Given the increasing complexity of acute care settings, high patient acuity and demanding workloads, new graduate nurses continue to require greater levels of support to manage rising patient ...clinical care needs. Little is known about how change in new graduate nurses' satisfaction with clinical supervision and the practice environment impacts on their transitioning experience and expectations during first year of practice. This study aimed to examine change in new graduate nurses' perceptions over the 12-month Transitional Support Program, and identify how organizational factors and elements of clinical supervision influenced their experiences.
Using a convergent mixed methods design, a prospective survey with open-ended questions was administered to new graduate nurses' working in a tertiary level teaching hospital in Sydney, Australia. Nurses were surveyed at baseline (8-10 weeks) and follow-up (10-12 months) between May 2012 and August 2013. Two standardised instruments: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS) were used. In addition to socio-demographic data, single -item measures were used to rate new graduate nurses' confidence, clinical capability and support received. Participants were also able to provide open-ended comments explaining their responses. Free-text responses to the open-ended questions were initially reviewed for emergent themes, then coded as either positive or negative aspects of these preliminary themes. Descriptive and inferential statistics were used to analyse the quantitative data and the qualitative data was analysed using conventional content analysis (CCA). The study was approved by the relevant Human Research Ethics Committees.
Eighty seven new graduate nurses completed the follow-up surveys, representing a 76% response rate. The median age was 23 years (Range: 20 to 53). No change was seen in new graduate nurses' satisfaction with clinical supervision (mean MCSS-26 scores: 73.2 versus 72.2,
= 0.503), satisfaction with the clinical practice environment (mean PES-AUS scores: 112.4 versus 110.7,
= 0.298), overall satisfaction with the transitional support program (mean: 7.6 versus 7.8,
= 0.337), satisfaction with the number of study days received, orientation days received (mean: 6.4 versus 6.6,
= 0.541), unit orientation (mean: 4.4 versus 4.8,
= 0.081), confidence levels (mean: 3.6 versus 3.5,
= 0.933) and not practising beyond personal clinical capability (mean: 3.9 versus 4.0,
= 0.629). Negative responses to the open-ended questions were associated with increasing workload, mismatch in the level of support against clinical demands and expectations. Emergent themes from qualitative data included i) orientation and Transitional Support Program as a foundation for success; and ii) developing clinical competence.
While transitional support programs are helpful in supporting new graduate nurses in their first year of practice, there are unmet needs for clinical, social and emotional support. Understanding new graduate nurses' experiences and their unmet needs during their first year of practice will enable nurse managers, educators and nurses to better support new graduate nurses' and promote confidence and competence to practice within their scope.
To explore how nurses and nursing knowledge contributed to the success of an Australian nurse-led medical hotel quarantine facility during the COVID-19 pandemic. The facility was established to ...accommodate returning travellers who were COVID-19 positive or at risk of becoming positive, to travellers requiring complex care and expanded to community members who could not quarantine at home.
This descriptive qualitative study explored how nurses and nursing knowledge in the quarantine facility contributed to the low transmission incidence of COVID-19 infection.
Twelve semi-structured interviews were conducted via ZOOM from February to May 2022 with all levels of nursing staff (nurse managers to assistants in nursing) who had worked in the facility for 3 months or more. The nurses were asked to describe their experiences, the challenges they faced and how they overcame them. The data were rich and were analysed using Braun and Clarke's six-step thematic analysis.
Four broad themes were generated demonstrating how nurses played a pivotal role in the success of the facility. First: nursing knowledge was evident through the development of policies, which minimized risks to nurses and patients. Second: a community of learning was developed as nurses supported upskilling and capacity building of staff, particularly new graduates with the facility. Third: a supportive management structure promoted teamwork and a positive workplace culture. And finally: the nurses were encouraged to develop techniques that promoted self-care which enabled them to develop resilience.
This was a nurse-led service that developed strategies to manage care delivery and overcame unanticipated difficulties in a unique clinical setting.
The quality of the research design was ensured by using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.
No patient or public contribution.
To determine the scope of published literature on healthcare transition (HCT) interventions that have been co-designed with adolescents and young adults with chronic conditions, and to undertake ...feasibility assessments.
Using Scopus, CINAHL, Medline-Ovid, Cochrane and PsycINFO databases, publications that included a HCT intervention to support paediatric to adult healthcare transition were included. Study location, design, population, description of the intervention, co-design methods, feasibility evidenced using Bowen and colleagues' framework, and outcome measures were extracted for review.
A total of 21 studies were included, relating to 17 co-designed HCT interventions that ranged across multiple medical specialties. There was no standard HCT intervention; characteristics, format and delivery mode varied. Only three studies reported a detailed description of the co-design method(s) used and none reported on the facilitators or barriers. Among the studies, five of Bowen and colleagues' eight dimensions of feasibility were measured.
Despite the co-design process being neither described or evaluated extensively, all co-designed HCT interventions included in this review were considered to be feasible. Nevertheless, HCT interventions varied in their format and delivery method making it difficult to compare between them. Furthermore, interventions were often condition-specific and not representative of the extensive range of chronic conditions.
Implications for Rehabilitation
Healthcare transition interventions can improve adherence to care, health outcomes, ongoing rehabilitation, and quality of life of adolescents and young adults with chronic conditions.
Healthcare transition interventions should maximise long-term functioning and prioritise rehabilitation aimed at enhancing independence and self-management skills, while reducing hospitalisations.
The engagement of individuals with lived experience in the co-design of interventions has been strongly advocated as it brings unique knowledge and experience to the research process.
Minimal attention has been given to the involvement of adolescents and young adults with chronic conditions in the development of healthcare transition interventions, however, healthcare transition interventions co-designed with adolescents and young adults with chronic conditions are both feasible and acceptable.
Guideline implementation has been an ongoing challenge in the dental practice setting. Despite this, there are no reviews summarising the existing evidence regarding effective guideline ...implementation strategies in this setting. In order to address this, this systematic review examines the effectiveness of guideline implementation strategies in the dental practice setting.
A systematic search was undertaken according to the PRISMA statement across nine electronic databases, targeting randomised controlled trials and quasi-experimental studies which evaluated the effectiveness of guideline implementation strategies in improving guideline adherence in the dental setting. All records were independently examined for relevance and appraised for study quality by two authors, with consensus achieved by a third author. Data were extracted from included studies using a standardised data extraction pro forma.
A total of 15 records were eligible for inclusion in this review, which focused on the effects of audit and feedback, reminders, education, patient-mediated interventions, pay for performance and multifaceted interventions. Although there were some conflicting evidence, studies within each category of implementation strategy indicated a positive effect on guideline adherence.
This study has identified education, reminders and multifaceted interventions as effective implementation strategies for the dental practice setting. Although this is similar to research findings from other health sectors, there is some evidence to suggest patient-mediated interventions may be less effective and pay for performance may be more effective in the dental setting. These findings can inform policy makers, professional associations, colleges and organisations in the future adoption of clinical guidelines in the dental practice setting.
This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration ID CRD42018093023.
To develop and test the psychometric properties of an expanded catheter self-management scale for patients with in-dwelling urinary catheters.
A cross-sectional validation study. Despite the utility ...of the original 13-item catheter self-management scale, this instrument did not include bowel management, general hygiene and drainage bag care, which are fundamental skills in urinary catheter self-management to prevent common problems resulting in unnecessary hospital presentations. The expanded catheter self-management scale was developed with 10 additional items to comprehensively assess all five essential aspects of urinary catheter self-management.
A total of 101 adult community-dwelling patients living with indwelling urinary catheters were recruited from Western Sydney, Australia. Using exploratory factor analysis with Varimax rotation, the number of factors to be extracted from the expanded 23-item expanded catheter self-management scale was determined using a scree plot. The reliability of the overall scale and subscales was measured using Cronbach's alpha. Convergent validity was assessed using Spearman's correlations between clinical characteristics, overall scale and subscales.
The 23-item expanded catheter self-management scale yielded a 5-factor solution, labelled as: (i) self-monitoring of catheter function, (ii) proactive, help-seeking behaviour function, (iii) bowel self-care function, (iv) hygiene-related catheter site function and (v) drainage bag care function. Cronbach's alpha of the expanded catheter self-management scale indicating all 23 items contributed to the overall alpha value. Convergent validity results showed a negative correlation between the overall expanded catheter self-management scale and catheter-related problems.
The 5-factor structure provided a comprehensive assessment of key aspects of urinary catheter self-management essential to reduce the likelihood of catheter-related hospital presentations.
The expanded catheter self-management scale can be used to assess and monitor effective patient-centred interventions for optimal self-management to prevent catheter-related problems and improve the quality of life of patients.
Many patients start their journey of living with a urinary catheter unexpectedly and are not supported with quality information to care for their catheter. The findings of this study show the correlation between catheter self-management skills and catheter-related problems. The expanded catheter self-management scale (E-CSM) assists with analysing the self-management skills of patients living with a catheter and developing tailored interventions to prevent problems and improve their quality of life. In addition, this screening tool can be included in policies, guidelines, and care plans as a standard for improving catheter management and developing educational resources for patients.
STROBE checklist was used to report all aspects of this study comprehensively and accurately.
Patients living with indwelling urinary catheter and their carers have participated in surveys, interviews and co-designing interventions. This paper reports the psychometric analysis of the expanded catheter self-management scale (E-CSM) used in the patient survey as part of the main study 'Improving Quality of Life of Patients Living with Indwelling Urinary Catheters: IQ-IDC Study' (Alex et al. in Collegian, 29:405-413, 2021). We greatly value our consumers' contributions and continue to communicate the progress of the study to them. Their contributions will be acknowledged in all publications and presentations. In addition, all participants will be provided the option of receiving the interventions and publications generated from this study.
End-of-life (EOL) decision-making in the intensive care unit (ICU) can be emotionally challenging for both doctors and nurses, who are sometimes placed in difficult positions where they are required ...to make decisions on behalf of patients. With an ageing population and advances in medical technology, there is an increase in such decisions being made in ICUs.
The objective of this study was to explore the perspectives of doctors and nurses involved in the EOL decision-making process in an ICU.
This study used a qualitative methodology based on naturalistic inquiry. Intensive care nurses and doctors from a large Sydney metropolitan public hospital were purposively selected, and data saturation was reached after a total of eight nurses and four doctors were interviewed. Data were collected through semistructured interviews, either face-to-face or over the telephone. Interviews were then transcribed verbatim, and themes were identified and coded through a line-by-line analysis of each transcript (manual thematic analysis).
The findings revealed two main themes: ‘Doctors' and nurses' roles in decision-making’ and ‘Managing family expectations’. These themes highlighted key differences in decision-making processes, in that doctors tended to aim to meet the family's needs, while the nurses tended to advocate on behalf of the patient and what they interpreted as the patient's best interests. Furthermore, nurses tended to feel undervalued in decision-making during family conferences, when in reality, the doctors were making decisions based on all information obtained, primarily from nursing staff.
EOL decision-making is complex and affects doctors and nurses involved in different ways. More emphasis on interprofessional education and collaboration between the two disciplines may enhance future decision-making processes.
With the increasing use of technology in nursing, the importance of interpersonal skills can often be forgotten. Patient safety can also be compromised if these skills are not emphasised in nursing ...education.
This review explores how drama in undergraduate and postgraduate nursing education can enhance the development of interpersonal skills such as empathy, emotional intelligence and communication.
A critical review of qualitative literature.
Seven databases (CINAHL, MEDLINE, Scopus, Eric, Psycinfo, and databases dedicated to the Arts, Modern Language Association (MLA) and JSTOR were searched.
Studies were screened against inclusion and exclusion criteria. Data from studies selected for the review were extracted using a summary table and a thematic analysis was conducted to identify major themes to answer the research question.
1275 studies were identified. Following a rigorous screening process, 29 studies met the inclusion criteria and were critically appraised using the CASP tool. Of the 29 studies, 17 were excluded due to their methodological quality. A final 12 studies were included in this review. Four themes demonstrated the value of drama in nursing education. These were an understanding of the patient experience, the development of professional identity, the enhancement of communication skills and increased self-reflection and critical thinking.
Interpersonal skills are at the core of nursing and educational interventions that use drama can enhance the development of these skills.
•Drama as a nursing educational intervention promotes interpersonal skills.•Students are assisted in understanding the patient experience through drama.•Drama can develop the professional identity of students.•Drama can enhance communication skills, self-reflection and critical thinking.
To examine misconceptions towards men in nursing from the perspective of undergraduate nursing students. Specifically, this study sought to explore contributing factors of misconceptions and ...attributions of the success of men in nursing.
A convergent parallel mixed-method study.
A national survey was conducted (July-September 2021). The quantitative data included demographics and responses to the Gender Misconceptions of Men in Nursing (GEMINI) scale. The qualitative data included responses to a provocative statement related to characteristics of men and their career in nursing. The GRAMMS guideline was used in reporting.
Undergraduate nursing students (n = 1245) from 16 Australian schools of nursing responded to the survey. Quantitative analysis demonstrated that most students (96%) did not have misconceptions about men in nursing. Those who did were more likely to be men, born overseas, not in health-related employment and did not have nursing as their first choice. Four broad overarching main themes were generated in response to the statement that suggested men do not have the right attributes for nursing: (1) 'This is a very misandristic viewpoint'; (2) 'Compassion and intelligence are distributed in men and women equally'; (3) 'Men bring a different quality to nursing' (4) 'Anyone can be whatever they want to be'.
Overall, nursing students did not have misconceptions about men in nursing, despite experiencing ongoing social stigma regarding archaic gender norms. The findings from this study indicate that the next-generation nurses were championing to challenge the gender stereotype and support the needs of a gender diverse society.
Attitudes and misconceptions that elicit gender inequalities must be addressed with comprehensive strategies and de-gendered language and imagery within the profession, schools, workplaces and the media. Shifting culture and attitudes towards inclusion, values the diversity in the workforce and supports healthy workplace environments.
No patient or public contribution.
Nurses working in adolescent health often lack educational opportunities to develop their knowledge and practical skills to address the challenges faced by adolescents and young adults. This ...integrative review synthesised the evidence from peer-reviewed research that focused on educational programs to improve nurses' knowledge, attitude, and practice in adolescent and young adult health.
The five-stage framework by Whittemore and Knafl guided the integrative literature review and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement.
A single search strategy was replicated across five electronic databases (CINAHL Plus, APA PsycInfo, PubMed, Scopus, and ERIC). Studies of educational interventions or training programs for nurses on adolescent and young adult health, published in English in the last 10 years were included.
All studies found were reviewed for relevance independently by two authors, who likewise critically appraised the quality using the “Critical appraisal checklist for an article on an educational intervention” adapted from Morrison et al. (1999), with a third author providing consensus. Data were extracted using study specific standardised proforma and thematically analysed.
Seven studies met the inclusion criteria. Topics covered included cancer care, mental health and self-harm, with only one program including general adolescent health. A mix of face-to-face and digital asynchronous mode of delivery was employed in these programs with multi-strategic approaches used to enhance accessibility and engagement. While all studies reported improvement in knowledge and practice, including enhanced communication skills, some studies reported limited change in attitude. Success of the interventions was attributed to the flexibility of programs to accommodate nurses' workloads.
Education interventions for nurses delivering care to adolescent and young adults enhance knowledge and skills, however, programs with institutional support for flexibility and accessibility are needed to influence a positive change in attitude.
To identify subject matter, pedagogical approaches and assess outcomes of interventions implemented to educate nurses in urinary catheterisation care and management.
A systematic review was conducted ...according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.
Databases (CINAHL; MEDLINE; ProQuest; ERIC; Scopus; Cochrane; and APA PsycINFO) were searched using key concepts: education interventions, indwelling urinary catheter and nurses, from inception to July 2021.
Two researchers searched the databases, whereupon data were extracted using a standardised proforma and were analysed applying an abductive approach. The Joanna Briggs Institute Critical Appraisal tool was used to assess the quality of the included studies. Findings were analysed and reported using narrative synthesis.
Out of 1159 studies screened, nine educational intervention studies related to upskilling nurses in catheter management were identified. Subject matter addressed included pathophysiology of the urinary system, clinical indications and management of indwelling catheter and associated complications. Although the subject matter and pedagogical approaches varied, all identified studies reported positive effects in improving participants' knowledge.
Upskilling nurses and increasing their confidence to deliver patient-centred catheter care practices is an important intervention to improve outcomes for patients with long-term indwelling urinary catheters. However, actively engaging nurses who provide direct patient care is essential, in planning and implementing targeted educational interventions specific to learning needs. This review has identified a gap in the educational interventions for nurses, in better supporting the psychosocial needs of patients living with indwelling catheter. Codesigning educational interventions with nurses that are tailored to their contextual learning needs is likely to enhance behaviour change and improve current practice.
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