Collegian最新文献

Aims

To review and assess the literature about the safety and appropriateness of weaning small babies from incubators to open cots weighing less than 1600 g.

Design

A systematic review.

Review methods

The Critical Appraisal Skills Programme tool was used to assess the relevance and quality of the available literature from May 1994 until November 2023.

Data sources

Google Scholar, PubMed, Ovid, Scopus, Cumulative Index of Nursing and Allied Health, and PsycInfo.

Results

A total of 164 articles were retrieved, of which 14 studies met the inclusion criteria and are included in this review. Randomised controlled trials have proven that babies could safely wean from incubators to cots at 1600 g. Retrospective chart review studies have shown that babies can successfully transition from a crib into an open cot at 1500 g or even 1400 g. One retrospective study also identified babies transitioning successfully at 1200 g. Eight studies showed no adverse outcomes for early weaning. Eight studies showed no difference or a shorter length of stay in smaller babies.

Conclusions

With the improving capacity of incubator technology to maintain a stable temperature in babies, it seems evident that using a specific and controlled approach to weaning small babies from an incubator to an open cot can lead to earlier discharge. Small babies can be weaned safely from an incubator to a cot, and those who are weaned more effectively and expediently may have better outcomes, such as better weight gain, reduced length of stay, and earlier discharge home.

Tweetable abstract

Small babies can be weaned successfully from an incubator into a cot at 34 weeks gestation or 1600 g or less without any adverse effects @Vskinner9.

Background

Nursing management encompasses actions such as planning, organising, commanding, coordinating, and controlling, all of which directly impact staff satisfaction and the quality of care provided in healthcare institutions. Therefore, the experience and qualifications of nurse managers are indispensable. Despite nursing management being taught in nursing schools through both theoretical and practical classes, gaps in the field are still evident, and even conceptualising the process can be challenging.

Aim

To describe nurses’ perceptions of nursing management through metaphors.

Methods

This is a descriptive study with a qualitative approach that involved a total of 84 participants (47 staff nurses and 37 nurse managers). Data were collected online in Brazil between February 10, 2024, and March 25, 2024, through Google Forms. The metaphor analysis technique was used.

Findings

Technical, interpersonal, and conceptual skills, as well as basic management functions, were identified through the metaphors of staff nurses and nurse managers. The categories of metaphors for ‘nurse manager’ are as follows: ‘Leadership and guidance’, ‘Coordination and balance’, ‘Adaptation and flexibility’, ‘Support and empathy’, and ‘Vision and vigilance’. The categories of metaphors for ‘nursing management’ are as follows: ‘Obstacles and strategic planning’, ‘Coordination and harmony’, and ‘Balance and control’.

Discussion

Nurse managers should act as role models for the other members of their teams. The lack of certain skills in nurse managers and failures in some functions of nursing management indicate that the selection and education of nurse managers deserve special attention.

Conclusion

Both staff nurses and nurse managers are aware of the important role played by nursing management in the well-being of the team and the quality of care, consequently, in the success of healthcare institutions. Healthcare institutions must be rigorous in choosing their nurse managers. Additionally, educational institutions must pay attention to the theoretical teaching and practical education of nurses to effectively perform nursing management.

Background

The knowledge nursing students acquire during their undergraduate degree influences the quality of patient care they provide for many years to come. However, previous studies indicate that students may have a limited understanding of core patient safety concepts.

Objectives

The objectives of this study were to (i) examine nursing students’ performance in an interactive patient safety e-learning module titled ‘One shift, four patients … a day in the life of a new graduate nurse’; and (ii) explore students’ level of satisfaction with the module using the Satisfaction with the Patient Safety E-Learning Module scale.

Design

A cross-sectional design was used with students’ knowledge and levels of satisfaction examined using descriptive statistics.

Setting and participants

In total, 1038 third-year undergraduate nursing students from 22 Australian universities attempted the module.

Results

The mean correct score was 74%, but there were significant differences in knowledge levels evident across the four activities that comprised the module. Participants achieved the highest mean score in Activity 2 (Predicting, monitoring, and responding to adverse events [79%]) and the lowest in Activity 3 (Clinical reasoning [66%]). The mean score for Activity 1 (Infection control and medication safety) was 74%, and for Activity 4 (Cultural competence), the score was 77%.

The level of student satisfaction with the module was high with responses to each survey item exceeding 4.0 out of 5.0. The Cronbach’s alpha for the satisfaction scale was 0.99, and the Content Validity Index was >0.9.

Conclusions

Universities are responsible for preparing nursing students to become safe clinicians. The results from this study indicate that participants’ overall level of knowledge of key patient safety concepts was adequate. However, as knowledge is the foundation for safe practice, these results suggest that further attention to imbedding patient safety in nursing curricula is required.

Problem

Patients and health systems rely on a skilled and available cancer nursing workforce to deliver quality nursing care to optimise cancer outcomes. Understanding the education, qualifications, and roles of cancer nurses across Australia is an essential aspect of effective service planning.

Aim

To explore the associations between the geographical location of cancer nurses and their education, qualifications, roles, activities, and scope of practice.

Methods

A cross-sectional electronic survey was distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The self-report survey captured demographics, education, qualifications, roles, scope of practice, and salary. Descriptive statistics and bivariate analysis were used to summarise and report the findings.

Findings

Responses were received from 930 nurses. Most identified as female (94%), lived in metropolitan areas (69%), worked in dedicated cancer centres (79%), and in the public sector (69%). While 80% had more than 10 years of nursing experience and 70% possessed postgraduate qualifications, 58% indicated their intention to remain in the profession for 10 years or less. Roles, pay, education, and activities varied across regions, states, and territories, with regional nurses more likely to be involved in multiple activities and roles compared with their metropolitan counterparts.

Conclusion

This study highlights the importance of understanding geographic variations within the cancer nursing workforce to formulate strategies aimed at enhancing workforce sustainability and, consequently, patient outcomes. Addressing disparities in education and opportunities for career advancement is crucial to ensuring equitable access to quality cancer care nationwide.

Background

During natural disasters, priorities are frequently revised, and new strategies are adopted to deal with the enormity and outcome of the disaster. Understanding how resilient healthcare systems adapt and respond under these unexpected conditions is important in learning how to respond more effectively in future events to provide high-quality care.

Aim

We aimed to understand concepts and definitions of resilient healthcare from a systems perspective in the context of natural disasters.

Methods

Using scoping review methodology, as described by Joanna Briggs Institute.

Findings

Of 1011 articles screened, 18 met eligibility criteria and were included in the review. Natural disasters in the included papers were bushfires, floods, earthquakes, hurricanes, and tsunamis, ranging across five geographical locations.

Discussion

We identified broad definitions of resilient healthcare that reflect the varied healthcare systems’ responses to disasters. Definitions of resilient healthcare came from the ecology field, resilient engineering, and resilience in healthcare systems. The adaptive capacity of health systems during a natural disaster response is key to ecological resilience. Moreover, resilient engineering and resilience in healthcare determined the proposed potential of a resilient system by monitoring, anticipating, responding, and learning from disasters. Consequently, healthcare systems are recognised as complex adaptive systems.

Conclusion

This review identified that adapting and adjusting at a systems level is crucial for effective resilience in healthcare and natural disasters. Further research is needed to explore what concepts of resilience healthcare are used from a whole system perspective and how the system’s adaptive capacity supports handling the event before, during, and after the disaster.

Background

Fatigue is commonly reported in shiftworking emergency department nurses. Fatigue can be both acute and chronic, with both types impacting organisational outcomes. However, chronic fatigue is reported to have a greater impact on nurses’ health and wellbeing.

Aim

To understand ways shiftworking emergency department nurses with varying levels of fatigue attempt to overcome and mitigate the effects of fatigue at work and home and essentially recover.

Methods

A mixed method approach utilised nurses’ free-text responses as part of an online survey. Shiftworking emergency department nurses’ responses were compared between those with low chronic fatigue and high chronic fatigue.

Findings

Regardless of fatigue level, shiftworking emergency department nurses reported sleep and rest, exercise and self-care activities at home, and caffeine consumption and work breaks at work to reduce the effects of fatigue. However, at work, only nurses with low chronic fatigue described using more and varied strategies, such as staying active, socialising with colleagues, and making healthy dietary choices, to mitigate fatigue effects.

Discussion

Shiftworking emergency department nurses with varying fatigue levels differ in strategies utilised to reduce the effects of fatigue. The use of diverse and numerous strategies to combat fatigue was associated more with low chronic fatigue than high chronic fatigue. These findings may be of benefit to shiftworking emergency department nurses and nursing managers to assist nurses in recovering from the effects of fatigue at home and through the allocation of rostering and resources to support nurses’ working lives.

Background

Community nurses delivering heart failure self-care education improve patient outcomes, but the cost-effectiveness of this type of nurse-led intervention has not been recently established.

Aim

To determine the cost-effectiveness of community nurses’ self-care education for heart failure patients compared with usual care.

Methods

We performed a cost-effectiveness analysis from the perspective of the Italian National Health Service. A Markov model simulated the progression of a cohort of 1000 heart failure patients receiving remote self-care education after hospital discharge or usual care. Outcomes included costs, quality-adjusted life years, and incremental cost-effectiveness ratio. The willingness-to-pay threshold was established at €40,000/quality-adjusted life years.

Findings

Over the 20-year time horizon, community nurses’ care incurred an extra cost of €1.3 million while gaining 247 quality-adjusted life years compared with usual care, and the incremental cost-effectiveness ratio was €5490/quality-adjusted life years.

Conclusions

The involvement of community nurses in self-care education is a potential cost-effective way of delivering home self-care education to heart failure patients.

Background

Since the radical years following the To Err is Human report, patient safety research has become settled on standardisation and audit cultures. Recent work suggests a change in direction. Current efforts exploring the intricate relationship between stability and change within organisations establish a more balanced patient safety perspective. Frontline staff insights are key to this new knowledge.

Aim

This study aims to explore the patient safety perceptions of registered nurses working directly with patients in acute care settings.

Method

Facilitated reflexive workshops were conducted with nine wards from October to November 2022. Data analysis explored creative works and reflective notes of group discussions with frontline registered nurses using a critical lens.

Findings

We offer four analytical interpretations of how frontline registered nurses understand and experience patient safety. These are as follows: buzzwords, keep ME safe, listen to US, and this is MY role. These manifest the business of patient safety where nurses are, under siege, the silenced team member and experience tension between accountability and responsibility.

Discussion

Critical questioning and reappraisal of patient safety practices require the vast knowledge of frontline staff to be fully utilised.

Conclusion

This research reveals much of what is avoided in patient safety literature — the tension between what registered nurses understand, experience, and can deliver in patient safety practice. It challenges organisational leaders to enable and support frontline nurses in driving local change.

Background

Until late 2021, mandatory quarantine for travellers returning to Australia was an important part of the national response to the COVID-19 pandemic. In South Australia, a nurse-led quarantine medihotel model was used.

Aim

To explore the lived experiences of nurses who worked in South Australian quarantine medihotels at the height of the pandemic.

Methods

The study employed a qualitative research design using van Manen’s phenomenology of practice method.

Findings

Four themes emerged: united on the frontline, moving in sync with traveller’s needs, the paradox of being yet not being right in it, and feeling let down by organisational systems. These themes emerged from the organisational structures, work design, and public understanding of the COVID-19 risk.

Discussion

Clashing priorities of the travellers and the organisation, travellers’ physical and psychological adjustments to quarantine, and substantial public anxiety around COVID-19 contributed to high levels of stress experienced by the quarantine medihotel nurses and presented challenges to uphold an image of nursing as a caring profession. Understanding, which was driven by novel ways of multi-agency problem-solving and compassionate provision of care, made it possible for nurses to act authentically and in ways congruent with their professional values.

Conclusion

Cross-functional teams will be required when responding to increasingly more complex problems, including future pandemics. Enhancing cross-functional leadership capacity through support and skills development promotes frontline pandemic nurses’ response capability.

Opportunity exists to learn from the nurse’s experiences, mitigate the negative mental health impact, and support the longer-term wellbeing of the quarantine medihotel nurses.