Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study.

BACKGROUND: Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings. OBJECTIVE: To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies. DESIGN: Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis. SETTING: Simulation laboratories in one university nursing school in Australia. PARTICIPANTS: 21 final year nursing students in seven teams. METHODS: Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies. RESULTS: Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness. CONCLUSIONS: Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.

The Widening Gap between the Digital Capability of the Care Workforce and Technology-Enabled Healthcare Delivery: A Nursing and Allied Health Analysis.

There is a need to ensure that healthcare organisations enable their workforces to use digital methods in service delivery. This study aimed to evaluate the current level of digital understanding and ability in nursing, midwifery, and allied health workforces and identify some of the training requirements to improve digital literacy in these health professionals. Representatives from eight healthcare organizations in Victoria, Australia participated in focus groups. Three digital frameworks informed the focus group topic guide that sought to examine the barriers and enablers to adopting digital healthcare along with training requirements to improve digital literacy. Twenty-three participants self-rated digital knowledge and skills using Likert scales and attended the focus groups. Mid-range scores were given for digital ability in nursing, midwifery, and allied health professionals. Focus group participants expressed concern over the gap between their organizations' adoption of digital methods relative to their digital ability, and there were concerns about cyber security. Participants also saw a need for the inclusion of consumers in digital design. Given the widening gap between digital innovation and health workforce digital capability, there is a need to accelerate digital literacy by rapidly deploying education and training and policies and procedures for digital service delivery.

Factors Impacting Retention of Aged Care Workers: A Systematic Review.

Retention of care support workers in residential aged care facilities and home-based, domiciliary aged care is a global challenge, with rapid turnover, low job satisfaction, and poorly defined career pathways. A mixed-methods systematic review of the workforce literature was conducted to understand the factors that attract and retain care staff across the aged care workforce. The search yielded 49 studies. Three studies tested education and training interventions with the aim of boosting workforce retention and the remaining 46 studies explored opinions and experiences of care workers in 20 quantitative, four mixed-methods and 22 qualitative studies. A range of factors impacted retention of aged care staff. Two broad themes emerged from the analysis: individual and organisational factors facilitating retention. Individual factors related to personal satisfaction with the role, positive relationships with other staff, families, and residents, and a cooperative workplace culture. Organisational factors included opportunities for on-the-job training and career development, appropriate wages, policies to prevent workplace injuries, and job stability. Understaffing was often cited as a factor associated with turnover, together with heavy workloads, stress, and low job satisfaction. With global concerns about the safety and quality of aged care services, this study presents the data associated with best practice for retaining aged care workers.

Polymers derived from the amino acid L-tyrosine: polycarbonates, polyarylates and copolymers with poly(ethylene glycol).

The natural amino acid L-tyrosine is a major nutrient having a phenolic hydroxyl group. This feature makes it possible to use derivatives of tyrosine dipeptide as a motif to generate diphenolic monomers, which are important building blocks for the design of biodegradable polymers. Particularly useful monomers are desaminotyrosyl-tyrosine alkyl esters (abbreviated as DTR, where R stands for the specific alkyl ester used). Using this approach, a wide variety of polymers have been synthesized. Here, tyrosine-derived polycarbonates, polyarylates, and polyethers are reviewed with special emphasis on recent developments relating to cellular and in vivo responses, sterilization techniques, surface characterization, drug delivery, and processing and fabrication techniques. The commercial development of tyrosine-derived polycarbonates is most advanced, with one polymer, poly(DTE carbonate) (E=ethyl), being under review by the USA Federal Drug Administration.

Preliminary development of a novel resorbable synthetic polymer fiber scaffold for anterior cruciate ligament reconstruction.

We are developing novel resorbable fiber-based scaffolds for reconstruction of the anterior cruciate ligament (ACL). For the first time, we report fabrication of fibers from poly(DTE carbonate) polymer. Poly(L-lactic acid) fibers were also fabricated for comparison purposes. The study was performed in three phases. In phase I, first-generation fibers were found to promote tissue ingrowth in a subcutaneous model. In phase II, second-generation fibers were fabricated from poly(DTE carbonate) and poly(L-lactic acid), with diameters of 79 and 72 microm, ultimate tensile strengths of 230 and 299 MPa, moduli of 3.1 and 4.9 GPa, and molecular weights of 65000 and 170000, respectively. These fibers were evaluated on the basis of molecular weight retention, strength retention, and cytocompatibility. After 30 weeks of incubation in phosphate-buffered saline, poly(DTE carbonate) and poly(L-lactic acid) fibers had 87 and 7% strength retention, respectively. Similar trends were observed for molecular weight loss. Fibroblasts attached and proliferated equally well on both scaffold types in vitro. Finally, in phase III, a prototype ACL reconstruction device was fabricated from poly(DTE carbonate) fibers with strength values comparable to those of the normal ACL (57 MPa). Collectively, these data suggest that poly(DTE carbonate) fibers are potentially useful for development of resorbable scaffolds for ACL reconstruction.

Small changes in the polymer structure influence the adsorption behavior of fibrinogen on polymer surfaces: validation of a new rapid screening technique.

Numerous studies conclude that the selective adsorption of plasma proteins on materials contacting blood or tissue affects all subsequent interactions related to the biocompatibility of artificial surfaces. However, there are only a few studies available, which clearly demonstrate that there is a correlation between surface chemistry and selective protein adsorption. Detailed knowledge of such correlations would facilitate the design of biocompatible materials. In this study, a rapid, fluorescence-based, screening technique using a 384-well format for polymer-protein interactions was developed. The screening assay was used to measure the adsorption of human fibrinogen on 46 test polymers (44 polyarylates selected from a combinatorial library of tyrosine-derived polyarylates, and two lactide-based polymers). In this library of polyarylates, structural changes are generated by variations in either the polymer backbone or the polymer pendent chain. Although no overall trend between polymer hydrophobicity and fibrinogen adsorption could be identified using the entire set of test polymers (R(2) = 0.43), fibrinogen adsorption was clearly correlated with variations in the pendent chain structure. Thus, when the test polymers were grouped by backbone composition, increased hydrophobicity of the pendent chain was significantly correlated with reduced fibrinogen adsorption. The following R(2) coefficients within the polymer backbone groups were determined: 0.87 (diglycolates); 0.98 (glutarates); 0.73 (adipates); 0.87 (suberates); 0.67 (3-methyl-adipates). Our results demonstrate that it is possible to screen for protein-material interactions in a cost-effective fashion using a miniaturized immunofluorescence technique. Further, we demonstrate that small changes in chemical composition can significantly influence the adsorption of human fibrinogen on polymer surfaces. The lactide-based polymers were among those polymers exhibiting the highest tendency to adsorb fibrinogen. This information may be useful when polymers have to be selected for specific biomaterial applications.

A photo-crosslinked poly(vinyl alcohol) hydrogel growth factor release vehicle for wound healing applications.

The objective of this study was to develop and evaluate a hydrogel vehicle for sustained release of growth factors for wound healing applications. Hydrogels were fabricated using ultraviolet photo-crosslinking of acrylamide-functionalized nondegradable poly(vinyl alcohol) (PVA). Protein permeability was initially assessed using trypsin inhibitor (TI), a 21 000 MW model protein drug. TI permeability was altered by changing the solids content of the gel and by adding hydrophilic PVA fillers. As the PVA content increased from 10% to 20%, protein flux decreased, with no TI permeating through 20% PVA hydrogels. Further increase in model drug release was achieved by incorporating hydrophilic PVA fillers into the hydrogel. As filler molecular weight increased, TI flux increased. The mechanism for this is most likely an alteration in protein/gel interactions and transient variations in water content. The percent protein released was also altered by varying protein loading concentration. Release studies conducted using growth factor in vehicles with hydrophilic filler showed sustained release of platelet-derived growth factor (PDGF-beta,beta) for up to 3 days compared with less than 24 hours in the controls. In vitro bioactivity was demonstrated by doubling of normal human dermal fibroblast numbers when exposed to growth factor-loaded vehicle compared to control. The release vehicle developed in this study uses a rapid and simple fabrication method, and protein release can be tailored by modifying solid content, incorporating biocompatible hydrophilic fillers, and varying protein loading concentration.