Nurses’ views on reporting medication incidents

Walker SB, Lowe MJ. International Journal of Nursing Practice 1998; 4: 97–102 Nurses’ views on reporting medication incidents The purpose of this project was to identify nurses’ beliefs about medication incident reporting. A new medication incident form was developed and trialled in six clinical units. Forty-three nurses from these areas were recruited to participate in the project, with a 20-point self-reporting questionnaire and focus group discussions being used to collect the data. Theme analysis of the data was undertaken with the results of the project indicating nurses report medication incidents that are life threatening to patients, but do not want identifying information collected about themselves. This situation represents nurses’ fear of reprimand from those in authority and may also indicate an unwillingness to accept responsibility for errors in which they may be merely the final player in a complex series of events. The results of the project also highlight problems associated with self-reported medication incident monitoring and challenge its effectiveness in gathering data required by managers and staff development educators.     

Parents’ and Service Providers’ Perceptions of the Family Goal Setting Tool: A Pilot Study

Background This qualitative study describes parents’ and service providers’ experiences in using the Family Goal Setting Tool (FGST). This article looks specifically at the tool’s perceived clinical utility during annual, collaborative goal setting. Methods Participants included eight parents and ten service providers involved in a Family and Early Childhood Service in Queensland, Australia. Participants were interviewed individually (parents and one service provider) or in a focus group (service providers). The transcribed interviews were analysed using standard content analysis techniques. Results Four key themes emerged including: (i) the facilitation of goal setting, (ii) strengths‐based focus, (iii) family centred processes and (iv) family empowerment. Conclusions Both parents’ and service providers’ were positive about the FGST. Insights into barriers to holistic goal setting and the clinical utility of the tool are described. Further refinement of the tool and trial in a range of early intervention contexts is required.     

Implementing evidence in clinical practice: the ‘therapies’ dilemma

Evidence-based practice involves the application of the best available evidence, often from research findings, into the clinical setting to ensure best practice. This paper discusses some of the issues faced by allied health therapists when attempting to integrate research evidence into their own clinical practice. Of particular concern in allied health research are the methodological flaws, which may seriously affect the capacity of the allied health therapist to use the evidence in their clinical practice. Single therapy intervention research, or research based on an occasion of service does not replicate the model of clinical reasoning that underpins the clinical process, nor the notion of an episode of care that characterizes the allied health therapies. Other issues such as the relevance of outcome measures used in allied health research to potential stakeholders, and the differences between therapy diagnostic criteria and research diagnostic criteria used will also adversely affect the capacity for therapists to use the research evidence. It is imperative that research paradigms begin to address the therapy paradigms, allowing research evidence to reflect the real-world situation. Allied health therapists must take a pro-active stance in the process, through undertaking organized reflective practice and forging links with researchers. Barriers associated with the implementation of evidence-based practice in the allied health professions may be reduced with the publishing of relevant clinically directed research.     

Constrained nursing: Nurses’ and assistant nurses’ experiences working in a child and adolescent psychiatric ward

The role of nurses and nursing in CAP inpatient care is unclear, and nurses are at risk of moral distress due to having to deal with complex demands while lacking organizational support. This study aimed to describe nurses’ and assistant nurses’ experiences working in child and adolescent psychiatric inpatient care. Eight nurses and seven assistant nurses working in a child and adolescent ward in Sweden participated in the study. Data were collected in 2019 using semi-structured qualitative interviews and subject to qualitative content analysis. Results describe nurses’ and assistant nurses’ experiences of child and adolescent psychiatric inpatient care in one theme, Constrained nursing, and four categories: Striving to be there for children and parents; Finding a way to manage work; Depending on others; Lacking nursing leadership. Findings suggest that good, person-centred and recovery-oriented nursing practice can exist in CAP inpatient care but remain unrecognized and lacking support due to unclear roles and responsibilities and lack of nursing leadership. This study is reported in accordance with the COREQ guidelines.     

Predictors and enablers of mental health nurses’ family‐focused practice

Family‐focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses’ family‐focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family‐focused behaviours and other factors that impact family‐focused activities. Hierarchical multiple regression identified 14 predictors of family‐focused practice. The most important predictors noted were nurses’ skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to elaborate on enablers of family‐focused practice. Participants described drawing on their parenting experiences to normalize parenting challenges, encouraging service users to disclose parenting concerns, and promoting trust. The opportunity to visit a service user's home allowed them to observe how the parent was coping and forge a close relationship with them. Nurses’ personal characteristics and work setting are key factors in determining family‐focused practice. This study extends current research by clearly highlighting predictors of family‐focused practice and reporting how various enablers promoted family‐focused practice. The capacity of nurses to support families has training, organizational and policy implications within adult mental health services in Ireland and elsewhere.     

Appreciating the ‘person’ in long‐term care

Background. Internationally, approaches to the long‐term care of older people are changing. New models are being developed that aim to de‐institutionalise care settings, maximise opportunities for older people to participate in decision‐making and move from a predominant medical model of care to one that is community orientated. Aims. The aim of this study is to highlight similarities and differences between the different models that exist and explore the implications of these for the role of the registered nurse in long‐term care. Methods. We chose three models for review as these represent a range of views of person centredness, each having distinct roots and focus. The models chosen were as follows: (i) culture change, (ii) person‐centred practice and (iii) relationship‐centred care. Results. The review highlights two key issues – (i) the distinctiveness of different models and frameworks and (ii) different interpretations of ‘person’. Firstly, we identify a disconnection between espoused differences between models and frameworks and the reality of these differences. The evidence also identifies how some models and frameworks adopt a more inclusive conceptualisation of person and personhood and do not define personhood in relation to role (resident, nurse and family member). Conclusions. There is merit in the development of models and frameworks that try to make explicit the different dimensions of person centredness in long‐term care. However, the focus on the development of these, without sufficient attention being paid to evidence of best practices grounded in the concept of personhood, person‐centred care is in danger of losing its original humanistic emphasis. Further, models and frameworks need to take account of the personhood of all persons. Implications for practice. Registered nurses need to have an understanding of the concept of personhood to make sense of the various person‐centred practice frameworks that exist. Without this understanding, there is a danger that the essence of personhood may be lost in the zeal to implement particular models and frameworks.     

‘It's just a peripheral issue’: A qualitative analysis of mental health clinicians’ accounts of (not) addressing sexuality in their work

Sexuality, relationships, and intimacy are integral parts of many peoples’ lives, not negated by mental distress and illness. Yet typically, these needs are not addressed adequately in mental health settings. In‐depth interviews were conducted with mental health clinicians with an aim of exploring their perceptions and understandings of sexuality and sexual concerns within mental health settings. Participants were 22 mental health nurses, psychologists, and psychiatrists working with people across a range of settings in four Australian cities. Sexuality or aspects of this were often not addressed in clinical practice, and this was common across participants’ accounts. A critical thematic analysis was conducted to explore how participants made sense of or explained this silence in relation to sexuality. Two key themes were ‘Sexuality is hard to talk about’ and ‘Sexuality is a “peripheral issue”’. In positioning sexuality as a peripheral issue, participants drew on three key explanations (sub‐themes): that sexuality rarely ‘comes up’, that it is not pragmatic to address sexuality, and that addressing sexuality is not part of participants’ roles or skill sets. A third theme captured the contrasting perception that ‘Sexuality could be better addressed’ in mental health settings. This analysis indicates that, beyond anticipated embarrassment, mental health clinicians from three disciplines account for omissions of sexuality from clinical practice in similar ways. Moreover, these accounts serve to peripheralize sexuality in mental health settings. We consider these results within the context of espoused holistic and recovery‐oriented principles in mental health settings.     

Final year Australian nursing students’ experiences with bioscience: A cross‐sectional survey

Nursing students have reported bioscience to be challenging and difficult to understand. This might have a negative impact upon their ability to understand patients’ clinical conditions and nursing practice. We sought information about students’ experiences with bioscience. A total of 126 final year nursing students completed a questionnaire. The findings showed that the majority of participants considered bioscience subjects to require more work compared to nursing subjects (65.9%), and that they would like a better understanding of bioscience (73.8%), but understood that bioscience forms the foundation of nursing practice (76.2%). Younger participants without secondary school science rated bioscience harder than nursing subjects and spent more time studying bioscience compared to older participants. Participants without any secondary school science lacked an ability to apply bioscience concepts to patient conditions. These results showed that nursing students, especially those without secondary school science, would benefit from improved bioscience integration with nursing practice. Nursing and bioscience educators should consider greater alignment of bioscience with nursing practice subjects, especially earlier in the curriculum.