ORCID Profile
0000-0002-2376-3989
Current Organisation
Deakin University
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Nursing | Clinical Pharmacology and Therapeutics | Anaesthesiology | Clinical Nursing: Secondary (Acute Care)
Publisher: Wiley
Date: 27-06-2023
DOI: 10.1111/JAN.15763
Abstract: To analyse the compliments received from patients' and companions and to describe the characteristics of high‐quality nursing and midwifery care from the perspective of healthcare consumers. Retrospective analysis of health service compliments data. All compliments specific to nursing and midwifery care received between July 2020 and June 2021 were extracted from the reporting database for six hospital sites of a large public health service in Victoria, Australia. Inductive coding captured the characteristics and qualities of nurses and midwives elicited from the compliments. Deductive coding used two frameworks: an adapted health complaints assessment tool, and 10 dimensions of nursing and midwifery care used in the health service. Descriptive statistics were used for analysis of coded data. Of the 2833 records identified, 433 nursing and midwifery‐specific compliments were identified of these 225 consumer or care partner compliments were identified for analysis. Most compliments (80.4%, n = 181) were from the smaller hospital sites compared to 19.6% ( n = 44) received at the largest hospital site and from care programmes that typically care for older patients (42.7%, n = 113). Only 39% ( n = 89) of compliments related to quality and safety of clinical care, 9% ( n = 21) related to management and 17% ( n = 38) to relationships. Forty‐nine percent ( n = 113) related to dimensions of fundamental nursing and midwifery care, with psychological care best represented (39.8%, n = 89). Most often, compliments related to characteristics or attributes of nurses. Analysis of compliments reveals characteristics of nursing and midwifery care valued by healthcare consumers. Surprisingly, few compliments related to clinical dimensions of nursing and midwifery practice. Comments related to psychological aspects of nursing and midwifery care were most common. Understanding consumer perceptions of high‐quality care provided by nurses and midwives provide guidance about care delivery that meets or exceed consumer expectations. The findings suggest low consumer awareness about professional and clinical aspects of nursing and midwifery work. Compliments provide a unique insight into consumer perspectives of high‐quality nursing and midwifery care. When making compliments, consumers most often commented about the attributes and characteristics of nurses and midwives, rather than clinical aspects of care. Compliments specific to nursing and midwifery care provide guidance to enhance care delivery to meet or exceed consumer expectations. No patient or public contribution.
Publisher: Wiley
Date: 09-05-2019
DOI: 10.1111/JOCN.14857
Abstract: To examine underlying factor structure of the Critical Care Family Needs Inventory-Emergency Department across three countries to identify similarities and differences. Understanding family needs assists nurses to provide family-centred care to deliver optimal outcomes for critically ill patients and their families in Emergency Departments. Retrospective secondary analyses of data collected in three cross-sectional surveys. Convenience s les involved recruitment of family members accompanying a critically ill relative into four Emergency Departments in Australia (2), South Africa (1) and Taiwan (1). Item-matched raw data from 374 responses to 40 items from the surveys were collated and analysed using confirmatory factor analysis methods. Reporting adhered to an adapted STROBE checklist. The factor structure of the 40-item Critical Care Family Needs Inventory-Emergency Department differed between countries. Analyses of the Australian data revealed a four-factor solution comprised of 18 items across four categories of family need (support, communication, participation and comfort) the Taiwanese data also demonstrated a four-factor solution comprised of 13 items (support, communication, participation and comfort) alternatively, the South African data revealed a two-factor solution comprised of nine items (communication and participation). Fifteen items did not match across the countries. However, loading for four items common across all three countries was related to family participation (3) and communication (1). The findings suggest family members from different countries responded to Critical Care Family Needs Inventory-Emergency Department items in different ways. Consistent with concepts of family-centred care, the study identified participation and communication needs that were common across the countries. The outcomes illustrate the challenge of providing appropriate care for family members during critical illness of a relative in the ED. Family perceptions of important needs during critical illness in the Emergency Department differ across countries hence, the Critical Care Family Needs Inventory-Emergency Department has limited utility. Participation and communication needs emerged as common family needs.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH18231
Abstract: The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P& .05) and increased mean time spent at the bedside (from 21 to 28min h−1 P& .0001) reductions in patient-reported missed care and nurses’ walking distances were not significant. Qualitative themes included: (1) inconsistent expectations (perceptions about potential vs actual functionality and benefits of the technology) (2) decisional conflict between managers and end-user nurses (discordance between governance decisions and clinical operations 30% of beds were closed and six of the eight trained nurse ‘super-users’ were moved from the pilot ward) and (3) workflow effects (ergonomic set-up of the digital interface). This study highlights the complex challenges of implementing and examining the effects of technology to support nursing care. Shared understanding of the technology goals and project scope in relation to nursing care and flexible and adaptive project and contingency planning are fundamental considerations. Complexity, unpredictability and uncertainty of ‘usual business’ are common confounders in acute hospital settings. What is known about the topic?Although much has been written about the implementation of electronic records into hospital systems, there is little research evaluating the effect of information technology systems that support the complex clinical decision making and documentation required to meet nurse and patient needs at the point of care. What does this paper add?This study highlights the potential to reduce missed care through better nursing workflow. Contributing factors to low nurse adoption of new technology have been identified, including inconsistent expectations and goals for the design of systems to support quality nursing care, incongruous decision making in design, adaptation and implementation processes and constrained physical workability in relation to nursing workflow. What are the implications for practitioners?The design of information systems to support nursing work requires a shared understanding of ‘good practice’ for high-quality nursing care that is consistent with theories of nursing practice, best evidence and professional practice standards. Recognition of effective and ineffective sociotechnical interactions that occur during complex nursing processes can help avoid ‘disruption without benefit’ and ‘ lification of errors already in the system’ during acute care technology implementation. Ongoing dynamic input from in iduals and groups with different expertise and perspectives, as well as iterative, generative processes for moving towards a shared goal, are critical for effective and efficient implementation.
Publisher: Wiley
Date: 06-09-2019
DOI: 10.1111/JOCN.14650
Abstract: To test the mnemonic Have you SCAND MMe Please? as a framework to audit nursing care to prevent harms common to older inpatients. It is not known if acute hospital care comprehensively addresses eight interrelated factors that contribute to preventable harms common in older hospitalised patients. Retrospective audit of medical records. A random selection of 400 medical records of inpatients over 65 years of age with an unplanned admission of longer than 72 hr in acute medical wards at four hospitals in Victoria, Australia, during 2011-12, was examined for frequency of documented evidence of assessments, interventions or new problems related to eight factors contributing to common preventable harms during hospitalisation. Assessments of skin integrity (94%-97%), mobility (95%-98%) and pain (93%-97%) were most often documented. Gaps in assessment of continence (4%-31%), nutrition (9%-49%), cognition (delirium, depression and dementia) (10%-24%) were most common. No patient record had evidence of all eight factors being assessed. Almost 80% of records had interventions documented for one or more factors that contribute to preventable harms. In almost 20% of patient records, a new preventable harm was documented during hospitalisation. The mnemonic Have you SCAND MMe Please? brings together eight factors known to contribute to preventable harms common in older hospitalised patients. This framework was useful to identify gaps in assessment and interventions for factors that contribute to preventable harms during acute hospital care. Future research should test if the mnemonic can assist nurses with comprehensive harm prevention during acute hospitalisation. The mnemonic Have you SCAND MMe Please? represents eight factors that contribute to preventable harms common in older hospitalised patients. This framework provides a model for harm prevention to assist nurses to implement comprehensive harm prevention to improve quality of care and safety for older hospitalised patients.
Publisher: Wiley
Date: 18-12-2023
DOI: 10.1111/NIN.12545
Abstract: This article explores staff work patterns in an Australian residential aged care facility and the implications for high‐quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min) multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to explore the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector.
Publisher: Wiley
Date: 05-01-2023
DOI: 10.1111/JOCN.16598
Abstract: The aim of this systematic review was to examine the methodological quality of dignity‐related patient reported outcome measures (PROMs) used to measure patients' dignity during acute hospitalisation using the Consensus‐based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic review of PROMs. Previous scoping review studies on the methodological quality of dignity‐related PROMs lack specificity for dignity during acute hospital admission. They included PROMs that were developed to measure constructs of care other than patient dignity or designed to measure dignity in contexts outside of the acute hospital setting. A systematic review based on COSMIN methodology. A systematic search was undertaken using five databases (CINAHL Complete, Medline Complete, EMBASE, PsycINFo and AgeLine) for articles published between 2000 and 2022. Relevant papers were identified using strict adherence to eligibility criteria, and studies that included development of dignity‐related PROMs for use in acute hospital settings were selected. Two reviewers independently screened the identified papers, extracted data and examined the quality of studies. Six papers met the inclusion criteria. Two PROMs, the 25‐item Patient Dignity Inventory and the 34‐item Inpatient Dignity Scale, met the COSMIN quality criteria because of their sufficient quality of evidence for content validity and reliable internal consistency. None of the PROMs met the quality criteria for assessment of measurement error, criterion validity, cross‐cultural validity and responsiveness. We recommend the Patient Dignity Inventory and the Inpatient Dignity Scale as the PROMs of choice for evaluating patients' dignity and/or dignified care during acute hospital admissions. These PROMs were developed using robust procedures with sufficient overall quality for content validity, internal consistency reliability and other measurement properties, and with moderate to high quality of evidence for these measurement properties. Researchers and clinicians who wish to use other dignity‐related PROMs identified in this review should consider the methodological limitations of these PROMs, as highlighted in the present systematic review. The review findings will guide healthcare professionals about their choice of patient reported outcome measures for evaluating patients' dignity or dignified care during acute hospitalisation.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.AUCC.2018.09.004
Abstract: The objective of this review was to identify evidence to inform clinical practice guidelines for magnesium sulphate (MgSO Three databases were systematically searched: CINAHL Complete, MEDLINE Complete, and EmBase. A systematic literature review method was used to locate, appraise, and synthesise available evidence for each step of the medication management cycle (indication, prescription, preparation, administration, and monitoring) for MgSO Twenty-four included studies reported varying methodologies, data collected, and medication management practices. Of these, 23 studies (95.8%) excluded patients with comorbidities commonly observed in clinical practice. This review identified low-level evidence for two practice recommendations: (i) concurrent administration of MgSO Although MgSO
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.JPAIN.2015.03.016
Abstract: This study investigated the cross-cultural factor stability and internal consistency of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R), a measure of the quality of postoperative pain management used internationally. We conducted exploratory factor analysis (EFA) of APS-POQ-R data from 2 point prevalence studies comprising 268 and 311 surveys of Danish and Australian medical-surgical patients, respectively. Parallel analysis indicated 4- and 3-factor solutions for Danish and Australian patients, respectively, which accounted for 58.1% and 52.9% of variance. Internal consistency was unsatisfactory among both Danish (Cronbach α = .54) and Australian (Cronbach α = .63) cohorts. There was a high degree of between-group similarity in item-factor loadings of variables coded as "pain experience," but not "pain management." This finding reflected cross-cultural differences in ratings of treatment satisfaction. For Danish patients, satisfaction was associated with the degree of pain severity and activity interference, whereas for Australian patients, satisfaction was associated with their perceived ability to participate in treatment. To facilitate further cross-cultural comparison, we compared our findings with past research conducted in the United States and Iceland. EFA supported the construct validity of the APS-POQ-R as a measure of "pain experience" but indicated that items measuring "pain management" may vary cross-culturally. Findings highlighted the need for further validation of the APS-POQ-R internationally. This study revealed the APS-POQ-R as a valid measure of postoperative pain experience for Danish and Australian patients. Measures of patients' perception of pain management were not robust to group differences in treatment expectations and demonstrated cross-cultural instability. Results highlighted the difficulties in establishing stable cross-cultural, cross-population subscales for the APS-POQ-R.
Publisher: Wiley
Date: 02-2020
DOI: 10.1111/IMJ.14330
Abstract: Standardised structure and content of interdisciplinary medical ward rounds can promote patient safety and patient-centred teamwork. To evaluate interdisciplinary ward rounds using a Structured Interdisciplinary Bedside Rounding (SIBR) intervention. The study involved multi-method, repeat measures with a non-equivalent control group. Non-participant observations were collected at: 1 and 6 months, on an intervention ward that introduced SIBR and a control ward that continued traditional rounds. Focus group and survey data were also collected on the intervention ward. Participants were clinicians (medicine, nursing and allied health) working in two general medicine wards at a tertiary hospital in Melbourne, Australia. Seventy-eight patient rounds were observed at Time 1, and 239 at Time 2. The SIBR ward rounds had all clinician disciplines represented, whereas allied health and nurses were present for less than 20% of non-SIBR rounds. Interdisciplinary participation and frequency of desired clinician behaviours increased, and variability in duration of time per patient decreased, on the SIBR rounds. Longitudinal data reflected decreased performance of some SIBR behaviours in the intervention ward, while some desired behaviours increased in the control ward. Qualitative survey and focus group data indicated many positive views, but fit with broader ward routines impacted SIBR implementation. The overall recommendation by staff was that SIBR should continue. The results provide insights into the adoption of SIBR behaviours and illustrated diffusion of behaviours across wards. Highlighting successes and identifying barriers can help meet challenges for ongoing improvement.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.AUCC.2015.09.002
Abstract: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation failure to check patient identity handover located away from patients and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.
Publisher: BMJ
Date: 13-03-2017
DOI: 10.1136/BMJQS-2016-005867
Abstract: Standard risk screening and assessment forms are frequently used in strategies to prevent harm to older people in hospitals. Little is known about good practices for their use. Scope the preventable harms addressed by standard forms used to screen and assess older people and how standard forms are operationalised in hospitals across Victoria, Australia. Mixed methods study: (1) cross-sectional audit of the standard risk screening and assessment forms used to assess older people at 11 health services in 2015 (2) nine focus groups with a purposive s le of 69 participants at 9 health services. Descriptive analysis examined the number of items on forms, preventable harms assessed and sources of duplication. Qualitative thematic analysis of focus group data identified themes explaining issues commonly affecting how health services used the forms. 152 standard assessment forms from 11 Victorian health services included over 3700 items with 17% duplicated across multiple forms. Assessments of skin integrity and mobility loss (including falls) were consistently included in forms however, nutrition, cognitive state, pain and medication risks were inconsistent and continence, venous thromboembolism risk and hospital acquired infection from invasive devices were infrequent. Qualitative analyses revealed five themes explaining issues associated with current use of assessment forms: (1) comprehensive assessment of preventable harms (2) burden on staff and the older person, (3) interprofessional collaboration, (4) flexibility to in idualise care and (5) information management. Ex les of good practice were identified. Current use of standard risk screening and assessment forms is associated with a high burden and gaps in assessment of several common preventable harms that can increase risk to older people in hospital. Improvement should focus on streamlining forms, increased guidance on interventions to prevent harm and facilitating front-line staff to manage complex decisions.
Publisher: Wiley
Date: 09-12-2003
DOI: 10.1046/J.1365-2648.2003.02865.X
Abstract: The Critical Care Family Needs Inventory (CCFNI) has been used widely over the last two decades for analysing the needs of family members in the intensive care unit. However, it has significant limitations as a needs assessment tool for use with families in the Emergency Department (ED). This paper discusses the methodological challenges encountered during the process of reviewing and adapting this tool for use in the ED. The purpose of this study was to revise and adapt the CCFNI for use with a population of family members of critically ill patients in an Australian Emergency Department. The process of tool revision, adaptation and reconstruction included: critique of the CCFNI concept definition item review content and structure revision scale revision and testing with a s le of the target population. Data collection methods were aimed at accessing a vulnerable population, while enhancing response rate and data quality. A s le of 84 relatives of critically ill patients from one Melbourne Metropolitan Emergency Department was used, 73% of whom returned questionnaires. Pilot data were examined with the specific purpose of identifying elements of the tool that required refinement or modification. Methods used for establishing reliability and validity of the revised tool provided satisfactory results. Limitations of this study include inadequate s le size for exploratory factor analysis, and an incomplete response set for some items, which influenced item analysis. The process used for addressing the identified methodological issues in reviewing and adapting the CCFNI for use in the ED provides a framework for adapting an established tool for a specific purpose.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.IENJ.2016.05.002
Abstract: Family members' experience a range of physiological, psychological and emotional impacts when accompanying a critically ill relative in the emergency department. Family needs are influenced by their culture and the context of care, and accurate clinician understanding of these needs is essential for patient- and family-centered care delivery. The aim of this study was to describe the needs of Taiwanese family members accompanying critically ill patients in the emergency department while waiting for an inpatient bed and compare these to the perceptions of emergency nurses. A prospective cross-sectional survey was conducted in a large medical center in Taiwan. Data were collected from 150 family members and 150 emergency nurses who completed a Chinese version of the Critical Care Family Needs Inventory. Family members ranked needs related to 'communication with family members,' as most important, followed by 'family member participation in emergency department care', 'family member support' and 'organizational comfort' rankings were similar to those of emergency nurses. Compared to nurses, family members reported higher scores for the importance of needs related to 'communication with family members' and 'family members' participation in emergency department care'. Family members place greater importance than emergency nurses on the need for effective communication.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Elsevier BV
Date: 02-2023
Publisher: Wiley
Date: 24-09-2012
DOI: 10.1111/J.1365-2702.2012.04326.X
Abstract: To explore the effects of introducing an electronic medication management system on reported medication errors. Computerised medication management systems have been found to improve medication safety however, introducing medication management system into healthcare environments can create unanticipated or new problems and opportunities for medication error. Descriptive analysis of medication error reports. This was a retrospective analysis of 359 incident reports drawn from the period of 1 May 2005-30 April 2006 across two hospital sites of a single not-for-profit private health service located in metropolitan Melbourne. Site A used a conventional pen and paper system for medication management, and Site B had introduced a computerised medication management system. Most medication errors occurred at the nurse administration (71·5%) and prescribing (16·4%) stages of delivery. The most common medication error type reported at Site A was omission (33%), and at Site B was wrong documentation (24·2%). A higher proportion of errors at the prescribing phase, and less nurse administration errors, were detected at Site B where the medication management system was in use. The incidence of other, less frequent errors was similar across the two hospital sites. This examination of medication error reports suggests there are differences in the types of medication errors that are reported in association with the introduction of electronic medication management system compared to pen and paper system systems. The findings provide a new insight into the effects of introducing an electronic medication management system on the types of medication errors reported. The findings provide a new insight into the types of medication errors that are reported during implementation of an electronic medication management system. Extra support for physicians prescribing practices should be considered.
Publisher: BMJ
Date: 23-02-0007
DOI: 10.1136/BMJQS-2017-007292
Abstract: Meaningful partnering with patients is advocated to enhance care delivery. Little is known about how this is operationalised at the point of care during hospital ward rounds, where decision-making concerning patient care frequently occurs. Describe participation of patients, with differing preferences for participation, during ward rounds in acute medical inpatient services. Naturalistic, multimethod design. Data were collected using surveys and observations of ward rounds at two hospitals in Melbourne, Australia. Using convenience s ling, a stratified s le of acute general medical patients were recruited. Prior to observation and interview, patient responses to the Control Preference Scale were used to stratify them into three groups representing erse participation preferences: active control where the patient makes decisions shared control where the patient prefers to make decisions jointly with clinicians and passive control where the patient prefers clinicians make decisions. Of the 52 patients observed over 133 ward rounds, 30.8% (n=16) reported an active control preference for participation in decision-making during ward rounds, 25% (n=13) expressed shared control preference and 44.2% (n=23) expressed low control preference. Patients’ participation was observed in 75% (n=85) of ward rounds, but few rounds (18%, n=20) involved patient contribution to decisions about their care. Clinicians prompted patient participation in 54% of rounds and in 15% patients initiated their own participation. Thematic analysis of qualitative observation and patient interview data revealed two themes, supporting patient capability and clinician-led opportunity , that contributed to patient participation or non-participation in ward rounds. Participation in ward rounds was similar for patients irrespective of control preference. This study demonstrates the need to better understand clinician roles in supporting strategies that promote patient participation in day-to-day hospital care.
Publisher: JMIR Publications Inc.
Date: 31-01-2022
Abstract: dvances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. he aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. mplementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation phase 2, supported implementation of the intervention and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. he outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91%) found the program easy to use and most (n=64, 62%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses’ views on who was responsible for facilitating this intervention. he findings provide evidence that the structured implementation of the multimedia intervention was robust and successful in terms of patient participant recruitment and application however, it was difficult to assess the level of engagement by nurse clinicians with the program. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000340639 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000340639
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.IJMEDINF.2021.104654
Abstract: Electronic medical record system implementations impact nurses, their work and workflows. The aim of this study was to understand nurses' perceptions of barriers and enablers to using a new electronic medical record in an acute hospital environment. Data were collected just prior to an organisation-wide new electronic medical record implementation at a large tertiary healthcare organization in Victoria, Australia. Sixty-three nurses from five hospital sites participated in 12 focus group interviews. Transcripts were transcribed and deductive content analysis used the 14-domain Theoretical Domains Framework to identify barriers and enablers. Coded data mapped to 13 of the 14 domains. Nurse motivation emerged as a dominant theme among both barriers and enablers. Nurses' most common perceived barriers related to emotions (24.1%) and environmental context and resources (21.3%). Conversely, the most common enablers related to social influences (21%) and reinforcement (20.8%). In addition to effecting changes in their work and workflows, the dominance of nurses' emotional responses reveals the potential for implementation of a new electronic medical record to negatively affect nurses' psychological well-being. Using data aligned to the Theoretical Domains Framework assisted identification of behavior change strategies to target the barriers and enablers perceived by nurses. Strategies aligned with nine behavioral intervention categories are recommended for successful implementation and optimization of an electronic medical record by nurses. Multifaceted strategies targeting multiple behaviors are required to support adoption of the electronic medical record by nurses, and reduce the risk for nurse attrition in the workforce.
Publisher: Elsevier BV
Date: 10-2022
Publisher: Wiley
Date: 25-04-2018
DOI: 10.1111/JOCN.14329
Abstract: To develop and test a clinical tool to guide nurses' assessment of postoperative patients for Deep Vein Thrombosis. Preventing venous thromboembolism in hospitalised patients is an international patient safety priority. Despite high-level evidence for optimal venous thromboembolism prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis remains high. A two-stage sequential multi-method design was used. In stage 1, the STOPDVTs tool was developed using a review of the literature and focus groups with local clinical experts. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective s le of 50 postoperative orthopaedic patients. Stage 1: The focus group members who were members of the nursing leadership team agreed on eight local and systemic signs and symptoms that should be included in a nursing patient assessment tool for early Deep Vein Thrombosis. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. Systemic signs included in the tool were as follows: increased shortness of breath, increased respiratory and heart rates, and decreased oxygen saturation. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of in idual signs and symptoms varied between 44%-94%. Surgical nurses were less likely than the expert nurse to identify signs indicative of Deep Vein Thrombosis. Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. The findings reveal a gap in nursing knowledge and skill in assessing for Deep Vein Thrombosis in postoperative orthopaedic patients. This study identified a possible risk to patient safety related to under-recognition of the signs and symptoms of possible Deep Vein Thrombosis (DVT) in postoperative orthopaedic patients. The findings demonstrate the feasibility of developing and implementing a protocol for consistent screening by nurses for possible DVT in the postoperative period.
Publisher: MDPI AG
Date: 08-03-2021
Abstract: Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses’ key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. This concurrent mixed-methods study included surveys from 540 nurses (response rate 15.5%), and interviews with 63 nurses to examine their perceptions of using a new EMR prior to implementation at a single healthcare organisation. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. In contrast, 40.3% (n = 216) of nurses reported high work satisfaction, 62.3% (n = 334) had high intentions of staying in their role, and 34.3% (n = 185) were engaged in their work. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. Thematic analysis of focus group interviews revealed two themes, each with three subthemes: (1) Us and Them, detailed the juxtaposition between nurses’ professional role and anticipated changes imposed on them and their work with the EMR implementation and (2) Stuck in the middle, revealed nurses’ expectations and anticipations about how the EMR may affect the quality of nurse-patient relationships. In conclusion, anticipation of the EMR implementation emerged as a stressor for nursing staff, with some groups of nurses particularly vulnerable to negative consequences to their well-being.
Publisher: Wiley
Date: 24-05-2023
DOI: 10.1111/JAN.15714
Abstract: To develop and validate a culturally appropriate patient‐reported outcome measure for measuring dignity for older adults during acute hospitalization. A three‐phased exploratory sequential mixed‐method design was used. Domains were identified and items were generated from findings of a recent qualitative study, two systematic reviews and grey literature. Content validity evaluation and pre‐testing were undertaken using standard instrument development techniques. Two‐hundred and seventy hospitalized older adults were surveyed to test construct and convergent validity, internal consistency reliability and test–retest reliability of the measure. Analysis was performed using Statistical Package for the Social Sciences, version 25. The STROBE checklist was used to document reporting of the study. We established the 15‐item Hospitalized Older Adults' Dignity Scale (HOADS) that has a 5‐factor structure: shared decision‐making (3 items) healthcare professional‐patient communication (3 items) patient autonomy (4 items) patient privacy (2 items) respectful care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability and good test–retest reliability were demonstrated. We established the HOADS is a valid and reliable scale to measure dignity for older adults during acute hospitalization. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may inform the development of strategies to improve dignity‐related care in the future. The development and validation of the HOADS will provide nurses and other healthcare professionals with a feasible and reliable scale for measuring older adults' dignity during acute hospitalization. The HOADS advances the conceptual understanding of dignity in hospitalized older adults by including additional constructs that have not been captured in previous dignity‐related measures for older adults (i.e. shared decision‐making and respectful care). The factor structure of the HOADS, therefore, includes five domains of dignity and offers a new opportunity for nurses and other healthcare professionals to better understand the nuances of dignity for older adults during acute hospitalization. For ex le, the HOADS enables nurses to identify differences in levels of dignity based on contextual factors and to use this information to guide the implementation of strategies that promote dignified care. Patients were involved in the generation of items for the scale. Their perspectives and the perspectives of experts were sought in determining the relevance of each item of the scale to patients' dignity.
Publisher: SAGE Publications
Date: 07-07-2016
Abstract: Purpose: There is a lack of clarity regarding nursing roles and strategies in providing culturally meaningful end-of-life care to elderly immigrants admitted to Australian hospitals. This article redresses this ambiguity. Method: A qualitative exploratory descriptive approach was used. Data were obtained by conducting in-depth interviews with a purposeful s le of 22 registered nurses, recruited from four health services. Interview transcripts were analyzed using content and thematic analysis strategies. Results: Despite feeling underprepared for their role, participants fostered culturally meaningful care by “doing the ground work,” “facilitating families,” “fostering trust,” and “allaying fear.” Discussion and Conclusion: The Australian nursing profession has a significant role to play in leading policy, education, practice, and consumer engagement initiatives aimed at ensuring a culturally responsive approach to end-of-life care for Australia’s aging immigrant population. Implications for Practice: Enabling elderly immigrants to experience a “good death” at the end of their lives requires highly nuanced and culturally informed nursing care.
Publisher: SAGE Publications
Date: 17-08-2022
DOI: 10.1177/13674935211036547
Abstract: The qualitative exploratory descriptive study explored parents’ experience of family-centred care during delayed transfer from a paediatric post-anaesthetic care unit to an inpatient ward. Data were collected in a tertiary children’s hospital in Melbourne, Australia, using in-depth, semi-structured interviews. Participants ( n = 15) were parents of children ( n = 10, aged 6 months to 16 years) delayed in a Stage 1 post-anaesthetic care unit for longer than 30 min. Elements of the family-centred care framework guided thematic analysis, the core concepts of which are respect and dignity, information sharing, participation and collaboration. Respect and dignity was most often identified, expressed in three subthemes: (1) the caring behaviour of staff, (2) being present with their child and (3) a journey shared with other families. Information sharing was also common, illustrated through (1) being told information and (2) being heard. Participation, the third element of the framework, was infrequently identified by participants however, parents of children under 6 years of age alluded to contributing to their child’s care. The final element, collaboration, was not identified in the study data. Only two of four elements of the family-centred care framework were common in parents’ experiences: respect and dignity, and information sharing. ‘Being with’ their child emerged as a central concern for parents’ perceptions of family-centred care.
Publisher: Wiley
Date: 25-02-2021
DOI: 10.1111/JOCN.15695
Abstract: To use expert consensus to develop guidance for nurse leaders implementing e‐health tools to support nursing work in hospitals. Nurse leaders are increasingly required to make decisions about the selection, development, implementation and optimisation of e‐health tools for nursing work in hospitals. Guidance in this rapidly evolving and complex space is limited. A two‐phase modified Delphi study. Phase one involved in‐depth interviews with five nursing informatics experts. Analysis used the qualitative framework method, informed by the Theoretical Domains Framework (TDF), to develop statements for an anonymous online Delphi scoring survey. This was distributed using snowball s ling methods to Australian nurse informatics leaders and experts. Final analysis involved synthesis of qualitative and quantitative data. The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. Ten guidance statements to support nurse leaders to implement e‐health tools in hospitals were developed from the synthesis of qualitative interview data and 29 experts’ responses to the 55‐item Delphi response survey. Implementation of e‐health tools for nursing work is complex in health settings and requires careful examination of multiple factors and interactions between clinicians, tools, service users and the health organisation. This research proposes ten statements to support nurse leaders with decisions about implementing e‐health tools to support nursing work in hospitals. The ten statements developed by this research provide a resource to assist policy and practice decisions about e‐tools to ensure they are suited to supporting nursing work. Nurse leaders can use the ten statements for guidance in the selection, development, implementation and optimisation of e‐health tools to ensure suitability and adaptation for nursing work in hospitals.
Publisher: Wiley
Date: 24-07-2022
DOI: 10.1111/JOCN.16467
Abstract: To explore the long‐term impact of the COVID‐19 pandemic on nurse alcohol consumption. The COVID‐19 pandemic has caused immense disruption to healthcare services worldwide, and nurses have not been immune, experiencing burnout, declining mental health and ultimately, attrition from the profession. Increases in alcohol consumption have been reported across subsections of society, including those with pre‐existing mental ill health and experiencing high stress, and exploring this phenomenon in nurses is essential for workforce well‐being and sustainability. Qualitative descriptive study design. Secondary analysis of in idual, semi‐structured interviews with nurses ( N = 42) from erse settings across Australia, including community, primary and hospital settings, conducted in July and August 2021. Data were analysed using structural coding and reported in accordance with the CORE‐Q guidelines. Two key themes were found after analysis of the data: (1) factors influencing alcohol consumption (subthemes: workplace factors and external factors), and (2) the pandemic's influence on alcohol consumption (subthemes: increased consumption, moderation of consumption and alcohol as a reward). Several participants described increased alcohol consumption because of the COVID‐19 pandemic, particularly due to the stress of working in an environment where resources were scarce. Workplace factors such as overtime, missed breaks and heightened workload were all described as driving stress, and in turn increased alcohol consumption. Increased alcohol consumption has been associated with burnout, absenteeism and intention to leave. The nursing profession is currently undergoing significant continuing stress providing care and management to patients with the SARS‐CoV‐2 virus, and increased alcohol consumption is a significant threat to personal and workforce well‐being, workforce sustainability and quality nursing care.
Publisher: Wiley
Date: 28-02-2020
DOI: 10.1111/JOCN.15213
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.AJIC.2019.01.006
Abstract: Health service hand hygiene programs have seen widespread use of chlorhexidine solutions. Reports of both immediate and delayed hypersensitivity to chlorhexidine are increasing among health care workers. This study examined the prevalence of self-reported symptoms of sensitivity to chlorhexidine solutions among health care workers. This study was a cross-sectional online anonymous survey of all workers at a single health service. Of the 1,050 completed responses, 76.3% were female, 35.3% were nurses and midwives, 28% were medical staff, and 8.7% were working in nonclinical areas. Over 95% used chlorhexidine-based hand hygiene products in their workplace. Nurses and midwives most frequently reported asthma (13.7%), contact dermatitis (27.8%), and previous testing for allergy to chlorhexidine (4.9%). There was a correlation between both the presence of atopy, eczema, or dermatitis and the self-reporting of dry skin, eczema, or dermatitis attributed to chlorhexidine use. Occupational chlorhexidine allergy is an important risk to health care workers. Self-reported symptoms of sensitivity to chlorhexidine solutions revealed high reported use and presence of skin symptoms among health care workers. Screening programs need to identify nurses who develop chlorhexidine sensitivity due to occupational exposure. Strategies to mitigate risk should provide alternatives for those with sensitization.
Publisher: Wiley
Date: 07-07-2022
DOI: 10.1111/JAN.15351
Abstract: Nurses' harm prevention practices during the admission of older persons to hospital have important consequences for patient safety, preventable patient harm and length of hospital stay. Novel solutions are needed to assist nurses to balance complexity, high workload burden and patient safety during admission processes. Explore the nurses' experiences of harm prevention practices during the admission of an older person to the hospital. A multi‐method qualitative study informed by frameworks of behaviour change and human‐centred co‐design. The purposive s le included 44 nurses, 5 clinicians from other disciplines and 3 consumers recruited from five general medicine wards across three hospitals of a large public health service in metropolitan Melbourne, Australia. Data were collected over 12 h of naturalistic observations of nurses during eight patient admissions, and during four participatory human‐centred co‐design workshops between August 2019 and January 2020. Observation, field notes and workshop artefact data were integrated for qualitative content and thematic analysis. Analysis revealed a 5‐step journey map, with a temporal logic, that captured nurses' experiences, as well as the enablers and barriers to harm prevention practices when admitting an older person to the hospital. The consensus was reached on three priority features to assist nurses to implement harm prevention practices when they admit an older person to the hospital: (1) prioritize important care (2) tailor care to the in idual and (3) see the big picture for the patient. The novel research approach identified five steps in nurses' activities and harm prevention practices during admission of an older person to the hospital, and key features for a solution to assist nurses to keep patients safe. The findings provide the foundation for further research to develop interventions to assist nurses to manage high workloads during this complex activity.
Publisher: Wiley
Date: 19-05-2017
DOI: 10.1111/JOCN.13833
Abstract: To identify patient care outcome indicators sensitive to the quality of interprofessional handover between the anaesthetist and the Post-Anaesthetic Care Unit nurse. The relationship between interprofessional clinical handover when patients are transferred from the operating theatre to the Post-Anaesthetic Care Unit and patient outcomes of subsequent patient care delivery is not well understood. Naturalistic, exploratory descriptive design using observation. Observations of 31 patient journeys through Post-Anaesthetic Care Units across three public and private hospitals. Characteristics of interprofessional handover on arrival in the Post-Anaesthetic Care Unit, the trajectory of patient care activities in Post-Anaesthetic Care Unit and patient outcomes were observed. Of the 821 care activities observed across 31 "patient journeys" in the Post-Anaesthetic Care Unit, observations (assessments and vital signs) (52.5 %), communication (15.8 %) and pain management (assessment of pain and analgesic administration) (10.3%) were most common. Examination of patterns in handover communications and subsequent trajectories of patient care activities revealed three patient trajectory typologies and two patient outcome indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit: pain on discharge from the Post-Anaesthetic Care Unit and timely response to clinical deterioration. An additional process indicator, seeking missing information, was also identified. Patient's pain on discharge from Post-Anaesthetic Care Unit, escalation of care in response to early signs of deterioration and the need for nurses to seek out missing information to deliver care are indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit. Future research should test these indicators. Patient outcomes sensitive to the quality of interprofessional handover on patient arrival in the Post-Anaesthetic Care Unit can be used to evaluate handover quality improvement initiatives. Quality handovers can improve management of pain and clinical deterioration in Post-Anaesthetic Care Unit and reduce time wasted searching for missing information.
Publisher: Wiley
Date: 18-07-2023
DOI: 10.1111/JOCN.16824
Abstract: To evaluate evidence that examined nurses' work experiences in hospital wards with single rooms. The research question was ‘What does the research tell us about nurses’ work experiences in hospital wards with single rooms?’ In the last decades, new hospital builds have moved towards including a high proportion of single rooms. Yet, single rooms create ‘complex environments’ that impact the nurses. A structured integrative review was undertaken of empirical evidence. Original, peer‐reviewed articles, written in English, were sourced from four databases: CINAHL, PubMed, Embase and Web of Science. The initial searches were performed in April 2021 and repeated in December 2022. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis approach was used to analyse the data. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Twelve studies, published between 2006 and 2022, with an international origin, and representing n = 826 nurses, were included in this review. The synthesis revealed mixed perspectives about nurses' work experiences in wards with single rooms. Whilst single rooms are ‘all good in theory (and) a good idea’, the reality was quite different. Synthesised findings are presented in four categories: (i) aesthetics and the physical space, (ii) privacy vs. isolation, (iii) safety, which includes situational awareness and (iv) communication and collaboration. This review describes how single rooms affects nurses' work experience. Whilst nurses shared multiple concerns about single rooms and the challenges they also acknowledged patient preference for the privacy and space afforded by single rooms. Findings from this review highlight the need for careful planning to maintain and strengthen teamwork, prevent nurses' sense of working in isolation, as well as creating opportunities for mentorship, and collaboration among nurses when working in single‐room settings.
Publisher: BMJ
Date: 11-04-2019
DOI: 10.1136/BMJQS-2018-008975
Abstract: Patient participation in care is a fundamental element of safe and high-quality healthcare with the potential to enhance health outcomes and improve patient satisfaction. To test the efficacy of a clinician-facilitated, bedside multimedia ( MyStay ) intervention designed to support patient participation in their recovery after total knee replacement surgery. The primary outcome was patients’ reported worst pain intensity on postoperative day 3. Secondary outcomes were patient activation, length of hospital stay, knee function and satisfaction with care. Unmasked, cluster randomised, four-period cross-over trial with a simultaneous process evaluation within in a large private, not-for-profit, metropolitan teaching hospital. Statistical analyses used linear mixed models with random effects for wards, cohorts within wards and patients within cohorts and fixed effects for treatment and period. 241 patients were recruited between March 2014 and June 2015. Patients were admitted to intervention (104) or control (137) clusters. Intervention group patients reported significantly lower mean pain intensity scores on postoperative day 3 (6.1 vs 7.1, 95% CI −1.94 to −0.08, p=0.04). The percentages of patients who reported severe pain (score ≥7) were 43.7% and 64.2% in the intervention and control groups, respectively (χ 2 9.89, p=0.002 generalised linear mixed model Wald test, p=0.05). Intervention group patients on average stayed in hospital one less day (5.3 vs 6.3, 95% CI 0.05 to 1.94, p=0.04), reported higher activation (45.1% vs 27.1% at level 4 activation) (p=0.04) and higher overall satisfaction with care (9.3 vs 8.6, 95% CI 1.09 to 0.219, p=0.01), and were more likely to refer family or friends to the health service (9.3 vs 8.7, 95% CI 1.07 to 0.13, p=0.02). The clinician-facilitated, MyStay bedside multimedia intervention enhanced patients’ activation and participation in their care after surgery pain intensity and length of stay in hospital were reduced and patients were more satisfied with their care. ACTRN12614000340639 ( www.anzctr.org.au/default.aspx ).
Publisher: IGI Global
Date: 04-2013
DOI: 10.4018/JANTTI.2013040103
Abstract: Based on initial pre-clinical data and results from focus group studies, proof of concept for an intelligent operational planning and support tool (IOPST) for nursing in acute healthcare contexts has been demonstrated. However, moving from a simulated context to a large scale clinical trial brings potential challenges associated with the many complexities and multiple people-technology interactions. To enable an in depth and rich analysis of such a context, it is the contention of this paper that incorporating an Actor-Network Theory (ANT) lens to facilitate analysis will be a prudent option as discussed below.
Publisher: Elsevier BV
Date: 10-2019
Publisher: Elsevier BV
Date: 07-2023
DOI: 10.1016/J.AUCC.2022.05.004
Abstract: Education guidelines and professional practice standards inform the design of postgraduate critical care nursing curricula to develop safety and quality competencies for high-quality care in complex environments. Alignment between nurses' motivations for undertaking postgraduate critical care education, and intended course learning outcomes, may impact students' success and satisfaction with programs. The objectives of this study were to explore nurses' motivations and desired learning outcomes on commencement of a postgraduate critical care course and determine how these align with safety and quality professional attributes. In this exploratory descriptive study, qualitative data were extracted from survey responses of four cohorts of students enrolled in a graduate certificate-level critical care course between 2013 and 2016 (N = 390, 93%), at one Australian university. Summative qualitative content analysis was used to code and quantify textual content followed by synthesis to identify themes and subthemes. Five themes of motivations were identified: (i) Knowledge development (ii) Skill development, (iii) Personal outcomes, (iv) Personal professional behaviours, and (v) Interpersonal professional behaviours. Most frequently, students' motivations and desired learning outcomes included 'Understanding' (329 participants [84%], 652 references), 'Development of technical skills' (241 participants [62%], 384 references), 'Development of confidence' (178 participants [46%], 220 references), and 'Career progression' (149 participants [38%], 168 references). Less frequent were motivations related to safety and quality competencies including teamwork, communication, reflective practice, and research skills. Findings suggest students' motivations to undertake postgraduate studies most often related to acquisition of new knowledge and technical skills. Desired skills and behaviours were consistent with many, but not all, of the key course outcomes and attributes specified by health professional education guidelines and nurses' professional practice standards. Understanding the differences between students' motivations and desired safety- and quality-related course learning outcomes informs course orientation, teaching activities, and student support to optimise achievement of essential learning outcomes.
Publisher: Wiley
Date: 03-09-2003
DOI: 10.1046/J.1365-2648.2003.02771.X
Abstract: Family members are a crucial part of the holistic approach to care in emergency departments. In particular, they are a group who are vulnerable, yet have been overlooked when considering care options. The primary aim of this systematic review was to appraise research relevant to identifying and meeting the needs of family members who accompany a critically ill person into the Emergency Department (ED). The information was intended to inform future research into the care of these people. A quality assessment strategy was specifically developed to evaluate the various research designs used. The outcomes of the highest quality studies were used to develop evidence-based clinical practice guidelines to inform clinicians caring for family members who accompany a critically ill person into the ED. Recommendations for family care drawn from this review provide the foundation for more rigorous methodologies in future research into this topic. Key findings concern family needs for communication, proximity, support, comfort, assurance and to locate meaning in the event. The review has revealed current knowledge about the care of family members who accompany a critically ill person into the ED that provides guidelines for practice. Despite significant limitations, the knowledge can lead to recommendation to guide and inform future intervention research.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Wiley
Date: 22-04-2022
DOI: 10.1111/JAN.15269
Abstract: Preventable harms during hospitalization pose a major challenge for health systems globally. Nurse‐led strategies provide comprehensive harm prevention to keep the most vulnerable patients safe in hospital, but gaps in care are common. Nursing roles and activities to prevent harm to patients during acute hospitalization are poorly understood. The aim of this study was to identify nurses' perceived enablers and barriers to the implementation of comprehensive harm prevention for older people admitted to an acute hospital setting. Anonymous, online, cross‐sectional survey. The adapted Influences on Patient Safety Behaviours Questionnaire (IPSBQ) was used to collect data from nurses working on five general medicine wards across three hospitals of a single tertiary health service in Australia in 2019. Participants also rated their perceptions of overall quality of care, missed care and awareness of strategies for an eight‐factor framework for comprehensive harm prevention. The STROBE reporting checklist was used. Ward response rates between 35% and 58% resulted in 132 complete questionnaires for analyses. High mean scores for behavioural regulation (3.28), beliefs about capabilities (2.96) and environmental context and resources (2.73) indicated these domains were perceived by nurses as enablers. Low mean scores for the domains of intentions (1.65), beliefs about consequences (1.69), optimism (1.72) and professional role and identity (1.85) indicated these were barriers to comprehensive harm prevention by nurses. High perceived quality of care (scored 9–10/10) ( p = .024), and awareness of strategies for the eight‐factor framework ( p = .019) were significant enablers of comprehensive harm prevention. Targeted evidence‐based strategies that include education, persuasion, incentivization, coercion and modelling would be most useful for promoting comprehensive harm prevention by nurses. However, to be most effective the harm prevention strategy may need to be tailored for each ward.
Publisher: Wiley
Date: 31-01-2021
DOI: 10.1111/AJAG.12904
Abstract: To examine residential aged care (RAC) staff awareness of and engagement with dementia‐specific support services and education. A cross‐sectional survey of staff (n = 179) from 36 Victorian RAC facilities. 60% (n = 107) of respondents were aware of dementia‐specific support services, but only 27% (n = 48) accessed services in the previous 2 years. Approximately 77% (n = 137) were aware of dementia‐specific education, with 66% (n = 115) completing education in the previous 2 years. A significantly higher proportion of registered nurses had accessed dementia‐specific support services in the past 2 years compared with enrolled nurses and personal care assistants ( P 0.001). A relatively large proportion of RAC staff were unaware of available dementia‐specific support services and education. While approximately two thirds accessed such education, only one in four accessed dementia‐specific support services. To optimise the quality of care for people with dementia, strategies to increase awareness of and access to these resources are warranted.
Publisher: Wiley
Date: 16-06-2021
DOI: 10.1111/JAN.14931
Abstract: To examine nurse documentation of assessments using standard risk assessment forms in older inpatients, and to determine the value of such assessment. Cross‐sectional retrospective chart review. This retrospective review of risk evaluation documentation in patients’ medical records focused on skin, continence, medical complications, nutrition, cognition, mobility, medications and pain. A total of 1000 medical records from Taiwan hospitals were reviewed from January 2016 to December 2017, and 379 from Australian hospitals were reviewed from March 2011 to February 2012. Taiwanese patients with documented assessment of skin (aOR =2.94, 95%CI =1.88–4.54), nutrition (aOR =3.22, 95%CI =1.08–9.59), cognition (aOR =2.61, 95%CI =1.32–5.16) and pain (aOR =5.01, 95%CI=1.63–15.38) had significantly higher odds of developing new problems while Australian patients with documented assessments of continence (aOR =11.55, 95%CI =1.48–90.45) and nutrition (aOR =12.90, 95%CI =1.67–99.06) had significantly higher odds of developing new problems. Nursing assessments and interventions documented in standard risk assessment forms help clinical nurses detect new preventable problems and prevent harm in older hospital inpatients across geographic locations and hospital types. Standard nursing forms can be used in clinical practice to guide proactive care by nurses to prevent harm during hospitalisation. Older inpatients are at risk of preventable harm and new health problems. The present study found that incorporating eight factors sensitive to nursing care into standard risk assessment forms can help reduce preventable harm in older inpatients. In addition, these forms guide assessment and intervention effectively in different countries.
Publisher: Wiley
Date: 10-11-2022
DOI: 10.1111/JNU.12840
Abstract: Internationally, the adoption of technology into residential aged care settings has been slow and fraught with multiple challenges for residents, staff and service providers. The aim of this study was to evaluate the acceptability, efficiency, and quality of health information system implementation into aged care. Three‐stage, mixed‐methods participatory action research, concurrent with the natural experiment of a co‐designed health information system implementation into a 169‐bed aged care home in Australia. Data were collected pre‐, during, and post implementation between 2019 and 2021. Qualitative data included focus groups, interviews, and observations. Quantitative data included work observations, pedometers, record audits, incident reports and staff and resident surveys. There were 162 participants composed of 65 aged care residents, 90 staff, and 7 managers/consultants. Improved work efficiency included reduced staff time searching for information (6%) reduced nurse time on documentation (20.4% to 6.4%), and 25% less steps. Documentation improvement included resident assessments (68% to 96%) resident‐focused goals (56% to 88%) and evaluations (31% to 88%). The staff reported being better equipped to manage the ‘delicacies of dignity’. Implementation of a health information system into a residential aged care facility was associated with improved resident‐focused care and staff efficiency. Technology can support nurses and care staff to spend more time with residents in residential aged care homes, improve the quality of resident care, and assist meeting regulatory reporting requirements. Flexible and tailored co‐design strategies can enhance both effectiveness and success of technology implementation into residential aged care.
Publisher: Wiley
Date: 21-08-2023
DOI: 10.1111/JOCN.16850
Abstract: This study examined levels of self‐reported dignity and explored factors expected to influence dignity experienced by older adults during acute hospitalisation in Ghana. Dignified care has been recognised as inseparable from quality nursing care and maintaining patients' dignity has been highlighted in professional codes of conduct for nurses. However, there is a lack of research on self‐reported dignity and the factors that influence the dignity of older adults during acute hospitalisation in Africa. A large teaching hospital in the northern region of Ghana. Hospitalised older adults. A cross‐sectional survey was used to gather data from a convenience s le of 270 older inpatients, using the Hospitalized Older Adults’ Dignity Scale. Data were analysed using descriptive statistics and stepwise ordinal logistic regression to investigate stratified dignity outcomes. The study was reported following the STROBE checklist. More than half of the older adults surveyed reported low to moderate levels of dignity. Demographic characteristics such as age, marital status, religious status, occupation, level of education and type of hospital ward did not show any significant associations with dignity levels. However, there was a significant association found between dignity levels and sex and the number of hospitalisations. Most older adults in a Ghanian hospital experienced loss of dignity during their acute hospitalisation. Male older adults reported higher dignity levels during acute hospitalisation than their female counterparts. Further, older adults who were admitted to hospital for the second time reported less dignity compared to those admitted three or more times. The results emphasise the importance of healthcare professionals having the necessary knowledge and skills to provide gender‐sensitive care, which ultimately promotes the dignity of all patients. Additionally, the results underscore the urgency of implementing measures that guarantee patients' dignity during all hospital admissions. Survey questionnaires were completed by hospitalised older adults at the study setting.
Publisher: Informa UK Limited
Date: 03-2022
DOI: 10.1080/14740338.2022.2044786
Abstract: Hyper-polypharmacy and potentially inappropriate prescribing (PIP) are common among older inpatients. This study investigated associations between hyper-polypharmacy and PIP with clinical and functional outcomes in older adults at 3-months after hospital discharge. At discharge, prescribed medications were collected and PIPs, comprising potentially inappropriate medications (PIM) and potential prescribing omissions (PPO), were retrospectively identified using STOPP/START version 2. Outcomes were collected prospectively via telephone follow-up and audit. Data for 232 patients (mean age 80 years) were analyzed. PIP prevalence at discharge was 73.7% (PIMs 62.5%, PPOs 36.6%). Exposure to at least 1 PIM was associated with an increased occurrence of unplanned hospital readmission (adjusted odds ratio (AOR) 5.09 95% CI 2.38─10.85), emergency department presentation (AOR 4.69 95% CI 1.55─14.21) and the composite outcome (AOR 6.83 95% CI 3.20─14.57). The number rather than the presence of PIMs was significantly associated with increased dependency in at least 1 activity of daily living (ADL) (AOR 2.31 95% CI 1.08─4.20). Increased PIP use was associated with mortality (AOR 1.45 95% CI 1.05─1.99). PIPs overall, and PIMs specifically, were frequent in older adults at hospital discharge, and were associated with increased re-hospitalizations and dependence in ADLs at 3-months post-discharge.
Publisher: Wiley
Date: 21-04-2023
DOI: 10.1111/JOCN.16730
Abstract: To examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well‐being. Implementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter‐personal interactions in healthcare settings. Multiple in idual and organisational‐level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety. Five‐step realist review method and Realist And Meta‐narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources. Literature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021. In all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre‐ and post‐technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery social supports skills implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory). Nurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well‐being. Complex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well‐being with the implementation of new technology into healthcare settings. Nurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care. No patient or public contribution. CRD42020131875 ( www.crd.york.ac.uk rospero/display_record.php?RecordID=131875 ).
Publisher: Wiley
Date: 21-04-2019
DOI: 10.1111/JOCN.14874
Abstract: (a) Describe the co-development of a point-of-care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital. Strategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations. Three-stage, mixed-methods, process and outcome evaluation. The App was co-developed with experts, nurse end-users and a consumer. Evaluation data were collected from a convenience s le of nurses observed during delivery of 80.5 hr of care to 38 patients the App (n = 32 patients) and in idual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist. The App included three components: cognition and risk assessment tailored evidence-based strategies and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device-related factors. The App provided an evidence-based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation. Co-development using best evidence and key stakeholders enabled creation of a novel, feasible and acceptable technology. Real-time access to assessment tools and tailored knowledge supported nurses' clinical decision-making workload and unfamiliarity were barriers to use.
Publisher: SAGE Publications
Date: 20-09-2019
Abstract: To identify spatial design factors that influence informal interprofessional team-based communication within hospital emergency departments (EDs). Effective team communication in EDs is critical for interprofessional collaborative care and prevention of serious errors due to miscommunication. Limited evidence exists about how informal communication in EDs is shaped by the physical workspace and how workplace design principles can improve the quality of ED team communication. Two health services with four hospital sites in Victoria, Australia, participated. A multistage mixed-methods approach used (1) an anonymous online communication network survey ( N = 103) to collect data on patterns and locations of informal interprofessional team communication among ED staff, (2) focus groups ( N = 37) and interviews ( N = 3) using photoelicitation to understand the perspectives of ED staff about how spatial design influences team communication, and (3) validity testing of preliminary findings with executives and ED managers at the participating sites. Informal communication with peers and within discipline groups on nonspecific areas of the ED was most common. Three key factors influenced the extent to which ED workspaces facilitated informal communication: (1) staff perceptions of privacy, (2) staff perceptions of safety, and (3) staff perceptions of connectedness to ED activity. Our research supports the proposition that ED physical environments influence informal team communication patterns. To facilitate effective team communication, ED workspace spatial designs need to provide visibility and connectedness, support and capture “case talk,” enable privacy for “comfort talk,” and optimize proximity to patients without compromising safety.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.AUEC.2019.12.004
Abstract: Little is known about how Australian national safety standards for communicating multidisciplinary care are operationalised during high-risk care transitions. We examined transfer of care for complex patients from the emergency department (ED) to medical wards to explore nurse-to-nurse communication about multidisciplinary care provided in the ED. Using naturalistic, mixed-methods design, observation, audit and interview data were collected from a convenience s le of 38 nurses during transfer of care for 19 complex patients from the ED to medical wards at a tertiary hospital. A focus group with 19 clinicians from multiple disciplines explored explanations for findings and recommendations. Quantitative data were analysed using frequencies and descriptive statistics the Connect, Observe, Listen, Delegate (COLD) framework informed qualitative content analysis. Nurses seldom communicated multidisciplinary care at patient transfer. Most handovers included Connect and Observe (63-95%) and Listen (90%) Delegate (42%) behaviours were infrequent. Behaviours consistent with good practice recommendations (90%) and known to increase communication risk (53%) were observed. Tensions between policies and clinical processes, and information quality negatively impacted transfers. This study revealed gaps in nurse-to-nurse communication about patients' multidisciplinary care. Complex factors negatively impact nurses' handover communication necessitating workarounds, and highlighting nurses' role as patient safety advocates.
Publisher: Wiley
Date: 03-2022
DOI: 10.1111/NHS.12930
Abstract: This study explored clinician perceptions of women's participation in decision‐making about antiemetic treatments during pregnancy, and the suitability of the five Choosing Wisely questions to increase women's involvement. The qualitative interpretive descriptive design used semi‐structured interviews to capture data. Participants were six obstetricians and six midwives experienced in providing care for pregnant women seeking support for nausea and vomiting at a single private, obstetrician‐led maternity health service in Australia. Thematic analysis revealed four themes that captured clinician perspectives about women's participation in decision‐making about antiemetic treatments: (i) information gathering (ii) developing an understanding (iii) using knowledge and (iv) making decisions. Clinician attitudes and perspectives, as well as their self‐reported styles of communication and negotiation, influenced how they engaged with women during decision‐making. While unfamiliar with the five Choosing Wisely questions, almost all participants considered them potentially useful, but for other clinicians. Strategies to actively involve women in decision‐making about antiemetics were inconsistently used. The five Choosing Wisely questions may provide a useful tool for clinicians, but further research is needed to better understand women's perspectives and clinician‐related barriers to shared decision‐making.
Publisher: Springer Science and Business Media LLC
Date: 28-08-2014
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.IJNURSTU.2022.104178
Abstract: Harm prevention research has seldom considered the complex demands on nurses negotiating multiple interrelated factors that contribute to preventable harms common in hospitalized patients. Best practice guidelines are available for in idual risk factors, but few consider multiple factors that contribute to risk. As a consequence, duplication, contradiction, gaps, and volume of information limit harm prevention guideline use by nurses in daily practice. To systematically synthesise best-evidence recommendations from clinical practice guidelines to support nurses to deliver comprehensive harm prevention during acute hospitalization. An integrative review process was used to systematically identify, examine, evaluate and synthesise clinical nursing guidelines to prevent harm to hospitalized patients. The search strategy developed with an expert librarian used a combination of targeted searching for guidelines published on websites, and forward and backward citation searching. Guidelines included were those most recently published, relevant to the international nursing context, and addressing one or more of eight factors contributing to preventable harms. The AGREE-REX (Appraisal of Guidelines Research and Evaluation-Recommendations Excellence) tool was used for critical appraisal of guidelines regarding appropriateness to target users (i.e., nurses), trustworthiness, and implementable in acute hospitals. EndNote and NVIVO 12 were used to manage the high volume of extracted data and facilitate analysis. Analyses involved using the framework method to code data for relevance to an eight-factor harm prevention framework steps for inductive thematic analyses were used for synthesis. Iterations of the thematic model were refined by sharing with hospital patient safety experts, who endorsed the final model. 154 guidelines met inclusion criteria, providing 7,429 recommendations. Synthesis involved mapping of recommendations across the eight-factor framework that informed a hierarchy of risk for harm prevention activity. Six themes represented nursing care strategies across the eight-factors that could be integrated into local practice contexts. The themes are framed into a model for nurse comprehensive harm prevention. The complexity and volume of guidance for comprehensive harm prevention necessitates contemporaneous, integrated, and accessible guidance to support nurses' decision-making in their daily care provision. This research provides an integrated model to assist nurses to identify patients most vulnerable to multiple preventable harms during hospitalization and guide a comprehensive harm prevention strategy to keep them safe in hospital. Review of nursing guidelines generates integrated model to help identify patients most vulnerable to multiple preventable harms during hospitalization.
Publisher: JMIR Publications Inc.
Date: 26-07-2022
DOI: 10.2196/39596
Abstract: Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted. This study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system. This qualitative descriptive study used focus group and in idual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework. A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional ide captured nurses’ feelings of ision related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as in iduals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.
Publisher: Wiley
Date: 21-03-2023
DOI: 10.1111/JOCN.16694
Abstract: To systematically review relevant literature to identify how Nurse Managers support graduate nurse work readiness. Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. A five‐step, systematic integrative review reported in accordance with the PRISMA 2020 Checklist. The steps of the review method included (1) problem identification, (2) literature search, (3) data evaluation and quality appraisal, (4) data extraction and analysis and (5) presentation. Analysis used the Framework method and was guided by theory of graduate nurse work readiness and the Theoretical Domains Framework. MEDLINE COMPLETE, Cumulative Index to Nursing and Allied Health (CINAHL) Complete, ERIC and PSYCINFO searched in December 2020. Studies eligible for inclusion ( N = 40) represented research from 15 countries most (67.5%, n = 27) used a qualitative design, 22.5% ( n = 9) were quantitative and 10% ( n = 4) used mixed methods. Three themes related to the social constructs and local area work environments influenced by nurse managers emerged: supporting people, supportive environment and supporting learning. The review identified a lack of robust evidence about the effectiveness of specific nurse manager‐led strategies to support development of graduate work readiness. However, the findings provide a framework to guide nurse managers in supporting graduate nurses and provide a foundation for further research about nurse manager roles in developing graduate work readiness. Previous research has described poor transition of graduate nurses as responsible for increased workplace errors, decreased job satisfaction and high rates of attrition. Exploring the role of nurse managers in graduate nurse transition is essential to ensure quality patient care and a sustainable workforce. What Problem Did the Study Address? Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. What Were the Main Findings? High rates of attrition are attributed to poor support during the initial transition phase of graduate nurses. Nurse managers can impact transition by providing a supportive environment, support learning and by providing a team of supportive people. Where and on whom will the research have an impact? The research will have an impact on graduate nurses and nurse managers. No patient or public contribution (integrative review exploring existing literature). This integrative review was registered with PROSPERO (CRD42021213142).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-06-2021
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.AUCC.2018.12.006
Abstract: Despite many Australians supporting organ donation, national posthumous organ donation rates have not increased as expected over the last three decades. Little is known about the barriers to organ donation for patients in intensive care that meet the criteria for organ donation. The aim of this study was to describe the characteristics of patients identified as potentially suitable for organ donation and to explore the variables associated with the success, or failure, of solid organ donation within the context of an Australian public hospital intensive care unit (ICU). A retrospective audit examined electronic records of 280 potential organ donors aged 18-80 years, admitted into the ICU between 1 July 2012 and 30 June 2016. Data extracted from three separate electronic hospital databases were amalgamated for analysis. Of the 280 potential organ donors identified, conversations with families of 182 (65%) patients resulted in their agreement to organ donation. Consent to organ donation was most often provided by the patient's spouse (65, 35.7%) however, only 63.7% (n = 116) were successful organ donors. The remaining 36.3% (n = 66) of patients did not donate organs for medical reasons. Compared with those who did not donate, the typical organ donor was significantly younger (M 49.9 years, p = 0.020), Australian-born (p = 0.031), and had a shorter length of ICU stay (M 64.9 h, p = 0.002). The most frequently donated organs were kidneys (103, 88.8%), lungs (59, 50.9%), and livers (52, 44.8%). This study provided insights into patient, family, and organisational factors contributing to the success of organ donation outcomes in the ICU. Two factors that adversely impacted donation outcomes were the following: (1) the family did not consent to organ donation on behalf of the patient and (2) consent was provided, but donation did not proceed for medical reasons. Although the focus on the consenting process has been raised, this study highlights the additional impact of medical suitability on rates of organ donation. Family members may experience significant disappointment after consent that may have repercussions on their health and also future donation considerations. This study also highlighted some deficiencies in the databases that, if addressed, could better inform organisational processes in the consent and support of those making decisions about consent.
Publisher: Wiley
Date: 29-08-2003
DOI: 10.1046/J.1365-2648.2003.02759.X
Abstract: Families who accompany critically ill relatives in emergency departments (EDs) are an integral part of the care unit. However, there are few empirical data on their needs during this phase of care. In order to guide quality care, general and specific needs of families accompanying these critically ill relatives should be systematically examined. The aim of this pilot project was to test the tool, methods and analysis plan for a study to examine the perceived needs of family members accompanying critically ill patients in EDs and their perceptions of ED staff's ability to meet these needs. Over a 6-week period in 1996, 84 relatives who met the inclusion criteria were recruited to the study. A postal questionnaire, to uncover the needs of family members, was pilot tested. The questionnaire consisted of 40 need statements reflecting five major themes: meaning, proximity, communication, comfort and support. Of the 84 relatives selected for the study, 73% returned completed questionnaires. The findings of this pilot study suggest that the questionnaire is a valid and reliable tool for researchers wishing to examine and rank the needs of family members who accompany critically ill people in EDs. In addition, the analysis plan was found to be appropriate. This pilot study provides both a method and a tool for further research into family needs. Examination of the pilot data supported the reliability and validity of the tool and produced findings that challenge nurses to move beyond traditional practice that has excluded families from being an integral part of caring for critically ill patients in EDs.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.APNR.2017.12.013
Abstract: Nurse bedside handover quality is influenced by complex interactions related to the content, processes used and the work environment. Audit tools are seldom tested in 'real' settings. Examine the reliability, validity and usability of a quality improvement tool for audit of nurse bedside handover. Naturalistic, descriptive, mixed-methods. Six inpatient wards at a single large not-for-profit private health service in Victoria, Australia. Five nurse experts and 104 nurses involved in 199 change-of-shift bedside handovers. A focus group with experts and pilot test were used to examine content and face validity, and usability of the handover audit tool. The tool was examined for inter-rater reliability and usability using observation audits of handovers across six wards. Data were collected in 2013-2014. Two independent observers for 72 audits demonstrated acceptable inter-observer agreement for 27 (77%) items. Reliability was weak for items examining the handover environment. Seventeen items were not observed reflecting gaps in practices. Across 199 observation audits, gaps in nurse bedside handover practice most often related to process and environment, rather than content items. Usability was impacted by high observer burden, familiarity and non-specific illustrative behaviours. The reliability and validity of most items to audit handover content was acceptable. Gaps in practices for process and environment items were identified. Context specific exemplars and reducing the items used at each handover audit can enhance usability. Further research is needed to develop context specific exemplars and undertake additional reliability testing using a wide range of handover settings. CONTRIBUTION OF THE PAPER.
Publisher: Wiley
Date: 03-06-2015
DOI: 10.1111/JOCN.12881
Abstract: To explore nurses' reactions to new novel technology for acute health care. Past failures of technology developers to deliver products that meet nurses' needs have led to resistance and reluctance in the technology adoption process. Thus, involving nurses in a collaborative process from early conceptualisation serves to inform design reflective upon current clinical practice, facilitating the cementing of 'vision' and expectations of the technology. An exploratory descriptive design to capture nurses' immediate impressions. Four focus groups (52 nurses from medical and surgical wards at two hospitals in Australia one private and one public). Nursing reactions towards the new technology illustrated a variance in barrier and enabler comments across multiple domains of the Theoretical Domains Framework. Most challenging for nurses were the perceived threat to their clinical skill, and the potential capability of the novel technology to capture their clinical workflow. Enabling reactions included visions that this could help integrate care between departments help management and support of nursing processes and coordinating their patients care between clinicians. Nurses' reactions differed across hospital sites, influenced by their experiences of using technology. For ex le, Site 1 nurses reported wide variability in their distribution of barrier and enabling comments and nurses at Site 2, where technology was prevalent, reported mostly positive responses. This early involvement offered nursing input and facilitated understanding of the potential capabilities of novel technology to support nursing work, particularly the characteristics seen as potentially beneficial (enabling technology) and those conflicting (barrier technology) with the delivery of both safe and effective patient care. Collaborative involvement of nurses from the early conceptualisation of technology development brings benefits that increase the likelihood of successful use of a tool intended to support the delivery of safe and efficient patient care.
Publisher: IGI Global
Date: 2016
DOI: 10.4018/978-1-5225-0920-2.CH020
Abstract: It is widely known that nurses are pivotal in coordinating and communicating patient care information in the complex network of healthcare professionals and service delivery. Yet, despite their pivotal role, information communication technologies have historically rarely been designed around nurses' operational needs. This could explain the poor integration of technologies into nursing work processes and consequent rejection by nursing professionals. The complex nature of acute care delivery in hospitals and the frequently interrupted patterns of nursing work suggest that nurses require flexible intelligent systems that can support and adapt to their variable workflow patterns. This study is designed to explore nurses' initial reactions to a new integrated point of care solution for acute healthcare contexts. We report on the first stage of a longitudinal project to use an innovative approach involving nurses in the development and refinement of this solution. Unified Theory of Acceptance and Use of Technology was used to evaluate acceptability of the proposed system by nurses.
Publisher: Wiley
Date: 16-07-2022
DOI: 10.1111/JAN.15370
Abstract: To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care from the perspective of hospitalized patients. The secondary aim was to examine the relationship between dignity and demographic, clinical and psychological characteristics of patients. A systematic review based on the protocol of the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guideline for reporting systematic reviews. Five electronic databases (PubMed, CINAHL, Embase, PsycINFO, AgeLine) were searched in February 2021, followed by backward‐forward searching using Web of Science and Scopus databases. Potentially eligible articles were scrutinized by two reviewers. Articles that met the eligibility criteria were appraised for quality using the Critical Appraisal Tool for Cross‐Sectional Studies. Two reviewers extracted data for the review and resolved differences by consensus. Out of 3052 potentially eligible studies, 25 met the inclusion criteria. Levels of dignity for hospitalized patients vary widely across geographic locations. Patients' dignity is upheld when healthcare professionals communicate effectively, maintain their privacy, and provide dignity therapy. Patients' perceptions of dignity were, in some studies, reported to be associated with demographic (e.g. age, marital status, gender, employment, educational status), clinical (e.g. hospitalization, functional impairment, physical symptoms) and psychological (e.g. depression, anxiety, demoralization, coping mechanisms) variables whilst other studies did not observe such associations. Patients in acute care settings experience mild to a severe loss of dignity across different geographic locations. Patients' dignity is influenced by several demographic, clinical and psychological characteristics of patients. The findings of the review support impetus for improvement in dignified care for hospitalized patients, addressing factors that facilitate or impede patients' dignity. Measures aimed at alleviating suffering, fostering functional independence and addressing patients' psychosocial needs can be used to promote dignity.
Publisher: Wiley
Date: 18-02-2022
DOI: 10.5694/MJA2.51433
Publisher: JMIR Publications Inc.
Date: 19-05-2022
DOI: 10.2196/36959
Abstract: Advances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. The aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. Implementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation phase 2, supported implementation of the intervention and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. The outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91%) found the program easy to use and most (n=64, 62%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses’ views on who was responsible for facilitating this intervention. The findings provide evidence that the structured implementation of the multimedia intervention was robust and successful in terms of patient participant recruitment and application however, it was difficult to assess the level of engagement by nurse clinicians with the program. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000340639 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000340639
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJOPEN-2021-055847
Abstract: Electronic medical record (EMR) systems are used worldwide as repositories for patients’ clinical information, providing clinical decision support and increasing visibility of and access to clinical information. While EMR systems facilitate improved healthcare delivery, emerging reports suggest potential detrimental effects on clinician well-being. EMR system implementation influences on nurses’ work motivation, engagement, satisfaction and well-being (including burnout) are not well understood, nor have they been examined in relation to contextual factors and mechanisms of action. This paper presents a realist review protocol to examine causal explanations to address the question: How, why and under what circumstances does the implementation of a new hospital EMR system or similar technology impact nurses’ work motivation, engagement, satisfaction or well-being? The five-step method for realist review will be used to identify causal relationships, how the relationships work, for whom and under what circumstances: (1) defining the review scope (2) developing initial program theories (3) searching the evidence (4) selecting and appraising the evidence (5) extracting and synthesising the data. Initial program theories were developed using scoping review findings and qualitative data collected from nurses pre-EMR and post-EMR. Five databases will be systematically searched from 1 January 2000 to 31 October 2021 (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete), and forward and backward citation searching, grey literature searching and literature recommended by the research team. Search results will be screened by two research team members. Data extracted will assist in refining program theories to develop a conceptual model that synthesises how work motivation, engagement, satisfaction and well-being may influence, or be influenced by, an EMR implementation. The larger project has previously obtained low-risk ethics approval. The review will be published in a peer-reviewed journal and reported as per RAMESES guidelines. CRD42020131875.
Publisher: Wiley
Date: 10-10-2017
DOI: 10.1111/JOCN.13978
Abstract: Explore clinicians' perceptions of practice improvement strategies used to prevent harms to older people during acute hospitalisation. Older people are vulnerable to many interrelated preventable harms during acute care hospitalisation. Improvement strategies recommend standardisation of practices to assist healthcare staff to mitigate risk however, older people continue to suffer preventable harms in acute hospitals. A qualitative exploratory descriptive design was used to collect data using focus groups and in idual interviews from a purposive s le of 33 participants. Participants represented a wide range of clinicians from four erse healthcare organisations. Qualitative content analysis used a framework informed by common preventable harms derived from key literature and policy documents. Participants' perceptions of practice improvement strategies varied depending on their role within their organisational hierarchy. Recognition of preventable harms was guided by standard risk assessment and management tools used in their organisations. Preventable harms relating to skin integrity and falls were universally recognised across all sites and roles. Alternatively, there was variability in participant recognition of preventable harms related to nutrition, continence, medications and cognition pain was consistently overlooked as a contributor to preventable harms. Hospital staff perceived standard clinical risk assessment and management tools as the main practice improvement strategy to prevent harms. These tools prompted staff recognition of preventable harms to older people during acute hospitalisation. Variability in the recognition of some preventable harms was attributed to variable use of standard assessment tools. Pain was unlikely to be recognised as contributing to preventable harms. Clinical Risk Management tools may assist clinicians in recognising and responding to preventable harms to older people during hospitalisation. These tools provide critical resources for consistent and timely assessment and evaluation of risk for preventable harms.
Publisher: Wiley
Date: 07-05-2021
DOI: 10.1111/NHS.12844
Abstract: Nurses' awareness and acceptance of their professional responsibilities across the full breadth of safety and quality‐related practices and behaviors are critical for high quality healthcare delivery. The purpose of this study was to develop and psychometrically test a new instrument to measure nurses' perceptions of their responsibilities related to healthcare quality. Participants were registered nurses, enrolled in a postgraduate program at an Australian university, who completed the Likert scale instrument with items developed from nurses' professional practice standards. Steps of pilot testing, item reduction, and confirmatory factor analysis resulted in a five‐subscale, 55‐item instrument with acceptable goodness‐of‐fit indices and good internal consistency reliability. Test–retest reliability demonstrated acceptable temporal stability. The Nurses Responsibilities in Healthcare Quality Questionnaire demonstrated acceptable validity and reliability. The instrument may assist education providers and health service managers to identify gaps between nurses' beliefs and professional role expectations, and evaluate the impact of educational and clinical initiatives designed to develop nurses' knowledge, skills, and attitudes related to healthcare quality.
Publisher: Wiley
Date: 25-01-2021
DOI: 10.1111/NHS.12803
Abstract: This naturalistic, pre‐ and post‐design study explored the feasibility and acceptability of a brief patient safety intervention to introduce a tool to standardize interdisciplinary communication processes at patient handoff between anesthetists and postanesthesia nurses in the postanesthetic care unit. Observation and interview data were collected pre‐ and post‐intervention from a convenience s le of 27 nurses and 23 anesthetists in a large tertiary hospital in Melbourne, Australia. Following the intervention, significant improvement was observed in nurses' performance of several patient safety behaviors, but trends in nurses' interdisciplinary communication behaviors such as asking questions and escalation of care were nonsignificant. This research provides evidence that tools to standardize clinical handoff communication may empower nurses to perform desired patient safety behaviors during interprofessional handoff. It underpins future research to explore strategies to empower nurses to advocate for patient safety during interdisciplinary communication, and provides a foundation for patient handoff improvement, education, and further research.
Publisher: Wiley
Date: 14-03-2023
DOI: 10.1111/JOCN.16285
Abstract: To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH). Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments. Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169‐bed RACH. This paper reports qualitative findings of the 2‐year evaluation. Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants resident/visitor and staff hallway interviews and responses to open‐ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines. 325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time‐saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling in idualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co‐design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents. A strong emphasis on co‐design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well‐being including identification of missed care. Nurses, carers, administrators, and advocates can support the co‐design creation of information systems that suit the workflow of an organisation and keep the focus on in idualised models of care provision.
Publisher: Wiley
Date: 20-03-2023
DOI: 10.1111/NICC.12897
Abstract: Nurses are often the first responders to in‐hospital cardiac arrest in postoperative cardiac surgical patients. Poor clarity about role expectations and responsibilities can hinder nurses' performance during cardiac advanced life support (CALS) procedures. To seek expert consensus on nurses' roles and responsibilities in CALS for patients in postoperative cardiac surgical patients. A two‐round modified eDelphi survey. Delphi items were informed by guideline literature, an audit of resuscitation records and expert interviews. Panellists, drawn from a single site of a large tertiary health service in metropolitan Melbourne, included nurses, doctors and surgeons familiar with the management of cardiac arrest in post‐operative cardiac surgical patients. The two rounds of the modified eDelphi generated 55 responses. A consensus of % agreement was reached for 24 of the 41 statements in Round 2. All items related to nurses' roles and responsibilities during nurses pre‐ and post‐arrest phases reached consensus. In contrast, only 29% ( n = 4/14) of items related to peri‐arrest, and 36% of those related to nurse scope of practise in CALS arrest ( n = 4/11) reached consensus. The study's aim was only partially achieved. Findings indicate high agreement about nurses' roles and responsibilities before and immediately after a cardiac arrest, but limited clarity about nurses' roles when implementing the CALS protocol, such as resternotomy and internal cardiac massage. There is an urgent need to address uncertainty about nurses' roles and scope of practice in CALS, which is essential to the recognition of nurses' contribution to the cardiac specialty workforce. Uncertainty about nurses ‘roles and responsibilities when implementing the CALS protocol may hinder their performance to their full scope of practice, leading to poor patient outcomes.
Start Date: 2019
End Date: 2021
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 07-2010
End Date: 12-2013
Amount: $140,000.00
Funder: Australian Research Council
View Funded Activity