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.

Celebrating Australian nurses who are pioneering the response to climate change: a compilation of case studies.

BACKGROUND: Nurses, the largest healthcare workforce, are well placed to provide leadership in initiatives that promote planetary health. Yet, few practical examples of nurse leadership in the health sector's response to climate change are evident in the scholarly literature. AIM: The aim of this discussion paper is to profile Australian nurses who are leading initiatives designed to champion planetary health and promote sustainable practice. METHODS: The paper presents a series of case studies derived from interviews conducted in October and November 2023. FINDINGS: The nurses' experiences and insights, along with the challenges they have encountered, are presented as evidence of Kouzes and Posner's five practices of exemplary leadership. CONCLUSION: The case studies demonstrate that appointment of more nurses with climate and sustainability expertise will accelerate the implementation of responsive strategies that target waste management, emissions reduction and climate resilience across healthcare organisations.

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.

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

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

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.

Method development to characterise elephant tail hairs by LA-ICP-MS to reflect changes in elemental chemistry.

This paper evaluated analytical methods used to generate time-series data from elephant tail hairs, which can be used to reflect changing exposure to environmental geochemistry. Elephant tail hairs were analysed by three methods sequentially, each providing data to inform subsequent analysis. Scanning Electron Microscopy (SEM) and X-ray Microanalysis visually showed the structure of the hair, specific structures such as tubules, and the mineral crusting around the edge of the hair, informing targeting of subsequent analysis by Laser Ablation-Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS). LA-ICP-MS generated time-series data which informed sectioning of the tail hairs for subsequent quantitative analysis for potentially toxic elements and micronutrients using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) of dissolved tail hairs. This novel approach to characterise the tail hair enabled time-series analysis to reflect changes in environmental exposure which may result from seasonal or geochemical spatial variation and could inform elephant movement patterns. The seasonal change between wet and dry seasons was reflected down the length of the hair. Correlations were seen between LA-ICP-MS data and ICP-MS data in several elements including Mg, P, Ca, Fe, Na, Mn and U. This study provided time-series data for the analysis of elephant tail hairs by evaluating analytical challenges to obtaining quantitative data, such as improving protocols to ensure removal of extraneous material, determining where to section the tail hairs to best reflect environmental changes/exposure and ensuring representative analyses. A protocol was established to determine mineral status across a 12-18 month time period utilizing single elephant tail hairs.

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.

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.

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.

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.

Trauma-informed care for people presenting to the emergency department with mental health issues.

There is a high prevalence of exposure to traumatic events in childhood among people who have mental health issues. Presentation to the emergency department (ED) can be challenging for these patients because the environment and their experience of care can trigger traumatic memories. Trauma-informed care is an approach to practice that is guided by knowledge of how trauma affects people's lives and their healthcare needs. Despite the increasing prevalence of mental health care delivery in EDs, the level of translation of trauma-informed care into nursing practice in this setting is largely unknown. Therefore, the authors undertook a narrative literature review, the aim of which was to gather evidence relevant to trauma-informed care in the ED and provide guidance on this practice for emergency nurses. Several databases were searched, and the relevant articles found were thematically analysed. Three emergent themes were identified from the literature: an access point for mental health care; staff attitudes; and the ED experience. Emergency nurses need to be aware of the effects of childhood trauma on people presenting with mental health issues and plan their approach to care to avoid potentially re-traumatising patients.

Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit.

Ventilator-associated pneumonia (VAP) is a preventable secondary consequence of intubation and mechanical ventilation. VAP is pneumonia that develops in an intubated patient after 48 hours or more of mechanical ventilator support. Mechanically ventilated patients in neurologic and other intensive care units (ICUs) are at an increased risk of VAP due to factors such as decreased level of consciousness; dry, open mouth; and microaspiration of secretions. VAP can be prevented by initiating interventions from the Institute of Healthcare Improvement's VAP bundle, including (a) elevating the head of the bed of ventilated patients to 30 degrees, (b) preventing venous thromboembolism through use of sequential compression devices or anticoagulation, (c) administering gastric acid histamine2 blockers, (d) practicing good hand hygiene, (e) initiating early mobilization, and (f) performing daily sedation interruption at 10 am to evaluate neurologic status. The one intervention not included in the IHI bundle is oral hygiene. The purpose of this project is to support the premise that oral care, including timed toothbrushing, combined with the VAP bundle can mitigate and prevent the occurrence of VAP. Our project specifically addressed timed oral care of mechanically ventilated patients on a 24-bed stroke, neurologic, and medical ICU. Patients were randomized into a control group that performed usual oral care or an intervention group that brushed teeth every 8 hours. The results were immediate and startling, as the VAP rate dropped to zero within a week of beginning the every-8-hours toothbrushing regimen in the intervention group. The study was so successful that the control group was dropped after 6 months, and all intubated patients' teeth were brushed every 8 hours, maintaining the zero rate until the end of the study.

DNR does not mean no care.

End-of-life care is a complicated topic, especially in a neurological intensive care unit. Death is a daily part of nursing care and should be treated with respect and a definite plan of care. Unfortunately, there are still hospitals that do not have protocols to deal with this outcome. The administration of opioids and appropriate sedation can be the difference between a calm serene death or one that is fraught with dyspnea, struggling, and unhappy families. Every hospital should have palliative care and hospice planning. This case study is about a dying patient that did not receive palliative care appropriately; however, through determination and personal knowledge of death and dying, a neurosurgical nurse was able to change the way a hospital dealt with do-not-resuscitate patients. Do not resuscitate does not mean no care; it means a different kind of care that can best be achieved through end-of-life protocols and education.