Pressure injury education for older adults and carers living in community settings: A scoping review.

Older adults are at increased risk of pressure injuries (PIs) due to age-related changes. Traditionally, PI knowledge and education have been delivered in hospitals and residential aged care facilities, however, there remains a critical gap in understanding how PI knowledge on prevention and management is shared with older adults and their carers living in the community. We aimed to describe the nature and characteristics of structured and unstructured PI education programs available to community-dwelling older adults and their carers. As coping review was undertaken. We searched five databases: CINAHL, Medline, Scopus, Cochrane Library and ProQuest from 2009 to August 2023. The review was guided by Arksey and O'Malley's six-step framework and adhered to the PRISMA-ScR guidelines. It included primary peer-reviewed papers published in English, which focus on PI education for older adults and/or their carers living in community settings. Data extraction was organised in a table, and findings presented as a narrative summary. One-hundred and thirty-six papers were screened and four included in the review. Results indicate that consideration was placed on literacy levels and cognitive status of older adults and their carers when designing PI education materials. Educational materials such as leaflets/brochures, in-person training sessions or a combination of both were used. However, duration of these interventions varied, lasting for 1-4 weeks while others were completed over 12 months. Some improvements in PI knowledge such as how to treat PI, dietary requirements and importance of mobility were noted. However, information retention and its translation into effective long-term behaviour change remained unclear. In conclusion, adopting a multifaceted educational approach increases the effectiveness of PI knowledge translation. Continuous education, support and reinforcement on PIs over time are necessary when interacting with older adults and caregivers to ensure long-term management and prevention success. Conversations on PIs should start at the primary care levels when older adults and carers are visiting their GP clinics and accessing support services for other healthcare needs. Understanding older adults' and carers' literacy levels, cognitive status and cultural background can assist clinicians in designing and delivering fit-for-purpose PI educational interventions that are accessible, relatable and effective in promoting knowledge transfer and behaviour change. Carers are vital conduits in the care continuum. These factors will lead to a more informed, collaborative and person-centred approaches to PI management and prevention.

Fatigue in nurses and medication administration errors: A scoping review.

BACKGROUND: Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already-strained healthcare budgets. An emerging factor contributing to these errors is nurse fatigue. Given medication administration is the most frequent clinical task nurses undertake; it is vital to understand how fatigue impacts MAEs. OBJECTIVE: Examine the evidence on the effect of fatigue on MAEs and near misses by registered nurses working in hospital settings. METHOD: Arksey and O'Malley's scoping review framework was used to guide this review and PAGER framework for data extraction and analysis. The PRISMA checklist was completed. Four electronic databases were searched: CINAHL, PubMed, Scopus and PsycINFO. Eligibility criteria included primary peer review papers published in English Language with no date/time limiters applied. The search was completed in August 2021 and focussed on articles that included: (a) registered nurses in hospital settings, (b) MAEs, (c) measures of sleep, hours of work, or fatigue. RESULTS: Thirty-eight studies were included in the review. 82% of the studies identified fatigue to be a contributing factor in MAEs and near misses (NMs). Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety. Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors. However, there was marked heterogeneity in strategies for measuring fatigue within the included studies. RELEVANCE TO CLINICAL PRACTICE: Fatigue is a multidimensional concept that has the capacity to impact nurses' performance when engaged in medication administration. Nurses are susceptible to fatigue due to work characteristics such as nightwork, overtime and the requirement to perform cognitively demanding tasks. The mixed results found within this review indicate that larger scale studies are needed with particular emphasis on the impact of overtime work. Policy around safe working hours need to be re-evaluated and fatigue management systems put in place to ensure delivery of safe and quality patient care.

Nurses and nursing students as second victims: A scoping review.

BACKGROUND: Second victim describes the impact on health care professionals after an error causing preventable patient harm. However, to date, the impact of making errors in practice by nurses and/or nursing students is unclear. PURPOSE: To describe and understand what is known about nurses and nursing students as second victims. METHODS: A scoping review was completed using three databases: CINAHL, Medline, and Proquest for the period between 2010 and 2022. A total of 23 papers underwent thematic analysis. DISCUSSION: Three themes were identified: (a) Psychological distress and symptomatology, (b) Coping-response/reactions to errors, and (c) Seeking support and understanding. CONCLUSION: Nurses and nursing students' well-being and productivity levels can be negatively affected by inadequate team and organisational support. To improve team functioning, appropriate support mechanisms must be implemented to assist nurses who experience significant distress after making errors. Nursing leadership should prioritise improving support programs, assessing workload allocation, and increasing awareness amongst leaders of the potential benefits of providing support to second victims.

Feasibility, satisfaction, acceptability and safety of telehealth for First Nations and culturally and linguistically diverse people: a scoping review.

OBJECTIVES: The COVID-19 pandemic has highlighted the importance of access to telehealth as an alternative model of service during social restrictions and for urban and remote communities alike. This study aimed to elucidate whether First Nations and culturally and linguistically diverse (CALD) patients also benefited from the resource before or during the pandemic. STUDY DESIGN: This study was a scoping review. METHODS: A scoping review of MEDLINE, CINAHL and PsycINFO databases from 2000 to 2021 was performed. Paired authors independently screened titles, abstracts and full texts. A narrative synthesis was undertaken after data extraction using a standard template by a team including First Nations and CALD researchers. RESULTS: Seventeen studies (N = 4,960 participants) mostly qualitative, covering First Nations and CALD patient recipients of telehealth in the United States, Canada, Australia, and the Pacific Islands, met the inclusion criteria. Telehealth was perceived feasible, satisfactory, and acceptable for the delivery of health screening, education, and care in mental health, diabetes, cancer, and other chronic conditions for remote and linguistically isolated populations. The advantages of convenience, lower cost, and less travel promoted uptake and adherence to the service, but evidence was lacking on the wider availability of technology and engagement of target communities in informing priorities to address inequalities. CONCLUSIONS: Further studies with larger samples and higher level evidence methods involving First Nations and CALD people as co-designers will assist in filling the gap of safety and cultural competency.

Graduate nurse views on patient safety: Navigating challenging workplace interactions with senior clinical nurses.

AIM AND OBJECTIVE: To explore and understand the negative experiences of graduate nurses' interaction with senior nurses and the implications for safe patient care. BACKGROUND: Patient safety is dependent on the nursing care they receive. Working in environments where there is reduced collegial support and increased emotional distress, increases the likelihood of nurses making errors that may negatively impact on patient outcomes. Insights drawn from graduate nurses' negative interactions with senior nurses may provide an understanding of the impact of nurse-to-nurse interactions on patient safety outcomes. METHODS: A qualitative exploratory descriptive design was used. A purposive sample of 18 graduate registered nurses participated in this study. Semi-structured interviews were conducted, audio-recorded and transcribed verbatim. Data were thematically analysed. The COREQ checklist was followed. RESULTS: The overarching theme, 'Navigating workplace challenges' was identified with two sub-themes: Processing unsupportive nurse behaviour and responding to nurse deviations from best practice. Common deviations in practice included erosion of safe medication practice, wound care and non-compliance with universal precautions. Graduate nurses also observed unsafe workplace practice, however, were hesitant to speak up due to fear of retribution. Unsupportive behaviours impacted on their critical thinking ability, follow-up interactions with other nurses and subsequent delivery of patient care. CONCLUSION: Quality and safety strategies should not ignore and/or overlook the impact of interpersonal relationships on patient safety and risk. Strategies for delivering evidence-based, safe and quality care to patients go beyond the establishment of standards and technically focussed management strategies. RELEVANCE TO CLINICAL PRACTICE: It is vital to examine the quality of working relationships between all levels of healthcare professionals including graduate nurses and their supervisors to ensure supportive behaviours prevail in advancing delivery of quality care within the practice environment. The study alludes to the fact that disruptive workplace behaviours are more hierarchical than horizontal (i.e., graduate nurse-to-graduate nurse).

Nurse leader agency: Creating an environment conducive to support for graduate nurses.

AIM: The aim of the study was to gain insight on how nurse leaders manage a culture of safety for graduate nurses. BACKGROUND: Current theoretical approaches to safety culture tend towards a checklist approach that focuses on institutional characteristics, failing to examine the quality of interpersonal relationships. These interpersonal interactions are often seen as separate from the institutional realities of resource allocation, nurse-patient ratios, patient acuity or throughput. A theoretical approach is required to illuminate the dialectic between the structure of an organisation and the agency created by nurse leaders to promote patient safety. DESIGN: Qualitative exploratory descriptive study. METHODS: Semi-structured interviews were undertaken with 24 nurse leaders from hospital and aged care settings. Thematic analysis and Giddens structuration theory was used to describe the findings. RESULTS: Nurse leaders identified a range of reciprocal communicative and cultural norms and values, decision-making processes, personal nursing philosophies, strategies and operational procedures to foster patient safety and mentor graduate nurses. The mentoring of graduate nurses included fostering critical thinking, building and affirming formal structural practices such as handover, teamwork, medication protocols and care plans. CONCLUSIONS: The study provides insight into how nurse leaders foster a culture of safety. Emphasis is placed on how agency in nurse leaders creates an environment conducive to learning and support for graduate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leadership functions and decision-making capacity hinges on multiple factors including practicing agency and aspects of the social structure such as the rules for safe communication, and the various institutional protocols. Nurse leaders enforce these forms of engagement and practice through their legitimation as leaders. They have both allocative and authoritative resources; they can command resources, direct staff to attend to patients and/or clinical tasks, mentor, guide, assign, correct and encourage with the authority vested in them by the formal structure of the organisation. In doing so, they sustain the structure and reinforce it.

Transition support arrangements to support new graduate & novice nurses entry into perioperative nursing: A scoping review.

Background and objectives: As novice nurses transition into the workforce, they often experience transition shock as they assimilate into a new role, causing cause significant stress, anxiety and job dissatisfaction. This phenomenon is commonly observed within the perioperative nursing speciality. The development of transition support programs is aimed at assisting novice nurses' transition by providing fundamental knowledge, socialisation, support, and training.This review aimed to uncover the support programs and their components available to nurses transitioning into the perioperative speciality. The research question that provided guidance for this review was 'What are the transition support arrangements, and their characteristics, to support new graduate nurses and novice nurses who are transitioning into perioperative nursing?'. Literature search: Arksey & O'Malley's' five-step scoping review framework was used. The researchers performed a comprehensive literature search of PubMed, Proquest, CINHAL and SCOPUS with no limit on publication date until April 2023. A blinded screening process was undertaken, and the data extraction was tabulated. Data was presented as a narrative synthesis following thematic analysis. Results: The initial search identified 537 publications. Screening and duplicate removal led to the exclusion of 512 publications. Of the 25 publications included in this review, two were primary research publications, while the other 23 were discussion papers. Analysis indicated that program approaches and components of programs were frequently described. Conclusion: The findings highlight the significance of transition programs within the perioperative speciality area. However, the paucity of empirical evidence on the pedagogical underpinnings and evaluation of effectiveness indicates the need for further research. Conducting further research within perioperative transition to practice will enable programs to be designed based on theoretically-sound and evidence-based approaches to support nursing transition to practice within the speciality perioperative environment.

A Scoping Review of Compassion Fatigue Among Oncology Nurses Caring for Adult Patients.

BACKGROUND: Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF). OBJECTIVES: To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients. METHODS: A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting. RESULTS: Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF. CONCLUSIONS: Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF. IMPLICATIONS FOR PRACTICE: Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.

Advanced care planning in the early phase of COVID-19: a rapid review of the practice and policy lessons learned.

Background: The importance of advance care planning (ACP) has been highlighted by the advent of life-threatening COVID-19. Anecdotal evidence suggests changes in implementation of policies and procedures is needed to support uptake of ACPs. We investigated the barriers and enablers of ACP in the COVID-19 context and identify recommendations to facilitate ACP, to inform future policy and practice. Methods: We adopted the WHO recommendation of using rapid reviews for the production of actionable evidence for this study. We searched PUBMED from January 2020 to April 2021. All study designs including commentaries were included that focused on ACPs during COVID-19. Preprints/unpublished papers and Non-English language articles were excluded. Titles and abstracts were screened, full-texts were reviewed, and discrepancies resolved by discussion until consensus. Results: From amongst 343 papers screened, 123 underwent full-text review. In total, 74 papers were included, comprising commentaries (39) and primary research studies covering cohorts, reviews, case studies, and cross-sectional designs (35). The various study types and settings such as hospitals, outpatient services, aged care and community indicated widespread interest in accelerating ACP documentation to facilitate management decisions and care which is unwanted/not aligned with goals. Enablers of ACP included targeted public awareness, availability of telehealth, easy access to online tools and adopting person-centered approach, respectful of patient autonomy and values. The emerging barriers were uncertainty regarding clinical outcomes, cultural and communication difficulties, barriers associated with legal and ethical considerations, infection control restrictions, lack of time, and limited resources and support systems. Conclusion: The pandemic has provided opportunities for rapid implementation of ACP in creative ways to circumvent social distancing restrictions and high demand for health services. This review suggests the pandemic has provided some impetus to drive adaptable ACP conversations at individual, local, and international levels, affording an opportunity for longer term improvements in ACP practice and patient care. The enablers of ACP and the accelerated adoption evident here will hopefully continue to be part of everyday practice, with or without the pandemic.

Mentoring students in doctoral nursing programs: A scoping review.

BACKGROUND: Academic mentorship usually involves an ongoing, supportive relationship between experienced academics and research candidates, and is fundamental to establishing and nurturing scholarship and the skills for dealing with the changing demands of the academic environment. Mentoring is a valuable strategy for the development of students enrolled in doctoral nursing programs (Doctor of Philosophy in Nursing - PhD, Doctor of Nursing Practice - DNP, Doctor of Nursing Science - DNS, and Doctoral Education in Nursing - EdD). PURPOSE: To report mentorship experiences among doctoral nursing students and academic mentors, identify positive and negative attributes of mentors and the relationship between mentors and students, and assess the benefits and barriers of mentoring. METHODS: Relevant empirical studies published until September 2021 were identified using PubMed, CINAHL and Scopus electronic databases. Quantitative, qualitative, and mixed method studies published in English language which reported on mentorship among doctoral nursing students were included. Data were synthesized into a scoping review with findings presented as a narrative summary. RESULTS: The review included 30 articles, mostly from the USA, which reported on the mentoring relationship, experiences, benefits, and barriers of mentoring for the student and the mentor. Students valued mentor attributes such as being a role model, respectful, supportive, inspiring, approachable, accessible, a content expert and a good communicator. Benefits of mentoring included enhanced experience of research endeavours, scholarly writing and scientific publication, networking support, improved student retention, timely completion of the project, and career readiness, as well as developing one's own mentoring skills for future mentoring of others. Despite the identified benefits, there are a number of barriers related to mentoring including access to mentorship support, limited mentoring skills among faculty, and lack of compatibility between students and mentors. CONCLUSIONS: This review highlighted students' expectations versus their reality of mentoring, which suggested areas for improvement in mentoring doctoral nursing students, in particular the need for mentorship competency, support, and compatibility. Additionally, there is a need for more robust research designs to understand the nature and characteristics of mentorship programs for doctoral nursing students and to assess the expectations and wider experiences of mentors.

Delivering Prognostic News to Older People with Chronic Disease: What Format Preference and Level of Involvement in Decision Making? A Hospital Survey.

Shared decision making near end of life is a balancing act of communicating prognosis to patients and their surrogates/families and engaging them in considering value-concordant management choices. This cross-sectional survey aimed to determine the format in which older patients with chronic illnesses would prefer to receive prognostic information on their treatment options and disease progression, and their desired level of engagement in decision making. With a 60% participation rate, 139 inpatients in two hospitals and five surrogates were presented with six hypothetical scenarios with a randomly assigned sequence: verbal and written summary, graph, table, photo, video, and pamphlet. The majority (76%) of respondents chose the traditional verbal communication of prognosis by their doctor with a written summary as a reference and to share with family; the second choice was a condition-specific pamphlet (63%). Many found the graph and photo to be distressing (36% and 42%, respectively). Most (71%) wanted to know everything about their condition trajectory, and 63% chose shared decision making rather than completely autonomous or full delegation to clinicians or family. There were no gender differentials between wanting to know it all, supporting shared decision making or the preferred format for breaking news (p > 0.05). Older hospitalized patients with chronic conditions are willing to discuss end-of-life issues, learn about their prognosis, and be involved in shared decision making. Innovative formats such as graphs, videos, or photos were not welcome as part of the prognostic discussion.

Exploring the influence of workplace supports and relationships on safe medication practice: A pilot study of Australian graduate nurses.

BACKGROUND: Despite the growing awareness of the benefits of positive workplace climates, unsupportive and disruptive workplace behaviours are widespread in health care organisations. Recent graduate nurses, who are often new to a workplace, are particularly vulnerable in unsupportive climates, and are also recognised to be at higher risk for medication errors. OBJECTIVES: Investigate the association between workplace supports and relationships and safe medication practice among graduate nurses. DESIGN AND PARTICIPANTS: Exploratory study using quantitative survey with a convenience sample of 58 nursing graduates in two Australian States. METHODS: Online survey focused on graduates' self-reported medication errors, safe medication practice and the nature of workplace supports and relationships. RESULTS: Spearman's correlations identified that unsupportive workplace relationships were inversely related to graduate nurse medication errors and erosion of safe medication practices, while supportive Nurse Unit Manager and supportive work team relationships positively influenced safe medication practice among graduates. CONCLUSIONS: Workplace supports and relationships are potentially both the cause and solution to graduate nurse medication errors and safe medication practices. The findings develop further understanding about the impact of unsupportive and disruptive behaviours on patient safety and draw attention to the importance of undergraduate and continuing education strategies that promote positive workplace behaviours and graduate resilience.