Registered nurses' knowledge, attitudes and beliefs about end-of-life care in non-specialist palliative care settings: A mixed studies review.

AIM: The aim of this study was to describe, evaluate and synthesise the literature on registered nurses' knowledge, attitudes and beliefs towards end-of-life care in adult non-specialist palliative care settings. BACKGROUND: Little is known about the knowledge, attitudes and beliefs of Registered Nurses working in non-specialist palliative care settings about end-of-life care. DESIGN: A mixed-methods systematic review and narrative synthesis was conducted (PROSPERO Registration No: CRD4202148114). Five databases (Medline, CINAHL, PubMed, PsycINFO and Web of Science) were searched from inception to August 2020. Study quality was assessed using the Mixed Methods Appraisal Tool. RESULTS: Nineteen studies met the inclusion criteria. Registered nurses in non-specialist palliative care settings demonstrated good knowledge of pain symptoms and management and positive attitudes towards caring for dying patients and their families. Knowledge deficits were identified in the psychosocial and spiritual aspects of end-of-life care and registered nurses reported negative attitudes towards communication about death. Only five of the included studies explored registered nurses' beliefs towards end-of-life care. CONCLUSIONS: There is a need to enhance palliative care education in clinical practice settings and in undergraduate programs to improve registered nurses' knowledge, attitudes and beliefs about end-of-life care. Future studies that use reliable and validated methods to measure registered nurses' beliefs about end-of-life care should be conducted. TWEETABLE ABSTRACT: RNs in non-specialist palliative care settings want more education on pain management & greater knowledge on communicating about death/dying.

How does the environment influence consumers' perceptions of safety in acute mental health units? A qualitative study.

AIMS AND OBJECTIVES: To explore how the physical and social environment of acute mental health units influences consumers' perception and experience of safety. BACKGROUND: Acute mental health units are places in which consumers should feel safe. Not all consumers, however, feel safe in this environment. Little is known about what contributes to consumers' feelings of safety in this setting. DESIGN: The study used a qualitative descriptive design, influenced by naturalistic enquiry. Data were analysed using thematic analysis and are reported according to the COREQ checklist. METHODS: Fifteen people who had experienced admission to an acute mental health unit were individually interviewed. RESULTS: Having a supportive environment enhanced consumers' perception and experience of safety. A supportive environment was experienced when consumers had privacy, felt safe from other consumers and had meaningful activities to participate in within the acute mental health unit. In contrast, having their privacy breached by other consumers made participants feel unsafe. Many participants were fearful of other consumers, and felt unsafe and unable to protect themselves. Lack of meaningful activities led to boredom and contributed to consumers feeling unsafe. CONCLUSIONS: Personal spaces should address consumers' privacy needs without compromising staff access. Staff presence enhances consumers' feelings of safety, but this need can be heightened when consumers are unable to alert staff when they feel unsafe. Meaningful activities link consumers to their lives outside of the hospital and can enhance recovery. RELEVANCE TO CLINICAL PRACTICE: Understanding how the acute unit environment is perceived by consumers can assist nurses and managers to promote feelings of safety among consumers. Feeling safe can, in turn, optimise recovery.

Understanding how personhood impacts consumers' feelings of safety in acute mental health units: a qualitative study.

Being admitted to an acute mental health unit can lead to feelings of shame, and loss of personhood for some consumers. Promoting safety for consumers is a function of acute mental health units. This paper explores how consumers' personhood influences their perception and experience of safety in acute mental health units. Semi-structured interviews were conducted with 15 participants who had previously been admitted to an acute mental health unit. Thematic analysis was used to analyse the data. Participants perceived safety as being intrinsically linked to their personhood. When participants' innate worth was affirmed in their interactions with staff, participants felt safe. Three subthemes were identified: 'Seen as an equal', 'Being respected', and 'Able to make choices'. These findings can be used to inform nursing practices that enhance consumers' sense of personhood and, in so doing, promote consumers' safety and recovery in acute mental health units.

Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study.

AIMS AND OBJECTIVES: To explore how nurses influence the perceptions and experience of safety among consumers who have been admitted to an acute mental health unit. BACKGROUND: Safety is a priority in acute mental health inpatient units, yet consumers do not always experience acute units as safe. Despite being primary stakeholders, little is known about what safety means for consumers in acute mental health units. DESIGN: A qualitative descriptive study informed by naturalistic enquiry was conducted and is reported using the COREQ checklist. METHODS: Fifteen consumers with experience of mental illness participated in semi-structured individual interviews. These interviews explored what safety meant for them during their acute mental health unit admissions. Thematic analysis was used to analyse the data. FINDINGS: The theme Influence of Nurses reflected that the way nurses engaged in acute mental health units had a profound impact on participants' sense of safety. Three sub-themes emerged as follows: (a) Availability: "It's about nurses spending time with you"; (b) Being responsive: "They would listen if you had a concern"; and (c) Caring: "Little acts of kindness." CONCLUSIONS: These findings challenge the dominant discourse around safety in mental health organisations, in which nursing practice is often oriented towards the management of risk, rather than the promotion of safety. The findings demonstrate that, through their clinical practice, nurses can enhance consumers' feelings of safety in the acute mental health unit. RELEVANCE TO CLINICAL PRACTICE: Nurses play a key role in providing care within acute mental health units. It is vital that the behaviours and actions nurses can enact in order to promote feelings of safety among consumers in this setting are enabled at individual, unit and organisational levels.

The impact of curriculum on nursing students' attitudes, perceptions and preparedness to work in primary health care: An integrative review.

BACKGROUND: The ageing population and growing burden of chronic disease has increased demands for primary health care services, necessitating growth of this nursing workforce. Studies have explored strategies in retaining nurses, employment conditions in primary health care, and transitioning of acute care nurses to primary health care employment. Few studies have explored how undergraduate nursing students perceive and are prepared to work in this sector. AIM: This review synthesises evidence on the impact of undergraduate curriculum on nursing students' attitudes, perceptions and preparedness to work in primary health care. DESIGN: An integrative literature review guided the synthesis of evidence. DATA SOURCES: Scopus, ScienceDirect, CINAHL and MEDLINE were searched for relevant studies published between 2008 and 2018. REVIEW METHODS: 491 studies were identified from the database searches. Following the removal of duplicates, review of abstracts and keywords against the inclusion and exclusion criteria, 39 papers were subjected to full-text review. Twelve papers, including one thesis, met the inclusion criteria. Using an appraisal system, no paper was excluded based on methodological quality. RESULTS: Three themes were identified, namely: impact of curricula; knowledge and attitudes to primary health care; and students' intention to work in primary health care. The preparation of undergraduate nursing students to work in this area is inconsistent as curricula remain acute-care focussed. Negative perceptions about the primary health care nursing role impact intentions of nursing students to work in primary health care. CONCLUSION: This review highlights a need to implement strategies to improve the understanding of undergraduate nurses around the primary health care nursing role. In particular, providing students with skills, knowledge and an understanding of working in this area through curriculum content and structure may provide undergraduates with the desire and confidence to seek employment in primary health care following graduation.

An exploration of the experiences of Australian Grey Nomads travelling with chronic conditions.

Internationally, the population is ageing and people are living well, longer. In Australia, extended travelling has gained popularity among older Grey Nomads due to time and opportunity post retirement. However, there is limited research available focusing on older Australians' health while travelling. This paper reports the qualitative phase of a larger mixed-method project that explores the experience of Australian Grey Nomads travelling with chronic conditions. Eight Grey Nomads participated in telephone interviews. Data were analysed using inductive thematic analysis. Two themes emerged, namely: continuity of care while travelling and experts on the road. Participants described encountering a fragmented health system, with challenges regarding finding health services; a lack of shared medical records; and difficulties accessing regular medications. Despite these challenges, participants demonstrated health preparedness, an ability to accommodate health on the road, and were all travelling for their health. This study highlights key systems issues that challenge health care while travelling, and identifies opportunities for both usual practices and rural health services to enhance the care provided to this group.

Empowering clinical supervisors to flourish though critical companionship.

Education for professional nursing practice has undergone a significant shift over the last few decades impacting nursing practice and the relationship between nurses. Enhancing professional practice and acting as a conduit for empowering nurses to be active participants in their learning and development is Practice Development. This action research project with philosophical premises of critical companionship and human flourishing aimed to develop the knowledge and skills of registered nurses in their ability to provide clinical supervision of nursing students in practice. The overall project consisted of two action research cycles in two different health facilities. Participants in both projects identified similar issues and common learning needs including; how to better understand and develop skills in reflective practice; how to provide a positive learning and enabling environment; and how to provide effective solution focused feedback. Workshop facilitators witnessed the flourishing of participants as they were enabled to negotiate their learning requirements; grow and develop in their roles over the workshop series. Participants themselves identified personal growth in skills, knowledge and confidence in being a preceptor as a result of the workshops in the study. Overall, this study has resulted in the development and capacity building of the nursing workforce clinical placement capacity through the development of clinical supervisors.

INCORPORATING THE NURSING AND MIDWIFERY ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH CURRICULUM FRAMEWORK INTO A BN PROGRAM.

Preparing nursing students for authentic person-centred practice demands an awareness and understanding of Australian culture and history and the impact of these things on the health of Aboriginal and Torres Strait Islander peoples.

The health and health preparation of long-term Australian travellers.

A growing number of Australians are travelling domestically for extended periods. This creates challenges in both continuity of health care and burdens on health services. This paper reports a cross-sectional survey aimed to explore the health needs and health planning of long-term travellers. In total, 316 respondents who had travelled for more than 3 months consecutively in the last year participated. Most respondents were retired (n=197; 62.3%); however, ages ranged from 26 to 89 years. Nearly half of the respondents or their travel companion had a long-term illness that affected their daily life (n=135; 42.7%). Nearly half of respondents visited a GP (n=133; 42.1%), nearly one-quarter visited an Emergency Department (n=72; 22.8%) and 19.9% (n=63) visited another health provider while travelling. The level of preparation around health while travelling varied between participants. This study highlights that long-term travellers have significant health needs and are likely to require health services during their extended travel. Additionally, it identifies that currently few strategies are used to plan for health care during travel. This raises issues for rural and remote health services in terms of both capacity and continuity of care.

The experience of waiting for a kidney transplant: A qualitative study.

BACKGROUND: In Australia over 1100 people are living on dialysis while waiting for a kidney transplant from a deceased donor. Worldwide there are an estimated 170,000 people who wait an average of three years before an organ becomes available. OBJECTIVE: To provide an understanding of the lived experience of people waiting on dialysis for a kidney transplant from a deceased donor. APPROACH: A qualitative descriptive research design was used. Participants were recruited from a large metropolitan hospital. Two focus groups were conducted with six participants ranging in age from 29-63 years, with dialysis experience of 10-72 months. Data saturation was achieved and thematic analysis was used to interpret the data providing a descriptive account of the experience of waiting for a kidney transplant. FINDINGS: Waiting for a kidney transplant takes place in the context of living on dialysis. Four main themes were identified: living on dialysis is physically and mentally demanding; living with uncertainty; altered relationship dynamics; and feelings towards the deceased donor. CONCLUSIONS: This study provides a descriptive summary of what it is like to live on dialysis while waiting for a kidney transplant from a deceased donor from the perspective of the person waiting. People are burdened by; uncertainty; the experience of the dialysis therapy; and the thought of the human cost of transplantation. These findings suggest that this cohort may benefit from strategies to relieve uncertainty such as effective communication from the treating team and peer support from the dialysis community.

The development of professional practice standards for Australian general practice nurses.

AIMS: The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. BACKGROUND: Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. DESIGN: Concurrent mixed methods design. METHODS: Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. FINDINGS: Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. CONCLUSION: The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance.

The significance of personal learning environments (PLEs) in nursing education: Extending current conceptualizations.

BACKGROUND: Personal learning environments (PLEs) have been shown to be a critical part of how students negotiate and manage their own learning. Understandings of PLEs appear to be constrained by narrow definitions that focus primarily on technological engagement with a range of web tools and associated applications. This paper addresses a gap in the literature around PLEs for students currently enrolled in undergraduate nursing degrees. PURPOSE: To provide in-depth insights into how undergraduate students of nursing manage and experience their learning. METHODS: This was an international multi-site qualitative study, utilizing focus groups. A schedule of 10 questions and nominal group techniques were used. FINDINGS: Whilst the focus groups took place in very different geographical locations, there were strong similarities in student understandings of effective PLEs. These went well beyond current technological definitions. Findings were organized into three major themes; technologies, learning modalities and influencing factors. DISCUSSION: We propose a broader understanding of PLEs that acknowledges individual personal and cultural contexts which we call the personally significant learning environment (PSLE). There is a need for greater investigation of how students understand and systematize their PSLE. CONCLUSIONS: This paper and our findings will be of interest to educators, researchers and institutions for developing appropriate frameworks that may maximize learning outcomes, encourage cultural sensitivities and facilitate greater understandings of how to support students to create appropriate PSLEs.

Burnout and the provision of psychosocial care amongst Australian cancer nurses.

PURPOSE: To assess the prevalence of burnout amongst Australian cancer nurses as well as investigate the systemic and individual factors associated with burnout, including training and supervision for nurses in psychosocial care. Burnout amongst cancer nurses can have serious consequences for the individual nurse, the hospital and patients. Psychosocial care has been demonstrated in many studies to reduce distress in cancer patients; however, previous studies have suggested that providing psychosocial care can be stressful if nurses feel they lack appropriate training. Psychosocial skill training and supervision may be a way of improving job satisfaction and reducing burnout amongst nurses. METHOD: Two hundred and thirty cancer nurses were recruited between November 2010 and April 2011 and completed an online questionnaire. RESULTS: Burnout levels within this population were found to be below nursing norms. Adequacy of training and supervision, frequency of supervision and percentage of role spent managing psychosocial care were found to be associated with burnout. Workload, Control, Reward and Community were independent predictors of burnout, and nurses with a greater mismatch in these areas identified as having High levels of burnout. CONCLUSIONS: Strategies to reduce burnout include providing cancer nurses with a varied and sustainable workload, awarding financial and social recognition of efforts and encouraging nurses to develop a sense of control over their work. Providing regular training and supervision in psychosocial care that is perceived to be adequate may also assist in reducing burnout.

Review of transnational nursing education programme curricula: process, findings, and recommendations.

BACKGROUND: The University of Wollongong (UOW) delivers two Transnational International Programmes (TNEP) in Hong Kong (HK): a 1-year undergraduate Bachelor of Nursing (Conversion) degree and a 2-year postgraduate Master of Nursing degree. A curriculum review of these programmes has been undertaken to ensure the quality of the programme remains consistently high and competitive in an international environment. AIM: The aim of the Curriculum Review Project was to utilise the experience of expert academic staff to review the TNEP curricula delivered by an Australian University in Hong Kong (HK) to ensure it met contemporary needs of students, the university, and the Hong Kong Authority. METHODS: The curriculum review projects followed a qualitative research methodology. Thematic analysis was undertaken utilising Braun and Clarke's six-phase method (2006), as this method facilitated an inductive semantic approach where themes are strongly linked to the data and sourced from the explicit meaning of the discourse within the interview (Braun and Clarke, 2006). RESULTS: In total, there were 6 participants who were all permanent academic staff members within the School of Nursing at the UOW. The results of this project have been reported within a strengths, weaknesses, opportunity, and threats (SWOT) framework. Participants recognised the value and challenges to both individual students and the broader nursing profession in HK. Overall, there was a perception that being involved as an academic staff member in a TNEP developed both their subject knowledge and teaching skills. CONCLUSIONS: This project has demonstrated that the TNEP makes an important contribution to the nursing profession in HK, while also facilitating the growth and development of academic staff at UOW.

Nursing competency standards in primary health care: an integrative review.

AIMS AND OBJECTIVES: This paper reports an integrative review of the literature on nursing competency standards for nurses working in primary health care and, in particular, general practice. BACKGROUND: Internationally, there is growing emphasis on building a strong primary health care nursing workforce to meet the challenges of rising chronic and complex disease. However, there has been limited emphasis on examining the nursing workforce in this setting. DESIGN: Integrative review. METHODS: A comprehensive search of relevant electronic databases using keywords (e.g. 'competencies', 'competen*' and 'primary health care', 'general practice' and 'nurs*') was combined with searching of the Internet using the Google scholar search engine. Experts were approached to identify relevant grey literature. Key websites were also searched and the reference lists of retrieved sources were followed up. The search focussed on English language literature published since 2000. RESULTS: Limited published literature reports on competency standards for nurses working in general practice and primary health care. Of the literature that is available, there are differences in the reporting of how the competency standards were developed. A number of common themes were identified across the included competency standards, including clinical practice, communication, professionalism and health promotion. Many competency standards also included teamwork, education, research/evaluation, information technology and the primary health care environment. CONCLUSION: Given the potential value of competency standards, further work is required to develop and test robust standards that can communicate the skills and knowledge required of nurses working in primary health care settings to policy makers, employers, other health professionals and consumers. RELEVANCE TO CLINICAL PRACTICE: Competency standards are important tools for communicating the role of nurses to consumers and other health professionals, as well as defining this role for employers, policy makers and educators. Understanding the content of competency standards internationally is an important step to understanding this growing workforce.

The experiences of adults who are on dialysis and waiting for a renal transplant from a deceased donor: a systematic review.

BACKGROUND: Kidney transplantation has been recognized as the best renal replacement therapy option for people with end stage renal disease. With an estimated 170,000 people waiting for a kidney transplant around the world and a limited supply of donor organs, the waiting time is often prolonged for many years. OBJECTIVES: The aim of this review was to examine the existing evidence of patients' experiences of living on dialysis and waiting for a renal transplant from a deceased donor. TYPES OF PARTICIPANTS: This review considered studies that included adult patients aged 18 years and over who had been on dialysis (hemodialysis or peritoneal dialysis) for up to 15 years and who were waiting for a renal transplant from a deceased donor. Types of intervention(s)/phenomena of interest: The phenomena of interest were the experiences of adults waiting for a renal transplant from a deceased donor and more specifically, the impact of waiting on their lifestyle and day to day living. Types of studies: This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Types of outcomes: This review considered studies that included the experiences of people who were waiting on dialysis for a kidney transplant from a deceased donor. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies through electronic databases, reference list searches and the World Wide Web. Extensive searches were undertaken of the CINAHL, Embase, Medline and PsychInfo databases of published literature, the Cochrane Database of Systematic Reviews and the Virginia Henderson International Nursing Library, OpenGrey and the New York Academy of Medicine databases of unpublished literature. METHODOLOGICAL QUALITY: Each study was assessed for methodological quality by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument checklist. Disagreements between the reviewers were resolved through discussion or with a third reviewer. DATA COLLECTION: Qualitative data was extracted from papers included in the review using the standardized data extraction tool from JBI-Qualitative Assessment and Review Instrument. DATA SYNTHESIS: Qualitative research findings were pooled to generate a set of statements that represented the aggregation and categorizing of these findings on the basis of similarity in meaning. These categories were then subjected to a meta-synthesis in order to produce a comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. RESULTS: A total of 12 studies were included in the final review. Thirty-seven findings from the 12 studies were extracted and aggregated into 11 categories and then into three synthesized findings. The three synthesized findings were: 1. People who are waiting for a kidney transplant from a deceased donor are affected by the experience of living on dialysis with end stage renal disease and its impact on their physical health and normal activities of living. 2. The experience of waiting for a kidney transplant from a deceased donor impacts a person's psychological wellbeing. 3. People who are waiting for a kidney transplant from a deceased donor place value on relationships and being part of a community. The experience of waiting for a renal transplant from a deceased donor while living on dialysis with end stage renal disease changes a person's relationships. CONCLUSIONS: Synthesized findings of the review conclude that people who are waiting for a kidney transplant from a deceased donor live with the physical effects of a life limiting chronic illness and dialysis therapy. Waiting for a kidney transplant is psychologically challenging. People waiting for a kidney transplant value knowledge, although the information they require to alleviate the uncertainty they feel is not available. The dynamics of relationships with family and friends are affected by the experience of waiting for a kidney transplant. People can feel isolated from others leading a 'normal' life, while new relationships are developed within the medical team and community of dialysis patients. IMPLICATIONS FOR PRACTICE: There is limited evidence from the review to support the development of recommendations for clinical practice. Healthcare workers caring for people who are waiting for a kidney transplant from a deceased donor should be mindful of the physical and lifestyle effects of living on dialysis with end stage renal disease. Wherever possible, information should be provided to alleviate the stress and anxiety related to the uncertainty of waiting. The experience of waiting is stressful and people waiting for a kidney transplant may require support and reassurance. It is important to recognize that there are people within communities who may also benefit from receiving information and encouragement. Significant community members should be included in invitations to appointments and education sessions with the consent of the person being treated. IMPLICATIONS FOR RESEARCH: Future studies should be undertaken exclusively with people waiting for a kidney transplant from a deceased donor. Qualitative research designs such phenomenology and grounded theory could be used to investigate the psychological experience of waiting and the relationship between hope, uncertainty and knowledge. Quantitative studies using validated tools could also be conducted. By producing more evidence relating to this significant specific patient population, interventions to improve the experience of waiting could be developed and trialed.

The work of living with a rare cancer: multiple myeloma.

AIM: To report findings from a qualitative study of the experiences of long-term survivors of multiple myeloma. BACKGROUND: Multiple Myeloma is a malignant disease of the bone marrow. Until recently, it was rapidly fatal. Although it remains incurable, people diagnosed with it are living longer on average, largely due to new treatments, some of which have onerous side effects. DESIGN: Prospective descriptive study. METHOD: A series of 47 in-depth interviews were conducted at 6-12 month intervals over 18 months in 2008-2010 with 10 long-term survivors of myeloma and their primary support person. Interviews were analysed using the constant comparative method (Grounded Theory). FINDINGS: To adapt to the effects of both the disease and ongoing medical treatments, participants undertook extensive 'illness work'. Most of this work fell into two broad categories. Risk work aimed to mitigate risks to the well-being of both the person with myeloma and his/her carer. Emotion work aimed to manage the feelings of self and others in a protracted cycle of remission and relapse. CONCLUSION: The experience of myeloma is increasingly characterized by issues associated with chronic disease and 'survivorship'. It is important for nurses working with people with myeloma to understand the overwhelming nature of illness work in this context. Nurses can put in place supportive measures to address the two main 'drivers' of this work: constant risk to well-being of survivors (including carers) and the recurrent need to manage emotions in social interactions.

Religious perspectives on abortion and a secular response.

This paper concerns the medical, religious, and social discourse around abortion. The primary goal of this paper is to better understand how seven of the world's major religious traditions (Roman Catholic, Lutheran, Jewish, Islamic, Buddhist, Confucian, and Hindu) address abortion 'in the clinic'. We do not aim to critique these commentaries but to draw out some of the themes that resonate through the commentaries and place these within complex social contexts. We consider the intersection of ontology and morality; the construction of women's selfhood; the integration of religious beliefs and practices in a secular world. We suggest that for many women, religious doctrine may be balanced with secular logic as both are important and inextricably linked determinants of decision making about the termination of pregnancy.