Assessment of workplace integration of migrant nurses and midwives within international health care settings: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to map the available evidence on the assessment of workplace integration of migrant nurses and midwives in international health care settings. INTRODUCTION: Internationally, migrant nurses and midwives are an increasingly important resource in government strategy for addressing the current and predicted workforce shortages in health care. Much has been documented about the orientation stages of their transition to foreign workplaces but few sources have considered the workplace integration of this population. INCLUSION CRITERIA: The review will include all studies involving migrant nurses and midwives who are working outside their country of initial nurse or midwife registration for at least one year. The context will be all hospital, community, and residential care home settings, including the mental health, intellectual disability, and maternity care sectors. METHODS: The JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to conduct this review. The databases to be searched will include CINAHL, MEDLINE, Embase, CENTRAL, and Google Scholar. Gray literature will also be searched and a hand search will be conducted of sources that fall outside these database searches. Two reviewers will independently screen titles, abstracts, and full-text articles. The extracted data will be presented in a tabulated chart accompanied by a narrative summary that aligns with the objectives and scope of this review.

Assessment and management of metastatic bone cancer in emergency departments.

A cancer diagnosis in emergency departments (EDs) is often associated with advanced or metastatic cancer. Patients with bone metastases have a complex range of physical and psychological needs. Meeting the needs of patients with cancer is an important part of the role of emergency nurses, but evidence suggests that they often do not feel adequately prepared to provide effective care for this patient group. This article uses a case study of a patient who presented to an ED with metastatic cancer in his right lower limb, to provide an overview of bone metastases, including the relevant anatomy, pain management and psychological support. The article also outlines the signs and symptoms of bone metastases and discusses patient assessment, symptom management and available treatments.

Assessment and management of patients with tibial plateau fractures in emergency departments.

Tibial plateau fractures are complex injuries and relatively common presentations in emergency departments (EDs), yet the diagnosis is not always obvious. Patients with this injury are managed increasingly in EDs by registered advanced nurse practitioners (RANPs), who are recognised in Ireland as senior clinical decision-makers. RANPs are broadening their scope of practice to maximise their responses to current and emerging challenges in healthcare services. They use a range of skills, including taking comprehensive health histories, problem solving, clinical decision-making and using their expert judgement to diagnose and create management plans for patients who attend EDs. In Ireland, RANP is a protected title and practitioners work within an agreed scope of practice, meeting criteria set by the Nursing and Midwifery Board of Ireland to register. RANPs ensure continuity of care, improve the quality of care, provide a quick response to patient care, reduce waiting times and improve flow of patients through EDs. The main scope of RANPs' practice in emergency care includes management of patients with non-life-threatening limb conditions or injures, such as a tibial plateau fracture. This article gives an overview of tibial plateau fractures, including anatomy, and presents a case study to analyse critically the management of a patient with this injury and the care provided by a RANP. In the context of the case study, the article reviews the RANP's diagnostic decisions and the available management options.

Lisfranc injury: assessment and management in emergency departments.

Injuries to the tarsometatarsal joint complex, also referred to as a Lisfranc injury, are relatively uncommon presentations to emergency departments (EDs), however accurate diagnosis is vital to prevent the risk of long-term disability. Advanced nurse practitioners (ANPs) must use a broad range of clinical skills to manage patients' injuries effectively. A high level of suspicion, recognition of the clinical manifestations of Lisfranc injury and appropriate radiographic images are required to formulate a correct diagnosis. This article describes Lisfranc injuries, revises the anatomy of the midfoot, and discusses diagnosis and management. It includes a case study to illustrate assessment and management of a patient who presented to an ED with a Lisfranc injury following a fall from a height and considers the diagnostic decisions and management options available to ANPs.

Fight bite injury: emergency department assessment and management.

Human bite wounds to the hand are relatively common injuries and are associated with high infection rates. Given the unique anatomy of the hand, the bite mechanism and the organisms found in human saliva, even the smallest wound can result in an aggressive infection. Failure to recognise and treat human bite wounds appropriately, can therefore have negative outcomes for patients. This article outlines the diagnostic features of, and complications associated with, bite wounds and discusses the recommended treatment options.

Personal and professional challenges of nurse prescribing in Ireland.

This article presents the challenges regarding the development of a collaborative practice agreement in order to undertake nurse prescribing in an emergency department in a large teaching hospital. Nurse prescribing has been introduced quite recently in Ireland. Although there is a plethora of knowledge regarding the topic, there are many personal and professional challenges in relation to this emerging role. The nurse prescribing initiative in Ireland is continually developing and many nurses now have the authority to prescribe from almost the same range of medicines as doctors. Prescribing has the potential to improve job satisfaction, autonomy and ultimately improves patient outcomes. However, nurses need to be cognisant of the impact it can have on the dynamics of the healthcare team. An analysis of some complexities of nurse prescribing is given, in conjunction with reflective thoughts on a clinical incident in the area of morphine prescribing.

Board's eye view.

THE DEATH of a loved one is a traumatic and emotional experience, to which emergency nurses are frequently exposed.

Emergency nurses' provision of spiritual care: a literature review.

The emergency setting has undergone significant changes in recent years. Notably, the throughput and acuity of patients has increased, with a concomitant improvement in the clinical and technical management of these patients (Dolan, 1998; Coughlan and Corry, 2007). However, there is evidence to suggest that the increase in workload and proliferation of technology, at such a fast pace, has potentially threatened the caring component of nursing, including spiritual care (Wilkin and Selvin, 2004). During hospitalization, the majority of patients tend to become anxious because of the fear of the unknown, an uncertain future, and possible resultant complications of their respective illnesses. In this regard, patients being treated in emergency departments are at vulnerable periods of their lives. Consequently, while the emergency department can be physically demanding, nurses spend considerable time in intense interactions with patients. In spite of this, changes have brought associated pressures on both nurses and patients (Bailie, 2005). Therefore, although advances in technology can enable nurses to objectively measure responses to care; conversely, it can supersede the premise of holistic health care. Nonetheless, it has been empirically shown that caring and the provision of spiritual care is not only possible within the technological world of emergency nursing, but it can be positively enhanced by the mastery of the technological environment (Locin, 1995; Little, 2000).

Nurses' provision of spiritual care in the emergency setting--an Irish perspective.

BACKGROUND: The researcher's interest in spiritual care arose during clinical experience in an emergency department. Over a 10-year period, I have observed, that in midst of a busy and increasingly overcrowded setting, nurses find time to provide spiritual care. Although this dimension of nursing practice is not explicitly labelled as spiritual care, it is apparent that interventions such as active listening, touch and ultimately connecting with the patient has, on most occasions, positive effects on the patient's spiritual dimension. Subsequently, this has provided the momentum to carry out a study on how nurses provide spiritual care, in an emergency setting. The findings revealed that participants regarded spiritual care to be an integral component of their role. In addition, participants reported that they derived positive personal outcomes from providing this aspect of nursing care. Nevertheless, although most participants would argue that spiritual care is central to nursing practice, concerns were expressed with regard to its provision, in the emergency setting.

Non-invasive ventilation: a nurse-led service.

Respiratory diseases are the third most common presentations to emergency departments (EDs) in the Republic of Ireland. Evidence suggests that early non-invasive ventilation (NIV) is often the treatment of choice, particularly for patients with chronic obstructive pulmonary disease. Therefore, having access to NIV in EDs is likely to improve patient outcomes and reduce the likelihood of their mechanical ventilation.

Translating change: the development of a person-centred triage training programme for emergency nurses.

Within health care, there has been a change in practice from an illness-orientated service to one that is more health-focused and person-centred. The concept of person-centredness is frequently espoused by practitioners as being not only a desirable, but a necessary element of health care provision. Indeed, nationally and internationally, person-centred care has underpinned many healthcare documents and policies. Person-centred practice focuses on providing care, utilising a variety of processes that operationalise person-centred nursing and include working with patients' beliefs and values, engagement, presence, sharing decision-making and providing for physical needs. In the field of emergency nursing, the incorporation of person-centred care and its holistic foundation may require a significant shift in practice. There is evidence to suggest that emergency nurses view their role as one, which is predominantly concerned with providing urgent physical care, rather than one, which espouses the theories of holistic healthcare. To this extent, being person-centred in the context of emergency care, requires the nurse to move beyond the traditional notions of his/her role and to embrace the more holistic aspects of patient care. The aim of this article is to critically analyse how a change in nurse-led triage training in one Irish Emergency Department facilitated an improved person-centred approach in practice.

Evidence-based care: enhancing the rigour of a qualitative study.

Qualitative research methodology is a suitable approach for clinical inquiry into nursing practice, leading to theory development and advancement in clinical practice. Rigour is necessary to enhance the consistency and quality of qualitative research. It is the framework for demonstrating credibility and integrity of the qualitative research process. Methodological decisions regarding rigour can have implications for the quality, integrity and interpretability of the findings. Rigour, therefore, is a principle that should be present during all stages of the research study, from its inception to the writing of the final report. For qualitative researchers, reaching the desired goal and meeting the requirements of rigour become particularly problematic due to the considerable debate about what it means to do valid research in the field of qualitative inquiry. This article outlines methods that can be used to maintain rigour in a qualitative study, including member-checking, peer debriefing, audit trail and reflexivity.

Learning from practice--reflections on a critical incident.

Reflective practice is considered not only as a valuable tool for providing appropriate levels of care but also as an important prerequisite for the provision of professional nursing. Indeed, there appears to be consensus in the literature that reflections have the potential to assist practitioners to tap into knowledge gained from experience and connect theory to practice. However, evidence suggests that nurses, including emergency nurses, neglect reflective techniques. This paper outlines how the processes of reflection led to one emergency nurse developing new insights and understandings on nursing practice.

Exercising restraint: clinical, legal and ethical considerations for the patient with Alzheimer's disease.

The number of older people using emergency care is increasing steadily and older people account for over half of all emergency admissions. In the emergency setting, nurses caring for older people with Alzheimer's disease can be faced with many complex ethical and legal challenges. Moreover, challenges such as the use of physical restraint can precipitate conflict when the nurse is placed in the precarious position of doing good, respecting autonomy and avoiding paternalism. Although, there is no complete set of "rules" that can provide nurses with an answer to each dilemma, it is of significant value for nurses to have sound knowledge of ethical and legal positions in order to analyse the many complex situations that they may encounter.

Clinical teaching and support for learners in the practice environment.

The purpose of planned clinical experience for students of nursing is primarily to provide students with the opportunity to develop their clinical skills, integrate theory and practice, and assist with their socialization into nursing. Nursing, in the main, is a practice-based profession. To this extent, it is essential that nurse education continues to have a strong practical element despite its full integration into higher education institutions (Department of Health, 1999). However, providing adequate support and supervision for learners is challenging. Undoubtedly, exacerbated by increasing numbers of learners, staff shortages and mentors training deficits. This article aims to critically analyse several strategies, which can be used to promote clinical learning.

A concept analysis of spirituality.

According to the holistic model of care, nurses must consider their patients' spiritual needs in order to provide total patient care (Govier, 2000). There is growing awareness of the contribution that spiritual wellbeing can make to a patient's actual and perceived health and quality of life (Chibnall et al, 2002; Mount, 2003). Spirituality and spiritual care has gained much momentum in the current nursing arena. Draper and McSherry (2002) assert that it has emerged from the shadows to occupy a prominent part of contemporary health care. Moreover, within the nursing profession, a focus on individuals as biopsychosocial-spiritual beings is gaining recognition. This notion is based on the premise that there should be balance of mind, body and spirit for the maintenance of health in a person (Stoll, 1989; Stooter, 1995). However, there is evidence that many nurses, including nurse educators, have difficulty with the concept of spirituality and consequently, may neglect this aspect of care (Greenstreet, 1999; McSherry, 2000). The aim of this article is to contribute towards clarifying the concept of spirituality.