Exploration of a nurse practitioner-led phase two cardiac rehabilitation programme on attendance and compliance.

AIMS AND OBJECTIVES: To evaluate the impact of a nurse practitioner-led phase two cardiac rehabilitation and secondary prevention programme on attendance and compliance. BACKGROUND: Despite strong evidence for the benefits of cardiac rehabilitation, attendance/completion rates remain low. Nurse practitioner-led services have been reported as more effective than physician-led services at increasing patient adherence to evidence-based recommendations. However, nurse practitioner-led programmes are uncommon and there appears to be no current evidence examining the impact of these programmes on attendance/completion rates. METHODS: A retrospective audit of the Country Access to Cardiac Health (CATCH) database was undertaken to identify patients who attended a nurse practitioner-led cardiac rehabilitation programme between April 2014 and May 2016. Data from key performance indicators were exported to Stata/SE 15.0. The study utilised the Strengthening the Reporting of OBservational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies to ensure quality reporting during this study (See Data S1). RESULTS: Seventy-seven per cent (n = 199) of participants were men, and participants had a mean age of 67 years. Half (52.5%) of participants completed all CR sessions. Male participants (78%) were more likely to complete the CR programme as compared with women (67%). Participants with a family history of cardiovascular disease and a higher number of risk factors at baseline were more likely to commence and complete the programme. Attendance and completion had a positive impact on smoking cessation. CONCLUSIONS: The nurse practitioner-led programme evaluated in this study demonstrated high levels of attendance and completion rates compared to standard programmes. This high attendance/completion rate could in turn decrease the rate of subsequent cardiac events and improve mortality and morbidity rates. Relevance to clinical practice provides valuable insights into the effectiveness of nurse practitioner-led cardiac rehabilitation and secondary prevention on attendance/complete rates. These findings could guide future research and clinical practice development.

Understanding how nurse managers see their role in supporting ICU nurse well-being-A case study.

AIM: To explore how nurse managers perceive and experience their role in supporting the well-being of intensive care nurses. BACKGROUND: While it is known that nurse manager behaviours affect nurse well-being, literature indicates that intensive care nurses may not receive the support they require. Understanding how nurse managers see their role in supporting nurse well-being is crucial to offer recommendations for improvement. METHODS: Qualitative multiple case study design. Twelve semi-structured, in-depth interviews were conducted with nurse managers from Australian intensive care unit settings. Data were analysed using thematic analysis. RESULTS: Nurse manages felt unsure about what their supportive role involved, lacked training on how to support nurse well-being and called for organisational backup to carry out their role effectively. The study also provided insight into the strategies that enabled nurse managers to support nurse well-being. CONCLUSION: There is currently no consensus on the role of the nurse manager in supporting nurse well-being resulting in inconsistencies and wide practice variations. Furthermore, nurse managers need support and training if they are required to support nurse well-being. IMPLICATIONS FOR NURSING MANAGEMENT: A clear definition of the nurse manager supportive role describing the purpose and core functions involved in this role must be developed to support nurse well-being.

The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review.

INTRODUCTION: The number of patients requiring admission into intensive care units (ICUs) is increasing worldwide. Concurrently, recruitment and retention of the ICU nursing workforce is becoming a major challenge due to the high intensity environment, heavy workloads, and decreasing nurse wellbeing. Nurse unit managers play a vital role in promoting and supporting ICU nurse wellbeing, yet little is known about perceptions and experiences of this role. OBJECTIVES: To examine the perceived and experienced role of the nurse unit manager in supporting the wellbeing of ICU nurses. REVIEW METHODS: A comprehensive review of the literature was undertaken using Whittemore and Knafl's five stage approach: (i) problem identification, (ii) literature search, (iii) quality appraisal, (iv) data analysis, and (v) presentation of findings. DATA SOURCES: The following databases were searched for literature published between January 2007 and December 2017: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Informit, Joanna Briggs Institute Library of Systematic Review, ProQuest, PubMed, Scopus, and Wiley online library digital databases. Variations and synonyms of key words included: nurse unit manager, ICU, compassion fatigue, burnout, stress, job satisfaction, bullying, wellbeing, and work environment. RESULTS: Rigour and trustworthiness of the included studies were assessed using the Critical Appraisal Skills Program qualitative research checklist,71 a modified Critical Appraisal Skills Program Cohort study checklist for quantitative research,72 and the Mixed Methods Appraisal Tool for mixed-method studies.73 The critical review guidelines by Shenton74 and Polit and Beck75 were also used to make judgements about the worth of the evidence. All of the 11 qualitative studies provided moderate to strong evidence. The overall quality of the quantitative studies was lower, with three of seven studies providing only adequate evidence. The majority of the 19 included studies represented the voices of ICU nurses. Three major themes emerged from the analysis; '1) building professional relationships', '2) leading the way' and '3) satisfying the needs of ICU nurses'. CONCLUSION: Nurse unit manager behaviours clearly affect the wellbeing of ICU nurses. However, the role of supporting ICU nurses is complex and challenging. More research is needed to investigate the needs of ICU nurses and the facilitators and barriers nurse unit managers face when supporting the wellbeing of nurses in their unit.

How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation?

AIMS AND OBJECTIVES: To examine how clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation. BACKGROUND: Family presence during resuscitation has important benefits for family and is supported by professional bodies and the public. Yet, many clinicians restrict family access to patients during resuscitation, and rationales for decision-making are unclear. DESIGN: Secondary analysis of an existing qualitative data set using deductive category application of content analysis. METHODS: We analysed 20 interview transcripts from 15 registered nurses, two doctors and three paramedics who had experienced family presence during resuscitation in an Australian hospital. The transcripts were analysed for incidents of beneficent decision-making when allowing or denying family presence during resuscitation. RESULTS: Decision-making around family presence during resuscitation occurred in time poor environments and in the absence of local institutional guidelines. Clinicians appeared to be motivated by doing "what's best" for patients and families when allowing or denying family presence during resuscitation. However, their individual interpretations of "what's best" was subjective and did not always coincide with family preferences or with current evidence that promotes family presence during resuscitation as beneficial. CONCLUSIONS: The decision to allow or deny family presence during resuscitation is complex, and often impacted by personal preferences and beliefs, setting norms and tensions between clinicians and consumers. As a result, many families are missing the chance to be with their loved ones at the end of life. The introduction of institutional guidelines and policies would help to establish what safe and effective practice consists of, reduce value-laden decision-making and guide beneficent decision-making. RELEVANCE TO CLINICAL PRACTICE: These findings highlight current deficits in decision-making around FPDR and could prompt the introduction of clinical guidelines and policies and in turn promote the equitable provision of safe, effective family-centred care during resuscitation events.

Modeling Missed Care: Implications for Evidence-Based Practice.

BACKGROUND: There is a growing nursing literature that views missed care as an inevitable consequence of work intensification associated with the rationing of nursing and material resources available to deliver care. Global studies recognize that missed care is now ubiquitous, although studies tend to be conducted in one region, rather than nationwide. This study seeks to understand the Australian context of missed care. AIMS: To explore self-reported reasons for missed care and to identify the main factors for predicting missed care within a sample of Australian nurses and midwives working in public and private hospitals in New South Wales, Victoria, Tasmania, and South Australia. METHODS: A nonexperimental, descriptive method using Kalisch's (2006) MISSCARE survey was used. Responses from 1,195 nursing and midwifery staff with differing qualifications, English language skills, and Australian employment settings were analyzed using Rasch analysis and then modeled using the Structural Equation Modeling. RESULTS: The frequency of missed care on the morning shift directly impacted on higher priority care missed during the afternoon shift. Staff skill mix imbalances and perceived inadequacy of staff numbers for the work demands further exacerbated all aspects of care during afternoon shifts. Other major factors associated with missed care were the different clinical work settings and staff to patient ratios. LINKING EVIDENCE TO ACTION: The incidences, types, and reasons behind missed care are a multidimensional construct which can be predicted when known significant factors behind missed care are simultaneously accounted for.

Can Nursing Students Practice What Is Preached? Factors Impacting Graduating Nurses' Abilities and Achievement to Apply Evidence-Based Practices.

BACKGROUND: In order to meet national Australian nursing registration requisites, nurses need to meet competency requirements for evidence-based practices (EBPs). AIMS: A hypothetical model was formulated to explore factors that influenced Australian nursing students' ability and achievement to understand and employ EBPs related to health care provision. METHODS: A nonexperimental, descriptive survey method was used to identify self-reported EBP efficacy estimates of 375 completing undergraduate nursing students. Factors influencing participants' self-rated EBP abilities were validated by Rasch analysis and then modeled using the partial least squares analysis (PLS Path) program. RESULTS: Graduating nursing students' ability to understand and apply EBPs for clinical improvement can be directly and indirectly predicted by eight variables including their understanding in the analysis, critique and synthesis of clinically based nursing research, their ability to communicate research to others and whether they had actually witnessed other staff delivering EBP. LINKING EVIDENCE TO ACTION: Forty-one percent of the variance in the nursing students' self-rated EBP efficacy scores is able to be accounted for by this model. Previous exposure to EBP studies facilitates participants' confidence with EBP, particularly with concurrent clinical EBP experiences.

Factors influencing decision-making around family presence during resuscitation: a grounded theory study.

AIM: The aim of this study was to examine factors impacting family presence during resuscitation practices in the acute care setting. BACKGROUND: Family presence during resuscitation was introduced in the 1980s, so family members/significant others could be with their loved ones during life-threatening events. Evidence demonstrates important benefits; yet despite growing support from the public and endorsement from professional groups, family presence is practiced inconsistently and rationales for poor uptake are unclear. DESIGN: Constructivist grounded theory design. METHODS: Twenty-five health professionals, family members and patients informed the study. In-depth interviews were undertaken between October 2013-November 2014 to interpret and explain their meanings and actions when deciding whether to practice or participate in FPDR. FINDINGS: The Social Construction of Conditional Permission explains the social processes at work when deciding to adopt or reject family presence during resuscitation. These processes included claiming ownership, prioritizing preferences and rights, assessing suitability, setting boundaries and protecting others/self. In the absence of formal policies, decision-making was influenced primarily by peoples' values, preferences and pre-existing expectations around societal roles and associated status between health professionals and consumers. As a result, practices were sporadic, inconsistent and often paternalistic rather than collaborative. CONCLUSION: An increased awareness of the important benefits of family presence and the implementation of clinical protocols are recommended as an important starting point to address current variations and inconsistencies in practice. These measures would ensure future practice is guided by evidence and standards for health consumer safety and welfare rather than personal values and preferences of the individuals 'in charge' of permissions.

Experiences of registered nurses who supervise international nursing students in the clinical and classroom setting: an integrative literature review.

AIMS AND OBJECTIVES: To examine the literature reporting the experiences and perceptions of registered nurses who supervise international nursing students in the clinical and classroom setting. BACKGROUND: Nursing education relies on clinical experts to supervise students during classroom and clinical education, and the quality of that supervision has a significant impact on student development and learning. Global migration and internationalisation of nursing education have led to increasing numbers of registered nurses supervising international nursing students. However, a paucity of relevant literature limits our understanding of these experiences. DESIGN: An integrative literature review. METHODS: Comprehensive database searches of CINAHL, Informit, PubMed, Journals@Ovid, Findit@flinders and Medline were undertaken. Screening of 179 articles resulted in 10 included for review. Appraisal and analysis using Whittemore and Knafl's (Journal of Advanced Nursing, 52, 2005, 546) five stage integrative review recommendations was undertaken. RESULTS: This review highlighted some unique challenges for registered nurses supervising international nursing students. Identified issues were, a heightened sense of responsibility, additional pastoral care challenges, considerable time investments, communication challenges and cultural differences between teaching and learning styles. CONCLUSION: It is possible that these unique challenges could be minimised by implementing role preparation programmes specific to international nursing student supervision. Further research is needed to provide an in-depth exploration of current levels of preparation and support to make recommendations for future practice, education and policy development. RELEVANCE TO CLINICAL PRACTICE: An awareness of the specific cultural learning needs of international nursing students is an important first step to the provision of culturally competent supervision for this cohort of students. There is an urgent need for education and role preparation for all registered nurses supervising international nursing students, along with adequate recognition of the additional time required to effectively supervise these students.

Torn between dual roles: the experiences of nurse-family members when a loved one is hospitalised in a critical condition.

AIMS AND OBJECTIVES: To understand and interpret the experiences of nurse-family members when a family member or loved one is hospitalised in a critical condition. BACKGROUND: Having a family member hospitalised with a critical illness is a traumatic stressor, often with long-term sequelae. Providing holistic care for family members who are also nurses makes the provision of care more complex because of their professional expertise; yet few studies have explored this issue. DESIGN: In this descriptive study, qualitative data were collected using a questionnaire and analysed using van Manen's (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990, State University of New York Press, London, ON) six-step approach. METHODS: Twenty nurse-family members completed an online questionnaire in June 2013. Qualitative findings from 19 participants were included in the analysis. The phenomenological analysis approach described by van Manen (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990, State University of New York Press, London, ON) was used to describe and interpret nurse-family member experiences. RESULTS: Nurse-family members experience significant dual role conflicts between their personal and professional personas due to their specialised knowledge, need for watchfulness and competing expectations. Our findings describe how dual role conflicts developed and were managed, and reveal the resultant emotional toll and psychological distress as nurse-family members struggled to resolve these conflicts. CONCLUSIONS: Nurse-family members require a different type of care than general public family members, yet their unique needs are often unmet, leading to increased anxiety and distress that could potentially be minimised. An increased awareness and emphasis on the nurse-family member experience can ensure health care professionals are better placed to provide appropriate and targeted care to minimise distressing dual role conflicts. RELEVANCE TO CLINICAL PRACTICE: There is a need for targeted and specialised communication appropriate to each nurse-family members' needs and level of understanding, and to clarify expectations to ensure nurse-family members' professional knowledge and skills are recognised and respected without being exploited.

Psychometric Evaluation of a Self-Report Evidence-Based Practice Tool Using Rasch Analysis.

AIMS: This paper reports if estimates of final year nursing students' self-rated abilities in responding to evidence-based practice (EBP) issues is a psychometrically robust measure. BACKGROUND: EBP as it applies to nursing continues to be heralded as a method to improve clinical patient care. Health professionals such as nurses are well positioned to respond to this demand; however, evidence suggests they are not always able to embrace this important foundation of everyday nursing practice. DESIGN: Instrument development. METHODS: The study was a survey set in a large teaching university in Adelaide, South Australia. The evidence-based practice survey was made available to a convenience sample of 471 final year nursing students, with a response rate of 79.6% (n = 375). Rasch analysis was used to critique and develop a scale for future learning based on the conjoint estimates of nursing students' self-efficacy estimates, when meeting the challenges of various EBP of differing complexities. RESULTS: Outcomes confirm that final year nursing students' EBP ability measures can be reliably estimated and a hierarchical scale of learning can be developed for use by beginning registered nurses' in their staff development. LINKING EVIDENCE TO ACTION: Although Australian health and nursing authorities acknowledge the desirability of the nursing workforce in adopting EBP for patient management, elements of this approach remains problematic for nurses. Measures to estimate EBP skills difficulty can be reliably generated to inform EBP education and skills development.

Nurses' experiences of the hospitalisation of their own children for acute illnesses.

BACKGROUND: The hospitalisation of a child is a stressful event for parents. Parents who are also nurses may face additional challenges not encountered by other parents; yet, scant attention has been given to this issue in the literature. AIM: To explore the experiences of Nurse-Parents whose children were hospitalised for acute illnesses. METHODS/DESIGN: Using a case-study design, semi-structured interviews were conducted with six registered nurses and thematically analysed. RESULTS/FINDINGS: Nurse-Parents experienced significant conflicts between their parental role and nurse persona as they were 'torn between dual roles'. Nurse-Parents' specialised knowledge prompted them to elevate the care their child needed, leading to increased stress and anxiety as they struggled to balance these roles. CONCLUSION: Nurse-Parents want and need a different type of input into their children's care than non-nurse-parents. An increased awareness among healthcare professionals is the first step to ensuring that effective and individualised support is provided to Nurse-Parents.

Qualitative systematic review: the unique experiences of the nurse-family member when a loved one is admitted with a critical illness.

AIM: To interpret and synthesize nurse-family member experiences when a critically ill loved one is admitted to hospital. BACKGROUND: Having a family member hospitalized in a critical condition is an important stressor. When the family member is also a nurse, the provision of care is more complex, yet little research exists on this issue. DESIGN: Systematic review using Thomas and Harden's approach to thematic synthesis of qualitative research. DATA SOURCES: Primary studies were located by searching CINAHL, Proquest, Journals@Ovid, SCOPUS, Cochrane Library and Google Scholar. No date restrictions were applied due to a lack of relevant literature. All studies that met inclusion criteria were retrieved (n = 1717) and seven met the review aim. REVIEW METHODS: Following critical appraisal, seven studies from 1999-2011 describing the nurse-family member's experience were reviewed and synthesized. RESULTS: Six characteristics of the nurse-family member experience were identified: specialized knowledge; dual-role conflicts; competing expectations; building relationships; being 'let in'; and healthcare setting. CONCLUSION: Nurse-family members experience important stressors that can negatively affect their psychological health and experience as a healthcare consumer. Nurse-family members want a different type of care than other healthcare consumers. Acknowledging nurse-family members' specialized knowledge and dual role, keeping them fully informed and allowing them to be with the patient and feel in control can reduce their fear and anxiety. Further research is needed to develop a deeper understanding of the unique experiences, challenges and needs of nurse-family members to provide them with an enhanced level of care.

Barriers to education in cardiac rehabilitation within an Iranian society: a qualitative descriptive study.

INTRODUCTION: Cardiac rehabilitation programmes that include patient education aim to maximise physical, psychological and social functioning, and enable people with acute coronary syndrome to lead fulfilling and productive lives. Despite strong evidence for the benefits of patient education, various barriers exist that need to be addressed to ensure the effective delivery of care. This study explores patients/family members and health professionals' perceptions and experiences of the barriers to cardiac rehabilitation education in an Iranian context. METHODS: A thematic analysis of in-depth interviews was undertaken using a constant comparative approach. Participants (10 health professionals, 15 patients/family members) were recruited from educational-medical centers and hospitals in Iran. Credibility and trustworthiness were grounded on four aspects: factual value, applicability, consistency and neutrality. RESULTS: Five major barriers to cardiac rehabilitation were identified relating to human resources, service provision, available educational services, unfavourable attitudes and collaboration gaps. Two main challenges exist to the provision of effective patient education; inadequate human resources in the hospital wards, specifically in terms of trained health care professionals and service users specific health related views and behaviours. CONCLUSION: Barriers to comprehensive patient education and cardiac rehabilitation in Iran must be addressed and urgent consideration should be given to the introduction and evaluation of education programmes to prepare health/support system professionals as well as service users, and cardiac rehabilitation services that employ a collaborative and individualised approach. This in turn may reduce the burden of CVD and improve the overall health and quality of life for people in Isfahan Iran.

Benchmarking to the international pressure ulcer prevalence survey.

PURPOSE: Authors and team members from the naval medical center at portsmouth (NMCP), virginia, obtained data on the prevalence and incidence of pressure ulcers (PUs) in our agency and compared them to national benchmark data as a basis for improving our wound care protocols. SUBJECTS AND SETTING: health care facilities throughout the nation volunteered to participate in the data collection process for a multiday PU prevalence survey performed in february 2009, including nmcp. Each facility collected prevalence data during a preselected 24-hour period out of the 72-hour time frame selected by the national study. METHODS: A standardized 1-page data collection form for each subject included demographic data, use of wound care protocols and pressure redistribution surfaces, PU stage and location, risk assessment using the braden scale for pressure sore risk, head-of-bed position, turning and repositioning, mobility, weight, incontinence, documentation of a PU within 24 hours of admission, device-related ulcers, and adequacy of documentation. Facility-specific data on a second form included braden scale score, bed type, use of pressure redistribution devices on the heels, hospital unit, turn schedule use, plastic brief use, presence of incontinence-associated dermatitis, and nursing documentation. Chart reviews were performed to determine hospital- versus non-hospital-acquired PU occurrence. Each PU was recorded separately and linked to its identifying stage. RESULTS: The PU incidence of adults managed in acute care inpatient units at NMCP was 6.6% and the prevalence was 10%. The most common location of facility-acquired PUs was the heels (50%). In contrast, national benchmarking data found that the highest incidence of PUs occurred in the sacral region. CONCLUSIONS: Benchmarking allows health care professionals to compare outcomes in their agencies to outcomes in comparable facilities. Identification of areas in which agency outcomes compare negatively to benchmark data should prompt implementation of quality improvement initiatives. National PU prevalence surveys provide a benchmark to evaluate an individual facility's care and treatment of patients at risk for pressure ulceration. The true benefit of participation in such surveys, however, is determined by local health care professionals' ability to use national data to improve clinical practice.

Nurses' perceptions and experiences of caring for patients who die in the emergency department setting.

INTRODUCTION: The number of people dying in emergency departments (EDs) is increasing. However, EDs are not well designed or resourced for safe and effective End-Of-Life (EOL) care encounters, and there is little evidence regarding clinicians' perceptions and experiences of providing such care when the death is sudden and unexpected. AIM: This study explored nurses' perceptions and experiences of caring for patients who die suddenly and unexpectedly in the ED. METHODS: Open-end responses were collected as part of a larger descriptive survey design. The qualitative data were analysed thematically. RESULTS: 211 ED nurse completed the online survey. Within the qualitative data, five themes were identified during analysis: 1) key elements of EOL care, 2) systemic and environmental barriers, 3) educational deficits, 4) role ambiguity, and 5) emotional impact. Participants identified communication, a standardised approach, and better educational preparedness as the most important elements of EOL care when the death was sudden and unexpected. CONCLUSIONS: ED nurses want to provide high quality care to dying patients and their families. However, their efforts are hampered by systemic and environmental barriers outside their control. There is a need for a culture shift to overcome the barriers that currently obstruct ED nurses from providing meaningful and effective EOL care in the ED.

Coding, Constant Comparisons, and Core Categories: A Worked Example for Novice Constructivist Grounded Theorists.

Grounded theory method has been described extensively in the literature. Yet, the varying processes portrayed can be confusing for novice grounded theorists. This article provides a worked example of the data analysis phase of a constructivist grounded theory study that examined family presence during resuscitation in acute health care settings. Core grounded theory methods are exemplified, including initial and focused coding, constant comparative analysis, memo writing, theoretical sampling, and theoretical saturation. The article traces the construction of the core category "Conditional Permission" from initial and focused codes, subcategories, and properties, through to its position in the final substantive grounded theory.

Nursing students' perceptions regarding the amount and type of written feedback required to enhance their learning.

Effective feedback can enhance student learning, but limited evidence exists on whether nursing students actually use and learn from written feedback. This descriptive survey explored nursing students' perceptions regarding the amount and type of written feedback required to enhance their learning. In stage one, 362 students completed a 28-item questionnaire regarding feedback experiences and preferences; in stage two, 227 students selected a preferred feedback option for a final topic assignment. Findings revealed that many of the students wished to be engaged with the feedback process and believed effective written feedback can and does enhance their learning. However many students also reported learning barriers-including absent, inadequate, ambiguous, inconsistent, and ineffective feedback-indicating a significant disconnect between desired and actual feedback. Recommendations include a greater focus on engaging nursing students in the feedback process and evaluating the effectiveness of written feedback for individual students.

The timing of the literature review in grounded theory research: an open mind versus an empty head.

The timing of the literature review in grounded theory has been debated for decades, with previous recommendations to delay the review now under question. Mounting evidence suggests that a preliminary review can enhance theoretical sensitivity and rigor and may lead to innovative insights. However, researchers must acknowledge the influence of prior knowledge during data analysis and theory development to avoid bias. This article critically examines the ongoing debate and recommends that we should not seek to avoid preconceptions but ensure that they are well grounded in evidence and always subject to further investigation, revision, and refutation. If used reflexively, a preliminary literature review may well enhance grounded theory research.