: High patient acuity or complexity, as well as inadequate bed space on wards, are “very high” risks that occur “often” and “very often,” respectively. The pressure to admit patients, delayed medical review and patient boarding are all “high” risks that occur “often.” Though only occurring “sometimes,” inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a “very high” risk to patient care. Conclusion: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. Relevance to clinical practice: This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care. © 2020 John Wiley & Sons Ltd
- Rantung, Gilny, Griffiths, Debra, Plummer, Virginia, Moss, Cheryle
- Authors: Rantung, Gilny , Griffiths, Debra , Plummer, Virginia , Moss, Cheryle
- Date: 2022
- Type: Text , Journal article , Review
- Relation: Journal of Clinical Nursing Vol. 31, no. 7-8 (2022), p. 843-859
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- Description: Aims and objectives: The aim of this integrative review was to assess how emergency nurses cope and motivate themselves to sustain their caring work. Background: The need to enhance sustainability of the workforce creates a demand to consolidate contemporary evidence related to emergency nurses’ motivations, how they cope and sustain themselves for caring work. Design and methods: The integrative literature review informed by Whittemore and Knafl involved searching four databases, which yielded 977 published research papers (2008–2021). A total of 33 studies met the inclusion and quality assessment criteria. The PRISMA checklist for review was followed. Results: No studies addressing all three areas (motivations, coping and caring sustainability) together were identified. Integration of evidence from quantitative and qualitative research was achieved in three categories: (1) emergency nurses’ motivations to sustain their work, (2) emergency nurses’ coping strategies and (3) sustaining care as emergency nurses. Conclusion: To sustain themselves in caring work, emergency nurses need to be intrinsically and extrinsically motivated and know how to cope effectively with stressors and work demands. There is need for research examining the relationships between these aspects of emergency nursing work. Relevance to clinical practice: To ensure the sustainability of emergency nurses’ work and careers understanding of the factors that influence and sustain their motivations and coping strategies is important for nurses and their clinical leaders and managers. © 2021 John Wiley & Sons Ltd.
Communities of practice : a systematic review and meta-synthesis of what it means and how it really works among nursing students and novices
- Terry, Daniel, Nguyen, Hoang, Peck, Blake, Smith, Andrew, Phan, Hoang
- Authors: Terry, Daniel , Nguyen, Hoang , Peck, Blake , Smith, Andrew , Phan, Hoang
- Date: 2020
- Type: Text , Journal article , Review
- Relation: Journal of Clinical Nursing Vol. 29, no. 3-4 (2020), p. 370-380
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- Description: Aims and objectives: To evaluate the enablers, barriers and impact that communities of practice have on novice nurses and students learning to become registered nurses. Background: Communities of practice have formed the basis for conceptualising the process of learning that occurs among groups of people within a place of work—a mainstay of healthcare practice. There is a dearth of literature that focuses specifically on the outcomes from student and novice engagement with existing communities of practice. Design: Systematic review and Meta-synthesis. Methods: MEDLINE, PubMed, EMBASE, CINAHL, ProQuest, Scopus and PsycINFO databases were accessed between 1997–2019. The screening and selection of studies were based on eligibility criteria and methodological quality assessment using the Critical Appraisal Skills Programme tool for qualitative research. Meta-synthesis was grounded in the original experiences and collectively synthesised into meaningful themes. The review follows the PRISMA reporting guidelines and PRISMA checklist. Results: The findings highlight three major themes and included enablers for successful communities of practice, barriers to successful communities of practice, and success in action as described by students and novice nurses. Discussion: We suggest successful communities of practice occur when safe and supported spaces ensure students and novices feel comfortable to experiment with their learning, and we emphasise the benefits of having more novice nurses situated within close proximity and under the direct influence of the established practices of more experienced or core group of peers. Relevance to clinical practice: Communities of practice that function successfully create an environment that prioritises the embedding of novices into the broader group. In so doing, students and novice nurses feel supported, welcomed, empowered, and able to make the transition from student to colleague and novice nurse to more experienced nurse. It allows them to experiment with ever new ways of fulfilling the role, while aiding better clinical outcomes. © 2019 John Wiley & Sons Ltd
- Authors: Terry, Daniel , Nguyen, Hoang , Peck, Blake , Smith, Andrew , Phan, Hoang
- Date: 2020
- Type: Text , Journal article , Review
- Relation: Journal of Clinical Nursing Vol. 29, no. 3-4 (2020), p. 370-380
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- Description: Aims and objectives: To evaluate the enablers, barriers and impact that communities of practice have on novice nurses and students learning to become registered nurses. Background: Communities of practice have formed the basis for conceptualising the process of learning that occurs among groups of people within a place of work—a mainstay of healthcare practice. There is a dearth of literature that focuses specifically on the outcomes from student and novice engagement with existing communities of practice. Design: Systematic review and Meta-synthesis. Methods: MEDLINE, PubMed, EMBASE, CINAHL, ProQuest, Scopus and PsycINFO databases were accessed between 1997–2019. The screening and selection of studies were based on eligibility criteria and methodological quality assessment using the Critical Appraisal Skills Programme tool for qualitative research. Meta-synthesis was grounded in the original experiences and collectively synthesised into meaningful themes. The review follows the PRISMA reporting guidelines and PRISMA checklist. Results: The findings highlight three major themes and included enablers for successful communities of practice, barriers to successful communities of practice, and success in action as described by students and novice nurses. Discussion: We suggest successful communities of practice occur when safe and supported spaces ensure students and novices feel comfortable to experiment with their learning, and we emphasise the benefits of having more novice nurses situated within close proximity and under the direct influence of the established practices of more experienced or core group of peers. Relevance to clinical practice: Communities of practice that function successfully create an environment that prioritises the embedding of novices into the broader group. In so doing, students and novice nurses feel supported, welcomed, empowered, and able to make the transition from student to colleague and novice nurse to more experienced nurse. It allows them to experiment with ever new ways of fulfilling the role, while aiding better clinical outcomes. © 2019 John Wiley & Sons Ltd
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