Promoting sustainability in nursing and midwifery clinical laboratories: Strategies for resource reduction, reuse, and recycling.

BACKGROUND: The impacts of climate change on planetary health are multifaceted and threaten public health gains made since World War II. Healthcare is the fifth largest global emitter of greenhouse gas emissions, demanding significant efforts to transition to an environmentally sustainable future. Addressing these issues will require collective societal action. In this regard, universities have a dual responsibility - (1) to tackle complex social, economic, and environmental challenges by championing sustainability initiatives designed to positively impact planetary health; and (2) to ensure that graduates are equipped with the knowledge, attitudes and skills needed to steward planetary health towards a more sustainable future. The future nursing and midwifery workforce must be educated to mitigate the health sector's impact on the environment, advocate for action on climate change, prepare for ongoing health impacts of unpredictable climate and environmental changes, and help communities and healthcare systems become more climate resilient. WHAT THIS PAPER CONTRIBUTES: To help increase nursing and midwifery educators' and students' capacity to support planetary-health related interventions, the overarching purpose of this paper is to provide a series of exemplars that illustrate sustainability initiatives used in four university-based clinical skills laboratories. These initiatives each demonstrate a commitment to the United Nation's Sustainable Development Goals and can be used to help embed the importance of planetary health in student learning.

Letter to the editor referencing Effect of inspiratory muscle training associated or not to physical rehabilitation in preoperative anatomic pulmonary resection: a systemic review and meta-analysis.

The recent systematic review and meta-analysis by de Oliveria Vacchi, Martha, and Macagnan (2022) on the effect of inspiratory muscle training (IMT) and its association with physical rehabilitation in preoperative anatomic pulmonary resection raises some interesting findings, and the authors should be congratulated for their work. However, additional factors should be considered in the context of this study. These include frailty, postoperative pulmonary complications, and the high correlation between lung cancer and chronic obstructive disease. This study is paramount considering the potential to improve patient suitability for curative surgery, the high risks associated with surgery and shifting demographics with an increased prevalence of comorbidities, alongside fiscal pressures. This study suggests the need for further high-quality research in this high-risk population, considering IMT alone or with physical rehabilitation, with methodologies that are reproducible.

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic academics: An international interview study.

BACKGROUND: The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. DESIGN AND OBJECTIVES: This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. SETTING AND PARTICIPANTS: Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. DATA ANALYSIS: Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. RESULTS: Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. CONCLUSIONS: The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered.

Cell Cycle Progression Score, but Not Phosphatase and Tensin Homolog Loss, Is an Independent Prognostic Factor for Metastasis in Intermediate- and High-risk Prostate Cancer in Men Treated With and Without Salvage Radiotherapy.

PURPOSE: The prognostic value for metastasis of the cell-cycle progression score and phosphatase and tensin homolog haven't been evaluated jointly in contemporary men with exclusively intermediate- or high-risk prostate cancer. We evaluated associations of cell-cycle progression and phosphatase and tensin homolog with metastasis-free survival in contemporary intermediate/high-risk prostate cancer patients overall, and intermediate/high-risk men receiving salvage radiotherapy. MATERIALS AND METHODS: In a case-cohort of 209 prostatectomy patients with intermediate/high-risk prostate cancer, and a cohort of 172 such men who received salvage radiotherapy, cell-cycle progression score was calculated from RNA expression, and phosphatase and tensin homolog was analyzed by immunohistochemistry. Proportional hazards regression, weighted for case-cohort design or unweighted for the salvage radiotherapy cohort, was used to evaluate associations of cell-cycle progression, phosphatase and tensin homolog with metastasis-free survival. Improvement in model discrimination was evaluated with the concordance index. RESULTS: In the case-cohort 41 men had metastasis, and 17 developed metastasis in the salvage radiotherapy cohort, at median follow-up of 3 and 4 years, respectively. For both case-cohort and salvage radiotherapy cohort, cell-cycle progression was independently associated with metastasis-free survival after adjustment for Cancer of the Prostate Risk Assessment Post-Surgical: hazard ratio (95% confidence interval) = 3.11 (1.70-5.69) and 1.85 (1.19-2.85), respectively. Adding cell-cycle progression to Cancer of the Prostate Risk Assessment Post-Surgical increased the concordance index from 0.861 to 0.899 (case-cohort), and 0.745 to 0.819 (salvage radiotherapy cohort). Although statistically significant in univariate analyses, phosphatase and tensin homolog was no longer significant after adjustment for Cancer of the Prostate Risk Assessment Post-Surgical. Analysis of interaction with National Comprehensive Cancer Network risk group showed that cell-cycle progression had the strongest effect among unfavorable intermediate-risk men. CONCLUSIONS: In the first study to evaluate metastasis risk associated with cell-cycle progression and phosphatase and tensin homolog in exclusively intermediate/high-risk prostate cancer, and in such men with salvage radiotherapy, cell-cycle progression but not phosphatase and tensin homolog was associated with significantly increased 2- to 3-fold risk of metastasis after Cancer of the Prostate Risk Assessment Post-Surgical adjustment.

Why are physical assessment skills not practiced? A systematic review with implications for nursing education.

BACKGROUND: Physical assessment skills are taught in pre-registration nursing programs to equip nurses with the competencies to provide holistic nursing care. However, only a fraction of the skills they acquired during training are routinely performed in clinical practice thus highlighting a disconnect between learning and practicing. OBJECTIVE: To better understand the issues surrounding the teaching and practice of physical assessment skills among nurses as described in the literature. DESIGN: A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used. REVIEW METHOD: A search of databases including PubMed, EMBASE, CINAHL and Scopus was conducted from January 1970 to December 2019. Two independent researchers performed the methodological quality assessment using the Joanna Briggs Institute's Critical Appraisal Checklists. Twenty-one papers, including two qualitative studies, 17 quantitative studies and two mixed methods study, were selected in this review. Data were synthesised narratively. RESULTS: The review identified six overarching themes: (1) role ambiguity, (2) reliance on technology, (3) collegial support and culture, (4) practice variations across specialties, (5) a lack of confidence and knowledge, and (6) over-teaching using biomedical model. CONCLUSION: This review identified the need to improve the teaching of the physical assessment skills. There is also a need to evaluate the physical assessment content taught within nursing curricula, with emphasis on depth rather than breadth of skills. The ability to interpret physical assessment observations and develop clinical judgement need to be incorporated into the curriculum. To aid in the development of an effective care plan, the physical assessment framework should move away from a biomedical framework to include nursing models such as nursing process and clinical reasoning model. This revised framework can be used in future studies in the development and testing of teaching and evaluation tools for physical assessment skills.

Nursing and Midwifery Students' Sense of Connectedness Within Their Learning Communities.

BACKGROUND: Recognition of the importance of a supportive academic and clinical learning environment for nursing and midwifery students enrolled in health care programs is not new. However, the factors that influence social connections within these environments and the consequences for students' learning are not well understood. METHOD: This study used a multisite mixed-methods design to examine students' learning experiences. RESULTS: Participants stated that to develop a sense of professional connectedness, opportunities are needed to develop meaningful relationships with academic staff and peers through increased face-to-face on-campus learning experiences, as well as through off-campus contexts. CONCLUSION: To enhance nursing and midwifery students' sense of connectedness, the balance between online and face-to-face learning experiences needs to be reexamined, and a renewed focus on the development of quality clinical learning experiences that foster a sense of belonging also is needed. [J Nurs Educ. 2019;58(1):47-52.].

The effectiveness of mindfulness meditation for nurses and nursing students: An integrated literature review.

BACKGROUND: A growing body of literature has identified a range of beneficial physiological and psychological outcomes from the regular practice of mindfulness meditation. For healthcare professionals, mindfulness meditation is claimed to reduce stress, anxiety and burnout, and enhance resilience. OBJECTIVE: The objective of this integrative review was to critically appraise the literature that related to the effectiveness of mindfulness meditation programs for nurses and nursing students. DESIGN: This review was conducted using Whittemore and Knafl's framework for integrated reviews. DATA SOURCES: Using the terms mindfulness, mindfulness-based-stress reduction, Vipassana, nurses, and nurse education a comprehensive search of the following electronic databases was conducted: CINAHAL, Medline, PsycINFO, EMBASE. EMCARE, ERIC and SCOPUS. REVIEW METHODS: The initial search located 1703 articles. After screening and checking for eligibility 20 articles were critically appraised using the Critical Appraisal Skills Program checklist for qualitative papers and McMaster's Critical appraisal form for quantitative papers. The final number of papers included in the review was 16. RESULTS: The results of this review identified that mindfulness meditation has a positive impact on nurses' and nursing students' stress, anxiety, depression, burnout, sense of well-being and empathy. However, the majority of the papers described small scale localised studies which limits generalisability. CONCLUSION: Contemporary healthcare is challenging and complex. This review indicated that mindfulness meditation is an effective strategy for preventing and managing the workplace stress and burnout, which so often plague nursing staff and students. Further studies with larger sample sizes using rigorous research methods would be useful in extending this work.

Complementary therapies in healthcare: design, implementation and evaluation of an elective course for undergraduate students.

Complementary therapies are making a significant and cost effective contribution to the health of the community, especially in relation to chronic disease management and prevention of disease. Because of the increased use of complementary therapies, nurses, and other health professionals need to be familiar with specific practices so that they can assist clients to make informed decisions in the use of these therapies. Importantly, with the increased interest in complementary therapies, there is a need to ensure these practices are safe, cause no harm and are used to enhance the well-being of patients. This paper reports on the design, implementation and evaluation of a complementary therapies course and a linked Thai cultural studies tour. The course was implemented at The University of Newcastle for the first time in 2009 with an enrollment of 200 students. It is an elective course for both nursing students and those from other disciplines. In this paper we describe the reasons for the introduction of this course and its value in nursing education. We then provide an overview of the course and report on evaluation results from both the course and the Thai cultural studies tour.

Implementing a clinical competency assessment model that promotes critical reflection and ensures nursing graduates' readiness for professional practice.

AIM: This paper describes the design, implementation and evaluation of the Structured Observation and Assessment of Practice (SOAP), a model used to assess third year undergraduate nursing students' clinical competence. BACKGROUND: Competence is a complex concept that is difficult to define and measure. The assessment of nursing students' clinical competence has confronted universities with problems of validity, reliability, subjectivity and bias for many years. This presents particular problems in nursing as patient outcomes may be compromised by incompetent practice. Too often assessments of nursing students' competence comprise brief assessments of psychomotor skills, vague global assessment of generic skills/attributes or assessments undertaken in simulated laboratory settings rather than the real world of practice. METHODS: The Structured Observation and Assessment of Practice (SOAP), is a full day holistic practice-driven clinical competence assessment approach that motivates nursing students' learning, promotes critical reflection and confirms graduates' readiness for professional practice. This model was introduced in 2004 and since then 1031 students have been assessed. Quantitative and qualitative data has been collected via an anonymous online evaluation. RESULTS: Survey results have been statistically analysed using The Statistical Package for the Social Sciences (SPSS) (Version 13) with exploratory factor analysis employed to ascertain construct validity. This paper will report on the four components that showed acceptable factor loadings and that together accounted for 77.65 per cent of the variance: perceived learning outcomes, consistency with general clinical performance, quality of assessors, and anxiety/stress impact. CONCLUSION: The results of the SOAP approach supports the premise that quality clinical assessment requires nursing students' exposure to complex challenges undertaken in authentic clinical contexts, observed by registered nurses who are trained as assessors and have a strong educational and clinical background.