Acupressure Intervention Program for Older Adults in Australian Residential Aged Care Facilities: A Qualitative Evaluation.

The current study explored participants' experiences and perceptions of receiving acupressure within an Australian aged care context. Participants were older adults living in three residential aged care facilities who had received an acupressure intervention. Data were collected using semi-structured interviews and analyzed using a thematic approach. Twelve participants (10 females and two males) were interviewed. Four major themes emerged: Having Better Sleep, Feeling Calm and Relaxed, Promoting Well-Being and Functional Status, and Acceptability of Acupressure. Participants' perception of the acupressure was positive, as participants found acupressure to be beneficial for the improvement of sleep, mood, and general well-being. Participants' overall perception supports the acceptability of acupressure and suggests acupressure may be beneficial for improving sleep, relaxation, and well-being in older adults. [Journal of Gerontological Nursing, 50(1), 30-36.].

Documented nursing practices of pain assessment and management when communicating about pain in dementia care.

AIM: To evaluate nurses' documented practice when communicating about pain for people with dementia in hospital. DESIGN: Retrospective medical record review. METHOD: Medical records were retrieved from four inpatient units in a district and a tertiary teaching hospital of people aged 65 years and over with documented dementia. Data were extracted on nurses' documented pain assessment and management. Pain frequency and association between patient self-report, pain scores, cognition levels and analgesics used during hospitalization were analysed using descriptive and inferential statistics. Multivariate regression examined patient characteristics, pain characteristics and length of hospital stay. RESULTS: One-hundred patient records met the inclusion criteria between 1 January and 31 August 2017. Sixty-six percent of patients with dementia had pain documented at least once during hospitalization with 58% reported as moderate to severe pain intensity. Patients' pain severity during admission was associated with their length of hospital stay. Ninety-three percent of nurses used a self-reporting pain tool and 7% used an observational pain tool. Pain scores were not associated with patients' cognition level, nurses' pain reports or analgesic management. CONCLUSION: Pain frequently occurs in people with dementia during hospitalization. Fragmented pain reporting influences the translation of pain messages. Disproportionate pain tool application and non-association between pain scores and analgesic management suggest a potential knowledge gap among nurses about the practical use of pain tools and practice gap between pain assessment and management in dementia care. IMPACT: Pain was regularly assessed by nurses and implemented as a fifth vital sign for people with dementia in hospitals. However, the high frequency of pain affects care outcomes. Areas for improvement include nursing practice of pain assessment and management in dementia care in hospitals. Further understanding of the usefulness of pain tools and the efficacy of pain scores when communicating about pain in dementia care in hospitals is required.

The Effect of Acupressure on Sleep Quality of Older People in Australian Residential Aged Care Facilities: A Pilot Randomized Controlled Trial.

This study investigated the effects of acupressure on sleep quality, anxiety, depression, and quality of life among older people in Australia. Acupressure improved overall subjective sleep quality and anxiety but no differences in depression and quality of life. Future studies with larger sample sizes are required to generate good evidence.

The effectiveness of interventions to improve pain assessment and management in people living with dementia: A systematic review and meta-analyses.

AIMS: To synthesize and evaluate the effectiveness of interventions for nurses to improve the assessment and management of pain in people living with dementia. DESIGN: Systematic review and meta-analyses of randomized controlled trials. DATA SOURCES: CINAHL, Joanna Briggs Institute (JBI) EBP, Cochrane Library, PubMed, and Scopus databases were searched for all journal articles published between 2009 -2019. REVIEW METHODS: Papers were included under population intervention comparator outcome (PICO) framework for: (a) people living with dementia aged 65 years and over; (b) interventions developed for nurses or other health professionals; (c) comparison group of standard care or control; and (d) outcome that measures the intervention effects on nurses and people living with dementia. Independent reviewers undertook critical appraisal, data abstraction, and synthesis. Meta-analyses were performed to determine the effectiveness of interventions. RESULTS: Of 2099 titles and abstracts screened, six interventions with low-to-moderate risk of bias met inclusion criteria. Studies that implemented a routine pain assessment tool showed no effect on nurses' analgesic management. Studies that developed a comprehensive pain model involving multidisciplinary health professionals showed overall effects on pain assessment and management in dementia care. Physician involvement had an impact on analgesic management. CONCLUSION: Comprehensive pain models improve nurses' pain assessment and management. A lack of balance between analgesia use and non-pharmacological pain management in dementia care is evident. Multidisciplinary health professionals' involvement is essential for effective intervention design for pain management in dementia. IMPACT: Various pain assessment tools have been considered to assist identification and management of pain in people living with dementia. Nevertheless, challenges exist when caring for people living with dementia in pain. These findings support the development of a comprehensive pain model, which may be a more effective strategy than routine use of a pain tool alone for nurses to improve pain management in dementia care.

"But I'm not going to be a mental health nurse": nursing students' perceptions of the influence of experts by experience on their attitudes to mental health nursing.

BACKGROUND: Mental health nursing skills and knowledge are vital for the provision of high-quality healthcare across all settings. Negative attitudes of nurses, towards both mental illness and mental health nursing as a profession, limit recognition of the value of these skills and knowledge. Experts by Experience have a significant role in enhancing mental health nursing education. The impact of this involvement on attitudes to mental health nursing has not been well researched. AIM: To explore the impact of Expert by Experience-led teaching on students' perceptions of mental health nursing. METHODS: Qualitative exploratory study involving focus groups with nursing students from five European countries and Australia. RESULTS: Following Expert by Experience-led teaching, participants described more positive views towards mental health nursing skills and knowledge in three main ways: learning that mental health is everywhere, becoming better practitioners, and better appreciation of mental health nursing. CONCLUSIONS: Experts by experience contribute to promoting positive attitudinal change in nursing students towards mental health nursing skills and knowledge. Attitudinal change is essential for the provision of high-quality mental health care in specialist mental health services and throughout the healthcare sector.

Prevalence of burnout in mental health nurses in China: A meta-analysis of observational studies.

OBJECTIVE: Burnout is common in mental health nurses because of work-related stress. Burnout has a negative impact on nurses' health and work performance. The prevalence of high burnout in mental health nurses has been inconclusive across studies. This meta-analysis aimed to estimate the pooled prevalence of high burnout in mental health nurses in China. METHODS: Electronic databases (PubMed, EMBASE, PsycINFO, Web of Science, CNKI, WanFang and SinoMed) were independently and systematically searched from their commencement date up to 14 May 2018. Studies that reported the prevalence of any of the 3 burnout dimensions (high Emotional Exhaustion (EE), Depersonalization (DP), and low Personal Accomplishment (PA)) as measured by the Maslach Burnout Inventory (MBI) were included and analyzed using the random-effects model. RESULTS: A total of 19 studies were included in this meta-analysis. The pooled prevalence of high EE was 28.1% (95% CI: 20.4-35.8%), DP was 25.4% (18.1-32.6%) and low PA was 39.7% (28.3-51.1%). Subgroup analyses found that short working experience, use of MBI-Human Services Survey (HSS), and younger age had moderating effects on prevalence of high burnout. CONCLUSIONS: Burnout is common in mental health nurses in China. Considering its negative impact on health and work performance, regular screening, preventive measures and effective interventions should be implemented.

An integrative review of acupressure interventions for older people: A focus on sleep quality, depression, anxiety, and agitation.

OBJECTIVES: This integrative review aimed to synthesize studies that investigated the effects of acupressure on sleep quality, depression, anxiety, and agitation in older people, and to describe the acupressure procedures and techniques applied in the included studies. METHODS: A literature search was conducted using electronic databases including CINAHL, Cochrane Library, EMBASE, and MEDLINE. The inclusion criteria for the review were studies examining the effect of acupressure in older people aged 60 years and above, measured the outcomes for sleep quality, depression, anxiety or agitation, applied body acupressure, and published in English language. The exclusion criteria were studies using auricular acupoints only, and articles published in any language other than English. Methodological quality of studies was assessed using the critical appraised tools developed by the Joanna Briggs Institute. The information about study design, findings, and description of acupressure intervention were extracted, summarized, and synthesized. RESULTS: A total of 255 articles were identified from the search and as well one article from cross-references. From there, a total of 19 studies were included in this review. Nine studies consistently showed positive effects of acupressure on sleep quality, and four studies consistently showed that acupressure reduced depression. The outcomes of acupressure on anxiety and agitation showed inconsistent findings, in which three studies measured anxiety and five studies measured agitation. There was also variation of acupressure techniques applied in the reviewed studies. CONCLUSION: This review found some emerging evidences that acupressure can be beneficial for older people who suffer from sleep problems and depression. Use of specific acupressure points, with standardized acupressure treatment protocols, may improve sleep quality and possibly psychological wellbeing of older people. Future research with well-designed mixed method studies are required to produce stronger evidence, as well as in-depth understanding of acupressure intervention in aged care context.

Expert by Experience Involvement in Mental Health Nursing Education: Nursing Students' Perspectives on Potential Improvements.

Expert by experience involvement in mental health education for health professional programmes has increased in recent decades. The related literature has articulated the benefits, and changes in attitudes have been measured in some studies. Less attention has been devoted to ways this learning approach could be improved. The aim of this paper is to present the nursing students perspectives on how Expert by Experience input into nursing curricula could be enhanced. Qualitative exploratory research was undertaken, involving focus groups with students who had completed a mental health learning module co-produced by Experts by Experience and nurse academics. Results show two main themes: getting the structure right, and changes to content and approach. Some student responses could directly influence changes to the learning module. In other instances, responses indicate the need to better prepare students of the value of lived experience knowledge in its own right, rather than adjunct to more traditional methods of education. These findings are important in encouraging reflection on how future learning modules co-produced by Experts by Experience and Mental Health Nursing academics can be refined and better articulated.

Increasing nurses' emotional intelligence with a brief intervention.

BACKGROUND: Emotional intelligence (EI) is associated with a wide range of personal, professional and social benefits with numerous applications evident for nursing education and clinical practice. Despite growing support for increasing the focus on EI in nursing and nurse education, empirical evidence for the effectiveness of training to increase EI is sparse. The aim with this study was to test the effect of a brief EI training program for registered nurses. METHODS: We conducted a cross-site quasi-experimental study measuring nurses' EI pre- (T1) and three months post- (T2) EI training with a matched (untrained) control group (total n = 60). EI training consisted of a five-hour workshop, a 30-minute one-on-one feedback session, and an individualised follow-up reminder sent via SMS. RESULTS: Training resulted in a significant increase in EI scores over baseline levels for the trained group while scores for the control group did not increase. CONCLUSION: This pilot study has provided clear evidence of the applicability and efficacy of a low-cost training intervention for nursing staff in a real world setting.

Determining the optimal cut-off scores for the Workplace Bullying Inventory.

BACKGROUND: Over the past two decades, there has been considerable research into workplace bullying. One area that remains poorly developed is a tool with the capacity to accurately differentiate between exposed and unexposed employees. AIM: To determine optimal cut-off scores for the Workplace Bullying Inventory (WBI) that accurately classify cases of exposure to workplace bullying. DISCUSSION: Secondary analysis of data collected from Australian public sector employees ( n =2,197) was conducted. Receiver operator characteristic (ROC) curve analysis was used with a minimum sensitivity of 80%, to determine those scores on the WBI that corresponded with the highest accuracy of the tool to distinguish cases from non-cases. The results suggest using a cut score of 29 from the total score on the WBI (possible range: 18-90). When compared to a sum-score from a single dichotomous self-report variable, the cut-off score estimated a more conservative bullying rate. The single-item rate was potentially inflated by misconceptions about what constitutes bullying in the workplace. CONCLUSION: Employing validated cut-off points for exposure provides an objective threshold for establishing exposure to workplace bullying. The results of the analysis provide a more rigorous approach to quantifying exposure to workplace bullying, in a tool that has been designed and tested in the nursing workforce. This is the first such tool with empirically-derived, discriminant accuracy. IMPLICATIONS FOR PRACTICE: It is common for nurse researchers to employ sum-scores from single items to identify exposure to workplace bullying. By providing reliable cut-off points for exposure, this study offers standardised, diagnostic accuracy for researchers, clinicians and managers.

Quick Response Tracheotomy: A Novel Surgical Procedure.

Quick response tracheostomy (QRT) is a novel open surgical technique to emergently establish an airway. The method is simple; the skills necessary to perform this procedure are rapidly acquired; and it is expedient, minimally traumatic, and remarkably devoid of complications often encountered with percutaneous dilatational tracheotomies, including those complications seen with cricothyroidotomies. Unlike all other tracheotomies in which considerable blunt dissection is required, QRT avoids tissue crushing because sharp dissection alone is used to acquire surgical access to the trachea. The QRT does not entail inserting a guidewire into the trachea, a standard feature for percutaneous tracheal access; it avoids any risk of unintended laceration of the posterior tracheal wall and proximal subjacent esophagus. The technique averts tracheal ring fracture and tracheoesophageal fistula complications. The QRT has a uniquely low incidence of inducing hemorrhage, and it requires no steps that cause temporary tracheal occlusion and will therefore not facilitate hypoxia. The QRT contributes minimally to conditions favorable for generating subglottic stenosis, and the procedure is swiftly executed with very low probability for external tracheal placement of the tracheostomy tube. The QRT is not a blind procedure. No special instruments are required for its execution nor is concurrent tracheoscopy required at any stage while performing a QRT as is specified for percutaneous tracheotomies.

A narrative inquiry: Humour and gender differences in the therapeutic relationship between nurses and their patients.

BACKGROUND: Although the use of humour in health care has been well investigated, the humorous interactions between nurse and patient are not. This research project investigated the humorous interaction between patient and nurse. AIMS: This study aimed to explore four registered nurses' experiences of the use of humour in relation to gender differences and how humour influences the therapeutic relationship. DESIGN: Narrative inquiry was the chosen methodology as it allows participants to include what is important to participants and highlights how experiences shape social interaction and understanding of events. METHODS: Registered nurses were recruited from a regional hospital. Interested participants contacted the researchers and shared their stories. Data were analysed using a narrative enquiry methodology. RESULTS: The study indicated gender differences in the way humour is used by patients. For female patients, humour is often instant and situation bound and used as a reassuring discourse for others, whereas male patients' humour through stories and anecdotes is designed to establish a sense of equalising power between the patient and nurse.

Can monitoring consumer requests for opioid-replacement therapy improve access to treatment?

OBJECTIVE: This study examined data recorded by one urban publicly funded opioid-replacement therapy clinic (from 2009 to 2011) to identify whether these data could be used to inform the rostering of clinicians more effectively to improve access to treatment. METHODS: Data analysis incorporated descriptive and inferential methods. RESULTS: There were trends in the times of the year consumers seek opioid-replacement therapy, similarity and differences between gender requests for treatment and variation in consumer wait time on triage. CONCLUSIONS: National reporting of opioid-replacement therapy triages would help gain a better understanding of the number of people in need of treatment. If opioid-replacement therapy providers monitored consumer triages, they could roster more effectively, have gender-specific clinicians available, acknowledge and inform consumers of wait time on triage and allow re-orientation of services to lower wait time.

A Chinese help-seeking model for psychological distress in primary care: An adaptation of Andersen's Behavioral Model of Health Services Use.

Help-seeking for depression and anxiety disorders from primary care physicians in Western countries is at three times the rate of China. Western help-seeking models for common mental disorders have limitations in the Chinese settings. This article argues that an adapted model based on Andersen's Behavioral Model of Health Services Use could be an appropriate tool to better understand patients' help-seeking behaviors and improve outcomes. We applied a narrative review approach to integrate research findings from China into Andersen's model to generate a model that fits the Chinese context. We found 39 relevant articles in PubMed, MEDLINE, and Chinese journal databases from 1999 to 2022. Findings were mapped onto predisposing, enabling, and need factors of the model. This model emphasizes that predisposing factors including demographics, social norms, and health beliefs influence help-seeking preferences. Mental health service users in China tend to be older and female. Chinese generally have high concern about psychotropic medications, and social norms that consider psychological distress a personal weakness may discourage help-seeking. However, help-seeking can be enhanced by enabling factors in the health system, including training of primary care physicians, longer consultation time, and continuity of care. Need factors for treatment increase with the severity of distress symptoms, and doctor's skills and attitudes in recognizing psychosomatic symptoms. While predisposing factors are relatively hard to change, enabling factors in the health system and need factors for treatment can be targeted by enhancing the role of family doctors and training in mental health.

Triage in opioid replacement therapy: what's the wait?

In Australia, a wait for Opioid Replacement Therapy (ORT) has been reported although the magnitude is unknown. This study examined data recorded by one urban publicly funded ORT clinic (from 2009 to 2011) to identify if people (n = 803) were waiting for ORT assessment appointments and to explore how triage influences access to ORT. Data analysis incorporated descriptive methods and the use of Kaplan-Meier estimator of the cumulative incidence function. The implications and limitations of this study are included with further research suggestions.

Nurse practitioner prescribing practices: the most frequently prescribed medications.

AIMS AND OBJECTIVES: To explore which medications Australian nurse practitioners most frequently prescribe. BACKGROUND: Although nurse practitioners in Australia have prescriptive authority, little is known about which specific medications nurse practitioners are prescribing and how frequently they do so. DESIGN: Descriptive electronic survey. METHODS: A total of 209 nurse practitioners reported current prescribing practices. Medications reported were categorised according to the Australian Medicines Handbook major drug classifications and frequencies presented. RESULTS: Seventy-eight per cent of respondents reported prescribing medications as part of their Nurse Practitioner practice. In total, participants reported prescribing 234 separate medications from most Australian Medicines Handbook major drug classifications. Medications from the classification anti-infective drugs were most frequently prescribed followed by medications from analgesic, psychotropic, cardiovascular, musculoskeletal, genitourinary and gastrointestinal classifications. CONCLUSION: The majority of nurse practitioners in Australia prescribe medications in their clinical practice, although the proportion of nurse practitioners prescribing has not changed significantly in the past four years. The medications prescribed are comparable with those most frequently prescribed by all prescribers in Australia and highlight the diversity in scope of practice among nurse practitioners. RELEVANCE TO CLINICAL PRACTICE: Findings highlight the importance of Nurse Practitioner's a capacity to prescribe wide variety of medications, especially in practice areas such acute, primary and emergency care. The unique role nurse practitioners in relation to management of patients with infective processes and patients requiring pain relief is highlighted. Insight into current Nurse Practitioner prescribing trends informs future Nurse Practitioner curricular and future continuing education programmes. Findings give unique insight for future service planning, especially service providers considering introducing nurse practitioners to their service. The finding that nurse practitioners prescribing patterns are similar to other non-nurse practitioner prescribers in Australia highlights the potential for service providers to introduce new models of care that are Nurse Practitioner lead.

John or Jane? Exploring how clinical judgment is applied in managing access to opioid replacement therapy.

In Australia, access to Opioid Replacement Therapy (ORT) poses a problem for clinicians when confronted with multiple requests for ORT treatment. This article forms part of a broader grounded theory study exploring how clinicians apply clinical judgement in managing access to ORT programs. The focus of this article is to report on the codes generated from the study's data analysis and to discuss how they influence clinician responses to the process. From March to August 2012, 35 clinicians from 10 publicly funded ORT clinics within the states of Queensland and New South Wales were recruited. To stimulate clinicians to use their clinical judgment, a scenario was presented requiring participants to choose between two consumers for preferential access to ORT and explain why. Responses as to who should receive treatment first varied between clinicians. Reasoning for their decisions was diverse, except "prioritising" was a consistently presenting element. Previous education, training, work experience, and their peers were all factors identified as influencing their decision making. Not all clinicians were confident with their choice. This study examined how clinical judgement is applied in managing access to ORT, showing variation in clinician responses and the factors influencing those decisions.

Addressing the mental health nurse shortage: undergraduate nursing students working as assistants in nursing in inpatient mental health settings.

The population of mental health nurses is ageing and in the next few years we can expect many to retire. This paper makes an argument for the employment of undergraduate nursing students as Assistants in Nursing (AINs) in mental health settings as a strategy to encourage them to consider a career in mental health nursing. Skill mix in nursing has been debated since at least the 1980s. It appears that the use of AINs in general nursing is established and will continue. The research suggests that with the right skill mix, nursing outcomes and safety are not compromised. It seems inevitable that assistants in nursing will increasingly be part of the mental health nursing workforce; it is timely for mental health nurses to lead these changes so nursing care and the future mental health nursing workforce stay in control of nursing.

Accessibility versus quality of care plus retention: the formula for service delivery in Australian opioid replacement therapy?

The aim of this paper is to investigate how Australian Opioid Replacement Therapy (ORT) policy influences access to ORT treatment, including the resources required for implementation. In doing so, we also compare the accessibility of ORT treatment in Australia (AU) with ORT in the United Kingdom (UK) and United States (US). A review of government data and policy that influence service delivery was undertaken. When comparing across AU, the UK, and the US, we found several differences. To improve access to treatment in Australia more general practitioners need to provide ORT. Additionally, criteria for quality care, a centralised intake system, a national ORT treatment outcome measure, and a shift towards a recovery focus are recommended.

Nurses' perspectives of pain assessment and management in dementia care in hospital.

OBJECTIVE: To explore nurses' perspectives and generate recommendations for nursing practice of pain assessment and management in dementia care in a hospital setting. METHODS: Semi-structured face-to-face interviews were conducted with nurses who had experience in dementia care from two care units of a regional hospital. Data were analysed using six phases of reflexive thematic analysis. RESULTS: Eight nurses from two inpatient units of a local district hospital were interviewed. Five themes were identified: (1) ways of understanding, (2) practicality of pain assessment tools, (3) usefulness of pain scores, (4) analgesia use and (5) limitations to practice. Nurses perceived pain tools did not sufficiently help to assess pain in people with dementia, and adaptation was often needed when scoring pain. Overuse of analgesia, trial-and-error practice and delayed prescriptions for analgesia limited pain management effectiveness for people with dementia during hospitalisation. CONCLUSIONS: Pain tools are preferably used as a complementary method in addition to nurses' intuitional judgement. Reporting pain via scores requires a more complete narrative description from the source of pain reports to allow clinicians to accurately report a persons' pain. Clinicians must minimise trial-and-error practice in analgesia by conducting comprehensive pain assessments. Health-care organisations need to foster timely collaboration between clinicians to support nurses' practice limitations for effective analgesia administration in dementia care.