Scoping review of systematic reviews of nursing interventions in a neonatal intensive care unit or special care nursery.

AIM(S): To identify, synthesise and map systematic reviews of the effectiveness of nursing interventions undertaken in a neonatal intensive care unit or special care nursery. DESIGN: This scoping review was conducted according to the JBI scoping review framework. METHODS: Review included systematic reviews that evaluated any nurse-initiated interventions that were undertaken in an NICU or SCN setting. Studies that reported one or more positive outcomes related to the nursing interventions were only considered for this review. Each outcome for nursing interventions was rated a 'certainty (quality) of evidence' according to the Grading of Recommendations, Assessment, Development and Evaluations criteria. DATA SOURCES: Systematic reviews were sourced from the Cochrane Database of Systematic Reviews and Joanna Briggs Institute Evidence Synthesis for reviews published until February 2023. RESULTS: A total of 428 articles were identified; following screening, 81 reviews underwent full-text screening, and 34 articles met the inclusion criteria and were included in this review. Multiple nursing interventions reporting positive outcomes were identified and were grouped into seven categories. Respiratory 7/34 (20%) and Nutrition 8/34 (23%) outcomes were the most reported categories. Developmental care was the next most reported category 5/34 (15%) followed by Thermoregulation, 5/34 (15%) Jaundice 4/34 (12%), Pain 4/34 (12%) and Infection 1/34 (3%). CONCLUSIONS: This review has identified nursing interventions that have a direct positive impact on neonatal outcomes. However, further applied research is needed to transfer this empirical knowledge into clinical practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Implementing up-to-date evidence on effective nursing interventions has the potential to significantly improving neonatal outcomes. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement in this scoping review.

The community nurse in Australia. Who are they? A rapid systematic review.

AIM: This study aimed to profile the community nurse in Australia. BACKGROUND: The need for nurses in the community health care sector is increasing in response to shorter hospital stays, an aging population and chronic disease. The increase in demand has not been followed by appropriate workforce planning, leading to structural issues and lack of qualified nursing workforce in the community sector. EVALUATION: MEDLINE and ProQuest Public Health and grey literature were searched for records published between 2010 and 2020 relative to the profile of the community nurse in Australia. Twenty-five records (21 publications, 2 databases and 2 reports) were included in the review. Abstracted data followed the principles of workforce planning and included demographics, qualifications and roles. KEY ISSUES: Inconsistent definitions, self-reported data and a focus on practice nurses have contributed to data irregularities. Little is known about the specific aspects of community nursing work. CONCLUSION: A lack of concrete data has overshadowed a community nursing workforce crisis with implications for patients' health and safety across the lifespan. IMPLICATIONS FOR NURSING MANAGEMENT: There is urgent need for nurse managers globally to refocus nursing recruitment to the community sector to maintain quality and ensure sustainability of the nursing workforce.

A systematic review of activities undertaken by the unregulated Nursing Assistant.

AIM: To identify activities performed by Nursing Assistants in acute and primary healthcare. DESIGN: Systematic review. DATA SOURCES: The databases MedLine/PubMed, ProQuest and Google Scholar were searched for empirical studies published in the English language between 2008 and 2018 that addressed the work of Nursing Assistants. REVIEW METHODS: From an initial yield of 2,944 publications, 71 publications were retained for full text review and 20 publications included in this review. Activities undertaken by Nursing Assistants from eight countries were extracted and categorized into one of six categories. RESULTS: Over 200 activities were identified as being delegated to Nurse Assistants globally. Many of these activities are beyond the training of the Nurse Assistant and are being performed with limited Registered Nurse supervision. CONCLUSION: Patient safety is at risk. Nurse Assistants' roles vary widely, with some seeing their role as similar to that of a regulated nurse, while recognizing their need for additional training. IMPACT: Over 31% of activities delegated to Nurse Assistants require skill and comprehension beyond their level of training. Patients and regulated nurses need to have confidence that Nursing Assistants responsible for care provision are appropriately trained and practicing within regulatory standards.

Healthcare interpreter utilisation: analysis of health administrative data.

BACKGROUND: Few people with limited English proficiency are provided with the services of a healthcare interpreter when admitted to hospital. This retrospective study utilised health administrative data to explore which patients with limited English proficiency were provided with a healthcare interpreter during their hospital admission. METHOD: A retrospective analysis of health administrative data for adult overnight-stay patients admitted to a public hospital in a region of significant cultural and linguistic diversity in Sydney, Australia in 2014-2015. Descriptive analyses were used to explore demographic and diagnostic data. Chi-square and analysis of variance were used to test for association between variables. RESULTS: The site hospital provided for 19,627 overnight-stay episodes of care over the one year period. Emergency admissions made up 70.5% (n = 13,845) of all hospital admissions and obstetric patients 11.7% (n = 2291). For 15.7% (n = 3074) of episodes of care a healthcare interpreter was identified at hospital admission as being required. In 3.7% (n = 727) of episodes of care a healthcare interpreter was provided. Patients who received an interpreter were more likely to be female, of a younger age and admitted to hospital for childbirth. CONCLUSIONS: A minority of patients with limited English proficiency received a healthcare interpreter during their episode of care. The majority of interpreter services were provided to obstetric patients.

Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data.

AIMS AND OBJECTIVES: To determine whether there was an association between intra-hospital transfers and adverse outcomes. BACKGROUND: Transfers between clinical units and between beds on the same unit are routine aspects of an episode of care in acute hospitals. The rate of these transfers per episode has increased in response to high occupancy levels, a decline in bed numbers, and increased demand for hospital services. The impact of the number of transfers between both wards and beds on patient outcomes is not widely explored. DESIGN: Retrospective cross sectional design using hospital administrative data. METHOD: Data were extracted from existing hospital administrative datasets for one large metropolitan hospital for the financial year 2008-09 in Australia (n = 14,133). Descriptive analyses and logistic regression models were developed for each of 3 selected patient outcomes. RESULTS: Nearly one-tenth of patients (9.2%) experienced a fall with injury, 3.8% of surgical patients a wound infection and 0.1% a complication from medication errors. For each bed or ward transfer, the odds of falls and wound infections increased. Medication errors were not associated with either bed or ward moves. CONCLUSION: Hospitals should minimise the number of bed and ward transfers per episode of care in order to reduce the likelihood of adverse patient outcomes. Current bed management policies and practices should be evaluated and further refined to address this need. Additional strategies include improving coordination and communication during and after transfer. RELEVANCE TO CLINICAL PRACTICE: Nurses must consider the potential cost of intrahospital transfers on patients, length of stay and bed availability.

Intrahospital transfers and the impact on nursing workload.

AIMS AND OBJECTIVES: To determine the rate of patient moves and the impact on nurses' time. BACKGROUND: Bed shortages and strategies designed to increase patient flow have led to a global increase in patient transfers between wards. The impact of transferring patients between wards and between beds within a ward on nurses' workload has not previously been measured. DESIGN: A two-stage sequential study. Retrospective analysis of hospital data and a prospective observational-timing study. METHODS: Secondary analysis of an administrative data set to inform the rate of ward and bed transfers (n = 34,715) was undertaken followed by an observational-timing study of nurses' activities associated with patient transfers (n = 75). RESULTS: Over 10,000 patients were moved 34,715 times in 1 year which equates to an average of 2.4 transfers per patient. On average, patient transfers took 42 min and bed transfers took 11 min of nurses' time. Based on the frequency of patient moves, 11.3 full-time equivalent nurses are needed to move patients within the site hospital each month. CONCLUSION: Transferring patients is workload intensive on nurses' time and should be included in nursing workload measurement systems. RELEVANCE TO CLINICAL PRACTICE: Nurses at the site hospital spend over 1700 hr each month on activities associated with transferring patients, meaning that less time is available for nursing care.

Nurse-Performed Endoscopy: Implications for the Nursing Profession in Australia.

Increasing demands for health care globally often lead to discussions about expanding the involvement of nurses in a range of nontraditional roles. Several countries have introduced nurse endoscopists as a means of easing the burden of demand for a range of endoscopic procedures. A shortage of medical staff in Australia combined with increasing demand for endoscopy led to the implementation of nurse endoscopists as a pilot program in the state of Queensland, where a nurse practitioner model was implemented, and Victoria, where an advanced practice model was used. This article will discuss the implementation of and responses from the nursing, medical, and policy community to nurse-performed endoscopy in this country. Regarding health policy, access to cancer screening may be improved by providing nurses with advanced training to safely perform endoscopy procedures. Moreover, issues of nurse credentialing and payment need to be considered appropriate to each country's health system model.

Methodological integrative review of the work sampling technique used in nursing workload research.

AIM: To critically review the work sampling technique used in nursing workload research. BACKGROUND: Work sampling is a technique frequently used by researchers and managers to explore and measure nursing activities. However, work sampling methods used are diverse making comparisons of results between studies difficult. DESIGN: Methodological integrative review. DATA SOURCES: Four electronic databases were systematically searched for peer-reviewed articles published between 2002-2012. Manual scanning of reference lists and Rich Site Summary feeds from contemporary nursing journals were other sources of data. REVIEW METHODS: Articles published in the English language between 2002-2012 reporting on research which used work sampling to examine nursing workload. RESULTS: Eighteen articles were reviewed. The review identified that the work sampling technique lacks a standardized approach, which may have an impact on the sharing or comparison of results. Specific areas needing a shared understanding included the training of observers and subjects who self-report, standardization of the techniques used to assess observer inter-rater reliability, sampling methods and reporting of outcomes. CONCLUSION: Work sampling is a technique that can be used to explore the many facets of nursing work. Standardized reporting measures would enable greater comparison between studies and contribute to knowledge more effectively. Author suggestions for the reporting of results may act as guidelines for researchers considering work sampling as a research method.

A systematic review of time studies to assess the impact of patient transfers on nurse workload.

Patients in hospital are increasingly being moved between clinical units and between bedspaces; however, the impact of patient transfers and bedspace moves on nurses' workload is not known. Time studies are an established observational research method that can be used to determine the duration of time taken to perform an activity or process. This review systematically searched four databases for literature published between 2000 and 2013 for observational time study techniques and patient transfers as a nurse activity. Eleven publications from three countries were included in the review. All studies used timing techniques to explore nurse work associated with the transfer process. The review highlights the duration of time spent by nurses on certain aspects of the transfer process. However, as few studies published results from timings, the impact on nurse time is likely to be higher than indicated. Further research is recommended.

Sexual harassment among young tourists visiting Mediterranean resorts.

Despite the known increase in substance use and risky sexual behaviors among young people during holiday periods, issues of sexual harassment (SH) and having sex against one's will (SAW) have not received adequate attention. We implemented a cross-sectional airport-based study to identify experience of SH and SAW in 6,502 British and German holidaymakers aged 16-35 years visiting tourist resorts in Southern Europe (Crete, Cyprus, Italy, Portugal, and Spain) in summer 2009. Across all participants, 8.6 % reported SH during their holiday and 1.5 % reported SAW. Women reported higher levels of SH than heterosexual males. However, gay and bisexual males reported SH levels similar to females and the highest levels of SAW. Of 19 predictor variables tested, ten were independently associated with SH. SH was increased in those who were visitors to Mallorca or Crete, British, younger, female, gay or bisexual, frequently drunk on holiday, cocaine users, and attracted to bars where people get drunk, or where there are opportunities for sex. Among 13 predictor variables tested for SAW, four were significant. SAW reduced in those visiting Cyprus, and was strongly associated with being a gay or bisexual male, using cannabis on holiday and being attracted to bars where there were opportunities for sex. Holiday resorts represent a key location for SH and SAW, especially for holidaymakers who get drunk and use drugs. Preventive programs can raise awareness of the risks of unwanted sexual encounters on holiday and work with the tourist industry and tourist authorities to develop environments where sexual aggression is not tolerated.

Randomized controlled trials of mental health nurse-delivered interventions: A systematic review.

WHAT IS KNOWN ON THE SUBJECT?: Well conducted randomized controlled trials provide the highest level of evidence of effectiveness of healthcare interventions, including those delivered by mental health nurses. Trials have been conducted over the years but there has not been a comprehensive review since 2005, and never one including studies conducted outside the UK. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides a comprehensive overview of results from randomized controlled trials of mental health nurse-delivered interventions conducted in the UK, Ireland, US, Australia, New Zealand, or Canada and reported 2005 to 2020. It highlights that the trial evidence is limited and offers only partial evidence for interventions that are central to mental health nursing practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Much mental health nursing practice is not supported by the highest level trial evidence. Mental health nurses need to carefully select evidence on which to base their practice both from the mental health nursing literature and beyond. Mental health nurses and other stakeholders should demand greater investment in trials to strengthen the evidence base. ABSTRACT: INTRODUCTION: Nurses are the largest professional disciplinary group working in mental health services and have been involved in numerous trials of nursing-specific and multidisciplinary interventions. Systematic appraisal of relevant research findings is rare. AIM: To review trials from the core Anglosphere (UK, US, Canada, Ireland, Australia, New Zealand) published from 2005 to 2020. METHOD: A systematic review reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive electronic database searches were conducted. Eligible studies were randomized controlled trials of mental health nurse-delivered interventions conducted in relevant countries. The risk of bias was independently assessed. Synthesis involved integration of descriptive statistics of standardized metrics and study bias. RESULTS: Outcomes from 348 between-group comparisons were extracted from K = 51 studies (N = 11,266 participants), Standardized effect sizes for 68 (39 very small/small, 29 moderate/large) statistically significant outcomes from 30 studies were calculable. All moderate/large effect sizes were at risk of bias. DISCUSSION: Trial evidence of effective mental health nurse-delivered interventions is limited. Many studies produced few or no measurable benefits; none demonstrated improvements related to personal recovery. IMPLICATIONS FOR PRACTICE: Mental health nurses should look beyond gold standard RCT evidence, and to evidence-based interventions that have not been trialled with mental health nurse delivery.

Patient transfers in Australia: implications for nursing workload and patient outcomes.

AIM: To discuss the impact of patient transfers on patient outcomes and nursing workload. BACKGROUND: Many patient transfers are essential and occur in response to patients' clinical changes. However, increasingly within Australia transfers are performed in response to reductions in bed numbers, resulting in 'bed block'. EVALUATION: A discussion of the literature related to inpatient transfers, nursing workload and patient safety. KEY ISSUES: Measures to increase patient flow such as short-stay units may result in an increase in patient transfers and nursing workload. Frequent patient transfers may also increase the risk of medication incidents, health-care acquired infections and patient falls. CONCLUSIONS: The continuing demand for health care has led to a reactionary bed management system that, in an attempt to accommodate patients, has resulted in increased transfers between wards. This can have a negative effect on nursing workload and affect patient outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: High nursing workload is cited as one reason for nurses leaving the profession. Reductions in non-essential transfers may reduce nurse workload, improve patient outcomes and enhance continuity of patient care.

Substance users' perspective of pain management in the acute care environment.

The aim of this exploratory study was to examine substance users' perspectives towards their acute pain management in the acute hospital setting. Barriers to optimal pain management in the substance user population include: altered physiologic responses to analgesia; cultural values; and health professionals' perceptions of drug-seeking behaviours.

Nightlife young risk behaviours in Mediterranean versus other European cities: are stereotypes true?

BACKGROUND: Mediterranean lifestyle has long been hailed as protective against certain risk behaviours and diseases. Mediterranean drinking patterns of moderate alcohol consumption as part of daily life have often been assumed to protect young people from harmful alcohol consumption, in contrast to Northern European drinking patterns. Nightlife environments are strong related to alcohol and drugs use, and other health risk behaviours but few cross-national studies have been undertaken amongst young Europeans frequenting bars and nightclubs. This study aims to understand differences in nightlife risk-taking behaviours between young nightlife users from Mediterranean and non-Mediterranean cultures, including alcohol and illicit drug use, unprotected sex, violence and driving under the influence of alcohol. METHODS: A total of 1363 regular nightlife users aged 16-35 years were surveyed in nine European cities by means of a self-reported questionnaire. Sample selection was done through respondent driven sampling techniques. RESULTS: after controlling for demographic variables, no differences among the Mediterranean and non-Mediterranean samples were found in current alcohol, tobacco, cannabis, or cocaine use, neither in violent behaviours, but Northern people were more likely to get drunk [adjusted odds ratio (AOR) = 0.53], while Mediterranean were more likely to have unprotected sex (AOR = 2.01) and to drive drunken (AOR = 5.86). CONCLUSION: Our data suggest that stereotypes are partially confirmed, and that Mediterranean lifestyle is protective for some risk behaviours (drunkenness, ecstasy and amphetamines current use), but not for all of them. Further research in depth is needed in order to clarify the relations between cultural patterns, social norms and nightlife risk behaviours assumed by the young people.

Factors associated with risky sexual behaviour: a comparison of British, Spanish and German holidaymakers to the Balearics.

BACKGROUND: Previous studies exploring risk-taking behaviour on holiday are typically limited to single nationalities, confounding comparisons among countries. Here we examine the sexual behaviour of holidaymakers of three nationalities visiting Ibiza and Majorca. METHODS: A comparative cross-sectional study design was used focusing on British, Spanish and German holidaymakers in the age range of 16-35 years. Overall, 3003 questionnaires were gathered at airports in Majorca and Ibiza from holidaymakers returning home. RESULTS: Of those surveyed, 71.1% were single (travelling without a current sexual partner) (Majorca, 74.3%; Ibiza, 68.0%). Overall, 34.1% of single holidaymakers had sex on holiday. Amongst single participants, factors associated with having sex on holiday were high levels of drunkenness, being Spanish and holidaying for over 2 weeks. Of those single and having sex on holiday, factors associated with multiple sexual partners were being male and age ≤19 years. Unprotected sex was predicted by being German and holidaying in Majorca, holidaying with members of the opposite sex and using four or more drugs on holiday. All sexual behaviours were predicted by a high number of sexual partners in the previous 12 months. Furthermore, single holidaymakers having sex abroad were more likely to prefer night-time venues facilitating casual sex and excessive alcohol consumption. CONCLUSIONS: Casual sex encounters in youth holiday resorts may be commonplace and mediated through substance use. Further focused public health efforts, including in bars/nightclubs, are needed to prevent sexual risk-taking which can increase the likelihood of poor sexual health outcomes and associated factors such as regretted sex.

Nursing unit managers, staff retention and the work environment.

AIM AND OBJECTIVE: This paper examined the impact of leadership characteristics of nursing unit managers, as perceived by staff nurses, on staff satisfaction and retention. BACKGROUND: A positive work environment will increase levels of job satisfaction and staff retention. Nurse leaders play a critical role in creating a positive work environment. Important leadership characteristics of the front-line nurse manager include visibility, accessibility, consultation, recognition and support. DESIGN: Secondary analysis of data collected on 94 randomly selected wards in 21 public hospitals across two Australian states between 2004-2006. METHODS: All nurses (n = 2488, 80·3% response rate) on the selected wards were asked to complete a survey that included the 49-item Nursing Work Index-Revised [NWI-R] together with measures of job satisfaction, satisfaction with nursing and intention to leave. Subscales of the NWI-R were calculated. Leadership, the domain of interest, consisted of 12 items. Wards were divided into those reporting either positive or negative leadership. Data were analysed at the nurse level using spss version 16. RESULTS: A nursing manager who was perceived to be a good leader, was visible, consulted with staff, provided praise and recognition and where flexible work schedules were available was found to distinguish the positive and negative wards. However, for a ward to be rated as positive overall, nurse leaders need to perform well on all the leadership items. CONCLUSION: An effective nursing unit manager who consults with staff and provides positive feedback and who is rated highly on a broad range of leadership items is instrumental in increasing job satisfaction and satisfaction with nursing. RELEVANCE TO CLINICAL PRACTICE: Good nurse managers play an important role in staff retention and satisfaction. Improved retention will lead to savings for the organisation, which may be allocated to activities such as training and mentorship to assist nurse leaders in developing these critical leadership skills. Strategies also need to be put in place to ensure that nurse leaders receive adequate organisational support from nursing executives.

Factors impacting on career progression for nurse executives.

This discursive paper examines recent research on career progression for nurse executives in Australia. In particular, it focuses on the personal, work-related and professional factors which influence progression. The role of gender, location and the provision of mentoring are also considered. It is suggested that family friendly policies (such as the option to job share or to perform an executive role on a part-time basis), the availability of a mentor, and the opportunity to pursue further education/training are vital in assisting nurses to progress in their executive careers.

Staffing, skill mix and the model of care.

AIMS AND OBJECTIVES: The study aimed to explore whether nurse staffing, experience and skill mix influenced the model of nursing care in medical-surgical wards. BACKGROUND: Methods of allocating nurses to patients are typically divided into four types: primary nursing, patient allocation, task assignment and team nursing. Research findings are varied in regard to the relationship between these models of care and outcomes such as satisfaction and quality. Skill mix has been associated with various models, with implications for collegial support, teamwork and patient outcomes. DESIGN: Secondary analysis of data collected on 80 randomly selected medical-surgical wards in 19 public hospitals in New South Wales, Australia during 2004-2005. METHODS: Nurses (n = 2278, 80.9% response rate) were surveyed using The Nursing Care Delivery System and the Nursing Work Index-Revised. Staffing and skill mix was obtained from the ward roster and other data from the patient record. Models of care were examined in relation to these practice environment and organisational variables. RESULTS: The models of nursing care most frequently reported by nurses in medical-surgical wards in this study were patient allocation (91%) and team nursing (80%). Primary nursing and task based models were unlikely to be practised. Skill mix, nurse experience, nursing workload and factors in the ward environment significantly influenced the model of care in use. Wards with a higher ratio of degree qualified, experienced registered nurses, working on their 'usual' ward were more likely to practice patient allocation while wards with greater variability in staffing levels and skill mix were more likely to practice team nursing. CONCLUSIONS: Models of care are not prescriptive but are varied according to ward circumstances and staffing levels based on complex clinical decision making skills. RELEVANCE TO CLINICAL PRACTICE: Variability in the models of care reported by ward nurses indicates that nurses adapt the model of nursing care on a daily or shift basis, according to patients' needs, skill mix and individual ward environments.

[Violence in nightlife environments and its relationship with the consumption of alcohol and drugs among young Spaniards]. / Violencia en contextos recreativos nocturnos: su relación con el consumo de alcohol y drogas entre jóvenes españoles.

Violence in nightlife environments (NE) is a rarely studied phenomenon. There is growing interest in determining its prevalence and its relationship with sociodemographic variables, drunkenness and drug use. A survey to 440 youngsters, selected by the respondent-driven sampling methodology, was conducted, and the inclusion criteria were: to go out regularly, and to use alcohol and/or illegal drugs. The survey was carried out in the Balearic Islands, Galicia and Comunidad Valenciana. During the past year and while going out at night, 5.2% of the youngsters carried weapons, 11.6% were attacked or threatened with a weapon and 23% got into a fight. Logistic regression revealed that the best predictor for the behaviour of carrying a weapon is polydrug use; whereas amongst those who had been threatened, it was being frequently involved in rows or arguments related to substance use; and for those involved in fights, it was being younger (14-18) and being frequently involved in rows or arguments related to substance use. There is a high prevalence of violent behaviors in NE. Prevention should take into account particularly the younger individuals, those who engage in polydrug use and those who often have fights and discussions related to drug consumption.