Contemporary nurse最新文献

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.

Background: Bladder ultrasound (BUS) provides an accurate measurement of post-void residual (PVR) volume and bladder assessment. Access to BUS is dependent on practitioner availability with delays resulting in poor symptom management, delayed discharge and dissatisfaction. Developing nursing practice to perform BUS can address these patient's needs.Aims: Through a quality improvement initiative the aims were (1) to develop theoretical knowledge and practical competence of nurses to perform BUS, (2) to evaluate nursing activity in relation to BUS, (3) to evaluate stakeholders perceptions of the initiative.Methods: Based on the Deming Plan-Do-Study-Act (PDSA) cycle, an interprofessional team was created and a theoretical/practical based education program was devised. Activity in relation to the nurse-performed BUS was collected and analysed descriptively. Stakeholder perceptions were evaluated via patient and physician questionnaires subject to descriptive analysis and a focus group with nurses analysed descriptively.Results: The team developed a training program to perform BUS, certifying 11 nurses. Investigation of nursing activity related to BUS (n = 202) showed its use for PVR evaluation, and symptom and catheter assessment. It aided decision-making and nurse-physician communication. Stakeholders were satisfied with the initiative. Patients (n = 30) felt nurses were competent, clearly explaining the procedure, results and inspiring confidence. Physicians (n = 2) saw BUS as enhancing efficiency and care quality, while nurses (n = 7) felt this new skill enhanced nursing care providing a more holistic approach. Team reflection on the results of the evaluation confirmed BUS utility and activity, while nurses requested continuing education and a post-certification refresher course.Conclusion: Through reflection on clinical practice areas for improvement to enhance patient care were identified by the nursing team. Application of the PDSA cycle provided a structured approach to guide the quality improvement initiative. Improvements in nursing care and patient care processes have been observed and this has been a positive experience for stakeholders.

Background: Hypokalemia is a frequently occurring electrolyte disorder in hospital patients and is often treated with intravenous (IV) potassium replacement. In Australia, most hospital departments use IV potassium replacement therapies, which are known anecdotally to cause pain. To our knowledge, there have been no studies on Australian clinicians' practices in managing IV potassium replacement.

Aims: To investigate the management of IV potassium infusions by clinical staff in a regional Local Health District in New South Wales, Australia.

Methods: An interprofessional team of clinicians was formed and utilised the Plan-Do-Study-Act (PDSA) cycle. An online case-based survey was created to collect infusion management issues from clinicians' perspectives. The survey utilised a fictional case study with multiple-choice questions. It aimed to investigate clinicians' self-reported clinical practice behaviours when managing potassium infusions, which were analysed descriptively. Data from open-ended questions about managing potassium infusion pain were analysed using inductive content analysis.

Results: The study found that clinicians (n = 177) manage IV replacement, with two-thirds reporting multiple weekly instances. Clinicians observed that patients report pain during infusions. Factors such as potassium concentration (n = 130), patient anxiety (n = 118), peripheral administration (n = 109) and cannula sites in the lower arm (n = 102) were reported as pain risk factors. Clinicians reported using various strategies to manage infusion pain, including slowing the infusion, simple pain relievers, and topical applications. Severe potassium deficiency was a barrier to managing pain. Clinicians felt the management of pain to be challenging both clinically and ethically. Survey comments also suggest that IV potassium may be overused, presenting an opportunity for future improvement.

Conclusion: The PDSA cycle structured the quality improvement initiative. This research explores how clinicians manage IV potassium infusions. Our findings uncover how frequently clinicians manage pain caused by IV potassium infusions, an area that is not well-documented. Further research is needed for pain management strategies.

Background: Our understanding of how nursing and midwifery students in Australia are prepared to support people in unintended pregnancy prevention and care is currently limited.

Objective: This study examined Australian nursing and midwifery students and recent graduates' perspectives on their preparation and confidence in providing unintended pregnancy prevention and care.

Methods: A descriptive, cross-sectional online survey of nursing and midwifery students and graduates was undertaken. An invitation email with information sheet and link to the survey was sent to heads of departments at Australian universities for distribution to nursing and midwifery students. Social media platforms of professional organisations were used to promote the study to nurses and midwives within two years of graduation. The survey instrument was based on US educational competencies for unintended pregnancy prevention and care, adapted for the Australian context.

Results: Participants (N = 109) from 14 institutions completed the survey. The majority of (92%) expressed that nursing and midwifery graduates should possess unintended pregnancy prevention and care knowledge and skills. Five competencies, out of 29, were identified as taught as core curriculum by 50% or more of participants; reproductive anatomy and physiology (72%); effective communication skills encompassing culture, sexual orientation, and gender identity (58%), understanding how contraceptives work (54%), obtaining a sexual/reproductive history (53%), and identifying preconception health risks (50%). Students felt well prepared to provide independent care related to pregnancy testing (44%), pregnancy prevention (26%), sexual history taking (23%), ethical/legal considerations around abortion (9%), options counseling/referral (5%), and pre/post-abortion care (5%).

Conclusion: With the decriminalization of abortion care, the Australian nursing and midwifery workforce must prepare students to care for people in all aspects of pregnancy prevention, early pregnancy decision-making, and abortion services. Our data show students are interested in this preparation but the entry-to-practice curricula has not yet been standardized to enable this.

Background: Indigenous Australians are disproportionately affected by diabetes, with a diagnosis rate nearly four times higher than people from a non-Indigenous background. This health disparity highlights the urgent need for healthcare providers to develop cultural empathy - a critical competency for delivering culturally safe and person-centered care. Cultural empathy is essential for building trust and effective communication in diabetes education and management within Indigenous people. However, there is a significant gap in targeted interventions to enhance this skill among healthcare providers.Aims: The aim of this study was to evaluate the effectiveness of a digital storytelling intervention for enhancing cultural empathy levels of postgraduate diabetes education students.Design: This study has a pre-post survey design to measure changes in participants' cultural empathy levels after exposure to a digital story.Methods: Students enrolled in a postgraduate diabetes education course at an Australian university were eligible to participate. The intervention included a first-person digital story about an Indigenous man with type 2 diabetes, accompanied by group-based discussions and self-reflection. The Comprehensive State Empathy Scale was utilised to assess empathy levels.Results: A total of 98 students completed both pre- and post-intervention surveys. There was a statistically significant increase in mean Comprehensive State Empathy Scale scores post-intervention (p < 0.001), indicating higher empathy levels. Improvements were observed across all six Comprehensive State Empathy Scale subscales, suggesting a multidimensional impact of the intervention.Conclusions: The digital story intervention significantly enhanced the cultural empathy levels of postgraduate diabetes education students. This study contributes to the evidence base for narrative-based pedagogies in cultivating empathy among healthcare providers. The findings highlight the potential of digital storytelling as a tool for improving cultural competency in healthcare education and practice, ultimately contributing to more empathic care for Indigenous people with diabetes.