Nursing students' preparedness for the digitalised clinical environment in Australia: An integrative review.

AIM: The aim of this integtrative review is to examine the literature on nursing students preparedness for the digitalised clinical setting. BACKGROUND: Digital literacy skills ensure nursing students can provide quality and safe care to patients in a digitalised clinical setting. DESIGN: Integrative review of the literature. METHODS: The integrative review of the literature incorporated Whittemore and Knafl's (2005) framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2021 statement. A review of the literature comprised of a search of the following databases: ERIC, Scopus, CINAHL, Medline, Cochrane Library and Google Scholar from 2010-2022. Data were critically appraised using the Critical Appraisal Skills Programme (CASP), the Mixed Method Tool (MMAT) and Joanna Biggs Institute (JBI). RESULTS: The literature reported on nine studies from 2010 to 2022. The four themes identified using Braun and Clarke's thematic analysis were curriculum design, education and training, digital literacy level and professional digital literacy competency standard framework. Major findings include the need for the development and integration of a professional digital literacy competency standard framework embedded into nursing curricula to equip nursing students with appropriate digital literacy skills to navigate digitalised healthcare settings. CONCLUSION: Current registered nurses and preregistration nurses are required to be upskilled with the understanding and knowledge of health informatics and its role in the clinical setting. This will enable future registered nurses to keep up with the rapidly evolving technological clinical environment.

"Their tenacity to just keep going": Nurses' experiences in medical hotel quarantine during the COVID-19 pandemic.

AIM: To explore how nurses and nursing knowledge contributed to the success of an Australian nurse-led medical hotel quarantine facility during the COVID-19 pandemic. The facility was established to accommodate returning travellers who were COVID-19 positive or at risk of becoming positive, to travellers requiring complex care and expanded to community members who could not quarantine at home. DESIGN: This descriptive qualitative study explored how nurses and nursing knowledge in the quarantine facility contributed to the low transmission incidence of COVID-19 infection. METHOD: Twelve semi-structured interviews were conducted via ZOOM from February to May 2022 with all levels of nursing staff (nurse managers to assistants in nursing) who had worked in the facility for 3 months or more. The nurses were asked to describe their experiences, the challenges they faced and how they overcame them. The data were rich and were analysed using Braun and Clarke's six-step thematic analysis. RESULTS: Four broad themes were generated demonstrating how nurses played a pivotal role in the success of the facility. First: nursing knowledge was evident through the development of policies, which minimized risks to nurses and patients. Second: a community of learning was developed as nurses supported upskilling and capacity building of staff, particularly new graduates with the facility. Third: a supportive management structure promoted teamwork and a positive workplace culture. And finally: the nurses were encouraged to develop techniques that promoted self-care which enabled them to develop resilience. CONCLUSION: This was a nurse-led service that developed strategies to manage care delivery and overcame unanticipated difficulties in a unique clinical setting. REPORTING METHOD: The quality of the research design was ensured by using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A global exploration of palliative community care literature: An integrative review.

AIM: This review sought to discover how community nurses globally provide palliative care, with specific focus on how they manage the personal and professional stressors associated with caring for dying clients in the home. DESIGN: An integrative review methodology was used to gain insight into how community palliative care is delivered worldwide. BACKGROUND: The provision of home palliative care by community nurses gives clients the ability to spend their final days in familiar surroundings. Research has focussed on the provision of palliative care in the inpatient setting, with little known about the community setting. METHODS: Data were collected through a literature search, then a critical analysis approach was used to evaluate the strengths of palliative care literature by analysing recurrent themes to stimulate further research on the topic. DATA SOURCES: The following databases were used to conduct the literature search: CINAHL, Medline, Pubmed, Scopus, Ovid. RESULTS: The results highlighted the importance of building a skilled palliative community nursing workforce and the need to offer specialised palliative care training to nurses, particularly around difficult conversations and service coordination. CONCLUSION: The literature identified the challenges implicit within the community nursing role in delivering palliative care, but it did not identify the factors that enhance the nurses' ability to manage the stressors associated with this role. The input of nurses must be sought to understand the development of resilience. IMPLICATIONS FOR THE PROFESSION: Community palliative care nursing requires time spent with clients and family members who are suffering, therefore predisposing nurses to stress. Effort must be made to provide palliative care nurses with support to enhance professional resilience.

Exploring nurses' perceptions of clinical handover in regional health care facilities: A exploratory qualitative study.

AIM: This study sought to explore nurses' perceptions of clinical handover in a regional health care facility to better understand the local context and identify the most appropriate clinical handover models. BACKGROUND: Clinical handover is an essential aspect of clinical care, and yet using accurate spoken and written communication can be neglected in nursing, potentially resulting in patient harm. Although much information is available on clinical handover in metropolitan settings, few studies have examined the regional context. METHODS: This study was an exploratory qualitative study based at one small regional health care facility located 100 km from a metropolitan Australian centre. The study utilized an Appreciative Inquiry approach to identify how nurses perceive the use of standardized oral and written clinical handover. Focus groups were engaged to explore the perceptions of nurses "handing over" in the smaller regional facility. RESULTS: Through focus group interviews with Registered and Enrolled Nurses, the data revealed that the cultural context of the ward influenced perceptions of clinical handover and that handover served as a light in the dark for all nursing staff; as an evolving communication tool illuminating patient care needs. CONCLUSION: This study facilitated understanding of the handover needs of smaller Australian regional hospitals. This study identified gaps in perception about handover practices between junior and senior nurses. New graduate nurses develop confidence in supportive clinical environments. A transition to practice programme would need to address the challenges new graduates face in the regional setting. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers in regional facilities can champion supportive senior nurses to mentor new graduate nurses and enhance the transition to practice for the new nurse.

The river of postnatal psychosis: A qualitative study of women's experiences and meanings.

OBJECTIVE: This paper reports findings from a study about women's experience of postpartum psychosis which affects 1-2 women in 1000 in the first four to six weeks following childbirth. Previous research reports many women are relucent to disclose symptoms of mental ill health to healthcare professionals, although they are most likely to discuss symptoms and concerns with a health professional known to them. DESIGN: A qualitative interpretive study using semi-structured interviews. PARTICIPANTS: Ten women in Australia who had recovered from postpartum psychosis in the last ten years were interviewed. DATA ANALYSIS: Data were analysed thematically by three researchers to enhance trustworthiness. RESULTS: The women described their overall experience as traumatic and described what they saw as contributing factors such as a previous history of mental illness or a significant life event that was present before or during pregnancy; the women described how they made meaning of the symptoms they experienced, such as a lack of sleep or changes in their thoughts or behaviours; and the difficulties they experienced during recovery. The women also identified novel ways to support themselves and each other as they recovered. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwives require further education to recognise the symptoms of postpartum psychosis, to ask further probing questions to identify postpartum psychosis in its early stages and to support women as they recover from this illness.

Psychometric evaluation of the 11-item English language usage scale in commencing nursing students.

BACKGROUND: Globalisation has increased the number of students from culturally and linguistically diverse backgrounds enrolling in nursing programs where English is the primary medium of instruction. These students may experience challenges with English language usage and need to be identified early to ensure academic success. OBJECTIVE: To develop and test the psychometric properties of a self-report English language usage scale (ELUS-11). METHODS: Prospective, correlational study of commencing nursing students enrolled in a communication unit at a university in the western Sydney region of Australia. English-language usage was measured using the ELUS-11, an 11-item self-report tool with a 5-point Likert scale response format. Factorial validity was examined using exploratory and confirmatory factor analysis and logistic regression was used to compute the predictive validity of the ELUS. RESULTS: Of the 1723 students enrolled, 1100 (64%) returned surveys with all items of the ELUS-11 completed. The mean age of respondents was 25.4 years (SD: 8.0 years), 85% were female and 67% spoke a language other than English at home. Exploratory factor analysis yielded a one-factor structure that explained 65% of the variance, with factor loadings ranging from 0.72 to 0.86; and high internal consistency (α = 0.96). The ELUS-11 was able to discriminate among different groups of students based on age, domestic/international enrolment status and language spoken at home (all p < 0.001). Logistic regression revealed the ELUS-11 had good predictive validity, with those in the high ELUS-11 group over three times more likely to obtain a pass grade in their first written assessment (Adjusted odds ratio: 3.01, 95% CI: 2.05-4.43). CONCLUSION: The ELUS-11 is a valid and reliable measure of English-language usage, and appropriate for use in an undergraduate nursing population to identify students at risk of poor academic performance.

The educational benefits of drama in nursing education: A critical literature review.

BACKGROUND: With the increasing use of technology in nursing, the importance of interpersonal skills can often be forgotten. Patient safety can also be compromised if these skills are not emphasised in nursing education. OBJECTIVES: This review explores how drama in undergraduate and postgraduate nursing education can enhance the development of interpersonal skills such as empathy, emotional intelligence and communication. DESIGN: A critical review of qualitative literature. DATA SOURCES: Seven databases (CINAHL, MEDLINE, Scopus, Eric, Psycinfo, and databases dedicated to the Arts, Modern Language Association (MLA) and JSTOR were searched. REVIEW METHODS: Studies were screened against inclusion and exclusion criteria. Data from studies selected for the review were extracted using a summary table and a thematic analysis was conducted to identify major themes to answer the research question. RESULTS: 1275 studies were identified. Following a rigorous screening process, 29 studies met the inclusion criteria and were critically appraised using the CASP tool. Of the 29 studies, 17 were excluded due to their methodological quality. A final 12 studies were included in this review. Four themes demonstrated the value of drama in nursing education. These were an understanding of the patient experience, the development of professional identity, the enhancement of communication skills and increased self-reflection and critical thinking. CONCLUSIONS: Interpersonal skills are at the core of nursing and educational interventions that use drama can enhance the development of these skills.

Developing Person-Centered Care Through the Biographies of the Older Adult.

BACKGROUND: A lack of specialized knowledge about providing health care to older people decreases their health outcomes and quality of life. This article presents an innovative learning strategy for preregistration nursing students to raise awareness of person-centered care of the older adult. METHOD: This report is based on the authors' own experience and includes comments from students to the authors who taught the unit of study from 2010 to 2015, supported by current literature and theory discussing contemporary educational strategies. RESULTS: Students came to value the older adult as a person to whom they could relate and the learning promoted person-centered care delivery. Although many students found this approach to learning to be challenging, student feedback demonstrated that the overall reception of the strategy was very positive. CONCLUSION: This strategy facilitated learning to improve person-centered care and addressed negative attitudes toward older adults, which improved health outcomes and their quality of life. [J Nurs Educ. 2018;57(12):742-746.].

The effectiveness of short answers test papers in evaluating academic nursing programs: A review of the literature.

Short answer tests (SAT) are an assessment that examines nursing students' knowledge and can be used to evaluate expectations for student educational success. The purpose of this literature review is to combine the best available evidence as to whether short answer test papers meet nursing facility curricula learning outcomes. A literature review was performed consisting of data bases which included; ERIC, SCOPUS, CINAHL MEDLINE, COCHRANE LIBRARY and JOHANNA BIGGS INSTITUTE (JBI). The following keywords were used: Short answer test, written assessment, quiz, organisations, university, higher degree education, tertiary education, nursing, perceptions, attitude, opinions, thoughts, feeling and belief. The majority of studies demonstrated that short answer tests equip nursing students with the knowledge and critical thinking skills for the clinical setting. Three major themes were identified: the effects of increasing class sizes; authenticity and the validity of short answer tests. Short answer tests are commonly used in undergraduate nursing programs to evaluate students' level of knowledge which consists of their ability to critically analyse and problem solve. To maintain authenticity and validity of an assessment, there is a need for an evidence-based approach to their design to meet the core learning objectives within the curriculum.

Challenges in adapting a survey: ensuring cross-cultural equivalence.

BACKGROUND: The increase in the number of international research studies means more surveys need to be adapted for use in different languages. To obtain valid cross-cultural study results, researchers often use translated surveys. AIM: To describe the translation process used, and lessons learned by a bilingual English/Mandarin PhD student and her three English-speaking supervisors when developing and translating an English-language survey for use in a study in Taiwan. DISCUSSION: In evaluating the translation process in this study, the three criteria of content equivalence, semantic equivalence and conceptual equivalence are discussed in relation to the challenges these presented to the research team. Some of the ways the team addressed these challenges are also considered. CONCLUSION: The time available for the research and the ability of translators need to be assessed when adapting surveys for use in different languages and cultures. Sharing experiences and lessons learned in the translation process was worthwhile, as all members of the research team came away with new knowledge and an understanding of the need to ensure the final version of a translated survey is culturally congruent. IMPLICATIONS FOR PRACTICE: To accurately translate a survey into another language, it is essential that one of the researchers be fluent in that language. This guarantees the closest fit of content and semantic and conceptual meaning.

Understanding the experience of women admitted to a psychiatric hospital in Sydney with psychosis or mania following childbirth after World War II (1945-1955).

In the present study, we investigated a unique set of historical health-care records of women admitted to a psychiatric hospital in Sydney, Australia with a diagnosis of psychosis or mania after childbirth in the post-World War II (WWII) period, from 1945 to 1955. This research is part of a larger project examining how the descriptions of these women documented in the health-care records from 1885 to 1975 affected their treatment and the outcome of their admission. In the present paper, we report on the findings from an intensive examination of the post WWII documents. Eighteen health-care records from a psychiatric facility (Gladesville Hospital) were identified from admission registers housed in the State Records Office of New South Wales in 2014. Although seven records had been destroyed, 11 were transcribed verbatim. The records contain demographic information; descriptions of the women's signs and symptoms on admission; and information about the women before, during, and after their admission found in letters from relatives or medical staff. A content analysis of admission information showed how the women were described by health-care professionals, but a textual analysis of the records revealed that there were other factors that could have contributed to the women's condition, which might not have been taken into consideration when treatment and care were devised. The present study demonstrates the value of investigating historical health-care records to understand how prevailing attitudes and practices might affect diagnosis and treatment.

The importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice: A systematic review.

OBJECTIVES: This systematic review was designed to assess the importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice. It aimed to explore the link between academic literacy and writing in an undergraduate nursing degree and the development of critical thinking skills for their future professional clinical practice. DESIGN: A systematic review of qualitative studies and expert opinion publications. DATA SOURCES: A systematic literature search was undertaken of the following databases: ERIC, PubMed, CINAHL, MEDLINE and Scopus. All papers reviewed were from 2000 to 2016 and were written in English. REVIEW METHODS: We identified 981 studies and expert opinion papers from the selected databases. After reviewing key words and abstracts for the inclusion and exclusion criteria, 48 papers were selected for review. These were read and reread, with 22 papers, including one thesis, selected for quality appraisal. One paper was discarded due to the exclusion criteria. RESULTS: Three major themes were evident from this study. First, students need assistance to develop tertiary level academic literacy skills when they commence their undergraduate nursing degree. Second, that teaching practices need to be consistent in both designing assessments and in giving feedback to students, in order to assist improvement of academic literacy skills. And finally, academic literacy can facilitate critical thinking when students are assessed using discipline specific genres that relate to their future professional nursing practice. CONCLUSIONS: This review highlights the importance of critical thinking in clinical nursing practice and its strong relationship with academic writing skills. It has shown critical thinking is discipline specific and nursing students need to be taught discipline specific literacy genres in undergraduate nursing degrees. Nursing has a diverse educational and cultural mix of students, and educators should not assume academic literacy skills upon commencement of an undergraduate nursing programme.

Blurring reality with fiction: Exploring the stories of women, madness, and infanticide.

PROBLEM: Often, there is a sense of shock and disbelief when a mother murders her child. BACKGROUND: Yet, literary texts (plays, poems and novels) contain depictions of women experiencing mental illness or feelings of desperation after childbirth who murder their children. AIM: To further understand why a woman may harm her child we examine seven literary texts ranging in time and place from fifth century BCE Greece to twenty-first century Australia. METHODS: A textual analysis approach examined how the author positioned the woman in the text, how other characters in the text reacted to the woman before, during, and after the mental illness or infanticide, and how the literary or historical critical literature sees the woman. FINDINGS: Three important points about the woman's experience were revealed: she is represented as morally ambiguous and becomes marginalised and isolated; she is depicted as murdering or abandoning her child because she is experiencing mental illness and/or she is living in desperate circumstances; and she believes there is no other option. CONCLUSION: Literary texts can shed light on socio-psychological struggles women experience and can be used to stimulate discussion by healthcare professionals about the development of preventative or early intervention strategies to identify women at risk.

Historical perspectives: a snapshot of women admitted to psychiatric facilities with psychosis or mania after childbirth in the late Victorian and inter-war periods.

AIM: This study analysed historical healthcare records to investigate how women diagnosed with mania or psychosis and admitted to two mental health facilities in Australia following childbirth, were described in the late Victorian (1885-1895) and inter-war period (1925-1935). BACKGROUND: Although historians have examined the history of mental health systems in Australia, there is no published scholarship that considers the healthcare records of these women. This was a unique opportunity to explore these documents. DESIGN: An historical study examining healthcare records. The data collection occurred in 2012. METHODS: Women admitted to mental health facilities with a diagnosis of psychosis or mania were identified in the admission registers found in the State Record Office of New South Wales and, if available, their healthcare record was transcribed verbatim. The records were imported into NVivo 10 for content analysis to determine the range and scope of information. A further textual analysis was conducted to see if the woman's diagnosis was congruent with the outcome of her admission. RESULTS/FINDINGS: 155 cases were identified across the two periods. Although, demographic data and the description of the women on admission were remarkably similar, 17% of women were physically, rather than mentally, ill and died soon after admission. The findings demonstrate the importance of current practices such as taking a comprehensive healthcare assessment and the use of antibiotics and sanitary measures during labour and in the postnatal period. CONCLUSION: Historical investigations of healthcare records provide legitimacy for current healthcare practices.

Tools to reduce first year nursing students' anxiety levels prior to undergoing objective structured clinical assessment (OSCA) and how this impacts on the student's experience of their first clinical placement.

BACKGROUND: One form of assessment that tests students' theoretical skills and confidence in their clinical practice is known as the Objective Structured Clinical Assessment (OSCA). Traditionally it was first launched from medical education, and is now being incorporated by other disciplines, such as nursing. OBJECTIVES: This review seeks to present the best available evidence into strategies that help reduce first year nursing students' anxiety levels prior to undergoing OSCA and clinical placement. SEARCH STRATEGY: A systematic literature search was performed using Medline and CINAHL. SELECTION CRITERIA: This review considered any English language original research published between 2005 and 2013. RESULTS: A literature search located 117 articles. Eight articles were identified as meeting the inclusion in criteria. Majority of studies reported simulation session prior to the OSCA increased students confidence and reduced their anxiety levels. This resulted in students' reporting that they valued the OSCA as a worthwhile assessment. However there were four major themes: that students were anxious about attending the OSCA; that adequate preparation was seen as a coping strategy; that simulation was a further cause for anxiety; and that the simulation experience could also be used as an OSCA tool. CONCLUSIONS: Students who have been exposed to simulation scenarios before the OSCA are able to cope much better during the OSCA. Therefore, it is highly recommended to incorporate simulation scenarios into the nursing curricula for first year nursing students' clinical units to help reduce their anxiety levels prior to OCSA.

Rekindling the role of nurses in patients' oral nutrition.

Hospital malnutrition is a worldwide problem. A nutritional care policy was evaluated to determine whether nutrition was enhanced by improving patients' access and nurses' supervision of meals. Fourteen pre-audit wards (435 patients) and 20 postaudit wards (422 patients) across three hospitals participated in a pre-post audit and observation study with an examination of documentation. A food satisfaction survey was completed by 226 patients (pre) and 240 patients (post). A modest increase in the proportion of patients receiving supervision with meals (83% pre, 88% post, P = 0.058) was not associated with an increase in consumption (50% or more of meal). Patients report poor appetite in the presence of good to fair food quality. The nurse's role in nutritional care was defined. Protected mealtimes supported by nurse managers reorganizing staff mealtimes with assistance from carers, volunteers and other health professionals were endorsed. Nurses must ensure that patient's meal trays are accessible.

Comparing written and oral approaches to clinical reporting in nursing.

Patient safety is compromised if vital clinical information is not available to all members of the healthcare team. Therefore, it is important to understand the differences between patient information found in nursing documentation and information presented at clinical nursing handover. Content and textual analyses of two data sets were undertaken: one containing 67 examples of nursing documentation and the other containing 195 transcripts of clinical handover to understand the scope and construction of patient information found in each communication system. Clinical handover produced a comprehensive picture of the patient's condition and care whereas nursing documentation tended to present a series of descriptions of tasks performed by nurses. There is a need to investigate new systems of communication promoting congruence between clinical handover and nursing documentation to ensure that all patient information can be accessed by all interested parties.

Exploring the structure and organization of information within nursing clinical handovers.

Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress.