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AIM: The utility and uptake of pain management interventions across intensive care settings is inconsistent. A rapid realist review was conducted to synthesise the evidence for the purpose of theory building and refinement. DESIGN: A five-step iterative process was employed to develop project scope/ research questions, collate evidence, appraise literature, synthesise evidence and interpret information from data sources. METHODS: Realist synthesis method was employed to systematically review literature for developing a programme theory. DATA SOURCES: Initial searches were undertaken in three electronic databases: MEDLINE, CINHAL and OVID. The review was supplemented with key articles from bibliographic search of identified articles. The first 200 hits from Google Scholar were screened. RESULTS: Three action-oriented themes emerged as integral to successful implementation of pain management interventions. These included health facility actions, unit/team leader actions and individual nurses' actions. CONCLUSION: Pain assessment interventions are influenced by a constellation of factors which trigger mechanisms yielding effective implementation outcomes. IMPLICATIONS: The results have implications on policy makers, health organisations, nursing teams and nurses concerned with optimising the successful implementation of pain management interventions. IMPACT: The review enabled formation of a programme theory concerned with explaining how to effectively implement pain management interventions in intensive care. REPORTING METHOD: This review was informed by RAMESES publication standards for realist synthesis. PUBLIC CONTRIBUTION: No patient or public contribution. The study protocol was registered in Open Science Framework. 10.17605/OSF.IO/J7AEZ.
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Manejo da Dor , Humanos , Manejo da Dor/métodos , Manejo da Dor/normas , Cuidados Críticos/métodos , Cuidados Críticos/normas , Unidades de Terapia Intensiva , Medição da Dor/métodosRESUMO
OBJECTIVES: Academic literacy in nursing students has historically been poor this research therefore aimed to investigate the effectiveness of an embedded multidisciplinary approach to academic written communication skills for first year Bachelor of Nursing students in Australia. METHODS: This initiative consisted of (1) collaboratively embedding academic skills with nursing staff and Learning and Academic Skills Advisors using scaffolded tasks, curriculum/material development, workshops/tutorials on writing skills; and (2) individual support sessions. Data was obtained via questionnaire. RESULTS: Responses were received from 92 (74% local and 26% international) students. Key findings showed the collaborative approach to embedding skills with added follow up, was beneficial for students' skills development, including improved academic writing, increased confidence, and recognition of the importance of academic writing. CONCLUSIONS: It is important to equip student to develop academic literacy and an embedded academic literacy program has been determined to assist and may contribute to future professionalisation in nursing.
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Recursos Humanos de Enfermagem , Estudantes de Enfermagem , Humanos , Austrália , Aprendizagem , AlfabetizaçãoRESUMO
AIMS: The aim of this study was to examine professional identity through the group performances of nurses within a specific work environment. BACKGROUND: Professional identity and social identity are closely linked. Nurses undertake clinical practice usually within a social group environment. The literature is limited on the development of professional identity within the context of nurses' daily work. DESIGN: An integrated ethnographic case context design was adopted, consisting of two clinical wards in one acute health-care facility in Australia. The application of the social identity theory (SIT) was used to study two specific professional activities to describe the group performance of nurses within this organizational cultural context and how this influenced nurses' professional identity. METHOD: The research was undertaken between 2012 and 2014. Data collection included observation, interviews and fieldnotes of a convenience sample of nurses and allied health-care professionals who undertook two professional activities in their normal work environment. FINDINGS: The development of group efficacy contributed to the development of the professional identity in the homogenous handover activity. Self-efficacy was demonstrated in the heterogenous multidisciplinary activity. CONCLUSION: The results indicated the importance of recognizing core identity-building activities and understanding the value of these activities to professional identity development.
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Processos Grupais , Recursos Humanos de Enfermagem/psicologia , Papel Profissional/psicologia , Identificação Social , Antropologia Cultural , Austrália , Humanos , Autoeficácia , Local de TrabalhoRESUMO
BACKGROUND: The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia. METHODS: An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1263 nursing students, across all year levels at six Australian Universities and one further education college in 2019-20, to confirm validity, reliability and feasibility. RESULTS: The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r = .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach's alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 min) and students' comments, the tool was deemed applicable and feasible. CONCLUSIONS: The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.
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AIM: To increase understanding of strategies graduate nurses use on a day-to-day basis to integrate themselves into pre-existing social frameworks. BACKGROUND: Being a graduate nurse and transitioning from a novice to beginner in the first year of clinical practice is stressful, challenging and overwhelming due to steep learning curves and adjusting to working in professional environments. How graduate nurses socially adapt and fit into ward cultures is a hurdle to successful transition and can be difficult. DESIGN: A qualitative constructivist grounded theory methodology was used. METHODS: Seven adult, Registered Nurses were recruited using a purposive sampling technique. Participants were undertaking a graduate nurse transition programme, in one of two acute care, adult public hospitals in South Australia. Data collection conducted in 2016 used individual interviews consisting of open-ended questions in an unstructured format. Transcripts were transcribed verbatim. Data analysis processes included initial and focused coding, theory building, memo-writing and theoretical sampling. RESULTS: Three main categories: self-embodiment and self-consciousness, navigating the social constructs and raising consciousness, supported by subcategories describe the main strategies graduate nurses use to facilitate adaptation into complex clinical environments and ward cultures. Subsequent concept and theory development explains how graduate nurses find the social and professional balance to fit in. CONCLUSIONS: Understanding the graduates' adaptation strategies can inform improvements in graduate nurse transition programmes. Facilitating and enhancing graduate nurse adaptation is the precursor in creating more resilient nurses ready to face the challenges that exist in today's work environments.
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Adaptação Psicológica , Papel do Profissional de Enfermagem/psicologia , Recursos Humanos de Enfermagem Hospitalar/psicologia , Local de Trabalho/psicologia , Adulto , Feminino , Teoria Fundamentada , Humanos , Masculino , Pesquisa Qualitativa , Austrália do SulRESUMO
BACKGROUND: Research exploring nurses' experiences working with families in paediatric intensive care unit (PICU) is limited. No studies have been undertaken in a mixed adult-paediatric ICU. OBJECTIVES: To explore nurses' perceptions of working with families of critically ill children in a mixed adult-paediatric intensive care unit (ICU). DESIGN: Descriptive qualitative design. METHODOLOGY: Five PICU nurses participated in semi-structured interviews. Data were analysed using thematic analysis. Trustworthiness was enhanced using an audit trail, member checks and peer review of all data. RESULTS: Three main themes and one overarching theme emerged. Role confusion and delineation examined the roles which nurses ascribed to themselves and the families; and demonstrated the conflict which could arise if roles were challenged. Information sharing demonstrated the positive and negative ways in which nurses utilized information with families in their daily practice. The contextual environment of the PICU scrutinized the physical, cultural and institutional factors which impacted on the nurses' ability to work with families in the PICU. Finally, the overarching theme Competing values explores the interplay between the nurses' personal values and those of the PICU and the institution. CONCLUSIONS: Working with families in a mixed adult-paediatric ICU is influenced by multiple personal and institutional factors. The value placed on families and on the time nurses spent with them often competed for priority with nurses' other values and the wider culture of the PICU. The potential for role confusion, the management of information and the physical environment of the PICU further contributed to variability in nurses' working with families. RELEVANCE TO CLINICAL PRACTICE: The results highlighted a need for education for both nurses and medical staff who work with families of critically ill children. Additionally, the need for each PICU to have a written policy on family presence and participation is crucial to guide practice and maintain continuity of care.
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Enfermagem de Cuidados Críticos/organização & administração , Estado Terminal/enfermagem , Unidades de Terapia Intensiva Pediátrica/organização & administração , Relações Profissional-Família/ética , Adulto , Austrália , Criança , Pré-Escolar , Feminino , Grupos Focais , Humanos , Lactente , Entrevistas como Assunto , Papel do Profissional de Enfermagem , Percepção , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Centros de Atenção TerciáriaRESUMO
AIMS AND OBJECTIVES: To review extant research on family-centred care in a paediatric intensive care environment and identify gaps in the literature. BACKGROUND: Family-centred care is currently a core concept in paediatric nursing, focusing on the premise that families are central to a child's well-being, and as such, should be included as equal members of the child's healthcare team. Due to the nature of critical care, family-centred care may be challenging to implement and maintain. DESIGN: An integrative literature review. METHODS: The review was conducted using the Cumulative Index to Nursing and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar databases, from 1990 to present. The search focused on the following terms: 'p(a)ediatric critical care', 'paediatric intensive care unit', 'family cent(e)red care', 'parental needs', 'family presence' and 'family/nurse roles'. Additionally, the search was limited to studies conducted in a developed country and published in English. RESULTS: Eighteen studies were included in the review. The results demonstrated that implementing family-centred care into a paediatric intensive care environment posed several challenges. The discrepancy between nurses' and parents' perception of their roles, the reluctance of medical staff to share potentially negative or rapidly changing information, restrictive family presence and poor understanding of family needs emerged as the key difficulties. No studies evaluated strategies to improve family-centred care practice. CONCLUSIONS: Family-centred care presents many challenges in a paediatric intensive care environment; however, nurses are uniquely positioned to foster relationships with families, encourage accurate and honest information sharing and advocate for families to be present when they choose. RELEVANCE TO CLINICAL PRACTICE: This review outlines the extant research to enhance awareness of the unique state of family-centred care in paediatric intensive care and makes recommendations for future research.
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Família , Unidades de Terapia Intensiva Pediátrica , Papel do Profissional de Enfermagem , Assistência Centrada no Paciente , Criança , Criança Hospitalizada , Humanos , Enfermagem PediátricaRESUMO
The profession of nursing continues to struggle with defining and clarifying its professional identity. The definitive recognition of nursing as a profession was the moving of training from the hospital apprentice model to the tertiary sector. However, this is only part of the story of professional identity in nursing. Once training finishes and enculturation into the workplace commences, professional identity becomes a complicated social activity. This paper proposes social identity theory as a valuable research framework to assist with clarifying and describing the professional identity of nurses. The paper outlines the key elements of a profession and then goes on to describe the main concepts of social identity theory. Lastly, a connection is made between the usefulness of using social identity theory in researching professional identity in nursing, recognizing the contextual nature of the social activity of the profession within its workplace environment.
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Recursos Humanos de Enfermagem , Identificação SocialRESUMO
Abstract This paper explores the reflections of a student nurse upon hearing of the sudden death of a patient she had cared for the previous night on clinical placement. Her journey, and those of colleagues she has observed, prompted this paper's discussion of nurse grief, the support mechanisms available and those preferred by nurses, and the potential outcomes if grief is not acknowledged, supported, and managed. Disenfranchised grief is a major factor in the development of prolonged and cumulative grief responses and negative outcomes for nurses, patients, and the collective nursing profession, however the establishment and utilisation of informal support networks has been found to encourage a discussion of feelings and lead to a healthy resolution of nurse grief.
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Morte Súbita , Pesar , Recursos Humanos de Enfermagem/psicologia , HumanosRESUMO
BACKGROUND: Medicare provides significant funding to improve, encourage and coordinate better practices in primary care. Medicare-rebated Chronic Disease Management (CDM) plans are a structured approach to managing chronic diseases in Australia. These chronic disease care plans are intended to be a vehicle to deliver guideline-based / evidence-based care.. However, recommended care is not always provided, and health outcomes are often not achieved. This scoping review aimed to identify the specific components of CDM plans that are most effective in promoting self-management, as well as the factors that may hinder or facilitate the implementation of these plans in general practice settings in Australia. METHOD: A comprehensive search was conducted using multiple electronic databases, considering inclusion and exclusion criteria. Two reviewers independently screened the titles and abstracts of the identified studies via Covidence, and the full texts of eligible studies were reviewed for inclusion. A data extraction template was developed based on the Cochrane Effective Practice and Organization of Care Group (EPOC) to classify the intervention methods and study outcomes. A narrative synthesis approach was used to summarize the findings of the included studies. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist. RESULTS: Seventeen articles were included in the review for analysis and highlighted the effectiveness of CDM plans on improving patient self-management. The findings demonstrated that the implementation of CDM plans can have a positive impact on patient self-management. However, the current approach is geared towards providing care to patients, but there are limited opportunities for patients to engage in their care actively. Furthermore, the focus is often on achieving the outcomes outlined in the CDM plans, which may not necessarily align with the patient's needs and preferences. The findings highlighted the significance of mutual obligations and responsibilities of team care for patients and healthcare professionals, interprofessional collaborative practice in primary care settings, and regular CDM plan reviews. CONCLUSION: Self-management support remains more aligned with a patient-centred collaboration approach and shared decision-making and is yet to be common practice. Identifying influential factors at different levels of patients, healthcare professionals, and services affecting patients' self-management via CDM plans can be crucial to developing the plans.
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Diabetes Mellitus , Medicina Geral , Autogestão , Idoso , Humanos , Programas Nacionais de Saúde , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Austrália/epidemiologia , Gerenciamento ClínicoRESUMO
BACKGROUND: Pain management of sedated and ventilated patients in intensive care units lacks consistency. OBJECTIVES: To investigate nurses' training, governance, practices, knowledge and attitudes relating to pain management in consideration of published guidelines and explore nurses' perspectives. METHODS: A survey design, using an online questionnaire with free text responses, was employed. Quantitative and qualitative data from nurses working across different hospitals were collated and saved on Qualtrics platform. Quantitative data were analysed non-parametrically and narrative responses thematically. CROSS and SRQR reporting guidelines were adhered to. OUTCOME MEASURES: Demographics, training, governance, clinical practice, knowledge, and attitudes. RESULTS/FINDINGS: 108 nurses participated with ninety-two completed surveys analysed. Analgesia was used to complete nursing tasks regardless of comfort needs (n = 49, 53.3 %). Changes in vital signs prompted opioid administration (n = 48, 52.1 %). Choice of analgesia depended on doctor's preference (n = 63, 68.5 %). Non-opioid therapy was administered before opioids (n = 42, 45.7 %). Sedatives were used to alleviate agitation(n = 50,54.3 %). No statistically significant difference in nurses' knowledge existed between hospitals. Weak positive relationship: r = [0.081], p = [0.441] between "knowledge scores" and "years of ICU experience" and weak negative relationship r = [-0.119], p = [0.260] between "knowledge scores" and "hours of clinical practice" was detected. Lack of training, resources, policies, high patient acuity and casual employment were acknowledged barriers to pain management. Two overarching themes emerged from narrative responses: "Pain assessment, where is it?" And "Priorities of critical illness." CONCLUSION: The study uncovered pain management situation and examined nurses' demographics, training, governance, practices, knowledge and attitudes. Narrative responses highlighted barriers to pain management. IMPLICATIONS FOR CLINICAL PRACTICE: Health organisations should provide education, institute governance and develop policies to inform pain management. Nurses' role encompasses updating knowledge, adhering to interventions and overcoming biases. This subsequently manifests as improvement in patient outcomes.
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Unidades de Terapia Intensiva , Manejo da Dor , Respiração Artificial , Humanos , Unidades de Terapia Intensiva/organização & administração , Inquéritos e Questionários , Adulto , Manejo da Dor/métodos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Feminino , Masculino , Respiração Artificial/métodos , Respiração Artificial/enfermagem , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
AIM: The research aim of this study was to seek feedback from prevention of aggression training experts about the suitability of Entrustable Professional Activities (EPAs) as an assessment tool for an Aggression Prevention Protocol. The protocol was designed to structure intervention to prevent aggression and reduce the use of restrictive practices following risk assessment using a validated instrument (the Dynamic Appraisal of Situational Aggression). BACKGROUND: Preventing aggression and limiting the use of restrictive practices are key priorities for inpatient mental health services. Assessing clinical activities using a competence framework has limitations, particularly when determining complex interventions. EPAs could provide a suitable method for assessing complex clinical activities like de-escalation and limit setting, which comprise some of the interventions in the Aggression Prevention Protocol. EPAs are new to forensic mental health nursing; therefore, feedback was sought regarding the utility of EPAs to assess aggression prevention interventions. METHODS: Data were collected via focus groups including 11 aggression prevention experts from Australia and New Zealand. A thematic analysis, comparative analysis and a Strength, Weakness, Opportunity and Threats analysis was conducted. RESULTS: Three themes were interpreted from the data: 1) Frameworks such as the APP are needed to work towards elimination of restrictive practices; 2) APP-EPAs afford an opportunity to set the standard for practice; and 3) 'who watches the watchers', were identified by the experts as well as areas to enhance EPAs prior to introduction into practice. CONCLUSIONS: EPAs address a practice-gap and offer a framework to assist movement towards elimination of restrictive practices, while prompting best-practice, self-reflection and practice improvement guidance.
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Internato e Residência , Serviços de Saúde Mental , Humanos , Agressão , Educação Baseada em Competências , Grupos Focais , Competência ClínicaRESUMO
Forensic mental health nurses (FMHN) provide care to address the needs of people who have mental illnesses across a range of diverse settings. The Clinical Reasoning Cycle (CRC) has been identified as a potential framework to assist FMHNs; however, adaptations were required to reflect the unique nature of the clinical setting. This study aimed to explore adaptations made to determine suitability prior to implementation in practice. Nominal Group Technique was used to explore suggested adaptations determined from a previous study and reach a consensus on the changes. Fourteen senior nurses from a state-wide Forensic mental Health (FMH) service participated. A consensus was reached for two proposed changes. Data were analysed using thematic analysis. Three main themes were interpreted from the data; FMH adaptations are warranted, the focus of the CRC, and who owns the cycle? Nurses in this study considered the need to include offence and risk issues due to the impact these factors have on the therapeutic relationship and cognitive bias; however, they also identified the need to focus on recovery-oriented care while engaging in clinical reasoning. Nurses in this study also expressed some reluctance for nursing to 'own' the model, due to concern that ownership may cause division among the team or result in inconsistency in care. However, some participant's suggested the CRC with adaptations assisted FMH nurses to articulate their specialist skills and knowledge to others and highlight the nursing contribution to care. Further work is needed to finalize adaptations with a focus on engaging the consumer carer workforce and interdisciplinary team.
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Transtornos Mentais , Enfermagem Psiquiátrica , Humanos , Enfermagem Psiquiátrica/métodos , Transtornos Mentais/terapia , Pesquisa Qualitativa , Recursos Humanos , CuidadoresRESUMO
Forensic mental health nursing (FMHN) is a specialized field, designed to meet the needs of people who have a serious mental illness across the criminal justice system, inpatient services and community. Frameworks can assist assessment, planning, intervention, documentation and evaluation of nursing care. However, there is no prior research investigating frameworks in FMHN. This study aimed to explore the Nursing Process (NP) and the Clinical Reasoning Cycle (CRC), with nurses, to determine a suitable framework for use service-wide. A Nominal Group Technique was used to facilitate exploration of the two frameworks, where open-ended verbal and written responses collected from a Nominal Group were thematically analysed, and the participants voted on their preferred framework. Seventeen nurses from a state-wide forensic mental health (FMH) service participated. The four main themes were as follows: challenges to current practice, limitations of the NP, perceived benefits of the CRC and addressing implementation. Consensus was reached with the nurses selecting the CRC as the framework of choice. This is the first study to explore frameworks to guide practice in FMHN. Nurses in this study considered the CRC to be a suitable framework for novice through to expert, offering a contemporary framework to guide nursing care in complex FMH settings. Some adjustments to the existing cycle were suggested to emphasize recovery-oriented practice, and inclusion of family and carers. Any changes to the cycle warrant exploration with the interdisciplinary team and consumer carer workforce.
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Processo de Enfermagem , Enfermagem Psiquiátrica , Raciocínio Clínico , Humanos , Saúde Mental , Pesquisa QualitativaRESUMO
In nursing, it is vital that educational techniques are developed to improve students' capabilities to communicate with and assess mental health consumers while on placement. Simulation is a valid learning technique used to prepare students to encounter consumers with mental illness before exposure in the clinical environment. The aim of this study was to explore undergraduate nursing students' experience mental health simulation following their mental health clinical placement. An explorative descriptive qualitative study. Participants were recruited from a metropolitan Melbourne university using purposive convenience sampling. The participants were interviewed after their mental health clinical placement using semi-structured interview format. A total of n = 14 participants were interviewed. Overall, the participants expressed the fact that the mental health simulation enhanced their clinical placement experience. Two themes were identified: 'The things I might see' and 'Felt better prepared'. There was a total of five subthemes: 'The link between ', 'Having the know how', 'Like an 8-hour shift', 'Took away the fear factor' and 'Feeling more confident'. It is important that nursing students entering mental health settings receive adequate preparation prior to the commencement of their placements. Students need to be prepared in the areas of building therapeutic relationships, communication, assessment and how to work within a mental health clinical setting. The mental health simulation enhanced students' confidence and better prepared them to undertake their clinical placement which can ultimately affect the care provided to consumers.
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Bacharelado em Enfermagem , Estudantes de Enfermagem , Humanos , Aprendizagem , Saúde Mental , Pesquisa QualitativaRESUMO
The coronavirus global pandemic interrupted teaching at Australian universities. Face-to-face teaching was replaced by online delivery. This presented challenges for nursing programmes due to the hands-on teaching requirements and clinical placements. Questions were raised around students' resilience and stress in the face of adversity. This study explored undergraduate nursing students' resilience, challenges experienced, and supports utilized during the pandemic. Convenience sampling recruited students from one nursing programme (n = 340). Quantitative and qualitative data were collected. The Connor-Davidson Resilience Scale (CD-RISC-25) examined resilience scores through non-parametric analysis. Narrative responses were analysed using inductive thematic analysis. 121 surveys (40.3%) were completed. Most participants were from second year (n = 77, 63.6%). The difference in median resilience scores among employed participants was statistically significant (P = 0.029) and higher than the unemployed. The median scores of students working in nursing-related roles were higher than others. Median resilience score across all year levels was 70 (IQR = 62-80), in the lowest score range. Major themes identified were fear of the virus, isolation, and mental health problems. The coping strategies identified were developing daily routines, staying connected, and establishing self-help techniques. This research has implications to optimize students' learning experience, enhance resilience, and promote mental health and well-being.
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Coronavirus , Bacharelado em Enfermagem , Resiliência Psicológica , Estudantes de Enfermagem , Austrália , Humanos , PandemiasRESUMO
BACKGROUND: Pain is frequently encountered in the intensive care setting. Given the impact of pain assessment on patient outcomes and length of hospital stay, studies have been conducted to validate tools, establish guidelines and cast light on practices relating to pain assessment. OBJECTIVE: To examine the extent, range and nature of the evidence around pain assessment practices in adult patients who cannot self-report pain in the intensive care setting and summarise the findings from a heterogenous body of evidence to aid in the planning and the conduct of future research and management of patient care. The specific patient cohort studied was the sedated/ ventilated patient within the intensive care setting. DESIGN: A scoping review protocol utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping review checklist (PRISMA-ScR). METHODS: The review comprised of five phases: identifying the research question, identifying relevant studies, study selection, charting the data and collating, summarizing, and reporting the results. Databases were systematically searched from January to April 2020. Databases included were Scopus, Web of Science, Medline via Ovid, CINAHL COMPLETE via EBSCO host, Health Source and PUBMED. Limits were applied on dates (2000 to current), language (English), subject (human) and age (adult). Key words used were "pain", "assessment", "measurement", "tools", "instruments", "practices", "sedated", "ventilated", "adult". A hand search technique was used to search citations within articles. Database alerts were set to apprise the availability of research articles pertaining to pain assessment practices in the intensive care setting. RESULTS: The review uncovered literature categorised under five general themes: behaviour pain assessment tools, pain assessment guidelines, position statements and quality improvement projects, enablers and barriers to pain assessment, and evidence appertaining to actual practices. Behaviour pain assessment tools are the benchmark for pain assessment of sedated and ventilated patients. The reliability and validity of physiologic parameters to assess pain is yet to be determined. Issues of compliance with pain assessment guidelines and tools exist and impact on practices. In some countries like Australia, there is a dearth of information regarding the prevalence and characteristics of patients receiving analgesia, type of analgesia used, pain assessment practices and the process of recording pain management. In general, pain assessment varies across different intensive care settings and lacks consistency. CONCLUSION: Research on pain assessment practices requires further investigation to explore the causative mechanisms that contribute to poor compliance with established pain management guidelines. The protocol of this review was registered with Open Science Framework (https://osf.io/25a6) Tweetable abstract: Pain assessment in intensive care settings lacks consistency. New information is needed to understand the causative mechanisms underpinning poor compliance with guidelines.
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Cuidados Críticos , Respiração Artificial , Adulto , Humanos , Dor , Medição da Dor , Reprodutibilidade dos TestesRESUMO
AIM: This study aimed to evaluate Australian nursing students' views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET). BACKGROUND: Clinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences. DESIGN: A survey design was used with a contemporary survey tool- the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed. METHODS: A total of 1263 nursing students completed the Placement Evaluation Tool (PET) - 19 items (rated 1-5), one global rating (rated 1-10) - following placement in three Australian States (July 2019-February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall. RESULTS: The total PET mean score was 78.3% with 29.8% being 'extremely satisfied' (10 out of 10 - Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle. CONCLUSIONS: Whilst students' clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.
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Bacharelado em Enfermagem , Estudantes de Enfermagem , Atitude do Pessoal de Saúde , Austrália , Humanos , Aprendizagem , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Self-efficacy is crucial for student success. Studies have demonstrated a positive relationship between flipped learning approach and self-efficacy. Anxiety, however, can reduce self-efficacy. OBJECTIVE: Testing the relationship between the flipped approach and self-efficacy by flipping a nursing module within an externally-imposed and once-off anxiety-inducing context. METHOD: Students completed a self-efficacy survey before (n = 71) and after (n = 91) a compressed semester, which provided the anxiety-inducing context. RESULTS: Pre-semester self-efficacy was 2.93/4, and post-semester was 2.98/4. The results demonstrated no significant change in students' self-efficacy. CONCLUSION: We argue the flipped approach counters anxiety-inducing effects to maintain self-efficacy. In less anxiety-inducing contexts, we argue the flipped approach would develop students' confidence, capability, persistence and strength beliefs, collectively enhancing self-efficacy perceptions.
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Ansiedade/psicologia , Avaliação Educacional/estatística & dados numéricos , Aprendizagem Baseada em Problemas , Autoeficácia , Estudantes de Enfermagem/psicologia , Currículo , Humanos , Modelos Educacionais , Inquéritos e QuestionáriosRESUMO
Undertaking a mental health clinical placement can be anxiety-provoking for nursing students at times. There is a need to adequately prepare undergraduate nursing students for clinical placement in a mental health setting in relation to their skills and confidence. This study aimed to evaluate the effect of a mental health simulation workshop on the skills and confidence of nursing students in providing care to consumers living with a mental illness. The study also evaluated the design of the mental health simulation workshop from an educational perspective. A pre/post-test survey was administered to a cohort of N = 89 Australian pre-registration nursing students. Exploratory factor analysis identified three factors: Mental health therapeutic engagement, mental health assessment skills, and mental health placement preparedness. Analyses of pre-post differences indicated that all three factors were significantly different between the initial and follow-up responses, with follow-up responses being more favourable. The findings of this study demonstrate that there is value in including mental health simulated patient exercise as part of the learning strategies in the curriculum of pre-registration nurses. This has implications for the quality of care in the clinical environment and level of preparedness of these students' nurses for mental health clinical placement where they will be providing care to consumers living with a mental illness under direct supervision.