Collegian最新文献

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.

Background

Aggression and violence (AV) towards frontline healthcare professionals (FHPs) represent a rapidly increasing strain on hospitals, impacting clinician mental health and the provision of patient care. Little is known about the perceptions of healthcare professionals on current aggression management practices.

Aim

This study aimed to investigate the perceptions of FHPs on AV in hospital emergency departments (EDs).

Methods

Eight semi-structured focus groups consisting of 6–10 participants from five hospital EDs were held. Participants included medical doctors, nurses, and work health safety staff. Focus groups were audio-recorded and transcribed before undergoing thematic analysis.

Findings

Four main themes were identified: (i) workplace AV in healthcare are increasing in frequency and difficulty to manage, (ii) local strategies in place to manage workplace AV are perceived to be insufficient, (iii) systemic issues exacerbate the consequences of workplace AV, and (iv) staff feel inadequately equipped to manage the impact of workplace AV on their own well-being.

Discussion

There are substantial perceived barriers to the effective management of workplace aggressive and violent behaviour within Australian hospital EDs. Participants suggest perceived increases in the prevalence of aggressive incidents and systemic issues surrounding incident reporting and follow-up exacerbate existing deficiencies in workplace AV management.

Conclusion

Further research into risk reduction strategies, investigation of targeted interventions to better prepare staff, and improved reporting processes and pathways are needed to mitigate fallout of workplace exposures to AV in the ED.

Background

Australia sells education to international students, with education currently Australia’s third-largest export. Asia is Australia’s main source of international students, and Australian immigration policy supports international students to stay in the country after graduation. For international students, moving to Australia can involve a stressful adjustment, with major cultural and social differences.

Objectives

This study explores the cultural, societal, and learning experiences of international nursing students at a regional university in Australia.

Design

This study uses a qualitative research design.

Setting

Regional university in Queensland, Australia.

Participants

All international students enrolled in the Bachelor of Nursing program were invited to participate via advertising on the course website, flyers, and mail-outs.

Methods

We conducted six small focus groups, clustered by nationality: South Asian, Nepalese (three groups), Indian, and a multi-ethnicity group to explore student experiences in clinical placement settings. We conducted a seventh group, with First Nations Australian students, which will be discussed in a separate publication.

Results

Student responses were clustered into eight thematic groups: preparedness to study; communication challenges; barriers or challenges to learning; face-to-face learning environments; bias, racism, or discrimination; preferences for support from the university; community support; and their personal strategies for supporting learning.

Conclusions

The findings of this research build on previous research which shows that international students experience linguistic barriers, insufficient social support, and cultural diversities that compound their social isolation and negatively impact their well-being. Our participants reported experiences of racism and communication difficulties in clinical placement settings. International nursing students need support to manage cultural differences and Australian teaching styles. Nursing academics and clinical placement supervisors need professional development in cultural safety to improve the learning opportunities they provide for international students.

Background

Research into missed care has been conducted in various acute and some community healthcare settings; however, the experiences of general practice nurses (GPNs) are poorly represented in the literature.

Aim

To explore the role of the GPN and whether care activities are missed.

Methods

A qualitative descriptive design was used, employing semistructured interviews with 10 participants. The participants were GPNs working in a metropolitan or regional general practice in Australia, with a minimum of three years of experience in the role. A six-step process for thematic analysis was utilised for the extraction and presentation of findings.

Findings

GPNs rarely miss care; it is either delayed or rescheduled. Findings illustrate missed opportunities to provide care and enhance the role of the GPN. Factors contributing to missed opportunity are as follows: (i) difficulties navigating the GPN–general practitioner (GP) relationship, (ii) GPNs lack ongoing education commensurate with their scope of practice, (iii) Medicare policy fails to fund the GPN role, (iv) a rise in the number of salaried GPs leads to time pressures that limit the GPN role, (v) scope of practice constrained by time deficits, and (vi) communication problems within a siloed healthcare system limit GPN scope of practice.

Discussion

The initial aim was to identify missed care; however, findings suggest that GPNs rarely miss care, but they do miss opportunities to provide care and practice to their full scope.

Conclusion

Internal and external factors specific to the general practice context can contribute to missed opportunities for the work of the GPN.

Background

Routine blood sampling can be conducted using venepuncture, inserting a new peripheral intravenous cannula (PIVC), or utilising an existing one. The practice of blood sampling from a cannula requires handling and movement of the cannula bung. It is discouraged due to safety concerns linked to increased risk of phlebitis, infection, or reduced dwell time.

Aim

To assess cannula dwell time, the prevalence of phlebitis, and bloodstream infection when using a PIVC compared with venepuncture for blood sampling.

Design

A randomised controlled study. Reporting followed CONSORT recommendations.

Methods

Adult patients admitted to the emergency department whose health condition required a blood sample to be drawn and insertion of a PIVC were screened for eligibility between May and July 2022. Participants were randomised to either have blood sampled by venepuncture as the control or drawn through the PIVC as the intervention. Follow-up occurred on day three post emergency department presentation.

Results

One hundred and five participants were randomised of whom 50 had blood sampled by venepuncture and 55 through the PIVC. No difference was observed in cannula dwell time, prevalence of phlebitis, or signs of bloodstream infection.

Conclusion

This study showed PIVC outcomes were no different when the PIVC was used to sample blood compared with participants whose blood was sampled by venepuncture.