Barriers and enablers to scholarship for post basic nursing students in clinical service.

BACKGROUND: Clinical scholarship is defined as an approach that enables evidence-based nursing and the development of best practices to meet the needs of clients efficiently and effectively. However, there are many barriers that impede its progress. OBJECTIVE: This study aimed to identify the barriers and enablers to scholarship for post basic nursing students in clinical service areas. METHOD: This multimethods study used a structured questionnaire followed by semi-structured individual interviews of post basic nursing students and their lecturers (nurse educators). RESULTS: The 81 students who completed the questionnaire indicated a lack of support or funding assistance and mentoring, as well as no mechanisms to reward or recognise scholarship as top barriers to clinical scholarship. Top enablers were noticed as reward mechanisms in place, more protected time and availability of role models and mentoring. Twelve respondents engaged in the qualitative phase and three categories emerged from the data, namely (1) resource dependent, (2) 'what's the use of research', (3) making a change. CONCLUSION: It has been shown that there is a need to adopt and promote a culture of clinical scholarship to ensure that the best available evidence is being utilised by nurses to effectively manage their patients; however, to support clinical scholarship, resources are needed.Contribution: This study highlighted the lack of funding and resources as being a major barrier to scholarship, together with an institutional culture that did not promote clinical scholarship. Providing protected time, mentoring and criteria for promotion and reward based on scholarship is viewed as enabling.

Factors influencing critical care nurses' family engagement practices: An international perspective.

BACKGROUND: Family engagement positively impacts patient and family members' experiences of care and health outcomes. While partnering with families denotes best practice in intensive care units (ICUs), its full adoption requires improvement. A better understanding of the factors that influence the implementation of family engagement practices is necessary. AIM: To investigate the factors that enable or hinder adult ICU nurse-family engagement and to explore potential international variations. STUDY DESIGN: Descriptive, cross-sectional survey. Nurses from 10 countries completed the 'Questionnaire on Factors that Influence Family Engagement' (QFIFE), including five open-ended questions. We performed descriptive statistics on quantitative data and content analysis for open-ended questions, and then integrated the findings according to influencing factors and geographical patterns. This was part of a larger qualitative study where 65 nurses participated from adult intensive care units. RESULTS: Sixty-one nurses completed the questionnaire, making a response rate of 94%. Overall, patient acuity (Md = 5.0) and nurses' attitudes (Md = 4.6) seemed to be the most influential facilitator, followed by nurse workflow (Md = 4.0) and ICU environment (Md = 3.1) (score 1-6 most influential). The open-ended question data showed a more nuanced picture of the complexity of family engagement in care around these four determinants. Adding a fifth determinant, namely Families are complex structures that respond uniquely to the ICU and patient, revealed that difficult family dynamics, miscommunication and family having difficulty in understanding the situation or health literacy, hindered family engagement. Exploring geographical variations, Africa/Middle East consistently differed from others on three of the four QFIFE subscales, showing lower median levels. CONCLUSIONS: Some determinants are perceived to be more influential than others, becoming barriers or enablers to nurse-family engagement in adult ICU. Research that investigates contextual determinants and which compares implementation and improvement initiatives tailored to address family engagement practices barriers and enablers are needed. RELEVANCE TO CLINICAL PRACTICE: Knowledge of this international study expands our understanding of enablers and barriers in family engagement that may inform family engagement practice improvement efforts around the world.

Nursing stakeholder identification guidelines for human resources for health and health workforce development: A scoping review.

AIM: To investigate the existence of guidelines on the identification of nursing stakeholders as part of planning for human resources for health processes. BACKGROUND: Effective involvement of nursing stakeholders in planning and implementing human resources for health policies is strongly advocated by leading global bodies. Systematic identification of nursing stakeholders at an early stage is fundamentally important. Guidelines to support appropriate identification and inclusion of nursing stakeholders could support the active involvement of nurses and midwives in human resources for health planning processes at all levels. METHODS: We conducted a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. We conducted a widely inclusive search for all types of records, including searches of bibliographic databases (PubMed, CINAHL, Scopus and Web of Science) and manual searches of selected websites and internet archives to identify grey literature, published in English since 2009. Search terms related to guidelines, stakeholder engagement and the health workforce. RESULTS: Of the 1058 potentially relevant sources identified, two studies met inclusion criteria. Both were guidelines produced by global bodies more than 12 years ago. Cochrane guidance on reporting 'near-empty' reviews was followed, and eight additional sources meeting most of the inclusion criteria were identified and critiqued. CONCLUSIONS: Guidelines regarding the process of nursing stakeholder identification specific to human resources for health planning processes are scarce and require updating. Critique of recent practices suggests considerable methodological variety and sub-optimal identification of nursing stakeholders. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing stakeholder engagement is an essential component of human resources for health planning processes, and the gap in literature points to a need for up-to-date guidance to ensure nurses' active involvement.

A retrospective audit of nursing-related morbidity recorded in a state hospital in KwaZulu-Natal.

BACKGROUND:  Health care professionals are expected to deliver safe and effective health services; however there is increased realisation that adverse events in the health system are a major cause of preventable morbidity and mortality. OBJECTIVES:  To conduct a retrospective audit of nursing-related morbidities in a state hospital in KwaZulu-Natal, South Africa. METHOD:  A retrospective audit of nursing-related morbidities documented by the surgical service was carried out using the Hybrid Electronic Medical Registry data for a period of 3 years - 01 November 2013 to 31 October 2016. RESULTS:  There were a total of 12 444 admissions to surgical service during the study period, with 461 nursing-related morbidities reported. There was an increase in the number of documented nursing-related morbidities noted during November 2015 to October 2016, with 79% of all reported nursing-related morbidities documented during this period. A total of 54% of nursing-related morbidities were associated with males (n = 248) and 46% (n = 213) with females. The most commonly documented nursing-related morbidity was drugs/medication (n = 167, 36%) with the second most common being adjunct management (n = 130, 28%). CONCLUSION:  The study has identified the most commonly documented nursing-related morbidities in the surgical service of a state hospital. The findings of the study could provide direction for further research and educational initiatives.

Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery.

Perceptions of newly-qualified nurses performing compulsory community service in KwaZulu-Natal.

BACKGROUND: Compulsory community service (CCS) for nurses commenced in South African January 2008 after it was legislated in the new Nursing Act (Act No. 33 of 2005). Nurses completing their registered nurse programme are registered as community nurse practitioners (CNPs) during the CCS period and make up the largest number of health professionals serving CCS. Whilst health institutions have welcomed CNPs as additional resources for the shortage of nursing staff, no structured guidelines have been provided at a regional level as to how these nurses should be utilised or managed during the CCS year. To date, no large-scale study has been conducted on nurses carrying out CCS in order to generalise the findings. OBJECTIVES: To establish the perceptions of newly-qualified nurses carrying out CCS in KwaZulu-Natal, South Africa. METHOD: A quantitative survey design was used to obtain data from a randomly selected sample of the 2012 cohort of nurses carrying out CCS in KwaZulu-Natal. RESULTS: CNPs have a positive attitude toward CCS and perceive themselves as being well prepared for the year of community service in terms of knowledge, skills and ability to administer nursing care. They identified positive benefits of the year of community service.The concerns raised were limited orientation and support; and a few CNPs experienced problems of acceptance by the nurses with whom they work. CONCLUSION: It is recommended that all health institutions who receive CNPs develop structured orientation and support for these nurses in order to promote their development, thereby enhancing their benefit to the communities they serve.

Guideline for the assessment of trauma centres for South Africa.

INTRODUCTION: Trauma is a well-known leading cause of unnatural death and disability in South Africa. Internationally the trend is moving toward systematised care. AIM: To revise the Trauma Centre Criteria of the Trauma Society of South Africa and align these with the terminology and modern scope of emergency care practice, using best-care principles as a prelude to the development of trauma systems in South Africa. METHODOLOGY: Revision of existing documents of the Trauma Society of South Africa, the Emergency Medicine Society of South Africa and the Critical Care Society of Southern Africa, where these are relevant to the care of trauma. The committee attempted to harmonise these criteria with the goals of the World Health Organization essential trauma care guidelines for trauma centres and trauma systems. Wide expert consultation was undertaken to refine the criteria before final compilation. RESULTS AND RECOMMENDATIONS: Four levels of trauma care facility are outlined, with the criteria focusing on the trauma-specific requirements of the facilities and their place in the greater trauma system. Accreditation of hospitals according to the criteria will allow for appropriate transfer and designation of patient destination for trauma patients and will improve the quality of care provided. The criteria address structural, process and human resource requirements and medical aspects for the accreditation of various level of trauma centre. CONCLUSION: There is a great opportunity to apply best practice criteria to improve the care of trauma in South Africa and improve patient outcome.

A description of the forensic nursing role in emergency departments in Durban, South Africa.

INTRODUCTION: South Africa has unenviable rates of violent crime and low rates of conviction and prosecution. Contributing to this is the poor collection of medical evidence by health workers. METHODS: A quantitative exploratory descriptive survey using a questionnaire was carried out with nurses, either registered or enrolled with the South African Nursing Council, who had a minimum of 6 months experience in the Emergency Department. The Emergency Departments of two provincial (state) and two private hospitals, as well as two comprehensive care clinics (state) were used. RESULTS: The findings revealed that most of the forensic tasks to be performed by the Emergency Department nurses were rated as never or seldom done and this was due to a lack of training and knowledge in the field of forensic nursing. The respondents did however indicate that forensic nursing was very important to their daily activities in the Emergency Departments. DISCUSSION: Emergency nurses in South Africa are facing new challenges in acquiring the skills to effectively care for crime victims. It is becoming extremely important for these nurses to correctly manage the forensic evidence, as failure to do so can have far reaching legal consequences.

Emergency nursing experience in Malawi.

Malawi has a population of 13 million with the vast majority of its people living in the rural areas. Government health facilities are the main providers of health care services in the country with a few private facilities charging for their services. Emergency medical care in Malawi is offered in all health care delivery areas, however the quality offered and its accessibility is compromised especially in rural areas. Every health care professional receives a component of emergency training during their generic programme although there are very limited specialized emergency professionals. Working as a nurse in the emergency department in Malawi is a challenging experience due to these various difficulties.

Emergency nursing in South Africa.

The role of the emergency nurse in South Africa is a challenging one due to a variety of reasons. This article describes the healthcare system of South Africa with particular attention to the emergency medical system as well as the reason why most emergency clients present to the emergency departments. The actual experience of working as an emergency nurse in South Africa is highlighted.

The lived experience of losing a loved one to a sudden death in KwaZulu-Natal, South Africa.

AIM: The aim of this study was to describe the lived experiences of families in KwaZulu-Natal, South Africa, who had lost a loved one to a sudden death. BACKGROUND: Sudden death implies a natural or unnatural death which is unexpected; occurs without warning; and in some cases, could have been prevented. It usually occurs out of hospital, in the emergency department, or shortly after handing the client over to either critical care or operating theatre personnel. A sudden death has the capacity to leave the bereaved emotionally damaged and may exaggerate the responses to grief. METHOD: An interpretive hermeneutic phenomenological research approach was chosen for this study, as this allows the researcher to describe a phenomenon as experienced and to attempt to provide an understanding of the internal meanings of a person's experiences in the lived world. SAMPLE: The sample included five bereaved family members who had lost a loved one to a sudden death and who were all members of a bereavement support group held in Durban, South Africa. RESULTS: Bereaved families interviewed described five themes namely: 'cold reception' of the hospital staff, lack of closure, acknowledgement of loss, 'loneliness of grief' and helping others. RELEVANCE FOR CLINICAL PRACTICE: This qualitative study provides rich data regarding what bereaved family members view as important in their care during this time of crisis. The value of simple, small gestures by the health professional is enlightening. This information can be used to ensure that health professionals purposely direct their interventions and interactions with the bereaved family to ensure that they are managed in the most therapeutic way possible.

The lived experience of working in a mortuary.

A four year action research study was undertaken in an attempt to foster change in the current management of sudden deaths in the Accident and Emergency Departments in South Africa. During the phase of interviewing bereaved families and health professionals it became apparent that there was a need to involve mortuary staff as victims of sudden deaths have to undergo an autopsy. The researcher chose an interpretive hermeneutic phenomenological research approach to explore the lived experience of working in a mortuary. The mortuary is a place of mystery, sadness, grief or repulsion and we all hope, while we are alive, we will never need to visit. For families who have lost a loved one to a sudden death, this becomes a reality. Working in a mortuary is an extremely stressful experience which is made worse in South Africa due to the large number of people dying sudden violent deaths due to trauma. The themes which emerged from the interviews with mortuary staff were; secondary trauma for families, delays by health professionals and dehumanised mortuary staff. There is a need for a change in the way bereaved families are being managed as well as revision of the environment for the staff working in mortuaries.