Contemporary nurse最新文献

Background: The number of patients with neurological disorders and severe disability is increasing globally. These patients often need help with positioning and the amount of support varies with their level of impairment. High rates of work-related musculoskeletal disorders are observed among healthcare professionals (HCP) with patient contact due to injuries during manual handling. There is insufficient research on manual handling by nurses and other HCP.

Objectives: The primary aim of this study was to explore manual handling strategies by HCP in neurological inpatient and outpatient settings. A secondary aim was to explore pain during and post manual handling activities.

Design: A convergent parallel mixed methods design.

Methods: A quantitative survey was combined with qualitative semi-structured telephone interviews of HCP. The inclusion criteria were licensed allied HCP with at least seven years of experience with neurological patients in inpatient and/or outpatient settings and expertise in manual handling. Exclusion criteria included insufficient proficiency in German and pre-existing illness prior to start of professional education. The survey data were analysed using descriptive statistics and interviews were evaluated through inductive-reflexive thematic analysis.

Results: Ten nurses, 10 occupational, 12 physiotherapists participated. Survey findings showed moderate time pressure, body strain, and low back and neck pain during patient transfers. HCPs spent an average of 7.3 (± 5.5) hours per week on personal endurance and strength training. They considered transfer aids moderately important and accessible, predominantly using the transfer board. Interdisciplinary collaboration in patient transfers was reported as crucial and usually available. We identified three themes from interviews: (1) individualised manual handling; (2) facilitating active patient participation during transfers; (3) maintaining personal physical fitness.

Conclusions: Neurological symptoms, patient fears, and goal setting necessitated personalised transfer strategies. Patient characteristics, lack of space and time complicated transfers, prompting HCPs to use perception-oriented techniques, leverage, gravity, and momentum.

Background: A shift from a content-focused curriculum to a competency-based curriculum has occurred in nursing education. Competency-based education (CBE) is highly debated within higher education despite the need for competency. Competency-based education (CBE) is a form of education that takes a curriculum from a focus on an actual role or analysis perspective to an individual student's progress based on their demonstrated performance of aspects of the role. While debate exists regarding the pros and cons of CBE, theories of expertise exist to understand competency via the worldview of expert performance. Researchers and educational scholars are delving into the role of knowledge, particularly clinical knowledge, in developing and enhancing expertise and the practice of experts. In addition, CBE focuses on individual students' development and skill performance into experts. Many competency frameworks prioritize applying clinical knowledge, skills, and abilities as the building blocks of professional expertise. However, these models often overlook the capability of a nurse to handle unforeseen challenges effectively in practice as an expert.Aim and Design: This discussion piece is dedicated to exploring the ongoing debates and developments in the conceptualization of expertise. It also serves to underscore the urgent and crucial need for a paradigm shift in our approach to competency-based education (CBE) in nursing. The discussion will delve into various cognitive perspectives on expertise, particularly how accumulated knowledge is conceptualized in expert development and practice models and the implications for understanding competence through expert performance. This piece will also provide critical implications for understanding competence through expert performance, such as the conceptualizations of knowledge. Finally, this discussion will highlight the significant impact of competence as expertise within CBE, emphasizing the weight and importance of competency as expertise in nursing education.Findings and Conclusion: Literature has found that expertise in nursing practice is a result of a developmental pathway involving appropriate training and substantial practice. We propose that an integrated understanding of expertise could lead to a more comprehensive set of expert nursing practice competencies. This integration of educational concepts and situated knowledge into competency and expertise understanding requires a shift in learning environments where future experts are educated.

Aims and objectives: This discussion paper proposes four new nursing leadership roles to address planetary health challenges.

Background: Nurses are essential in reducing healthcare's greenhouse emissions. The Planetary Health Education Framework (PHEF) supports integrating planetary health concepts into sustainable healthcare practice. Nurse educators with planetary health expertise should teach the PHEF, while nurse climate advocates promote it to health professionals, with nurse-led planetary health researchers undertaking climate-change research and Planetary Health Nurse Practitioners practicing sustainable healthcare.

Design: Discussion paper.

Data sources: A PICO framework was used to identify relevant articles: In nursing (P) should new roles be introduced (I) compared to no new roles (C) to understand climate change impacts on both nursing and planetary health (O).

Discussion: Barriers to sustainable healthcare include denial, group-think, and ignorance. National and International organisation enablers highlight the importance of climate change in nurse education. The Australian College of Nursing recommends government funding for nurse-led planetary health research.

Conclusion: Educators should focus on curricula development, nurse climate advocates on education and policy, researchers on supporting planetary health research, and PHNPs on climate justice, environmental protection, and emissions reduction.

Background: Quality improvement partnerships between healthcare organisations and higher education require further research to explore their potential to provide a valuable education experience for pre-registration nursing students.

Aims: Develop and validate a questionnaire for nurse academics to evaluate quality improvement content in pre-registration nursing curricula and the extent of partnership with higher education providers in developing this content. Conduct a pilot test of the questionnaire.

Study design: Use a content validity approach.

Methods: The Australian higher education sector was the setting and participants were nurse academics with knowledge of the quality improvement content taught in pre-registration nursing courses. The quality improvement collaboration (QuIC) questionnaire was informed by the literature and sent to ten quality improvement and higher education experts for content validation. Each question was scored on a Likert scale for relevance and clarity. The QuIC questionnaire was distributed by email to the 37 higher education organisations offering pre-registration programmes in Australia. Descriptive statistics were used to analyse the questionnaire data.

Results: Eight experts completed the content validity questionnaire in full, with the QuIC questionnaire achieving an excellent content validity score of 0.94 for relevance and clarity. The QuIC questionnaire was completed by 24 participants. The results indicated that quality improvement education partnerships are only used occasionally in Australia. The education methods used to teach this content were case studies (online cases n = 11, 46%; patient cases n = 9, 38%) and the development of quality improvement education materials (n = 7, 29%).

Conclusions: The QuIC questionnaire demonstrates excellent relevance and clarity, and is the first in the literature to address the constructs of quality improvement education and partnerships. The pilot results provide insight into quality improvement education methods used in Australia and the presence of partnerships. These results may be used to assist in the implementation of quality improvement education partnerships into curricula across the health professions.

Background: Falls are the most reported patient safety incident for patients >65 years in acute hospital settings worldwide. While multifactorial fall interventions reduce the number of falls in subacute and rehabilitation settings, fall interventions in acute hospital settings are unknown.

Aim: To evaluate the effectiveness of multifactorial fall interventions on the number of falls using codesigned education targeting staff and the patient and review the environment in acute hospital settings in NSW, Australia for patients over 65 years of age.

Method: A pre-post-test design with a non-equivalent group was conducted. All acute hospital inpatient falls occurring both pre- and post-intervention within one health district were included in this study. The use of Quality Improvement methodology identified gaps in risk screening and assessment, education and information, communication of risk, and standardised fall prevention equipment. Codesigned interventions to address these gaps were undertaken.

Results: The number of falls (p = 0.038) and injurious falls (p < 0.001) significantly decreased in the post-intervention group. There was a significant improvement in fall assessments (p < 0.001), delirium risk screening (p < 0.001), the provision of fall information (p < 0.001) and fall risk discussed at shift handover (p < 0.001) in the post-intervention group. Following the intervention, staff were significantly more likely to undertake fall education modules (p < 0.001) and develop a fall management plan (p < 0.001).

Conclusion: Falls continue to have a significant economic impact on the acute hospital setting. Our findings highlight multifactorial fall interventions that included staff and patients in the development phases reduced the number of falls. Multifactorial fall interventions targeting staff, patients and the environment may influence a reduction in the number of falls and the severity of falls in the acute hospital setting.

Impact statement: Multifactorial fall interventions reduce injurious falls, minor injuries, and falls resulting in serious injury and death.

Background: Cognitive impairment and cardiovascular disease often coexist, and nurses are ideally positioned to detect and manage cognitive impairment in cardiac patients.Objectives: This study explored nurses' perspectives on understanding, detecting, and acting on cognitive impairment in cardiac patients.Design and Methods: Using an exploratory descriptive design, nurses from acute and outpatient cardiac units were interviewed. Data were thematically analyzed.Results: Sixteen nurses were interviewed, working in acute cardiology (n=7), cardiothoracic and intensive care (n=4), and cardiac rehabilitation (n=5). Three themes emerged: (1) Cognitive screening was not routine, with no clear protocols on who, when, and how to screen; (2) Nurses had varying understanding of cognitive impairment, dementia, and delirium; (3) Nurses acted on suspected cognitive changes to ensure patient safety, including referrals and care modifications.Conclusions: Cognitive screening was inconsistent, with barriers, such as workload and lack of education. Guidelines for feasible screening across settings are needed.

Background: Nurses play a key role in the recognition and response to clinical deterioration.

Aim: The aim of this scoping review was to explore, map and synthesise existing research related to the ward nurses' role in recognising and responding to clinical deterioration.

Methods: A scoping review was undertaken to identify English only studies focused on the ward nurse's role in recognition and response to clinical deterioration of the hospitalised adult. Search terms included 'clinical deterioration', 'nurses', 'wards', 'general', 'hospital, units' and 'hospitals'. The Cumulative Index to Nursing and Allied Health Literature, EMBASE, Ovid MEDLINE, PubMed, ProQuest and Science Direct databases were searched for eligible studies.

Results: Forty-six studies met the inclusion criteria and three major themes were synthesised: (i) recognition of deterioration; (ii) nursing assessment; and, (iii) challenges responding to patient deterioration.

Conclusion: The review highlighted significant variability in the ward nurses' role, activities, and skills in assessing, monitoring, managing and escalating care for clinical deterioration.

Background: Childhood is a time when health behaviours are established and the foundations for health literacy are cemented. In Aotearoa New Zealand nurses are responsible for communicating health messages to children at key stages in children's lives.

Objectives/aims: This review explores the ways in which nurses communicate health messages to children and adolescents in Aotearoa New Zealand. It evaluates whether current approaches to health communication are in-line with a child's rights-based approach.

Design: An integrative review using a systematic literature search strategy.

Data sources: In July 2022, 9 databases were searched including: Medline (Ovid), Embase (Ovid), Scopus (Elsevier), Cochrane Library, EBSCO (host), Web of Science Core Collection, CINHIAL plus, psychINFO and PsychEXTRA.

Methods: Following title and abstract screening 41 articles went through to full-text screening. These were uploaded into NVivo v.12 for analysis. Results were analysed using content analysis with a deductive coding framework informed by the UN Convention on the Rights of the Child. A total of 20 articles met all inclusion criteria and were assessed of high quality using the Mixed Methods Appraisal Tool.

Results: Nurses communicate health messages using a variety of strategies, some of which align with the rights of the child. No evidence was found of nurses communicating health messages through play or creative activities or by adopting principles and practice of continuity of care, including health communication beyond the paediatric context.

Conclusion: Opportunities exist for improvements to the rights of children and adolescents within nursing practice. Further research about the rights of children in healthcare services including not only identifying the barriers but research that includes interventions and proposes solutions is necessary .

Background: A case-management model of care is frequently used in acute-care settings for patients with major traumatic injuries; however, its application to trauma follow-up care after hospital discharge remains unclear.

Aim: To describe the services provided by the Trauma Connect Clinic (TCC): a NP- led case management model, in trauma follow-up care.

Methods: An exploratory descriptive study design was used. Data collected included patient and injury characteristics, clinic activities, attendance rates, referral patterns and complications.

Results: Three-hundred and twenty-four TCC appointments were scheduled for 194 patients (n = 302) with an attendance rate of 93% (n = 302). Ongoing health issues included pain (n = 22, 37%), thrombotic events (n = 8, 13%) and infection (n = 7, 12%). Clinic activity included 77 referrals to the wider MDT (n = 77), radiology reviews (n = 225) and 39 prescribing events, consisting mainly of analgesia.

Conclusion: A case management model can successfully deliver trauma follow-up care and efficiently use limited resources. Key elements involve careful assessment and management of patients' physical and emotional needs. Evaluation of longer-term outcomes of this model of care in trauma settings is required.