A theoretical discussion about the clinical value of phenomenology for nurses

This article develops a theoretical discussion related to the value of a phenomenological framework in contributing to contemporary nursing knowledge. Nursing is based on the understanding of patients' personal experiences and their responses to their illness. Phenomenological methodology utilizes the patient's own language to reflect meanings embedded in their health experience.

Nursing education and graduates : profiles for 1999 and 2000, with projections for 2001

An analysis of DEST statistical data on nursing education had suggested that there were issues with the classification of undergraduate data and new initiatives, such as combined degrees, which were poorly captured. This project had two distinct aims. First, to explore and map exhaustively the range of undergraduate programs offered by tertiary education providers across Australia leading to an initial qualification and entry into nursing practice. Second, to explore and map in detail specialist nursing education courses offered by tertiary and other education providers across Australia. This research was funded under the Evaluations and Investigations Programme (EIP).

Clinical environment : a source of stress for undergraduate nurses

The clinical area is an important learning environment for undergraduate nursing students. Unfortunately, it can also be a source of significant stress and anxiety for students and there are a number of reasons for this. Much can be done to help alleviate this stress and create a positive learning environment for students. This paper explores the literature to ascertain the common sources of stress for undergraduate students in the clinical area. It also reviews strategies for improving the quality of the learning experience.

Patient safety, ethics and whistleblowing : a nursing response to the events at the Campbelltown and Camden Hospitals

In November 2002, in what stands as one of the most significant whistleblowing cases in the history of the Australian health care system, four nurses went public with concerns they had about the management of clinical incidents and patient safety at two hospitals in Sydney, New South Wales. The handling of this case and its aftermath raises important moral questions concerning the nature of whistleblowing in health care domains and the possible implications for the patient safety and quality of care movement in Australia. This paper presents an overview of the case, the moral risks associated with whistleblowing, and some lessons learned.

A systematic review of nursing administration of medication via enteral tubes in adults

Aim. This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults.
Background. Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown.
Design. Systematic review.
Methods. CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data
were presented in a narrative summary.
Results. Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself.
Conclusion. The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication.
Relevance to clinical practice. Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.

Critical care nurses' decision-making activities in the natural clinical setting

• This article reports on observation of 18 nurses in urban and rural based critical care settings.

• The purpose of the study was to observe and describe the decision-making activities of critical care nurses within natural clinical settings.

• During the 2-hour observation, the researcher dictated a detailed commentary on to audio-tape of each nurse's actions. Tapes were transcribed and subjected to content analysis.

• Findings indicated three main categories of decisions. Decision frequencies were linked to nurses' critical care experience, appointment level, and location, as well as nursing shifts.

• The findings are discussed in relation to previous empirical evidence and the implications for practice.

• The author concludes that future research should be directed towards measuring the contextual influences on nurses' decision-making on the outcome of patient care.

The career development year : responding to the emergency nursing shortage in Australia

Background: The Career Development Year (CDY) is a 12 month supported entry program at one health care service in Victoria, Australia. The program targets Division One Registered Nurses with little or no emergency nursing experience. The intent of CDY is to improve recruitment to, and retention in, emergency nursing by educational and experiential preparation for emergency nursing practice.

Method: This study used a retrospective exploratory design to examine recruitment and retention of emergency nurses recruited via CDY (n = 72) and compare these findings with recruitment and retention data for a cohort of non-CDY participants (n = 15). CDY data was collected by self-report questionnaires. Descriptive statistics, correlations and inferential statistics were calculated using SPSS.

Results: CDY was found to promote recruitment of novice nurses to emergency nursing, with almost half the respondents (n = 25, 48.1%) reporting they would not have entered emergency nursing were it not for the supported entry program. Further, comparison with non-CDY participants revealed that CDY promoted retention within emergency nursing, with both short-term (n = 47, 90.4% vs. n = 8, 53.4%) and long-term retention doubling (n = 50, 96.1% vs. n = 7, 46.6%) following the introduction of CDY.

Conclusion: CDY was a valuable recruitment tool and successful retention strategy in the ED. Future research using a larger sample may demonstrate potential applicability to other clinical areas.

Clinical risk management and the ethics of open disclosure : part 1 : benefits and risks to patient safety

Patient safety experts and other authorities have strongly postulated the open disclosure of errors and adverse events to patients as an essential component of effective clinical risk management in health care. Commentators also contend that ‘when things go wrong’, openly disclosing such events to the patient and his or her nominated support person is simply ‘the right thing to do’. Despite the obvious importance of the issue of open disclosure and its possible implications for the nursing profession, it has not been comprehensively addressed in the nursing literature. A key aim of this article (the first of a two-part discussion) is to contribute to the positive project of redressing this oversight by providing a brief overview of what open disclosure is and what its intended purpose, aims, and rationale are. Consideration is also given to the risks and benefits of open disclosure as a public policy and whether it will succeed in achieving the anticipated outcomes envisaged. In a second article (to be presented as Part II), the ethics of open disclosure and its possible implications for the nursing profession are explored.

Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients

Objective: To determine the prevalence of malnutrition in a population of elderly hospitalised patients and to explore health professionals' perceptions and awareness of signs and risks of malnutrition and treatment options available.

Subjects and design: One hundred elderly patients and 57 health professionals from medical wards of a tertiary teaching hospital. Quantitative and qualitative study design using a validated malnutrition assessment tool (Mini Nutritional Assessment) and researcher-designed questionnaire to assess health professionals' knowledge of nutrition risk factors.

Main outcome measures: Mini Nutritional Assessment score, nutrition risk category and themes in health professionals' knowledge and awareness of malnutrition and its risk factors.

Results: Thirty per cent of patients were identified as malnourished while 61% were at risk of malnutrition. Documentation by health professionals of two major risk factors for malnutrition—recent loss of weight and appetite—were poor with only 19% and 53% of patients with actual loss of weight or appetite, respectively, identified by staff and only 7% and 9% of these patients, respectively, referred for dietetic assessment. While health professionals' knowledge of important medical risk factors for malnutrition was good, their knowledge of malnutrition risk factors such as recent loss of weight and loss of appetite was poor. Medical staff focused on biochemical factors when assessing nutrition status, while nursing staff focused on skin integrity and turgor.

Conclusion: Malnutrition in elderly hospitalised patients remains a significant problem with low rates of recognition and referral by medical and nursing staff. Considerable scope exists to develop training and education tools and to implement an appropriate nutrition screening policy to improve referral rates to dietitians.

Nursing handover : it's time for a change

Nursing handover is a common part of nursing practice that is fundamental to safe patient care. Despite this, the literature provides little direction on the best way to conduct handover. This project aimed to examine nurses' perceptions of handover and to determine the strengths and limitations of the handover process. A staff survey was distributed to nurses in all inpatient wards at a metropolitan tertiary hospital. A total of 176 nurses responded to the staff survey. The findings revealed conflicting opinions about the effectiveness of the handover process; although a number of nurses were positive about current handover practice, indicating they were provided with sufficient information about patients and given opportunity to clarify patient care information, other nurses identified aspects of handover that could be improved. These included: the subjectivity of handover information, the time taken to conduct handover, repetition of information that could be found in the patients' care plans, and handing over of information by a nurse who has not cared for the patient. Some attention needs to given to addressing the perceived weaknesses associated with the handover process.

Almost there : empirical insights into clinical method and ethics courses in climbing the hill towards lawyers' professionalism

Results of a study into the relationships between values and ethical behaviour for early-career legal practitioners - effect of gender, clinical experience and prior ethics education - implications for ethics education in tertiary institutions and after admission to legal practice.

Targeted clinical education for staff attitudes towards deliberate self-harm in borderline personality disorder : randomized controlled trial

Objective: The aim of the present study was to assess the impact of attending targeted clinical education on borderline personality disorder on the attitudes of health clinicians towards working with deliberate self-harm behaviours commonly exhibited by patients diagnosed with this complex disorder. Comparisons of clinicians across service settings, occupational fields, and other demographic areas were also made.

Method: A purpose-designed demographic questionnaire and the Attitudes Towards Deliberate Self-Harm Questionnaire were used to collect the demographic information and assess the attitudes of 99 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service, both before and after education attendance.

Results: Statistically significant improvements in attitude ratings were found for both emergency medicine clinicians and mental health clinicians in working with deliberate self-harm behaviours in borderline personality disorder, following attendance at the education program with a medium affect size (t(32)=−3.45, p=0.002, d=0.43 and t(65)=−5.12, p=0.000, d=0.42, respectively). Clinicians across occupational areas of nursing, allied health, and medical fields demonstrated equivocal levels of improvement in their attitude ratings.

Conclusions: Results are discussed in terms of the necessity of providing regular access to targeted clinical education for health professionals working with patients diagnosed with borderline personality disorder.

Implementation of evidence into practice : Development of a tool to improve emergency nursing care of acute stroke

Background
Stroke is an increasing global health issue that places considerable burden on society and health care services. An important part of acute stroke management and decreasing stroke-related mortality is preventing complications within the first 24–48 hours. The current climate of prolonged time spent in the Emergency Department (ED) means that many aspects of stroke management are now the responsibility of emergency nurses.

Aims
The aims of this paper are to: i) examine the evidence related to nursing care of acute stroke, ii) identify evidence-based elements of stroke care with most applicability to emergency nursing and iii) use evidence-based stroke care recommendations to develop a guideline for the emergency nursing management of acute stroke.

Results
Emergency nursing care of acute stroke should focus on optimal triage decisions, physiological surveillance, fluid management, risk management, and early referral to specialists.

Conclusions
The role of emergency nurses in stroke care will increase and it is important that emergency nurses deliver evidence-based stroke care in order to optimise patient outcomes. Guidelines and decision support tools for use in emergency nursing must be practical and have high levels of clinical utility for maximum uptake in a busy clinical environment.

Consumer notes clinical indicators : determining inter-rater reliability with multiple users, nominal categories and several cases

A method of determining inter-rater reliability when there are multiple raters, nominal rating categories and several cases is described and applied in the development of an instrument for auditing the ANZCMHN (1995) standards of practice for mental health nursing in New Zealand. Clinical statements (n=41) from the O’Brien et al (2002a, 2003) study, which reflected nursing behaviours contributing to the achievement of the standards of practice, were used to audit consumer files. During two Phases, the clinical indicator statements were refined and rules for judging the achievement of each statement from case note documentation were established. The resultant statements have adequate inter-rater reliability for the assessment of nursing practice with respect to the ANZCMHN (1995) standards of practice.