Collegian最新文献

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.

Background

Educational interventions can decrease the rates of healthcare-associated infections (HAIs). We do not know current evidence on what kind of educational interventions are the most effective to reduce HAIs and infectious diseases. The aim of this systematic review was to examine the impact of educational interventions for health and social care professionals on infection control practices to reduce HAIs and prevent infectious diseases.

Methods

We searched for papers published between January 1, 2006 and November 16, 2021, using the CINAHL, Medic, MEDLINE, and Scopus databases. Quality appraisal was conducted using the Cochrane risk of bias tool for randomised controlled trials and ROBINS-I for quasi-experimental studies. Data were analysed using a deductive content analysis with The Guideline for Reporting Evidence-based Practice Educational interventions and Teaching checklist and The Classification Rubric for Evidence-based Practice Assessment Tools in Education as frameworks.

Findings

The data included 12 studies. Educational interventions on infection control practices have been developed as single, one-time interventions on a local basis. Two studies reported statistically significant outcomes in three of the areas evaluated, which were skills, knowledge, and self-efficacy for the first study, and benefits to the patient, behaviours, and knowledge for the second one. Benefits to the patient were evaluated in seven studies, and out of these, five showed statistically significant improvement.

Conclusions

There is currently no evidence of long-term learning paths or comparisons of different interventions to determine the most effective way to educate healthcare professionals. Statistically significant findings indicate that educational interventions on infection control practices should include both theoretical and practical learning activities.

Background and aim

Increasing the diversity of future healthcare professionals is essential to support inclusive patient care. However, course inherent requirements (IRs) may act as (un)intentional and potentially harmful gatekeepers to diverse students entering entry-to-practice courses. A decade beyond the establishment of formal IRs, it is timely to reconsider if and how IRs might be impacting diversity and inclusion.

Methods

This study analysed IRs published by the 37 Australian universities offering nursing and midwifery entry-to-practice courses.

Findings

IRs were not uniform across all institutions. Most universities placed the responsibility to meet IRs solely upon the student, without sufficient information about possible reasonable adjustments. When institutional support was offered, the level of and means of accessing support were often unclear, again putting the onus to navigate support structures on the student.

Discussion and conclusions

Whilst it is helpful for prospective students to understand the types of tasks they will be required to undertake as part of learning within the course and upon graduation, many IRs may be better positioned as expected learning. With increasing student diversity, alternate models requiring all students to demonstrate readiness for clinical placement immediately before placement may be helpful. Rather than presenting a static list of requirements, diverse students and practitioners may be better supported through the concept of ‘fitness to practice’ where more flexible and in-the-moment evaluations can be made.

Objective

To map and review current literature to describe evidence-based nonpharmacological interventions for delirium prevention and management in adult critically ill patients.

Introduction

Previous research has demonstrated the efficacy of nonpharmacological interventions for intensive care unit (ICU) delirium; however, the heterogeneity and complexity of these interventions make it challenging to disseminate and integrate into clinical practice.

Design

This scoping review follows the Joanna Briggs Institute (JBI) Protocol Guidelines.

Data sources

Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsycINFO, JBI, ProQuest, and Excerpta Medica databases were searched until August 2023.

Review methods

Double screening, extraction, and data coding using thematic analysis and frequency counts. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using the extension for scoping reviews.

Results

Thirty-three primary research articles were included; thirty-one were quantitative, and two were qualitative. Four categories of interventions were identified: instrument-based therapeutic interventions (n = 10) consisting of the use of music, light, mirror, and occupational therapy; nurse-led interventions (n = 5) consisting of interventions directly delivered by the nurses with mobilisation, orientation, and cognitive stimulation being the most common types of intervention. Family-delivered interventions (n = 5) are delivered directly by family members, with extended visitation and orientation being the most utilised. Multicomponent interventions (n = 13) combine different aspects of single interventions into care bundles and programs.

Conclusion

This review identified a lack of consistency in applying nonpharmacologic interventions to prevent and manage delirium in adult ICUs. Standardised evidence-based guidelines addressing all aspects of single-component or multicomponent nonpharmacological delirium interventions, along with support for ICU staff utilising these interventions and family member education and support, are required. Without consistent involvement from the healthcare team and patient families, opportunities may have been lost to optimise family-centred care practices in critical care settings.

Patient or public contribution

No patient or public contribution was necessary for this review.

Protocol registration

The protocol registration for this review can be accessed via Open Science Framework at https://doi.org/10.17605/OSF.IO/CMQWG.