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AIMS: This study quantifies the types and frequencies of missed care identified by nurses and measures its impact on their capacity to demonstrate mandatory practice standards as future hospital staff. BACKGROUND: Considerable literature exists as to the nature of missed care but there is a paucity of findings about how missed care impacts on learning firstly as a student and then as a graduate nurse employed in a hospital setting. Additionally, there is little emphasis as to how staff development for nurses exposed to missed care may be implemented. METHODS: A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed care from nurses engaging in clinical experience. A convenience sample of 471 nursing students completing their undergraduate nursing degree programme was explored. A multi-variate statistical approach was used to apply and then model the consensus scores of undergraduate nurses' beliefs about the frequency of missed care. Implications for their developing competence in critical thinking, therapeutic communication and maintaining capacity for professional practice has been considered. RESULTS: Eight variables directly affect student's total scores underpinning their understanding of missed care and their ability to meet professional standards of practice, given their exposure to care omission. These factors reflect differing nurse attributes, the nature of the clinical venues and shift times, preceptor type, student satisfaction with work teams and staffing adequacy. CONCLUSIONS: Modelling outcomes suggest possible changes to hospital staff development learning programme content, learning processes and how it may be better delivered through to minimize episodes of missed care. IMPLICATIONS FOR NURSING MANAGEMENT: Staff development needs to note that nursing staff believe missed care occurs across all three-patient acuity domains with patient observation, education, support, and timely medication administration being most frequently omitted. Different clinical venues within the hospital sector and shift times vary in nurses' exposure with missed care. Student nurses' learning and associated development of practice standards is impacted by prior exposure to missed care during clinical placement. Non-native English-speaking nurses require greatest learning support in the presence of missed care. As missed care can be predicted, remedial changes to the nurse staff development program content and learning processes can be orchestrated.
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Bacharelado em Enfermagem , Recursos Humanos de Enfermagem Hospitalar , Estudantes de Enfermagem , Humanos , Desenvolvimento de Pessoal , AprendizagemRESUMO
AIM: To compare the perceptions of nurses with infection control expertise and ward nurses as to what infection control activities are missed and the reasons why these activities are omitted. BACKGROUND: Infection prevention activities are viewed as important for reducing health care-acquired infections (HAIs) but are often poorly performed. METHODS: Data were collected through the Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey delivered to 500 Australian nurses prior to COVID-19. RESULTS: Significant differences were found on the mean scores between infection control and other nurses on ten items. In eight cases, five relating to hand hygiene, infection control specialists viewed the activity as more likely to be missed. Factors viewed as having greater contribution to omission of infection control prevention were as follows: 'Patients have to share bathrooms', 'Urgent patient situation' and 'Unexpected rise in patient volume and/or acuity on the ward/unit'. Infection control nurses were more likely to highlight the role of organisational and management factors in preventing effective infection control. CONCLUSIONS: Differences in response between nurses suggest that the extent of omission of infection control precautions may be under-estimated by ward nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Infection control specialists are more likely to identify organisational barriers to effective infection control than other nurses. Work demands arising from pandemic management may contribute to infection control precautions being missed.
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COVID-19 , Enfermeiros Clínicos , Cuidados de Enfermagem , Recursos Humanos de Enfermagem Hospitalar , Austrália , Humanos , Controle de Infecções , SARS-CoV-2RESUMO
PROBLEM: Families living in rural communities need to relocate, be transferred or travel long distances to access specialist maternal and neonatal care, leading to isolation from their support networks. BACKGROUND: High-risk maternal and neonatal complexities in rural maternity units results in more transfers and retrievals to metropolitan services. There is limited understanding of the physical and psychological impacts for women and their families when they are transferred or displaced from their rural communities during pregnancy. AIM: To investigate the lived experience of relocation for specialist pregnancy, birthing, postnatal and neonatal care on women and families. METHODS: Women (n=5) and partners (n=4) from rural South Australia, participated in semi-structured interviews on their experiences of transfer from local maternity providers. Couples interviewed together, interactions were recorded, transcribed verbatim and thematically analysed to identify overarching and sub-themes. FINDINGS: The overarching theme was 'mismatched expectations', with three identified sub-themes: 'communication', 'compassion' and 'safety'. Discrepancies between expectations and realities during relocation left participants feeling isolated, alone and needing to self-advocate during this vulnerable period. Despite receiving specialist care, women and partners encountered unique hardships when separated from their rural community. Their social needs were poorly understood and seldom addressed in specialist units, resulting in poor experiences. DISCUSSION: Consideration regarding the impact of attending specialist maternity services for women and partners from rural areas is required. The 'one size fits all' approach for maternity care is unrealistic and research is needed to improve the experiences for those uprooted from rural communities for higher levels of care.
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Serviços de Saúde Materna , Transferência de Pacientes , População Rural , Humanos , Feminino , Gravidez , Recém-Nascido , Serviços de Saúde Rural , Apoio Social , Complicações na Gravidez , Pesquisa Qualitativa , Masculino , AdultoRESUMO
AIM: To identify the barriers and facilitators having an impact on the progression and completion of studies for students who give birth during their midwifery program. BACKGROUND: Balancing the demands of pregnancy and new motherhood with the rigorous academic requirements of a tertiary-level midwifery program is challenging for students wishing to progress and complete their studies. Understanding the barriers and facilitators students face when resuming midwifery studies following birth can assist universities in providing educational environments that support students in achieving their midwifery education. DESIGN: Social media online Qualtrics survey with closed and open questions. METHOD: Participants were Australian midwifery students who gave birth and returned to their midwifery studies within the past 5 years. Responses from 35 students were descriptively analysed. RESULTS: For students who commenced pregnancy during their midwifery degree, 40â¯% chose to take leave from their studies at term (37-40 weeks gestation) or continue their studies without leave. Almost half of the students (n=17) chose to return to their studies before six weeks post birth (68â¯% (n=24) opting for a part-time pathway). Most of the childcare was undertaken by the student's partner (n=9) or other family members (n=8). Work integrated learning, rostering of shifts and being on call for Continuity of Care Experience relationships accounted for the most significant number (n=19) of responses when identifying barriers to resuming midwifery studies. CONCLUSIONS: The greatest barrier for students is work integrated learning while juggling the transition to parenthood. Universities must work closely with maternity services to support students in completing their studies.
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Tocologia , Licença Parental , Estudantes de Enfermagem , Humanos , Feminino , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários , Tocologia/educação , Austrália , Projetos Piloto , Gravidez , Adulto , Bacharelado em EnfermagemRESUMO
BACKGROUND: The military is a male-dominated environment and culture in which women veterans can experience significant institutional prejudice. Transition can be confusing and isolating for women veterans. Group programs are an important source of transition support. However, we know little about the specific group program needs of women veterans. OBJECTIVES: To examine mental health and well-being support group programs delivered to women veterans, to understand what they value and find most helpful. ELIGIBILITY CRITERIA: Women military veterans (all types); empirical studies using any design; published between 1990 and 2022; group programs focused on transition issues (such as housing, employment, education, physical health, mental health). SOURCES OF EVIDENCE: Peer-reviewed journals and theses. CHARTING METHODS: Six databases searched: Medline (via Ovid SP), PsycINFO (via Ovid SP), EmCare (via Ovid SP), CINAHL, Scopus, and ProQuest. RESULTS: There was significant heterogeneity across 35 included studies in type of groups, program content and structure, length of sessions, measurement of impact, follow-up, and so forth. Most programs were delivered face to face. Physical health and preventative healthcare were important topics for women veterans, particularly reproductive health, mental health, and chronic pain. Groups that included physical activity, creative arts, and alternative therapies were beneficial to women's physical and mental health. Strengths-based women-only groups, facilitated by women, that created safe spaces for women veterans to share their experiences, enhanced self-expression, agency, and self-empowerment. This was particularly important for women who had experience military sexual trauma. CONCLUSION: This review found a small but diverse range of group programs available for women veterans. Many program evaluations were of moderate or low quality and lacked sufficient information to determine whether benefits were sustained over time. No studies involved Australian women veterans. Despite these concerns, this review highlighted several useful lessons that could help inform improved design, delivery, and evaluation of group programs for women veterans.
Review of women veteran transition mental health and well-being support group programsWomen veterans learn to become soldiers, sailors and aviators in a male-dominated environment and culture in which their presence is highly visible, challenged and often subject to institutional prejudice. Transition can be confusing and isolating for women veterans. We know little about the specific needs of women veterans to support them to transition successfully to civilian life. Group programs are an important source of transition and post-transition support for veterans. The aim of this review was to examine the existing literature on mental health and well-being support group programs delivered to women veterans to understand what women veterans value and find most helpful in the design and delivery of such programs. Thirty-five studies were included in this review; 33 of these were conducted in the United States. They were of mixed quality and diverse design. Women only groups were favored. Strengths-based Programs that help to build emotional strengths, agency and empowered women were valued by them. Physical health and preventative healthcare are important topics for group programs for women veterans, as are creative arts and alternative therapies that facilitate self-expression and self-empowerment.
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Saúde Mental , Veteranos , Humanos , Feminino , Veteranos/psicologia , Grupos de Autoajuda , Saúde da MulherRESUMO
Women's experiences of military service and transition occur within a highly dominant masculinized culture. The vast majority of research on military veterans reflects men's experiences and needs. Women veterans' experiences, and therefore their transition support needs, are largely invisible. This study sought to understand the role and impact of gender in the context of the dominant masculinized culture on women veterans' experiences of military service and transition to civilian life. In-depth qualitative interviews with 22 Australian women veterans elicited four themes: (1) Fitting in a managing identity with the military; (2) Gender-based challenges in conforming to a masculinized culture-proving worthiness, assimilation, and survival strategies within that culture; (3) Women are valued less than men-consequences for women veterans, including misogyny, sexual harassment and assault, and system failures to recognize women's specific health needs and role as mothers; and (4) Separation and transition: being invisible as a woman veteran in the civilian world. Gendered military experiences can have long-term negative impacts on women veterans' mental and physical health, relationships, and identity due to a pervasive masculinized culture in which they remain largely invisible. This can create significant gender-based barriers to services and support for women veterans during their service, and it can also impede their transition support needs.
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Veteranos , Humanos , Feminino , Veteranos/psicologia , Austrália , Adulto , Pessoa de Meia-Idade , Militares/psicologia , Cultura , IdosoRESUMO
Objective There are no guidelines to assist midwifery academics or students in determining the optimal time to return to their educational programs following pregnancy. Rather, students need to navigate balancing new motherhood with the pressures of returning to their clinical midwifery placement and completing their statutory requirements to meet the Australian Midwife Accreditation Standards before the end of their program. The aim of this study was to seek best practice information that provides guidance to academics supporting midwifery students returning to study after maternity leave. Methods An analysis of contemporary Australian legislation, workforce guidelines, professional association statements, and university policies was undertaken to determine what guidance is available to assist midwifery academics in providing advice to midwifery students about the optimal time to return to their studies following birth. This document analysis was performed during 2021-2022 and followed Altheide and Schneider's 12 step process divided into five stages to clarify best practice advice for midwifery academics to provide guidance to students returning to study after maternity leave. Results Policy documents that refer to pregnancy confirm women have legal rights, and there is clear guidance on maternity leave; however, advice for midwifery students on the optimum time to return to study and clinical placements after birth is missing from the result of this document analysis search. Conclusion Transition to motherhood during the postnatal period is an important time. Clear national guidelines are needed to provide support and recommendations regarding a safe and optimal time to return to study and placement.
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Tocologia , Estudantes de Enfermagem , Feminino , Humanos , Gravidez , Austrália , Licença Parental , Tomada de DecisõesRESUMO
A major patient safety challenge is recognition and response to deteriorating patients since early warning signs are often not detected in a timely manner. Nursing students typically learn the skills for early identification through clinical placement, but clinical placements are not guaranteed to provide exposure to deteriorating patients. Nursing students require practice with emergency scenarios to develop their competency and confidence to act in this area. This study aimed to explore the impact of a virtual simulation intervention on the recognition and response to the rapidly deteriorating patient among undergraduate nursing students. A mixed methods study involving a quasi-experimental pre/post design and focus groups. The participants were third or final year undergraduate nursing students from five university sites across four countries (Canada, England, Scotland and Australia, n = 88). Students were randomly assigned to a treatment or control group. The treatment group received a virtual simulation intervention and participated in a focus group. The virtual simulation intervention had a significant effect on improving nursing student knowledge and clinical self-efficacy in the recognition and response to the rapidly deteriorating patient. Students reported that the virtual simulations decreased anxiety, helped them prioritize, filled gaps in their learning, and encouraged autonomous learning within a safe 'low risk' environment. Virtual simulation is an effective strategy for improving knowledge and confidence in recognizing and responding to the rapidly deteriorating patient among undergraduate nursing students.
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Bacharelado em Enfermagem , Estudantes de Enfermagem , Competência Clínica , Simulação por Computador , Bacharelado em Enfermagem/métodos , Humanos , Aprendizagem , Simulação de Paciente , AutoeficáciaRESUMO
This article reviews the literature addressing exercise programs for dialysis patients to identify elements necessary for sustaining exercise programs in this population. Literature searches for publications (January 1980-February 2009) in Medline (OVID), PubMed, CINAHL (EBSCO), EBSCOhost EJS, ProQuest Central, Web of Science, Cochrane Library, Google Scholar, ScienceDirect, SpringerLink (Kluwer), and Wiley Interscience (Blackwell) were performed. Reference lists from relevant articles were hand-searched for further publications. Criteria for inclusion included full-text primary research and review articles focused on exercise for adult hemodialysis patients. One hundred and seventy one publications were found with a primary focus on exercise in hemodialysis. Of these, 28 primary research and 14 review articles addressed one or more aspects of sustainability of hemodialysis exercise programs. Factors contributing to sustainable exercise programs included: dedicated exercise professionals; encouragement to exercise intradialytically; dialysis and medical staff commitment; adequate physical requirements of equipment and space; interesting and stimulating; cost implications need to be addressed; exercise is not for everyone; requires individual prescription; and there is no age barrier to exercise on hemodialysis.
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Terapia por Exercício , Diálise Renal , HumanosRESUMO
INTRODUCTION: The incidences and types of missed nursing care in the acute care and community sectors are both ubiquitous and quantifiable, however, there are few research studies relating to the type and frequency of missed maternity-based care for mothers and families. The aim of this study is to estimate the incidences and types of Australian missed midwifery care and to identify those factors that have causal links to it. METHODS: A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to ascertain consensus estimates made by Australian midwives. Electronic invitations were extended to their membership using an inclusive link to the MISSCARE survey. Inclusion criteria were all ANMF members who were midwives and currently employed within the Australian public and private healthcare systems. Data analysis was undertaken using both Rasch analysis and Structural Equation Modelling. RESULTS: The type and frequency of missed Australian midwifery care can be quantified and several demographic factors are significant predictor variables for overall missed midwifery care. The most prevalent aspects of missed care in the Australian midwifery setting are midwives' hand hygiene, supportive care, perinatal education, and surveillance type midwifery practices. CONCLUSIONS: As the frequencies and types of missed midwifery care in Australia have been identified, it is possible for midwives to be mindful of minimising care omissions related to hand hygiene, providing supportive care and education to mothers as well as surveillance-type midwifery practices.
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This article was migrated. The article was marked as recommended. Background: Developing critical thinking in health care education is pivotal in student development and patient outcomes. Gamification and learning through play within health care education is rising in popularity and may assist to develop problem-solving and critical thinking skills. Aim: To develop and enhance students' capacity to rapidly recall and communicate critical links in practice through a modified 'snap' game. Method: Students are provided decks of cards depicting clinical pictures (syringe, bath, blood, medications etc). Turning over two cards at a time, the students race to link the two concepts together. Findings: Linking Out Loud was well received by students and worked to develop knowledge, critical thinking, communication and problem-solving. Linking Out Loud could be easily replicated for all health disciplines.
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AIMS AND OBJECTIVES: To review the literature and identify opportunities for nutritional practice improvement in the critically ill and opportunities to improve nurses' knowledge relating to enteral feeding. BACKGROUND: The literature reports varying nutritional practices in intensive care. DESIGN: Systematic review. METHODS: A systematic search, selection, analysis and review of nursing, medical and dietetic primary research articles was undertaken. Fifteen studies met the selection criteria. RESULTS: Delivery of nutrition to the critically ill varied widely. Patients were frequently underfed and less frequently, overfed. Both under- and overfeeding have been linked with unacceptable consequences including infections, extended weaning from mechanical ventilation, increased length of stay and increased mortality. Underfeeding was related to slow initiation and advancement of nutrition support and avoidable feed interruptions. The most common reasons for interrupting feeds were gastrointestinal intolerance and fasting for procedures. Certain nursing practices contributed to underfeeding such as the management of gastric residual volumes. CONCLUSIONS: Consistent and reliable nutrition support in intensive care units is hampered by a lack of evidence leading to varying nutrition practices. Factors impeding delivery of enteral nutrition were considered avoidable. A new concept of a therapeutic range of energy delivery in the critically ill has emerged implying the need for re-evaluation of energy recommendations and improved delivery of enteral nutrition. RELEVANCE TO CLINICAL PRACTICE: This review supports the multi-disciplinary development and implementation of an evidence-based enteral feeding protocol in intensive care units as a strategy to improve adequacy of nutritional intake. Critical care nurses are well placed to improve this process.
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Nutrição Enteral/enfermagem , Unidades de Terapia Intensiva , Nutrição Enteral/normas , Humanos , Qualidade da Assistência à SaúdeRESUMO
The nursing profession struggles with providing a bridge to close the theory to practice gap for students. Students are expected to graduate with competencies that promote their safe and comprehensive nursing care provision in accordance with professional standards. This paper reports on students' a simulated clinical educational intervention embedded into a second-year nursing student clinical topic offering experiential learning opportunities for a large cohort. Feedback was analysed using Braun and Clarke's (2006) thematic qualitative process to investigate student-learning experiences and present student perceptions of this experience. Three key themes were identified: support promoted learning, focus on the bigger picture and practice clarifies puzzle pieces. Students perceived the simulated clinical experience as beneficial to their confidence, learning and ability to develop their professional practice. Promotion of learning outcomes facilitated by the structured, supportive and educational approach was important for students. Nurse educators have a responsibility to develop learning experiences that enable student's ability to link theory to practice in context. Ongoing exploration and evaluation of this intervention is required however, such an approach appears to support student's knowledge development for transference across situations and within large student cohorts.
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Avaliação Educacional/normas , Percepção , Preceptoria/normas , Estudantes de Enfermagem/psicologia , Competência Clínica/normas , Avaliação Educacional/métodos , Humanos , Preceptoria/métodos , Aprendizagem Baseada em Problemas/métodosRESUMO
BACKGROUND: Immersive virtual reality is an advancing technology that has the potential to change the traditional pedagogical approaches to teaching tertiary nursing and midwifery students. The application of immersive virtual reality in nursing and midwifery education may be a novel, accessible method for information provision and skill acquisition, however little is known of the extent of immersive virtual reality technology integration into tertiary nursing and midwifery programs. OBJECTIVES: The purpose of this review is to identify the application and integration of immersive virtual reality within nursing and midwifery tertiary education programs. DESIGN: A scoping review based on the Joanna Briggs Institute methodology for scoping reviews was undertaken. An a priori review protocol and eligibility criterion was developed with the protocol subject to review a posteriori following first round screening. An electronic search of ten databases was conducted in January 2018. RESULTS: A total of nâ¯=â¯506 non-duplicate records were identified and subjected to level one and level two screening. The search strategy and screening process identified nâ¯=â¯2 articles that were quality checked and included for review. CONCLUSIONS: There is currently a paucity of quality published literature on the application and/or integration of immersive virtual reality into nursing and midwifery tertiary education. Immersive virtual reality has the potential to increase competence and confidence for students providing accessible and repeatable learning opportunities in a fail-safe environment. There is a need for educators to be involved in the conceptualisation, design, integration and research of immersive virtual reality technology into undergraduate nursing and midwifery programs.
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Competência Clínica , Bacharelado em Enfermagem/métodos , Tocologia/educação , Estudantes de Enfermagem/psicologia , Realidade Virtual , Feminino , Humanos , AprendizagemRESUMO
While use of simulation in nursing education is both complex and well established, learning by re-doing is a scaffolded learning strategy neglected in simulation and minimal research has been conducted with it.
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Bacharelado em Enfermagem/métodos , Manequins , Modelos Educacionais , Austrália , Competência Clínica , HumanosRESUMO
Effective feedback can enhance student learning, but limited evidence exists on whether nursing students actually use and learn from written feedback. This descriptive survey explored nursing students' perceptions regarding the amount and type of written feedback required to enhance their learning. In stage one, 362 students completed a 28-item questionnaire regarding feedback experiences and preferences; in stage two, 227 students selected a preferred feedback option for a final topic assignment. Findings revealed that many of the students wished to be engaged with the feedback process and believed effective written feedback can and does enhance their learning. However many students also reported learning barriers-including absent, inadequate, ambiguous, inconsistent, and ineffective feedback-indicating a significant disconnect between desired and actual feedback. Recommendations include a greater focus on engaging nursing students in the feedback process and evaluating the effectiveness of written feedback for individual students.
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Atitude do Pessoal de Saúde , Bacharelado em Enfermagem/métodos , Retroalimentação , Aprendizagem , Estudantes de Enfermagem/psicologia , Redação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa em Educação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Pesquisa Metodológica em Enfermagem , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Given increasing demand for renal replacement therapy, this study sought to identify of key workforce issues facing dialysis units, based on a "snapshot" of the current workforce. METHODS: A web-based survey of all dialysis unit managers in Australia and New Zealand, in October 2008, about their workforce. RESULTS: A significant minority of dialysis staff in most regions were not registered nurses. Many renal registered nurses worked part-time. Staff/patient ratios in dialysis units varied significantly by region, reflecting the relative prevalence of home therapies. Most dialysis units were generally adequately staffed. The proportion of registered nurses with specific renal qualifications varied significantly by region. CONCLUSION: The changing character of the workforce in the dialysis unit in the future will require clarification of the relationships between different categories of dialysis staff. Specialty education for nurses needs to be oriented to equipping staff to be effective in their changing work environment.