Indigenous social exclusion to inclusion: Case studies on Indigenous nursing leadership in four high income countries.

AIMS AND OBJECTIVES: This discursive paper provides a call to action from an international collective of Indigenous nurse academics from Australia, Canada, Aotearoa New Zealand and the USA, for nurses to be allies in supporting policies and resources necessary to equitably promote Indigenous health outcomes. BACKGROUND: Indigenous Peoples with experiences of colonisation have poorer health compared to other groups, as health systems have failed to address their needs and preferences. Achieving health equity will require leadership from Indigenous nurses to develop and implement new systems of care delivery. However, little is known about how Indigenous nurses influence health systems as levers for change. DESIGN: A Kaupapa Maori case study design. METHODS: Using a Kaupapa Maori case study methodology, coupled with expert Indigenous nursing knowledge, we developed a consensus on key themes. Themes were derived from three questions posed across the four countries. Themes were collated to illustrate how Indigenous nurses have provided nursing leadership to redress colonial injustices, contribute to models of care and enhance the Indigenous workforce. RESULTS: These case studies highlight Indigenous nurses provide strong leadership to influence outcomes for Indigenous Peoples. Five strategies were noted across the four countries: (1) Indigenous nationhood and reconciliation as levers for change, (2) Indigenous nursing leadership, (3) Indigenous workforce strategies, (4) Development of culturally safe practice and Indigenous models of care and (5) Indigenous nurse activism. CONCLUSIONS: In light of 2020 declared International Year of the Nurse and Midwife, we assert Indigenous nurses' work must be visible to support development of strategic approaches for improving health outcomes, including resources for workforce expansion and for implementing new care models. RELEVANCE TO CLINICAL PRACTICE: Curating strategies to promote Indigenous nurse leaders around the world is essential for improving models of healthcare delivery and health outcomes for Indigenous Peoples.

Understanding maternal resilience; Lesson learnt from rural mothers caring for a child with a chronic health condition.

AIM: This study aimed to understand the lived experience of rural mothers caring for a child with a chronic health condition and to understand their perspectives on the support, services and resources they identify as necessary to effectively manage caregiving. BACKGROUND: Maternal caregivers in rural areas experience difficulty accessing specialist health care for their child and can also experience geographical and social isolation. Understanding the factors that enable these maternal caregivers to overcome the challenges and adversities faced is crucial to help nurses identify and facilitate avenues for support and resources. DESIGN: This study employed a phenomenological design. The study is reported in line with Consolidated criteria for reporting qualitative research guidelines (COREQ). METHODS: Semi-structured interviews were conducted with 17 maternal caregivers in rural New South Wales, Australia, who had at least one child with a chronic health condition aged between 2-18 years. Data were collected from March to June 2018. Thematic analysis was used to develop a thematic framework. This paper reports on one of the major themes identified in this research, specifically maternal resilience. RESULTS: Participants demonstrated maternal resilience by creating meaningful social connections, cultivating networks, developing problem-solving skills, enhancing their self-efficacy and finding a sense of purpose through hope and optimism. These strategies provide nurses insight into how some rural women overcome adversities associated with their maternal labour required in caring for a child with a chronic health condition. CONCLUSION: This study found that participants overcame the challenges related to their caregiving work, emerging as resilient caregivers. Understanding maternal resilience assists nurses to provide the services rural mothers in Australia need to care for their child with a CHC. RELEVANCE TO CLINICAL PRACTICE: Findings from this study provide insight into the experiences of rural maternal caregivers of children with a chronic health condition and identify the strategies they adopt to overcome caregiver challenges. Understanding these strategies allows nurses to improve care and support for rural mothers using a strength-based approach to build maternal resilience.

Learning to be a doctoral supervisor: Experiences and views of nurse supervisors of higher degree research students.

AIMS AND OBJECTIVES: Given the importance of doctoral training to the future of the discipline, we sought to gain insight into nurse doctoral supervisor's experiences of supervision training and preparation and their views on what quality training for doctoral supervisors in nursing would look like. BACKGROUND: Doctorally prepared nurses have been found to contribute significantly to improvements in knowledge to inform patient care; yet there is little focus on the development of this aspect of the nursing workforce, and little evaluation of supervisor training, confidence and competence. DESIGN: Qualitative storytelling, semi-structured interviews were conducted via a videoconferencing programme, audio-recorded and thematically analysed with twenty-one experienced nurse doctoral supervisors. Findings are reported in line with the COREQ guidelines. RESULTS: Thematic analysis revealed four themes: 'I had a great mentor': the importance of mentorship and role modelling; 'Sometimes it's just trial and error': learning through experience; 'It's like tick a box': strengths and limitations of formal supervisor training; and 'The training should be more holistic': what should be in supervisor training. CONCLUSIONS: We recommend doctoral supervisors be encouraged to seek mentoring for supervision, formal mentoring and clinical supervision for the first five completions and the formation of discipline-based supervisor learning groups in nursing as an adjunct to generic mandatory supervisor training. RELEVANCE TO CLINICAL PRACTICE: Further development of clinical nursing is inextricably linked to quality nurse-led research, and doctorally prepared nurses are essential to the continued development of nursing as an evidence-informed practice discipline. Quality doctoral supervision for and by nurses is crucial and we argue that focus must be given to ensuring the development of a skilled doctoral supervision workforce in nursing.

Living with diabetes and disadvantage: A qualitative, geographical case study.

AIMS AND OBJECTIVES: To elucidate the experiences of people living with diabetes, residing in an urban diabetogenic area. BACKGROUND: Community-level social and environmental factors have a role to play in the development of type 2 diabetes mellitus. Socio-economic deprivation; high obesity rates; high access to fast foods; and multiculturalism contribute to higher rates of diabetes in some geographical areas. However, there is a lack of research examining people's experiences of living with diabetes in diabetogenic areas. The word diabetogenic implies that the phenomenon of interest contributes to the development of diabetes. DESIGN: Qualitative, geographical case study approach. METHODS: A convenience sample of 17 people living with diabetes in a diabetogenic, low-socio-economic urban area participated in face-to-face, semi-structured interviews. Interviews were audio-recorded, transcribed and analysed thematically. This paper adheres to the COREQ guidelines. FINDINGS: Four main themes were identified: 1. Diabetes fatalism: Inevitability and inertia; 2. Living with Inequity: Literacy and intersectionality; 3. Impersonal services: Intimidating and overwhelming; and, 4. Education in the community: Access and anecdotes. CONCLUSIONS: This study has highlighted the need to develop local solutions for local problems. In this geographical area, solutions need to address generally lower health literacy, how the community would prefer to receive diabetes education and the issue of diabetes fatalism. RELEVANCE TO CLINICAL PRACTICE: Findings from this study have highlighted a need to re-examine how diabetes education is delivered in communities that are already experiencing multiple disadvantages. There are research and practice connotations for how fatalism is positioned for people at high risk of developing diabetes.

Pondering practice: Enhancing the art of reflection.

AIMS AND OBJECTIVES: The aim of this study was to describe the effect that immersive simulation experiences and guided reflection can have on the undergraduate nurses' understanding of how stressful environments impact their emotions, performance and ability to implement safe administration of medications. BACKGROUND: Patient safety can be jeopardised if nurses are unsure of how to appropriately manage and respond to interruptions. Medication administration errors are a major patient safety issue and often occur as a consequence of ineffective interruption management. The skills associated with medication administration are most often taught to, and performed by, undergraduate nurses in a controlled environment. However, the clinical environment in which nurses are expected to administer medications is often highly stressed and nurses are frequently interrupted. DESIGN/METHODS: This study used role-play simulation and written reflections to facilitate deeper levels of student self-awareness. A qualitative approach was taken to explore students' understanding of the effects of interruptions on their ability to undertake safe medication administration. Convenience sampling of second-year undergraduate nursing students enrolled in a medical-surgical subject was used in this study. Data were obtained from 451:528 (85.42%) of those students and analysed using thematic analysis. RESULTS: Students reported increasing consciousness and the importance of reflection for evaluating performance and gaining self-awareness. They described self-awareness, effective communication, compassion and empathy as significant factors in facilitating self-efficacy and improved patient care outcomes. CONCLUSIONS: Following a role-play simulation experience, student nurses reported new knowledge and skill acquisition related to patient safety, and new awareness of the need for empathetic and compassionate care during medication administration. Practicing medication administration in realistic settings adds to current strategies that aim to reduce medication errors by allowing students to reflect on and in practice and develop strategies to ensure patient safety. RELEVANCE TO CLINICAL PRACTICE: Experiencing clinical scenarios within the safety of simulated environments, offers undergraduate student nurses an opportunity to reflect on practice to provide safer, more empathetic and compassionate care for patients in the future.

Calm to chaos: Engaging undergraduate nursing students with the complex nature of interruptions during medication administration.

AIMS AND OBJECTIVES: To describe undergraduate student nurse responses to a simulated role-play experience focussing on managing interruptions during medication administration. BACKGROUND: Improving patient safety requires that we find creative and innovative methods of teaching medication administration to undergraduate nurses in real-world conditions. Nurses are responsible for the majority of medication administrations in health care. Incidents and errors associated with medications are a significant patient safety issue and often occur as a result of interruptions. Undergraduate nursing students are generally taught medication administration skills in a calm and uninterrupted simulated environment. However, in the clinical environment medication administration is challenged by multiple interruptions. DESIGN/METHODS: A qualitative study using convenience sampling was used to examine student perceptions of a simulated role-play experience. Data were collected from 451 of a possible 528 student written reflective responses and subject to thematic analysis. RESULTS: Students reported an increased understanding of the impacts of interruptions while administering medications and an improved awareness of how to manage disruptions. This study reports on one of three emergent themes: "Calm to chaos: engaging with the complex nature of clinical practice." CONCLUSIONS: Interrupting medication administration in realistic and safe settings facilitates awareness, allows for students to begin to develop management strategies in relation to interruption and increases their confidence. Students were given the opportunity to consolidate and integrate prior and new knowledge and skills through this role-play simulation.

Resilience of African migrants: An integrative review.

African migrant women represent a rapidly growing cohort of new arrivals in many countries. Many of these women demonstrate strength and resilience throughout the stressful migration process. In this integrative review, we explore the literature on African migrants' resilience using an ecological framework. Nine peer-reviewed journal articles and six grey literature documents were reviewed. Key internal and external factors in achieving resilience were identified, discussed, and diagrammatically represented using Bronfenbrenner's Ecological Framework under micro-, meso-, exo-, and macro-levels. Our findings show that the capacity for resilience demonstrated during migration could have implications for policy and practice.

Towards international consensus on patient harm: perspectives on pressure injury policy.

AIMS: To analyse influential policies that inform practice related to pressure injury management in Australia, England, Hong Kong, New Zealand, Scotland and the United States of America. BACKGROUND: Pressure injuries are associated with significant harm to patients, and carry economic consequences for the health sector. Internationally, preventing and managing pressure injuries is a key nursing activity and quality indicator. EVALUATION: Comparative review and synthesis of pressure injury policies that inform practice. KEY ISSUES: The predominant focus of policy is on patient risk assessment, compliance with documentation and pressure relief. Financial penalty for institutions is emerging as a strategy where pressure injuries occur. Comparisons of prevalence rates are hampered by the lack of consensus on data collection and reporting. To date there has been little evaluation of policy implementation and implemented policy strategies, associated guidelines remain founded upon expert opinion and low-level evidence. IMPLICATIONS FOR NURSING MANAGEMENT: The pressure injury policy agenda has fostered a discourse of attention to incidents, compliance and penalty (sanctions). Prevention and intervention strategies are informed by technical and biomedical interpretations of patient risk and harm, with little attention given to the nature or design of nursing work. Considerable challenges remain if this policy agenda is successfully to eliminate pressure injury as a source of patient harm.

Misunderstood as mothers: women's stories of being hospitalized for illness in the postpartum period.

AIM: This paper aims to explore women's experiences with healthcare providers to ascertain ways health care may be improved for women disrupted in their mothering. BACKGROUND: Women can find it difficult to relinquish care even when they are acutely unwell requiring hospitalization. Despite mothering being a priority for women, many healthcare professionals do not understand the importance of continuing to mother during maternal illness. DESIGN: This research used a qualitative methodology drawing on principles of feminism and storytelling. METHODS: Women's stories were collected through face-to-face interviews, email and via the telephone. The twenty-seven women who participated were from either Australia or the USA, had between one and six children and identified themselves as having been disrupted in their mothering by illness. Data were collected in 2011 and were analysed thematically. FINDINGS: The majority of participants had been hospitalized at some point in time for acute illness. A subset of participants reported feeling judged by nurses and that their efforts to continue to mother their newborn children despite their illness were misunderstood and not facilitated. CONCLUSION: Findings from this study suggest that women are more likely to remember times that health professionals failed to understand the primacy that mothering held for them or facilitate their efforts to continue to mother despite illness. Nurses and midwives should regularly reflect on their personal values in regard to mothering, validate women's attempts to mother to the best of their ability during illness and find ways to support and empower women in their mothering.

Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration.

AIMS AND OBJECTIVES: The purpose of this review was to explore what is known about interruptions and distractions on medication administration in the context of undergraduate nurse education. BACKGROUND: Incidents and errors during the process of medication administration continue to be a substantial patient safety issue in health care settings internationally. Interruptions to the medication administration process have been identified as a leading cause of medication error. Literature recognises that some interruptions are unavoidable; therefore in an effort to reduce errors, it is essential understand how undergraduate nurses learn to manage interruptions to the medication administration process. DESIGN: Systematic, critical literature review. METHODS: Utilising the electronic databases, of Medline, Scopus, PubMed and CINAHL, and recognised quality assessment guidelines, 19 articles met the inclusion criteria. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. RESULTS: Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them. Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. CONCLUSIONS: Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates. RELEVANCE TO CLINICAL PRACTICE: Better preparing nurses to safely fulfil the task of medication administration in the clinical environment, with increased confidence in the face of interruptions, could lead to a reduction in errors and concomitant improvements to patient safety.

Mothering at a Distance: what incarcerated mothers value about a parenting programme.

BACKGROUND: Children with incarcerated mothers experience adverse health, social and emotional circumstances, and are a particularly vulnerable group. Mothers in custody face significant challenges in parenting their children. AIMS: The study aimed to identify participants' views on impact of a parenting support programme for incarcerated mothers in NSW Australia. METHODS: The mixed-methods study examined 134 responses to open and closed questions on a questionnaire for programme participants. RESULTS: Participants found the programme worthwhile, engaging and relevant. It enhanced their parenting knowledge and confidence. Open-ended responses highlighted program elements which participants valued, specifically support for their parenting role in complicated circumstances, greater understanding of child development and perspectives, and practical strategies for facilitating connections with their children during their incarceration. CONCLUSIONS: The study informs nurses working with women who have experienced incarceration and their children, both in custodial and community settings.

"Holes in my memories": a qualitative study of men affected by father absence.

This qualitative study explored adult men's experiences of father absence. Interviews with 21 men between the ages of 24 and 70 explored narratives of father absence and how the men perceived this influenced their life trajectory. Thematic analysis revealed that these men experienced a range of difficulties and challenges, including episodes of sadness and depression associated with loss and grief for the paternal relationship, self-esteem issues, feelings of anger and rejection, and difficulty forming trusting relationships particularly with other men. This study contributes to understanding mental health issues that can be associated with paternal absence for men.

Small group learning: Graduate health students' views of challenges and benefits.

UNLABELLED: Abstract Background: For health-care professionals, particularly nurses, the need to work productively and efficiently in small groups is a crucial skill required to meet the challenges of the contemporary health-care environment. Small group work is an educational technique that is used extensively in nurse education. The advantage of group work includes facilitation of deep, active and collaborative learning. However, small group work can be problematic and present challenges for students. Many of the challenges occur because group work necessitates the coming together of collections of individuals, each with their own personalities and sets of experiences. AIM: This study aimed to identify challenges and benefits associated with small group work and to explore options for retaining the positive aspects of group work while reducing or eliminating the aspects the students experienced as negative. METHOD: Online survey; thematic analysis. RESULTS: Over all, students experienced a range of challenges that necessitated the development of problem-solving strategies. However, they were able to elucidate some enjoyable and positive aspects of group work. Implications for teaching and learning are drawn from this study. CONCLUSION: The ability to work effectively in small groups and teams is essential for all health-care workers in the contemporary health environment. Findings of this study highlight the need for educators to explore novel and effective ways in which to engage nurses in group work.

Avoiding controversy: Considerations for point-of-view nursing simulations.

Point-of-view simulations involve participants engaging in simulation to experience what it might be like to live with a health condition or disability. These types of simulations have been used frequently in nurse education as a valuable pedagogical tool, as research has shown that student engagement with point-of-view simulations increases student empathy. However, point-of-view simulations have also been problematised by disability community members and scholars researching in the disability space, as ableist and culturally unsafe. This manuscript explores recommendations for, and criticisms of, point-of-view simulations and offers considerations to address these concerns.

Amazingly resilient Indigenous people! Using transformative learning to facilitate positive student engagement with sensitive material.

If health professionals are to effectively contribute to improving the health of Indigenous people, understanding of the historical, political, and social disadvantage that has lead to health disparity is essential. This paper describes a teaching and learning experience in which four Australian Indigenous academics in collaboration with a non-Indigenous colleague delivered an intensive workshop for masters level post-graduate students. Drawing upon the paedagogy of Transformative Learning, the objectives of the day included facilitating students to explore their existing understandings of Indigenous people, the impact of ongoing colonisation, the diversity of Australia's Indigenous people, and developing respect for alternative worldviews. Drawing on a range of resources including personal stories, autobiography, film and interactive sessions, students were challenged intellectually and emotionally by the content. Students experienced the workshop as a significant educational event, and described feeling transformed by the content, better informed, more appreciative of other worldviews and Indigenous resilience and better equipped to contribute in a more meaningful way to improving the quality of health care for Indigenous people. Where this workshop differs from other Indigenous classes was in the involvement of an Indigenous teaching team. Rather than a lone academic who can often feel vulnerable teaching a large cohort of non-Indigenous students, an Indigenous teaching team reinforced Indigenous authority and created an emotionally and culturally safe space within which students were allowed to confront and explore difficult truths. Findings support the value of multiple teaching strategies underpinned by the theory of transformational learning, and the potential benefits of facilitating emotional as well as intellectual student engagement when presenting sensitive material.

Working together to make Indigenous health care curricula everybody's business: a graduate attribute teaching innovation report.

Previously there has been commitment to the idea that Indigenous curricula should be taught by Indigenous academic staff, whereas now there is increasing recognition of the need for all academic staff to have confidence in enabling Indigenous cultural competency for nursing and other health professional students. In this way, Indigenous content can be threaded throughout a curriculum and raised in many teaching and learning situations, rather than being siloed into particular subjects and with particular staff. There are many sensitivities around this change, with potential implications for Indigenous and non-Indigenous students and staff, and for the quality of teaching and learning experiences. This paper reports on a collaborative process that was used to reconceptualise how Indigenous health care curricula would be positioned throughout a programme and who would or could work with students in this area. Effective leadership, establishing a truly collaborative environment, acknowledging fears and perceived inadequacies, and creating safe spaces for sharing and learning were crucial in effecting this change.