The role of the intensive care nurse in the medical emergency team: A constructivist grounded theory study.

BACKGROUND: Intensive care nurses are essential members of rapid response systems (RRSs) with little qualitative data available to capture what intensive care nurses do as they navigate their way around the complexity of a medical emergency call. OBJECTIVE: The study aims to describe and explain the role of the intensive care nurse within the medical emergency team (MET) of a tertiary-level hospital to develop an understanding of the intensive care nurse role, the way it is enacted, and their responsibilities within the team. METHOD: A constructivist grounded theory research approach collected qualitative data from intensive care nurses who had experience attending MET calls. Data were collected through participant observation (16 MET calls), followed by 12 semistructured interviews. FINDINGS: A substantive theory was developed that 'keeping patient's safe' is a fundamental role of the intensive care nurse within the MET. This is derived from four key concepts: Systematic framework for decision making, Figuring it out, Directing care, and Patient safety. Each of these concepts was developed from categories that describe the role of the intensive care unit nurse on the MET. They include performing assessments and interventions, figuring it out, critical thinking, prioritising care, directing care, being supportive, and ensuring patient safety. CONCLUSION: This study provides new insights into and an understanding of the ways intensive care nurses work within the MET, making a significant contribution to our existing understanding of the role.

Development of a position statement for Australian critical care nurse education.

Position statements are used by large organisations such as the Australian College of Critical Care Nurses to publically present an official philosophy or beliefs and to propose recommendations. Position statements are increasingly used by health departments and healthcare facilities to allocate resources and to guide and audit nursing practice, yet there are limited resources on the process of their development. A position statement should help readers better understand the issue, communicate solutions to problems, and inform decision-making. It should be supported by the highest level of evidence available and reflect the organisation's governing objectives and goals. In this article, we describe the structured approach used to develop a position statement for Australian critical care nurse education. The formation of an expert advisory panel, synthesis of available evidence using Whittemore and Knafl's integrative review methodology, use of Donabedian's structure-process-outcomes quality framework as a theoretical approach, and multiple layers of consensus building and consultation enabled the development of an important critical care document and informed an implementation plan. The framework and processes we have outlined in this discussion article may provide a useful starting point for other professional organisations wishing to develop similar position statements.

Structures, processes and outcomes of specialist critical care nurse education: An integrative review.

OBJECTIVES: The objective of this study was to review and synthesise international literature to reveal the contemporary structures, processes, and outcomes of critical care nurse (CCN) education. METHOD: An integrative review on specialist critical care education was guided by Whittemore and Knafl's integrative review steps: problem identification; literature search; and data evaluation, analysis, and presentation. Donabedian's Quality Framework (Structure-Process-Outcome) provided a useful analytical lens and structure for the reporting of findings. RESULTS: (1) Structures for CCN education incorporated transition-to-practice and ongoing education programs typically offered by hospitals and health services and university-level graduate certificate, diploma, and masters programs. Structural expectations included a standard core curriculum, clinically credible academic staff, and courses compliant with a higher education framework. Published workforce standards and policies were important structures for the practice learning environment. (2) Processes included incremental exposure to increasing patient acuity; consistent and appropriately supported and competent hospital-based preceptors/assessors; courses delivered with a flexible, modular approach; curricula that support nontechnical skills and patient- and family-centred care; stakeholder engagement between the education provider and the clinical setting to guide course planning, evaluation and revalidation; and evidence-based measurement of clinical capabilities/competence. (3) Outcomes included articulation of the scope and levels of graduate attributes and professional activities associated with each level. The role of higher degree research programs for knowledge creation and critical care academic leadership was noted. CONCLUSIONS: Provision of high-quality critical care education is multifaceted and complex. These findings provide information for healthcare organisations and education providers. This may enable best practice structures and processes for critical care specialist training that meets the needs of industry and safely supports developing CCN expertise. There is an acknowledged tension between the expectations of governing bodies for policies, standards, and position statements to enhance quality and reduce care variance and the availability of high-quality evidence to underpin these across international contexts.

Hearing voices: Comparing two methods for analysis of focus group data.

AIM: This paper compares two qualitative approaches used to thematically analyse data obtained from focus groups conducted with critical care nurses from Australia. BACKGROUND: Focus groups are an effective mechanism to generate understanding and gain insight into the research participants' world. Traditional verbatim transcription of participants' recorded words necessitates significant investment of time and resources. An alternative approach under reported in the literature is to directly analyse the audio recordings. To identify the effectiveness of the audio recording only approach, the study aimed to independently compare two qualitative methods of data analysis, namely the traditional transcribed method with the audio recording method. METHODS: The study to revise the specialist critical care competency standards included focus groups conducted in each state in Australia (n=12) facilitated by experienced researchers. Two of the research team analysed transcribed focus group data and two team members were blinded to the transcription process and directly analysed audio recordings from the focus groups. A process of thematic analysis used independently by the two teams was used to identify themes. RESULTS: When the findings were compared, the themes generated using each technique were consistent and there were no different themes or subthemes identified. The two techniques appeared to be comparable. Overarching key themes were consistent with the approach. CONCLUSION: The direct analysis method appears to have advantages. It is cost effective, trustworthy and possibly a superior alternative when used with focus group data. However, the audio only method requires experienced researchers who understand the context and if combining the two approaches takes time to do.

A two phase study to revise the Australian Practice Standards for Specialist Critical Care Nurses.

BACKGROUND: Observational work to develop the ACCCN Competency Standards was undertaken more than 20 years ago. Since then the landscape of critical care nursing as a specialty has changed and it is not known if the Competency Standards reflected contemporary practice. OBJECTIVES: To revise the ACCCN Competency Standards for Specialist Critical Care Nurses to ensure they continue to meet the needs of critical care nurses and reflect current practice. METHODS: A two-phased project was undertaken. In Phase I focus groups were held in all states. Thematic analysis was conducted using two techniques. The standards were revised based on the main themes. Phase II consisted of an eDelphi technique. A national panel of critical care nurses responded to three survey rounds using a 7 point likert-type scale to indicate their level of agreement with the revised standards. A 70% agreement level for each statement was determined a priori. RESULTS: Phase I: 12 focus groups (79 participants) were conducted. Phase II: A panel of specialist critical care nurses (research, management, clinical practice and education) responded to round 1 (n=64), round 2 (n=56), and round 3 (n=40). Fifteen practice standards with elements and performance criteria were grouped into four domains (professional practice, provision and coordination of care, critical thinking and analysis, collaboration and leadership). The revised Practice Standards for Specialist Critical Care Nurses build upon and are additional to the Nursing & Midwifery Board of Australia National Competency Standards for Registered Nurses. The standards reflect contemporary critical care nurse practices using an expanded range of technologies to care for complex critically ill patients across the lifespan in diverse settings. CONCLUSION: The national study has resulted in the 3rd edition of the Practice Standards for Specialist Critical Care Nurses. There was input from stakeholders and agreement that the revised standards capture contemporary Australian critical care nursing practice.

What are the Clinical and Social Outcomes of Integrated Care for Older People? A Qualitative Systematic Review.

Introduction: Older people with multiple chronic conditions have most to gain from successful integrated care models but there is a need to understand current evidence of outcomes for older people. Methods: A qualitative meta-aggregation method was used for the review. Systematic searching of CINAHL, PubMed (Medline), Web of Science, PsycINFO, Scopus and Cochrane identified an initial 93 papers, of which 27 were reviewed. Studies were selected according to the pre-defined protocol and quality assessed using The Joanna Briggs Institute Critical Appraisal Tools (JBIQARI). Eleven, peer-reviewed, English-language papers published between 2000 to 2020 were included. Results: Thirty-three findings were extracted and aggregated into six categories. Three synthesised statements were identified denoting outcomes of integrated care for older people. These indicate social participation and connectedness for older people and their families; the older person feeling motivated to engage in health goals when their preferences were taken into consideration; and older people experiencing support and wellbeing when a therapeutic relationship with a key worker is established. Discussion and conclusion: There was scant evidence of the older person's voice within included studies and a limited focus on outcomes. Stronger evidence is needed to provide meaningful and robust evaluation of outcomes within integrated care models for the older person.

Purposive sampling: complex or simple? Research case examples.

BACKGROUND: Purposive sampling has a long developmental history and there are as many views that it is simple and straightforward as there are about its complexity. The reason for purposive sampling is the better matching of the sample to the aims and objectives of the research, thus improving the rigour of the study and trustworthiness of the data and results. Four aspects to this concept have previously been described: credibility, transferability, dependability and confirmability. AIMS: The aim of this paper is to outline the nature and intent of purposive sampling, presenting three different case studies as examples of its application in different contexts. RESULTS: Presenting individual case studies has highlighted how purposive sampling can be integrated into varying contexts dependent on study design. The sampling strategies clearly situate each study in terms of trustworthiness for data collection and analysis. The selected approach to purposive sampling used in each case aligns to the research methodology, aims and objectives, thus addressing each of the aspects of rigour. CONCLUSIONS: Making explicit the approach used for participant sampling provides improved methodological rigour as judged by the four aspects of trustworthiness. The cases presented provide a guide for novice researchers of how rigour may be addressed in qualitative research.

Capacity building in burns and mental health care.

Delivery of safe quality care in health is augmented by better research capacity building. This can include financial investment in research and system development, and, mostly notably, human capacity to undertake research. Establishing capacity to undertake research warrants attention to a range of activities to build and sustain health professions' impact on health outcomes. This editorial reflects on burns and mental health care to identify challenges for capacity building. These challenges range from resource restrictions, organisational culture and identification of enablers to assess broader health impact. Strategies to promote capacity building for practice include harmonisation of international standards, financial resourcing to build research capacity in low and middle-income countries, effectively implemented and monitored training, any involvement of multiple perspectives in design and delivery.

Postgraduate nursing student knowledge, attitudes, skills, and confidence in appropriately referencing academic work.

Preventing plagiarism is an ongoing issue for higher education institutions. Although plagiarism has been traditionally seen as cheating, it is increasingly thought to be the result of poor referencing, with students reporting difficulties citing and referencing bibliographic sources. This study examined the academic knowledge, attitude, skills, and confidence of students in a school of nursing to understand poor referencing. A cross-sectional quantitative and qualitative survey was distributed to postgraduate (N = 1,000) certificate, diploma, and master's students. Quantitative data gathered demographics, cultural and linguistic background, and use of technology. Thematic analysis discovered patterns and themes. Results showed participants understood requirements for referencing; half indicated poor referencing was due to difficulty referencing Internet sources or losing track of sources, and many lacked confidence in key referencing tasks. Despite this, 50% did not make use of referencing resources. Overall, these data suggest incorrect referencing is rarely intentional and predominantly caused by skills deficit.