Consensus-based recommendations for the care of women with a breech presenting fetus.

OBJECTIVE: To establish consensus related to aspects of breech presentation and care. DESIGN: A multinational, three round e-Delphi study. PARTICIPANTS: A panel of 15 midwives, four obstetricians and an academic with knowledge and/or experience of caring for women with a breech presenting fetus. METHODS: An initial survey of 45 open-ended questions. Answers were coded and amalgamated to form 448 statements in the second round and three additional statements in the third round. Panellists were asked to provide their level of agreement for each statement using a 5-point Likert scale. Consensus was deemed met if 70% of panellists responded with strongly agree to somewhat agree, or strongly disagree to somewhat disagree after the second round. FINDINGS: Results led to the development of a consensus-based care pathway for women with a breech presenting fetus and a skills development framework for clinicians. KEY CONCLUSIONS: A cultural shift is beginning to occur through the provision of physiological breech workshops offered by various organisations and may result in greater access to skilled and experienced clinicians for women desiring a vaginal breech birth, ultimately improving the safety of breech birth. IMPLICATIONS FOR PRACTICES: The care pathway and skills development framework can be used by services wishing to make changes to their current practices related to breech presentation and increase the level of skill in their workforce.

Adherence to screening and management guidelines of maternal Group B Streptococcus colonization in pregnancy.

AIMS: To investigate Group B Streptococcus (GBS) colonization in pregnancy; adherence to antenatal GBS screening and adherence to the intrapartum antibiotics protocol within two models of care (midwifery and non-midwifery led). DESIGN: This retrospective quantitative study has employed a descriptive design using administrative health data. METHODS: Data from five maternity hospitals in metropolitan and regional Western Australia that included 22,417 pregnant women who gave birth between 2015 and 2019 were examined, applying descriptive statistics using secondary data analysis. RESULTS: The study revealed an overall GBS colonization rate of 21.7% with similar rates in the different cohorts. A lower adherence to screening was found in the midwifery led model of care (MMC, 68.76%, n = 7232) when compared with the non-midwifery led model of care (NMMC, 90.49%, n = 10,767). Over the 5 years, screening rates trended down in the MMC with stable numbers in the counterpart. Adherence in relation to intrapartum antibiotic prophylaxis revealed discrepant findings between the study groups. CONCLUSION: Adherence to screening and management guidelines of maternal GBS colonization in pregnancy is lower within the MMC when compared with the NMMC. IMPACT: This is the first cohort study to describe the adherence to the recommended Western Australian GBS screening guidelines in the two different models of care. Findings may assist in the guidance and improvement of clinical protocols as well as the planning of clinical care in relation to GBS screening to reduce the risk of neonatal GBS infection.

Women's experiences of breech birth decision making: An integrated review.

INTRODUCTION: Currently, caesarean section is the primary mode of birth for a breech presenting fetus, leading to a deskilling of clinicians and limitation of birth choices for women. The aim of this review is to present a synthesized summary of existing literature related to women's experiences of breech birth mode decision-making. METHODS: A systematic search of the literature was conducted in April 2021, utilizing five databases to identify and obtain peer-reviewed articles meeting the predetermined selection criteria. RESULTS: Four major categories were synthesized from the integrated review: 1) Women who desire a vaginal birth may experience a range of negative emotions such as feelings of disempowerment, loss, uncertainty and a sense of isolation; 2) Women who experience a breech presentation at term experience significant pressures to conform to expectations of medical professionals and their families due to perceptions of risk related to breech birth; 3) Breech birth decision-making in a limiting system; and 4) Overall satisfaction with the decision to plan a vaginal breech birth. CONCLUSION: Women with a breech presenting fetus at term experience a complex range of emotions and internal and external pressures due to perceptions of risk around breech birth. Midwives were seen as helpful throughout the breech experience. The reduced caesarean section rate for breech, observed in studies exploring specialized care pathways or dedicated services, could reduce the incidence of Severe Acute Maternal Morbidity.

Breech presentation management: A critical review of leading clinical practice guidelines.

PROBLEM: Clinical practice guidelines are designed to guide clinicians and consumers of maternity services in clinical decision making, but recommendations are often consensus based and differ greatly between leading organisations. BACKGROUND: Breech birth is a divisive clinical issue, however vaginal breech births continue to occur despite a globally high caesarean section rate for breech presenting fetuses. Inconsistencies are known to exist between clinical practice guidelines relating to the management of breech presentation. AIM: The aim of this review was to critically evaluate and compare leading obstetric clinical practice guidelines related to the management of breech presenting fetuses. METHODS: Leading obstetric guidelines were purposively obtained for review. Analysis was conducted using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist and reviewing the content of each guideline. FINDINGS: Antenatal care recommendations and indications for Caesarean Section were relatively consistent between clinical guidelines. However, several inconsistencies were found among the other recommendations in terms of birth mode counselling, intrapartum management and the basis for recommendations. DISCUSSION: Inconsistencies noted in the clinical practice guidelines have the potential to cause issues related to valid consent and create confusion among clinicians and maternity consumers. CONCLUSION: Clinical practice guidelines, which focus on the risks of a Vaginal Breech Birth without also discussing the risks of a Caesarean Section when a breech presentation is diagnosed, has the potential to sway clinician attitudes and impact birth mode decision-making in maternity consumers. To respect pregnant women's autonomy and fulfil the legal requirements of consent, clinicians should provide balanced counselling.

Does participation in extended immersive ward-based simulation improve the preparedness of undergraduate bachelor's degree nursing students to be ready for clinical practice as a registered nurse? An integrative literature review.

AIMS AND OBJECTIVES: To determine if extended immersive ward-based simulation programmes improve the preparedness of undergraduate bachelor's degree nursing students to be ward ready for professional practice as a registered nurse. BACKGROUND: The practice readiness of new graduate nurses to enter the workforce continues to raise concern among educators and industry. Often the transition period is a vulnerable time when the reality of clinical practice bears little resemblance of their experiences as a student. Simulation of a busy ward offers the opportunity for pre-registered nurses to practise a variety of situations they are likely to encounter once qualified in a safe and supportive learning environment. METHODS: The review considered studies that investigated the experiences and learning outcomes of nursing students following participation in extended immersive ward-based simulation. Databases searched included CINAHL, EMBASE, Medline and Scopus. Two reviewers independently assessed retrieved studies that matched inclusion criteria using standardised critical appraisal instruments. Reporting of review followed PRISMA checklist. RESULTS: Fourteen studies met the inclusion criteria. The majority of studies used a quasi-experimental mixed methods approach (10). Programme evaluations focused on self-reporting in learning satisfaction and student perceptions of performance. Six studies used a pre- and post-test design to compare the after effect on preparedness for professional practice. Two studies investigated student learning between simulated experiences and experiences gained during clinical placements. CONCLUSION: Learning satisfaction was high among students who participated in programmes that incorporated extended immersive ward-based simulation experiences. Students are able to practise what they need to know and on what will be expected of them in professional practice. Evidence on whether these programmes make a difference in workplace performance, and retention of graduate nurses is yet to be established. RELEVANCE TO CLINICAL PRACTICE: Extended immersive ward-based simulation allows educators the opportunity to meet the perceived needs of students in preparation for professional practice.

Women's experiences of breech birth and disciplinary power.

AIMS: To explore women's experiences of breech pregnancy and birth to identify areas in practice for improvement. DESIGN: A descriptive exploratory study was conducted involving 20 women who had experienced a breech birth between 2013 and 2018. METHODS: Semi-structured interviews were audio recorded and transcribed. Transcripts were examined using a free-form 'circling and parking' style of analysis. Foucault's concepts of power/knowledge were utilized to describe existing power relations. RESULTS: Women experienced varying degrees of disciplinary power throughout their experiences. Knowledge was used as a means of enforcing disciplinary power by some clinicians and by women to 'arm' themselves and 'fight' to regain what they perceived as a loss of power and autonomy. Midwives were seen as navigators of a restrictive, medicalized healthcare system. CONCLUSION: By better understanding the power dynamics which exist as well as the stages women go through when experiencing a breech presentation, there remains the potential to identify areas in practice which need improving, and aid clinicians in better supporting women through what can be a very difficult time.

What are the shared decision-making experiences of adult children in regard to their parent/s' health care in residential aged care facilities?

AIM: This scoping literature review aimed to answer the question: What are the shared decision-making experiences of adult children in regard to their parent/s' health care in residential aged care facilities? BACKGROUND: Shared decision-making has been an important patient-centred approach to nursing care since the 1990s, yet it is becoming increasingly evident that it is still not the reality in aged care facilities fifty years on. Currently, it is not well understood how adult children participate in shared decision-making and the types of decisions they are required to make. DESIGN: A review of original research papers using Kable, Pich and Maslin-Prothero 12-step systematic approach to documenting a search strategy. METHOD: The researcher screened 597 articles from four databases, published in the English language, during the period 1985-2019. The researcher used the Mixed Methods Appraisal Tool version 2011 to determine the methodological quality of the included studies. The Joanna Briggs Institute QARI data tool was used to appraise the seven selected articles and thematically analyse findings, respectively. RESULTS: Four themes were highlighted: communication; staffing; being involved; and staff-family relationships. Despite these themes being apparent, families have limited opportunities to participate in shared health decision-making in regard to their parents' care. CONCLUSION: The findings from this literature show how shared decision-making is affected by the RACF environment. There is a need to find out and understand what is important from a family member's point of view to optimise shared decision-making and nursing care of the family member in residential aged care settings. RELEVANCE TO CLINICAL PRACTICE: The limited findings specific to the SDM experiences of adult children of parents in RACFs in this review could help staff and RACFs to develop strategies and staff training to encourage and facilitate the implementation of shared health decision-making with staff and families on older people's care.

Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study.

BACKGROUND: The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. OBJECTIVE: This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women's experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. METHODS: A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals' knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. RESULTS: Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. CONCLUSIONS: The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23514.

Group B Streptococcus Screening Guidelines in Pregnancy: A Critical Review of Compliance.

INTRODUCTION: Colonization with Group B Streptococcus in pregnancy is a major risk factor for neonatal infection. Universal screening for maternal streptococcal colonization and the use of intrapartum antibiotic prophylaxis has resulted in substantial reductions of neonatal early-onset Group B Streptococcus disease. To achieve the best neonatal outcomes, it is imperative for maternity healthcare providers to adhere to screening and management guidelines. AIM: This literature review uses a systematic approach and aims to provide a synthesis of what is known about compliance with Group B Streptococcus screening protocols in a variety of global settings, including maternity homes, private obstetric practice, and hospital clinical environments. METHODS: The review was carried out using electronic databases as well as hand-searching of reference lists. Included papers reported primarily on compliance with Group B Streptococcus screening guidelines, potential factors which influence compliance rates, and implementations and outcomes of interventions. RESULTS: Six international studies have been retained which all focused on adherence to Group B Streptococcus screening guidelines and demonstrated that different factors might have an influence on adherence to GBS screening protocols such as financial aspects and high caesarean section rates. Findings of relatively low compliance rates led to recognizing the need of developing improved strategies for optimising antenatal GBS screening adherence. CONCLUSION: Adhering to Group B Streptococcus screening guidelines to prevent neonatal infection is crucial. Various factors influence compliance rates such as financial aspects and high proportions of caesarean sections. The implementation of strategies and different forms of education can result in improved compliance rates.

Sociocultural Practices Affecting the Care of Preterm Infants in the Ghanaian Community.

INTRODUCTION: Although culture is an integral part of health, there is scarcity of evidence on the influence of culture on caregiving experiences of parents of preterm infants. The aim of this study was to explore the influence of sociocultural practices on caring for preterm infants in the Ghanaian community. METHOD: Narrative inquiry was utilized to explore the influence of sociocultural practices on the care of preterm infants from 21 mothers, 9 fathers, and 12 household members. Data were collected through face-to-face semistructured interviews and observations at participants' homes. RESULTS: Analysis of data resulted in three threads/themes-respect for the elderly, use of herbal medicines, and communal living. DISCUSSION: Community and extended family members have great influence on the care of preterm infants. Traditional herbal medicines are considered effective in treating traditional illnesses among preterm infants. Understanding the influence of culture on the care of vulnerable preterm infants in the community is essential in developing interventions for infant survival.

Postgraduate nurse education and the implications for nurse and patient outcomes: A systematic review.

OBJECTIVES: To synthesise the current evidence of the implications of postgraduate nursing qualifications on patient and nurse outcomes. DESIGN: A systematic review. DATA SOURCES: Primary research findings. REVIEW METHODS: A systematic search following PRISMA guidelines and the Joanna Briggs Institute's framework was conducted. A structured and comprehensive search of three electronic databases CINAHL, MEDLINE, PsychINFO, search engine Google Scholar, and a manual-search of reference lists was undertaken. The search was limited to articles in English between 2000 and 2019. The combined search yielded 3710 records. Search records were exported to EndNote X8 and duplicates were removed. Inclusion eligibility was assessed by title, abstract and full text. All team members were involved in selecting the studies and assessing methodical quality. Discrepancies were resolved through rigorous discussion between the reviewers. Twenty studies (quantitative and qualitative) were finally selected as suitable for inclusion in the review. A qualitative descriptive synthesis was undertaken to summarise and report the findings. RESULTS: This systematic review has shown that the empirical evidence to date does not support nurses' perceptions of the implications of postgraduate education. The findings from this review fell into three major themes: perceived implications of postgraduate study, clinical outcomes and patient satisfaction. Nurses perceived that postgraduate qualifications had improved their knowledge and skills and thus clinical practice, patient outcomes and health services. This perception has not been borne out by measurable outcomes as yet. The literature also suggests that postgraduate education should improve career opportunities and progression for nurses. This is not supported by the nurses' perceptions in the research available to date. It should be noted that these findings predominantly came from qualitative data. A few studies did report descriptive statistical analysis: demographics, knowledge levels, qualifications etc. None conducted any inferential statistical analysis. CONCLUSION: Although the literature suggests that postgraduate nursing qualifications improve outcomes for patients, the level of evidence is weak. Exploration methods are suggested to move beyond examining nurses' perceptions, to empirical measures of the value of postgraduate education on nurse and patient outcomes.

A Mixed-Methods Study on Patient Safety Insights of New Graduate Registered Nurses.

BACKGROUND: New graduate nurses transition with limited experience, and with anxiety and stress. They present an increased risk of contributing to preventable errors or adverse events. PURPOSE: The purpose was to develop an understanding of new graduate registered nurses' (RNs) patient safety knowledge and actions within the first year of registration. METHODS: The longitudinal mixed-methods study was conducted using a questionnaire delivered at 3 time points (n = 68). Qualitative data were collected by semistructured interviews (n = 11). RESULTS: Self-reported knowledge of medical error decreased over the 3 time points. Themes emerging from qualitative data include patient safety and insights, time management, making a mistake, experiential learning, and transition. CONCLUSIONS: Medical errors and time management persist during transition to the RN role. New graduates reported moderate knowledge of safety and quality issues; however, questioning their own abilities overshadowed growth in their involvement in patient safety.

New graduate nurses' clinical safety knowledge by the numbers.

AIM: To explore new graduate registered nurses' knowledge and attitudes concerning medical error and patient safety, during their first 6 months of professional practice. BACKGROUND: New graduate registered nurses demonstrate basic skills and levels of performance due to limited exposure and experience in actual situations. There is a concern held for their clinical reasoning skills required to recognize patient deterioration, posing a threat to patient safety. METHODS: An online questionnaire was used to survey new graduate registered nurses at three time points during graduate nurse programmes between August 2016 and February 2018. RESULTS: A decrease in self-reported knowledge and attitudes regarding medical errors was noted over the three time points. These results indicate initial confidence in theoretical knowledge and attitudes upon completion of undergraduate education, and prior to commencing professional practice. CONCLUSION: Results suggest that a theory practice gap persists with respect to medical error for transitioning new nurses. IMPACT FOR NURSING MANAGEMENT: New nurses lack confidence around compromised patient safety situations and a knowledge gap around actions related to medical error. Nurse managers and educators should be made aware of this gap to implement strategies to decrease risk during novice nurse transition.

New graduate nurses' understanding and attitudes about patient safety upon transition to practice.

AIMS: To explore the transition experiences of newly graduated registered nurses with particular attention to patient safety. BACKGROUND: New graduate registered nurses' transition is accompanied by a degree of shock which may be in tune with the described theory-practice gap. The limited exposure to clinical settings and experiences leaves these nurses at risk of making errors and not recognising deterioration, prioritising time management and task completion over patient safety and care. DESIGN: Qualitative descriptive approach using semi-structured interviews. METHODS: Data were collected during 2017-18 from 11 participants consenting to face-to-face or telephone semi-structured interviews. Interviews were transcribed verbatim, and data were analysed using thematic analysis techniques assisted by Nvivo coding software. The study follows the COREQ guidelines for qualitative studies (see Supplementary File 1). RESULTS: Key themes isolated from the interview transcripts were as follows: patient safety and insights; time management; making a mistake; experiential learning; and transition. Medication administration was a significant cause of stress that adds to time management anguish. Although the new graduate registered nurses' clinical acumen was improving, they still felt they were moving two steps forward, one step back with regards to their understanding of patient care and safety. CONCLUSION: Transition shock leaves new graduate registered nurses' focused on time management and task completion over patient safety and holistic care. Encouragement and support needed to foster a safety culture that foster safe practices in our new nurses. RELEVANCE TO PRACTICE: Having an understanding of the new graduate registered nurses' experiences and understanding of practice will assist Graduate Nurse Program coordinators, and senior nurses, to plan and provide the relevant information and education during these initial months of transition to help mitigate the risk of errors occurring during this time.

Benner's model and Duchscher's theory: Providing the framework for understanding new graduate nurses' transition to practice.

The transition to quality and safety in the new graduate registered nurses' practice remains problematic directly impacting patient outcomes. Effective mentoring during transition serves to enhance experiential learning, allowing the development and establishment of safe, quality nursing practice. Comprehensive understanding of the transition process, including the barriers and effective enablers to transition is the key to effective mentoring. A theoretical framework guided by Duchscher's Stages of Transition Theory and Transition Shock Model and Benner's From novice to expert model can facilitate such understanding. Nurse Theorists play an important part in shaping nurse education and practice and have provided nurse educators and leaders an understanding to shape skill acquisition and the transition process for new graduate registered nurses. The res ultantresearchmodels and theory of these influencial nurses are pertinent to transition of new graduate registered nurses. This paper outlines the theories of Duchscher and Benner and how their research formed the theoretical framework to facilitate the measurement, understanding and improvement of the safety and quality of nursing care and impact the future nursing workforce.

A Web-Based Recovery Program (ICUTogether) for Intensive Care Survivors: Protocol for a Randomized Controlled Trial.

BACKGROUND: Those who experience a critical illness or condition requiring admission to an intensive care unit (ICU) frequently experience physical and psychological complications as a direct result of their critical illness or condition and ICU experience. Complications, if left untreated, can affect the quality of life of survivors and impact health care resources. Explorations of potential interventions to reduce the negative impact of an ICU experience have failed to establish an evidence-based intervention. OBJECTIVE: The aim of this study is to evaluate the impact of a Web-based intensive care recovery program on the mental well-being of intensive care survivors and to determine if it is a cost-effective approach. METHODS: In total, 162 patients that survived an ICU experience will be recruited and randomized into 1 of 2 groups. The intervention group will receive access to the Web-based intensive care recovery program, ICUTogether, 2 weeks after discharge (n=81), and the control group will receive usual care (n=81). Mental well-being will be measured using the Hospital Anxiety and Depression Scale, The Impact of Events Scale-Revised and the 5-level 5-dimension EuroQoL at 3 time points (2 weeks, 6 months, and 12 months post discharge). Family support will be measured using the Multidimensional Scale of Perceived Social Support at 3 time points. Analysis will be conducted on an intention-to-treat basis using regression modeling. Covariates will include baseline outcome measures, study allocation (intervention or control), age, gender, length of ICU stay, APACHE III score, level of family support, and hospital readmissions. Participants' evaluation of the mobile website will be sought at 12 months postdischarge. A cost utility analysis conducted at 12 months from a societal perspective will consider costs incurred by individuals as well as health care providers. RESULTS: Participant recruitment is currently underway. Recruitment is anticipated to be completed by December 2020. CONCLUSIONS: This study will evaluate a novel intervention in a group of ICU survivors. The findings from this study will inform a larger study and wider debate about an appropriate intervention in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/10935.

Surviving ICU: Stories of recovery.

AIM: The aim of this study was to investigate stories of recovery through the lens of intensive care unit (ICU) survivors. BACKGROUND: Survival from ICUs is increasing, as are associated physical and psychological complications. Despite the significant impact on survivors, there is inadequate support provision in Australia and world-wide for this population. DESIGN: An interpretive biographical approach of intensive care survivors' experiences of recovery. METHODS: Data were collected during 2014-2015 from diaries, face to face interviews, memos and field notes. Six participants diarized for 3 months commencing 2 months after hospital discharge. At 5 months, participants were interviewed about the content of their diaries and symbols and signifiers in them to create a shared meaning. Analysis of diaries and interviews were undertaken using two frameworks to identify themes throughout participants' stories and provides a unique portrait of recovery through their individual lens. FINDINGS: Participants considered their lives had irreparably changed and yet felt unsupported by a healthcare system that had "saved" them. This view through their lens identified turmoil, which existed between their surface and inner worlds as they struggled to conform to what recovery "should be". CONCLUSION: The novel biographical methods provided a safe and creative way to reveal survivors' inner thoughts and feelings. Participants' considered creating their stories supported their recovery process and in particular enabled them to reflect on their progress. Findings from this study may lead to increased awareness among health care providers about problems survivors face and improved support services more broadly, based on frameworks appropriate for this population.

Education on invasive mechanical ventilation involving intensive care nurses: a systematic review.

BACKGROUND: Intensive care unit nurses are critical for managing mechanical ventilation. Continuing education is essential in building and maintaining nurses' knowledge and skills, potentially improving patient outcomes. AIMS: The aim of this study was to determine whether continuing education programmes on invasive mechanical ventilation involving intensive care unit nurses are effective in improving patient outcomes. METHODS: Five electronic databases were searched from 2001 to 2016 using keywords such as mechanical ventilation, nursing and education. Inclusion criteria were invasive mechanical ventilation continuing education programmes that involved nurses and measured patient outcomes. Primary outcomes were intensive care unit mortality and in-hospital mortality. Secondary outcomes included hospital and intensive care unit length of stay, length of intubation, failed weaning trials, re-intubation incidence, ventilation-associated pneumonia rate and lung-protective ventilator strategies. Studies were excluded if they excluded nurses, patients were ventilated for less than 24 h, the education content focused on protocol implementation or oral care exclusively or the outcomes were participant satisfaction. Quality was assessed by two reviewers using an education intervention critical appraisal worksheet and a risk of bias assessment tool. Data were extracted independently by two reviewers and analysed narratively due to heterogeneity. RESULTS: Twelve studies met the inclusion criteria for full review: 11 pre- and post-intervention observational and 1 quasi-experimental design. Studies reported statistically significant reductions in hospital length of stay, length of intubation, ventilator-associated pneumonia rates, failed weaning trials and improvements in lung-protective ventilation compliance. Non-statistically significant results were reported for in-hospital and intensive care unit mortality, re-intubation and intensive care unit length of stay. CONCLUSION: Limited evidence of the effectiveness of continuing education programmes on mechanical ventilation involving nurses in improving patient outcomes exists. Comprehensive continuing education is required. RELEVANCE TO CLINICAL PRACTICE: Well-designed trials are required to confirm that comprehensive continuing education involving intensive care nurses about mechanical ventilation improves patient outcomes.

Parents' experiences of caring for preterm infants after discharge with grandmothers as their main support.

AIMS AND OBJECTIVES: To explore parents of preterm infants' experiences of caring for their preterm infants with the grandmother as their primary support after discharge. BACKGROUND: Preterm delivery is the major cause of high neonatal mortality in sub-Saharan Africa. There is poor neonatal health outcome in the Ghanaian community with some illnesses culturally classified as not-for-hospital. In the community, grandmothers or older women provide support for new parents and decide treatment options for sick infants. However, there is paucity of research on how parents of preterm infants experience this support in the Ghanaian community. METHOD: Qualitative narrative inquiry methodology was used. Face-to-face interviews using semi-structured interview guide were used to collect data from 21 mothers and nine fathers. Participant observation and field notes were used to complement interview data. Thematic content analysis of data within the three-dimensional narrative space was employed. Analysis focussed on the relationship of time, place, person and cultural practices affecting the care of preterm infants in the community. RESULTS: Three themes emerged from the data, namely (i) Grandmother's prescriptions, (ii) Fighting for the well-being of the infant and (iii) Being in a confused state. Cultural practices mainly initiated by grandmothers resulted in adverse health problems for preterm infants and disruption in parents' mental health. CONCLUSION: As grandmothers perform their traditional role of supporting new parents to care for preterm infants after discharge, they give both positive and negative advice which can adversely affect the health of vulnerable preterm infants in the community. RELEVANCE TO CLINICAL PRACTICE: Grandmothers are the main support providers of parents of preterm infants after neonatal unit discharge. Nurses should identify and include grandmothers in predischarge education in order to equip them to render appropriate support to parents and preterm infants.

The nexus of nursing leadership and a culture of safer patient care.

AIMS AND OBJECTIVES: To explore the connection between +6 nursing leadership and enhanced patient safety. BACKGROUND: Critical reports from the Institute of Medicine in 1999 and Francis QC report of 2013 indicate that healthcare organisations, inclusive of nursing leadership, were remiss or inconsistent in fostering a culture of safety. The factors required to foster organisational safety culture include supportive leadership, effective communication, an orientation programme and ongoing training, appropriate staffing, open communication regarding errors, compliance to policy and procedure, and environmental safety and security. As nurses have the highest patient interaction, and leadership is discernible at all levels of nursing, nurse leaders are the nexus to influencing organisational culture towards safer practices. DESIGN: The position of this article was to explore the need to form a nexus between safety culture and leadership for the provision of safe care. CONCLUSIONS: Safety is crucial in health care for patient safety and patient outcomes. A culture of safety has been exposed as a major influence on patient safety practices, heavily influenced by leadership behaviours. The relationship between leadership and safety plays a pivotal role in creating positive safety outcomes for patient care. A safe culture is one nurtured by effective leadership. RELEVANCE TO PRACTICE: Patient safety is the responsibility of all healthcare workers, from the highest executive to the bedside nurse, thus effective leadership throughout all levels is essential in engaging staff to provide high quality care for the best possible patient outcomes.