Ethics in healthcare: Knowledge, attitude and practices of nurses in the Cape Coast Metropolis of Ghana.

BACKGROUND: Nursing is a profession that care for personal and private aspects of people's lives. Therefore, nurses need to know the basic ethical aspects of nursing which is integral in nursing practices. The purpose of the study was to describe the ethical knowledge, attitude and practice of nurses in the Cape Coast Metropolis of Ghana. METHOD: A cross-section design was used to collect data from 264 nurses in three selected healthcare facilities in the Metropolis. A structured questionnaire was administered to all the categories of these nurses in the selected facilities. Frequency counts and multiple regression statistics were used to analyze the data. RESULTS: The results show 78% of nurses possess good ethical knowledge, 84% had a positive attitude, while 98% had good ethical practices. The results further show that nurses' professional rank [F (1, 259), 2.35, p = .02] and academic qualification [F (1, 259), 2.67, p = .008] were significant predictors of their ethical knowledge and attitude, respectively. CONCLUSION: Inadequate resources, poor set up of working areas and understaffing are the major barriers limiting the practice of good ethical standards among the nurses. The Regional Health Directorate, the Ministry of Health and the Managers in charge of the health facilities need to work together to eliminate these barriers as they have the potential to negatively impact quality healthcare delivery in the Metropolis.

Conhecimento e prática de enfermeiros sobre protocolos de segurança na tomografia computadorizada / Nurses' knowledge and practice toward computed tomography safety protocols

RESUMO Objetivo avaliar o conhecimento e as práticas de enfermeiros quanto às recomendações de segurança para realização de tomografias computadorizadas. Métodos estudo transversal utilizando amostra de conveniência de dois hospitais públicos. Foi elaborado um questionário para avaliar as características sociodemográficas, conhecimento e práticas dos enfermeiros. Realizou-se análise descritiva para avaliar as características, e as correlações foram avaliadas através da correlação de Spearman. Os testes U de Mann-Whitney e H de Kruskal-Wallis foram usados para comparar as médias das pontuações de conhecimento e práticas. Resultados a maioria dos participantes era do sexo feminino (91,6%), de 20 a 29 anos (57,3%), e tinha a graduação como seu nível de formação (74%). Níveis de conhecimento e prática foram de 58% e 78,9%, respectivamente. Houve correlação positiva entre o conhecimento e a prática nos enfermeiros (r=0,684, p<0,001), mas, sem diferenças estatisticamente significativas entre características sociodemográficas e a pontuação de conhecimento ou práticas. Conclusão enfermeiros mostraram um nível adequado em sua prática do preparo seguro para tomografias computadorizadas, embora seu nível de conhecimento tenha se mostrado deficiente. Contribuições para a prática esse estudo demonstra a importância do conhecimento enquanto guia da prática de enfermagem rumo a um uso melhor das medidas de segurança para tomografias computadorizadas.

ABSTRACT Objective to assess nurses' knowledge and practice toward computed tomography scan safety guidelines. Methods a cross-sectional study was conducted using a convenience sample of 131 nurses from two government hospitals. Self-designed questionnaire was used to assess nurses' sociodemographic characteristics, knowledge, and practice. Descriptive analysis was performed to evaluate characteristics, correlations were evaluated using Spearman's rank correlation coefficient, and the Mann-Whitney U and the Kruskal-Wallis H tests were used to compare the mean ranks of knowledge and practice scores. Results most respondents were female (91.6%), were aged 20-29 years (57.3%), and had bachelor's degrees (74%). Knowledge and practice levels were 58% and 78.9% respectively. A positive correlation between knowledge and practice was observed among nurses (r=0.684, p<0.001). No statistically significant differences were observed between sociodemographic characteristics and knowledge and practice scores. Conclusion nurses showed adequate level of practice toward computed tomography scan safety preparations while their knowledge level was deficient. Contributions to practice this study informs the importance of knowledge in guiding nursing practice toward appropriate computed tomography scan safety measures.

Documented diabetes care among older people receiving home care services: a cross-sectional study.

BACKGROUND: Home care services plays an important role in diabetes management, and to enable older adults remain home-dwellers. Adequate follow-up and systematic nursing documentation are necessary elements in high quality diabetes care. Therefore, the purpose of this study was to examine the diabetes treatment and management for older persons with diabetes receiving home care services. METHODS: A cross-sectional study was used to assess the diabetes treatment and management in a Norwegian municipality. Demographic (age, sex, living situation) and clinical data (diabetes diagnose, type of glucose lowering treatment, diabetes-related comorbidities, functional status) were collected from electronic home care records. Also, information on diabetes management; i.e. follow-up routines on glycated haemoglobin (HbA1c), self-monitoring of blood glucose, insulin administration and risk factors (blood pressure, body mass index and nutritional status) were registered. HbA1c was measured upon inclusion. Descriptive and inferential statistics were applied in the data analysis. RESULTS: A total of 92 home care records from older home-dwelling persons with diabetes, aged 66-99 years were assessed. Only 52 (57 %) of the individuals had the diabetes diagnosis documented in the home care record. A routine for self-monitoring of blood glucose was documented for 27 (29 %) of the individuals. Only 2 (2 %) had individual target for HbA1c documented and only 3 (3 %) had a documented routine for measuring HbA1c as recommended in international guidelines. Among 30 insulin treated older individuals, a description of the insulin regimen lacked in 4 (13 %) of the home care records. Also, documentation on who performed self-monitoring of blood glucose was unclear or lacking for 5 (17 %) individuals. CONCLUSIONS: The study demonstrates lack of documentation in home care records with respect to diagnosis, treatment goals and routines for monitoring of blood glucose, as well as insufficient documentation on responsibilities of diabetes management among older home-dwelling adults living with diabetes. This indicates that home care services may be suboptimal and a potential threat to patient safety.

The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients' Perspective.

PURPOSE: This study investigates the expectations, perceptions, and gaps of the healthcare service quality (HSQ) from the patients' perspective, and explores the significant demographic and clinical factors associated with the HSQ in nurse practitioner practice (NPP). DESIGN: A cross-sectional design was carried out, with convenience sampling performed under the NPP in Taiwan, from June to November 2016. METHODS: The Nurse Practitioner Healthcare Service Quality Scale was used to assess the expectations, perceptions, and gaps of the HSQ. The demographics, clinical characteristics, and symptom severity of patients were collected, and the Importance-Performance Analysis was applied to identify the priority of ranking items for the improvement of nurse practitioners (NPs). The Generalized Estimating Equation was used to explore the factors associated with the HSQ in NPP. FINDINGS: A total of 200 patients completed the questionnaires. The results revealed that the patients had overall high expectations (M = 6.35, SD = 0.46), moderate perceptions (M = 4.21, SD = 0.95), and a mild HSQ gap (M = -2.14, SD = 0.69), with statistically significant differences (p < .001). In NPP, the largest gap in the HSQ dimensions was reliable responsiveness, followed by empathy, assurance, and tangibility. Patients with greater symptom severity and a longer in-hospital stay were associated with larger HSQ gaps; however, patients who were transferred from the emergency department had smaller gaps than those in the outpatient department. CONCLUSIONS: The patients' expectations were not fully satisfied in the NPP, especially for the dimensions of reliable responsiveness and empathy. The patients' symptom severity was a significant factor related to the gaps in the HSQ. The awareness of unmet needs, from the patients' perspective, could guide the convergence of a rational policy to promote healthcare delivery in the NPP. CLINICAL RELEVANCE: The managers of NPP need to pay attention to increasing NPs' reliable responsiveness and empathy, by setting the appropriate scope of practice, regulating the NP-to-patient ratio, applying for certification programs in prescribing training, and cultivating patient-centered care with shared decision making. In addition, building up the knowledge and competency of symptom management is also suggested for NP training.

Rapid Spread and Control of Multidrug-Resistant Gram-Negative Bacteria in COVID-19 Patient Care Units.

We describe rapid spread of multidrug-resistant gram-negative bacteria among patients in dedicated coronavirus disease care units in a hospital in Maryland, USA, during May-June 2020. Critical illness, high antibiotic use, double occupancy of single rooms, and modified infection prevention practices were key contributing factors. Surveillance culturing aided in outbreak recognition and control.

The experiences of privately practising midwives in Australia who have been reported to the Australian Health Practitioner Regulation Agency: A qualitative study.

BACKGROUND: In Australia the majority of homebirths are attended by privately practising midwives (PPMs). In recent years PPMs have been increasingly reported to the Australian Health Practitioner Regulation Agency (AHPRA) mostly by other health professionals. PURPOSE: to explore the experiences of PPMs in Australia who have been reported to the AHPRA. METHODS: A qualitative interpretive approach, employing in-depth interviews with eight PPMs was undertaken and analysed using thematic analysis. A feminist theoretical framework was used to underpin the research. RESULTS: The majority of reports made to AHPRA occurred when midwives supported women who chose care considered outside the recommended Australian College of Midwives (ACM) Consultation and Referral Guidelines. During data analysis an overarching theme emerged, "Caught between women and the system", which described the participants' feelings of working as a PPM in Australia. There were six themes and several sub-themes: The suppression of midwifery, A flawed system, Lack of support, Devastation on so many levels, Making changes in the aftermath and Walking a tight rope forever. The findings from this study reveal that midwives who are under investigation suffer from emotional and psychological distress. Understanding the effects of the process of investigation is important to improve the quality of professional and personal support available to PPMs who are reported to AHPRA and to streamline processes. CONCLUSION: It is becoming increasingly difficult for PPMs to support the wishes and needs of individual women and also meet the requirements of the regulators, as well as the increasingly risk averse health service.

Desde la enfermería basada en evidencia: patrones de conocimiento: mirando su narrativa: fenómeno del cuidado / From nursing based nursing: patterns of knowledge: looking at his narrative: phenomenon of car / De enfermagem baseada em enfermagem: padrões do conhecimento: olhando

INTRODUCCIÓN: Desde la enfermería basada en evidencia, como procesos cognitivos que ponen en marcha frente a cada situación hacen evidente al proceso de Enfermería como herramienta fundamental para la dirección del cuidado. En el fenómeno de cuidado, surge la situación de enfermería como herramienta científica que permite poner en evidencia los patrones de conocimiento enfermero propuestos por Barbara Carper, los elementos del metaparadigma, así como las fases del proceso de enfermería. Para la operacionalización del mismo, se utilizó la taxonomía de diagnósticos propuestos por la NANDA, así como los resultados esperados (NOC) y las intervenciones sugeridas (NIC). METODOLOGÍA: Para precisar la realidad, se abordó desde el equipaje etnográfico focalizado como metodología analítica explorando desde el aspecto antropológico del cuidado, la enfermería basada en evidencia, patrones de conocimiento desde la narrativa del cuidado como base epistémica para los dominios y taxonomías, teniendo en cuenta la adecuación teórico- epistemológica fundamentado en el paradigma cualitativo- interpretativo a través del interaccionismo simbólico. RESULTADOS Y DISCUSIONES: La enfermería basada en evidencia, surge como el nuevo paradigma emergente, a través de los patrones de conocimiento, hacen parte de la enseñanza y de la práctica de enfermería, de tal forma que aumentan su complejidad y su diversidad epistemológica. Por lo tanto, cada patrón da una orientación de los problemas y las preguntas de la disciplina, reconociendo que los cambios son inherentes al desarrollo del conocimiento en enfermería. Propuestas metodológicas. El fenómeno del cuidado, emerge como necesidad la simbiosis entre el proceso de enfermería y su transcendencia en la investigación científica a través de la enfermería basada en evidencia, vista como un proceso único, individualizado de la práctica de enfermería a través de la narrativa, usando la herramientas de los patrones de conocimiento, teniendo en cuenta que las repuestas de salud-enfermedad de los seres humanos, forman parte del núcleo central del relato y de los significados que las personas les otorgan

INTRODUCTION: From nursing based on evidence, as cognitive processes that put in place in front of each situation make evident to the process of Nursing as a fundamental tool for the direction of care. In the care phenomenon, the nursing situation arises as a scientific tool that allows to put into evidence the patterns of nursing knowledge proposed by Barbara Carper, the elements of the metaparadigm, as well as the phases of the nursing process. For the operationalization of the same, the taxonomy of diagnoses proposed by the NANDA was used, as well as the expected results (NOC) and the suggested interventions (NIC). METHODOLOGY: To clarify reality, it was approached from the ethnographic baggage focused as analytical methodology, exploring from the anthropological aspect of care, evidence-based nursing, patterns of knowledge from the care narrative as an epistemic basis for domains and taxonomies, taking into account the theoretical-epistemological adaptation based on the qualitative-interpretive paradigm through symbolic interactionism. RESULTS AND DISCUSSIONS: Nursing based on evidence, emerges as the new emerging paradigm, through the knowledge patterns, are part of the teaching and practice of nursing, in such a way that they increase its complexity and its epistemological diversity. Therefore, each employer gives an orientation of the problems and the questions of the discipline, recognizing that the changes are inherent in the development of knowledge in nursing. Methodological proposals. The phenomenon of care, emerges as a need the symbiosis between the nursing process and its transcendence in scientific research through evidence-based nursing, seen as a unique, individualized process of nursing practice through the narrative, using the tools of knowledge patterns, taking into account that the health-illness responses of human beings are part of the central core of the story and the meanings that people give them

INTRODUÇÃO: A partir da enfermagem baseada em evidências, como processos cognitivos que se colocam à frente de cada situação, evidencia-se o processo de Enfermagem como uma ferramenta fundamental para a direção do cuidado. No fenômeno do cuidado, a situação de enfermagem surge como uma ferramenta científica que permite evidenciar os padrões de conhecimento de enfermagem propostos por Barbara Carper, os elementos do metaparadigma, bem como as fases do processo de enfermagem. Para a operacionalização dos mesmos, utilizou-se a taxonomia de diagnósticos proposta pela NANDA, bem como os resultados esperados (NOC) e as intervenções sugeridas (NIC). METODOLOGIA: Para esclarecer a realidade, foi abordada a partir da bagagem etnográfica focada como metodologia analítica, explorando desde o aspecto antropológico do cuidado, enfermagem baseada em evidências, padrões de conhecimento da narrativa do cuidado como base epistêmica para domínios e taxonomias, levando em consideração a adaptação teórico-epistemológica baseada no paradigma qualitativo-interpretativo através do interacionismo simbólico. RESULTADOS E DISCUSSÕES: A enfermagem baseada em evidências, emerge como o novo paradigma emergente, através dos padrões de conhecimento, fazem parte do ensino e prática de enfermagem, de forma a aumentar sua complexidade e sua diversidade epistemológica. Portanto, cada empregador dá uma orientação sobre os problemas e as questões da disciplina, reconhecendo que as mudanças são inerentes ao desenvolvimento do conhecimento em enfermagem. Propostas metodológicas. o fenômeno do cuidado, emerge como uma necessidade a simbiose entre o processo de enfermagem e sua transcendência na pesquisa científica por meio da enfermagem baseada em evidências, vista como um processo único e individualizado de prática de enfermagem através do narrativa, utilizando as ferramentas dos padrões de conhecimento, levando em conta que as respostas saúde-doença dos seres humanos fazem parte do núcleo central da história e dos significados que as pessoas lhes dão

The completion of partograms: knowledge, attitudes and practices of midwives in a public health obstetric unit in Bloemfontein, South Africa.

INTRODUCTION: most maternal and 24.3% of infant deaths occur during childbirth. Interventions during childbirth may reduce maternal and neonatal deaths. The Guidelines for maternity care in South Africa (2015) stipulates that all observations during labour should be recorded on a partogram. The objective of this study was to assess the knowledge and attitudes of nursing personnel and to evaluate their practices of completing partograms at National District Hospital, South Africa. METHODS: a two-phase, quantitative, cross-sectional, descriptive study design was used. In phase 1, the knowledge and attitudes of midwives and nurses were evaluated. Midwives and nurses completed anonymous, self-administered questionnaires that assessed their knowledge and attitudes. In Phase 2, partogram practices were measured by assessing completed partograms using a data collection tick sheet. RESULTS: twelve of the 17 nursing personnel completed the questionnaires. More than 90% of participants answered basic partogram knowledge questions correctly, but only two thirds knew the criteria for obstructive labour and just more than half that for foetal distress. Participants displayed a positive attitude toward the use of partograms. Of the 171 randomly selected vaginal deliveries during the study period, only 57.1% delivered with a completed partogram. Most elements of foetal monitoring and progress of labour scored above 80%, however, for maternal monitoring scored poorly in 26.4% of cases. CONCLUSION: although 71.4% of partograms scored more than 75% for completion, the critical components that influence maternal and foetal death, like the identification of foetal distress, maternal wellbeing and progress of labour, were lacking.

The Impact of Nurse-Led Cardiac Rehabilitation on Quality of Life and Biophysiological Parameters in Patients With Heart Failure: A Randomized Clinical Trial.

BACKGROUND: Cardiovascular diseases are the leading cause of mortality in the Indian subcontinent, accounting for 38% of deaths annually. One cardiovascular disease in particular, heart failure, is a growing public health problem both in India and worldwide. PURPOSE: Heart failure is a chronic, progressive disease with increasing rates of incidence and prevalence. This study was conducted to determine the influence of a nurse-led cardiac rehabilitation program on quality of life and biophysiological parameters in patients with chronic heart failure. In this study, it was hypothesized that participants in the cardiac rehabilitation program would report significantly more-positive changes in quality of life and biophysiological parameters than their peers who did not participate in this program. METHODS: In this randomized controlled trial, the participants were patients with chronic heart failure who had been admitted to a tertiary care hospital in India. The participants assigned to the intervention group received both nurse-led cardiac rehabilitation and routine care. In addition, intervention group participants received a booklet on cardiac rehabilitation, Healthy Way to Healthy Heart, at discharge and fortnightly telephone reminders about good cardiac rehabilitation practices. A standard questionnaire was used to collect targeted information on participants' general and disease-specific quality of life at 1 and 3 months postintervention. Biophysiological parameters such as body mass index, blood pressure, and serum cholesterol values were also measured. RESULTS: Two thirds of the participants in each group (65% in the intervention group and 66% in the control group) were between 51 and 70 years old. The mean score for the mental component summary of generic quality of life steadily decreased in the control group and steadily increased in the intervention group at the first and second posttests. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Nurses working in cardiology units play a pivotal role in educating and managing the health status of patients with heart failure. Providing cardiac rehabilitation to patients with heart failure benefits the quality of life of these patients. Nurses working in cardiology units should encourage patients with heart failure to practice cardiac rehabilitation for a longer period to further improve their quality of life.

The evaluation of a nurse-led hypertension management model in an urban community healthcare: A randomized controlled trial.

BACKGROUND: Hypertension is a silent disease of the masses with an increasing prevalence and poor control rates. This study aims to establish and test the efficacy of a nurse-led hypertension management model in the community. METHODS: A single-blind, randomized controlled trial was performed. 156 hypertensive patients with uncontrolled blood pressure were equally and randomly allocated into 2 groups. Patients in the study group received a 12-week period of hypertension management. Blood pressure, self-care behaviors, self-efficacy, and satisfaction were assessed at the start of recruitment, 12 and 16 weeks thereafter. RESULTS: After the intervention, blood pressure of patients in the study group had greater improvement in self-care behaviors and a higher level of satisfaction with the hypertensive care compared to the control group (both P < .05). CONCLUSIONS: The nurse-led hypertension management model is feasible and effective for patients with uncontrolled blood pressure in the community.

Organisational factors influencing non-pharmacological management of type 2 diabetes mellitus (T2DM) in public hospitals across Lagos, Nigeria: A qualitative study of nurses' perspectives.

BACKGROUND: The prevalence and incidence of Type 2 Diabetes mellitus (T2DM) are significantly increasing in Nigeria. Effective management of the condition, in clinical settings, can be achieved with a minimal financial cost, but this is often overlooked. It is crucial to understand organisational factors influencing non-pharmacological management of T2DM in Nigerian public hospitals for effective management of patients diagnosed with the condition. AIM: To examine healthcare delivery services influencing patient management and seek approaches to heighten optimisation of patient health outcomes. METHODS: Adopting a qualitative case study design, we used the Constant Comparative Method and semi-structured questions to interview17 nurses in public hospitals across Lagos. Using the five stages of the Framework Analysis process, the transcribed interviews were thematically analysed. RESULTS: Nurses suggested that a complex, multifaceted system constituted organisational factors influencing T2DM management in public hospitals across Lagos, Nigeria. Specific factors identified were levels of available information and knowledge, relationship, policy and decision-making management. These factors were, in turn, linked to political, infrastructural, health professional and the environments within which patients were given health services. CONCLUSIONS: The study revealed a significant gap in the organisation of care for individuals diagnosed with T2DM in public hospitals across Lagos. Timely and affordable strategies have been highlighted to secure effective care delivery to patients.

Early or delayed umbilical cord clamping? Experiences and perceptions of nurse-midwives and obstetricians at a regional referral hospital in Tanzania.

BACKGROUND: Umbilical cord clamping is a crucial step during the third stage of labour that separates the newborn from the placenta. Despite the available evidence that delayed umbilical cord clamping is more beneficial to infants, as well as the existence of 2014 WHO recommendation that the umbilical cord should be clamped between 1 and 3 minutes, its implementation is still low in many countries including Tanzania. OBJECTIVE: This study describes the experiences and perceptions of nurse-midwives`and obstetricians`about the timing of umbilical cord clamping at a regional referral hospital in Tanzania. METHODS: A descriptive qualitative study design that adopted a purposeful sampling strategy to recruit 19 participants was used. Nine semi-structured interviews with six nurse-midwives`and three obstetricians`, as well as one focus group discussion with ten nurse-midwives`were conducted. Thematic analysis guided the analysis of data. RESULTS: Three main themes generated from the data, each having 2 to 5 subthemes. 1. Experiences about the timing of umbilical cord clamping. 2. Perceptions about the umbilical cord clamping. 3. Factors influencing the practice of delayed umbilical cord clamping to improve newborn health outcomes. CONCLUSION: Although the nurse-midwives`and obstetricians`commonly practiced clamping the umbilical cord immediately after delivery, they understood that delayed cord clamping has a potential benefit of oxygenation to the newborn in the event of the need for resuscitation. To move forward with the good practice in maternal and newborn care, proper pre-service and providers training on matters underlying childbirth is essential to address the gap of knowledge. Delayed cord clamping should be practiced widely to improve the health outcomes of the newborn.

Misalignment of specialty nurse practitioners and the Consensus Model.

Nurse practitioner (NP) employment in specialty practice areas, such as subspecialty ambulatory practices and inpatient units is growing substantially. The Consensus Model provides guidelines to help states aligning NP education and certification with specialty practice area. Despite expansion of the Consensus Model, significant misalignment exists between specialty NPs' education, certification, and practice location. Therefore, further implementation of the Consensus Model across states could have significant impact on health systems and NPs working in specialty settings. More than 10 years after its introduction, it is time to evaluate the policy and practice implications of the Consensus Model. Important next steps include examination of the impact of the Consensus Model and how to help health systems with alignment when and if the Model is more widely implemented.

The implementation of midwifery competency standards in applying behaviour of normal childbirth care (APN) on BIDAN PRAKTIK MANDIRI PERA

Maternity illness and death rate is high in many developing countries, including Indonesia due to bleeding in the post childbirth (28%), miscarriage complication (12%), and sepsis (9%). The main reason for maternity illness in implementation of APN which is in accordance with midwife competence standard is carried out. The objective of the research was to find out the implementation of midwife competence standard in APN implementation behavior. The research used qualitative narrative method. It was conducted at RSU Ridos, Medan. The informants were 4 midwives, 1 owner, and 2 childbirth women. The data were analyzed qualitatively by interpreting the data in the form of sentences. The result of the research showed that the implementation of midwife competence standard in carrying out normal childbirth care in RSU was good. Midwives' knowledge was good since all of them were D-III midwifery graduates. Senior midwives' skill was better than that of young ones although the latter were controlled by their seniors and bay the hospital owner. The skilled midwives had participated in APN training, while the unskilled ones had not. Midwives behavior, especially the seniors' was good in implementing APN in RSU Ridos, but young midwives still needed experience in implementing APN so that their behavior was in accordance with midwife competence standard and to oath of office. It is recommended that the hospital management increase midwives' knowledge and skill in Normal Childbirth Care, and make midwives who not yet followed training participate in it

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A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: A mixed methods study.

BACKGROUND: United Kingdom legislation allows nurses to autonomously provide medications as independent nurse prescribers or using patient group directions. Evidence of medication safety and appropriateness is limited. We compared nurse prescribers and patient group direction users in terms of prevalence, types and severity of medication provision errors. METHODS: Objectives: Compare safety and appropriateness of medication provision between nurse prescribers and patient group direction users. DESIGN: MIXED METHODS: clinical notes review and nurse-patient consultation observations. SETTING: Five United Kingdom sexual health services. SELECTION CRITERIA: 'Clinical notes review' included a random selection of nurse-patient consultations July-December 2015, 743 consultations managed by nurse prescribers and 939 consultations by patient group direction users. 'Observation study' involved 15 nurse prescriber and 15 patient group direction user nurse-patient medication consultations. Patients aged under 16 or non-English speaking were excluded. MEASUREMENTS: Medication safety/appropriateness was compared between nurse prescribers and patient group direction users. Medication provision errors were categorised and assigned severity ratings. The Medication Appropriateness Index and the Prescribing Framework were used to assess medication provision. RESULTS: Of 1682 clinical notes (nurse prescribers=743, 44%; patient group directions=939, 56%), 879 involved the provision of 1357 medications (nurse prescribers=399, 54%; patient group directions=480, 51%). The overall error rate was 8.5% (1844 errors from a potential 21,738 errors), predominantly related to documentation omissions. Nurse prescribers were more likely to make an error compared to patient group directions users (error rates 9% versus 8%, respectively; p=0.001); most were 'minor' (nurse prescribers=489, 56%; patient group directions=602, 62%). Both nurse prescribers and patient group direction users made safe medication decisions (n=1640 of 1682 patient care episodes, 98%); however, patient group directions users worked outside patient group directions restrictions in 39 (8%) of consultations. In 101 consultations, medication was indicated but not documented as offered/provided. From 30 observed consultations assessed against the Prescribing Framework, nurse prescribers' and patient group directions users' clinical practice were comparable (maximum score 46: nurse prescribers=44.7; patient group direction=45.4, p=0.41). CONCLUSION: Sexual health nurse prescribers and patient group direction users provided safe and therapeutically appropriate medication. Improvements in clinical documentation are recommended. Moreover, patient group directions users should be encouraged to adhere to patient group directions' governance restrictions, such as through regular training, audits and staff updates.

The outcomes and experience of people receiving community-based nurse-led wound care: A systematic review.

AIMS AND OBJECTIVES: To review the literature related to the outcomes and experience of people receiving nurse-led care for chronic wounds in the community. BACKGROUND: Chronic wounds lead to a poor quality of life and are an economic burden to the Australian healthcare system. A lack of awareness into the significance of chronic wounds leads to limited resources being available to facilitate the provision of evidence-based care. The majority of chronic wounds are managed by nurses in the community, and a better understanding into current models of care is required to inform future practice. DESIGN: A systematic quantitative literature review. METHODS: A systematic search was conducted in four electronic databases, and the inclusion criteria were as follows: English language, peer-reviewed, published from 2009-2019 and primary research. The data were compiled into an Excel database for reporting as per the Pickering and Byrne (Higher Education Research & Development, 33, 534.) method of systematic quantitative literature review. This review used the PRISMA checklist. The Mixed Methods Appraisal Tool was used for quality appraisal. RESULTS: Twelve studies were included in the review. Home nursing care, social community care and nursing within a wound clinic were identified as three types of nurse-led care in the literature. The findings demonstrate that nurse-led care was cost-effective, reported high levels of client satisfaction and contributed to improved wound healing and reduced levels of pain. CONCLUSIONS: Nurse-led care is a positive experience for people with chronic wounds and leads to better outcomes. The findings suggested a need for further client education and specialised training for healthcare practitioners managing chronic wounds. RELEVANCE TO CLINICAL PRACTICE: This review demonstrates that nurse-led care for people with chronic wounds in the community is cost-effective and improves client outcomes. Raising awareness into the significance of chronic wounds aims to promote the resources required to facilitate evidence-based care.

Dilution is no solution.

Some nurses continue to routinely dilute I.V. push medications, a practice associated with a high risk of errors. This article reviews correct practices for administering I.V. push medications.

Empowering Nurses to Engage With Transplant Quality Data and Outcomes.

BACKGROUND: Understanding patient outcome data and quality improvement metrics can help the health-care team target interventions to improve patient care and guide practice. Challenges to understanding and use of data include finding time during clinical work, determining meaning, and understanding a connection to practice. PROBLEM STATEMENT: Acute care nurses who routinely care for organ transplant patients could not speak to transplant quality data or outcomes. This was evidenced by 81% accuracy in interpreting transplant quality data. METHODS: The setting was an inpatient/acute care organ transplant and progressive care unit. A survey was employed to staff; the lowest scoring areas were training to accurately interpret and having time to understand transplant quality data and outcomes. A multimodal intervention that included an education session at a mandatory staff education event followed by routine posting quality data on the unit was devised. Goals were to improve the accuracy of transplant quality data interpretation to an average of 90% and the average key confidence indicators to 6.0 (out of 7.0). PROCESSES ADDRESSED: Education was created to cover background and initial results, data interpretation, and clinical significance. A display board in the staff lounge was dedicated to transplant quality data. OUTCOMES: All goals were met. Accurate interpretation improved to 90% and average key confidence indicators increased to 6.54. IMPLICATIONS FOR PRACTICE: An interdisciplinary team process that involved stakeholders was essential to success. A similar method could be employed with nurses and other frontline staff.

Evaluation of a student-led midwifery group practice: A woman's perspective.

BACKGROUND: . OBJECTIVE: To evaluate women's experiences of a student-led midwifery group practice. DESIGN: A mixed methods design was used to examine women's experiences and level of satisfaction about a student-led midwifery model of care. An on-line survey elucidated women's levels of satisfaction and experiences with the student-led midwifery group practice. The online survey was sent to all women (n = 25) who were receiving care from third year Bachelor of Midwifery students in 2018 via email up to 6 weeks postnatally. The online survey was distributed in the first instance to obtain baseline information about the importance of this student-led midwifery group practice and so the survey information was linked to the in-depth interview in the analysis for the purpose of identifying if the women were primiparous or multiparous. Women (n = 9) were invited to participate in an in-depth interview by self-opting on the survey and this extra data provided a richer understanding about the level of satisfaction about woman-centred care led by midwifery students. Retrospective data were also collected from the Maternity database - E-Maternity about birth outcomes. SETTING: A tertiary teaching public hospital in New South Wales (NSW). PARTICIPANTS: Fifteen women participated in an online survey. Five primiparous and four multiparous women opted to be involved in the in-depth interviews on the online survey. MEASUREMENTS AND FINDINGS: Analysis in SPSS provided descriptive statistics including frequencies and percentages of data including birth outcomes. Simple correlations enabled associations to be established between levels of satisfaction, individualised care, quality of care, benefits and anxiety during pregnancy. The overarching themes from the qualitative findings identified the students' presence for the women as the most important component of the women's journey. The four main themes that emerged from the study included: familiarity of the caregiver, staying informed on the journey, feeling supported and reassured by their expertise, and control and decisions over birth events. KEY CONCLUSIONS: For a variety of reasons, women valued the presence of the students throughout their childbearing journey, including valuing the woman's private space during labour and her time with her partner. This combination of pedagogical approaches provides an alternative to the current placement approach, which includes working shifts in all areas of maternity. This approach will better support midwifery students to achieve the skills necessary to provide a continuity of care experience (CoCE) amongst a small team by a student-led midwifery group practice that is supported by a registered midwife in the antenatal clinic. The midwifery student is able to develop a relationship with the woman as a component of the CoCE under the guidance of a registered midwife and this is an important underpinning of the philosophy of woman-centred care. IMPLICATIONS FOR PRACTICE: This model of care provides evidence that women do value the students' support and presence throughout their experience and that the benefits of this model should be offered to all women as a normal component of their midwifery care.