Aged‐care nurses’ knowledge of nursing documentation: an Australian perspective

Aim. This study investigated registered nurses’ knowledge of documentation used in aged‐care nursing home facilities in Queensland, Australia. Background. The purpose of nursing documentation is to communicate health information, facilitate quality assurance and research, demonstrate nurses’ accountability and, within Australia, to support funding of residents’ care. Little is known about the relationship between RNs’ knowledge of nursing documentation, the documentation process within residential aged care and the outcomes of the documentation. Design. Cross‐sectional, retrospective design. Method. The study was conducted with a large sample of RNs (n = 360) located in 162 Queensland aged‐care facilities. Participants completed a postage‐return questionnaire in which they identified factors that influence their knowledge and understanding of documentation. Results. Participants reported that they have considerable knowledge of nursing documentation. They also indicated that they were most knowledgeable about policies on documentation and writing discharge instructions. However, their knowledge of nursing assessments ranked fifth and they were least knowledgeable about reading reports each shift. Conclusions. The modified version of Edelstein's questionnaire provided a valid and reliable instrument for measuring RNs’ knowledge of nursing documentation. A factor analysis of the 16 items in the Knowledge scale showed excellent reliability. The data indicated that RNs in aged‐care facilities have high levels of knowledge about documentation. Specific recommendations relate to the implementation of comprehensive documentation education programs that reflect the needs of organisations and the level of RNs’ skills and knowledge concerning documentation. Relevance to clinical practice. Accurate nursing documentation is relevant to residents’ care outcomes and to government funding allocations. Measuring RNs’ knowledge of nursing documentation can identify factors that impede and facilitate their documentation of care.     

Enhancing student nurses' medication calculation knowledge; integrating theoretical knowledge into practice

Background

Accurate calculation of dosages and safe administration of medications in clinical practice is an essential skill for the registered nurse. Appropriate educational preparation of student nurses is the key to ensuring they become safe practitioners in the workforce. A review of the literature on different approaches for teaching and assessing medication calculation with student nurses revealed three main factors that influenced student nurses' ability to calculate medications accurately and identify mistakes. These factors include mathematical ability, particularly around multiplying with decimals, understanding medication formulas, and conceptualising medication dose.

Objectives

This study evaluated teaching interventions that focused on improving the students' understanding of mathematical calculations, medication formulas and conceptualising medication doses.

Design

Evaluation study with teaching interventions and Time 1 and Time 2 medication tests.

Participants

156, 2nd year Bachelor of Nursing students from an Australian University.

Method

The teaching interventions over 8 weeks included teaching decimals and basic mathematical skills, using the correct mathematical formula for the medication and linking the medication to the patient case study. Time 1 and Time 2 medication tests out of ten, student demographics and reasons for attending tutorials were collected to evaluate the effectiveness of the teaching interventions.

Results

For Time 1 medication test pre interventions, the mean was 7.3 with a mode of 8 out of ten. Maths and incorrect medication formula were the most common mistake. For Time 2 medication test post interventions, the mean was 9.3 with a mode of 10. The most common reason for incorrect answer Time 2 was incorrect medication formula. The students identified that the smaller tutorial sizes and remediation of errors was the main reason for continued attendance.

Conclusions

The teaching intervention improved the accuracy of students' medication calculation, specifically, understanding the correct formula to use and identifying errors of calculation.     

Malignant fungating wounds: A survey of nurses’ clinical practice in Switzerland

BackgroundThe care of individuals with a fungating malignant wound represents challenging cancer management not only for patients and their families but also for health care professionals. Understanding the difficulties faced by nurses when they care for patients with such a wound can help guide practice and service development. The aim of this study was to investigate how many patients with a malignant fungating wounds did nurses see and what kind of difficulties in caring for patients with a malignant fungating wound did nurses experience.MethodA survey was conducted in three different geographical regions of Switzerland over a 6 month period.ResultsA total of 269 nurses participated in this survey. The nurses reported the prevalence rate of fungating wounds as 6.6%. There was a difference in perceived prevalence between the regions. The most frequent location for such wounds was the breast in women with breast cancer. The appearance was mainly ulcerating. The main difficulties nurses experienced in the management of patients related to malodour, pain and difficulties in applying the dressings to the wound. The most frequently used dressing was an absorbent dressing. The difficulties nurses had and what kind of dressings they used were closely connected.Conclusions and implications for practiceStrategies need to be explored to help understand the diverse range of wound problems including physical and psychological components. Furthermore, there is a need to raise the awareness of existing wound management specialists in the support of cancer patients.     

Factors influencing oncology nurses’ approaches to accommodating cultural needs in palliative care

Aims and objectives. The purpose of this study is to explore the social construction of cultural issues in palliative care amongst oncology nurses. Background. Australia is a nation composed of people from different cultural origins with diverse linguistic, spiritual, religious and social backgrounds. The challenge of working with an increasingly culturally diverse population is a common theme expressed by many healthcare professionals from a variety of countries. Design. Grounded theory was used to investigate the processes by which nurses provide nursing care to cancer patients from diverse cultural backgrounds. Methods. Semi‐structured interviews with seven Australian oncology nurses provided the data for the study; the data was analysed using grounded theory data analysis techniques. Results. The core category emerging from the study was that of accommodating cultural needs. This paper focuses on describing the series of subcategories that were identified as factors which could influence the process by which nurses would accommodate cultural needs. These factors included nurses’ views and understandings of culture and cultural mores, their philosophy of cultural care, nurses’ previous experiences with people from other cultures and organisational approaches to culture and cultural care. Conclusions. This study demonstrated that previous experiences with people from other cultures and organisational approaches to culture and cultural care often influenced nurses’ views and understandings of culture and cultural mores and their beliefs, attitudes and behaviours in providing cultural care. Relevance to clinical practice. It is imperative to appreciate how nurses’ experiences with people from other cultures can be recognised and built upon or, if necessary, challenged. Furthermore, nurses’ cultural competence and experiences with people from other cultures need to be further investigated in clinical practice.     

Determinants of critical care nurses’ pain management behaviour

Research findings over the last 20 years show that critical care nurses (CCNs) continue to underestimate and under medicate their patients’ pain, despite an allegedly strong commitment to pain relief. This literature review investigates the determinants of CCNs’ pain assessment and management behaviours. Fishbein and Ajzen's theory of reasoned action 1 and Ajzen's theory of planned behaviour 2 have been used as models to facilitate understanding of this phenomenon.

Fishbein and Ajzen highlight attitudes, beliefs, subjective norms and the motivation to comply to the anticipated expectations of significant others as the determinants of intention to perform behaviour. Attitudinal barriers, knowledge deficits and the influence of peers affect CCNs’ pain management behaviours, resulting in inadequate pain assessment and management practices. CCNs’ attitudes about narcotic analgesia and how this interacts with gender, age and culture are also explored.

Through an analysis of the behavioural determinants following the models described by Fishbein and Ajzen, strategies can be formulated to address CCN deficiencies, improve patient outcomes and satisfaction with nursing care and CCN fulfilment. Cervantes was quoted as saying “It's a long way from saying to doing”. This report aims to improve on this idea.Glynn G & Ahern M. Determinants of critical care nurses’ pain management behaviour. Aust Crit Care 2000; 13(4):144-151.