Publisher: RMIT Publishing   (Total: 387 journals)

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Showing 1 - 200 of 387 Journals sorted alphabetically
40 [degrees] South     Full-text available via subscription   (Followers: 4)
Aboriginal and Islander Health Worker J.     Full-text available via subscription   (Followers: 16)
Aboriginal Child at School     Full-text available via subscription   (Followers: 7)
About Performance     Full-text available via subscription   (Followers: 13)
Access     Full-text available via subscription   (Followers: 27)
ACCESS: Critical Perspectives on Communication, Cultural & Policy Studies     Full-text available via subscription   (Followers: 14)
Accounting, Accountability & Performance     Full-text available via subscription   (Followers: 18)
ACORN : The J. of Perioperative Nursing in Australia     Full-text available via subscription   (Followers: 19, SJR: 0.198, CiteScore: 0)
Adelaide Law Review     Full-text available via subscription   (Followers: 26, SJR: 0.122, CiteScore: 0)
Advocate: Newsletter of the National Tertiary Education Union     Full-text available via subscription   (Followers: 1)
Agenda: A J. of Policy Analysis and Reform     Full-text available via subscription   (Followers: 2)
Agora     Full-text available via subscription   (Followers: 6)
Agricultural Commodities     Full-text available via subscription   (SJR: 0.123, CiteScore: 0)
Agricultural Science     Full-text available via subscription   (Followers: 2)
AIMA Bulletin     Full-text available via subscription   (Followers: 4)
AJP : The Australian J. of Pharmacy     Full-text available via subscription   (Followers: 15, SJR: 0.142, CiteScore: 0)
Analysis     Full-text available via subscription   (Followers: 3)
Ancient History : Resources for Teachers     Full-text available via subscription   (Followers: 9)
Anglican Historical Society J.     Full-text available via subscription   (Followers: 4)
Annals of the Royal Australasian College of Dental Surgeons     Full-text available via subscription   (Followers: 5)
ANZSLA Commentator, The     Full-text available via subscription   (Followers: 4)
Appita J.: J. of the Technical Association of the Australian and New Zealand Pulp and Paper Industry     Full-text available via subscription   (Followers: 16, SJR: 0.168, CiteScore: 0)
AQ - Australian Quarterly     Full-text available via subscription  
Arena J.     Full-text available via subscription  
Around the Globe     Full-text available via subscription   (Followers: 1)
Art + Law     Full-text available via subscription   (Followers: 12)
Art Monthly Australia     Full-text available via subscription   (Followers: 11)
Artefact : the journal of the Archaeological and Anthropological Society of Victoria     Full-text available via subscription   (Followers: 3)
Artlink     Full-text available via subscription   (Followers: 5)
Asia Pacific J. of Clinical Nutrition     Full-text available via subscription   (Followers: 13, SJR: 0.697, CiteScore: 2)
Asia Pacific J. of Health Management     Full-text available via subscription   (Followers: 4)
Aurora J.     Full-text available via subscription  
Australasian Biotechnology     Full-text available via subscription   (Followers: 1, SJR: 0.1, CiteScore: 0)
Australasian Catholic Record, The     Full-text available via subscription   (Followers: 6)
Australasian Drama Studies     Full-text available via subscription   (Followers: 2)
Australasian Epidemiologist     Full-text available via subscription  
Australasian Historical Archaeology     Full-text available via subscription   (Followers: 7, SJR: 0.212, CiteScore: 0)
Australasian J. of Early Childhood     Full-text available via subscription   (Followers: 6, SJR: 0.535, CiteScore: 1)
Australasian J. of Gifted Education     Full-text available via subscription   (Followers: 7, SJR: 0.123, CiteScore: 0)
Australasian J. of Human Security     Full-text available via subscription   (Followers: 1, SJR: 0.144, CiteScore: 0)
Australasian J. of Irish Studies, The     Full-text available via subscription   (Followers: 9)
Australasian J. of Regional Studies, The     Full-text available via subscription   (Followers: 1, SJR: 0.118, CiteScore: 0)
Australasian Law Management J.     Full-text available via subscription   (Followers: 7)
Australasian Leisure Management     Full-text available via subscription   (Followers: 3)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 4)
Australasian Music Research     Full-text available via subscription   (Followers: 4)
Australasian Parks and Leisure     Full-text available via subscription   (Followers: 2)
Australasian Plant Conservation: J. of the Australian Network for Plant Conservation     Full-text available via subscription   (Followers: 4)
Australasian Policing     Full-text available via subscription   (Followers: 6)
Australasian Public Libraries and Information Services     Full-text available via subscription   (Followers: 34)
Australasian Review of African Studies, The     Full-text available via subscription   (Followers: 2)
Australian Aboriginal Studies     Full-text available via subscription   (Followers: 9, SJR: 0.13, CiteScore: 0)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Ageing Agenda     Full-text available via subscription   (Followers: 7)
Australian and Aotearoa New Zealand Psychodrama Association J.     Full-text available via subscription   (Followers: 1)
Australian and New Zealand Continence J.     Full-text available via subscription   (Followers: 3)
Australian and New Zealand Sports Law J.     Full-text available via subscription   (Followers: 10)
Australian Art Education     Full-text available via subscription   (Followers: 8)
Australian Bookseller & Publisher     Full-text available via subscription   (Followers: 1)
Australian Bulletin of Labour     Full-text available via subscription   (Followers: 2)
Australian Canegrower     Full-text available via subscription   (Followers: 2)
Australian Coeliac     Full-text available via subscription   (Followers: 1)
Australian Cottongrower, The     Full-text available via subscription   (Followers: 1)
Australian Family Physician     Full-text available via subscription   (Followers: 3, SJR: 0.317, CiteScore: 1)
Australian Field Ornithology     Full-text available via subscription   (Followers: 4, SJR: 0.209, CiteScore: 0)
Australian Forest Grower     Full-text available via subscription   (Followers: 4)
Australian Grain     Full-text available via subscription   (Followers: 2)
Australian Holstein J.     Full-text available via subscription   (Followers: 1)
Australian Humanist, The     Full-text available via subscription   (Followers: 4)
Australian Indigenous Law Review     Full-text available via subscription   (Followers: 21)
Australian Intl. Law J.     Full-text available via subscription   (Followers: 22)
Australian J. of Acupuncture and Chinese Medicine     Full-text available via subscription   (Followers: 4, SJR: 0.116, CiteScore: 0)
Australian J. of Adult Learning     Full-text available via subscription   (Followers: 15, SJR: 0.297, CiteScore: 0)
Australian J. of Advanced Nursing     Full-text available via subscription   (Followers: 15, SJR: 0.299, CiteScore: 1)
Australian J. of Asian Law     Full-text available via subscription   (Followers: 4)
Australian J. of Cancer Nursing     Full-text available via subscription   (Followers: 9)
Australian J. of Dyslexia and Learning Difficulties     Full-text available via subscription   (Followers: 8, SJR: 0.1, CiteScore: 0)
Australian J. of Emergency Management     Full-text available via subscription   (Followers: 31, SJR: 0.354, CiteScore: 0)
Australian J. of French Studies     Full-text available via subscription   (Followers: 7, SJR: 0.123, CiteScore: 0)
Australian J. of Herbal Medicine     Full-text available via subscription   (Followers: 5)
Australian J. of Language and Literacy, The     Full-text available via subscription   (Followers: 5, SJR: 0.282, CiteScore: 1)
Australian J. of Legal History     Full-text available via subscription   (Followers: 16)
Australian J. of Medical Science     Full-text available via subscription   (Followers: 2)
Australian J. of Music Education     Full-text available via subscription   (Followers: 4)
Australian J. of Music Therapy     Full-text available via subscription   (Followers: 9, SJR: 0.549, CiteScore: 1)
Australian J. of Parapsychology     Full-text available via subscription   (Followers: 2, SJR: 0.511, CiteScore: 0)
Australian J. on Volunteering     Full-text available via subscription   (Followers: 2)
Australian J.ism Review     Full-text available via subscription   (Followers: 8)
Australian Life Scientist     Full-text available via subscription   (Followers: 2)
Australian Literary Studies     Full-text available via subscription   (Followers: 7)
Australian Mathematics Teacher, The     Full-text available via subscription   (Followers: 7)
Australian Nursing J. : ANJ     Full-text available via subscription   (Followers: 6)
Australian Orthoptic J.     Full-text available via subscription  
Australian Primary Mathematics Classroom     Full-text available via subscription   (Followers: 5)
Australian Screen Education Online     Full-text available via subscription   (Followers: 3)
Australian Senior Mathematics J.     Full-text available via subscription   (Followers: 2)
Australian Sugarcane     Full-text available via subscription  
Australian TAFE Teacher     Full-text available via subscription   (Followers: 4)
Australian Tax Forum     Full-text available via subscription   (Followers: 3)
Australian Universities' Review, The     Full-text available via subscription   (Followers: 4)
Australian Voice     Full-text available via subscription   (Followers: 6)
Bar News: The J. of the NSW Bar Association     Full-text available via subscription   (Followers: 8)
Bioethics Research Notes     Full-text available via subscription   (Followers: 15)
BOCSAR NSW Alcohol Studies Bulletins     Full-text available via subscription   (Followers: 4)
Bookseller + Publisher Magazine     Full-text available via subscription   (Followers: 5)
Breastfeeding Review     Full-text available via subscription   (Followers: 18, SJR: 0.183, CiteScore: 0)
British Review of New Zealand Studies     Full-text available via subscription   (Followers: 4)
Brolga: An Australian J. about Dance     Full-text available via subscription   (Followers: 3)
Cancer Forum     Full-text available via subscription   (SJR: 0.115, CiteScore: 0)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Chain Reaction     Full-text available via subscription  
Childrenz Issues: J. of the Children's Issues Centre     Full-text available via subscription  
Chiropractic J. of Australia     Full-text available via subscription   (SJR: 0.111, CiteScore: 0)
Chisholm Health Ethics Bulletin     Full-text available via subscription   (Followers: 1)
Church Heritage     Full-text available via subscription   (Followers: 5)
Commercial Law Quarterly: The J. of the Commercial Law Association of Australia     Full-text available via subscription   (Followers: 5)
Communicable Diseases Intelligence Quarterly Report     Full-text available via subscription   (Followers: 2, SJR: 0.563, CiteScore: 1)
Communication, Politics & Culture     Open Access   (Followers: 14)
Communities, Children and Families Australia     Full-text available via subscription   (Followers: 3)
Connect     Full-text available via subscription   (Followers: 2)
Contemporary PNG Studies     Full-text available via subscription  
Context: J. of Music Research     Full-text available via subscription   (Followers: 8)
Corporate Governance Law Review, The     Full-text available via subscription   (Followers: 8)
Creative Approaches to Research     Full-text available via subscription   (Followers: 14)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 25, SJR: 1.032, CiteScore: 1)
Cultural Studies Review     Full-text available via subscription   (Followers: 16)
Culture Scope     Full-text available via subscription   (Followers: 4)
Dance Forum     Full-text available via subscription   (Followers: 6)
DANZ Quarterly: New Zealand Dance     Full-text available via subscription   (Followers: 4)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Deakin Law Review     Full-text available via subscription   (Followers: 15)
Developing Practice : The Child, Youth and Family Work J.     Full-text available via subscription   (Followers: 20)
Early Days: J. of the Royal Western Australian Historical Society     Full-text available via subscription  
Early Education     Full-text available via subscription   (Followers: 9)
EarthSong J.: Perspectives in Ecology, Spirituality and Education     Full-text available via subscription   (Followers: 1)
East Asian Archives of Psychiatry     Full-text available via subscription   (Followers: 3, SJR: 0.36, CiteScore: 1)
Educare News: The National Newspaper for All Non-government Schools     Full-text available via subscription  
Educating Young Children: Learning and Teaching in the Early Childhood Years     Full-text available via subscription   (Followers: 19)
Education in Rural Australia     Full-text available via subscription   (Followers: 3)
Education, Research and Perspectives     Full-text available via subscription   (Followers: 14)
Educational Research J.     Full-text available via subscription   (Followers: 18)
Electronic J. of Radical Organisation Theory     Full-text available via subscription   (Followers: 3)
Employment Relations Record     Full-text available via subscription   (Followers: 3)
English in Aotearoa     Full-text available via subscription   (Followers: 2)
English in Australia     Full-text available via subscription   (Followers: 3, SJR: 0.18, CiteScore: 0)
Essays in French Literature and Culture     Full-text available via subscription   (Followers: 9)
Ethos: Official Publication of the Law Society of the Australian Capital Territory     Full-text available via subscription   (Followers: 5)
Eureka Street     Full-text available via subscription   (Followers: 5)
Extempore     Full-text available via subscription  
Family Matters     Full-text available via subscription   (Followers: 10, SJR: 0.228, CiteScore: 1)
Fijian Studies: A J. of Contemporary Fiji     Full-text available via subscription   (Followers: 1)
Focus on Health Professional Education : A Multi-disciplinary J.     Full-text available via subscription   (Followers: 7)
Food New Zealand     Full-text available via subscription   (Followers: 4)
Fourth World J.     Full-text available via subscription   (Followers: 1)
Frontline     Full-text available via subscription   (Followers: 18)
Future Times     Full-text available via subscription   (Followers: 2)
Gambling Research: J. of the National Association for Gambling Studies (Australia)     Full-text available via subscription   (Followers: 5)
Gay and Lesbian Law J.     Full-text available via subscription   (Followers: 2)
Gender Impact Assessment     Full-text available via subscription   (Followers: 3)
Geographical Education     Full-text available via subscription   (Followers: 2)
Geriatric Medicine in General Practice     Full-text available via subscription   (Followers: 8)
Gestalt J. of Australia and New Zealand     Full-text available via subscription   (Followers: 2, SJR: 0.1, CiteScore: 0)
Globe, The     Full-text available via subscription   (Followers: 4)
Government News     Full-text available via subscription   (Followers: 2)
Great Circle: J. of the Australian Association for Maritime History, The     Full-text available via subscription   (Followers: 7)
Grief Matters : The Australian J. of Grief and Bereavement     Full-text available via subscription   (Followers: 11)
He Puna Korero: J. of Maori and Pacific Development     Full-text available via subscription   (Followers: 3)
Headmark     Full-text available via subscription   (Followers: 2)
Health Inform     Full-text available via subscription  
Health Issues     Full-text available via subscription   (Followers: 2)
Health Promotion J. of Australia : Official J. of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 8, SJR: 0.531, CiteScore: 1)
Health Voices     Full-text available via subscription  
Heritage Matters : The Magazine for New Zealanders Restoring, Preserving and Enjoying Our Heritage     Full-text available via subscription   (Followers: 2)
High Court Quarterly Review, The     Full-text available via subscription   (Followers: 3)
HIV Australia     Full-text available via subscription   (Followers: 3)
HLA News     Full-text available via subscription   (Followers: 3, SJR: 0.438, CiteScore: 1)
Hong Kong J. of Emergency Medicine     Full-text available via subscription   (Followers: 5, SJR: 0.19, CiteScore: 0)
Idiom     Full-text available via subscription   (Followers: 1)
Impact     Full-text available via subscription   (Followers: 2)
InCite     Full-text available via subscription   (Followers: 17)
Indigenous Law Bulletin     Full-text available via subscription   (Followers: 20)
InPsych : The Bulletin of the Australian Psychological Society Ltd     Full-text available via subscription   (Followers: 2)
Inside Film: If     Full-text available via subscription   (Followers: 6)
Institute of Public Affairs Review: A Quarterly Review of Politics and Public Affairs, The     Full-text available via subscription   (Followers: 12)
Instyle     Full-text available via subscription   (SJR: 0.116, CiteScore: 0)
Intellectual Disability Australasia     Full-text available via subscription   (Followers: 12)
Interaction     Full-text available via subscription   (Followers: 4)
Intl. Employment Relations Review     Full-text available via subscription   (Followers: 3)
Intl. J. of Disability Management Research     Full-text available via subscription   (Followers: 3)
Intl. J. of e-Business Management     Full-text available via subscription  
Intl. J. of Employment Studies     Full-text available via subscription   (Followers: 8)
Intl. J. of Home Economics     Full-text available via subscription   (Followers: 2)
Intl. J. of Narrative Therapy & Community Work     Full-text available via subscription   (Followers: 8)
Intl. J. of Punishment and Sentencing, The     Full-text available via subscription   (Followers: 9)
Irrigation Australia: The Official J. of Irrigation Australia     Full-text available via subscription   (Followers: 3)
ISAA Review     Full-text available via subscription   (Followers: 1)
J. (Australian Native Plants Society. Canberra Region)     Full-text available via subscription   (Followers: 1)
J. of Applied Law and Policy     Full-text available via subscription   (Followers: 3)
J. of Australian Colonial History     Full-text available via subscription   (Followers: 8)
J. of Australian Naval History, The     Full-text available via subscription   (Followers: 3)

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Similar Journals
Journal Cover
Australian Journal of Advanced Nursing
Journal Prestige (SJR): 0.299
Citation Impact (citeScore): 1
Number of Followers: 15  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0813-0531 - ISSN (Online) 1447-4328
Published by RMIT Publishing Homepage  [387 journals]
  • Volume 36 Issue 1 - The care of older people with dementia in rural
           Australian hospitals - a case study
    • Abstract: Shannon, Kay; Grealish, Laurie; Cruickshank, Mary
      Objective: Investigate how nurses in rural hospitals care for people with dementia.

      Design: A case study research design.

      Setting: Three rural hospitals in one region of the state of New South Wales, Australia.

      Subjects: A purposive sample of 21 nurses who were employed at the study sites.

      Main outcome measure: Description of how nurses working in rural hospitals care for people with dementia.

      Results: Nurses drew upon their community connectedness to creatively use limited resources to provide person-centred care for people with dementia. The physical environment of the hospital influenced rural nurses' practice, with chemical and physical restraint occasionally used when nurses' were concerned about workload and safety.

      Conclusion: Rural nurses used their community connectedness to help them provide person-centred care for people with dementia, but at times, this care was limited by overriding concerns about risk management and patient safety.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 36 Issue 1 - Does studying postgraduate palliative care have an
           impact on student's ability to effect change in practice'
    • Abstract: Rawlings, Deb; Devery, Kim
      Objective: To find out from alumni whether their postgraduate course in palliative care had an impact on their ability to change practice.

      Setting: Palliative and Supportive Services, Flinders University has delivered postgraduate palliative care courses via the online learning mode of delivery since 2004.

      Subjects: An online survey was administered to alumni asking about such issues as: the impact of learning for practice, and their ability to influence change (Flinders University ethics no: 7154). Seventy-six alumni responded to the survey, and were mostly older female nurses, which is not only a reflection of our student cohort but also of clinical practice.

      Primary argument: In this study, we are examining the relevance of our courses to practice, specifically how alumni report the impact of postgraduate study on both their individual clinical practice and organisational systems. Evidence based practice is the cornerstone of nursing and of education programs globally and while our students are learning best practice they report that they cannot easily translate their new knowledge into practice.

      Conclusion: Clinicians with postgraduate qualifications can be empowered to expand their clinical skills and more, for example, their leadership capabilities, to critically challenge health care systems and act as a role model for others. However, if we are to truly build the capacity of our students and alumni to implement changes in the workplace then we need to also engage them in evidence to practice strategies and change management theory and practice.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 36 Issue 1 - An integrative review: Adherence barriers to a
           low-salt diet in culturally diverse heart failure adults
    • Abstract: Chan, Alex; Kinsman, Leigh; Elmer, Shandell; Khanam, Masuma
      Objective: A sodium restricted diet (SRD) is generally included in chronic heart failure (HF) management. The objective of this review is to explore and synthesise the research findings of the adherence barriers to a SRD in adults from culturally and linguistically diverse (CALD) backgrounds with HF.

      Setting: The principle research question addressed in this review is: what are the adherence barriers to a SRD for chronic heart failure management in adults from CALD backgrounds'

      Primary argument Patient education plays an important role in health decision-making but it is only one of the many factors in dietary sodium restriction adherence. In order to promote the adherence behaviours among the adults with HF, nurses should develop a tailored approach to overcome individuals' perceived barriers and circumstances especially adults from CALD backgrounds.

      Results: The literature search was undertaken in PubMed, CINAHL and MEDLINE. After eliminating duplicates and applying the selection criteria, eleven titles were included in the review.

      Conclusion: This review found three major perceived barriers for adults living with HF to adhere to a SRD from CALD backgrounds: 1) lack of sufficient, appropriate provision of patient education; 2) the levels of interference with social and family life; and 3) the availability and affordability of healthier food alternatives. These barriers are critical to the design of nursing interventions for promoting adherence behaviours. Lack of published research in adults from CALD ethnic minority groups living with HF in Western countries limited the ability to explore all of the barriers identified in this review.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 36 Issue 1 - Factor analysis to validate a survey evaluating
           cultural competence in maternity care for Indigenous women
    • Abstract: Aitken, Robyn; Stulz, Virginia
      Objective: This research set out to develop and validate a tool to assess the self-reported progress of Australian publicly funded maternity services towards the goal of culturally competent maternity care for Indigenous women. The tool aimed to measure the degree to which these services had incorporated actions towards achieving 14 identified characteristics into the current fabric of their organisation.

      Design: An online exploratory survey was distributed to consenting respondents nationally.

      Setting: Public maternity services in each State and Territory of Australia.

      Subjects: The survey was distributed to 149 public maternity organisations, with 85 organisational consents and 44 respondents completing the survey.

      Main outcome measure: Construct validity of a survey designed to describe progress in working towards organisational cultural competence in maternity services was assessed by principal factor analysis and varimax with Kaiser rotation.

      Results: The results support the two subscales identified as appropriate groups of questions to address 1) assessment of cultural competence and 2) assessment of the survey. Reliability was assessed by Cronbach's reliability and results established evidence of a reliable survey.

      Conclusion: The results of this study show that the survey assessing and identifying organisational cultural competence in public maternity care for Indigenous women demonstrated acceptable reliability and validity for a newly developed instrument. Responses to the survey provided participants of this study with a baseline for assessing further progress. Upon further testing and refinement, the survey can provide a validated tool to guide both national and local activity to improve the maternity experiences of Indigenous women.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 36 Issue 1 - Complexities of the Australian perioperative nurse
           entrepreneur
    • Abstract: Hains, Toni; Turner, Catherine; Strand, Haakan
      Objective: This paper articulates a need for the nurse entrepreneur working as a surgical assistant. Negatively impacting on the role are the complex factors of:

      - lack of professional support from the Nursing and Midwifery Board of Australia;

      - lack of a process for remuneration through the Medical Benefits Schedule; and a

      - lack of guidance to navigate the bureaucratic system.

      Setting: Australian healthcare system.

      Subjects: Clinicians who are a registered nurse or nurse practitioner surgical assistant in the Australian healthcare system private sector.

      Primary Arguments: A need exists for the perioperative nurse entrepreneur working in the private sector for specialty surgical assisting skills; adding a dimension of cost saving; and enhancing patient safety.

      - The same mechanism for remuneration to medical practitioners, as surgical assistants, via the Medical Benefits Schedule is not available to nurse surgical assistants undertaking the same role. A contributor to this is the lack of support by the Nursing Midwifery Board of Australia.

      - Lack of remuneration through Medicare exposes the patient to out of pocket expenses.

      Conclusion: Absence of recognition of nurses (including Nurse Practitioners) as surgical assistants by the Nursing and Midwifery Board of Australia is not conducive to recognition of these roles by other government entities such as Medicare. Specialty advanced practice roles like that of the nurse surgical assistant enhance patient safety. While support for these specialty roles from the medical profession is applauded, it is an indictment on the peak Australian regulatory body for the nursing profession that support for the nurse surgical assistant including the nurse practitioner surgical assistant is not yet evident.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 36 Issue 1 - Preserving families psychological and psychosocial
           health in PICU: A review on the health professionals role
    • Abstract: Johnston, Teaghan
      Ojective: The aim of this review was to examine the health professional's role in preserving the psychological and psychosocial health of family units of paediatric intensive care patients, and to identify strategies used to reduce this risk long term.

      Setting: Paediatric Intensive Care Units.

      Subjects: Family units of paediatric intensive care unit patients.

      Primary Argument: For the family of a child admitted to the paediatric intensive care setting, the psychological and psychosocial impacts are varied, and in many cases detrimental to the family unit itself. Health professionals, in particular nurses, perform a vital role in identifying the risks posed to these families.

      Conclusion: The family unit becomes at great risk of poor psychological and psychosocial health when a child member is admitted to an intensive care unit. Nurses play a pivotal role in promoting and implementing strategies to reduce the negative impacts often experienced by these family units. Health professionals must have a thorough understanding of this risk, to be able to adequately screen and assist in preserving the health of these family units.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 4 - Effect of an evidence based quality improvement
           framework on patient safety
    • Abstract: Montgomery, Amy; Riley, Therese; Tranter, Shelley; Manning, Vicki; Fernandez, Ritin S
      Objectives: To investigate the impact of the introduction of The Productive Ward Program on two patient safety indicators; patient falls and medication errors.

      Design: Retrospective quantitative study.

      Setting: The study was conducted at a major metropolitan acute care hospital in Sydney, Australia.

      Subjects: This study was conducted in a medical, surgical and two aged care wards, with a combined total of 120 inpatient beds over a 32 month time period.

      Main Outcome Measures: The number of patient falls and medication errors for each of the participating wards.

      Results: The implementation of The Productive Ward Program, did not have an overall significant statistical reduction in the number of falls and medication incidents. Aged Care 1, had a reduction of 13 falls between intervention and post intervention phase, these results were not statistically significant (OR 1.17; 95% CI 0.86, 1.59). For Aged Care 1 ward there was a statistically significant reduction in medication errors from 66 errors pre intervention to 27 medication errors post intervention (OR 2.73;95% CI 1.71, 4.38).

      Conclusion: The results of this small study indicate that the implementation of The Productive Ward Program, did not have an overall significant statistical reduction in the number of falls and medication errors. This paper highlights the need for future research on the impact of the Productive Ward Program on patient safety.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 4 - Long term effects of child abuse: Lessons for
           Australian paediatric nurses
    • Abstract: James, Felicity; Green, Janet
      Objective: Child abuse has short and long term consequences. Literature that explores the long term effect of child abuse on children has been reviewed.

      Setting: Prevalence of the long term consequences of child abuse within the Australian paediatric population

      Sample: The search utilised medical search terms of 'child abuse', 'long term effects', 'adverse childhood events', 'violence', 'cortisol response to stress', 'post-traumatic stress disorder', 'nurs', 'paediatric', 'abuse', 'neglect' and 'prevention' in health related databases to locate literature published from 2007 until present.

      Primary argument: Data concerning child abuse and neglect in Australian children is sparse and inconsistent with no literature found specifically relating to the role of paediatric nurses.

      Conclusion: Further analysis on the effects of child abuse and neglect on Australian children will help to gauge its health burden on the country, and to help health professionals better understand this contemporary child safety concern.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 4 - Is provision of professional development by RNs to
           nursing students a choice'
    • Abstract: Anderson, Carina; Moxham, Lorna; Broadbent, Marc
      Objective: This paper reports on a major category that emerged as a result of a Grounded Theory study that explored Registered Nurses' (RN) understanding of the nursing standard requirement to provide nursing students with professional development during their clinical placements.

      Design: Grounded Theory study.

      Setting: Nursing clinical education.

      Subjects: Fifteen registered nurses participated in this study (n=15). Thirteen were female and two were male.

      Main outcome measures: In-depth semi-structured interviews were the means of data collection. Constant comparative method was used to analyse data.

      Results: The notion of choice emerged as a major finding. Choice is conceptualised as choosing whether or not to be involved in the professional development of nursing students. The category choice is informed by two themes; unsuited to teaching, and respecting peers.

      Conclusion: According to the Australian nursing standards RNs are responsible for providing professional development to nursing students on clinical placements. Results from this Grounded Theory study revealed that participants perceived it is an RNs choice whether or not to provide professional development to nursing students.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 4 - Validity testing of a tool for assessing nurse safety
           behaviour against blood borne infections
    • Abstract: Oh, HyunSoo; Seo, WhaSook
      Objective: This study was conducted to develop and verify a tool for assessing nurse safety behaviour against blood borne infections.

      Design: A cross-sectional correlation study design was used.

      Setting and Subjects: Items were developed based on reviews of related literature, published guidelines regarding the prevention of blood borne infections, and existing tools designed to assess compliance with blood borne infection control precautions. Face and content validities of the tool was assessed by expert panels. Construct validity and reliability were examined on 320 staff and charge nurses whose duties involved direct contact with patients.

      Results: A 12-item, 5-point Likert-type assessment tool of nurse safety behaviour against blood borne infections was devised. Construct validity, which was investigated by exploratory and confirmatory factor analysis, and reliability of the devised tool were well supported. The devised tool has a three-factor structure, 'use of personal protective equipment', 'hygiene', and 'compliance with precautions'. These factors were found to be interrelated, were not independent of each other, and their correlations and loading coefficients indicated good discriminant and convergent validities.

      Conclusion: The devised 12-item assessment tool offers a clinically useful means of properly assessing safety related behaviours, and provides specific guidelines for preventive practices that should be followed by healthcare workers.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 4 - Incorporating an undergraduate student in nursing
           program into the workforce: A prospective observational study
    • Abstract: Raffelt, Alison; Sidwell, Danny; Fennah, Wendy; Davies, Shari; Jauncey-Cooke, Jacqueline
      Objectives: The objective was to describe the organisational perspective of the implementation of the Undergraduate Student in Nursing (USIN) program and to describe the experience of nursing staff working with these Undergraduate Students in Nursing.

      Design: Prospective, observation design.

      Setting: The study took place at a large tertiary paediatric hospital in Brisbane, Australia over a twelve month period.

      Subjects: Participants were registered nurses (n=169) employed in a permanent capacity in the following clinical areas - medical, surgical, rehabilitation, paediatric intensive care unit and perioperative.

      Interventions: Pre and post staff questionnaires were distributed to staff based on three domains; anticipated thought; assertion in the workplace and role delineation; and reflective practice.

      Results: Prior to implementation of USINs, the primary concerns of staff surrounding the introduction of the role included; impact on patient safety, poor skill mix, decrease in quality of care and patient and family satisfaction, impact on unit/ward operation, and the potential attitudes of the students. At 12 months post-implementation, respondents felt that patient safety had increased, skill mix had not been adversely impacted, workload had improved, overall quality of patient care and satisfaction had increased among children and parents.

      Conclusion: This introduction improved important elements within the clinical space such as patient safety and quality of care. Registered nurses perceived their workload was reduced and parent and child satisfaction was increased. The results of this study could be generalised beyond paediatrics to adult facilities. We would recommend other organisations consider this model if faced with similar workforce demands.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 4 - Improving pain management through addition of the
           functional activity score
    • Abstract: Tong, Ying Ge; Konstantatos, Alex H; Yan, Cheng; Ling, Chai
      Objective: This study investigated the benefits of adding a new measurement tool, the Functional Activity Score to a validated measurement tool, the Numeric Rating Scale.

      Design: Prospective cohort comparing cases (with intervention) to controls (usual care).

      Setting: Inpatients from a Chinese Mainland teaching hospital.

      Subjects: Eighty three postoperative patients of mixed gender and Chinese ethnicity.

      Interventions: Adding Functional Activity score, a subjective observer assessed pain measurement tool, to usual postoperative pain intensity assessment.

      Main outcome measures: Median 24 hour dynamic pain rating intensity. Episodes of moderate to severe pain.

      Results: Median 24 hour dynamic numeric rating pain postoperative pain intensity rating with cough 3 [2.25, 3.75] versus 6 [5, 7] (p < 0.001), and at rest 0 [0,0] versus 2 [0,3] (p < 0.001) were both significantly lower in the intervention group versus the control group. The intervention group also experienced significantly less episodes of moderate to severe pain (p=0.02) and reported significantly less cough related interference with pain (p=0.003).

      Conclusion: Functional activity score is easy to teach and apply, complements existing objective pain assessment after surgery and is beneficial for patient care.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 3 - Outbreak management in residential aged care
           facilities - prevention and response strategies in regional Australia
    • Abstract: Latta, Rachel; Massey, Peter D; Merritt, Tony; Eastwood, Keith; Islam, Fakhrul; Durrheim, David N
      Objective:To identify the outbreak prevention and response preparedness of residential aged care facilities (RACFs) in the Hunter New England area of New South Wales (NSW).

      Design: A cross-sectional telephone survey.

      Setting: RACFs who provide full time nursing care in regional NSW.

      Subjects: Twenty randomly selected RACFs including nine metropolitan and 11 rural facilities within the regional Hunter New England (HNE) district of NSW. Main outcome measures Percentage of staff and residents vaccinated against influenza in 2013; availability and use of a surveillance system to detect outbreaks; knowledge of national outbreak resources; and presence of a facility outbreak management plan.

      Results: Across the 20 facilities more than 85% of residents were vaccinated against influenza in 2013. Staff influenza vaccination rates varied from less than 50% in six facilities to greater than 80% in nine facilities. Overall, 18/20 (90%) facilities reported having outbreak management plans available; however only 5/20 (25%) facilities reported having an outbreak surveillance system in place.

      Conclusion: RACFs in this sample reported varying levels of outbreak prevention and preparedness strategies. Nursing staff working in RACFs need to ensure strategies are in place to prevent and respond to communicable disease outbreaks. In particular all facilities are encouraged to have an outbreak surveillance system in operation, especially during the peak seasons. RACF accreditation should consider including outbreak prevention, preparedness and management outcomes in the review measures to ensure all RACFs have strategies in place to protect vulnerable residents from common communicable disease outbreaks.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 3 - Glycaemic response to three main meals or five smaller
           meals for patients on rapid-acting insulin
    • Abstract: Meng, Zhaolin; Overland, Jane; Shen, Xingping; Wu, Xiaobin; Wang, Yuanyuan; Liu, Yunyun
      Objective: To compare seven-point blood glucose profiles of patients with type 2 diabetes mellitus using rapid-acting insulin, when daily calories were provided as three main meals versus five smaller meals (three main meals + two snacks), while maintaining the same total daily calorie intake and composition of carbohydrates, fats and protein.

      Design: A cross-over study.

      Setting: Xiamen University Zhongshan Hospital, China.

      Subjects: Over a four week period, 22 patients with type 2 diabetes mellitus using fixed doses of rapid-acting insulin were recruited into the study. Two patients failed to complete the study and data from the remaining 20 subjects were analysed.

      Intervention: The subjects using fixed doses of rapid-acting insulin were randomised to five smaller meals versus three main meals treatment periods. Glycaemic response to each meal pattern was measured by seven-point blood glucose profiles.

      Main Outcome Measures: The mean seven-point blood glucose levels and the risk of hypoglycemia.

      Results: The mean seven-point blood glucose levels with the pattern of eating five smaller meals was lower than that with three main meals (9.1mmol/L vs. 9.5mmol/L), however the difference was not statistically significant (F=0.524, P=0.474). There were no differences in mean blood glucose levels across the seven-point profile. The risk of hypoglycaemia was also not statistically significant.

      Conclusions: This suggests that it may be unnecessary for patients using rapid-acting insulin to have five smaller meals.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 3 - No one said he was dying: Families' experiences of
           end-of-life care in an acute setting
    • Abstract: Odgers, Jade; Fitzpatrick, Denise; Penney, Wendy; Shee, Anna Wong
      Objective: To explore the family's experience of end-of-life care for their dying family member during the last few days of life in an acute rural hospital.

      Design: Interpretive design using qualitative methods, including 1:1 semi- structured interviews.

      Setting: The study was undertaken in a large regional health service in Victoria.

      Subjects: Twelve relatives who were next of kin of people who died between 1 January 2012 and 30 June 2013 in an acute ward at the health service agreed to participate in the study.

      Main outcome measure: Families' perceptions of end-of-life care for their dying family member.

      Results: Data analysis identified five themes that were grouped into two general dimensions - communication (guidance for family member's role in end of life care, the family's preparation for death, the dying experience) and care and support (the hospital care experience, follow-up after death).

      Conclusion: A lack of open and candid communication hindered family members' engagement in decision-making and involvement in their loved ones' last days of life. The absence of formal processes for end of life (EOL) care planning resulted in families being unprepared for what they perceived as their family member's 'sudden death'.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 3 - Pilot study: How Sydney community nurses identified
           food security, and student nurse focus group perceptions
    • Abstract: Saville, Lynette
      Objectives: This paper aims to discuss and explore food security in the context of community health nursing, to provide insight about how frontline workers may identify whether their client is food secure.

      Design: A qualitative descriptive design pilot study, using questionnaire and unstructured interviews.

      Setting: Community health services across Sydney.

      Subject: How community health nurses identify whether their client is food secure.

      Method: Three community health nurses were interviewed and their responses recorded. Two student nurses participated in a focus group during professional work experience in community health.

      Findings/Results: Although community health nurses claim they can identify whether their clients are food (in)secure, it remains unclear how they operationalise this claim, and indeed if they do, what the outcome may be for their clients' health determinants.

      Primary argument: To raise awareness and stimulate discussion about food security as a social determinant of health, and whether community nurses have a role identifying client food security.

      Conclusion: Food (in)security is increasingly recognised as a social determinant of health, with evidence that the prevalence of food insecurity is increasing in Australia. It is acknowledged that community health nurses have established professional relationships with their clients, and that food insecurity may be identified though formal and informal means. A more open discussion is required about food (in)security and potential ways in which it may be discussed in non-judgemental, sensitive ways. Further investigation is required to interview community health nurses, in the context of their relationships with clients, how they establish whether food security is occurring and being maintained.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 3 - Osteoporosis treatment preferences and satisfaction in
           postmenopausal women: Denosumab compared with oral bisphosphonates
    • Abstract: Bajger, Boguslawa
      Aim: This paper aims to investigate whether Denosumab is more effective in promoting adherence and satisfaction than oral bisphosphonates in the treatment of osteoporosis in postmenopausal women.

      Methods: Electronic database - MEDLINE, PubMed, CINAHL, Wiley online Library, ProQuest Nursing and Allied Health), free text engines Google Scholar and reference lists of retrieved papers were searched according to the inclusion and exclusion criteria. Twelve studies were ultimately selected.

      Primary argument:The author analyses and critically appraises literature comparing two common osteoporotic medications: oral bisphosphonates and subcutaneous Denosumab in view of patients' preferences and satisfaction. Findings from this review could provide suggestions for developing frameworks in clinical practice, identify strategies to improve patient adherence to treatment and develop policies promoting active patient involvement in treatment decisionmaking.

      Results: Following thematic organisation of the studies, four major themes emerged: patient's view on attributes on osteoporotic medications; patient satisfaction and preferences in oral bisphosphonates compared to Denosumab; adherence to treatment with oral bisphosphonates compared to Denosumab; and practice implications.

      Conclusion: Findings from reviewed studies favor Denosumab over oral bisphosphonates as the preferred long-term treatment in postmenopausal women. Patients have a greater satisfaction with less frequent dosing, mode of administration and side effects of Denosumab.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 3 - Sporting injuries amongst children in Australia: A
           review of the literature
    • Abstract: Yu, Amanda; Green, Janet; Walker, Karen
      Objective: Sports and recreation promotes health benefits to the child's wellbeing but can also expose him or her to injury risks. Literature that explores sporting injuries amongst children in Australia with discussions about the paediatric nursing role is reviewed.

      Setting: Prevalence of sporting injuries within the Australian paediatric population.

      Sample: The search utilized medical search terms of 'Sporting injuries' 'Children' 'Pediatric/paediatric Nurses' in health related databases to locate literature published from 2007 until present. Australian based studies were preferable but not exclusive. Relevant sources through hand selection helped to develop a potential relationship between the frequency of sports injuries occurrences and the types of injuries being treated in hospital.

      Primary argument: Of the twenty-five papers chosen, nineteen were related to sports injuries while a further thirteen focussed specifically on children involved in sports and recreation. Data concerning children sustaining sports related injuries, particularly in Australia, is scarce and inconsistent with no literature found relating to the role of paediatric nurses. With a particular focus on spinal injuries sustained through sports and recreation, how the paediatric nurse is involved is identified.

      Conclusion: Further analysis on sporting injuries in children in Australia will help to gauge its health burden to the country to better understand this contemporary child safety concern.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 2 - Designing simulation learning experiences to reduce
           technological burden on nursing academics: A discussion paper
    • Abstract: Ryan, Colleen; Roy, Sherre; O'Neill, Barbara; Simes, Tracey; Lapkin, Samuel; Riva, Elizabeth
      Objective: The literature reports nursing academics avoid manikin-based simulation because they feel intimidated by the technology. With that in mind we sought to design a manikin-based simulation learning experience for nursing students, with low technological burden for those nursing academics expected to work with the technology.

      Setting: A multi-campus Australian regional university school of nursing.

      Subjects: Nursing academics with little or no experience in manikin-based simulation.

      Primary argument: Nursing academics are encouraged to use manikins in their clinical teaching but little has been done to address their fears and concerns around the technology. We argue that taking simple steps to decrease the technological burden will help to encourage nursing academics uptake of manikin-based simulations, as a favoured pedagogy in clinical teaching.

      Conclusion: The technological burden around manikin-based simulation was reduced by: (1) choosing medium level fidelity simulations, (2) designing simulations where students operate the equipment, (3) preparing participants for the SLE with a pre-brief video and instruction handouts, (4) offering academics roles as observers, and (5) providing on-site technological support. Nursing academics were encouraged by the process and more inclined to engage with manikin simulations. Designing simulations that address nursing academics' fears and concerns around simulation technology encourages simulation uptake.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 2 - Improving diabetes control in the community: A
           nurse-managed intervention model in a multidisciplinary clinic
    • Abstract: Ginzburg, Tatyana; Hoffman, Robert; Azuri, Joseph
      Objective: To assess diabetes management and control measures in a central multidisciplinary primary care clinic, conducted by a nurse.

      Design: A cross sectional study.

      Setting: Central, multidisciplinary, primary care clinic.

      Subjects: Randomly selected 100 people with diabetes.

      Interventions: People with diabetes with suspected non optimal glucose control (HbA1c > 7%), were invited to the clinic nurse to discuss optimal personal diabetes control, treatment and follow up. All were provided the necessary referrals to consultants and were called in for follow up visits, and received telephone reminders. All interventions were made according to the current American Diabetes Association Standards of Medical Practice recommendations.

      Main outcome measures: Retrospective data were collected. Data included demographics and diabetes control measures (e.g. HbA1c, LDL, blood pressure, ophthalmologic examination etc.). Data was collected for three x 6 months periods: 1) six months before the nurse visit; 2) six months following the first nurse visit (the intervention); and 3) for patients who were followed up for at least one year after the intervention, the last six months of follow up.

      Results: With a median follow up of 25 months, HbA1c, LDL and systolic blood pressure levels dropped significantly from before starting the clinic through the intervention and remained low in the last half year of follow up. GP, Ophthalmologist and Dietician visits increased significantly during the study. Non-significant trends were observed with total and diabetes related hospitalisations decreased, foot examination rates increased and mild weight loss.

      Conclusion: Multidisciplinary intervention managed by a nurse, improve diabetes management and control measures. Observed changes persisted after the intervention period.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 2 - Profiling Australian school students' interest in a
           nursing career: insights for ensuring the future workforce
    • Abstract: Gore, Jennifer; Rickards, Bernadette; Fray, Leanne; Holmes, Kathryn; Smith, Maxwell
      Objective: Given that the current shortage of nurses threatens the quality of health care globally, we urgently need to find new ways to bolster recruitment. This paper aims to understand patterns and predictors of interest in a nursing career among school students in order to inform ways of ensuring a viable future workforce.

      Design: A four year longitudinal mixed methods study undertaken in New South Wales, Australia.

      Setting and subjects: Survey data collected annually (2012-2015), involving 6,492 students in Years 3-12 in government schools, were analysed using logistic regression. Focus group data (2013-2015) involving 553 students and open ended survey responses were analysed to investigate reasons for interest in nursing.

      Results: Significant predictors of interest in nursing included being female and having a parent in a nursing occupation. A 'helping orientation' and prior experiences with nurses or nursing were key factors underpinning students' interest in this career. Some students perceived nursing as a 'safe' career choice, balancing practical concerns, such as job security, with their desire to care. Other students expressed ambivalence, with nursing but one of many 'caring' careers to which they were drawn.

      Conclusion: Given that early experiences with nursing or nursing-related activities influenced the desire to pursue this career, developing new experiential strategies that engage school student interest are important for ensuring the growth and stability of the Australian nursing workforce.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 2 - Is it time to re-examine the doctor-nurse relationship
           since the introduction of the independent nurse prescriber'
    • Abstract: Pritchard, Michael John
      Objective: The aim of this paper is to stimulate a debate and discussion into how the nurse-doctor relationship needs to change.

      Setting: The National Health Service, United Kingdom.

      Primary argument: The nurse-doctor relationship needs to be re evaluated in light of the expanding role of nurse's into areas that traditionally had been considered a doctor's role. While the medical profession has been willing to relinquish some control to nurses in areas such as wound or incontinence care because these aspects do not threaten their authority, position or power. The issue of non-medical prescribing remains for some in the medical profession a topic of concern. Despite non-medical prescribing being discussed widely in the literature very little has been mentioned about how the introduction of the nurse prescriber has impacted the professional relationship between the nurse and the doctor.

      Conclusion: The blurring of the roles between nurses and doctors requires a re evaluation of this relationship. As nurses take on more responsibility such as prescribing medication the old traditional view of this relationship is no longer viable, if we are to maximise patient health care in the 21st century.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 2 - Nurses plastering and splinting in the emergency
           department: An integrative review
    • Abstract: Stevens, Leahanna; Thompson, Susie; Stoddart, Emma; Bost, Nerolie; Johnston, Amy NB
      Objective: Increasing numbers of presentations, high acuity of patients and a decreased access to hospital beds contribute to lengthy waiting times in Emergency Departments (EDs). Implementing models of care to improve patient flow through EDs is imperative. This integrative review was undertaken to evaluate existing evidence regarding the impact of nurses' plastering and splinting in EDs.

      Setting: Data included in the review was drawn from five International databases that include publications exploring acute care interventions using PRISMA guidelines. An unbiased search and then application of exclusion criteria by three independent researchers delineated 11 papers for inclusion. Full text analysis using a predefined framework enabled development of the primary outcomes.

      Primary argument: The research question guiding this integrative review is: What is the impact on patient and staff satisfaction, cost, ED length of stay, ED re-presentation rates when ED nurses apply plasters and splints to patients who present to ED with a fractured or sprained limb'

      While no literature focused specifically on outcomes from nurses applying plasters or splints, studies indicated that plastering, as part of a suite of nursing skills, had positive effects on patient outcomes such as reduced waiting times to treatment.

      Conclusions: There is insufficient evidence to inform protocols for nurses to perform plastering and splinting. Further research evaluating the impact of nurses using this skill in their practice is required to support evidence based practice.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 2 - The non-medical surgical assistant in Australia: Who
           should contribute to governance'
    • Abstract: Hains, Toni; Turner, Catherine; Strand, Haakan
      Objective: This paper focuses on the role of the Non-Medical Surgical Assistant (NMSA) in Australia. Registered Nurses predominately perform this role. This paper will articulate a position to:
      - validate this role as an Advanced Practice Nursing (APN) role in Australia through regulation and governance by the Nursing and Midwifery Board of Australia (NMBA) who sit under the umbrella of the Australian Health Practitioner Regulation Agency (AHPRA);
      - lobby AHPRA to recognise, regulate and protect the title of Advanced Practice Nursing (APN) roles other than the Nurse Practitioner (NP) in Australia; and
      - as a result of sanctioned regulation, facilitate APN (including NP) to seek appropriate remuneration for undertaking this role in the private sector in Australia.

      Setting: The Australian Healthcare system.

      Subjects: Clinicians performing the role of the NMSA in Australia.

      Primary Argument: The NMSA is well established with clear mechanisms for governance internationally. This role has been practiced in Australia for more than 20 years, and while clinicians function under the guise of advanced practice, the role is not clearly defined, standardised or regulated. This is partially attributed to lack of sanctioned governance from AHPRA.

      Conclusion: While the AHPRA via the NMBA are reluctant to formally recognise and regulate this role, the overwhelming majority of clinicians in Australia are nurses. Without regulation it is difficult to quantify the role as APN. Lack of governance excludes NMSA (including the NP) from access to the Medicare Benefits Schedule and private health funds for intraoperative reimbursement thereby rendering a potentially cost effective role unsustainable to many clinicians.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 1 - Potential drug-drug interactions in children with
           acute lymphoblastic leukaemia: A cohort study
    • Abstract: Soccal, Daiana Carbalho; dos Santos, Wendel Mombaque; de Campos, Marli Matiko Anraku
      Objective: To evaluate the potential drug interactions in patients with acute lymphoblastic leukaemia in the remission induction period of treatment. Design: A prospective cohort study.

      Setting: A tertiary referral centre.

      Subjects: Twenty-two children undergoing treatment for acute lymphoblastic leukaemia. The median age was 4.5 years (minimum of 1 and maximum of 18 years) with male predominance (54.4%).

      Main outcome measure: Presence of potential drug interactions in patients undergoing treatment for precursor cell lymphoblastic leukaemia-lymphoma. The potential drug interactions term refers to the ability of a drug to affect the pharmacologic intensity as well as the therapeutic effect of another and cause adverse reactions, as well as the possibility of clinical manifestations.

      Results: All participants were exposed to at least one potential drug interaction. About 60% of interactions classified as more severe. Every new drug included in the treatment increased the chance of potential drug-drug interactions by 0.4 times.

      Conclusion: These results demonstrated the patients under chemotherapeutic care for lymphoblastic leukaemia-lymphoma have high potential for drug interactions of greater severity.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 1 - A nurses' guide to ethical considerations and the
           process for ethical approval of nursing research
    • Abstract: Ingham-Broomfield, Rebecca
      Objective: A sound knowledge of the ethical principles that guide nursing practice and research are essential for any researcher. This article provides discussion regarding the principles as well as the history behind ethical practice in the construction of nursing research. The article also breaks down the process for achieving ethical consent and includes a simplified framework to guide the process of seeking ethical approval.

      Primary Argument: Nurses new to the field of conducting research may benefit from an organised structure that helps them understand the sequence of events required to gain appropriate ethical approval and ensure an ethical approach is adopted. It is crucial for all researching nurses to understand, and adhere to, already well developed nationally and globally prescribed ethical and validated research study structures to be able to achieve ethical, valid and reliable research outcomes.

      Conclusion: A framework is provided within this article to outline the process of gaining ethical consent for research. The information presented in the framework is based upon the discussion within the article and may assist the nurse researcher, who is unfamiliar with the process of obtaining ethics committee consent, to plan and prepare for their research approval, in a systematic logical manner. The framework reflects the National Health and Medical Research Council (NHMRC) criteria which guides Human Research Ethics Committees (HRECs). Nursing research needs to be able to ethically contribute to the body of Evidence Based Practice.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 1 - Graduate nurses' experience of feedback, support and
           anxiety: A pilot study
    • Abstract: Gardiner, Isabelle; Sheen, Jade
      Objective: The aims of this study were to investigate the association between feedback and anxiety, while also exploring the feedback and support experiences of graduate nurses.

      Design: This study used a mixed methods approach.

      Setting: Participants completed an online survey.

      Subjects: The study included 107 Australian graduate nurses.

      Main outcome measures: Anxiety and feedback.

      Results: Using bivariate regression a negative relationship was identified between feedback and anxiety. Further analysis using one-way analysis of variance revealed that participants who received regular and quality feedback and support, reported the lowest anxiety. The second aim was assessed by reviewing participants' subjective comments regarding their experiences as graduate nurses. Results revealed high variability in feedback and support experiences. The data gathered suggests graduate nurses experience anxiety during their transition from university to professional nursing.

      Conclusion: The provision of regular feedback and support was associated with reduced anxiety in graduate nurses. These preliminary findings highlight the importance of regular and appropriate feedback and support to facilitate learning, successful role transition and improved patient outcomes.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 1 - Antipsychotic use for behaviours by persons with
           dementia in residential aged care: The relatives' perspectives
    • Abstract: De Bellis, Anita; Bradley, Sandra; Xiao, Lily; Belan, Ingrid; Wallace, Tim
      Objective: To explore relatives' experience, knowledge and perceptions of challenging behavioural and psychological symptoms of dementia (BPSD) and association with antipsychotic use for persons with dementia in residential aged care.

      Design: A qualitative Interpretive Description design using semi-structured interviews was used for understanding the construct and context of perceptions and experiences using a six-step process to analyse themes.

      Settings: South Australia, Victoria and Western Australia.

      Subjects: Six relatives of a person with dementia in residential aged care.

      Main Outcome Measure: Themes describing relatives' experiences, knowledge and perceptions of antipsychotic medication use for the person with dementia in residential aged care.

      Results: Three themes were identified: 1) lack of education and information - relatives found it difficult to differentiate between behaviours influenced by disease or antipsychotic medication; 2) need to be included in decision-making - relatives believed challenging behaviours resulting from BPSD could be prevented with a more person-centred approach; and, 3) influence of aged care culture on attitudes towards use of antipsychotic medication - relatives identified this could be problematic depending on use of agency staff and time pressures.

      Conclusion: Relatives of persons with dementia require support and education about the progression of dementia, BPSD and the risks and benefits that antipsychotic medication may have on BPSD. Most importantly, relatives need to be involved in decision-making regarding the use of antipsychotic medication. Nurses have a role to educate care staff on the use of person centred care in preference to medication for better care of the person with dementia.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 1 - Assessment and management of acute pain in older
           people: Barriers and facilitators to nursing practice
    • Abstract: Fitzgerald, Sally; Tripp, Henrietta; Halksworth-Smith, Gillian
      Objective: The aim of this review was to examine the pain management practices of nurses, and identify barriers and facilitators to the assessment and management of pain for older people, within the acute hospital setting.

      Design: Integrative literature review.

      Setting: Acute care for inpatients in a tertiary hospital.

      Subjects: Older people defined as 65 years of age or over.

      Primary argument: A nurse's individual practice was found to significantly influence how pain is managed in the older patient; this encompassed nurses attitudes, communication, documentation, and the use of pharmacological and non pharmacological strategies. Nurses' ability to provide optimal care was found to be influenced by organisational factors such as workforce planning and the workplace environment. Provision of knowledge and skills to both nurses and older patients through education was found to facilitate better pain management; whilst a model of care whereby the nurse has authority and the patient is perceived as a passive recipient, was found to be a hindrance to optimal pain management outcomes.

      Conclusion: Findings indicate that nurses need to improve communication with older patients, increase their knowledge of pain assessment and management principles in regards to this population, and have a greater awareness of human and social influences. Whilst organisational factors can impact upon nursing care, pain management needs to be highly prioritised and promoted as essential. Targeted education is required to overcome many of the identified barriers, and is a key recommendation from this review.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 35 Issue 1 - The art of clinical supervision: The traffic light
           system for the delegation of care
    • Abstract: Russell, Kylie; Williamson, Sarah; Hobson, Ann
      Objective: The Traffic Light System for the Delegation of Care was developed as a tool to assist student nurses and their allocated clinical supervisor on clinical shift, to determine their scope of practice for the delivery of patient care.

      Setting: Western Australian health services.

      Primary Argument: With each clinical placement student nurses are required to determine their scope of practice according to the health service polices and guidelines in conjunction with their own School of Nursing practice policies and legislation. Health service nurses support students in this scope of practice determination, but often themselves are perplexed by the different placement structure in each university course, and the lack of consistency across these.

      Conclusion: Participant feedback and implementation of the tool supports its usefulness as a practical strategy to assist decision-making in the delegation of care to student nurses.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 4 - Managing medical service delivery gaps in a socially
           disadvantaged rural community: A Nurse Practitioner led clinic
    • Abstract: Kelly, Jo; Garvey, Deb; Biro, Mary Anne; Lee, Susan
      Objective: The aim of this pilot project was to investigate how Nurse Practitioners (NP) manage medical service delivery gaps in a socio-disadvantaged rural Victorian region.

      Design: A cross-sectional study utilising data from patient consultations that took place at the Nurse Practitioner Community Clinic (NPCC) over six months in 2013 and patient satisfaction survey.

      Setting: The NPCC is a rural clinic servicing a rural population in Victoria.

      Subjects: 629 patients.

      Main outcome measures: Numbers of patients; presentations; age; gender; postcode; reason for encounter; consultation length; availability of General Practitioner (GP); consultation activities and follow up; NP Medicare Benefits Scheme (MBS) item number rebate; and equivalent GP MBS item number rebates.

      Results: Over 50% of patients were female; 60% aged over 45 years. Patients had 2.6 encounters with the NPCC; over 50% lasting between 10 and 20 minutes. Approximately half the revenue of that claimed in equivalent GP encounters. Common reasons for attendance were symptoms and complaints (37.2%) and attendance was viewed as convenient and accessible, despite having a regular GP (47.8%). Fifty six Patients responded to a satisfaction survey and indicated they were satisfied with the service would use the service again and would recommend it.

      Conclusions: The NPCC provided an accessible service that met patients' needs in a rural community. The study provides evidence that NPs can provide medical management in areas where medical service delivery gaps exist. However, there was a significant discrepancy between funding reimbursements for services provided at the NPCC and those provided by GPs.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 4 - Accessibility and outcomes from a rural diabetes
           nurse-educator led self-management program
    • Abstract: Roberts, Diane Patricia; Ward, Bernadette Maree; Russell, Deborah Jane; O'Sullivan, Belinda Gabrielle
      Objective: To investigate factors associated with access to, and health outcomes of, a diabetes nurse-educator led self-management program for rural Australians with diabetes.

      Design: Retrospective cohort study

      Setting: A rural community-health service with a dispersed catchment of 10,000 population.

      Subjects: Clients diagnosed with type 2 diabetes mellitus and referred to the program between April 2008 and December 2012.

      Intervention: A diabetes self-management program comprising an initial assessment, a group education session, and 3, 6, and 12 month clinical reviews.

      Main outcome measures: Program attendance after referral; and achievement of management goals for HbA1c, BMI, total cholesterol, quality of life and psychological distress.

      Results: Ninety-four percent (n=219/232) of referred clients attended at least once. Multivariate logistic regression showed that attending at least once was significantly associated with living within 25km of the service. Non-smokers/former smokers, general practitioner-referred clients and those with diabetes management plans were significantly more likely to attend three or more sessions. At 12 months clients showed significant improvements in cholesterol, BMI, quality of life and psychological distress.

      Conclusion: This study demonstrates that diabetes nurse-educator led self-management programs which adapt to their rural contexts - including geographically dispersed catchment populations and resource constraints - provide highly accessible services meeting the needs of most. Nevertheless, some groups (cigarette smokers, those living furthest from the service) may remain marginalised and less able to access services. Improvements in health outcomes for these clients may require further adaptation of models of care to better target their health care needs.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 4 - A paediatric nurses' journal club: Developing the
           critical appraisal skills to turn research into practice
    • Abstract: Purnell, Margaret; Majid, Gina; Skinner, Virginia
      Objectives: The aim of this study was to determine if implementation of a regular journal club improves critical appraisal confidence and facilitates integrating research literature into nursing practice.

      Design: A survey was distributed to all paediatric nurses across two wards who had potentially attended the journal club in the previous two years.

      Setting: This small scale study was undertaken at a northern Australian hospital.

      Sample: The surveys were distributed to 58 nurses from the two paediatric wards and 33 of them responded but only 29 of these had attended the journal club leaving 29 surveys to be analysed for this study.

      Results: The majority of responses to the survey questions were positive. When statistically analysed by Pearson's correlation, four variables showed a strong association: increased confidence with interpreting research literature, developing critical appraisal skills, the sharing of knowledge and integrating evidence-based practice into nurses' workplace.

      A number of changes in practice have occurred as a direct result of the journal club.

      Conclusion: The results from this study support the benefits of utilising nursing journal clubs to promote clinical practice that is informed by research evidence.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 4 - Elements to promote a successful relationship between
           stakeholders interested in mental health promotion in schools
    • Abstract: Handley, Christine; McAllister, Margaret
      Objective: An evaluation of a mental health promotion program called iCARE which depended on collaboration between multiple partners.

      Design: A qualitative exploratory evaluation that involved purposeful sampling of a range of stakeholders in the School settings.

      Setting: Two Secondary Schools in Tasmania.

      Intervention: iCARE stands for Creating Awareness, Resilience and Enhanced Mental Health and is a structured six-week program in which trained facilitators engage Year 8 students in learning about mental health and developing resilience. The collaboration involved university researchers, child and youth mental health clinicians, and education staff. It required investment in time and resources as well as intellectual effort and good will from each of the key players.

      Results: Successful elements of collaboration were distilled from the interview data, indicating that for a mental health promotion program to succeed in schools, highly tuned negotiation and communication skills are required.

      Conclusion: Nurses are increasingly working within the community to promote the health and wellbeing of many groups. To work effectively with young people in schools, and to share the impact of that work with the professional community, requires collaboration between health, education and university stakeholders. This evaluation found that success in this interdisciplinary connection requires respect, communication, negotiation and appreciation for disciplinary differences.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 4 - Rotating shift work and colorectal cancer among nurses
           and midwives: A cross-sectional study
    • Abstract: Wickremaratne, Kalana; Strand, Haakan; Zhao, Isabella
      Objective: The main aim of this study was to explore any association between colorectal cancer (CRC) and rotating shift work in nurses and midwives. The secondary aim of this study was to identify risk factors for CRC in nurses and midwives who are rotating shift workers.

      Design: Cross-sectional study.

      Setting: Electronic survey of participants from Australia, New Zealand and the United Kingdom.

      Subjects: A sample of 8,199 male and female nurses and midwives from Australia, New Zealand and the United Kingdom invited through their registration papers or newsletter advertisement.

      Main outcome measure: Prevalence of CRC in participants who have worked rotating shifts for 1-14 years or >=15 years compared to participants who have never worked rotating shifts. In addition, risk factors for CRC in the rotating shift work population were analysed in a multivariate logistic regression model in order to obtain odds ratio of CRC.

      Results: No statistically significant difference was found in the prevalence of CRC between those who have never worked rotating shift work, worked 1-14 years and worked 15 or more years.

      Among rotating shift workers, diabetes was associated with a 123-fold (95% CI 39-392; p < 0.001) increased odds of CRC, while Inflammatory Bowel Disease (IBD) was associated with a 190-fold (95%CI 68-526; p < 0.001) increased odds of CRC. Screening colonoscopy or sigmoidoscopy for CRC was associated with a 10-fold (95% CI 3-35; p < 0.001) increased odds of being diagnosed with CRC.

      Conclusion: No significant association was found between rotating shift work and colorectal cancer in nurses and midwives. In nurses and midwives who are rotating shift workers, diabetes, IBD and CRC screening significantly increased the odds of CRC.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 4 - Literature review: Why do we continue to lose our
           nurses'
    • Abstract: Goodare, Pete
      Objective: To decrypt what determining factors contribute to nurses leaving the clinical facet of the profession.

      Primary argument: Nurses encompass the largest professional constituent of the health care workforce in most countries, resulting in the impact of a shortage of these professionals, as immense. A projection in the shortage of nurses is upon us, and the margin in the reduction of these health professionals is thought to be worse than any of the preceding cyclical reductions. More than half of the nursing profession feel they are underpaid and overworked, resulting in the likelihood of patient's needs not being met, significantly increasing. Lengthy hours, quality of working environments, lack of leadership and the ageing population and workforce, can all be seen as influential factors, in which have the potential to leave this profession in a situation of calamity.

      Conclusion: In light of the predicted global demand for nurses over the next decade, the departure and retirement of the existing nursing workforce will potentially result in the loss of significant and treasured experience and organisational knowledge, weakening the capacity and capability of the nursing profession.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 3 - Australian undergraduate nursing students' opinions on
           mental illness
    • Abstract: Millar, Rebecca
      Objective: To determine second year Bachelor of Nursing students' opinions on mental illness and relationship with demographic data for the purpose of curriculum development.

      Design: The present study is a pilot study for a larger project which will investigate undergraduate nursing student opinions across the duration of their undergraduate degree at an Australian university. The 'Student Opinions of Mental Illness Scale', a 53 point Likert type questionnaire was used in a sample of second year nursing students to investigate their opinions of mental illness.

      Setting: Metropolitan nursing school in Victoria, Australia.

      Subjects: 133 second year undergraduate Bachelor of Nursing students'.

      Main outcome measures: Student opinions based on Likert responses.

      Results: The study revealed that student experiences, education, employment history of country of birth may impact upon student opinions of mental illness.

      Conclusion: Overall, students were found to have a generally neutral opinion about mental illness except in the sub-scale factors of benevolence, mental hygiene ideology and interpersonal aetiology where students held less positive opinions. Knowing the student populations opinions about a subject matter can assist academics to direct and focus their efforts to improve those opinions in those areas.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 3 - A review for Australian nurses: Cannabis use for
           anti-emesis among terminally ill patients in Australia
    • Abstract: Chan, Alex; Molloy, Luke; Pertile, Joy; Iglesias, Miguel
      Objective: The objective of this article is to describe the potential benefits of medicinal cannabis in emesis control and the position of nurses looking after palliative patients who are on medicinal cannabis treatment in Australia.

      Setting: Palliative care

      Primary argument: Cannabis is the most commonly abused drug and its use for medical purposes was restricted throughout the world since the early 20th century. However many clinical studies show that the natural cannabinoid compounds can stimulate the cannabinoid receptors in the brain leading to attenuation of signal transmission, resulting in alleviation of the vomiting stimuli. The debate about the use of cannabis as an anti-emetic agent in patients with life-limiting conditions has renewed interest in recent years. The principle of palliative care is to improve the quality of life of patients living with life-limiting conditions based on the best evidence available. Although some evidence suggests cannabis may have therapeutic effects on some palliative patients and the Australian Commonwealth Government has recently changed the legislation, the concept of using medicinal cannabis in emesis control is very new to many Australians including the health care providers.

      Conclusion: In comparison to conventional medications, medicinal use of cannabis in palliative care is a new phenomenon and nurses as well as general public may be less prepared for the use of cannabis as a medical modality in all clinical settings. This review is intended to raise awareness of the physiological mechanism of cannabis and its medicinal use to the nurses in Australia.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 3 - Can patients and their caregivers boost identification
           of HIV Associated Neurocognitive Disorder (HAND)'
    • Abstract: Cummins, Denise; Murray, Kenneth; Trotter, Gary; Batterham, Marijka; Healey, Loretta; O'Connor, Catherine C
      Objective: To ascertain whether people living with HIV and their caregivers using a self reflective tool could identify S&S of HAND.

      Design: This study was a nurse led prospective observational multi-site study using a quantitative design.

      Setting: Participants were recruited from three sites in Sydney, New South Wales (NSW), Australia: an inner metropolitan HIV clinic, an inner metropolitan sexual health clinic and a suburban hospital HIV clinic.

      Subjects: 121 patients and 44 caregivers who attended ambulatory clinics providing HIV care.

      Main Outcome Measures: Observing usual standard of care to follow patients who had formal neuropsychological testing and diagnosis of HAND.

      Results: Sixty one percent of participants and 57% of caregivers identified more than four symptoms. Sixteen had neuropsychological exams; five were diagnosed with HAND. After changes to their medication regime all of those five showed an improvement in cognition. Of the remaining 11, four results were inconclusive, with some deficits noted.

      Conclusion: Patients and caregivers stated the booklet helped them to reflect on behavior changes which they could subsequently discuss with their doctor. The booklet was considered useful to identify S and S which could indicate HAND.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 3 - The impact of clinical placement model on learning in
           nursing: A descriptive exploratory study
    • Abstract: Birks, Melanie; Bagley, Tracy; Park, Tanya; Burkot, Camilla; Mills, Jane
      Background: Learning in the clinical setting is an essential component of nursing education. Two common models of clinical learning place students in facilities using either block or distributed approaches.

      Aim: The aim of this study was to examine nursing students' perceptions of the impact of block versus distributed model of clinical placement on their learning experience.

      Design: The study employed a descriptive, exploratory approach. Focus groups and an individual interview were conducted with third-year undergraduate nursing students.

      Setting: Students from four Australian universities took part in the study.

      Subjects: The average age of the 22 student participants was 37.5 years and 91% were female. More than half (55%) studied full time.

      Results: Thematic analysis of the data identified five overarching themes: We're there to learn; Taking all that knowledge out and practising it; You actually feel a part of the team; Just prepare them for us coming; and It's really individual.

      Conclusions: It is clear that both block and distributed modes of placement have inherent advantages and disadvantages that might be magnified depending on the individual student's circumstances. Sequencing, consistency and preparation must be considered when planning either mode of clinical placement to ensure the best possible experience for students. Most significantly, students need to feel as though they are part of the team while on placement to get the most out of the experience. These findings have implications for education providers planning the integration of clinical placement into the nursing curriculum.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 3 - Promoting student belongingness: 'WANTED' - the
           development, implementation and evaluation of a toolkit for nurses
    • Abstract: King, Chris; Russell, Kylie; Bulsara, Caroline
      Objective: Literature suggests that the need to belong influences health and well-being, behavioural, emotional and cognitive responses. This paper describes the impending development and validation of a toolkit for nurses to create the experience of belongingness with a team approach, for student nurses undertaking a clinical placement.

      Setting and Subjects: The design of the toolkit will be developed from a selected Delphi panel process involving nursing experts' experience and opinions. The toolkit will then be distributed to nurses in selected clinical areas for use during periods of clinical placements.

      Primary Argument: Clinical placements are essential for professional socialisation in which nurses provide compelling role models for how to think, feel and act. However, students have often identified a sense of alienation through poor clinical experiences. The need to belong and be part of a team exerts a powerful influence on cognitive processes and behavioural responses. The absence of meaningful interpersonal relationships can result in failure to develop optimal clinical reasoning and critical thinking skills to manage patient care safely.

      Conclusion: More needs to be achieved than to simply justify the core attributes of a good clinical learning environment. Understanding of the key role that clinical leaders and supervisors exert to create a belongingness environment can influence positively the attitude of other staff towards students. For a valued positive clinical learning experience to become the benchmark of best practice, it requires a structured process, a toolkit to enable nurses to comprehend the concept of belongingness and to support them in embedding this model into their role of supervision.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 3 - Assessing the effectiveness of clinical education to
           reduce the frequency and recurrence of workplace violence
    • Abstract: Adams, Jillian; Knowles, Alex; Irons, Garry; Roddy, Alison; Ashworth, John
      Objectives: This study assessed the effectiveness of clinical education to identify patients with a high risk for violence and to reduce the frequency of violent incidents.

      Design: A before and after design with an education intervention.

      Setting: Data were gathered from the direct care staff and from records of violent/aggressive incidents which occurred on two adult medical wards at a teaching hospital in Western Australia.

      Subjects: Nurses, Assistants in Nursing and Patient Care Assistants working on the study wards participated in the education intervention (n=65) and completed a questionnaire before and after the education. Details of 48 violent/aggressive incidents perpetrated by 21 patients were examined.

      Intervention: An education program addressed four key areas (assessment, planning, implementation [crisis], post incident). Case studies and in-patient scenarios provided context, immediacy and relevance, and 77% of the staff completed the program.

      Main outcome measure: Knowledge, confidence and capability of direct care staff to prevent/manage violent/aggressive incidents were measured. Incident data measured the frequency and recurrence of violence/aggression, and if perpetrators met the high risk criteria.

      Results: Post education, knowledge increased significantly (p=0.001, CI 0.256-0.542), the use of verbal de-escalation increased significantly (p=0.011, 1df) and the frequency and recurrence of incidents decreased. All perpetrators met criteria indicating a high risk for violence.

      Conclusions: Education and coaching provided by clinical experts resulted in increased knowledge, greater use of verbal de-escalation and less incidents. However, more time/coaching is required to improve the perceived capability of clinical staff to manage these incidents.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 2 - Exploring infant deformational or positional
           plagiocephaly prevention and management by Maternal Child Health Nurses
           and Paediatric Physiotherapists
    • Abstract: Williams, Elizabeth N; Galea, Mary P
      Objectives: To explore Maternal Child Health (MCH) nurses' and Paediatric Physiotherapists' (Physiotherapists) experience with infant deformational or positional plagiocephaly (plagiocephaly).

      Design: Cross-sectional online survey.

      Setting: Community health setting in Victoria, Australia.

      Subjects: MCH nurses and Paediatric Physiotherapists in Victoria were invited to participate.

      Main outcome measures: Survey results were collated and analysed descriptively.

      Results: Surveys were completed by 183/961(19%) MCH nurses and a sample of 16 Physiotherapists, from a cross section of metropolitan (62%), regional (18%) and rural/remote (24%) Victoria. All MCH nurses and Physiotherapists reported seeing infants with plagiocephaly in the previous 12 months. Responses indicated MCH nurses saw between 11-50 infants with plagiocephaly (n=110). These were first diagnosed by MCH nurses at one to three months. Infants first presented to Physiotherapists on average at four to six months. All MCH nurses and Physiotherapists implemented prevention strategies and both groups thought it was effective subject to parents' implementing the advice. Strategies for prevention and management of plagiocephaly included early prone play (tummy-time) and counter positioning. Physiotherapists also included gross motor exercises, stretches if torticollis was present and, if appropriate, referral for helmet therapy. Referrals of infants with plagiocephaly by MCH nurses were made to Physiotherapists, General Practitioners, Chiropractors and Osteopaths.

      Conclusions: All MCH nurses and Physiotherapist respondents see infants with plagiocephaly, MCH nurses earlier than Physiotherapists. The effectiveness of plagiocephaly prevention advice can be called into question because of the high numbers of infants presenting and subsequent referrals to different health professionals. Recommendations from respondents included a review of past initiatives including extensive education for Maternal Child Health Nurses, Pamphlets in their Home visiting pack and video for demonstration at first time mothers group and the provision of clearer early prevention advice in the Government Key Ages and Stages (KAS) Framework for MCH nurses.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 2 - What prompts nurses to seek help from wound care
           consultants in spinal cord injury management'
    • Abstract: Bundz, Julie; Schuurs, Sarita; Kendall, Melissa; Amsters, Delena
      Objective: This study aimed to identify clinical scenarios that might prompt nurses to seek advice from a spinal cord injury wound care nurse consultant for pressure injury management. In addition, some attributes of nurses were examined for associations with intention to seek the help of a consultant.

      Design: Exploratory quantitative survey.

      Setting: Queensland, Australia.

      Subjects: Fifty currently practising hospital and community based nurses

      Main outcome measure(s): Two part online survey - part one presented hypothetical clinical case scenarios, in which respondents indicated their likelihood of seeking help; and, part two examined participant attributes and work experience.

      Results: Each scenario presented was rated as either of little importance or utmost importance by at least one respondent. Participants identified consultant personality and proximity as more influential on help seeking than timeliness, common sense or knowledge.

      Conclusion: The study did not identify a pattern of association between the presence of certain clinical factors and intention to seek help from a spinal cord injury consultant nurse for pressure injury management. What is important and influential for one person may be of less importance for others. Consultants must market their value to nurses in order that they are front of mind during the help seeking process. Further studies are required to examine the decision making process associated with help seeking.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 2 - The Cancer Nurse Coordinator Service in Western
           Australia: Perspectives of specialist cancer nurse coordinators
    • Abstract: Monterosso, Leanne; Platt, Violet; Krishnasamy, Meinir; Yates, Patsy; Bulsara, Caroline
      Objective: In Western Australia the cancer nurse coordinator (CNC) role is unique, state wide and situated in nursing. It requires the domains of clinical expert, resource consultant, educator, change agent, researcher and advocate to facilitate seamless coordination of care for patients across metropolitan, rural and remote geographical areas of Western Australia. This study examined the role, function and impact of CNCs from the perspective of coordinators themselves.

      Design: Prospective two-phase mixed method study. This paper reports data from the Self Report Activity Questionnaire in Phase one.

      Setting: The state-wide Western Australian Cancer Nurse Coordinator Service.

      Subjects: Metropolitan and rural CNCs (n=18) who had worked in the role for at least six months.

      Results: Overall, CNCs spent 70% of time in clinical consultation and 41% of CNCs reported having an educational role. Most CNCs (71%) noted that at least half of their patients had complex psychosocial needs at referral. Key role-related activities related to direct nursing care and patient education were performed most frequently on a daily basis. Tasks related to care management planning, patient advocacy and multidisciplinary clinical care were performed weekly. Strategic, team communication and professional development activities were performed less frequently.

      Conclusion: Diversity of the CNC role was demonstrated with findings showing that CNCs fulfilled the core components of the specialist cancer nurse. Given the clear need to provide consistent support to cancer patients in an increasingly individualised and integrated manner, we consider the CNC role a fundamental element of quality cancer care.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 2 - Being a fellow patient to a critically ill patient
           leads to feelings of anxiety - an interview study
    • Abstract: Laursen, Jannie; Lundby, Trine Bonnevie; Danielsen, Anne Kjaergaard; Rosenberg, Jacob
      Objectives: To explore in-patients' experiences being a fellow patient to patients who become critically ill.

      Design: The study was designed as a qualitative phenomenological study.

      Setting: The study was conducted in a surgical ward of a hospital in Denmark.

      Subjects: Fifteen fellow patients to patients, who became critically ill.

      Results: Three key themes emerged from the analysis of the data: patients' interaction, anxiety, and professional support. These findings demonstrated the importance of understanding how patients experienced being a fellow patient to patients, who become critically ill, their views on interacting with such a patient, how the patients who become critically ill influenced them, and what kind of support they needed from the health professionals.

      Conclusion: The findings highlighted the different emotions and feelings experienced by fellow patients. It showed how the impact of the situation can lead to anxiety, a feeling of being forced into patient inter-action and the lack of professional support. Health professionals should have a central role in supporting the fellow patients and communicating with them about their experiences and this does not seem to be fulfilled sufficiently in daily clinical practice.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 2 - The transition of overseas qualified nurses and
           midwives into the Australian healthcare workforce
    • Abstract: Ohr, Se Ok; Holm, Doreen; Brazil, Sue
      Objective: The purpose of this paper is to discuss the key elements to consider when developing and implementing strategies to enhance the transition of overseas qualified nurses and midwives (OQNMs) into the Australian healthcare clinical practice environment.

      Setting: A local health district with a major metropolitan centre and a mix of large regional centres which provide a range of public health services, to a population of approximately 850,000 people located in New South Wales, Australia.

      Subjects: Newly recruited overseas qualified nurses and midwives. Many of these nurses and midwives are from culturally and linguistically diverse backgrounds and different countries.

      Primary argument: Within the Australian nursing and midwifery practice environment the recruitment of overseas qualified nurses has gradually increased. While transitioning into the practice environment requires a range of support strategies, there is limited information on how to support them.

      Conclusion: The culturally constructed support program and its strategies assisted in minimising the impact of the challenges and difficulties faced by OQNMs in their transition into the Australian nursing workforce. The program was instrumental in improving their well-being and it provided a strategic framework to facilitate a smoother transition. Risks to patient safety were mitigated by providing opportunities for education so the provision of safe quality care was enhanced. This was also seen as a factor that enhanced the recruitment and retention of nurses in the workforce.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 2 - Male or nurse what comes first': Challenges men
           face on their journey to nurse registration
    • Abstract: Juliff, Dianne; Russell, Kylie; Bulsara, Caroline
      Objective: This paper aims to provide an account of the first phase of a qualitative longitudinal study that explored the initial challenges men in nursing face to become registered. What is known is that men, a minority group within nursing, face the usual challenges of all new nurses in their quest to register as nurses. In addition, they have added pressures that hinder their quest due to being male.

      Primary Argument: An Australian nursing shortage is looming due to nurses retiring from this female-dominate profession. Hence, the retention of men in nursing is an area requiring attention in order to support a sustainable workforce.

      Subjects and Setting: Nine newly graduated male registered nurses participated. These nurses had recently commenced employment in the Western Australian metropolitan health region.

      Findings: Individual face-to-face interviews produced the theme of role misconception with a major focus on male or nurse what comes first. This theme was derived from the categories of gender stereotyping and marginalisation.

      Conclusion: This study suggests the need for a gender-neutral image when promoting nursing within and outside the professional environment. Furthermore, consideration for a professional title mutually accepted by both women and men in nursing, with the gender-neutral 'nurse' title preferred by the men in this study. Moreover to acknowledge that men in nursing will augment a technical savvy workforce that will complement emergent complex nursing practices, and enhance a more comprehensive Australian nursing workforce that will assist with meeting the health care needs of a diverse population.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 1 - Stoma and shame: Engaging affect in the adaptation to
           a medical device
    • Abstract: Diebold, Lionel
      Objective: The objective is to understand difficulties some patients have with their adaptation to a medical device, specifically a stoma and an ostomy appliance, following gastro-enterologic surgery. A partial or total colectomy is typically performed in cases of digestive cancers, Crohn's disease, or anal incontinence. A psychotherapeutic application deduced from this understanding is described. The therapeutic approach is informed by Lacanian psychoanalysis.

      Setting: The setting is the digestive surgery services section of a large public teaching hospital in France. The clinical team conducting the interventions described perform their work with patients post-operatively.

      Subjects: Selected cases are chosen to provide brief illustrations of the analysis and the psychotherapeutic approach developed.

      Primary argument: This study focuses on the impact of the stoma and the ostomy appliance on the subjectivity of the patient and shows how the affect of shame can appear. It is noted that the affect of shame in the adaptation to an ostomy appliance has not been investigated to date. This affect can in turn have psychological effects on the gastroenterologic treatment itself, even to the point of the patient's abandonment of ongoing care. The analysis reported here explores the recognition of shame when it might be present, and the process of accompanying the patient therapeutically, engaging the logic of the transference.

      Conclusion: Shame cannot be treated by ignorance or by indifference. A psychotherapeutic application engaging the transference between the patient and members of the nursing and psychotherapeutic team, helps patients support shame and adapt well to the ostomy bag.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 1 - Flooded with evidence: Using a 'spillway' model to
           improve research implementation in nursing practice
    • Abstract: Moloney, Clint; Taylor, Melissa; Ralph, Nicholas
      Objective: To identify barriers to implementing evidence-based practice initiatives in small to medium sub-acute facilities in Queensland.

      Design: The study uses a qualitative methodology in which field observations and convergent interviews were employed to generate data.

      Setting: Four south-east Queensland sub-acute care facilities participated in the study. Observational and interview data were collected.

      Subjects: Field observations were recorded across the sites. Five research fellows collected observational data on evidence-based practice implementation across a period of six months. Nine clinicians participated in in-depth, convergent interviews at the end of the period of observation.

      Main outcome measures: The authors analysed observational and interview data using qualitative thematic analysis.

      Results: Three themes emerged which described the needs of clinicians when evidence-based practice initiatives were being implemented: (1) valuing evidence; (2) risk prioritisation; and (3) controlling the flow of evidence. A 'Spillway Model' is proposed as a mechanism for targeting clinical priorities using integrated risk management.

      Conclusion: This study supports the use of integrated risk management as part of a Spillway Model to guide the introduction of evidence-based practice initiatives in the clinical setting.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 1 - A mental health nursing transition program for
           enrolled nurses at a forensic mental health hospital
    • Abstract: Quinn, Chris; Ryan, Jo
      Objective: There are difficulties in recruiting enrolled nurses to mental health positions. A six month program was developed with the aim to bridge possible knowledge gaps for enrolled nurses, and to provide them practical support to consolidate skills and knowledge for nursing in a forensic mental health hospital.

      Setting: The setting was a 116 bed secure forensic mental health hospital in the state of Victoria, Australia.

      Subjects: Nine enrolled nurses who had completed a Diploma of Nursing, were recruited into the program.

      Primary argument: There is a national decrease in enrolled nursing supply, and a paucity of data exploring the training needs of enrolled nurses transitioning from the Diploma to a mental health nursing role. Nursing programs are required to assist enrolled nurses with the knowledge and skills, and support required to effectively make their transition into mental health nursing.

      Conclusion: The results demonstrate the importance in providing a program to assist enrolled nurses transition to mental health and that the mental health course requirements within the Diploma of Nursing and placement length may not be adequate in preparing enrolled nurses for direct entry to mental health nursing. Providing a structured transition program for a group of enrolled nurses is a useful strategy to improve knowledge, skills, and retention.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 1 - Knowledge, attitudes and practices relating to
           fertility among nurses working in primary health care
    • Abstract: Hammarberg, Karin; Collison, Lisa; Nguyen, Hau; Fisher, Jane
      Objective: To explore knowledge, attitudes and practice relating to factors that affect fertility among nurses working in general practice and other primary health care settings.

      Design: Anonymous online survey.

      Setting: Primary care.

      Subjects: Members of the Australian Primary Health Care Nurses Association (APNA). Main outcome measures: Fertilityrelated knowledge, attitudes and practice.

      Results: 102 individuals completed the survey. More than half overestimated the age when male and female fertility declines and the chance of women conceiving with IVF. Most knew that smoking affects a man's sperm but only one quarter that smoking halves a woman's fertility. The majority recognised obesity and STI's as detrimental for fertility and agreed that educating patients about fertility is part of primary health care nurses' role to ask people of reproductive age about their reproductive life plan and alert them to the factors that influence fertility. The most commonly cited barrier for discussing fertility with patients was perceived lack of knowledge about the subject.

      Conclusion: This study identified opportunities and barriers for nurses working in primary health care to proactively discuss fertility and the factors that influence the chance of conceiving with their patients. Appropriate educational resources to improve knowledge and support from general practitioners (GPs) can enable nurses working in general practice and other primary health care settings to provide effective fertility related education as part of their role as health promoters.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 1 - Doctoral education for nurses today: The PhD or
           professional doctorate'
    • Abstract: Walker, Kim; Campbell, Steven; Duff, Jed; Cummings, Elizabeth
      Objective: This paper seeks to stimulate discussion and debate about the future of doctoral education for nurses in Australia.

      Setting: A large Magnet recognised acute care private hospital in New South Wales and a large regional university in Australia.

      Primary argument: Healthcare today and into the future is increasingly more complex and requires ever more highly skilled healthcare professionals to meet the challenges of providing safe, quality care. Doctoral research and education based in the workplace and designed to improve healthcare while skilling up nurses and other professionals in research methods has never been more relevant and appropriate.

      Conclusion: Nurses have generally not seen the PhD as the best fit for their higher professional development. The professional doctorate offers a compelling and dynamic alternative to the more academic focus of the PhD and prepares 'inquirydriven leaders' for tomorrow's challenges.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 1 - Nurse empathy and the care of people with dementia
    • Abstract: Digby, Robin; Williams, Allison; Lee, Susan
      Objective: Empathy is widely accepted as an essential nursing attribute yet the relationship between nurse empathy and the care of people with dementia in the hospital setting has rarely been explored. A number of themes have emerged from the relevant literature regarding the influences which shape a nurse's ability to deliver empathetic care to this patient cohort. These issues include a lack of hospital resources, an organisational focus on operational issues such as patient flow and risk management, and widespread stigmatisation of dementia in society.

      Setting: Acute and sub-acute facilities.

      Subjects: In-patients with dementia and nurses

      Primary argument: Although there is widespread acknowledgment that nurses require empathy to deliver quality care, the complexity of caring for people with dementia in hospital creates further challenges for both nurses and patients. This issue has been discussed previously but there is little evidence that the situation has improved.

      Conclusion: This paper details the relevant influences on the ability of nurses to care empathetically for people with dementia in hospital. The recognition that there are distinct factors related to this patient cohort is an important one and may assist nurses and health organisations to identify systemic and individual problems associated with hospitalisation and lead to the implementation of supportive strategies. Appropriate nurse-patient ratios which consider the additional workload attached to caring for people with dementia, clinical supervision and targeted nurse education must be considered to ensure health systems deliver appropriate person-centred care to people with dementia.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 34 Issue 1 - Access to healthcare services for people living with
           HIV experiencing homelessness - a literature review
    • Abstract: Crock, Elizabeth
      Objective: People living with HIV (PLHIV) who are homeless or at risk of homelessness experience significantly worse health outcomes than those in stable housing. They are more likely to be diagnosed late, use substances, engage in high-risk sexual activities and have difficulty adhering to treatments. This review identifies strategies described and evaluated in the international social science literature which can improve access to HIV-treatment and care for PLHIV who are homeless or at risk of homelessness, to inform policy and service development in Australia.

      Setting: The principle research question addressed in this review is:

      - What strategies enhance the ability of PLHIV who are homeless to access health care services, in particular community nursing services' A literature review of social science research relating to the research question in the international and Australian contexts was conducted.

      Primary argument: No literature was identified that addressed access to community nursing services for PLHIV experiencing homelessness in Australia, and very little internationally. Community-based nursing organisations are well-placed and experienced in engaging marginalised groups in health care. Specific interventions need not always be developed: rather, better use could be made of existing services that utilise assertive outreach models of care and co-location with other services.

      Conclusion: HIV-specialist community nursing services could be better integrated with homelessness services to enhance access to care, link PLHIV into the health system and keep them engaged in care. The absence of research on engagement with HIV specialist community nursing services demands exploration.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 4 - Home oxygen therapy assessment for COPD patients
           discharged from hospital: Respiratory NP Model of Care
    • Abstract: Hall, Toni
      Objectives: The research aim was to examine the impact of the introduction of the Chronic Respiratory Disease Nurse Practitioner (CRD NP) Model of Care (MOC) on the assessment for short term oxygen therapy (STOT), provision of care, and patient outcomes for patients discharged with oxygen therapy post an acute exacerbation of chronic obstructive pulmonary disease (COPD).

      Design: A retrospective uncontrolled comparative clinical audit was conducted in two six-month periods pre (2009) and post (2011) the introduction of the CRD NP MOC.

      Setting: Tertiary referral centre in central Victoria, Australia.

      Subjects: A total of 301 patient admissions with a discharge diagnosis of COPD were examined for hypoxia at rest and on exertion prior to discharge.

      Main outcome measures: The audit focused on the incidence of assessment for STOT prior to discharge, supply of STOT where indicated on discharge, and incidence of re-admission within 28 days of discharge with COPD related symptoms.

      Results: A statistically significant increase in the proportion of appropriate patients assessed with arterial blood gas analysis for eligibility of STOT from 7.7% in 2009 to 45% in 2011. Provision of STOT on discharge increased from 26.7% to 44.4%. Re-admission to hospital within 28 days of discharge for patients with STOT decreased from 25% in 2009 to 12.5% in 2011.

      Conclusion: Since the introduction of the CRD NP MOC there has been an increase in patient assessment for STOT, provision of STOT, reduction in hospital re-admissions, improved adherence to procedure protocols, improved patient outcomes and cost savings for the hospital.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 4 - The art of clinical supervision: Its development and
           descriptive mixed method review
    • Abstract: Russell, Kylie; Alliex, Selma; Gluyas, Heather
      Objectives: The Health Workforce Australia Clinical Supervision Support Program Discussion Paper (2010) highlighted the education deficits of health professionals responsible for the clinical supervision of students. This research aimed to develop, implement and evaluate a new education program for nurses to assist in the development of knowledge and attitude to supervise students whilst on clinical practicum.

      Design: The impact of the ACS program was determined using a descriptive methodology involving the collection and analysis of quantitative and qualitative data using a triangulation approach. This included the use of surveys, online reflections and interviews.

      Settings: The ACS program was presented in both the metropolitan and regional areas of Western Australia.

      Subjects: Participants (n=199) were from both the public and private health care sector working in a variety of nursing specialties within both the inpatient and community setting.

      Results: Analysis of the data determined that participants improved their knowledge and attitude towards students and clinical supervision.

      Conclusions: The ACS was confirmed as a strategy for providing effective education for nurses.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 4 - Key milestones in the operationalisation of
           professional nursing ethics in Australia: A brief historical overview
    • Abstract: Johnstone, Megan-Jane
      Objective: To provide a brief historical overview of the achievement of key milestones in the development of mechanisms for operationalising professional nursing ethics in Australia; examples of such milestones include: the publication of the first Australian text on nursing ethics (1989), the provision of the first Australian national distance education course on nursing ethics for registered nurses (1990), the adoption of the first code of ethics for Australian nurses (1993), and the commissioning of the first regular column on nursing ethics by the Australian Nurses Journal (2008).

      Setting: Australian nursing ethics.

      Primary argument: An historical perspective on the achievement of key milestones in the development of mechanisms for operationalising professional nursing ethics in Australia has been poorly documented. As a consequence an authentic 'Australian voice' is missing in global discourses on the history and development of nursing ethics as a field of inquiry. Compared with other countries, the achievement of key milestones pertinent to the operationalisation of nursing ethics in Australia has been relatively slow. Even so, over the past three decades an Australian perspective on nursing ethics has gained a notable voice in the international arena with Australian nursing scholars now making a significant contribution to the field.

      Conclusion: Nursing ethics in Australia remains a 'work in progress'. Although significant achievements have been made in the last three decades, the ongoing development of mechanisms for advancing nursing ethics in Australia would benefit from the development and implementation of a strategic agenda of collaborative, internationally comparative, cross disciplinary scholarship, research and critique.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 4 - The role of advance care planning in end-of-life care
           for residents of aged care facilities
    • Abstract: Waird, Allyson; Crisp, Elaine
      Objective: This report will present the case of an elderly woman with rapidly declining health admitted to hospital from a nursing home. It will discuss benefits of advance care planning for residents of aged care facilities who have expressed opinions/wishes regarding their end-of-life care, and identify barriers, varying legal status, the need for documentation of discussion outcomes specifying residents' wishes, and the importance of education and expert support for nursing staff.

      Setting: Nursing home and acute tertiary referral hospital.

      Subject: Female resident of a nursing home, aged 97 years, with acute onset of abdominal pain and multiple co-morbidities.

      Primary Argument: The majority of nursing home residents do not have advance care planning initiated, nor is this routinely raised by nursing staff. While wishes may be discussed with family, they may not be fully respected if undocumented. Acutely ill residents are frequently hospitalised, especially when death is imminent, and often die alone in unfamiliar surroundings, tended by strangers. Many of these admissions could be avoided with Advance Care Planning, as could the resultant medical interventions which may cause the resident acute pain and discomfort.

      Conclusion: Advance Care Planning can lead to avoidance of non-essential hospital transfers and their inherent risks and is likely to facilitate a dignified, peaceful death in familiar surroundings for nursing home residents, averting medical interventions which may cause needless pain and prolonged suffering.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 4 - A nurses' guide to mixed methods research
    • Abstract: Ingham-Broomfield, Rebecca
      Objective: This article provides a breakdown of the components of mixed methods research methodology. The intention of the article is to simplify the terminology and process of mixed methods research to enable novice readers of research to have a better understanding of the language and concepts involved. The Survey method, using both qualitative and quantitative research methods, will be used to explain the principles of mixing methods.

      Primary Argument: Australian nurses work in an environment where evidence-based practice is mandatory. Understanding the research process and terminology used may benefit nurses to implement research in their day-to-day practice. Gaining knowledge of the different approaches used in mixed methods research is paramount if nurses are to base their care on research which has utilised this style.

      Conclusion: As mixed methods are used in nursing, social and behavioural research it is essential that nurses understand the methodology. The main components of mixed methodology will, therefore, be discussed in a systematic, logical order.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 3 - A prospective comparison of the AUSDRISK and HbA1c for
           persons with spinal cord injury
    • Abstract: Jannings, Wendy; Fry, Margaret; Gallagher, Robyn
      Objective: The primary object of this study was to determine the validity of the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) for predicting the development of type 2 diabetes in persons with spinal cord injury (SCI).

      Design and setting: The prospective comparative study (December 2013-March 2014) collected data on AUSDRISK and haemoglobin A1c (HbA1c) in participants' homes.

      Participants: Participation rate was 67% (n=79). Study criteria: over 18 years of age, a SCI for more than 12 months, living at home, wheelchair dependant and no diabetes diagnosis.

      Main outcome measures: AUSDRISK sensitivity and specificity in predicting incident type 2 diabetes in persons with SCI.

      Results: Of the 79 participants, 81% were male, mean age was 53 years (SD 14.14) with 23.2years (median 23; SD +/- 13.2yrs) since injury. There was a positive correlation between length of time since SCI and risk score (AUSDRISK) (r = .242, p = .032). Participants with high AUSDRISK scores had higher HbA1c% (5.38 versus 5.2, p = .026) level. The high risk classification explained a moderate amount of HbA1c % (area under curve = .651; 95% CI .53 - .77). The level of HbA1c which had the highest sensitivity (.59) and specificity (.73) for risk classification was 5.25%. Waist circumference and physical activity items require further powered studies to determine if appropriately weighted.

      Conclusion: Comparing the AUSDRISK with HbA1c assays, the AUSDRISK can predict type 2 diabetes risk in a person with SCI, although further powered studies are needed to be undertaken, to refine the predictive capacity of the tool.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 3 - Moral distress of oncology nurses and morally
           distressing situations in oncology units
    • Abstract: Ameri, Malihe; Safavibayatneed, Zahra; Kavousi, Amir
      Objective: The purpose of this study was to evaluate the intensity and frequency of moral distress and determine clinical situations leading to moral distress in oncology units. The study also examined the relationship between moral distress scores and demographic characteristics of oncology nurses.

      Design: This descriptive study was performed between 25 January 2012 and 29 June 2013.

      Setting: The study was conducted in the oncology units of eight training hospitals in Tehran, Iran.

      Subjects: One hundred and forty eight nurses (131 females, 17 males; mean age 32.5 years; range 24 to 52 years) who had worked in oncology units of training hospitals in Tehran were included in the study.

      Main outcome measure(s): The main outcome measures included intensity and frequency of moral distress, which were assessed by the Moral Distress Scale - Revised (MDS-R).

      Results: Most of the 148 nurses had high to moderate scores. Nurses had experienced higher moral distress when receiving informed consent forms from patients and asking patients to carry out physicians' order for unnecessary tests in patients' last stages of life.

      Conclusion: Moral distress exists in oncology nurses and interventions will be developed and tested to decrease and prevent it.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 3 - A nurses' guide to the hierarchy of research designs
           and evidence
    • Abstract: Ingham-Broomfield, Rebecca
      Objective: This article provides a breakdown of the components of the hierarchy, or pyramid, of research designs. Its intention is to simplify the components of the hierarchy to enable novice readers of research to better understand the differing approaches and levels of evidence.

      Primary Argument: Evidence-based Practice (EBP) is the integration of the best research evidence with clinical expertise and the patient's unique circumstances. This includes respect of patient values, and their needs, whilst delivering high-quality, cost effective health care. Understanding the differing levels of evidence, and their reliability, is paramount to making correct and appropriate health care decisions. Nurses are required to use evidence-based practice as they are responsible for a significant amount of judgments and decisions every day, and therefore, they must use research literature as part of their clinical decision-making.

      Conclusion: The content, or levels of evidence, of the hierarchy will be discussed in a systematic, logical order from the base to the apex of the pyramid. A comparative grid at the end may lead the nurse to better understand the differing components of the seven levels of evidence or, depending on the source, eight.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 3 - Y doesn't Gen Y like 2 w8'
    • Abstract: Jackson, Karen; Drew, Kerry; Shaw, Jacqueline
      Objective: The aim of this small scaled research project was to identify any generational differences in expectations and satisfaction in waiting times, amongst Minor Injury patients with an ATS (Australian Triage score) four and five and how, or indeed if these relate to overall satisfaction of the Emergency Department (ED) Fast track or Treatment Stream (TS) Service. The question for this research was: In what ways do generational groups perceive waiting times for the service provided by an Emergency Department Fast track or Treatment Stream Service and with what implications for future services'

      Design: A descriptive survey design where patients entering the TS area of the ED were given a validated patient satisfaction questionnaire to complete during their stay, in order to quantify their expectations of the waiting times and their level of satisfaction. Data was descriptively analysed and discussed within the conceptual framework of generational descriptions.

      Setting: Emergency Department, within an independent Emergency Nurse Practitioner (ENP) led TS service.

      Subjects: Convenience sample, limited to a maximum of every third adult patient attending the Armadale ED TS area, was offered the opportunity to participate in the study.

      Main outcome measures: Expectations of waiting times and levels of satisfaction across generational groups.

      Results: There was no difference between the expectations of Gen Y and other generational groups (Pr Chi 0.135), however Gen Y were still significantly less satisfied with the service than the other generational groups (P=0.018).

      Conclusion: More research is required to address the expectations and satisfaction in waiting times and health services offered to different generational groups. This study offers beginning insights.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 3 - Why such success': Nursing students show
           consistently high satisfaction with bioscience courses at a regional
           university
    • Abstract: Clifton, IDelma; McKillup, Stephen C
      Background: An understanding of anatomy, physiology and pathophysiology is considered essential for graduate nurses, but many nursing students find such courses difficult and anxiety-provoking. This was contrary to the authors' experiences, so student perceptions were studied at the survey institution.

      Objective: This paper examines nursing students' satisfaction with bioscience and nursing courses in the first two years of a Bachelor of Nursing at an Australian university, in order to suggest strategies for effective bioscience teaching.

      Design: Quantitative data for student satisfaction, measured on the Likert scale, were collected for three bioscience and 11 nursing courses from 2010 - 2012. Mean satisfaction was compared among courses and offerings by ANOVA, with offerings nested within courses, and correlation analysis was used to examine the relationship between student satisfaction and pass rate. Qualitative data were sourced from open questions, emails and forum posts and examined for recurrent themes.

      Results: Students rated the three bioscience courses in the top four of the 14 courses. There was no relationship between satisfaction and pass rate. Qualitative responses showed satisfaction with the course content, the learning materials, the delivery style and lecturer support.

      Conclusion: It is possible to deliver bioscience courses that are appreciated by nursing students. Four principles are suggested in this paper that may improve student satisfaction with bioscience courses and, therefore, result in more effective learning and better prepared nursing graduates.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 2 - Exploring why some terminally ill people die in
           hospital when home was their preferred choice
    • Abstract: Champion, Nicola; Morrison, Paul; Medigovich, Kristina
      Objective: This small study was designed to gain a better understanding of issues that led to hospital admission of palliative care clients who had a preference for home death, but died in hospital.

      Design: A mixed method approach was chosen for the study using descriptive analysis of routinely collected client demographic and clinical data, and conventional content analysis of case note entries. Setting The study was undertaken in two community based palliative care services located in rural South Australia. Subjects: The case notes of fourteen deceased adults registered with the Northern Yorke Peninsula and Port Pirie Palliative Care Services, with a recorded preferred site of death (PSD) of home and who died in hospital were studied.

      Main outcome measure: Understanding of issues that may have led to hospital admission of palliative care clients who had a preference for home death but who died in hospital.

      Results: The findings reported here focus only on the qualitative aspect of the study. Issues that may lead to hospital admission include: unstable symptoms, deteriorating condition, client/caregiver decision making, lack of services over twenty four hours and the caregiver's ability to manage client care.

      Conclusion: Services can now consider these findings and develop local strategies to improve support for clients with a preference to die at home, and in particular, those that focus on improving caregiver training and information.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 2 - Using clinical reasoning and simulation-based
           education to 'flip' the Enrolled Nurse curriculum
    • Abstract: Dalton, Lisa; Gee, Tamara; Levett-Jones, Tracy
      Objective: This paper describes the development and implementation of an innovative Diploma of Nursing curriculum for preparing Enrolled Nursing students for acute care nursing practice.

      Setting: Vocational Education and Training at the Health Education and Research Centre in Hobart, Tasmania.

      Subjects: Vocational Education and Training students enrolled in the Diploma of Nursing (Enrolled Division 2 Nursing) (HLT51612).

      Primary Argument: The increasing complexity and acuity of contemporary practice environments requires a nursing workforce that is flexible and competent. In 2013 nurse educators developed an innovative approach to offering the national standardised Diploma of Nursing course that integrates three key pedagogical approaches: the 'flipped classroom', simulation based learning and the Clinical Reasoning Cycle.

      Conclusion: By 'flipping the curriculum' students are provided with opportunities to develop and extend their clinical reasoning skills as they respond to both routine and unpredictable 'patient' scenarios in the safety of a simulation environment. These simulated clinical learning experiences are designed to challenge students to 'think like a nurse' while actively engaging in the provision of safe and effective 'patient' care.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 2 - Risk stratification for obstructive sleep apnoea and
           optimal post-operative monitoring in an overnight stay ward
    • Abstract: Kadam, Vasanth Rao; Markman, Phuong; Neumann, Sally; Kingisepp, Sandi
      Objectives: Prospective data is required to clarify the role of a one night stay ward (23 hour ward, 23HW) for the post operative monitoring of surgical patients with obstructive sleep apnoea (OSA). The aim was to use a modified American Society of Anesthesiologists (ASA) screening tool to stratify the perioperative risk of OSA related complications and evaluate the role of a 23HW in the post operative management of this patient group.

      Design: Prospective cohort study.

      Setting: Tertiary referral centre.

      Subjects: Patients identified in pre-anaesthetic clinic as having a mild to moderate risk of complications from OSA were scheduled for post operative monitoring in a 23HW.

      Outcome measures: Primary end points were incidence of desaturation events (Continuous pulse oximetry measuring SpO2 90-94% mild,
      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 2 - Can generation Y nurses supply areas of shortage':
           New graduate challenges in today's job market
    • Abstract: Christopher, Sybele Anne; Chiarella, Elizabeth Mary; Waters, Donna
      Objective: Workforce attitudes, such as intent to stay, leave temporarily, or exit permanently from nursing, develop at an early career stage. This paper explores the mismatch between the challenges faced by nursing graduates (of whom many belong to Generation Y) in obtaining a Registered Nurse (RN) position following graduation and the continuing shortages in nurse workforce in aged care and mental health areas.

      Setting: Current Australian literature reveals the discontent of university graduates seeking positions in an industry that does not make arrangements to employ graduates, but concomitantly reports workforce undersupply. Areas of nursing shortages of concern discussed in this paper are aged care and mental health nursing.

      Primary argument: A number of reasons may explain why these areas are depleted of nurses: an ageing workforce, unattractive market positions for new graduate nurses and negative perceptions of the aged care and mental health sectors. Also, numerous generational negative opinions expressed in academic literature and popular media serve to discourage newly graduating nurses from working in these areas.

      Conclusion: The paper offers potential solutions to address three main issues raised in the discussion. Firstly, addressing the shortage of new graduate positions is an effort to retain qualified but inexperienced nurses. Secondly, drawing on the pool of new graduates to supply aged care and mental health rejuvenates these specialty areas and ensures these nursing fields are well catered for. Finally, directing efforts to retain new graduate nurses is an opportunity to address the 2025 projected Australian nurse workforce shortfall.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 2 - Health literacy: How nurses can make a difference
    • Abstract: Johnson, Anne
      Objective: To be a call to action to nurses and all health professionals to implement proven effective evidence based strategies that can decrease health literacy demands on health consumers, and improve health outcomes and the provision of safe person centred health care.

      Primary argument: Health professionals, specifically nurses, are important providers of health information to health consumers. They influence the health literacy demands placed on health consumers through the way they organise, present and communicate information (Australian Commission on Safety and Quality in Health Care, 2014). All health professionals need to be cognisant of the range of effective strategies they can implement to reduce the health literacy demands on health consumers through effective interpersonal communication, health materials in the written and visual formats and the creation of health literate environments to improve health outcomes and the provision of safe care.

      Population measurements of functional health literacy levels (Australian Bureau of Statistics 2008) indicate that 59 per cent of the Australian population aged 15 to 74 years did not achieve an adequate health literacy skill level to meet the complex demands of everyday life and work in a knowledge based economy.

      Conclusion: An understanding by all health professionals of the concept of health literacy, and the evidence based strategies they can implement to decrease health literacy demands on health consumers is imperative to enhancing the involvement of health consumers in their care, improving health outcomes and in the provision of safe health care.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 1 - The role of specialist nurses in cardiac genetics -
           The Victorian experience: supporting partnerships in care
    • Abstract: Thompson, Tina; Morgan, Natalie; Connell, Vanessa; Zentner, Dominica; Davis, Andrew; Pflaumer, Andreas; Woodford, Noel WF; Winship, Ingrid
      Objective: In Victoria, Australia, a unique referral process exists for families who require investigation for possible inherited cardiac disease. This is spearheaded by a team of specialist nurses located at the Royal Children's Hospital Melbourne (RCH), the Royal Melbourne Hospital (RMH) and the Victorian Institute of Forensic Medicine (VIFM), who ensure that all potentially at-risk families are offered the opportunity for clinical assessment and consultation.

      Setting: In Victoria, approximately 5,500 deaths are reported to the Coroner each year. Where there is a suspicion of a causative heritable cardiac condition, the surviving relatives are offered referral to a tertiary centre for assessment and screening.

      Subjects: A specialist nurse employed by the VIFM is the focal point for forensic pathologists to flag families requiring referral. Concurrently, specialist nurses within the cardiac genetic services of RMH and RCH accept, review, triage and action these referrals. All three services work closely to create a seamless model of care, which is age appropriate and provides ease and equity of access to consistent care.

      Primary argument: The nurse specialists are a critical part of the multidisciplinary team, providing the first entry point into the hospital system. Their background experience encompasses intensive care and cardiology nursing. This is essential to the provision of professional and empathetic care in which families can approach the difficult issues surrounding post mortem consideration of a diagnosis.

      Conclusion: The Victorian nurse led system is an effective model, which could be trialled in other jurisdictions, and other disorders, where multidisciplinary care is required.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 1 - Literature review: "Are you ok there'": The
           socialisation of student and graduate nurses: Do we have it right'
    • Abstract: Goodare, Pete
      Objective: To determine the effectiveness of the current socialisation processes for student and graduate nurses, into the clinical practice setting.

      Setting: The clinical nursing environment, with underlying links and reference to the academic setting of nurse education.

      Subjects: The sole focal subjects of this literature review are student/undergraduate and graduate/new nurses.

      Primary argument: Internationally, attrition rates of new graduate nurses in their first year of practice ranges between 30-60%. Undergraduate and new nurses enter the nursing profession with a beginning skill set, reflective of their education, coupled with preceded values and ideas about the profession itself. Recognition of an adjustment period undergraduate and new nurses require, is paramount to meeting the anticipated socialisation of these new professionals. Socialisation in the profession of nursing is an ongoing and complex interactive process by which the professional role, incorporating skills, knowledge, and behaviours, is learned and the individual consciously and subconsciously seeks their sense of occupational identity, and perfecting this process is crucial.

      Conclusion: Newcomers to the nursing profession have expressed that learning how to behave appropriately in the workplace is more difficult than bridging the gap between theory and practice. Intentional measures implemented by organisations, is paramount in enabling newcomers to adjust to the workplace, and it is unsafe to assume the process of socialisation is good, and underestimation of this socialisation process, would be negligent.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 1 - The clinical environment - do student nurses
           belong': A review of Australian literature
    • Abstract: Gilbert, Julia; Brown, Lynne
      Objective - broad aim: This paper aims to identify some of the issues related to the nursing students' experience of belonging on clinical placements from the current Australian literature. Anecdotal and empirical evidence suggests that nursing students on clinical placements often experience problems that can adversely affect their feeling of belonging in the clinical setting and ultimately their career decisions. As nursing shortages increase, retention of student nurses in their chosen profession is often affected by their clinical experiences, both positively and negatively (HWA, 2012).

      Setting and Subjects: Health professionals' attitudes towards nursing students may affect their feelings of belonging to the environment and the health care team. These health professionals include Registered Nurses and a range of other health professionals including medical staff, physiotherapists and dieticians. The clinical settings in which student nurses' practice vary greatly and may also make a difference to the student experience and their feelings of belonging.

      Primary Argument: Student expectations should include feeling welcomed to the clinical area and respected as part of the nursing culture. Clinical placements provide the 'real world' experience to complement classroom and laboratory education. These expectations are clearly not met in some clinical environments. Complimentary research reinforces the benefit of partnering students with experienced registered nurses who have an interest in teaching nursing students.

      Conclusion: The literature has identified some examples of where students have felt a sense of belonging to the clinical environment and others where the situation has been less than encouraging. Provision of support, guidance and ensuring appropriate clinical education remain ongoing challenges for Australian universities and the health care system (Henderson et al 2011).

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 1 - Exploring values in nursing: Generating new
           perspectives on clinical practice
    • Abstract: Drayton, Nicola; Weston, Kathryn M
      Objective: The 'Essentials of Care' (EoC) program seeks to develop a shared vision amongst nurses within particular workplace teams. The purpose of this study was to describe the experiences of nurses during the process of exploring their values and developing these into a shared vision at both an individual level and as a team.

      Design: A qualitative, focus group design was used to provide an accurate representation of the nurses experiences in reflecting on their values and developing these into individual ward/unit vision statements. Six focus groups were conducted by independent researchers. The focus group discussions were recorded and transcribed by an independent researcher. The transcription provided the data for thematic analysis.

      Setting: This study was conducted in two tertiary hospitals from the same Local Health District in New South Wales, Australia.

      Subjects: Forty-two nurses from fourteen hospital wards or units participated in the study. Seventeen were facilitators of the program and the remainder were nursing staff who had undertaken the program.

      Main outcome measures: The authors independently interpreted the transcripts using inductive qualitative analysis, reaching consensus on emergent themes. Representative quotations were chosen for each theme.

      Results: Six themes emerged which describe the experiences of nurses during the exploration of individual and team workplace values which were then developed into shared visions. The emergent themes were: shared values and commitment to patient care; empowerment and ownership for cultural change; real and observable outcomes; the meaning of the team; different active learning approaches equalling the same outcome; and culture change results in new perspectives.

      Conclusion: This study supports the benefits of value-based programs. Exploring values led to new perspectives on clinical practice, both individually and collectively by the nursing teams.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 1 - Delirium in the intensive care unit and long-term
           cognitive and psychosocial functioning: Literature review
    • Abstract: Bulic, Daniella; Bennett, Mike; Shehabi, Yahya
      Objective: This paper reviews existing literature on delirium that arises during mechanical ventilation in the Intensive Care Unit (ICU). It looks at the physiology of delirium, its subtypes and risk factors. It further considers the impact of delirium on cognitive and psychosocial function of patients after their discharge from acute care. The aim of this paper was to increase awareness of ICU delirium, accentuate the potential link between different sedation agents and the development of delirium, and inform practitioners, especially nurses, about this common neurocognitive disorder that appears in the Intensive Care Unit (ICU).

      Setting: Intensive Care Unit (of any acute hospital) where is ICU located.

      Subjects: Mechanically ventilated patients.

      Primary argument: This paper argues for the awareness of delirium in the Intensive Care Unit and examines sedation during mechanical ventilation with its potential role in promoting this disorder.

      Conclusion: Delirium is the most common neurobehavioral disorder in patients who are critically ill and mechanically ventilated in ICU. It frequently generates psychiatric and psychological outcomes such as depressed mood, anxiety and/ or Post Traumatic Stress Disorder (PTSD). Cognitive and psychological dysfunction following delirium seems to be overlooked, under recognised, and misdiagnosed in the ICU. These impairments are often incorrectly attributed to other processes, such as concurrent psychoactive medication use, substance use, or psychiatric disorders, in particular depression, rather than delirium. Although it is generally accepted that providing sedation for a patient's comfort is an essential part of bedside care for nearly every patient in ICU, an increasing number of researchers hypothesise there is a strong link between sedation practice and long-term patient centred outcomes, such as quality of life (Dimopoulou et al 2004) and cognitive and psychosocial functioning. Increasing nurses' awareness of this potential link is exceptionally important, as they are instrumental in administration and observing subsequent side effects of any medication, including sedatives.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 1 - Prevention of postnatal mental health problems: A
           survey of Victorian Maternal and Child Health Nurses
    • Abstract: Wynter, Karen; Rowe, Heather; Burns, Joanna; Fisher, Jane
      Objectives: To investigate Maternal and Child Health (MCH) nurses' views on what contributes to mental health problems among new mothers, and their current practices regarding risk factors for maternal mental health problems that are potentially modifiable in primary care.

      Design: Cross-sectional, online survey.

      Setting: Universal MCH service offered free to all new parents in Victoria, Australia.

      Subjects: All MCH nurses employed in full or part-time clinical practice were invited to participate.

      Main outcome measures: MCH nurses' views on risk factors for maternal mental health problems and for unsettled infant behaviour; and their current practice regarding addressing unsettled infant behaviour and inclusion of fathers in services.

      Results: Surveys were completed by 343/1051 eligible MCH nurses (32.6%). Respondents identified social factors as major determinants of postnatal mental health problems among women, including: parents having limited knowledge about infant sleep needs and skills to manage unsettled infant behaviour; and lack of support, including from intimate partners. Respondents offered widely divergent advice to mothers about management of unsettled infant behaviour. They regarded the inclusion of fathers in routine services as valuable, but acknowledged practical barriers, including difficulties in offering services and programs outside conventional office hours.

      Conclusions: MCH nurses identified risks to maternal mental health that are potentially modifiable in primary care, but face barriers in addressing these. To facilitate more consistent advice to new parents about management of unsettled infant behaviours, evidence-based guidelines and training programs should be developed. Inclusion of men in routine services would require practical barriers to be overcome.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 33 Issue 1 - Specialist nurses' experiences of using 'The Viewer',
           a consolidated electronic medical records system: A pre-post
           implementation survey
    • Abstract: Mills, Jane; Woods, Cindy; Hitchins, Marnie; Summers, Glynda
      Objective: Evaluate changes in specialty areas nurses' knowledge and perceptions of a consolidated electronic medical record (EMR) system before and after implementation.

      Design: A survey deployed pre-and six months post-implementation of 'The Viewer'.

      Setting: Regional Hospital and Health Service, Queensland.

      Subjects: Nurses working in specialist areas including community health, palliative care, discharge planning, wound and stoma care, diabetes education and renal dialysis satellite services (n=110) were invited to participate in the study. Response rate of the pre-implementation survey (n=42, 38%) was much higher than the post-implementation subset (n=10, 24%). A major health service restructure that included losses of nursing positions in specialist areas significantly affected post-implementation results.

      Intervention: An EMR system called 'The Viewer' to access consolidated electronic medical records of patient information produced by different parts of the organisation.

      Main Outcome Measures: Changes in participants' knowledge and perceptions of 'The Viewer', and their satisfaction with the quality, ease of use and access to patient information.

      Results: Pre-implementation, specialist nurses reported dissatisfaction with most aspects of the current patient information system but high confidence and comfort in using electronic systems. Post implementation satisfaction scores either remained the same or increased. Satisfaction with ease of access to consolidated patient data (U = 125.0, p = 0.038, r = 0.29) and usefulness of electronic systems (U = 115.0, p = 0.031, r = 0.30) increased significantly post-implementation of 'The Viewer'.

      Conclusion: Specialist nurses are positive about the possibilities EMRs offer to centralise, consolidate and improve access to patient data.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 32 Issue 4 - A nurse communication manager reduces the number of
           non-relevant contacts
    • Abstract: Wright, Nana Keir; Nielsen, Nina Seested; Lauersen, Jannie; Rosenberg, Jacob; Danielsen, Anne Kjaergaard
      Objective: The aim of this study was to reduce interruptions in nursing practice by exploring the effects on the number of non-relevant contacts received by the nursing staff after implementation of a Nurse Communication Manager.

      Design: The study was designed as a pre/post interventional study. All contacts to the nursing staff, either by telephone or in person, were registered 14 days before intervention and 14 days after intervention.

      Setting: The study was set in a department of surgery.

      Subjects: The subjects were contacts either in person or by telephone aimed at nurses and nurse assistants in the surgical department.

      Interventions: During the daytime a Nurse Communication Manager handled all incoming contacts irrespective of whether they were in person or by telephone. When the Nurse Communication Manager was not available and during the evening, night and weekends, telephone contacts were managed by an electronic Call Centre guiding the call to the care teams. Main outcome measure(s): The main outcome measures were the number of non-relevant contacts aimed at the nursing staff.

      Results: Results showed a significant reduction in non-relevant contacts to the nursing staff from a mean of 80 contacts per day (SD 43) to a mean of 18 contacts per day (SD 7), p < 0.01.

      Conclusion: Implementation of a Nurse Communication Manager (NCM) reduced the number of non-relevant contacts. Reduction of non-relevant contacts is important for nurses in the clinical setting as non-relevant contacts may be perceived as interruptive. When nurses do not have to spend time responding to non-relevant contacts, they have more time to perform direct patient care.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 32 Issue 4 - Registered nurses improving screening rates for non
           AIDS related comorbidities in people living with HIV
    • Abstract: Biggs, Karen; Power, Melissa
      Objective: To establish whether a nurse-led screening and brief intervention project could improve screening rates for non-AIDS comorbidities in people living with Human Immunodeficiency Virus (HIV).

      Design: A pre-post quantitative audit was used to evaluate the intervention of nurse-led comorbidities screening.

      Setting: A publicly-funded, metropolitan, outpatient sexual health service in Western Sydney, New South Wales, Australia.

      Subjects: One hundred medical records of people living with HIV were reviewed in each of the pre and post audits.

      Interventions: A standardised co-morbidities screening tool was developed; education sessions were conducted with the registered nurses (RNs) and written and electronic resources were used as an adjunct in screening and educating clients.

      Main outcome measure: To determine if interventions, including development of a structured screening tool and education with the RNs, would improve rates of nurse-led co-morbidities screening in people with HIV attending the service.

      Results: All of the co-morbidities screening done in year two was initiated by the sexual health RNs, rather than the medical officers. Improved rates of screening were noted in 20 of the 22 audited items, with 13 of these showing a statistically significant increase in the one year time period from audit one to audit two. Potential and existing co-morbidities were identified and managed according to local protocols.

      Conclusion: RN led comorbidities screening for people with HIV can improve rates of screening in this client group. The screening tool has now become part of nurse led standardised annual care for clients with HIV.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 32 Issue 4 - Enhancing the online learning experience using virtual
           interactive classrooms
    • Abstract: Leslie, Andrew; Beverley, Ewens; Sian, Maslin-Prothero
      Objective: Enhancing online learning through the design, implementation and evaluation of a project piloting virtual interactive classrooms.

      Design: The virtual interactive classroom (classroom) design was underpinned with current best practice in higher education pedagogy. Evaluation of the project used a cross-sectional, electronic survey.

      Setting: This study was undertaken at a School of Nursing and Midwifery in a Western Australia University.

      Subjects: 144 nurse students: 130 undergraduate, 14 postgraduate.

      Interventions: Classroom options were introduced into two online units, incorporating blended learning approaches and promoting active participation in learning.

      Main outcome measures: Quantitative measures included student demographics, ease of classroom navigation, percentage participating in the classroom option in real-time and those who did so actively (questioning, discussing, etc.). Qualitative data of student learning experiences informed the findings further.

      Results: Fifty-six percent of enrolled students participated in classrooms in real-time and 9% viewed recorded sessions. The survey response rate was 56%. Non-traditional students were highly represented; with 65% of undergraduate and 100% of postgraduate students being mature-age. Seventy-one percent of undergraduate and 89% of postgraduate survey responders who participated in classrooms in real-time did so actively. The most common reason for non-participation in real-time was family and work commitments (76%). Participating students gave overwhelming positive feedback of the classroom experience, in particular around its interactive nature, blended learning approaches and user-friendliness.

      Conclusion: The classrooms supported active student participation in online learning. Students valued the interactive and blended learning features, known to be congruent with effective learning, student satisfaction and retention.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 32 Issue 4 - Doctoral theses in nursing and midwifery: Challenging
           their contribution to nursing scholarship and the profession
    • Abstract: Wilkes, Lesley; Cummings, Joanne; Ratanapongleka, Mayryl; Carter, Bernie
      Objective: To determine the impact and outputs of research conducted as part of doctoral studies in nursing.

      Design: An online survey was conducted with 27 nursing doctoral graduates from United Kingdom and Australia who had graduated between 2001 and 2012. Textual and numerical data were collected and sorted on outcomes of research for management, education, practice and workforce. Numerical data were collected from journal article outputs regarding impact factors and citation rates; as well as demographic information on graduates. Frequencies were tallied, percentages calculated for both textual and numerical data and tables and figures formulated.

      Setting: University and health sector.

      Subjects: Doctoral nursing graduates who graduated between 2001 and 2012 from universities in Australia and the United Kingdom were recruited to complete the online survey.

      Main outcome measure: The outcomes and outputs of doctoral research are usually implied in the theses but assessment of these is often not apparent in the literature or clinical area. There is little evidence to demonstrate whether or not the nursing profession is influenced by the outcomes of and outputs from nurses' doctoral studies.

      Results: The top three topic areas covered by their theses were paediatrics, acute care and the role of nurses in practice. The key outputs from the 21 doctoral studies were 86 publications. Articles from the individual theses had verified citations ranging from 0 to 75. Outcomes from the research were evident in contributions to policy development, models of care, workplace issues at universities, and nursing curricula.

      Conclusion: The study shows the need for nursing research at the doctoral level should be directed towards professional needs which ultimately impact on patient care.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 32 Issue 4 - Advanced skills for enrolled nurses: A developing
           classification
    • Abstract: Cusack, Lynette; Smith, Morgan; Cummins, Bernadette; Kennewell, Louise; Dennett, Lydia; Pratt, Debra
      Objective: This paper is a report of a literature review designed to identify strategies central to the implementation of the industrial classification of enrolled nurses (second level nurse) with advanced skills within Australia.

      Setting: Australian healthcare and aged care organisations that employ enrolled nurses.

      Primary Argument: Designing a clearly defined enrolled nurse with advanced skills role within an industrial classification, requires incorporation of advanced competencies, scope of practice articulation and specifically targeted organisational policies and procedures. These three areas are fundamental to successful role implementation.

      Conclusion: There is limited discussion in the literature on strategies to ensure effective implementation of the enrolled nurse with advanced skills role. In addition minimal research has been reported on the effectiveness of these roles in enhancing patient care and increasing workforce flexibility and efficiency. Further research and evaluation of the enrolled nurse with advanced skills is urgently required.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 32 Issue 3 - Public health nurses' (PHNs) experiences of their role
           as part of a primary care team (PCT) in Ireland
    • Abstract: Giltenane, Martina; Kelly, Marcella; Dowling, Maura
      Objective: This study aimed to understand public health nurses' (PHNs) views and experiences of their role as part of a primary care team (PCT) and developments within primary care.

      Design: The study adopted a qualitative design guided by interpretative phenomenological analysis (IPA).

      Participants: Ten PHNs who were working as part of a PCT for at least two years and who also had PHN experience prior to PCT development were interviewed.

      Findings: Three super-ordinate themes representing the study participants' lived experience and meanings of PCT involvement were interpreted. 'We are a team' represents mostly positive experiences of being part of a team such as improved communication and teamwork. However, GP non-attendance at PCT meetings was also highlighted by all the PHNs. 'Pushed to the limit' revealed the PHNs' frustrations attributed to lack of resources. In addition, this theme represented PHNs' views of always having to 'take up the slack' within the team. Finally, 'PHN's role' revealed that the health promotion aspect of the PHNs' job was perceived to have been 'pushed aside', and mixed feelings around PHNs' future role were relayed.

      Conclusion: The findings contribute to the knowledge of PHNs' roles as part of PCT developments and highlight the need for more dialogue among PCTs on all roles within the team. It is clear that more resources for PHNs in Ireland are needed if they are to fulfil a vision of primary care. In addition, the study findings point to a need to investigate whether policy and practice changes introduced with the introduction of PCTs has improved patient outcomes.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 32 Issue 3 - A nurses' guide to qualitative research
    • Abstract: Ingham-Broomfield, Rebecca
      Objective: This article provides a breakdown of the components of qualitative research methodology. Its intention is to simplify the terminology and process of qualitative research to enable novice readers of research to better understand the concepts involved (Benner 1984).

      Primary Argument: Current Competency Standards for Australian Registered Nurses and Midwives include a requirement to evaluate and implement research as part of their care (Borbasi and Jackson 2012, p.22; Nursing and Midwifery Board of Australia 2012). They are also expected to be actively involved in research studies (Borbasi and Jackson 2012, p.22). Evidence, when available, can enhance clinical judgement (Hamer and Collinson 2014, p.9). As evidence and research are threaded through professional work and study in the health sciences (Wright-St Clair et al 2014, p.5) nurses, particularly novice nurses, may benefit from a discussion that helps them understand the sequence of a research paper (Moxham 2012) using qualitative methodology.

      Conclusion: A systematic and logical approach will be used to discuss the content of a typical qualitative research paper. A comparative grid at the end of this paper comparing the qualitative research designs, may lead the nurse to better understand the differing components of several qualitative research methods (Ingham-Broomfield 2014).

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 32 Issue 3 - Radiation awareness among nurses in nuclear medicine
           departments
    • Abstract: Alotaibi, Muhammad; Al-Abdulsalam, Amal; Bakir, Yousif Y; Mohammed, Ahmed M
      Objective: The aim of this study is to explore the awareness level of radiation risks among nurses working in nuclear medicine departments (NMDs).

      Design: A cross-sectional survey was used. Data were collected between February and March 2011.The data were collected using a self-administered, structured questionnaires. One open-ended question was added at the end of the questionnaire.

      Setting: The study was conducted in NMDs representing five Kuwaiti governmental general and specialised hospitals and centres.

      Subjects: This study comprised twenty one non-Kuwaiti female nurses who worked in NMDs.

      Results: Nearly all of the nurses did not attend any radiation protection courses, they were not aware of the ALARA principle and they were not familiar with Geiger-Mueller counter. Most of these nurses were not able to read the dosimetry reports and they were not familiar with the terms RSO, RSC, and the 10 day rule concept.

      Conclusion: Nearly all nurses working in NMDs in Kuwait are not aware of radiation protection and risks. This lack of awareness has serious implications on both patients and nurses. Courses on radiation risks and protection should be provided to nurses during and after their formal nursing education.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 32 Issue 3 - Patient satisfaction with their pain management and
           comfort level after open heart surgery
    • Abstract: Karabulut, Neziha; Aktas, Yesim Yaman; Gurcayır, Dilek; Yılmaz, Durdane; Gokmen, Volkan
      Objective: The aim of this study is to determine patient satisfaction with pain management and comfort levels after undergoing open heart surgery.

      Design: This descriptive study was performed between January 31 and April 29, 2011.

      Setting: The study was conducted in the cardiovascular surgery clinic of Region Training-Research hospital in Erzurum, Turkey.

      Subjects: Fifty two patients (32 males, 20 females; mean age 58.4 years; range 25 to 77 years) who had undergone open heart surgery were included in the study.

      Main outcome measure(s): The patient data was collected using Personal Information Form, Pain Satisfaction Surveys and General Comfort Scales at the time of discharge. The Pain Satisfaction Survey is a survey tool which was developed by the 'American Pain Society' in 1991. The General Comfort Scale was developed by Kolcaba in 1992 and its validity and reliability in a Turkish setting was tested by Kuğuoğlu and Karabacak in 2004.

      Results: In this study, 61.5% of the patients underwent coronary artery bypass graft surgery, 30.7% aorta and/or mitral valve replacement and 7.7% aneurysm repair. The mean scores of pain intensity immediately after surgery, at first post-operative ambulation, at 24 hours before discharge and at discharge were 7.07+2.6, 6.71+2.7, 6.32+2.4 and 4.57+2.3, respectively. Most subjects (88.5%) reported a wait time of 15 min as the longest time they had to wait for pain medication and patient satisfaction with pain management was found to be high. The mean score of comfort level at discharge was 3.16+0.2 and there was no statistically significant difference between the comfort level and pain rating at discharge (r=-0.225, p>0.05).

      Conclusion: It was found that pain intensity gradually decreased as patients neared hospital discharge and their overall satisfaction with the nurses' pain management was high.

      PubDate: Thu, 22 Aug 2019 08:48:00 GMT
       
  • Volume 36 Issue 4 - Evaluating the efficacy and impact of the nursing and
           midwifery exchange program: A study protocol
    • Abstract: Byrne, Amy-Louise; Harvey, Clare; Baldwin, Adele; Heritage, Brody; Chamberlain, Diane; Wood, Elspeth
      Objective: The following research protocol evaluates the Queensland Health Nursing and Midwifery Exchange Program (NMEP) and evaluates how exposure to diverse clinical settings, may impact the nursing and midwifery workforce on individual and organisational levels.

      Design: This protocol details a mixed methodology allowing for both quantitative and qualitative data. The study is being undertaken in three stages; a survey of the participating nurses and midwives; a systematic review; and a Delphi study with an expert review group.

      Setting: The study is a Queensland wide study across rural/remote, regional and metropolitan locations.

      Subjects: This study will follow approximately 70 nurses and midwives employed by Queensland Health from diverse areas and streams at various stages within their clinical career.

      Interventions: Nurses and Midwives participate in a three or six-month professional exchange to a rural/remote or metropolitan location.

      Main outcome measure(s): This study will evaluate the impact and sustainability of the NMEP program through measurement of burnout, job embeddedness, job strain, job satisfaction and attrition through a series of surveys. In addition to this, a systematic review and Delphi with executive experts will be conducted to consider a future pathway/model for nursing and midwifery exchange.

      Results: This study has commenced and will be completed September of 2019.

      Conclusion: The NMEP program is one novel approach to nursing and midwifery workforce concerns and looks to present excellent opportunities for the crossover of skills and ideas related to clinical, professional and service integration between metropolitan and rural practice.

      PubDate: Thu, 18 Jul 2019 18:54:49 GMT
       
  • Volume 36 Issue 4 - Workplace environment for nurses and healthcare
           assistants in residential aged care facilities in New Zealand
    • Abstract: Kussmaul, Joerg; Peri, Kathy; Boyd, Michal
      Objective: Continuous work under environmental and thermal discomfort such as cold, heat, and dim light has the potential to affect the health of nurses and healthcare assistants working in Residential Aged Care Facilities (RACF). The resulting health issues to workers from exposure to thermal discomfort include fatigue, concentration difficulty and work-related diseases such as cold and muscle tensions. Consequently, this often leads to higher labour absenteeism due to sick-leave which in turn correlates to poor nursing care quality for residents. This research investigated environmental factors which are temperature, humidity, noise, and lighting in nurse offices and resident lounges in RACFs in New Zealand and compared them with international standards.

      Design: Quantitative study approach.

      Setting: Seventeen Residential Aged Care Facilities (RACF) participated in this study, which were categorised in stand-alone (S-RACF), chain (C-RACF), and religious and charitable (RC-RACF) providers. The environmental measurements were conducted for 24 hours in the nurse offices and 12 hours in resident lounges.

      Results: The findings demonstrated that the environmental factors, noise and humidity level met international standards predominately, but temperature and lighting levels failed to comply in nursing offices and resident lounges in RACF.

      Conclusion: These findings indicate that nurses and healthcare assistants are working in environmental conditions that partially impedes the health and safety of nursing staff, and could affect their nursing care performance adversely for residents in RACF.

      PubDate: Thu, 18 Jul 2019 18:54:49 GMT
       
  • Volume 36 Issue 4 - Exploring life history methodology in chronic illness:
           A study in relapsing remitting multiple sclerosis
    • Abstract: Burke, Therese; Patching, Joanna
      Objective: The aim of this study was to gain insights into the lived experience of a chronic disease, Relapsing Remitting Multiple Sclerosis (RRMS). Selecting the most effective methodology to reflect the life span proved challenging. However, the life history approach proved to be a data-rich methodology for this study and is explored in detail in this paper as a qualitative nursing tool.

      Setting: This study recruited participants through a state based Multiple Sclerosis organisation in the community.

      Subjects: Thirteen participants living with RRMS were purposively recruited, ten female and three male, to discuss their lived experience. Participants were from diverse backgrounds and were at various stages of disease progression.

      Primary argument: Ethnography and life history is an under-utilised methodology in nursing research. However, the life history approach was used effectively to collect data to explore the life trajectory of living with a chronic illness. Semi-structured interviews and Braun and Clarke's (2006) method of thematic data analysis ensured a systematic, robust exploration of the lived experience of RRMS. The study developed eight key themes and over 70 subthemes, providing clarity into the experience of living with RRMS.

      Conclusion: Employing the life history approach to living with RRMS reflected the ebbs and flows of life, themes intertwining and changing positions of importance according to life events, whether directly or indirectly related to RRMS. Life history proved to be an effective method to gain a greater understanding of chronic illness and although often overlooked in nursing research, may represent an excellent methodology choice for nurse researchers working in other areas of chronic illness.

      PubDate: Thu, 18 Jul 2019 18:54:49 GMT
       
  • Volume 36 Issue 4 - Side effects of chemotherapy in children with cancer:
           Effects of nursing training administered to caregivers
    • Abstract: Uzun, Zeynep; Kucuk, Sibel
      Objective: The present study aimed to assess the consequences of providing nursing training to caregivers of children with cancer on the side effects associated with chemotherapy.

      Design: The present study used a pre-test-post-test experimental design.

      Setting: The study was conducted in a paediatric hematological oncology hospital in Ankara, Turkey

      Subjects: This study was conducted with 40 caregivers responsible for looking after child patients, all of which had been recently diagnosed with cancer, but who had not started chemotherapy.

      Primary argument: The knowledge scores of the caregivers on issues related to infection and bleeding risk, nutrition and oral care and total scores were significantly higher than their pre-test scores before undergoing training (p
      PubDate: Thu, 18 Jul 2019 18:54:49 GMT
       
  • Volume 36 Issue 4 - Pressure injury point prevalence: State-wide survey to
           identify variability in western Australian hospitals
    • Abstract: Ferguson, Chantal; Crouchley, Kathryn; Mason, Louise; Prentice, Jenny; Ling, Amanda
      Objective: A point prevalence survey was conducted across Western Australia to monitor adherence to national safety and quality health service standards, and to create baseline data on which to improve. The study identified significant areas for targeted interventions.

      Design: A state-wide point prevalence survey of patients and their medical records.

      Setting: Public hospitals in Western Australia (WA).

      Subjects: Data was collected from 2,281 inpatients.

      Main outcome measure(s): The aim of the study was to determine pressure injury prevalence and characteristics, adherence to guidelines, significant related factors and their attributable burdens.

      Results: 8.7% of patients had pressure injuries. 6.3% were hospital-acquired (HAPIs). Over 1,000 HAPIs per year were attributed to being older, a long-term patient, having acute renal failure or volume depletion. 65% of patients had a skin inspection; less likely in birthing mothers and long-term patients. 70% of patients were screened with a risk assessment tool. 36% of patients were identified as at risk of a pressure injury; and of these, 71% had prevention plans in place. One third of all adults with HAPIs were not identified as at risk using current practices.

      Conclusion: The prevalence and characteristics of pressure injuries and HAPIs was comparable with prior state-wide results. The survey identified variations in rates of: skin inspections, using risk assessment tools; and applying plans for those at risk of pressure injuries. Multivariable logistic regression identified areas for improvement: the main groups at risk of pressure injuries; and patient groups with lower rates of skin inspections and screening.

      PubDate: Thu, 18 Jul 2019 18:54:49 GMT
       
  • Volume 36 Issue 3 - Bioelectrical impedance analysis as a marker of
           nutritional status in chronically ill patients
    • Abstract: Krel, Cvetka; Piko, Nejc; Tomazic, Jozica; Bevc, Sebastjan
      Objective: The aim of the study was to evaluate different methods of nutritional status analysis like basic anthropometric data, laboratory data and bioelectrical impedance analysis (BIA) with phase angle (PA) in patients with chronic diseases.

      Setting: Clinic for Internal Medicine, Department of Nephrology, University Clinical Centre Maribor, a tertiary referral centre in Slovenia, Europe.

      Subjects: Patients with chronic disease and increased nutritional risk (>=1 fulfilled NRS 2002 criterion) at the time of inclusion in the study.

      Results: Patients had chronic kidney disease (93%), arterial hypertension (80%), active infection (33.3%), heart failure (23.3%), diabetes mellitus (20%), active malignancy (10%), autoimmune disease (6.6%), history of stroke (6.6%), chronic obstructive pulmonary disease (3.3%) and/or liver cirrhosis (3.3%). Mean serum albumin was 33.6+-5.7 g/L, mean BMI 25.6+-4.4 kg/m2 and mean PA 4.4+-1.2 degrees. No correlation between serum albumin and BMI was found. Lower PA was associated with lower serum albumin (p=0.045) and advanced age (p=0.043). The department nurses conducted nutritional education for all patients included in the study. Study was performed in accordance with the Strengthening the reporting of observational studies in epidemiology.

      Conclusion: Results of the study show the importance of nutritional risk assessment in all chronically ill patients. BIA is a promising method of determining nutritional status. PA values have important diagnostic, therapeutic and prognostic implications as they are a marker of body cell mass, membrane function and metabolic health. A multifaceted approach to assess malnutrition in patients with chronic diseases is important, followed by a prompt nutritional intervention.

      PubDate: Thu, 18 Apr 2019 20:21:19 GMT
       
  • Volume 36 Issue 3 - The art of clinical supervision: Strategies to assist
           with the delivery of student feedback
    • Abstract: Russell, Kylie
      Objective: The Art of Clinical Supervision (ACS) seminar was developed to provide health professionals with the essential knowledge, skill and attitude to support student clinical learning. This paper provides an outline of the strategies provided to participants to support the delivery of feedback to students on clinical placement.

      Setting: Western Australian health services.

      Primary argument: The provision of timely and descriptive feedback to students on clinical placement is essential for learning and achievement of competence. Health professionals working with students in the delivery of patient care, termed clinical supervisors, require effective strategies to support this communication technique.

      Conclusion: ACS participant feedback supports the use of both strategies to formulate the delivery of feedback. This ensures that the student and supervising health professional have discussed the required learning needs, strategies for learning and evaluation.

      PubDate: Thu, 18 Apr 2019 20:21:19 GMT
       
  • Volume 36 Issue 3 - Quality control circle improves self-monitoring of
           blood glucose in type 2 diabetic patients
    • Abstract: Wu, Jun; Su, Xiaoyou; Lian, Hong; Lin, Aijuan; Wei, Huiyan; Hu, Jibo
      Objective: To determine the effect of quality control circle (QCC) activity on self-monitoring of blood glucose (SMBG) in type 2 diabetic patients.

      Design: Pre-test Post-test study.

      Setting: Outpatient clinic of a tertiary hospital in Eastern China.

      Subjects: A total of 110 insulin-treated type 2 diabetic patients.

      Interventions: Quality control circle.

      Main outcome measures: Quality of self-monitoring of blood glucose and blood glucose control in patients.

      Results: At the end of QCC activity, the proportion of patients performingregular SMBG and the frequency of SMBG were significantly increased. The incidence of using expired test strips, incorrect timing of blood glucose monitoring, improper operation and non-calibration of meters were all significantly decreased. Consequently, the levels of glycosylated hemoglobin,one-week fasting blood glucose, and one-month incidence of hypoglycemia were significantly decreased in these patients.

      Conclusion: The QCC activity plays an active and beneficial role in improving SMBG and blood glucose control in patients with diabetes. This activity should be promoted in future clinical work.

      PubDate: Thu, 18 Apr 2019 20:21:19 GMT
       
  • Volume 36 Issue 3 - Fast-track rehabilitation and nursing care in
           post-anesthesia care unit on orthopedic patients
    • Abstract: Zou, Xiulan; Cong, Ling; Yu, Zhiping; Wang, Junru
      Objective: To assess the efficacy and outcome of fast-track rehabilitation (FTR) for orthopedic surgery patients.

      Design: Randomised trial.

      Setting: primary care.

      Subjects and Methods: Two hundred and twenty patients undergoing orthopedic surgery under general anesthesia between November 2015 to March 2017 were randomly divided into traditional care (control, n=110) and fast-track rehabilitation (FTR, n=110) groups. Patients in the control group were given regular and routine care, while those in FTR group were cared for with multimodal rehabilitation. Demographic and data, postoperative hospital stays, surgical and general complications were assessed.

      Results: One hour postoperative body temperature was higher in FTR group than in the control, and the incidence of restlessness, pain and 24 hour postoperative nausea and vomiting were significantly lower (P < 0.05, P < 0.01). The hospital stays were shorter following the FTR, but the difference was not statistically significant as compared with the control.

      Conclusion: FTR can effectively reduce the complications and promote the recovery of the orthopedic patient.

      PubDate: Thu, 18 Apr 2019 20:21:19 GMT
       
  • Volume 36 Issue 3 - Validity and reliability of the teamwork evaluation of
           non-technical skills tool
    • Abstract: Lin, Wei-Ting; Mayer, Celeste; Lee, Bih-O
      Background: TENTS (Teamwork Evaluation of Non-Technical Skills) is a valuable team performance, 13 item observational assessment tool that has been used in clinical settings, but validity and reliability have not been tested.

      Objective: This study conducted validity and reliability tests on the TENTS observation tool.

      Method: This study used a convenience sample of 109 teamwork event observations conducted in an academic medical center in the United States of America (USA). Five different events were observed; new admissions, transfers to and from other units, rapid response team events, morning rounds, and medical procedures. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted and the Cronbach's alpha coefficients of the inventory were obtained.

      Result: The EFA results indicated the TENTS tool consisted of three factors; communication, leadership, and crossmonitoring. These three factors accounted for 46.30% of the total variance and their internal consistencies (Cronbach's alpha) were .71-.79 (.88 overall).

      Conclusion: TENTS is a valid and reliable instrument for observing a variety of clinical teamwork events. EFA and CFA demonstrated that the tool is well-aligned with long-standing essential teamwork components described in the literature and in the TeamSTEPPS system.

      PubDate: Thu, 18 Apr 2019 20:21:19 GMT
       
  • Volume 36 Issue 2 - Exploring the experiences of internationally and
           locally qualified nurses working in a culturally diverse environment
    • Abstract: O'Callaghan, Cathy; Loukas, Patty; Brady, Michelle; Perry, Astrid
      Objective: This article explores the support needs, attitudes and experiences of both internationally and locally qualified nurses working within a culturally diverse environment.

      Design: Open and closed survey questions.

      Setting: Hospital in Sydney, Australia.

      Subjects: 108 nurses were surveyed, representing 14% of the nursing staff at the hospital.

      Main outcome measure(s): The research project measured the experiences encountered by internationally qualified nurses (IQNs) in relation to language use, discrimination, culture and differing health systems. It provided a forum to discuss how their cultural background, professional background and linguistic skills affect interactions with patients and other staff. It also explored suggestions for improvement in cross-cultural relations between staff, and support for IQNs and their peers in a diverse staff environment.

      Results: Although IQNs feel they are adjusting well to their role, locally qualified nurses largely disagree. Staff were aware of discrimination from patients towards staff, and from other staff towards staff. The research revealed that IQNs are unsure when to use their language skills, have different approaches to nursing and expectations of the staff-patient/family relationship.

      Conclusion: Adjustment to the Australian healthcare system for IQNs is challenging. There are a number of strategies that can support both IQNs in their integration, as well as all nurses to work more effectively together in a cross-cultural work environment.

      PubDate: Wed, 23 Jan 2019 10:09:18 GMT
       
  • Volume 36 Issue 2 - Emergency management of patients with Supratherapeutic
           INRs on Warfarin: A multidisciplinary education study
    • Abstract: Safatly, Inaam; Singleton, Hugh; Decker, Kelly; Roman, Cristina; Bystrzycki, Adam; Mitra, Biswadev
      Objective: Supratherapeutic INRs exceeding 4.5 are associated with increased risk of haemorrhage. The aim of this study was to evaluate the efficacy of an educational program focused at improving emergency clinician compliance with the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ) guidelines.

      Design: A pre and post-intervention study was undertaken. Retrospective data from 1 July 2014 to 30 June 2015 and prospective data 1 January 2016 to 31 December 2016 were collected.

      Setting: This study was conducted in a large tertiary care hospital in Melbourne, Victoria, Australia.

      Subjects: Included were all consecutive patients in the study periods that presented to the emergency department with an initial INR result of > 4.5 on warfarin only.

      Interventions: Development and delivery of an educational program in accordance with the current THANZ guidelines was implemented.

      Main outcome measures: To improve education regarding the correct management of emergency patients on warfarin with a supratherapeutic INR.

      Results: Data on 158 patients with an INR > 4.5 were collected. Data on 46 patients were excluded. Management in 31 patients did not follow recommended guidelines. There was no difference detected between groups with 17 compliant with guidelines pre-intervention and 14 post intervention; p=0.87.

      Conclusion: Emergency department management of patients on warfarin with supratherapeutic INR's requires continual quality improvement. Frequency of emergency clinician compliance with the current evidence-based guidelines was moderate and did not improve significantly with targeted education. This highlights the complexities of warfarin management and the need for multi-disciplinary engagement of patients presenting with supratherapeutic INRs.

      PubDate: Wed, 23 Jan 2019 10:06:33 GMT
       
  • Volume 36 Issue 2 - Perceived barriers and enablers to conducting nursing
           assessments in residential aged care facilities in Victoria, Australia
    • Abstract: Bauer, Michael; Fetherstonhaugh, Deirdre; Winbolt, Margaret
      Objective: Nurses working in aged care facilities need to be adequately prepared to manage the increasingly complex care needs of older people. This paper reports on the views of nurses on the barriers and enablers to conducting nursing assessments with older people in residential aged care, six weeks after attending a four day education and training workshop on this topic.

      Design: Descriptive evaluation.

      Setting: Data were collected in a range of venues in which the education was delivered.

      Subjects: Registered (RNs) and enrolled (ENs) nurses (n= 345) working in residential aged care facilities in Victoria, Australia.

      Findings: Fourteen barriers and eight enablers, which affect the capacity of nurses to conduct assessments with older people, were identified. The most common cited barriers included lack of time (78%), residents' poor state of health (41%) and the absence of equipment (33%). Common enablers were organisational support (38%); staff education and training (29%); having the appropriate equipment (22%); positive staff attitudes (17%) and the resident's condition and cooperation (16%).

      Conclusion: Nursing assessments are vital to the delivery of quality and evidence based aged care. The issues identified provide aged care services and managers with a basis for ensuring that nurses have the necessary preparation, training and ongoing support to perform the appropriate and required assessments to provide the best possible care.

      PubDate: Mon, 21 Jan 2019 16:14:10 GMT
       
  • Volume 36 Issue 2 - Analysis of interviews to uncover the effects of nurse
           prescribing on the doctor-nurse relationship
    • Abstract: Pritchard, Michael
      Objective: The introduction of nurse prescribing has had a profound effect on how patients obtain a prescription. Yet very little has been researched about the effects of nurse prescribing on the professional relationship between nurses and doctors since its introduction. It was this lack of enquiry that led to this research study to see if this relationship has changed since the introduction of the nurse prescriber.

      Design methods: A purposeful sample approach was chosen, interviews were undertaken using a semi-structured method and interpretative phenomenological analysis was used to analyse the data.

      Setting: A large teaching hospital in the north west of England.

      Subjects: Four nurse prescribers and four doctors working in orthopaedics, breast surgery or urology looking after adult elective surgery patients.

      Main outcomes: What emerged from this study is a complex pattern of readjustment within this relationship. The power once enjoyed by the medical profession is now challenged by the introduction of the nurse prescriber. A number of themes emerged around the topics of prescribing, relationship, educational and communication. Each help to focus how this change manifests itself in the relationship and how it needs to evolve if the maximum benefit from nurse prescribing is to be achieved.

      Conclusions: What has emerged from this research is how complex the relationship between the nurse prescriber and doctor really is. The power to prescribe medication that was once the sole preserve of the medical profession is now shared with the nurse prescriber. But this shared authority remains unequal; the medical profession remains at least unwilling to give up its position of control just yet, but the dialogue has begun.

      PubDate: Mon, 21 Jan 2019 16:14:10 GMT
       
 
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