Nurse rostering: understanding the current shift work scheduling processes, benefits, limitations, and potential fatigue risks.

BACKGROUND: Implementing appropriate shift work schedules can help mitigate the risk of sleep impairment and reduce fatigue of healthcare workers, reducing occupational health and safety risks. In Australia, the organisation has a responsibility to make sure all reasonable measures are taken to reduce fatigue of staff. Therefore, it is important to assess what the current rostering processes is for staff responsible for creating the rosters for nurses. AIM: The aims of the project were to understand (1) who creates the rosters and what the process is, (2) what training and knowledge these staff have in establishing rostering schedules that optimise the sleep and wellbeing of staff, and (3) what the benefits and limitations are of current rostering practices. METHODS: Findings were generated through semi-structured interviews, using cluster coding to form categories. Twenty four nurses responsible for rostering staff were interviewed from three different sites in Victoria (one metropolitan and two regional/rural hospitals). Data was analysed using selected grounded theory methods with thematic analysis. RESULTS: The common themes that came out of the interviews were that rostering staff were under prepared, unaware of fatigue and safety guidelines and polices from governing bodies and had not received any education or training before taking on the role. The most common rostering style was self-rostering, where staff could submit preferences. However, there were concerns about staff fatigue but were divided as to who should be responsible, with many saying it was up to staff to preference shifts that they could cope with. The final theme was cultural barriers to change. CONCLUSION: While self-rostering resulted in staff having more freedom and flexibility,  shift preferences may be influenced more so by a need to fit with lifestyle rather than to minimise fatigue and increase safety in the workplace. Greater consideration of the impact of shift work schedules on fatigue is required to ensure that the layers of clinical governance in health care organisations minimise the risk of occupation health and safety issues for employees delivering direct patient care.

Differences in shift and work-related patterns between metropolitan and regional/rural healthcare shift workers and the occupational health and safety risks.

OBJECTIVES: To explore if there are differences in shift patterns and work-related factors between metropolitan and regional/rural healthcare shift workers and their risk of poor sleep and mental health. Furthermore, explore whether these factors impact on medical errors, workplace and car/near car accidents. DESIGN: A cross-sectional study. SETTING: An anonymous online survey of healthcare shift workers in Australia. PARTICIPANTS: A total of 403 nurses, midwives and paramedics completed the survey. MAIN OUTCOME MEASURES: Sample characteristics, employment location, shift work-related features, sleep and mental health measurements, workplace accidents, medical errors and car/near car accident post shift. RESULTS: Regional/rural healthcare shift workers were significantly older, had more years' experience, worked more nights, on-call and hours per week. Those in metropolitan areas took significantly longer (minutes) to travel to work, had higher levels of anxiety, increased risk of shift work disorder, reported significantly more workplace accidents and were more likely to have a car/near car accident when commuting home post shift. Both groups reported ~25% having a medical error in the past year. Workplace accidents were related to more on-call shifts and poor sleep quality. Medical errors were associated with fewer years' experience, more evening shifts and increased stress. Car accidents were associated with metropolitan location and increased depression. CONCLUSION: Differences in work-related factors between metropolitan and regional/rural healthcare shift workers were observed. Some of these factors contributed to occupational health and safety risks. Further exploration is needed to understand how to reduce occupational health and safety risks, and improve employee and patient safety both in both regional/rural and metropolitan areas.

The learning needs and clinical requirements of post graduate critical care nursing students in rural and regional contexts: A scoping review.

OBJECTIVES: The objective of this review was to establish the learning needs and clinical requirements of postgraduate critical care nursing students preparing for clinical practice in rural and regional contexts. REVIEW METHOD USED: Scoping review. DATA SOURCES: Published and unpublished empirical studies. REVIEW METHODS: A scoping review based on database searches (CINAHL and Medline) using Aromataris and Munn's four-step search strategy, plus subsequent forward reference search strategy was undertaken, applying predetermined selection criteria. The review aligned to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Review. Studies were uploaded into Endnote 20© for storage and into Covidence 2.0© for data extraction. Screening was undertaken by a primary reviewer, with a secondary reviewer evaluating the studies identified as relevant by the first reviewer. Qualitative codes were derived, and reflexive thematic analysis synthesised the results of the review, using Braun and Clarke's six-phase process. RESULTS: Nine foundational learning needs for critical care nursing students were extracted from the literature. The nine established foundational learning needs were: behavioural attributes/personal base; critical thinking and analysis; ethical practice; identification of risk; leadership, collaboration, and management; professional practice; provision and coordination of clinical care; research knowledge, standards of care, and policy development; and the health consumer experience. Discerning learning needs specific to rural and regional critical care nursing students was difficult. Only one study that met the inclusion criteria was identified. This study identified some instances of interest in relation to rural and regional learning needs. These instances were related to preparation of rural students for low-volume, high-stake situations; transfer of critically ill patients; stabilisation and preparation of critically ill patients; and care of specific patient groups such as, critically ill, bariatric, paediatric, obstetric, trauma, and patients with behavioural issues. CONCLUSIONS: Limited literature exists within the rural and regional critical care nursing educational context, making it difficult to determine the unique learning needs of students within this group. This scoping review lays the groundwork for further research into the needs of critical care nursing students situated within the rural and regional context.

The extent and nature of stress of conscience among healthcare workers: A scoping review.

BACKGROUND: Healthcare workers experience morally stressful situations during delivery of care which may trouble their conscience. Literature emerging in the context of global pandemics suggest increased frequency of morally stressful situations in healthcare and a link with negative outcomes such as attrition and burnout. Little is known about the emerging concept of stress of conscience which could provide a meaningful way to highlight and address these morally stressful situations in healthcare. AIM: The aim of this scoping review was to provide an overview of the literature on, (i) the extent, (ii) the factors associated, and (iii) the interventions to prevent or mitigate stress of conscience among healthcare workers. DESIGN: The study was guided by the framework provided by Arksey and O'Malley in 2005 and the PRISMA Guidelines. Relevant healthcare databases were searched in November 2020 to identify relevant studies. RESULTS: The search identified 24 studies for inclusion in the analysis, 19 of these were from Nordic countries, particularly Sweden. Across those studies, stress of conscience was prevalent among healthcare workers and the levels varied with demographic factors, individual personalities, perceptions of belonging and the workplace culture and environment. Stress of conscience was associated with negative outcomes such as burnout, moral burden, workplace stress, and low quality of care. Although there were few quality interventions studies, facilitating healthcare workers to provide person-centred care appears to be a promising intervention. CONCLUSIONS: The concept of stress of conscience provides a contemporary framework to assess, highlight and discuss the degree of the negative impact of perceived violations of professional and personal values in healthcare. However, the limited studies suggest that exploring stress of conscience, including trials of potential interventions, particularly beyond Nordic countries is essential to fill the gaps in the literature.

Does undertaking rural placements add to place of origin as a predictor of where health graduates work?

OBJECTIVE: To determine the work location (metropolitan, regional, rural and remote) of graduates in nursing, allied health and oral health disciplines who complete their professional training, end-to-end training, in a regional or rural area noting the potential inclusion of a metropolitan-based placement for speciality practice not available in rural or regional Victoria. METHODS: We tracked the place of employment from the Australian Health Practitioners Regulation Agency (AHPRA) of all graduates from a regional/rural tertiary education provider. The student home address at enrolment, locations where they undertook all placements and their current place of work were described using an objective geographical model of access, the Modified Monash Model. RESULTS: Seventy-five per cent of 5506 graduates were located in the AHPRA database. About one third of graduates were working in metropolitan areas, 1/3 in regional cities and 1/3 in rural areas. Students' origin accounted for 1/3 of variance in current workplace location. The more placement days students completed in regional/ rural areas was also a significant predictor of working in a regional or rural area. CONCLUSION: End-to-end training in regional/rural areas is an effective approach to retaining a regional/rural workforce. Student origin is a strong predictor of working rural or regionally, as is undertaking placements in rural areas. This suggests that priority for rural/ regional student placements should be given to students in end-to-end regional/ rural programs and students from a regional/ rural background.

Adopting a Global Virtual Team Approach to Enhance Performance of an International Nursing Research Collaboration.

ABSTRACT: Global mobility, technological developments, and evolved organizational design have expanded the scope of workplace teams beyond traditional arrangements, giving rise to global virtual teams. As universities across the world encourage mobility, there are unprecedented opportunities to create discipline-specific international networks, increase cross-cultural understanding, and create rich interactions in research. Team structure, trust formation, and communication processes are known to positively influence global virtual team performance. They are discussed to illustrate the value of a structured model of work in an international research-focused collaboration of nursing academics from the United States, the United Kingdom, and Australia.

Psychometric properties of a modified cultural awareness scale for use in higher education within the health and social care fields.

BACKGROUND: Cultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields. METHODS: A modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument. RESULTS: The results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. CONCLUSION: The modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.

Trends in obesity and impact on obstetric outcomes in a regional hospital in Victoria, Australia.

AIMS: Obesity-related complications have been identified across the entire childbearing journey. This study investigated changes in obesity prevalence and their impact on obstetric outcomes in a regional hospital in Victoria, Australia. METHODS: All women delivering during 1 January 2010 and 31 December 2016 were eligible to participate. Trends over time and outcomes were assessed on body mass indices (BMI). Incidences of complications were compared by BMI categories. The effect of obesity on hospital length of stay (LoS) was further assessed using the Generalised Estimating Equations approach. RESULTS: During the study period a total of 6661 women of whom 27.5% were overweight, and 16.1, 7.7, and 5.5% were respectively obese class I, class II, and class III, contributed to 8838 births. An increased trend over time in the prevalence of obesity (BMI > 35.0) (P = 0.041) and a decreased trend for vaginal deliveries for the whole sample (P = 0.003) were found. Multiple adverse outcomes were associated with increasing maternal BMI including increased risk of gestational diabetes, gestational hypertension, preeclampsia, emergency caesarean section, shoulder dystocia, macrosomia, and admission to special care. The multivariable analysis showed no associations between LoS and BMI. CONCLUSIONS: Over a short period of seven years, this study provides evidence of a significant trend toward more obesity and fewer vaginal births in a non-urban childbearing population, with increasing trends of poorer health outcomes. Assessing needs and risk factors tailored to this population is crucial to ensuring a model of care that safeguards a sustainable and effective regional maternity health service.

Paramedic management of mental health related presentations: a scoping review.

BACKGROUND: Mental illness is a recognised global health issue and is a major burden of disease that health systems have failed to adequately address. National reforms in Australia to improve mental health service delivery propose building the knowledge and skills of service providers, such as paramedics, to ensure that they appropriately respond to the needs of people experiencing mental health issues. There is a paucity of literature on the role of paramedics in managing mental health presentations despite becoming an increasingly significant part of mental health care in the pre-hospital context. AIMS: This scoping review examined the available literature on the paramedic management of mental health related presentations. METHODS: The five stages of Arksey and O'Malley's methodological framework was used: (1) identifying the research question; (2) identifying relevant studies; (3) study section; (4) charting the data; and (5) collating, summarizing and reporting of results. Relevant databases were searched. RESULTS: Fourteen peer-reviewed articles met the inclusion criteria. Three themes were identified and structured the findings. These were education and training, organizational factors, and clinical decision making. CONCLUSION: The authors recommend that future research address these areas, as high quality evidence will support planning in this complex area of health care delivery.

Socioeconomic gradients in admission to coronary or intensive care units among Australians presenting with non-traumatic chest pain in emergency departments.

BACKGROUND: Socioeconomic inequalities in cardiovascular morbidity have been previously reported showing direct associations between socioeconomic disadvantage and worse health outcomes. However, disagreement remains regarding the strength of the direct associations. The main objective of this panel design was to inspect socioeconomic gradients in admission to a coronary care unit (CCU) or an intensive care unit (ICU) among adult patients presenting with non-traumatic chest pain in three acute-care public hospitals in Victoria, Australia, during 2009-2013. METHODS: Consecutive adults aged 18 or over presenting with chest pain in three emergency departments (ED) in Victoria, Australia during the five-year study period were eligible to participate. A relative index of inequality of socioeconomic status (SES) was estimated based on residential postcode socioeconomic index for areas (SEIFA) disadvantage scores. Admission to specialised care units over repeated presentations was modelled using a multivariable Generalized Estimating Equations approach that accounted for various socio-demographic and clinical variables. RESULTS: Non-traumatic chest pain accounted for 10% of all presentations in the emergency departments (ED). A total of 53,177 individuals presented during the study period, with 22.5% presenting more than once. Of all patients, 17,579 (33.1%) were hospitalised over time, of whom 8584 (48.8%) were treated in a specialised care unit. Female sex was independently associated with fewer admissions to CCU / ICU, whereas, a dose-response effect of socioeconomic disadvantage and admission to CCU / ICU was found, with risk of admission increasing incrementally as SES declined. Patients coming from the lowest SES locations were 27% more likely to be admitted to these units compared with those coming from the least disadvantaged locations, p <  0.001. Men were significantly more likely to be admitted to such units than similarly affected and aged women among those diagnosed with angina pectoris, arrhythmia, myocardial infarction, heart failure, chest pain, and general signs and symptoms. CONCLUSIONS: This study is the first to report socioeconomic gradients in admission to CCU / ICU in patients presenting with chest pain showing a dose-response effect. Our findings suggest increased cardiovascular morbidity as socioeconomic disadvantage increases.

A practice model for rural district nursing success in end-of-life advocacy care.

AIM: The development of a practice model for rural district nursing successful end-of-life advocacy care. BACKGROUND: Resources to help people live well in the end stages of life in rural areas can be limited and difficult to access. District nurse advocacy may promote end-of-life choice for people living at home in rural Australia. The lack of evidence available internationally to inform practice in this context was addressed by exploratory study. METHOD: A pragmatic mixed method study approved by the University Faculty Ethics Committee and conducted from March 2014 to August 2015 was used to explore the successful end-of-life advocacy of 98 rural Australian district nurses. The findings and results were integrated then compared with theory in this article to develop concepts for a practice model. RESULTS: The model illustrates rural district nurse advocacy success based on respect for the rights and values of people. Advocacy action is motivated by the emotional responses of nurses to the end-of-life vulnerability people experience. The combination of willing investment in relationships, knowing the rural people and resources, and feeling supported, together enables district nurses to develop therapeutic emotional intelligence. This skill promotes moral agency in reflection and advocacy action to overcome emotional and ethical care challenges of access and choice using holistic assessment, communication, organisation of resources and empowering support for the self-determination of person-centred end-of-life goals. Recommendations are proposed from the theoretical concepts in the model. LIMITATIONS: Testing the model in practice is recommended to gain the perceptions of a broader range of rural people both giving and receiving end-of-life-care. CONCLUSION: A model developed by gathering and comparing district nursing experiences and understanding using mixed methods and existing theory offers evidence for practice of a philosophy of successful person-centred advocacy care in a field of nursing that lacks specific guidance.

Advocating for end-of-life choice at home: a survey of rural Australian nurses.

INTRODUCTION: Rural healthcare resource limitations can affect the choices people make and their quality of life during its end stages. In rural regions of Australia, district nurses (DNs) working in generalist community roles provide access to care by visiting people in their homes. They may be well positioned to improve the quality of the end-of-life experience by advocating for choice and person-centred end-of-life goals; however, knowledge about care in this context is limited. Initial findings from an exploratory qualitative study describing how rural DNs are able to successfully advocate for the end-of-life choices and goals of people living at home need to be confirmed and further developed to inform clinical practice. This survey aimed to test and complement the findings from a narrative exploration of how DNs advocate successfully for the end-of-life goals of rural Australians. METHOD: A sequential mixed methods study based on a pragmatic design was used to explore how DNs advocate successfully for the end-of-life goals of rural Australians. In the first phase of the study two stages of reflection on experience by rural DNs from the state of Victoria (N=7) provided written and in-depth narrative understandings of how advocacy is enabled and actioned in the practice context. The data were analysed with interpretive description, resulting in findings that could be used to inform a survey for the second phase. The survey, reported here, was designed as an online questionnaire to be distributed by email across inner and outer regional Australia. It was trialled by rural health professionals (N=13) and modified according to the advice received. The participation criteria for the survey specified registered nurses working in generalist community nursing roles with experience in providing successful end-of-life advocacy for people at home. Scales were used to test and complement the phase 1 findings and analysed using Cronbach's alpha and descriptive statistics, with a 95% confidence interval calculated. Open-ended questions added to complement the understanding of how successful advocacy is enabled and actioned in this context were analysed with descriptive interpretation. RESULTS: A self-selecting sample of nurses (N=91) responded to the survey between March and July 2015. The response came from most Australian states and territories, and confirmed the findings that willing nursing involvement in end-of-life experiences, specialised rural relational knowledge, and feeling supported, together enable nurses to advocate successfully for person-centred goals. Actions based on advocacy that were highly rated for success include holistic assessment, effective end-of-life communication and the organisation of empowering and supportive care, confirming the phase 1 findings. High levels of emotional intelligence, understandings of 'going beyond duty', the types of support used and the need for advocacy for resources were reported. CONCLUSION: The results provide both confirmatory and new knowledge that can be used with confidence to inform practice with a model for rural end-of-life nursing advocacy in the home setting.

District nurse advocacy for choice to live and die at home in rural Australia: a scoping study.

BACKGROUND: Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. OBJECTIVES: The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. METHOD: Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. RESULTS: 34 international studies revealed themes of 'the nursing relationship', 'environment', 'communication', 'support' and 'the holistic client centred district nursing role. DISCUSSION: Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas. CONCLUSION: It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.

Factors that influence the approach to leadership: directors of nursing working in rural health services.

AIM: To identify factors that influence directors of nursing in their approach to leadership when working in rural Victoria, Australia. BACKGROUND: In rural areas, nurses account for the largest component of the health workforce and must be equipped with leadership knowledge and skills to lead reform at a service level. METHOD: A qualitative descriptive design was used. In-depth semi-structured interviews were undertaken with directors of nursing from rural Victoria. Data were analysed using thematic analysis and a thematic network was developed. RESULTS: Empowerment emerged as the highest order category in the thematic network. This was derived from three organising themes: influence, capital and contextual understanding and the respective basic themes: formal power, informal power, self-knowledge; information, support, resources; and situational factors, career trajectory, connectedness. CONCLUSION: Rural nurse leaders contend with several issues that influence their approach to leadership. This study provides a platform for further research to foster nurse leadership in rural healthcare services. IMPLICATIONS FOR NURSING MANAGEMENT: Acknowledgement of what influences the rural nurse leaders' approach to leadership may assist in the implementation of initiatives designed to develop leadership in a manner that is contextually sensitive.

Sleep and fatigue management strategies: How nurses, midwives and paramedics cope with their shift work schedules-a qualitative study.

AIMS: To understand the benefits and challenges of shift work, and the coping strategies used by nurses, midwives and paramedics to manage the impact of shift work on sleep and fatigue from shift work. DESIGN: A single case study with embedded units. METHODS: Twenty-seven participants were interviewed exploring their shift work experiences, coping strategies used to improve sleep, and what their recommendations are for improving shift work management. Interviews were completed between November and December 2022. RESULTS: Participants enjoyed the lifestyle, flexibility and financial rewards offered by working shift work. However, fatigue and sleep deprivation undermined these benefits, as it impacted their ability to enjoy social and family events. There were also concerns of long-term health consequences of shift work and delivery of care. Changes to rostering practices and sleep and shift work education were common recommendations. CONCLUSION: This study provides insights on how healthcare professionals manage sleep and fatigue due to shift work and the inadequate support. There is absence of adequate policies, processes and training at an organizational, academic and personal level on how to best manage sleep and fatigue when working shift work. Future research is needed to explore how to equip healthcare shift workers with the skills to successfully manage their schedules to mitigate the negative impact that poor sleep and fatigue has on the health and safety of themselves and their patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Understanding the specific challenges of shift work and how workers manage their shift work schedules is critical for improving the health and safety of themselves and their patients. This study identified that there is insufficient training regarding sleep and shift work management strategies, potentially leading to occupational health and safety concerns. Further education and training to equip staff with the necessary information, training and guidance to staff on how to reduce fatigue risk is required. PATIENT OR PUBLIC CONTRIBUTION: This study involved healthcare shift workers in semi-structured interviews. Data gathered from a previous survey that participants were involved in helped shape the interview topics and the study design.

Sustaining secondary school nursing practice in Australia: a qualitative study.

This interpretive descriptive, qualitative study explored secondary school nurses' perceptions of factors that impact on their role and their views on how their role can be best supported. Nine secondary school nurses from four Department of Human Services regions in Victoria, Australia, participated in semistructured, in-depth interviews. Purposive sampling was used, with participants required to have a minimum of 2 years' experience as secondary school nurses. Data were thematically analyzed, revealing a complex and challenging role. The findings identified key factors necessary to support quality practice. All stakeholders need a shared understanding of the purpose and principles underpinning the secondary school nurse role and the nurse's professional obligations. Knowledge and experience are required that recognize the breadth and depth necessary for secondary school nurses to work effectively within their scope of practice. The adoption of a model of critical companionship is recommended to provide facilitated reflection on practice as a support mechanism for the role.

Using participatory action research to foster nurse leadership in Australian rural hospitals.

This paper outlines the processes and results of a participatory action research study undertaken to identify issues that may impact on strategies to foster nurse leadership in rural hospitals. Five Directors of Nursing from rural regions of Victoria, Australia participated. The group activities involved discussion and analysis of previous research, a review of current literature and critical reflection of the leadership performance of their organization. The analysis identified five key themes; dispel the myths, adopt big-picture thinking, connect with colleagues, reflect on your own conduct, and create organizational buy-in. It is essential to have an awareness of contextual challenges, an understanding of the importance of your own conduct as a visible leader, and the need for effective communication to inform the development of strategies that may be used to foster nurse leadership in rural hospitals. The platform to discuss and critically analyze leadership saw a group consensus that affirmed the need for any approach to nursing leadership to be tailored to the individual healthcare organization.

A scoping review identifying contemporary issues in rural nursing leadership.

PURPOSE: Rural nurse leaders on a global scale are being challenged to create structures and processes to enable excellence in nursing care. The purpose of this scoping review is to offer an indication of the available literature relating to contemporary issues in rural nursing leadership. A review of contemporary issues facing rural nurse leaders is timely to assist strategy development that will achieve the goal of excellence in nursing. ORGANIZING CONSTRUCT: An interpretative scoping literature review methodological framework has been used with an emphasis on thematic construction. METHOD: Literature published between 2008 and 2012 was reviewed from five electronic databases using the key words rural, nursing, and leadership. FINDINGS: Four themes have been identified: expectations of rural nursing leadership, a highly educated workforce, competing interests, and partnering within rural healthcare systems. CONCLUSIONS: The content may resonate with rural nurse leaders and encourage a greater awareness of their relevance to leadership practices. CLINICAL RELEVANCE: The findings provide a greater awareness and understanding of contemporary issues facing rural nurse leaders and may assist with the development of context-sensitive leadership strategies to facilitate excellence in nursing care.