Development, reliability and validity of an instrument measuring the attitudes and knowledge of emergency department staff regarding the emergency nurse practitioner role

Introduction: The Emergency Department (ED) at The Northern Hospital is currently participating in the Victorian Department of Human Services funded Emergency Nurse Practitioner Project. This project aims to develop, implement and evaluate the Emergency Nurse Practitioner role in Victorian EDs. This led to a need to develop a specific data collection tool called The Northern Emergency Nurse Practitioner Staff Survey to examine the knowledge and attitudes of ED medical and nursing staff. This paper describes the development of The Northern Emergency Nurse Practitioner Staff Survey and presents the results of reliability and validity studies. Method: Twenty-five items were developed and piloted on a sample of 58 ED medical and nursing staff. Content and face validity were established by expert panel review. Reliability was established by tests of unidimensionality, exploratory factor analysis and internal consistency. Results: Four items were discarded because of low item to total correlation. Exploratory factor analysis of the remaining items revealed five factors with eigenvalues >1 and acceptable correlation coefficients that explained 76.7% of the variance. Cronbach’s coefficent α for these items was 0.926 indicating a high degree of internal consistency. The factors were titled to reflect the content domain of the items in each factor and the factors arranged in a logical sequence to form the final version of The Northern Emergency Nurse Practitioner Survey.

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

• There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers.

• This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work.

• Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate.

• Three major themes emerged from interview data: planning for ward allocation, communication and professionalism.

• In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff.

• Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses.

• For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration.

• A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles.

• The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled – with the aim of providing quality patient care.

The 'dis-ease' of dying: challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study

BACKGROUND: Changes in health care and an ageing population have meant that more people are dying in the acute hospital setting. While palliative care principles have resulted in quality care for the dying, many patients die in an acute care, still receiving aggressive/resuscitative care. AIMS: The aims were to explore nurses' 'recognition of' and 'responsiveness to' dying patients and to understand the nurses' influence on end-of-life care. DESIGN: A qualitative approach was taken utilising non-participant observation to elicit rich data, followed by focus groups and individual semi-structured interviews for clarification. SETTING/PARTICIPANTS: This study was conducted in two acute medical wards in one health service, identified as having the highest rates of death, once palliative care and critical care areas were excluded. Twenty-five nurses consented to participate, and 20 episodes of observation were conducted. RESULTS: Nurses took a passive role in recognising dying, providing active care until a medical officer's declaration of dying. Ward design, nurse allocation and nurses' attitude to death impacts patient care. End-of-life care in a single room can have negative consequences for the dying. Nurses demonstrated varying degrees of discomfort, indicating that they were underprepared for this role. CONCLUSION: When patients are terminally ill, acknowledgement of dying is essential in providing appropriate care. It should not be assumed that all nurses are adequately prepared to provide dying care. Further work is necessary to investigate how the attitudes of nurses towards caring for dying patients in the acute hospital setting may impact care of the dying patient.

A new instrument for targeting falls prevention interventions was accurate and clinically applicable in a hospital setting

Background and Objective: To describe the diagnostic accuracy and practical application of the Peter James Centre Falls Risk Assessment Tool (PJC-FRAT), a multidisciplinary falls risk screening and intervention deployment instrument.

Methods: In phase 1, the accuracy of the PJC-FRAT was prospectively compared to a gold standard (the STRATIFY) on a cohort of subacute hospital patients (n = 122). In phase 2, the PJC-FRAT was temporally reassessed using a subsequent cohort (n = 316), with results compared to those of phase 1. Primary outcomes were falls (events), fallers (patients who fell), and hospital completion rates of the PJC-FRAT.

Results: In phase 1, PJC-FRAT accuracy of identifying fallers showed  sensitivity of 73% (bootstrap 95% confidence interval CI = 55, 90) and specificity of 75% (95% CI = 66, 83), compared with the STRATIFY (cutoff ≥ 2/5) sensitivity of 77% (95% CI = 59, 92) and specificity of 51% (95% CI = 41, 61). This difference was not significant. In phase 2, accuracy of nursing staff using the PJC-FRAT was lower. PJC-FRAT completion rates varied among disciplines over both phases: nurses and physiotherapists, ≥90%; occupational therapists, ≥82%; and medical officers, ≥57%.

Conclusion: The PJC-FRAT was practical and relatively accurate as a predictor of falls and a deployment instrument for falls prevention interventions, although continued staff education may be necessary to maintain its accuracy.

Nursing work and nursing knowledge : exploring the work of women's health nurses, patterns of power and praxis

The majority of women's health nurses in this study work in generalist community health centres. They have developed their praxis within the philosophy and policies of the broader women's health movement and primary health care principles in Australia. The fundamental assumption underlying this study is that women's health nurses possess a unique body of knowledge and clinical wisdom that has not been previously documented and explored. The epistemological base from which these nurses' operate offers important insights into the substantive issues that create and continually shape the practice world of nurses and their clients. Whether this represents a (re)construction of the dominant forms of health care service delivery for women is examined in this study. The study specifically aims at exploring the practice issues and experience of women's health service provision by women's health nurses in the context of the provision of cervical cancer screening services. In mapping this particular group of nurses practice, it sets out to examine the professional and theoretical issues in contemporary nursing and women's health care. In critically analysing the powerful discourses that shape and reshape nursing work, the study raises the concern that previous analyses of pursing work tend to universalise the structural and social subordination of nurses and nursing knowledge. This universalism is most often based on examples of midwifery and nursing work in hospital settings, and subsequently, because of these conceptualisations, all of nursing is too often deemed as a dependent occupation, with little agency, and is analysed as always in relation to medicine, to hospitals, to other knowledge forms. Denoting certain discourses as dominant proposes a relationship of power and knowledge and the thesis argues that all work relations and practices in health are structured by certain power/knowledge relations. This analysis reveals that there IX are many competing and complimentary power/knowledge relations that structure nursing, but that nursing, and in particular women's health nurses, also challenge the power/knowledge relations around them. Through examining theories of power and knowledge the analysis, argues that theoretical eclecticism is necessary to address the complex and varied nature of nursing work. In particular it identifies that postmodern and radical feminist theorising provide the most appropriate framework to further analyse and interpret the work of women's health nurses. Fundamental to the position argued in this thesis is a feminist perspective. This position creates important theoretical and methodological links throughout the whole study. Feminist methodology was employed to guide the design, the collection and the analysis. Intrinsic to this process was the use of the 'voices' of women's health nurses as the basis for theorising. The 'voices' of these nurses are highlighted in the chapters as italicised bold script. A constant companion along the way in examining women's health nurses' work, was the reflexivity with feminist research processes, the theoretical discussions and their 'voices'. Capturing and analysing descriptive accounts of nursing praxis is seen in this thesis as providing a way to theorise about nursing work. This methodology is able to demonstrate the knowledge forms embedded in clinical nursing praxis. Three conceptual threads emerge throughout the discussions: one focuses on nursing praxis as a distinct process, with its own distinct epistemological base rather than in relation to 'other' knowledge forms; another describes the medical restriction and opposition as experienced by this group of nurses, but also of their resistance to medical opposition. The third theme apparent from the interviews, and which was conceptualised as beyond resistance, was the description of the alternative discourses evident in nursing work, and this focused on notions of being a professional and on autonomous nursing praxis. This study concludes that rather than accepting the totalising discourses about nursing there are examples within nursing of resistance—both ideologically and X in practice—to these dominant discourses. Women's health nurses represent an important model of women's health service delivery, an analysis of which can contribute to critically reflecting on the 'paradigm of oppression' cited in nursing and about nursing more generally. Reflecting on women's health service delivery also has relevance in today's policy environment, where structural shifts in Commonwealth/State funding arrangements in community based care, may undermine women's health programs. In summary this study identifies three important propositions for nursing: • nursing praxis can reconstruct traditional models of health care; • nursing praxis is powerful and able to 'resist' dominant discourses; and • nursing praxis can be transformative. Joining feminist perspectives and alternative analyses of power provides a pluralistic and emancipatory politics for viewing, describing and analysing 'other' nursing work. At the micro sites of power and knowledge relations—in the everyday practice worlds of nurses, of negotiation and renegotiation, of work on the margins and at the centre—women's health nurses' praxis operates as a positive, productive and reconstructive force in health care.

Nurse stress in hospital and satellite haemodialysis units

Focus groups of nurses from both in-centre and satellite dialysis units were undertaken followed by questionnaires. The In-centre nursing staff rated the busy-ness of the unit as the maximum stress. The mostly notable stressor for the staff at the satellite unit related to patient behaviour and the perceived unrealistic expectations of the patient followed by patients arriving unwell at the unit.

Nurses suffer stress on a daily basis in both in-centre and satellite dialysis units. The major stressors differ from in-centre to satellite dialysis units.

Pandemic (H1N1) 2009 influenza in Australia : absenteeism and redeployment of emergency medicine and nursing staff

Objective: The aim of the present study was to examine the impact of Pandemic (H1N1) 2009 Influenza on the Australian emergency nursing and medicine workforce, specifically absenteeism and deployment.

Methods: Data were collected using an online survey of 618 members of the three professional emergency medicine or emergency nursing colleges.

Results: Despite significant increases in emergency demand during the Pandemic (H1N1) 2009 Influenza, 56.6% of emergency nursing and medicine staff reported absenteeism of at least 1 day and only 8.5% of staff were redeployed. Staff illness with influenza-like illness was reported by 37% of respondents, and 87% of respondents who became ill were not tested for the Pandemic (H1N1) 2009 Influenza. Of the respondents who became ill, 43% (n = 79) reported missing no days of work and only 8% of respondents (n = 14) reported being absent for more than 5 days. The mean number of days away from work was 3.73 (standard deviation = 3.63). Factors anecdotally associated with staff absenteeism (caregiver responsibilities, concern about personal illness, concern about exposing family members to illness, school closures, risk of quarantine, stress and increased workload) appeared to be of little or no relevance. Redeployment was reported by 8% of respondents and the majority of redeployment was for operational reasons.

Conclusion: Future research related to absenteeism, redeployment during actual pandemic events is urgently needed. Workforce data collection should be an integral part of organizational pandemic planning.

Nursing care for the families of the dying child/infant in paediatric and neonatal ICU: Nurses’ emotional talk and sources of discomfort. A mixed methods study

BACKGROUND: The majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure.

OBJECTIVES: The objectives of this study were to explore how NICU/PICU nurses care for families before and after death; to explore the nurses' perspectives on their preparedness/ability to provide family care; and to determine the emotional content of language used by nurse participants.

METHODS: Focus group and individual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content.

RESULTS: Four core themes were identified: preparing for death; communication challenges; the nurse-family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses.

CONCLUSION: This study provided rich insights into the experiences of nurses who are caring for dying children including the nurses' need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses' provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.

Handover between anaesthetists and post anaesthetic care unit nursing staff using ISBAR principles: a quality improvement study

A structured approach to communication between health care professionals contains introduction/identification; situation; background; assessment and request/recommendation (ISBAR). ISBAR was introduced into the post-anaesthetic care unit (PACU) of a large Victorian health service in 2013. The aim of this study was to measure the effect of an education program on ISBAR compliance. 

Nurses' perceptions of discharge planning

The present paper investigates what the term discharge planning actually means to nurses working in the acute care environment. A qualitative approach was used for this study. Twelve volunteer registered nurses (RNs) working in a large metropolitan Victorian public hospital were interviewed. All participants stated emphatically that they were involved in the discharge planning process although differing levels of involvement existed. ‘Organizing’ and ‘planning’ were key words used by participants to define the term discharge planning. All but one participant considered the nurse to be the coordinator of the discharge planning process. How participants communicated with other nursing staff regarding the discharge planning needs of individual patients depended on the policy of each individual ward. Communication was perceived to be a major factor that either enhanced or impeded the discharge planning process.

Sources of well-being and commitment of staff in the Australian Disability Employment Services

This study examined the role of working conditions in predicting the psychological health, job satisfaction and organisational commitment of personnel responsible for helping people with disabilities gain employment in the mainstream Australian labour market. The working conditions were assessed using two theories: the Job Strain Model (job demand, social support and job control) and Psychological Contract Theory (unwritten reciprocal obligations between employers and employees). In the case of the Job Strain Model, the generic dimensions had been augmented by industry-specific sources of stress. A cross-sectional survey was undertaken in June and July 2005 with 514 staff returning completed questionnaires (representing a response rate of 30%). Comparisons between respondents and non-respondents revealed that on the basis of age, gender and tenure, the sample was broadly representative of employees working in the Australian disability employment sector at that time. The results of regression analyses indicate that social support was predictive of all of the outcome measures. Job control and the honouring of psychological contracts were both predictive of job satisfaction and commitment, while the more situation-specific stressors - treatment and workload stressors - were inversely related to psychological health (i.e. as concern regarding the treatment and workload stressors increased, psychological health decreased). Collectively, these findings suggest that strategies aimed at combating the negative effects of large-scale organisational change could be enhanced by addressing several variables represented in the models - particularly social support, job control, psychological contracts and sector-specific stressors.

Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context

Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients' postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians' decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.

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.

Academic staff take the lead : experimenting with social software at Deakin University

This paper reports on a two staged staff development exercise to help new academic staff to integrate Web 2.0 technologies including web-based communication and some digital technologies into their curricula. It involved professional development for the teaching staff in the first stage followed by these teachers providing professional development for the course participants. The teachers engaged in a blended community of inquiry with face-to-face sessions and online work while the professional development for the course participants included technical support, training and a peer group environment with formal allocation of time for the course, finally leading to an institutionally recognised qualification. Evaluations conducted through focus group interviews revealed that collegial networks and time were important for effective professional development. The paper reflects on the successes and limitations of the model and its potential for further development. It also highlights the importance of providing professional development in a safe environment for academics to adopt technologies for teaching and learning.