Australian and New Zealand nurses’ perceptions of procedural sedation and analgesia in the cardiac catheterisation laboratory : a qualitative study

Background: Australian and New Zealand College of Anaesthetists’ guidelines for procedural sedation and analgesia (PSA) are intended to apply across all clinical settings. As nurses are frequently responsible for patient care during PSA in the cardiac catheterisation laboratory (CCL), their perspectives can provide insight into the effectiveness of these guidelines within this particular setting. Methods: A cross-sectional sampling design was used to recruit nurses from urban, regional, public and private CCLs across Australia and New Zealand. Semi-structured interviews were conducted, digitally recorded and transcribed. Data were analysed using thematic analysis. Findings: Twenty-three nurses from 16 CCLs across four states in Australia and New Zealand participated. Most held senior positions (managers=14; educators=5) and CCL experience ranged from 4 to 26 years (mean 11). Participants were concerned about the legitimacy of their practice as they administered PSA outside of guideline recommendations and deemed present education and training as deficient. Participants noted also that guideline recommendations were sometimes not adhered to as it was difficult to balance the increasingly complex PSA requirements of their case-mix with limited access to anaesthetists while trying not to delay procedures. Conclusion: Findings suggest that application of current PSA guidelines may be impractical for CCL nurses and, as a consequence, they are often not followed. Participants were concerned about risks to patient safety as they felt education and training was not commensurable with practice requirements. The findings suggest existing guidelines should be reviewed or new guidelines developed which address nursing practice, education and competency standards for PSA in the CCL

A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand, and the United Kingdom

Objective The aim of this study was to examine the prevalence of overweight and obesity and the association with demographic, reproductive work variables in a representative cohort of working nurses and midwives. Design A cross sectional study of self reported survey data. Settings Australia, New Zealand and the United Kingdom. Methods Measurement outcomes included BMI categories, demographic (age, gender, marital status, ethnicity), reproductive (parity, number of births, mother's age at first birth, birth type and menopausal status) and workforce (registration council, employment type and principal specialty) variables. Participants 4996 respondents to the Nurses and Midwives e-Cohort study who were currently registered and working in nursing or midwifery in Australia (n=3144), New Zealand (n=778) or the United Kingdom (n=1074). Results Amongst the sample 61.87% were outside the healthy weight range and across all three jurisdictions the prevalence of obesity in nurses and midwives exceeded rates in the source populations by 1.73% up to 3.74%. Being overweight or obese was significantly associated with increasing age (35–44 yrs aOR 1.71, 95% CI 1.41–2.08; 45–55 yrs aOR 1.90, 95%CI 1.56–2.31; 55–64 aOR 2.22, 95% CI 1.71–2.88), and male gender (aOR 1.46, 95% CI 1.15–1.87). Primiparous nurses and midwives were more likely to be overweight or obese (aOR 1.37, 95% CI 1.06–1.76) as were those who had reached menopause (aOR 1.37, 95% CI 1.11–1.69). Nurses and midwives in part-time or casual employment had significantly reduced risk of being overweight or obese, (aOR 0.81, 95% CI 0.70–0.94 and aOR 0.75, 95% CI 0.59–0.96 respectively), whilst working in aged carried increased risk (aOR 1.37, 95% CI 1.04–1.80). Conclusion Nurses and midwives in this study have higher prevalence of obesity and overweight than the general population and those who are older, male, or female primiparous and menopausal have significantly higher risk of overweight or obesity as do those working fulltime, or in aged care. The consequences of overweight and obesity in this occupational group may impact on their workforce participation, their management of overweight and obese patients in their care as well as influencing their individual health behaviours and risks of occupational injury and chronic disease.

The Levels of Job Satisfaction, Stress and Burnout In Australian and New Zealand Haemodialysis Nurses

Background: Job dissatisfaction, stress and burnout is linked to high rates of nurses leaving the profession, poor morale, poor patient outcomes and increased financial expenditure. Haemodialysis nurses find their work satisfying although it can be stressful. Little is known, however, about job satisfaction, stress or burnout levels of haemodialysis nurses in Australia and New Zealand. Aims: To assess the current levels of job satisfaction, stress, burnout and nurses’ perception of the haemodialysis work environment. Methods: An observational study involved a cross-sectional sample of 417 registered or enrolled nurses working in Australian or New Zealand haemodialysis units. Data was collected using an on-line questionnaire containing demographic and work characteristics as well as validated measures of job satisfaction, stress, burnout and the work environment Results: 74% of respondents were aged over 40 and 75% had more than six years of haemodialysis nursing experience. Job satisfaction levels were comparable to studies in other practice areas with higher satisfaction derived from professional status and interactions with colleagues. Despite nurses viewing their work environment favourably, moderate levels of burnout were noted with frequent stressors related to workload and patient death and dying. Interestingly there were no differences found between the type or location of dialysis unit. Conclusion: Despite acceptable levels of job satisfaction and burnout, stress with workloads and facets of patient care were found. Understanding the factors that contribute to job satisfaction, stress and burnout can impact the healthcare system through decreased costs by retaining valued staff and through improved patient care.

Assessing the reliability of the sedation-agitation scale between nurses and doctors in a New Zealand ICU

The aim of the study was to determine whether nurses and doctors rate “real world” intensive care unit (ICU) patients similarly using the Sedation–Agitation Scale (SAS) in a generalist ICU context outside USA

Nursing care practices following a percutaneous coronary intervention : results of a survey of Australian and New Zealand cardiovascular nurses

Background: Although there is high-level evidence to guide optimal medical care for percutaneous coronary interventions, there are less explicit guidelines to support nurses in providing care. Aim: This study describes the practice standards and priorities of care of cardiovascular nurses in Australia and New Zealand. Method: Item generation for the survey was informed by an integrative literature review and existing clinical guidelines. A 116-item Web-based survey was administered to cardiovascular nurses, via electronic mail lists of professional cardiovascular nursing organizations, using a secure online data collection system. Results: Data were collected from March 2008 to March 2009. A total of 148 respondents attempted the survey, with 110 (74.3%) completing all items. All respondents were registered nurses with an average of 12.3 (SD, 7.61) years of clinical experience in the cardiovascular setting. A range of practice patterns was evident in ambulation time after percutaneous coronary intervention, methods of sheath removal, pain relief, and patient positioning. Respondents consistently rated psychosocial care a lower priority than other tasks and also identified a knowledge deficit in this area. Conclusion: This survey identified diversity of practice patterns and a range of educational needs. Increasing evidence to support evidence-based practice and guideline development is necessary to promote high-quality care and improved patient outcomes.

Intradialytic hypotension prevention and management knowledge and practices: Results from a survey of Australian and New Zealand nephrology nurses

Intradialytic hypotension (IDH) remains the most frequent serious side effect of hemodialysis, increasing morbidity in patients on hemodialysis. Nephrology nurses have a critical role in the prevention and management of IDH. The aim of this study was to investigate nephrology nurse knowledge and practice habits in the prevention and management of IDH. This was an explorative cross-sectional design, web-based survey of Australian and New Zealand nephrology nurses (n = 173). IDH definitions, blood pressureinterpretation, and IDH interventions were inconsistent and not always evidencebased.Demographic characteristics had little impact on the variation in responses. A universal definition for IDH may improve early recognition of the problem. Formal guidelines in considering individualized interventional strategies for asymptomaticepisodes prior symptomatic IDH occurrence may improve outcomes for patients on hemodialysis

Trends in nurse-administered procedural sedation and analgesia across cardiac catheterisation laboratories in Australia and New Zealand : results of an electronic survey

Background Knowledge of current trends in nurse-administered procedural sedation and analgesia (PSA) in the cardiac catheterisation laboratory (CCL) may provide important insights into how to improve safety and effectiveness of this practice. Objective To characterise current practice as well as education and competency standards regarding nurse-administered PSA in Australian and New Zealand CCLs. Design A quantitative, cross-sectional, descriptive survey design was used. Methods Data were collected using a web-based questionnaire on practice, educational standards and protocols related to nurse-administered PSA. Descriptive statistics were used to analyse data. Results A sample of 62 nurses, each from a different CCL, completed a questionnaire that focused on PSA practice. Over half of the estimated total number of CCLs in Australia and New Zealand was represented. Nurse-administered PSA was used in 94% (n = 58) of respondents CCLs. All respondents indicated that benzodiazepines, opioids or a combination of both is used for PSA (n = 58). One respondent indicated that propofol was also used. 20% (n = 12) indicated that deep sedation is purposefully induced for defibrillation threshold testing and cardioversion without a second medical practitioner present. Sedation monitoring practices vary considerably between institutions. 31% (n = 18) indicated that comprehensive education about PSA is provided. 45% (n = 26) indicated that nurses who administer PSA should undergo competency assessment. Conclusion By characterising nurse-administered PSA in Australian and New Zealand CCLs, a baseline for future studies has been established. Areas of particular importance to improve include protocols for patient monitoring and comprehensive PSA education for CCL nurses in Australia and New Zealand.

Generation of statements for the development of clinical indicators for mental heath nursing in New Zealand : achieving a bicultural focus

Aim : In this paper, the first of 4 stages of a large study aiming to develop culturally and clinically valid clinical indicators to flag the achievement of mental health nursing standards of practice in New Zealand are described.

Methods : A bicultural design was employed throughout the research project to ensure that nurses' views of practice and the cultural differences between New Zealand's indigenous Maori and non-Maori peoples could be identified. Accordingly, separate focus groups of Maori- and non-Maori-experienced mental health nurses were asked to develop lists of statementd reflective of the Australian and New Zealand College of Mental Health Nurses' Standards of Practice in New Zealand.

Results : The focus group participants produces 473 statements, which were synthesized into 190 clinical indicator statements. In keeping with the bicultural research design, Maori and non-Maori data were analysed separately until the data were merged to provide a single set of indicator statements. Although both Maori and non-Maori groups wrote statements relevant to clinical practice, there was a difference in the way the 2 groups addressed cultural issues. The Maori focus group wrote statements about cultural issues for 4 of the 6 Standards of Practice, whereas the non-Maori focus group participants wrote statements about cultural issues for only the Standard focusing on cultural safety.

Conclusion : The research design of this project in mental health nursing was unique in that it sought the perspectives of both indigenous and non-indigenous nurses about quality mental health nursing practice related to the professional standards of practice. The involvement of Maori and non-Maori mental health nurses enhanced the cultural and clinical validity of the study and the obtained from it. The bicultural approach adopted for the study highlights the need for more mental health nursing research involving indigenous partners.

Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand

Background. Numerous studies have employed the Delphi technique to seek expert opinion about aspects of clinical practice. When researching literature on the Delphi technique, however, we discovered discrepancies in its application, and a lack of detail when reporting design, administration, and analysis methods. Such lack of specificity hinders the replicability and assessment of the clinical and cultural validity and reliability of Delphi studies.

Aim. The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria.

Methods. Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarized responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4·5 after round 3 was set as the importance threshold.

Findings. Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark.

Conclusions. When rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritizing experts judgements.