Exploring rural Nurses' preparedness and post-resuscitation experiences. An ethnographic study.

AIM: The focus of this paper is to provide a detailed ethnographic exploration of rural nurses' experiences of their resuscitation preparedness and the subsequent post-resuscitation period. DESIGN: An ethnographic study across two small rural hospital sites in New South Wales, Australia. METHODS: Fieldwork was undertaken between December 2020 and March 2022 and included over 240 h of nonparticipant observation, journalling and interviews. Data were analysed using reflexive thematic analysis. RESULTS: The first key theme-'Sense of Preparedness'-included three subthemes: 'Gaining experience', 'Issues with training and education' and 'Lack of warning'. The second key theme 'Aftermath' comprised two subthemes: 'Getting on with it' and 'Making sense of the resus'. CONCLUSION: This study has highlighted the intricate relationship between resuscitative preparedness and the post-resuscitation period in shaping rural nurse's experiences and their well-being. Rural nurses are asking for an authentic and contextually relevant training experience that mirrors the unique rural challenges they experience. In the absence of frequent resuscitation presentations, the post-resuscitation period should be viewed as a crucible moment that can be leveraged as a valuable learning opportunity enhancing rural nurses' sense of preparedness and the provision of quality resuscitation care. IMPACT: Having a greater level of insight into the challenges that rural nurses experience in the pre- and post-resuscitation period is critical. This insight opens the door for fortifying policies and work processes that will better support rural nurses in the resuscitation environment. REPORTING METHOD: Reporting complied with COREQ criteria for qualitative research. NO PATIENT OR PUBLIC CONTRIBUTION: This study explored the experiences of rural nurses. No patient data were collected.

The Impact of Sensory Modulation Interventions on Practice in Acute Inpatient Mental Health Settings: A Meta-Ethnography.

This review explores the transformative impact of sensory modulation interventions in acute inpatient mental health care setting utilising meta-ethnography. The methodology by Noblit & Hare guided the approach to creating the review. Searches of articles published within the previous 10 years were conducted in Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, and PsycINFO. Searches aimed to identify rich qualitative data on the area of sensory modulation interventions and acute inpatient mental health care. Seven articles were selected for inclusion and a reciprocal translation synthesis was undertaken. Sensory modulation interventions emerged as a key alternative to traditional inpatient practices, including seclusion and restraint and the use of PRN psychotropic medication. It introduces a new dimension within care strategies that emphasise individual preferences and care plans that empower individuals. Sensory modulation interventions serve as an effective means to de-escalation that promotes shared responsibility between staff and individuals in care. The review highlights this practice as a departure from coercive practices and biomedical interventions, promoting meaningful therapeutic engagement. Our findings show that sensory modulation interventions have the potential to create a culture shift in acute inpatient mental health settings towards person-centred, recovery-orientated, trauma-informed clinical practice.

Structured interactions between nurses and patients through intentional rounding: A scoping review.

AIM: To synthesize existing literature describing the impact of intentional rounding on patient outcomes among hospitalized adults. BACKGROUND: Intentional rounding has been described as purposeful therapeutic communication between nurses and patients during regular checks with patients using standardized protocols. Despite the widespread adoption of intentional rounding, the current understanding of the benefits of these structured interactions between nurses and patients is limited. INTRODUCTION: The critical role of nurses in ensuring high-quality and safe care in acute hospitals is often noted only when things go wrong. This was highlighted by investigations into the reasons for the failures in patient care at the Mid Staffordshire National Health Services. METHODS: A scoping review was performed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review guidelines. FINDINGS: Sixteen studies were included in the final review. Various rounding models were noted among different clinical settings; four studies reported a significant reduction in falls, and a further three reported a decrease in pressure injuries. Two studies reported a reduction in call bell usage. Significant improvements in patients' satisfaction with intentional rounding were reported in three studies. DISCUSSION: Promoting intentional rounding without solid evidence of its acceptability, feasibility, and suitability in different clinical settings could compromise nurses' ability to provide safe care. CONCLUSION AND IMPLICATIONS FOR NURSING: There is weak evidence of the effectiveness of intentional rounding on patient outcomes because of the diversity of methods employed and methodological limitations in many studies. Our findings identify the need for robust studies to explore the acceptability and feasibility of a rounding protocol that can be implemented in different clinical settings.

Identifying differential trajectories and predictors for depressive symptoms in adolescents using latent class growth analysis: A population-based cohort study.

INTRODUCTION: This study investigated the differential trajectories and relevant determinants of depressive symptoms in adolescents by following cohorts that included junior, senior, and vocational high school adolescents, over a 3-year period in Taiwan. METHODS: Longitudinal data were obtained from 575 adolescents who participated in the Taiwan Adolescent to Adult Longitudinal Study. Data analysis included latent class growth with time-varying covariate, univariate, and multivariate analysis. RESULTS: A three-class ("low but increasing trajectory," "moderate and stable trajectory," and "high but decreasing trajectory") model fit the data of the cohort. Our findings indicated that 29%, 38%, and 33% of the adolescents were in the low but increasing, moderate and stable, and high but decreasing trajectories, respectively. After confounders were controlled for, bullying experiences were identified as a risk factor for depressive symptoms. The protective factors against depressive symptoms included resilience and peer and social support. CONCLUSIONS: The transitions between different educational stages critically influence the depressive symptoms of adolescents, and the adolescents follow different depressive trajectories, that have different etiology. Therefore, identifying adolescents at high risk for depression and designing student-centered intervention programs through individualized and multidimensional assessment of depressive symptoms are crucial for adolescents.

The impact of safety culture, quality of care, missed care and nurse staffing on patient falls: A multisource association study.

AIMS: To examine the association between nursing unit safety culture, quality of care, missed care and nurse staffing levels, and inpatient falls using two data sources: incidence of falls and nurses' perceptions of fall frequency in their units. The study explores the association between the two sources of patient falls and identifies if nurses' perceptions of patient fall frequency reflect the actual patient falls recorded in the incident management system. BACKGROUND: Inpatient falls are associated with severe complications that result in extended hospitalisation and increased financial consequences for patients and healthcare services. DESIGN: A multi-source cross-sectional study guided by the STROBE guidelines. METHODS: A purposive sample of 33 nursing units (619 nurses) from five hospitals completed an online survey from August to November 2021. The survey measured safety culture, quality of care, missed care, nurse staffing levels and nurses' perceptions of patient fall frequency. In addition, secondary data on falls from participating units between 2018 and 2021 were also collected. Generalised linear models were fitted to examine the association between study variables. RESULTS: Nursing units with strong safety climate and working conditions and lower missed care were associated with lower rates of falls using both data sources. Nurses' perceptions of the frequency of falls in their units were reflective of the actual incidence rate of falls, but the association was not statistically significant. CONCLUSION: Nursing units with a strong safety climate and better collaborations between nurses and other professionals, including physicians and pharmacists, were associated with lower incidents of patient falls. RELEVANCE TO CLINICAL PRACTICE: This study provided evidence for healthcare services and hospital managers to minimise patient falls. PATIENT OR PUBLIC CONTRIBUTION: Patients who had experienced a fall, which was reported in the incident management system, from the included units in the five hospitals were part of this study.

Observing resuscitative practice. A novice researcher's experience of obtaining ethics approval.

Undertaking research involving vulnerable groups, such as those requiring resuscitation involves careful analysis during the ethical review process. When a person lacks the capacity to make an informed choice about their participation in a research study, a waiver of consent offers an alternative. This paper is based on a doctoral research study using ethnography to explore the resuscitative practices and experiences of rural nurses through observation and interviews. This paper aims to explore the ethical issues raised by the Human Research Ethics Committee relating to consent of vulnerable patients requiring resuscitation within a rural context. In particular, the challenges of addressing risk (privacy) vs benefit (public) associated with a waiver of consent. This paper will consider why the rural context should be championed during the ethical review process, when decisions about public benefit are being deliberated. Utilising a communitarianism approach that advocates for greater rural representation during the ethical review processes will ensure that rural research involving vulnerable groups can be addressed safely and benefit not only the experiences and practices of rural nurses but also the wider rural communities they serve.

Voices from the 'resus room': An integrative review of the resuscitation experiences of nurses.

BACKGROUND: Nurses are often the first responders to resuscitations. Understanding their experiences of resuscitation will highlight the resuscitative context nurses work within and identify the conditions that support or hamper their delivery of safe and effective resuscitative care. AIM: The aim of this integrative review is to develop an understanding of nurses' experience of resuscitation, to gain knowledge of their challenges and identify gaps in evidence. DESIGN: Integrative review. METHODS: The electronic databases CINAHL, MEDLINE, Scopus and Web of Science were systematically searched from 2000-2021. Methodological quality of the papers was evaluated using the Mixed Methods Appraisal Tool (MMAT). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was used to guide and report the integrative review. RESULTS: Eleven articles met criteria for review. Four themes arose from the literature that addressed nurses experiences of resuscitation: Chaos (external/internal), ethical dilemmas, clinical confidence and need for support. CONCLUSION: Nurses' experiences of resuscitation are multifaceted. Addressing the challenges that nurses experience during resuscitation will help ensure that nurses' are supported in their professional growth and personal well-being. Relevance to clinical practice and research: Building nursing leadership capacity within resuscitations is an area of clinical practice/research that is gaining traction as a valid solution to address the challenges nurses experience during resuscitations. Whilst the barriers to debriefing requires a greater level of consideration within the workplace.

Implementation of Situational Awareness in the Pediatric Oncology Setting. Does a 'huddle' Work and Is it Sustainable?

BACKGROUND: Huddles are short, regular debriefings that are designed to engage clinical staff in discussions about existing or emerging safety issues. They allow a brief conversation to take place creating a 'situational awareness' about the complexities of the healthcare environment for that day. METHODS: The huddle was implemented in a pediatric oncology service as an intervention aimed at improving patient safety and staff communication to enhance situational awareness. To ensure an efficient format for each huddle a huddle observational tool (HOT) was developed. An initial electronic anonymous survey focusing on safety and situational awareness was distributed to all of the multi-disciplinary (MDT) team. A second survey was disseminated 18 months post huddle introduction to scrutinize its effectiveness. Sustainability was assessed using staff attendance and huddle numbers. RESULTS: Four key areas demonstrated high situational awareness; safety awareness, incident management, communication and teamwork. Positive/negative pooled responses from both survey time points demonstrated a high percentage of positive responses, particularly relating to teamwork enhancement. The overwhelming finding was sustainability of the intervention of the huddle. The pediatric oncology services have now conducted over 700 huddles events over a three-year period. CONCLUSION: The initiation of the huddle has led to increased situational awareness and promotion of safety. It has been shown to be sustainable in the pediatric oncology setting, with durability and attendance of the huddle being the most significant outcome.

Culture, the Stigma of Mental Illness, and Young People.

Culture is a crucial factor in understanding variations in stigma experiences among young people (age ≤25 years). Cultural beliefs influence the range of social responses that mental health issues elicit, including forms of treatment and role expectations of carers. The current article explores the influence that stigma and culture can have on young people with mental illness. It highlights that it is impossible for nurses to be cognizant of all belief systems related to mental illness. Hence, cultural safety is an approach that can facilitate engagement with the nuances of a young person's culture and provide the foundations of appropriate care. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 15-18.].

Prevalence of Trauma in an Australian Inner City Mental Health Service Consumer Population.

This study examined the rates and types of trauma reported by consumers utilising an inner city mental health service in Sydney, Australia. The study also explored whether consumers felt that it had been helpful to be asked about their experience of trauma, whether they thought that these questions should be asked routinely and if they wanted to talk about these experiences. Ninety-one consumers from an inner city mental health service were assessed. Eighty-eight percent of the consumers assessed reported that they had experienced at least one traumatic event, while 79% reported having experienced two or more events. A majority of consumers identified that they thought it was helpful to be asked about trauma and that it should be part of an assessment. However, less than one-third of these consumers surveyed wanted to talk about the trauma at the time of assessment. Concerns that clinicians may have in regards to addressing trauma in mental health assessment are not matched by consumers' expressed beliefs on the issue.

Mental Health Nursing Practice and Indigenous Australians: A Multi-Sited Ethnography.

Criticism of public mental services provided to Indigenous Australians have persisted over the last two decades, despite several national reports and policies that have attempted to promote positive service change. Mental health nurses represent the largest professional group practising within these services. This paper reports on a multi-sited ethnography of mental health nursing practice as it relates to this group of mental health service users. It explores the beliefs and ideas that nurses identified about specialist mental health nursing practice and Indigenous Australians. The study found a disunited approach to practice during the fieldwork. Practice was expressed as a series of individual constructions built upon the nurses' beliefs about Indigenous Australians and their experiences in practice with these peoples. The criticism of mental health services from Indigenous communities was understandable to the mental health nurses, but how they could address this through their individual practices was not always clear to them. The actions by public mental health services to improve cultural safety through generic training related to the broad area of Indigenous health and health service needs, does not appear to evolve into informed specialist mental health nursing practice for Indigenous Australian service users.

A Path Analysis of Self-determination and Resiliency for Consumers Living with Mental Illness.

Over the last three decades, resilience has become a key area in mental health research, practice and policy, due to its potential to positively impact on wellbeing and quality of life. Research findings have identified that resilience positively correlates with an individual's subjective sense of well-being and decreased mental health problems. Given the potential benefits of resilience for those living with mental illness, research should examine ways in which these individuals can increase their resilience levels. One such method of examining resilience in people living with mental illness is through a motivational lens. Using Self-Determination Theory (SDT) lens, this study examined the potential of a proposed model for understanding the correlation and influence of motivational constructs on the resilience of people with a lived experience of mental illness. Results illustrated a goodness-of-fit for the proposed model. Results can be used to illustrate the importance of motivation and self-determination for people living with mental illness.

Shared worlds: multi-sited ethnography and nursing research.

Background Ethnography, originally developed for the study of supposedly small-scale societies, is now faced with an increasingly mobile, changing and globalised world. Cultural identities can exist without reference to a specific location and extend beyond regional and national boundaries. It is therefore no longer imperative that the sole object of the ethnographer's practice should be a geographically bounded site. Aim To present a critical methodological review of multi-sited ethnography. Discussion Understanding that it can no longer be taken with any certainty that location alone determines culture, multi-sited ethnography provides a method of contextualising multi-sited social phenomena. The method enables researchers to examine social phenomena that are simultaneously produced in different locations. It has been used to undertake cultural analysis of diverse areas such as organ trafficking, global organisations, technologies and anorexia. Conclusion The authors contend that multi-sited ethnography is particularly suited to nursing research as it provides researchers with an ethnographic method that is more relevant to the interconnected world of health and healthcare services. Implications for practice Multi-sited ethnography provides nurse researchers with an approach to cultural analysis in areas such as the social determinants of health, healthcare services and the effects of health policies across multiple locations.

Trauma-Informed Care and Practice: Practice Improvement Strategies in an Inpatient Mental Health Ward.

A growing body of evidence highlights that trauma is the single most significant predictor that an individual will need support from mental health services. Yet despite this association, mental health services have been slow to provide approaches to care and treatment that deal directly with trauma. Embedding the principles of trauma-informed care and practice (TICP) in acute inpatient ward practice can lead to practice improvement and cultural change over a number of areas. The current service evaluation highlights how these principles can inform practice and the positive affect this has on areas such as seclusion and restraint, therapeutic engagement, and ward routines. TICP complements recovery-focused models of care and promotes collaborative and empowering relationships in the inpatient setting. Embedding this approach in inpatient mental health units can lead to changes in professional practice and service provision that benefit service users. [Journal of Psychosocial Nursing and Mental Health Services, 55(10), 34-38.].

More Satisfying Than Factory Work: An Analysis of Mental Health Nursing Using a Print Media Archive.

The move towards comprehensive nurse training in Australia thirty years ago continues to trouble many of its mental health nurses. It has been viewed as a failure by many and the profession has been judged by some commentators to have lost its preparedness for specialist care. Discourse put forward to support this negative evaluation usually centres on the recruitment of mental health nurses and a limited interest among student nurses to undertake mental health nursing because of their negative opinions towards it. Emerging from a larger ethnographic research project focused on mental health nursing practice in Australia, this article presents an analysis of the profession's current circumstances using historical print media. As we move further from the era of direct entry, specialist training, the article notes the development of assumptions within the profession. These include the idea that mental health nurses received better training in direct entry, specialist programs, and therefore were better prepared for their specialist roles. The article puts forward a critique that challenges this. The article argues the most profound change faced by the profession is the erosion of the mental health nursing identity in Australia. The loss of the stand-alone hospital system, direct entry specialist training, and specialist professional registration have left mental health nursing with a growing uncertainty about itself as the profession evolves into its (mostly) post-mental institution world. At a time when the specialty of mental health nursing is experiencing serious staff shortages throughout the developed world, the article points to the importance of using historical sources to contextualize our present circumstances.

Ethnonursing and the ethnographic approach in nursing.

AIM: To present a critical methodological review of the ethnonursing research method. BACKGROUND: Ethnonursing was developed to underpin the study and practice of transcultural nursing and to promote 'culturally congruent' care. Ethnonursing claims to produce accurate knowledge about cultural groups to guide nursing care. The idea that the nurse researcher can objectively and transparently represent culture still permeates the ethnonursing method and shapes attempts to advance nursing knowledge and improve patient care through transcultural nursing. DATA SOURCES: Relevant literature published between the 19th and 21st centuries. REVIEW METHODS: Literature review. DISCUSSION: Ethnography saw a 'golden age' in the first half of the 20th century, but the foundations of traditional ethnographic knowledge are being increasingly questioned today. CONCLUSION: The authors argue that ethnonursing has failed to respond to contemporary issues relevant to ethnographic knowledge and that there is a need to refresh the method. This will allow nurse researchers to move beyond hitherto unproblematic notions of objectivity to recognise the intrinsic relationship between the nurse researcher and the researched. IMPLICATIONS FOR RESEARCH/PRACTICE: A revised ethnonursing research method would enable nurse researchers to create reflexive interpretations of culture that identify and embody their cultural assumptions and prejudices.

The ideas of Frantz Fanon and culturally safe practices for aboriginal and Torres Strait Islander people in Australia.

Mainstream mental health services in Australia have failed to provide culturally appropriate care for Aboriginal and Torres Strait Islander people despite several national reports and policies that have attempted to promote positive service development in response to the calls for change from the Aboriginal and Torres Strait Islander communities. In light of this situation, this article considers the ideas of Frantz Fanon and their potential for promoting cultural safety (Ramsden, 2002) in mainstream mental health services. This article argues that Fanon's ideas provide a conceptual strategy for nurses that prompts reflection and establishes a critical theoretical perspective linking power imbalance and inequitable social relationships in health care, thus complementing the aims of cultural safety. The purpose of this critical reflection is to guide nurses' understanding of the relationship between colonization and health status in order to change their attitudes from those that continue to support current hegemonic practices and systems of health care to those that support the health of Aboriginal and Torres Strait Islander people.

Near-hanging and its management in the acute inpatient mental health setting.

Being admitted to an inpatient mental health unit does not necessarily protect a patient against suicidal behavior. Given their purpose and design, these clinical areas can provide a safe environment for reducing hanging deaths. Strategies for reducing suicide by hanging in acute inpatient units should include ongoing review of the safety of the environment and the emergency management of near-hanging. After receiving a request from inpatient nursing staff to develop an education program focused on the emergency management of near-hanging, the authors undertook a review of the literature to (a) identify the evidence base within this area and (b) establish an effective means to promote safe practice with the staff. This article provides a synthesis of the literature review and its implications for nursing practice. [Journal of Psychosocial Nursing and Mental Health Services, 52(5), 41-45.].

Nurses' adoption of diabetes clinical practice guidelines in primary care and the impacts on patient outcomes and safety: An integrative review.

BACKGROUND: Complications related to diabetes mellitus impose substantial health and economic burdens to individuals and society. While clinical practice guidelines improve diabetes management in primary care settings, the variability in adherence to these guidelines persist. Hence, there is a need to comprehensively review existing evidence regarding factors influencing nurses' adherence to implementation of clinical practice guidelines to improve clinical care and patient safety. OBJECTIVE: This integrative review seeks to investigate nurses' adherence to clinical guidelines for diabetes management in primary healthcare settings and to explore factors influencing effective implementation, focusing on the role of nurses and impacts on patient outcomes. METHODS: A comprehensive search was conducted in March 2023 across six electronic databases. The search targeted studies that examined the use of Type 2 diabetes mellitus guidelines by nurses in primary healthcare settings with a focus on clinical management outcomes related to diabetes care or patient safety. Included studies were classified using the Effective Practice and Organisation of Care taxonomy, synthesised narratively and presented thematically. Reporting of the review adhered to PRISMA guidelines. (PROSPERO ID CRD42023394311). RESULTS: The review included ten studies conducted between 2000 and 2020, and the results were categorised into three themes. These were: (i) Implementation strategies to promote clinical practice guidelines adherence, including health professional development, reminders for clinicians, patient-mediated interventions, health information systems, role expansion, and comprehensive package-of-care. A multifaceted educational approach emerged as the most effective strategy. (ii) Impact of guidelines adherence: These strategies consistently improved clinical management, lowering HbA1c levels, improving blood pressure and lipid profiles, and enhancing patient self-care engagement, along with increased nurses' adherence to diabetes clinical guidelines. (iii) The role of nurses in guideline implementation, enabling independent practice within multidisciplinary teams. Their roles encompassed patient education, collaborative practice with fellow healthcare professionals, program planning and execution, and comprehensive documentation review. Nurse-led interventions were effective in improving patient outcomes, underscoring the necessity of empowering nurses with greater autonomy in providing primary diabetes care. CONCLUSION: Implementing a diverse range of strategies, focusing on comprehensive education for healthcare providers, is paramount for enhancing guideline adherence in diabetes care, to improve clinical management towards optimal patient health outcomes. Tailoring these strategies to meet local needs adds relevance to the guidelines. Empowering nurses to take a leading role in primary care not only enhances patient safety but also promotes quality of care, resulting in improved overall outcomes. TWEETABLE ABSTRACT: In primary care, empowering nurses with diabetes guideline education and tailoring strategies to local needs enhance guideline adherence and improve patient outcomes.