"You don't want to know just about my lungs, you want to know more about me". Patients and their caregivers' evaluation of a nurse-led COPD supportive care service.

AIM: To evaluate a nurse-led model of supportive care in a COPD outpatient service from patient and caregiver perspectives. DESIGN: Case study methodology. METHODS: Data were collected from semi-structured interviews with patients (n = 12) and caregivers (n = 7) conducted between April 2020 and September 2022. A purposive sampling strategy was used. Interviews were transcribed verbatim and analysed using content analysis with an inductive approach. COREQ guidelines informed reporting of this study. RESULTS: Eight categories were identified from the data evaluating of the model of care relating to the most helpful aspects of COPD supportive care and suggested improvements to the model of care. The categories were: guidance with managing symptoms; participating in advance care planning; home visiting; expert advice; continuity and trust; caring; caregiver support and improvements to the model of care. CONCLUSION: In a nurse-led model of COPD supportive care, what patients and caregivers valued most was expert advice and guidance with symptom management, flexible home visiting, participation in advance care planning, caring and continuity within an ongoing trusted therapeutic relationship. Understanding what patients and caregivers value most is essential in designing and delivering models of care that meet the needs of patients living with chronic, life-limiting illness. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses can lead effective models of supportive care that offer valuable support to patients living with COPD and their caregivers.

Embedding nurse-led supportive care in an outpatient service for patients with Chronic Obstructive Pulmonary Disease.

AIM: To describe a small multidisciplinary team's experience of the process of embedding nurse-led supportive care into an existing Chronic Obstructive Pulmonary Disease outpatient service. DESIGN: Case study methodology METHODS: Data were collected from multiple sources including key documents and semi-structured interviews with healthcare professionals (n = 6) conducted between June and July 2021. A purposive sampling strategy was used. Content analysis was applied to key documents. Interviews were transcribed verbatim and analysed using an inductive approach. RESULTS: Subcategories under the four-stage process were identified from the data. ASSESSMENT: evidence of needs of patients with Chronic Obstructive Pulmonary Disease; gaps in care and evidence of other models of supportive care. Planning: setting the supportive care service structure and intention; resources and funding; leadership, specialization and respiratory/palliative care roles. IMPLEMENTATION: relationships and trust; embedding supportive care and communication. EVALUATION: benefits and positive outcomes for staff and patients, and, improvements and future considerations for supportive care in the COPD service. CONCLUSION: A collaboration between respiratory and palliative care services resulted in successfully embedding nurse-led supportive care in a small outpatient service for patients with Chronic Obstructive Pulmonary Disease. Nurses are well placed to lead new models of care that aim to address unmet biopsychosocial-spiritual needs of patients. More research is needed to evaluate nurse-led supportive care in Chronic Obstructive Pulmonary Disease and other chronic illness settings; the effectiveness of nurse-led supportive care from the perspective of patients and caregivers and the impact of nurse-led supportive care on health service usage. PATIENT OR PUBLIC CONTRIBUTION: The development of the model of care is informed by ongoing discussions with patients with COPD and their caregivers. Data availability statement: Research data are not shared (due to ethical restrictions). IMPACT: Embedding nurse-led supportive care in an existing Chronic Obstructive Pulmonary Disease outpatient service is achievable. Nurses with clinical expertise can lead innovative models of care that address the unmet biopsychosocial-spiritual needs of patients with conditions such as Chronic Obstructive Pulmonary Disease. Nurse-led supportive care may have utility and relevance in other chronic disease contexts.

The influence of mathematics self-efficacy on numeracy performance in first-year nursing students: A quasi-experimental study.

AIM AND OBJECTIVES: To examine the factors that influence nursing students' mathematics self-efficacy, the effect of numeracy instruction on self-efficacy, and the association between self-efficacy and numeracy test performance. BACKGROUND: Medication administration errors, including administering incorrect dosages or infusion rates, can result in serious harm to patients. Hence, it is essential that nursing students are adequately prepared with the necessary numeracy skills during their nursing program. DESIGN: This quasi-experimental cohort study used a pre- and post-test survey design. The study complied with the STROBE checklist for cohort research. METHODS: In total, n = 715 undergraduate first year nursing students participated in the study from June to October 2017 at a single multi-campus university in the Western Sydney region of Australia. Data were collected at three time-points: (a) baseline, including assessing pre-instruction mathematics self-efficacy (NSE-Math scale); (b) 6-week follow-up; including assessing post-instruction mathematics self-efficacy; and (c) numeracy test performance was collected at 7-week follow-up. FINDINGS: At baseline, those with high NSE-Math scale scores were more likely to be male and have at least high school advanced mathematics level education. Following structured numeracy instruction, NSE-Math scale scores increased significantly, and those who obtained a satisfactory grade in their numeracy assessment were more likely to have high NSE-Math scale scores and high academic performance in the previous semester. CONCLUSION: The study shows that structured numeracy instruction improved mathematics self-efficacy, which in turn influenced numeracy test performance. RELEVANCE TO CLINICAL PRACTICE: Using a structured medication numeracy pedagogical approach, to teach skills in nursing undergraduate programs, provides students with the foundations to improve mathematics self-efficacy and to be successful and safe with medication numeracy calculations and administration in clinical practice.

Interprofessional learning at work: what spatial theory can tell us about workplace learning in an acute care ward.

It is widely recognized that every workplace potentially provides a rich source of learning. Studies focusing on health care contexts have shown that social interaction within and between professions is crucial in enabling professionals to learn through work, address problems and cope with challenges of clinical practice. While hospital environments are beginning to be understood in spatial terms, the links between space and interprofessional learning at work have not been explored. This paper draws on Lefebvre's tri-partite theoretical framework of perceived, conceived and lived space to enrich understandings of interprofessional learning on an acute care ward in an Australian teaching hospital. Qualitative analysis was undertaken using data from observations of Registered Nurses at work and semi-structured interviews linked to observed events. The paper focuses on a ward round, the medical workroom and the Registrar's room, comparing and contrasting the intended (conceived), practiced (perceived) and pedagogically experienced (lived) spatial dimensions. The paper concludes that spatial theory has much to offer understandings of interprofessional learning in work, and the features of work environments and daily practices that produce spaces that enable or constrain learning.

Chronic obstructive pulmonary disease and advance care planning: A synthesis of qualitative literature on patients' experiences.

OBJECTIVE: Advance Care Planning supports patients to share their personal values, goals, and preferences for future medical care with their family members and healthcare professionals. The aim of this review was to uncover what is known about patients with Chronic Obstructive Pulmonary Disease and their experiences with Advance Care Planning. METHODS: A systematic review and thematic synthesis of qualitative studies was undertaken. Five databases were searched for qualitative articles published between 2009-2019. The review was guided by the PRISMA framework and seven studies met the eligibility criteria. Thematic synthesis of descriptive themes in each article was undertaken to develop overarching analytical themes, related to the experience of patients with Chronic Obstructive Pulmonary Disease and Advance Care Planning. RESULTS: Four analytical themes emerged from the review of the articles that met the inclusion criteria: patient readiness and willingness for Advance Care Planning discussions; considering the future; trusted relationships with healthcare professionals; and shared decision making. DISCUSSION: Patients with Chronic Obstructive Pulmonary Disease are generally open to Advance Care Planning discussions with healthcare professionals who are well-informed, and trusted by the patient. Models of care that integrate Advance Care Planning are beneficial in other non-malignant settings, and may be a way forward to support Advance Care Planning as part of routine care for patients with Chronic Obstructive Pulmonary Disease.

Intensive care nurses' experiences with the new electronic medication administration record.

AIM: To explore the experiences of Registered Nurses who administered medications to patients using the electronic medication administration record (eMAR) in Electronic Record for Intensive Care (eRIC) at one adult intensive care unit (ICU) in NSW, Australia. DESIGN: The study research design used a qualitative descriptive exploratory approach that took place in two stages. METHODS: Five participants attended one focus group followed by the observation of each participant as medications were administered to their assigned patient using the eMAR in eRIC. RESULTS: From the data, three themes and one subtheme were identified. Themes included forcing nurses to work outside legal boundaries; patient safety; with a subtheme titled experiencing computer fatigue; and taking time away from the patient. To practise safely, nurses were required to implement workaround practices when using the new eMAR in ICU. Nurses also were concerned that the eMAR in eRIC took time away from the patient at the bedside and 'added more screen time' to their day.

Scope of practice conflict in nursing: a new war or just the same battle?

The changing roles within health care teams reflect the rapid pace of change in contemporary health care environments. Traditional nursing roles and responsibilities are being challenged as fiscal constraints drive health reform. How nursing teams are configured in the future and the scope of practice of the individuals within those teams will require clear and unambiguous boundaries. This study explores the relationships in and between scope of practice and communication amongst teams of nurses. Six focus groups with both Registered and Enrolled Nurses were undertaken in three Sydney metropolitan hospitals in New South Wales. Nurses report that confusion surrounding scope of practice particularly in the areas of medication administration, patient allocation and workload are resulting in situations whereby nurses are feeling bullied, stressed and harassed. With the imminent widespread introduction of a third tier of nursing into acute care hospitals in Australia the findings of this study are timely and suggest that unless nursing team members clearly understand their roles and scope of practice there is potential for intra-professional workplace conflict. Furthermore the impact of the conflict may have consequences for both the individual nurse and their patients.

First year undergraduate nursing students' perceptions of the effectiveness of blended learning approaches for nursing numeracy.

The ability to safely calculate and administer medications are indispensable, core nursing skills in nursing education and practice. Therefore, it is imperative that nursing students are adequately prepared with the necessary numeracy skills during their undergraduate nursing studies. The focus of this study, conducted at a single multi-campus university in the western Sydney region of Australia, was to determine the effectiveness of a suite of blended learning approaches on numeracy self-efficacy from the students' perspective. Surveys were administered as part of the study and included open-ended questions. 525 students provided open-ended responses that were analysed by the research team. Four main themes were identified from the open-ended responses: (i) Self-realisation; (ii) Practice, practice, practice; (iii) Boosting confidence; and (iv) Wanting more. The themes captured students' perceptions of the benefits of having a rigorous learning design in blended learning approaches. The study showed that a structured pedagogical approach to nursing numeracy in undergraduate programs improved students' self-reported self-efficacy with mathematics and assisted students in realising the importance of learning and applying these skills as nursing clinicians.

Competency measurements: testing convergent validity for two measures.

AIM: This paper is a report of a study to investigate whether the Australian National Competency Standards for Registered Nurses demonstrate correlations with the Finnish Nurse Competency Scale. BACKGROUND: Competency assessment has become popular as a key regulatory requirement and performance indicator. The term competency, however, does not have a globally accepted definition and this has the potential to create controversy, ambiguity and confusion. Variations in meaning and definitions adopted in workplaces and educational settings will affect the interpretation of research findings and have implications for the nursing profession. METHOD: A non-experimental cross-sectional survey design was used with a convenience sample of 116 new graduate nurses in 2005. The second version of the Australian National Competency Standards and the Nurse Competency Scale was used to elicit responses to self-assessed competency in the transitional year (first year as a Registered Nurse). FINDINGS: Correlational analysis of self-assessed levels of competence revealed a relationship between the Australian National Competency Standards (ANCI) and the Nurse Competency Scale (NCS). The correlational relation between ANCI domains and NCS factors suggests that these scales are indeed used to measure related dimensions. A statistically significant relationship (r = 0.75) was found between the two competency measures. CONCLUSION: Although the finding of convergent validity is insufficient to establish construct validity for competency as used in both measures in this study, it is an important step towards this goal. Future studies on relationships between competencies must take into account the validity and reliability of the tools.

Psychometric properties of the Australian nurse competency 2000 standards.

BACKGROUND: The Australian Nursing Competency Incorporated (ANCI) 2000 standards provide a standardised framework of accepted professional standards for the registered nurse. AIM: The study aimed to examine the psychometric properties of the ANCI 2000 national competency standards for measuring nursing competence in new graduate nurses. RESEARCH DESIGN AND METHODS: One hundred and sixteen new graduated nurses from three metropolitan public hospitals were surveyed. The psychometric properties of the ANCI 2000 including internal consistency and construct validity were examined. RESULTS: The mean score was lowest for competency unit 6 (mean 5.96) and highest for competency unit 4 (mean 8.83). The internal reliability for the total ANCI 2000 was alpha=.93 and for the domain alpha=.81 (Domains 1 and 3), alpha=.79 (Domain 2), and alpha=.77 (Domain 4). Confirmatory factor analysis using the domains as factors confirmed the 4 factor structure although 3 factors had two items each with loadings in the .4-.5 range. CONCLUSIONS: There are inconsistencies in the psychometric properties of the ANCI 2000 which suggest that further investigation is warranted before it can be used as an instrument for the measurement of new graduate competencies.

Relating new graduate nurse competence to frequency of use.

The healthcare workplace can be a stress-laden environment for new graduates and job performance indicators are an important sign of developing confidence and expertise that will lead to improved patient outcomes. What is not evident from nursing studies is whether new graduate nurse competencies relate to the frequency of their use. This study sought to determine the relationship between perceived nursing competence and self-assessed frequency of use by new graduate nurses. Three cohorts (n = 116) of new graduate nurses undertaking year-long transition to graduate practice programs responded to a questionnaire that utilised the 2001 ANCI competencies and the Nurse Competency Scale and a Visual Analogue scale to self assess their perceived competence and the relative frequency of use for specific competence items. Results indicate that a relationship exists between perceived competence and frequency of use and that research competency scores are substantially lower than all other categories of competency. Implications for education and practice indicate that assessment of nurse competency for the new graduate nurse should focus on the development of generic nursing competencies rather than current expectation of advanced and workplace specific nurse competencies.

Immobility and supination in garter snakes (Thamnophis elegans) following handling by human predators.

A common response of animals to physical restraint is tonic immobility. The authors observed the behavior of garter snakes, Thamnophis elegans, in the field to determine the frequency of immobility as a response to handling. Most snakes fled after release, but the remainder remained immobile, sometimes on their backs (supination), for up to 10 min. Immobility was seen most often in pregnant snakes, which also were more likely than other snakes not to have moved before capture. Failure to move, either before or after capture, might be a consequence of the limited locomotory ability of gravid snakes. However, the lack of observations of interactions between snakes and their natural predators impedes researchers' understanding of the antipredator value, if any, of tonic immobility.

Manufacture of measles viruses.

Measles viruses have shown potent oncolytic activity as a therapeutic against a variety of human cancers in animal models and are currently being tested in clinical trials in patients. In contrast to using measles virus as a vaccine, oncolytic activity depends on high concentrations of infectious virus. For use in humans, the high-titer measles virus preparations must also be purified to remove significant levels of cellular proteins and nucleic acid resulting from the cytolytic products of measles virus replication and release. Pleomorphic measles virus must be treated as >1-µm particles that are extremely shear sensitive to maximize recoveries and retain infectivity. Therefore, to maximize the recovery of sterile, high titer infectious measles viruses, the entire production and purification process must be done using gentle conditions and aseptic processing. Here we describe a procedure applicable to the production of small (a few liters) to large (50-60 L) batches of measles virus amplified in Vero cells adapted to serum-free growth. Cell culture supernatant containing the measles virus is clarified by filtration to remove intact Vero cells and other debris, and then treated with Benzonase(®) in the presence of magnesium chloride to digest contaminating nucleic acid. The measles virus in the treated cell culture supernatant is then concentrated and purified using tangential flow filtration (TFF) and diafiltration. The concentrated and diafiltered measles virus is passed through a final clarifying filter prior to final vialing and storage at <-65°C. An infectivity assay to quantify infectious measles virus concentration based on the TCID(50) method is also described. This procedure can be readily adapted to the production and purification of measles viruses using good manufacturing practices (GMP).

Telomere instability in the male germline.

Telomeres play a key role in upholding the integrity of the genome, and telomerase expression in spermatogonial stem cells is responsible for the maintenance of telomere length in the human male germline. We have previously described extensive allelic variation in somatic cell telomere length that is set in the zygote, the ultimate source of which may be the germline. This implies that despite telomerase activity, substantial telomere length variation can be generated and tolerated in the germline; in order to investigate this further, we have examined the nature of telomere length variation in the human male germline. Here, we describe an analysis of both genome-wide telomere length and single molecule analysis of specific chromosome ends in human sperm. We observed individual specific differences in genome-wide telomere length. This variation may result from genetic differences within the components that determine the telomere length setting of each individual. Superimposed on the genome wide telomere length setting was a stochastic component of variation that generates germ-cells containing severely truncated telomeres. If not re-lengthened during early embryogenesis, such telomeres may limit the replicative capacity of cells derived from the zygote and have the potential to create fusagenic chromosomes, unbalanced translocations and terminal micro-deletions. These data may have implications for the genetic determination of ageing, genetic disease and fertility.