The Experiences of Informal Caregivers of People With Dementia in Web-Based Psychoeducation Programs: Systematic Review and Metasynthesis.

BACKGROUND: Informal caregivers of people living with dementia experience a higher level of physical and mental stress compared with other types of caregivers. Psychoeducation programs are viewed as beneficial for building caregivers' knowledge and skills and for decreasing caregiver stress. OBJECTIVE: This review aimed to synthesize the experiences and perceptions of informal caregivers of people with dementia when participating in web-based psychoeducation programs and the factors that enable and impede informal caregivers' engagement in web-based psychoeducation programs. METHODS: This review followed the Joanna Briggs Institute protocol of systematic review and meta-aggregation of qualitative studies. We searched 4 English databases, 4 Chinese databases, and 1 Arabic database in July 2021. RESULTS: A total of 9 studies written in English were included in this review. From these studies, 87 findings were extracted and grouped into 20 categories. These categories were further synthesized into 5 findings: web-based learning as an empowering experience, peer support, satisfactory and unsatisfactory program content, satisfactory and unsatisfactory technical design, and challenges encountered in web-based learning. CONCLUSIONS: High-quality and carefully designed web-based psychoeducation programs offered positive experiences for informal caregivers of people living with dementia. To meet broader caregiver education and support needs, program developers should consider information quality and relevancy, the support offered, individual needs, flexibility in delivery, and connectedness between peers and program facilitators.

Causal links behind why Australian midwifery care is missed.

AIMS: The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it. BACKGROUND: Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched. METHODS: A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling. RESULTS: Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted. CONCLUSIONS: Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed. IMPLICATIONS FOR NURSING MANAGEMENT: While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care.

The presence of missed care: A staff development response.

AIMS: This study quantifies the types and frequencies of missed care identified by nurses and measures its impact on their capacity to demonstrate mandatory practice standards as future hospital staff. BACKGROUND: Considerable literature exists as to the nature of missed care but there is a paucity of findings about how missed care impacts on learning firstly as a student and then as a graduate nurse employed in a hospital setting. Additionally, there is little emphasis as to how staff development for nurses exposed to missed care may be implemented. METHODS: A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed care from nurses engaging in clinical experience. A convenience sample of 471 nursing students completing their undergraduate nursing degree programme was explored. A multi-variate statistical approach was used to apply and then model the consensus scores of undergraduate nurses' beliefs about the frequency of missed care. Implications for their developing competence in critical thinking, therapeutic communication and maintaining capacity for professional practice has been considered. RESULTS: Eight variables directly affect student's total scores underpinning their understanding of missed care and their ability to meet professional standards of practice, given their exposure to care omission. These factors reflect differing nurse attributes, the nature of the clinical venues and shift times, preceptor type, student satisfaction with work teams and staffing adequacy. CONCLUSIONS: Modelling outcomes suggest possible changes to hospital staff development learning programme content, learning processes and how it may be better delivered through to minimize episodes of missed care. IMPLICATIONS FOR NURSING MANAGEMENT: Staff development needs to note that nursing staff believe missed care occurs across all three-patient acuity domains with patient observation, education, support, and timely medication administration being most frequently omitted. Different clinical venues within the hospital sector and shift times vary in nurses' exposure with missed care. Student nurses' learning and associated development of practice standards is impacted by prior exposure to missed care during clinical placement. Non-native English-speaking nurses require greatest learning support in the presence of missed care. As missed care can be predicted, remedial changes to the nurse staff development program content and learning processes can be orchestrated.

A systematic review: Unfinished nursing care and the impact on the nurse outcomes of job satisfaction, burnout, intention-to-leave and turnover.

AIM: To investigate the association of unfinished nursing care on nurse outcomes. DESIGN: Systematic review in line with National Institute for Health and Care Excellence guideline. DATA SOURCES: CINAHL, the Cochrane Library, Embase, Medline, ProQuest and Scopus databases were searched up until April 2020. REVIEW METHODS: Two independent reviewers conducted each stage of the review process: screening eligibility, quality appraisal using Mixed Methods Appraisal Tool; and data extraction. Narrative synthesis compared measurements and outcomes. RESULTS: Nine hospital studies were included, and all but one were cross-sectional multicentre studies with a variety of sampling sizes (136-4169 nurses). Studies had low internal validity implying a high risk of bias. There was also a high potential for bias due to non-response. Only one study explicitly sought to examine nurse outcomes as a primary dependent variable, as most included nurse outcomes as mediating variables. Of the available data, unfinished nursing care was associated with: reduced job satisfaction (5/7 studies); burnout (1/3); and intention-to-leave (2/2). No association was found with turnover (2/2). CONCLUSION: Unfinished nursing care remains a plausible mediator of negative nurse outcomes, but research is limited to single-country studies and self-reported outcome measures. Given challenges in the sector for nurse satisfaction, recruitment and retention, future research needs to focus on nurse outcomes as a specific aim of inquiry in relation to unfinished nursing care. IMPACT: Unfinished nursing care has previously been demonstrated to be associated with staffing, education and work environments, with negative associations with patient outcomes (patient satisfaction, medication errors, infections, incidents and readmissions). This study offers new evidence that the impact of unfinished nursing care on nurses is under investigated. Policymakers can prioritize the funding of robust observational studies and quasi-experimental studies with a primary aim to understand the impact of unfinished nursing care on nurse outcomes to better inform health workforce sustainability.

Factors affecting the adoption of the Community of Inquiry Framework in Australian online nursing education: A transition theory perspective.

OBJECTIVES: This paper aims to understand the factors influencing the adoption of teaching, social and cognitive presence in online nursing education and explain the novice nurse academics journey in adopting these aspects. BACKGROUND: The quality of the online/blended courses is about the content and a need for suitable pedagogical design, clear instructions and a collaborative environment based on a valid and reliable theoretical framework. DESIGN AND SETTINGS: A qualitative study involves semi-structured interviews with 11 nurse academics from three Australian Universities and thematic analysis was conducted. RESULTS AND CONCLUSIONS: The Community of Inquiry framework informed three themes including several factors in each from the interviews: (1) Teaching Presence (TP): the lack of understanding of educational theory use, the inadequate course evaluation and the resources scarcity found to be the factors affecting the adoption of TP in online nursing education; (2) Social Presence: the engagement difficulty and creating a learning community affected the adoption of SP; and (3) Cognitive Presence: the variety in learning styles and formative assessment and discussion forums found to be affecting the adoption of CP. This study paper is unique because it uses the Community of Inquiry framework and Meleis's Transition Theory and provides insight on how to facilitate the transition [from role insufficiencies to role supplementation to role mastery] of nurse academics' journey in adopting teaching, social and cognitive presence for online higher education.

A Community of Inquiry lens into nursing education: The educators' experiences and perspectives from three Australian universities.

AIM: Nursing is a social and collaborative profession; therefore, nursing education requires a pedagogy that supports the establishment of a collaborative learning community. Despite the limited use of the Community of Inquiry framework in Australian nursing courses, the educators viewed it as applicable for course design. This paper aims to understand Australian nurse educators' current practices in designing and delivering courses using the Community of Inquiry lens. DESIGN AND METHODS: This paper represent the second phase of the explanatory mixed-methods approach-the data collected in October 2019 via semi-structured interviews with eleven nurse academics from 3 Australian universities. RESULTS: the deductive thematic analysis using the Community of Inquiry coding template confirmed that the 'cognitive presence' and its indicators are implicitly embedded in online/blended courses. But the 'social presence' and 'teaching presence' are faced with some challenges: the underuse of discussion forums by students, the use of social media pages with exclusion of educators and the educators' role of content development rather than course design. CONCLUSIONS: The study findings suggest that the Community of Inquiry framework's explicit application would strengthen 'social and teaching' presences in nursing courses design. Further studies on nursing students' evaluation and perspectives about courses design regarding Community of Inquiry are essential.

Developing evidence-based practice champions in the Maldives.

Evidence-based practice (EBP) is an approach that has gained recognition for facilitating the transfer of evidence into clinical practice. EBP champions is a strategy that can be adopted to encourage the uptake of EBP. This paper describes an action research project that was undertaken in Maldives. EBP champion model has been introduced in the Maldives early 2012 and aims to produce clinical leaders from variety of backgrounds who could implement EBP. This paper provides an extended discussion of the process that was undertaken to prepare EBP champions and their roles in implementing EBP.

An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department.

This study aimed to investigate the effectiveness of nurse practitioner services for minor injuries in an adult emergency department and to ascertain consumers' satisfaction with the care received. Nurse practitioner roles in Australia have been progressively developing since a pilot project in 1990 examined their feasibility. Currently, nurse practitioners in Australia practise in a variety of specialist areas including coronary care cardiology, adult and paediatric palliative care, emergency, diabetics, aged care and perinatal care. The reported study used a retrospective design that conducted case-note audits and explored patient satisfaction with after-care questionnaires. One hundred case notes of patients treated by the nurse practitioner were audited and 57 patients completed questionnaires exploring their satisfaction and perception of the care received. Analysis of the case-note data indicated that the majority of presenting complaints were minor injuries. Of these injuries, 96.3% of presentations triaged level 4 and 94.4% of those triaged level 5 were seen within the time frame recommended by the Australasian Triage Scale. Forty-six per cent of patients required X-rays and 2% required pathology tests during their emergency department stay. The majority of patients were satisfied with the treatment received from the nurse practitioner. Patients are satisfied with management of small injury presentations by nurse practitioners in the emergency department. Incidentally, it was noted that the flow of patients through the department was improved, resulting in medical resources concentrated to higher priority presentations.