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1.
Angela Christiansen Elisabeth Jacob Di Twigg 《Collegian (Royal College of Nursing, Australia)》2018,25(5):567-571
Background
The need for new graduate nurses to have the capabilities to function effectively in increasingly complex, dynamic and diverse health care settings has energised debate about the need for four year nursing degrees.Questions
What types of four year bachelor degrees are evident globally and what are the key arguments and evidence suggesting a need for four year nursing degrees in Australia?Methods
A scoping of contemporary literature is conducted to identify and discuss the key trends, concerns and evidence that informs the current debate on the appropriate duration of nursing degrees.Findings
A unique combination of emerging health care challenges and shifting health care priorities are fuelling the call to reconsider the duration of nursing degrees in Australia.Discussion
Future nurses will need the capabilities to work effectively across organisational and geographical boundaries, work as partners with a well-informed public, engage with advancing technologies and work autonomously and collaboratively as equals in inter-professional teams.Conclusion
The need for nurse education to produce nurse graduates with key capability for the future, gives credence to a call for a four year nursing degree in Australia. 相似文献2.
Linden Johnson Karen-Leigh Edward Jo-Ann Giandinoto 《Collegian (Royal College of Nursing, Australia)》2018,25(3):355-361
Background
Care planning is an essential part of nursing practice. Formulating nursing care plans within the framework of standardised nursing language warrants further examination.Aim
The aim of this systematic review was examine the available literature related to nursing documentation and care plans, in relation to the impacts of using standardised nursing language.Methods
The electronic databases of Medline and Cumulative Index to Nursing and Allied Health Literature were searched using predetermined search strategy. A narrative synthesis was undertaken.Findings
Of the 198 articles identified 21 articles were included in the review.Discussion
The examination of the available evidence suggests that a global and Australian difference in use of standardised nursing language in nursing care planning and documentation, including research related to nursing documentation exists.Conclusion
There are major benefits for systematically integrating nursing classification systems and standardised nursing language. Standardised nursing language is essential for the successful integration of nursing documentation into contemporary healthcare where electronic health care records will be the norm. 相似文献3.
4.
Objective
To conduct a narrative review on the evolution of intensive care and the cost of intensive care services in Australia.Review method
A narrative review using a search of online medical databases and grey literature with keyword verification via Delphi-technique.Data sources
Using Medical Subject Headings and keywords (intensive care, critical care, mechanical ventilation, renal replacement therapy, extracorporeal membrane oxygenation, monitoring, staffing, cost, cost analysis) we searched MEDLINE, PubMed, CINAHL, Embase, Google and Google Scholar.Results
The search yielded 30 articles from which we provide a narrative synthesis on the evolving intensive care practice in relation to key service elements and therapies. For the review of costs, we found five relevant publications and noted significant variation in methods used to cost ICU. Notwithstanding the limitations of the methods used to cost all publications reported staffing as the primary cost driver, representing up to 71% of costs.Conclusion
Intensive care is a highly specialised medical field, which has developed rapidly and plays an increasingly important role in the provision of hospital care. Despite the increasing importance of the specialty and the known resource intensity there is a paucity of data on the cost of providing this service. In Australia, staffing costs consistently represent the majority of costs associated with operating an ICU. This finding should be interpreted cautiously given the variation of methods used to cost ICU services and the limited number of available studies. Developing standardised methods to consistently estimate ICU costs which can be incorporated in research into the cost-effectiveness of alternate practice is an important step to ensuring cost-effective care. 相似文献5.
The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study
Background
Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges. However little is known about the care of these patients in intensive care.Objective
To explore medical and nursing practices and attitudes in intensive care when caring for critically ill morbidly obese patients.Methods
A focused ethnographic approach was adopted. Participant observation of care practices and interviews with intensive care doctors and nurses were undertaken over a four month period. Qualitative analysis was conducted using constant comparison.Setting
An 18 bedded tertiary intensive care unit in New Zealand.Participants
Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40 kg/m2.Findings
Morbidly obese patients present significant physical and language challenges for intensive care practice. The physical shape of morbidly obese patients did not appropriately fit the different equipment used. Staff used specific knowledge of the patient’s body size and shape to adapt care practices and keep patients safe and comfortable. There were also specific language challenges where staff expressed concern about what words were most appropriate to use to describe body mass when in the presence of morbidly obese patients.Conclusions
Bariatric care pathways need to be developed that use more suitable body measurements to inform the use of bariatric equipment. Intensive care staff need to engage in debate about what is acceptable, respectful, and appropriate language in the delivery of bariatric patient care. 相似文献6.
Tasneem Islam Alison M. Hutchinson Tracey K. Bucknall 《Collegian (Royal College of Nursing, Australia)》2018,25(4):401-407
Background
Nurse managers enact changes to practice based on information collected from the local ward environment with the aid of electronic risk management and incident reporting systems. Despite being key users of electronic risk management and incident reporting systems, little knowledge exists on nurse managers’ use and communication of information derived from these systems.Aim
This qualitative study aimed to explore nurse manager information requirements, risk management practices, and influences on decision-making when interacting with an electronic risk management and incident reporting system.Methods
Focus groups with eight nurse managers were conducted at a teaching hospital in Melbourne, Australia.Findings
Decision-making and information management approaches varied depending on whether the nurse manager investigated a single incident report or viewed summarised incident reports. Thematic and content analysis produced three themes: navigating the system, relying on data, and communication and feedback.Discussion
Nurse managers faced individual and organisational barriers preventing them from using the risk management and incident reporting system to its full potential.Conclusion
The findings from this study will assist nursing and health care administrators in identifying ineffective practice and meeting nurse manager information requirements. 相似文献7.
Helen Myers Judith D. Pugh Diane E. Twigg 《Collegian (Royal College of Nursing, Australia)》2018,25(4):447-456
Background
Nurse-sensitive patient outcomes that are suitable for general medical and surgical settings are well developed. Indicators developed for general ward settings may not be suitable for stand-alone high acuity areas; therefore, a different set of indicators is required.Aim
The aim of this review was to identify suitable indicators for measuring the impact of nurse staffing and nurse skill mix variations on patient outcomes in stand-alone high acuity areas.Methods
A systematic review of the literature was undertaken for studies published between January 2000 and November 2016. Suitable indicators were identified based on simple criteria. That is, if there were at least three studies that found a significant relationship between the outcome and staffing variables and at least 50% of all the studies that investigated that outcome reported a significant association, that variable was included in the list of potential outcomes.Findings
This review identified eight indicators from 44 eligible research articles. These were: mortality, length of stay, central-line-associated bloodstream infection, ventilator-associated pneumonia, sepsis, falls with injury, reintubation, and medication errors.Discussion
Further work is needed to clarify the definitions for each of the indicators. Standard definitions should be developed using algorithms linked to International Classification of Diseases codes to ensure consistency and comparability across studies. The majority of these outcomes could be measured using administrative patient datasets. Reintubation and medication errors may be difficult to measure with available datasets requiring specialised data collections.Conclusion
This comprehensive review identified a number of indicators that could be developed for further testing to monitor the quality of nursing care in Intensive Care Units. 相似文献8.
9.
Tamsin H.T. Thomas Jacqueline G. Bloomfield Christopher J. Gordon Christina Aggar 《Collegian (Royal College of Nursing, Australia)》2018,25(2):201-208
Background
In Australia, there is an increasing demand for registered nurses in primary health care. Registered nurses graduating from university typically enter the workforce via supported transition to professional practice programs in acute-care hospital settings. A prospective strategy to create a sustainable primary health care workforce is to develop comparable transition programs in primary health care settings, such as general practice. We developed, implemented, and evaluated Australia’s first transition to professional practice in primary care program.Aim
To explore the experiences and perceptions of graduate registered nurses and practice nurses participating in a novel transition to professional practice in primary care program.Methods
Thematic analysis of semi-structured interviews with graduate registered nurses (n = 4) and their preceptors (practice nurses, n = 5) on completion of the program.Findings
Three themes emerged from the graduate registered nurse interviews: opportunities for education and clinical development, job satisfaction, and career progression opportunities. Graduate registered nurses were satisfied with the available learning opportunities, indicated a career in primary health care could be potentially rewarding, and anticipated moderate career progression opportunities within general practice. Preceptor themes included program positivity and early career opportunities. The preceptors were positive about the program and believed it supported the graduate registered nurses to become confident and competent. However, both the graduate registered nurses and preceptors perceived an acute-care hospital transition to professional practice program was necessary to gain adequate nursing skills, even if they intended to have a future career in primary health care. Furthermore, they appeared to believe that a career in general practice is more appropriate for “older nurses”.Discussion
These beliefs may be a barrier for transition to professional practice in primary care programs to develop and support a sustainable primary health care workforce.Conclusions
Improved primary health care transition programs, policy, and educational strategies are required. 相似文献10.
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12.
Toby Raeburn Carol Liston Jarrad Hickmott Michelle Cleary 《Collegian (Royal College of Nursing, Australia)》2018,25(3):347-353
Background
Historical accounts of Australia’s early colonial lunatic asylums often neglect to mention the asylum that operated in Liverpool, NSW between 1826 and 1839.Aim
To find and explore the earliest available evidence of the mental health care provided within Liverpool lunatic asylum.Methods
A literature search was followed by manual searches of primary sources held by the State Records Authority of New South Wales, the State Library of NSW, Liverpool Library and Liverpool Regional Museum. International records available through Ancestry.com were also accessed.Findings
Contrary to previous historical accounts, Liverpool lunatic asylum was located within the parsonage of St Luke’s Church in Liverpool. This building was better suited to mental health care than the disused military barracks previously home to the patients of Australia’s first asylum at Castle Hill.Discussion
Despite the substantial challenges of delivering mental health care in the early colony of NSW, the lunatic asylum at Liverpool retained long term staff who worked there throughout the 13 years of its operation. Payment of wages to a nurse within the Liverpool lunatic asylum indicates a shift in approach to nursing in colonial mental health care that makes an important contribution to the historical identity of nursing in Australia.Conclusion
Clarifying historical information using primary sources that illuminate care within Liverpool lunatic asylum is important because history has the potential to inform and contextualise modern approaches to health care. 相似文献13.
Objective
To investigate factors affecting the development of nursing competency based on a review of the literature.Method
A systematic review was utilized. The articles were taken from the databases of Pro-Quest, ScienceDirect, SpringerLink, and Scopus. They were retrieved using the following keywords: nursing competence, nurse competencies and clinical competence. Twenty-one papers were selected.Results
Competence development is a continuous process of improving knowledge, attitudes and skills, and is influenced by a myriad of factors. Six factors were identified that affected the development of nursing competence in our systematic review: (1) work experience, (2) type of nursing environment, (3) educational level achieved, (4) adherence to professionalism, (5) critical thinking, and (6) personal factors. Work experience and education were shown to significantly influence the development of competency of nurses.Conclusions
Nurse managers need to support staffing competence through ongoing education, mentoring-preceptorship training, and case-reflection-discussion teaching programs. 相似文献14.
Amy J. Spooner Leanne M. Aitken Amanda Corley Wendy Chaboyer 《Australian critical care》2018,31(1):47-52
Background
Despite increasing demand for structured processes to guide clinical handover, nursing handover tools are limited in the intensive care unit.Objectives
The study aim was to identify key items to include in a minimum dataset for intensive care nursing team leader shift-to-shift handover.Methods
This focus group study was conducted in a 21-bed medical/surgical intensive care unit in Australia. Senior registered nurses involved in team leader handovers were recruited. Focus groups were conducted using a nominal group technique to generate and prioritise minimum dataset items. Nurses were presented with content from previous team leader handovers and asked to select which content items to include in a minimum dataset. Participant responses were summarised as frequencies and percentages.Results
Seventeen senior nurses participated in three focus groups. Participants agreed that ISBAR (Identify-Situation-Background-Assessment-Recommendations) was a useful tool to guide clinical handover. Items recommended to be included in the minimum dataset (≥65% agreement) included Identify (name, age, days in intensive care), Situation (diagnosis, surgical procedure), Background (significant event(s), management of significant event(s)) and Recommendations (patient plan for next shift, tasks to follow up for next shift). Overall, 30 of the 67 (45%) items in the Assessment category were considered important to include in the minimum dataset and focused on relevant observations and treatment within each body system. Other non-ISBAR items considered important to include related to the ICU (admissions to ICU, staffing/skill mix, theatre cases) and patients (infectious status, site of infection, end of life plan). Items were further categorised into those to include in all handovers and those to discuss only when relevant to the patient.Conclusions
The findings suggest a minimum dataset for intensive care nursing team leader shift-to-shift handover should contain items within ISBAR along with unit and patient specific information to maintain continuity of care and patient safety across shift changes. 相似文献15.
Anna Maria Bosco Natalie Williams Jacqueline Marie Graham Dianne Lorraine Malagas Yvonne Hauck 《Collegian (Royal College of Nursing, Australia)》2018,25(1):73-80
Background
Nurses working in clinical settings are instrumental to translating research into practice. The Delphi approach has been used by clinicians worldwide to set research agendas relevant to their clinical work.Aim
To identify nursing research priorities at the tertiary women's hospital in Western Australia and to develop an agenda for gynaecological nursing research.Methods
A three-round Delphi study was used. Round one incorporated an open-ended questionnaire to generate ideas or issues important to gynaecology nurses. During round two, the 32 topics generated from the first round were prioritised into 12 topics with a final ranking performed in round three.Findings
Fifty-four nurses who work in gynaecology clinical areas at the study hospital were invited to participate with 18 (33.3%) participating in round one, 41 (75.9%) in round two and 40 nurses (74.1%) in the final round. The highest ranked research priorities were: managing trial of void; providing compassionate care to women who experience pregnancy loss – the role of the gynaecological nurse; and understanding a woman's journey of treatment following a diagnosis of gynaecological cancer.Discussion
We explore potential factors from the literature around the identified gynaecology research topics plus challenges around the generation and translation of evidence into clinical practice.Conclusion
Establishing a partnership between researchers and gynaecology nurses has contributed to the development of a nursing research agenda. We anticipate that using the Delphi approach may facilitate future collaboration in implementing this research agenda and translating the findings into clinical practice. 相似文献16.
Paula Harding Angela Burge Kerrie Walter Bridget Shaw Carolyn Page Uyen Phan Desiree Terrill Susan Liew 《Physiotherapy》2018,104(1):98-106
Objective
To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists.Design and setting
A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015.Main outcome measures
The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding).Results
2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding.Conclusions
The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models. 相似文献17.
Background
Compassion satisfaction and compassion fatigue influence nurses’ intention to stay or leave nursing. Identification of compassion satisfaction or fatigue in critical care nurses is important in this high turnover workforce.Objectives
The aim of this study was to examine factors predicting and contributing to compassion satisfaction and compassion fatigue experienced by critical care nurses in Australian intensive care units.Methods
A self-reported cross-sectional survey using an established tool collected data from critical care nurses of two adult Australian intensive care units.Results
Overall, these critical care nurses reported what Professional Quality of Life Scale guidelines designated as ‘average’ levels of compassion satisfaction and burnout, and ‘low’ levels of Secondary Traumatic Stress (STS). Compared to Site B, nurses at Site A had significantly higher compassion satisfaction (p = 0.008) and lower STS scores (p = 0.025), with site significantly predictive for compassion satisfaction (p < 0.024) and STS (p < 0.002). Nurses with postgraduate qualifications had significantly higher compassion satisfaction scores (p = 0.027), and compassion satisfaction significantly increased with increasing duration of practice (p = 0.042) as a nurse and in their current ICU (p = 0.038). Burnout scores significantly reduced with increasing age, years of tenure and practice; burnout was predicted by lower years of tenure (p < 0.016).Conclusion
These critical care nurses revealed profiles that, whilst not in crisis, fell short of the ideal high compassion satisfaction and moderate/low fatigue. More recent tenure flags those potentially at higher risk of compassion fatigue, whilst the better scores associated with postgraduate education and from one site need further exploration. Further research should develop understanding and interventions to enhance compassion satisfaction and support retention of this crucial nursing workforce. 相似文献18.
19.
Fiona Bogossian Simon Cooper Michelle Kelly Tracy Levett-Jones Lisa McKenna Julia Slark Philippa Seaton 《Collegian (Royal College of Nursing, Australia)》2018,25(3):327-334
Background
Simulation is potentially a means of increasing clinical education capacity. Significant investments have been made in simulation but the extent to which this has improved uptake, quality and diversity of simulation use is unclear.Aim
To describe the current use of simulation in tertiary nursing education programs leading to nurse registration Australia and New Zealand, and determine whether investments in simulation have improved uptake, quality and diversity of simulation experiences.Methods
A cross sectional electronic survey distributed to lead nursing academics in programs leading to nurse registration in Australia and New Zealand.Findings
51.6% of institutions responded and reported wide variation in allocation of program hours to clinical and simulation learning. Simulation was embedded in curricula and positively valued as an adjunct or substitute for clinical placement. While simulation environments were adequate, staff time, training and resource development were barriers to increasing the quality, amount and range of simulation experiences. Quality assurance and robust evaluation were weak.Discussion
Simulation program hours are inconsistently reported and underutilized in terms of potential contribution to clinical learning. Benefits of capital investment in simulation physical resources have been realised, but barriers persist for increasing high quality simulation in nursing programs.Conclusion
Transitioning components of clinical education from the clinical to tertiary sectors has resource implications. Establishment of sustainable, high quality simulation experiences requires staff training, shared resources, best practice and robust evaluation of simulation experiences in nursing curricula. 相似文献20.
Helen Eleni Zournazis Annette Marlow Carey Mather 《Collegian (Royal College of Nursing, Australia)》2018,25(4):371-375