Initial emergency nursing management of patients with severe traumatic brain injury : development of an evidence-based care bundle for the Thai emergency department context.

Thai emergency nurses play a vital role in caring for patients with severe TBI, and are an important part of the healthcare team throughout the resuscitation phase. They are also responsible for continuous physiological monitoring, and detecting deterioration associated with increased intracranial pressure and preventing secondary brain injury. However, there is known variation in Thai nurses' knowledge and care practices for patients with severe TBI. In addition, there are no specific evidence-based practice guidelines available for emergency nursing management of patients with severe TBI.

What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients.

To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients.

Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios

Aims and objectives: To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Background: Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Design: Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Methods: Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Results: Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. Conclusions: There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills. Relevance to clinical practice: There is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies. © 2014 John Wiley & Sons Ltd.

Situation awareness in undergraduate nursing students managing simulated patient deterioration

Nursing work often occurs in complex and potentially hazardous settings. Awareness of patient and practice environments is an imperative for nurses in practice.

Evaluation of postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning: a descriptive study

The aim of this study was to evaluate postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning (TBL).

Barriers and enablers to learning during team-based clinical simulations: reflective interviews with final year undergraduate nursing students

Background: Contemporary approaches to clinical simulation can enhance educational outcomes. However, simulation approaches do have limitations with possible compromises for learning and teaching. This paper aims to identify barriers
and enablers to learning in simulated clinical settings.
Methods: A generic qualitative design was applied. Semi-structured group video debriefing interviews were held with Australian final-year nursing students who completed three patient deterioration scenarios with a standardized patient.
Audio-recorded interviews were transcribed and analysed to identify emergent themes.
Results: Interviews with 15 teams of three students (n = 45) from three universities were analysed. Learning enablers were ‘Realism of the simulated environment’; ‘Practicing: we should do this at uni’; ‘Learning from reflection and expert feedback’, and ‘How to become competent: know the gaps’. Barriers to learning included ‘Increased stress from inexperience; ‘Expectations when pretending’ and ‘Lack of assistance’. Skills practice in team-based settings with applicable reflection and debriefing was regarded as beneficial. Simulated patients enhanced fidelity but were unable to replicate actual clinical signs. High stress levels were perceived as a barrier to learning.
Conclusions: Applicably designed high fidelity simulations with video-based reflective review offer repeated rehearsal of clinical situations to enable learning. This educational strategy may reduce the time it takes undergraduate students to
reach competency.

Majors in mental health nursing: issues of sustainability and commitment

PURPOSE: Major streams in mental health nursing in undergraduate nursing programs were introduced in Australia as a strategy to address current and projected workforce shortages. Of the 14 programs originally planned or implemented, only five are continuing. DESIGN AND METHODS: A qualitative exploratory study was conducted involving in-depth interviews with representatives of universities that had ceased the major streams or abandoned plans to introduce them. FINDINGS: Significant themes from interview material on abandoned programs were efficient use of resources, expertise, and problems with registration. On the programs now terminated significant themes were viability and commitment to mental health nursing. PRACTICE IMPLICATIONS: These findings suggest demonstrable and sustainable commitment to mental health nursing is a precursor to success of major streams and advancement of the mental health nursing specialty.

Opportunity lost? The major in mental health nursing in Australia

The ongoing difficulty in educating and sustaining an adequate nursing workforce in mental health settings has been identified throughout the world. Different strategies have been implemented internationally to deal with this situation. In Australia major streams in mental health nursing were introduced in some Australian universities to promote mental health nursing as a viable career choice for nursing students. Fourteen universities had implemented or planned to implement a major stream in mental health nursing. From a survey of these programs a lack of consistency in the structure and content of programs was evident. For most programs the intakes had been relatively small, although retention rates appeared promising.

Power, effects, confidence, and significance: an investigation of statistical practices in nursing research

Objectives: To (a) assess the statistical power of nursing research to detect small, medium, and large effect sizes; (b) estimate the experiment-wise Type I error rate in these studies; and (c) assess the extent to which (i) a priori power analyses, (ii) effect sizes (and interpretations thereof), and (iii) confidence intervals were reported. Design: Statistical review. Data sources: Papers published in the 2011 volumes of the 10 highest ranked nursing journals, based on their 5-year impact factors. Review methods: Papers were assessed for statistical power, control of experiment-wise Type I error, reporting of a priori power analyses, reporting and interpretation of effect sizes, and reporting of confidence intervals. The analyses were based on 333 papers, from which 10,337 inferential statistics were identified. Results: The median power to detect small, medium, and large effect sizes was .40 (interquartile range [. IQR]. = .24-.71), .98 (IQR= .85-1.00), and 1.00 (IQR= 1.00-1.00), respectively. The median experiment-wise Type I error rate was .54 (IQR= .26-.80). A priori power analyses were reported in 28% of papers. Effect sizes were routinely reported for Spearman's rank correlations (100% of papers in which this test was used), Poisson regressions (100%), odds ratios (100%), Kendall's tau correlations (100%), Pearson's correlations (99%), logistic regressions (98%), structural equation modelling/confirmatory factor analyses/path analyses (97%), and linear regressions (83%), but were reported less often for two-proportion z tests (50%), analyses of variance/analyses of covariance/multivariate analyses of variance (18%), t tests (8%), Wilcoxon's tests (8%), Chi-squared tests (8%), and Fisher's exact tests (7%), and not reported for sign tests, Friedman's tests, McNemar's tests, multi-level models, and Kruskal-Wallis tests. Effect sizes were infrequently interpreted. Confidence intervals were reported in 28% of papers. Conclusion: The use, reporting, and interpretation of inferential statistics in nursing research need substantial improvement. Most importantly, researchers should abandon the misleading practice of interpreting the results from inferential tests based solely on whether they are statistically significant (or not) and, instead, focus on reporting and interpreting effect sizes, confidence intervals, and significance levels. Nursing researchers also need to conduct and report a priori power analyses, and to address the issue of Type I experiment-wise error inflation in their studies. © 2013 .

Development of a postgraduate interventional cardiac nursing curriculum

Interventional cardiology practices have advanced immensely in the last two decades, but the educational preparation of the workforce in cardiac catheter laboratories has not seen commensurate changes. Although on-the-job training has sufficed in the past, recognition of this workforce as a specialty practice domain now demands specialist educational preparation. The aim of this paper is to present the development of an interventional cardiac nursing curriculum nested within a Master of Nursing Practice in Australia. International and national health educational principles, teaching and learning theories and professional frameworks and philosophies are foundational to the program designed for interventional cardiac specialist nurses. These broader health, educational and professional underpinnings will be described to illustrate their application to the program's theoretical and clinical components. Situating interventional cardiac nursing within a Master's degree program at University provides nurses with the opportunities to develop high level critical thinking and problem solving knowledge and skills.

Adult cardiothoracic transplant nursing: an ISHLT consensus document on the current adult nursing practice in heart and lung transplantation.

The role of nurses in cardiothoracic transplantation has evolved over the last 25 years. Transplant nurses work in a variety of roles in collaboration with multidisciplinary teams to manage complex pre- and post-transplantation issues. There is lack of clarity and consistency regarding required qualifications to practice transplant nursing, delineation of roles and adequate levels of staffing.

Transition to specialty practice programs in Australian emergency nursing

 Transition to Specialty Practice Programs (TSPPs) provide structured support and education to novice nurses. This study examined the prevalence, design, characteristics and functions of emergency nursing TSPPs in Australia, and found that TSPPs served an important function in recruitment, preparation and retention of emergency nurses. A framework for future emergency nursing TSPPs was developed based on study findings.