Enhancing new graduate nurses and midwives person-centredness through clinical supervision during COVID-19; evaluation of a non-randomized intervention study.

AIM: The aim of the study was to evaluate a person-centred model of clinical supervision to enhance person-centredness. DESIGN: Experimental, quantitative. METHODS: One hundred and three New Graduates were supported to reflect through a person-centred lens (July-December 2020). Evaluation was undertaken at 6 months using: the Manchester Clinical Supervision Scale-26 (effectiveness of supervision) and the Person-centred Practice Inventory (measures attributes of the nurse/midwife, the care environment and person-centred processes). Due to participation difficulties, scores were calculated by attendance rates using descriptive and inferential statistics. RESULTS: Regular attendees scored higher on the supervision's effectiveness; however, this did not reach efficacy. 'Finding time' to attend contributed to low scores. Supervision scored well on its supportive function when attended. Many New Graduates perceived a decline in their care environment. Attendance aside, New Graduates averaged an increased in their person-centred attributes and processes. Greater participation was found in those who scored higher at baseline on their person-centred attributes and processes, and this higher scoring continued at 6 months than those who attended less. CONCLUSION: New Graduates who perceive themselves as person-centred and reflective at baseline are more likely to attend a person-centred clinical supervision and score higher at 6 months than those who attended less often. New Graduates found support within supervision during challenging times. IMPLICATIONS FOR PRACTICE FOR PROFESSIONAL AND/OR PATIENT CARE: For successful implementation of Person-centred Clinical Supervision, New Graduates need support to attend, as attendance supports them to begin seeing value in the process. IMPACT: This intervention kept person-centred practice at the forefront of New Graduates reflection, in a time of extreme change. The research has implications for nursing and midwifery management with the imperative to deliver person-centred care and create the person-centred cultures for staff to feel supported and empowered. REPORTING METHOD: Transparent Evaluation of Non-randomized Designs (TREND). PATIENT OF PUBLIC CONTRIBUTION: No patient or public contribution. CONTRIBUTION TO WIDER COMMUNITY: New Graduates grow their person-centredness over their transitioning year; however, this can be enhanced with regular clinical supervision underpinned by person-centred theory. Clinical supervisors can provide support to New Graduates when the environment is challenged.

Clinical supervision: A mechanism to support person-centred practice? An integrative review of the literature.

AIMS: To explore whether clinical supervision has an influence on person-centred practice. BACKGROUND: The ability to deliver person-centred care and the ability to engage in reflective practice are two key skills expected of nurses. Person-centred care shifts nurses thinking from the patient's disease state to their personhood. Clinical supervision has been proposed as a place to explore person-centred care. Person-centred practice extends person-centredness to enhance healthful relationships between care providers, services users and their significant others. METHODS: An integrative literature was conducted with the key words 'clinical supervision' and 'person-centredness' within CINAHL, Medline, PsychInfo and Google Scholar. The PRISMA statement was used to report the identification, selection, appraisal and synthesis of articles and PRISMA diagram reports the selection process. The Mixed Methods Appraisal Tool was used to appraise the articles, followed by a thematic analysis. The Template for Intervention Description and Replication was used to explore the concept of clinical supervision. RESULTS: Twelve articles met the inclusion criteria. Person-centredness and clinical supervision are not universally defined concepts. Clinical supervision in this context was mainly an adjunct to educative programmes. Clinical supervision has a positive influence on participants' person-centred attributes, but the influence on others is less clear. The clinical supervisor's qualities are pivotal to supervisions' success. CONCLUSIONS: Clinical supervision is a common reflective strategy used to explore nursing practice, yet as a strategy to enhance person-centred practices, is under-researched. Participants can experience person-centredness when their supervisor has person-centred attributes, an important aspect in delivering person-centred care. RELEVANCE TO CLINICAL PRACTICE: This review identified a gap in the literature between two common nursing concepts 'clinical supervision' and 'person-centred care/practices'. There is a need to conduct further research into the combination of these concepts to seek ways to embed person-centredness into health care and everyday nursing practice.

Education on the Sustainable Development Goals for nursing students: Is Freire the answer?

Significant global events in recent years have had a substantial impact on the nursing profession. The COVID-19 pandemic, climate change, and systemic racism are a few of the many complex issues that create a landscape of disruption and uncertainty in healthcare. With the aims of protecting both people and the planet, the United Nations' Sustainable Development Goals offer a road map to combat these global concerns, yet require more widespread consideration as a way forward. Education on the Sustainable Development Goals is recognised as a key aspect for healthcare professionals to take action towards achieving the targets of the goals. For student nurses, the undergraduate curriculum offers an opportunity to enculturate future nurses on the important role they play in the global agenda to transform our world. Brazilian pedagogue Paulo Freire's theoretical approach to education, critical pedagogy, espouses transformation with conscientization, dialogue and liberation, which may create a paradigm shift toward global action. This discussion paper seeks to provide an argument for embedding the Sustainable Development Goals into nursing curricula using the philosophies of Freire's critical pedagogy. It will argue that a critical approach to education is required to create the transformation needed for student nurses to be educated on the Sustainable Development Goals.

Nursing and the Sustainable Development Goals: A Scoping Review.

PURPOSE: In 2015, all member states that comprise the United Nations unanimously adopted the Sustainable Development Goals (SDGs), a set of ambitious and inclusive targets toward global economic, social, and environmental betterment. Nurses have a key role to play in the achievement of the SDGs. The aim of this article was to conduct a scoping review to synthesize the literature related to nursing and the SDGs. METHODS: This scoping review utilized Arksey and O'Malley's five-stage framework. Several electronic databases were searched for literature published from 2015 to 2020 using the key words "nurse OR nurses OR nursing" and "Sustainable Development Goals OR SDGs". FINDINGS: A total of 447 articles were identified through the databases searches, of which 35 articles were deemed relevant and included for final review and content analysis. Analysis of relevant literature on nursing and the SDGs revealed two distinct, yet connected, perspectives: the nurse and the profession. CONCLUSIONS: Individual nurses may feel disconnected from the SDGs and struggle to relate the goals to their clinical role, calling for an increase in awareness and education on the goals. The wider profession could also increase both research and policy with relation to the SDGs, strengthening nursing's position to have a voice in and contribute towards achievement of the goals. CLINICAL RELEVANCE: Individual nurses and the wider nursing profession have opportunities to more meaningfully contribute to the SDGs, beginning with an increased awareness through education and a commitment to research and participation in local and global decision making.

The influence of engaging authentically on nurse-patient relationships: A scoping review.

The current international healthcare focus on ensuring the perspectives and needs of individual persons, families or communities are met has led to the core tenet of person-centred care for all. The nurse-patient relationship is central to the provision of care, and enhancing this relationship to ensure trust and respect supports optimal care outcomes for those accessing healthcare services. Engaging authentically is one of the recognised key approaches in person-centred practice, and this scoping review of the literature aims to gain an understanding of the role this process plays in developing effective relationships between nurses and the people they care for. A systematic search of databases and grey literature was undertaken, and twenty-one research papers met the inclusion criteria. A thematic analysis revealed four themes: 'getting to know the patient as a person', 'the complexity of relationship building-it takes time', 'the nurse: characteristics and behaviours that support the nurse-patient relationship' and 'the patient voice'. Nurses and patients both benefit from effective relationships, feeling valued and experiencing greater satisfaction with care. Key elements of engaging authentically were revealed as a nurse-patient relational process through this literature review; however, further research is needed to gain a greater understanding of this concept.

Shifting the load: Improving bioscience performance in undergraduate nurses through student focused learning.

Background: Bioscience has a long history of being challenging to teach and learn within nursing courses and little has been published on new ways to assist students in their learning. The aim of this study was to determine which of three different interventions would assist student performance in a nursing bioscience unit. Method: To begin, the contribution of recent prior learning in science was investigated by comparing the final exam marks of 182 students in the bioscience unit with the science marks they achieved at high (secondary) school. The effect of recent prior learning was then tested by investigating whether the first intervention, a pre-nursing bioscience workshop of 63 students, would substitute for recent high school science. Two further interventions were tested that used a stronger student-focused contribution to the teaching and learning within the bioscience unit. These were the Human Body Club which was composed of 44 under-performing students and an online learning platform known as LearnSmart that was used by a cohort of 263 students. Results and discussion: Good and recent high school attainment in the sciences did improve student performance, whilst recent prior learning in the form of a bioscience workshop did not. Both student-focused interventions improved student performance. The longer a student spent using LearnSmart the more their mark increased. However, the Human Body Club which provided additional support and shifted the bulk of the teaching and learning to the students was the most effective of the three interventions in assisting students to pass the bioscience unit.

Involving relatives in ICU patient care: critical care nursing challenges.

AIMS AND OBJECTIVES: To identify the barriers critical care nurses experience to relative involvement in intensive care unit patient care. BACKGROUND: Previous studies have discussed the experiences of relatives visiting an intensive care unit, the needs of relatives in the intensive care environment, critical care nurse and relative interaction, intensive care unit visiting policies and the benefits of including relatives in patient care. The barriers that critical care nurses experience to relative involvement in patient care have received minimal exploration. DESIGN: Critical care nurses were recruited for a mixed methods study. An explanatory mixed method design was used, with two phases. Phase 1 was Quantitative and Phase 2 was Qualitative. METHODS: Data collection occurred over five months in 2012-2013. Phase 1 used an online questionnaire (n = 70), and semi-structured interviews (n = 6) were conducted in Phase 2. Phase 1 participants were 70 critical care nurses working in Australian intensive care units and six critical care nurses were recruited from a single Sydney intensive care unit for Phase 2. Through sequential data collection, Phase 1 results formed the development of Phase 2 interview questions. RESULTS: Participants reported various barriers to relative involvement in critically ill patient care. Factors related to the intensive care unit patient, the intensive care unit relative, the critical care nurse and the intensive care environment contributed to difficulties encompassing relative involvement. CONCLUSIONS: This study has identified that when considering relative involvement in patient care, critical care nurses take on a paternalistic role. The barriers experienced to relative involvement result in the individual critical care nurse deciding to include or exclude relatives from patient care. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the barriers to relative involvement in critically ill patient care may provide a basis for improving discussion on this topic and may assist intensive care units to implement strategies to reduce barriers.

The voice of the second-level regulated nursing role: a qualitative approach.

BACKGROUND: With an international nursing shortage, there is a need to navigate towards an improved nursing workforce structure where each nursing role is valued and recognised for the work they contribute. The second-level regulated nursing role is seen as integral; however, there is role confusion, especially with the registered nurse, and high attrition. To implement strategies to retain an integral nursing workforce, there is a need to better understand the role from the experiences and expectations of the second-level regulated nursing role. AIM: To gain a better understanding of the second-level regulated nursing role in the Australian nursing workforce. DESIGN: Qualitative descriptive study from a larger mixed methods study. METHOD: Five focus groups in 2018. The findings were analysed through the lens of organisational behaviour. RESULTS: The findings identified that enrolled nurses' intrinsic and extrinsic motivators influenced levels of job satisfaction and sense of feeling valued. The findings also identified key determinants that influence job satisfaction and occupational stress: enrolled nurses' understanding of their role and scope of practice; the registered nurses' understanding of the enrolled nurses' role and their role when working with the enrolled nurse; and the organisation's understanding and recognition of their role. When these determinants align, there is job satisfaction, less occupational stress and enrolled nurses feel valued. At a professional level, the title does not reflect the role, and there are no career pathways. CONCLUSION: This study explained why recurrent challenges impact the role and what contributes to those in the role feeling valued. Challenges that affect job satisfaction and occupational stress for the second-level (enrolled) nurse are related to the working environment and with whom the nurse works. From a professional level, there are limited career opportunities that recognise and retain the enrolled nurse in their role.

Nursing action towards the sustainable development goals: Barriers and opportunities.

BACKGROUND: Climate change, poverty, hunger and complex diseases are just some of the many wicked problems impacting human health. The Sustainable Development Goals aim to alleviate these and many other global issues. Although the nursing profession is paramount to successfully achieving the goals, nurses require increased education to maximise their contributions. OBJECTIVES: The aim of this study was to determine the impact of education on graduate nurses' action towards the Sustainable Development Goals. DESIGN: This study applied a qualitative case study methodology. SETTING: The study took place within an Australian Higher Education institution. Graduate nurses working in clinical settings were invited to reflect on the Sustainable Development Goals. PARTICIPANTS: Participants included thirteen graduate nurses (n = 13) working in a variety of clinical settings that had completed the final year capstone subject. METHODS: Individual semi-structured interviews were undertaken with graduate nurses who undertook education on the Sustainable Development Goals in an undergraduate Bachelor of Nursing capstone subject. The interviews were transcribed and thematically analysed. FINDINGS: Data was analysed through two lens focusing on the barriers and opportunities for action towards the Sustainable Development Goals. Three core barriers were identified as 'Drowning'; 'Powerless'; and 'Invisible'. Three key opportunities were designated as 'War on Waste'; 'Front and Centre'; and 'Revolutionary Leadership'. CONCLUSIONS: Educating undergraduate nurses on the Sustainable Development Goals had limited impact on specific graduate nurses' action towards the goals due to significant barriers within the healthcare system. However, graduate nurses recognised the importance of contributing to the goals and identified opportunities for future action. Education providers and the healthcare industry should work in partnership to create a more sustainable future for healthcare.

Midwives' and registered nurses' role and scope of practice in acute early pregnancy care settings in Australia: A qualitative descriptive study.

PROBLEM: There is little documented evidence regarding the practice of midwives providing care for women with acute concerns in early pregnancy (< 20 weeks) in Australia. BACKGROUND: Women can experience unexpected complications at any gestation of pregnancy and may seek acute care in an emergency or gynaecology service, usually staffed by registered nurses (RNs). They may not receive care from specialised pregnancy clinicians, including midwives. The role and scope of practice of midwives working in acute early pregnancy settings in Australia has not been previously reported. This study provides an opportunity to document practice in an area of pregnancy care not often visible within maternity services in Australia. RESEARCH AIM: To describe midwives' and RNs perceptions, perspectives and experiences of role and scope of practice in acute early pregnancy care provision in Australia. METHODS: A qualitative descriptive approach was adopted. Midwives and RNs with acute early pregnancy knowledge and experience were recruited. Semi-structured interviews were conducted, and data analysed using inductive thematic analysis. FINDINGS: Fifteen participants were interviewed. Three themes were constructed from interview data: Personal and Professional Influences; Being There for Women; The Impact of Setting. DISCUSSION: Findings reinforce the lack of clarity around how midwives' scope is enabled in traditional acute early pregnancy care. Setting of care has influenced practice and seen a barrier for midwives who don't hold nursing registration from fulfilling professional scope. Results provide novel benchmarking evidence regarding a largely hidden area of midwifery, signposting areas for reform within education, policy and health service sectors.

Enlightening and empowering students to take action: Embedding sustainability into nursing curriculum.

Graduate nurses are set to face complex global challenges in their future careers. Yet, current pedagogical practices fall short in preparing the future workforce for what lies ahead. There is, thus, an urgent need to disrupt traditional nursing education methods in order to transform our society. Transformation includes ensuring our students are educated on their responsibility toward social, economic and environmental sustainability. The Sustainable Development Goals (SDGs), a set of global targets developed by the United Nations, offer a framework for engaging in higher education that promotes a better future; however, to date there are few examples of how the goals have been embedded into nursing curriculum. This article showcases a case study of how the SDGs can be integrated and taught in nursing higher education through the principles of critical pedagogy. Through significant course re-development in an Australian undergraduate nursing course, students engaged with the SDGs along a transformative continuum of enlightenment and empowerment to awaken critical consciousness. While this article offers some findings in relation to student development, the article's key contribution is in detailing the methodology and framework for embedding SDGs in nursing curricula and to encourage other nursing academics to take up the challenge to empower their students' to take action toward addressing global sustainability challenges.

Exploring the role of the second-level regulated nurse in the Australian nursing workforce: an integrative review.

BACKGROUND: The enrolled nurse is the second-level regulated nursing role in Australia and internationally. Reports and research indicate that the nursing profession requires greater understanding of the role, so it can be utilised to its potential. AIM: To explore issues that may impact the EN role in the Australian nursing workforce. DESIGN: An integrative review. METHODS: A seven-step framework was used to review scholarly papers, government documents, and grey literature. RESULTS: Three themes from 24 documents were identified: understanding the EN's scope of practice, standardised practice, and career development. DISCUSSION: A lack of understanding of their scope of practice creates role confusion and a lack of standardised practice, with an expected progression to become a registered nurse. These factors contribute to ENs' not feeling valued. CONCLUSION: The nursing profession do not understand the enrolled nurse role, and further work is required to value its place in the Australian nursing workforce.

Developing a self-administered questionnaire: methods and considerations.

BACKGROUND: Using a structured process to develop a self-administered questionnaire provides a robust tool for collecting data that enhances the credibility of the results. Describing this process mitigates any complexity and confusion for the nurse researcher which can be generated by many sources of information that either lack detail or have complex statistical approaches. AIM: To discuss the development of a self-administered questionnaire with a focus on face, content, construct validity and reliability testing. DISCUSSION: Adopting a well-established, sequential, five-step approach ensures that important concepts of questionnaire development are addressed: assessing existing tools and qualitative data, if available; drafting of the questionnaire with consideration for question styles, comprehension, acquiescent bias and face validity; expert panel review to establish content validity and inter-rater reliability; pilot testing to assess construct validity; and exploratory factor analysis to establish reliability testing. This approach results in a robust and credible tool for collecting data. CONCLUSION: This article provides nurse researchers with a structured process for developing self-administered questionnaires. IMPLICATIONS FOR PRACTICE: Investing time and effort to assess a newly developed questionnaire for validity and reliability and consider question styles, comprehension and acquiescent bias results in an improved and strengthened tool for collecting data. This in turn enhances the quality and credibility of a study's findings.

What knowledge of breastfeeding do nursing students hold and what are the factors influencing this knowledge: An integrative literature review.

AIM: The aim of this review was to explore the preregistration nursing students' breastfeeding knowledge and the sources they used to develop that knowledge as a health care professional. BACKGROUND: New registered nurses do not feel prepared to support breastfeeding women in neonatal and paediatric settings. RESULTS: Preregistration nursing students have sufficient knowledge of the physiology of lactation but insufficient knowledge on supporting women to decide on the practical aspects of breastfeeding and its challenges for healthy or sick babies. The sources of knowledge included the students' personal experiences and the education and training that they received during their nursing course. The two themes extracted from the data that related to the sources of knowledge were: a) informal knowledge through experience and b) formal education. CONCLUSIONS: There is a need for new ways to align the students' informal sources of breastfeeding knowledge to their formal education, focusing on supporting women to make decisions on the practical aspects of breastfeeding, including the most common challenges. TWEETABLE ABSTRACT: Nursing students' knowledge of breastfeeding practice: an integrative review.

Exploring the contribution of clinical placement to student learning: A sequential mixed methods study.

BACKGROUND: Increasing demand and limited supply of clinical placements in nursing underscore the need to better understand the role of clinical placements in students' learning. Identifying pedagogically rich activities that support work place learning alongside factors that influence educational outcomes has the potential to optimise professional placement experiences. OBJECTIVE: To explore student nurses perceptions of the value of nursing clinical placements to their learning. DESIGN AND METHODS: A descriptive research design was employed using a sequential mixed method approach. A cross-sectional student survey captured students' perceptions of work integrated learning based on the perceived contribution of a pre-determined list of activities undertaken on clinical placement. SETTING AND PARTICIPANTS: Four Australian universities took part. Participants included students undertaking entry to practice programs. RESULTS: Four hundred and sixty-nine students completed the survey. Thirty-eight students participated in 12 focus groups. Participants rated PRA including interacting and time with patients and performing assessments as the most useful activities. Less useful, were activities that took them away from the patient. CONCLUSIONS: To maximise workplace learning, consideration must be given to ensuring students are presented with goal directed activities that support learning and are focused on an expanding scope of practice with opportunities to discuss and engage with staff.

Active learning pedagogy transformation: A whole-of-school approach to person-centred teaching and nursing graduates.

In contemporary higher education contexts, active learning pedagogy pervades in discourses around designing quality student experiences. Transposing student bodies from passive to active participants in learning experiences is widely considered best practice in curriculum and pedagogical design. While literature on active learning is vast and recommendations on how to transform into an active learning approach abounds, such advice is often prescribed to individual teachers or courses. What remains unknown in this transformational space is how leadership for person-centred teaching can guide a whole school to shift philosophical presuppositions and take-up active learning as the guiding pedagogy. This paper describes the challenges, processes and steps for how one school, the School of Nursing at an Australian University, invoked transformational change through a philosophical and practice-based shift across all learning spaces (online/ face-to-face/ blended, undergraduate and postgraduate domains). This paper offers recommendations for other schools interested in establishing a whole-of-school commitment to an active learning pedagogy transformation underpinned by person-centred teaching.

Digital explanations and nursing students' perception of learning science.

A thorough understanding of human physiology and anatomy are pivotal in the preparation of competent nursing students for clinical practice. However, anatomy and physiology are among the most conceptually perplexing subjects that nursing students will encounter throughout the duration of their course. Research in other science-based contexts has demonstrated a positive relationship between student-generated digital media and learning scientific concepts. Therefore, the aim of this study was to explore nursing students' experience in learning science concepts through a formative assessment task which was based on making a 'digital explanation'. Our work was guided by semiotic theory and the study design was a mixed method study where 428 first-year nursing students across five campuses volunteered to complete self-reported surveys during the first and last week of the academic session. Students who consented for an interview were invited to attend one of five focus groups. More than half of the participating cohort had prior experience with science (66%), but only 24% had previous experience with making digital media. After completion of the assessment task, two-thirds of the students strongly agreed or agreed that they learned more about science and fewer students agreed that searching for scientific knowledge could be boring. The qualitative findings confirmed the presence of learning about science and four themes were identified: 'learning about science', 'linking knowledge to practice', 'using technology', and 'making it real'. A key point was that the students began to see connections between science knowledge and nursing practice. But many students were challenged by the technology and the fact that the task was ungraded. Although the digital explanation was an overall positive experience for the nursing students, there is a need for a flexible and graded assessment task to achieve its potential benefits as a teaching and learning task in nursing. We conclude that additional intervention studies are warranted.