Upskill training and preparedness of non-critical-care registered nurses deployed to intensive care units during the COVID-19 pandemic: A scoping review.

BACKGROUND: The increase in intensive care unit (ICU) capacity compelled by the COVID-19 pandemic required the rapid deployment of non-critical-care registered nurses to the ICU setting. The upskill training needed to prepare these registered nurses for deployment was rapidly assembled due to the limited timeframe associated with the escalating pandemic. Scoping the literature to identify the content, structure, and effectiveness of the upskill education provided is necessary to identify lessons learnt during the COVID-19 pandemic response so that they may guide workforce preparation for future surge planning. AIM: The aim of this scoping review was to map the literature to identify the available information regarding upskill training and preparedness of non-critical-care registered nurses deployed to the ICU during the COVID-19 pandemic. METHODS: This scoping review was conducted in accordance with JBI methodology. A protocol outlined the review questions and used the participants, concept, and context framework to define the inclusion and exclusion criteria. A search of healthcare databases MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane, and Scopus was supplemented with a grey literature search via Google. RESULTS: Screening and review found 32 manuscripts that met the inclusion criterion for examination. Analysis revealed variation in duration of programs, theoretical versus practical content, face-to-face or online mode of delivery, and duration of preparation time at the bedside in the ICU setting. Data on contributors to preparedness for deployment were sparse but included training, support, peer education, buddy time, and clarity around responsibilities and communication. DISCUSSION: Evaluation of upskill education was mostly limited to post-training surveys. Few studies explored the preparedness of deployed registered nurses as an outcome of their upskill training or described measures of effectiveness of ICU deployment. CONCLUSION: There is limited evidence describing preparedness of non-critical-care registered nurses on deployment to the ICU. Further research is needed to identify what elements of upskill education led to preparedness and effective deployment to the ICU setting.

Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta-analysis.

AIMS: To examine the patient-related factors that have been linked to glycaemic control in people living with type 2 diabetes mellitus in Middle Eastern countries. DESIGN: A systematic review and meta-analysis. DATA SOURCES: A computerized search was conducted using the databases MEDLINE (via PubMed and Ovid), EMBASE, Scopus and CINAHL to identify peer-reviewed articles published in English between 1 January 2010 and 21 May 2020. On 28 June 2021, the search was updated with the same keywords and databases; however, no further relevant studies were identified. REVIEW METHODS: Extracted data were analysed using Review Manager 5.4. RESULTS: The final sample consisted of 54 articles with a total of 41,079 participants. Pooled data showed an increased risk of inadequate glycaemic control in smokers [OR = 1.26, 95% confidence interval (CI): 1.05, 1.52; p = .010], obese patients (OR = 1.30, 95% CI: 1.10, 1.54; p = .002), patients with elevated waist to hip ratio (OR = 1.62, 95% CI: 1.16, 2.26; p = .004) and longer disease duration (OR = 2.01, 95% CI: 1.64, 2.48; p < .001). A lower risk of inadequate control was associated with physical activity (OR = 0.40, 95% CI: 0.24, 0.67; p < .001) and self-management (OR = 0.49, 95% CI: 0.29, 0.82; p = .006). CONCLUSION: These findings highlight the opportunity to address factors to improve glycaemic control. Further longitudinal studies are required to better understand these variations, to assess all predictors of glycaemic control in participants with type 2 diabetes, and to provide a strong basis for future measures to optimize glycaemic control.

Bowen Family Systems Theory: Mapping a framework to support critical care nurses' well-being and care quality.

Intensive care nursing is prone to episodic anxiety linked to patients' immediate needs for treatment. Balancing biomedical interventions with compassionate patient-centred nursing can be particularly anxiety provoking. These patterns of anxiety may impact compassion and patient-centred nursing. The aim of this paper is to discuss the application of Bowen Family Systems Theory to intensive care nursing, mapping a framework to support critical care nurses' well-being and, consequently, the quality of care they provide. This article is founded on research, theoretical papers and texts focused on Bowen Family Systems Theory (BFST), and findings from a constructivist study on patient-centred nursing and compassion in the intensive care unit. The goal of Bowen Family Systems Theory is to empower individuals, decreasing blame and reactivity. Bowen Family Systems Theory can be applied to the sometimes intimate relationships that develop in this environment, aiding understanding of nurses' experience of compassion satisfaction and fatigue. Where organizational factors and management styles fall short in supporting critical care nurses to meet expectations, BFST can offer a perspective on the processes that occur within the intensive care unit, impacting nurse well-being and quality of care. This paper makes plain the importance of understanding the anxiety that occurs within the intensive care unit as a system, so that individuals, such as critical care nurses, can be supported appropriately to ensure nurse well-being and quality care.

Health literacy support for Australian home-based care recipients: A role for homecare workers?

Clear links have been established between low health literacy (HL) levels and poor health outcomes. One means of improvement may be found in the rapidly growing paid home care workforce, whose direct and frequent contact with aged/disabled care recipients positions them to provide HL support. This study examines Australian homecare worker (HCW) experiences in HL when providing assistance to their care recipients. A self-reported cross-sectional survey collected data from 75 HCWs. They reported concerns about their clients' HL, yet were cautious about providing support in this area. HL levels of the HCWs themselves were unconvincing, and the majority requested targeted education and training. Further research is needed into HL levels of both HCWs and care recipients, client demographics, the types of HL support being requested of HCWs, a more detailed scoping of the HCW role, and the curriculum and pedagogies which may comprise a HL education and training program for HCWs.

Health literacy training for Australian home care workers: Enablers and barriers.

The rapidly expanding Australian home care workforce represents an untapped resource for improving health literacy (HL) and health outcomes of their clients. Nine home care workers (HCWs) were interviewed for this study to gain data around their experiences of providing HL support to their clients, key HL needs and priorities, and training that would best these needs. Findings indicate that HCWs are providing HL support, and identify a number of enablers and barriers to providing this support. Core inclusions for a HL training checklist are suggested. Implications for future research are considered.

Insights on compassion and patient-centred nursing in intensive care: A constructivist grounded theory.

AIMS AND OBJECTIVES: To explore patient-centred nursing, compassion satisfaction and compassion fatigue from intensive care nurses' perspectives. BACKGROUND: Compassion satisfaction and compassion fatigue can influence critical care nurses' decisions to either continue or leave the profession, and could impact the compassionate patient-centred nursing care patients receive during their ICU admission. DESIGN: This qualitative research design was informed by Charmaz's Grounded Theory Constructivist methodology. METHODS: In-depth interviews were conducted with 21 critical care nurses of two ICUs in Australia during 2016. Interview data were analysed using grounded theory processes. RESULTS: Findings reflected positive and negative impacts on critical care nurses' ability to deal compassionately with their patients. Effects on patient-centred nursing and critical care nurses' own well-being were revealed. A core category of "Expectations" emerged, explaining the tension between critical care nurses' biomedical, clinical skills and knowledge versus compassionate, patient-centred nursing care. This tension was clarified and expanded in subcategories of "Life in the Balance," "Passion and Pressure," "Understanding and Advocacy" and "Tenacity and Fragility". CONCLUSION: Providing patient-centred nursing may enhance critical care nurses' experience of compassion satisfaction, in turn impacting delivery of compassionate patient-centred nursing to generate a virtuous circle. Critical care nurses who feel respected and supported by their management team and colleagues experience feelings of compassion satisfaction, leading to greater engagement and care towards their patient. RELEVANCE TO CLINICAL PRACTICE: Systematically addressing critical care nurses' needs to successfully balance biomedical with compassionate nursing care may lead to greater well-being in the critical care nursing workforce and improve patient experience of intensive care.

Home care in Australia: an integrative review.

The home care sector comprises one of Australia's fastest growing workforces, yet few papers capture the overall landscape of Australian home care. This integrative review investigates home care with the aim of better understanding care recipients and their needs, funding, and regulation; care worker skills, tasks, demographics, employment conditions, and training needs. Over 2,700 pieces of literature were analyzed to inform this review. Results suggest sector fragmentation and a home care workforce who, although well-placed to improve outcomes for care recipients, are in need of better training and employment support. Suggestions for future research regarding Australian home care include studies that combine both aged and disability aspects of care, more research around care recipients, priority needs and strategies for addressing them, and how best to prepare home care workers for their roles.

Compassion satisfaction and fatigue: A cross-sectional survey of Australian intensive care nurses.

BACKGROUND: Compassion satisfaction and compassion fatigue influence nurses' intention to stay or leave nursing. Identification of compassion satisfaction or fatigue in critical care nurses is important in this high turnover workforce. OBJECTIVES: The aim of this study was to examine factors predicting and contributing to compassion satisfaction and compassion fatigue experienced by critical care nurses in Australian intensive care units. METHODS: A self-reported cross-sectional survey using an established tool collected data from critical care nurses of two adult Australian intensive care units. RESULTS: Overall, these critical care nurses reported what Professional Quality of Life Scale guidelines designated as 'average' levels of compassion satisfaction and burnout, and 'low' levels of Secondary Traumatic Stress (STS). Compared to Site B, nurses at Site A had significantly higher compassion satisfaction (p=0.008) and lower STS scores (p=0.025), with site significantly predictive for compassion satisfaction (p<0.024) and STS (p<0.002). Nurses with postgraduate qualifications had significantly higher compassion satisfaction scores (p=0.027), and compassion satisfaction significantly increased with increasing duration of practice (p=0.042) as a nurse and in their current ICU (p=0.038). Burnout scores significantly reduced with increasing age, years of tenure and practice; burnout was predicted by lower years of tenure (p<0.016). CONCLUSION: These critical care nurses revealed profiles that, whilst not in crisis, fell short of the ideal high compassion satisfaction and moderate/low fatigue. More recent tenure flags those potentially at higher risk of compassion fatigue, whilst the better scores associated with postgraduate education and from one site need further exploration. Further research should develop understanding and interventions to enhance compassion satisfaction and support retention of this crucial nursing workforce.

An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit.

AIMS AND OBJECTIVES: To systematically review the literature describing factors perceived by nurses as impacting the provision of patient-centred nursing in the intensive care unit. BACKGROUND: Patient-centred nursing in critical care differs from other healthcare areas, and the aggressive curative environment of the ICU has potential to compromise some of its elements. Understanding critical care, nurses' perceptions of promoting and deterrent factors may inform development of strategies to support effective patient-centred nursing and job satisfaction in this workforce. DESIGN: An integrative literature review. REVIEW METHOD: Whittemore and Knafl's method was used with "best-fit" framework synthesis. CINAHL, PsycINFO, Medline and EMBASE were searched for 2000-2016 literature using search terms drawn from the ICU patient-centred framework. RESULTS: In total, 3,079 papers were identified, with 23 retained after applying eligibility criteria. Five themes were identified: Nurse identity; Organisation; Communication; Relationships; and Ideology of ICU. Almost every theme and related categories referred to factors acting as barriers to patient-centred nursing in the ICU; only four referred to supports/facilitators. Findings showed that provision of patient-centred nursing may be compromised by some factors of the critical care environment, and illustrate the challenges and complexity of providing effective patient-centred nursing in this environment. CONCLUSION: Findings should be applied to address barriers and to enhance facilitators of effective patient-centred nursing in critical care. The emotional and physical demands of critical care nursing are major considerations; supporting these nurses to fulfil their challenging role may empower them in their professional quality of life and provide a basis for workforce retention as well as delivery of effective patient-centred nursing. RELEVANCE TO CLINICAL PRACTICE: Measures to enhance patient-centred nursing could promote critical care nurses' job satisfaction and workforce retention, and be applied more broadly and collaboratively to promote multidisciplinary patient-centred care.

A concept analysis of patient-centred nursing in the intensive care unit.

AIM: To report an analysis of the concept of patient-centred nursing in the context of intensive care. BACKGROUND: Clarification of patient-centred nursing in the intensive care unit is important because consensus definition of this concept is lacking. The severely compromised physiological state of these people and the sequelae of this differentiate patient-centred nursing in intensive care from that occurring in other hospital settings. While the broad concept has been analysed, it has not been examined in the context of intensive care. DESIGN: Concept analysis. DATA SOURCES: CINAHL, PsycINFO, Medline and PubMed databases (2000-2014) were searched. Peer-reviewed papers were identified and reference lists of relevant articles searched. METHODS: Walker and Avant's eight-stage approach was used. RESULTS: Patient-centred nursing in the intensive care unit incorporates antecedents of a physiologically compromised patient requiring biomedical intervention, a professional and competent nurse and organizational support. The concept's defining attributes entail maintenance of patient identity by a compassionate and professional nurse exercising biomedical expertise. Consequences include patient satisfaction, positive patient experience, nurse job satisfaction and better nurse workforce retention. CONCLUSION: Patient-centred nursing in intensive care is differentiated from other healthcare areas by the particular characteristics of critically ill patients, the critical care environment and the challenging bio-psycho-social demands made on intensive care nurses. Effective patient-centred nursing in this environment promotes beneficial outcomes for patients, nurses and healthcare service. Decision-makers and policymakers should support critical care nurses in this challenging role, to maintain delivery of patient-centred nursing and grow an effective nursing workforce.

An investigation of factors that impact patients' subjective experience of nurse-led clinics: a qualitative systematic review.

AIMS AND OBJECTIVES: To systematically review the qualitative evidence on factors that affect the experience of patients attending nurse-led clinics and compare with key elements of person-centred care. BACKGROUND: As the number of nurse-led clinics increases in response to health system needs, evaluation has focused on clinical outcomes and cost. Patient experiences are less researched and yet, they are an important influence on clinical outcomes and an indicator of person-centred care. A detailed review of existing research in this area is needed. DESIGN: A systematic review of primary, qualitative literature was conducted using the Joanna Briggs Institute methodology of meta-aggregation. METHODS: Published research from 1990-2012 was located using CINAHL, PubMed, Medline and PsycINFO. Reference lists were searched and analysed. Two reviewers assessed the papers for methodological quality using instruments from the Joanna Briggs Institute to critically appraise, extract data and meta-aggregate findings. RESULTS: Eleven studies met all inclusion criteria. Three meta-synthesis statements were derived from 46 findings aggregated to nine categories. The key themes relating to establishment of a therapeutic relationship, effective communication, and clinical skills and collaboration mapped closely to the person-centred care framework. CONCLUSION: Concepts central to person-centred care proved to be factors impacting patients' subjective experience. Further research is warranted to meet the challenge to transform the key concepts of the person-centred care model into everyday nursing practice. RELEVANCE TO CLINICAL PRACTICE: Knowledge of patients' feelings and the importance of person-centred, individualised care may contribute to development of future training and re-training programs in basic nursing skills. This is significant in that it contributes to future positive patient experience.

Improving Distress Screening for People with Prostate Cancer: Evaluation of an E-Learning Course to Increase Healthcare Professionals' Knowledge.

OBJECTIVES: Psychological distress can occur following diagnosis and treatment for prostate cancer, compromising psychosocial wellbeing. Improved recognition and management of distress by healthcare professionals can enhance clinical practice and promote evidence-based prostate cancer care. This paper explores the effectiveness and feasibility of the online Distress Screening for Prostate Cancer course, designed to improve healthcare professionals' understanding of screening for prostate cancer-related distress. It aims to evaluate whether this e-learning course increases learners' knowledge of distress screening for prostate cancer. METHODS: Healthcare professionals were invited to enroll in the online course and complete optional evaluation questions. The pretest posttest design identified changes in learners' knowledge about distress screening for people with prostate cancer, including prevalence, risk factors, assessment and management strategies for distress (n = 149). Learners also rated satisfaction in a cross-sectional survey (n = 116). Most respondents were nurses, including Prostate Cancer Specialist Nurses. RESULTS: Learners' knowledge of distress screening was higher after course completion. Improvement between pre- and posttest results was statistically significant for four of ten items, including risk of prostate cancer-related distress, and suicidality, and the purpose of distress screening. Learners reported high satisfaction with course content, structure, engagement, relevance, and approach. They particularly valued the narrative-based approach and interactivity. Small numbers encountered technological problems and some offered suggestions to improve learner feedback. CONCLUSIONS: The course improved healthcare professionals' knowledge of distress among people affected by prostate cancer. Learners found the e-learning format feasible and acceptable. IMPLICATIONS FOR NURSING PRACTICE: Deeper understanding of the psychological implications of diagnosis and treatment of prostate cancer can help healthcare professionals respond to and manage distress among men and their families, and provide supportive care to improve health-related quality of life. Access to an online course can offer effective, feasible education on distress screening.

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic academics: An international interview study.

BACKGROUND: The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. DESIGN AND OBJECTIVES: This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. SETTING AND PARTICIPANTS: Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. DATA ANALYSIS: Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. RESULTS: Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. CONCLUSIONS: The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered.

Distress Screening for Men with Prostate Cancer.

OBJECTIVE: Although screening for distress and referral to evidence-based psychosocial support is a well-endorsed standard of cancer care, the extent to which this standard has been implemented varies widely. Lack of awareness, knowledge and skills in screening for distress in this patient group are likely key barriers to psychosocial care provision. The objective therefore was to discuss the development, design and evaluation of the effectiveness of the Distress Screening for Prostate Cancer (DSPC) module in targeting the perceived challenges and barriers to distress screening and psychological care by healthcare professionals. DATA SOURCES: The DSPC module was piloted with five senior prostate cancer specialist nurses prior to the planned implementation with 50 prostate cancer nurses. Their average age was 49.8 years (range 43 to 57 years); there were three females and two males. Results from the Satisfaction with the Distress Screening Prostate Cancer E-Learning Module instrument indicated a high level of overall satisfaction with individual participants' scores ranging from 83-125/125 (mean 108.2). CONCLUSION: Distress screening is an essential component of prostate cancer care and based on the information collected from stakeholders an e-learning module was designed and developed as an interactive and engaging evidence-based, pedagogically sound educational platform. The preliminary results from piloting the e-learning module indicated a high level of learner satisfaction and a measurable improvement in pre-post knowledge acquisition scores. These results suggest that this approach has the potential to increase screening for distress in men with prostate cancer and lead to more timely referral to psychosocial and supportive care to improve men's quality of life after diagnosis and over the illness trajectory. IMPLICATIONS FOR NURSING PRACTICE: Specialist nurses and other healthcare professionals play an important role in screening men with prostate cancer for distress. This newly designed educational resource supports nurses in their practice of screening men with prostate cancer and the appropriate referral process.

Evaluation of the 'Empathic Care of a Vulnerable Older Person' e-simulation.

BACKGROUND: Healthcare reports have identified that the nursing care provided to frail older people is sometimes indifferent, unkind, and lacking in empathy. Compelling research indicates that these types of healthcare interactions can result in both emotional and physiological harm. Thus, there is a need for authentic learning experiences that enhance nursing students' empathy towards older people and that they can reflect upon, learn from and transfer to their real-world practice. e-Simulations provide a pragmatic way of addressing this need. AIM: The aim of this study was to evaluate the impact of an 'Empathic Care of a Vulnerable Older Person' e-simulation on nursing students' empathy levels. SETTING AND PARTICIPANTS: A convenience sample of first year nursing students from one university in the United Kingdom and two Australian universities was recruited for the study. DESIGN AND ANALYSIS: A three-group pre-post study was conducted using the Comprehensive State Empathy Scale to evaluate the impact of the effectiveness of the e-simulation. Sample characteristics were summarised using descriptive statistics. Dependent t-tests and analysis of variance (ANOVA) were used to compare the changes in empathy scores pre post and differences between groups. RESULTS: A total of 684 nursing students participated in the study; their average age was 23 years. Overall, there was a significant increase in empathy scores from pre-test to post-test. Post-hoc comparison of the three groups indicated that the e-simulation had a greater impact on the empathy levels of participants from Universities 2 and 3, compared to those from University 1. CONCLUSION: e-Simulations using narrative methodologies that cater for learners' emotional memory appear to be an effective approach for enhancing empathy towards older people. However, further studies are needed to explore how this learning activity might inform and influence learners' future clinical practice.