Contemporary nurse最新文献

Background: Patient harm from unsafe care is an increasingly global phenomenon leading to death or disability. Drawing on their expertise, Advanced Practice Nurses provide the opportunity to improve care quality and safety.

Aim: To explore Nurse Practitioners and Clinical Nurse Consultants' experiences in patient safety.

Design: A qualitative design was used involving six audio-visually recorded focus group interviews. Participants working in an acute or community adult nursing speciality were involved.

Methods: Twenty-eight Advanced Practice Nurses (female 82.1%, mean age 47.5 ± 10 years) were recruited by convenience and snowball sampling. After transcription of interview data, qualitative content analysis was conducted.

Results: Six categories were identified: patient safety as the highest priority (1), special contribution to patient safety (2), patients/relatives role in safety (3), multidisciplinary team approach (4), government regulation in safety (5), and further needs to improve safety (6). Advanced Practice Nurses saw themselves as role models and leaders for other healthcare staff through their expertise and professional experience and thus able to see the bigger picture in health. They identified as change agents at the system-level due to their decision-making ability and multi-professional team connectivity.

Conclusions: This study emphasises the key position of extended nursing roles and the need for future development of patient safety strategies in hospitals and community care. As influential leaders, Advanced Practice Nurses are best placed to identify improvements. They play a central role in guiding the multi-professional team, the patient and their family, educating nursing staff, and identifying and addressing system-wide safety gaps to improve patient safety.

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.

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: In an undergraduate Bachelor of Nursing course, students enrol in an evidence-based Practice (EBP) subject. Three scaffolded tasks assess students' ability to find, summarise and synthesise professional literature. For each assessment task, students are provided feedback that informs subsequent assessments. It is unclear how students use the feedback, and what elements of feedback are perceived as being most useful.

Aim: This study aimed to examine nursing students' perspectives of receiving feedback from scaffolded assessments and how feedback received influenced the development of the final assessment task.

Design: A mixed-methods approach was used with a cross-sectional survey and online qualitative interviews.

Setting: This research was conducted at Deakin University, School of Nursing and Midwifery in Melbourne, Australia.

Participants: One hundred forty-eight students (17.4%, n = 851) participated in the cross-sectional survey. Seven students participated in the online qualitative interviews.

Methods: Students enrolled in the EBP subject in Trimester, 2023 were invited to participate in a survey where they rated their experience of assessment feedback using a Likert scale. Students were also invited to participate in an online qualitative interview that further explored their perceptions.

Results: Assessment exemplars were highly beneficial to understanding the assessment task (87.8% agree/strongly agree, n = 107). Responding to feedback was challenging (38.5%, n = 47). Qualitative themes identified were engagement with assessments, appropriateness of feedback, and use of scaffolded feedback.

Conclusions: This study highlights that scaffolded feedback is valuable for student learning. Feedback in each rubric criterion helps with the alignment of learning outcomes. Resources that support students in how to respond to feedback are important.

Background: The rapid growth of artificial intelligence in healthcare is transforming how nurses deliver care and make clinical decisions. From supporting diagnostics to providing virtual health assistants, artificial intelligence offers new ways to enhance patient outcomes and streamline healthcare processes. However, these advancements also bring challenges, particularly around ethics, potential biases, and ensuring technology complements rather than replaces human expertise.

Methods: A discussion paper designed to break down key artificial intelligence terms and demonstrate real-world applications to guide nurses to develop the skills needed to navigate this evolving technological landscape.

Findings: This discussion emphasises the importance of maintaining the critical role of human clinical judgment, highlighting that artificial intelligence should support nurses' expertise rather than diminish it. The need for continuous education to keep nurses equipped with the knowledge to effectively integrate artificial intelligence into their practice is argued. With an inclusive approach, artificial intelligence has the potential to become a powerful tool that supports nurses in improving patient care while preserving the essential human touch in healthcare.

Background: The omission of time-critical medication doses may result in poor patient outcomes. There are few publications about the influence of electronic medication management (EMM) systems, including automated dispensing cabinets (ADC), on timely medication administration. The study aimed to evaluate the influence of EMM systems, including ADCs, on timely medication administration 6 and 30 months after EMM implementation, focussing on preventable time-critical medication dose omissions and documented reasons for not administering a dose.Methods: Data on doses of regular inpatient medications not administered were obtained from electronic medication records (EMR) over 1 week in March 2019 and 4 weeks in March 2021. An omission was a dose not administered before the next due dose. Time-critical medications were defined using the health service's guidelines. Reasons for doses not being administered were obtained from nursing documentation in the EMR collated from digital health reports. Reasons for time-critical medication doses not given were defined as 'valid' or 'preventable'.Results: In 2019 and 2021, 620 and 2524 patients with 44,756 and 146,940 scheduled medication doses were reviewed. Of these, 4385 (9.8%) and 19,610 (13.4%) doses were not administered. In 2019 and 2021, there were 593 (1.3%) and 1811 (1.2%), p < 0.0001, time-critical doses not administered. Preventable time-critical dose omissions decreased from 0.20% in 2019 to 0.15% (p = 0.015) in 2021. Wards with ADCs had a significantly lower rate of time-critical dose omissions compared to those without ADCs (1.1% vs 1.3%, p = 0.014).Conclusion: With the introduction of an EMM system, there was a decrease in the rate of time-critical medications not administered, including a reduced rate of preventable omissions over the 24-month period. Regular assessment of time-critical medication administration will help target patient safety improvements.

Nurses' important role in cancer treatment shows the need to explore their experiences caring for older adults with cancer, an area where previous research has identified a research gap.

This review aimed to synthesize the existing qualitative findings on nurses' experiences of caring for older adults with cancer.

Meta-synthesis.

A systematic search of four electronic databases was conducted using relevant keywords, from January 2000 to April 2024, with an update in July 2024.

A meta-synthesis using thematic analysis was employed to integrate the primary qualitative findings. The reporting of this review adhered to the ENTREQ guidelines.

Four analytical themes emerged: (1) unpacking the emotional and psychological toll, (2) facilitating effective connections with patients, (3) addressing practical and logistical challenges, and (4) navigating role dynamics in cancer care.

This meta-synthesis identified the need of prioritizing nurses' emotional, psychological, and practical well-being in cancer care, particularly when caring for older adults. By acknowledging and addressing the emotional and psychological strain, fostering meaningful patient connections, managing practical challenges, and navigating role dynamics, healthcare systems can enhance the quality of care for older cancer patients and support the well-being of nurses in this critical role.

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.

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: Peripheral intravenous indwelling catheters (PIVC) are the most frequently used medical device in acute care settings. Approximately 80% of patients require the insertion of at least one PIVC at some point during their hospital stay. PIVC associated bloodstream infections are preventable and account for almost 40% of all hospital acquired bloodstream related infections.Methods: A taskforce was convened to plan, develop and implement hospital-wide, evidence-based practice approaches, aligned with clinical care standards, to reduce the incidence of PIVC related infection. A prospective observational audit was designed to evaluate taskforce efficacy. The primary aim of the audit was to determine the effectiveness of the taskforce in reducing the incidence of PIVC-related infection.Results: The PIVC-related bloodstream infection rate per 10,000 occupied bed days fell below the expected benchmark from the initial implementation of taskforce strategies. In the 12 months following taskforce strategy implementation there were 7 (58.3%) months in which there were no infections reported.Conclusion: Successful infection prevention programs require a multitude of initiatives and processes. Transparency in governance and leadership support for implementing prevention strategies in crucial as contextual factors impact barriers and facilitators for the uptake and implementation of behaviour change initiatives.