Fenella J. Gill

Using a web-based survey tool to undertake a Delphi study: Application for nurse education research

BACKGROUND The Internet is increasingly being used as a data collection medium to access research participants. This paper reports on the experience and value of using web-survey software to conduct an eDelphi study to develop Australian critical care course graduate practice standards. METHODS The eDelphi technique used involved the iterative process of administering three rounds of surveys to a national expert panel. The survey was developed online using SurveyMonkey. Panel members responded to statements using one rating scale for round one and two scales for rounds two and three. Text boxes for panel comments were provided. COLLECTING DATA AND PROVIDING FEEDBACK For each round, the SurveyMonkeys email tool was used to distribute an individualized email invitation containing the survey web link. The distribution of panel responses, individual responses and a summary of comments were emailed to panel members. Stacked bar charts representing the distribution of responses were generated using the SurveyMonkey software. Panel response rates remained greater than 85% over all rounds. DISCUSSION An online survey provided numerous advantages over traditional survey approaches including high quality data collection, ease and speed of survey administration, direct communication with the panel and rapid collation of feedback allowing data collection to be undertaken in 12 weeks. Only minor challenges were experienced using the technology. Ethical issues, specific to using the Internet to conduct research and external hosting of web-based software, lacked formal guidance. CONCLUSIONS High response rates and an increased level of data quality were achieved in this study using web-survey software and the process was efficient and user-friendly. However, when considering online survey software, it is important to match the research design with the computer capabilities of participants and recognize that ethical review guidelines and processes have not yet kept pace with online research practices.

The Impact of Implementation of Family‐Initiated Escalation of Care for the Deteriorating Patient in Hospital: A Systematic Review

BACKGROUND Rapid response systems incorporate concepts of early recognition of patient deterioration, prompt reporting, and response which result in escalation of patient care. The ability to initiate escalation of care is now being extended to families of hospitalized patients. RESEARCH AIMS To identify the impact of implementation of family-initiated escalation of care for the deteriorating patient in hospital? METHODS A systematic review of peer-reviewed publications was conducted. Databases were searched from January 2005 to May 2015 for articles reporting the implementation and evaluation of family involvement programs. Reference lists of retrieved articles were searched. RESULTS Ten articles (all descriptive studies) reported implementation and evaluation of response systems for patients and families to trigger an alert for help; five described a triaged response; five reported systems for families to directly activate the rapid response team. Five articles reported implementation in the pediatric setting. There were a total of 426 family-initiated calls, range 0.17 to 11 per month, with no deaths reported. All calls were deemed to be appropriate and three calls resulted in intensive care unit admissions. The basis of patient- or family-initiated calls stemmed from communication or systems breakdown. The large range in frequency of calls was associated with the process implemented, the strategies used and the calling criteria (up to four). Feedback from families was positive. There appeared to be a level of staff stress associated with introducing this process. LINKING EVIDENCE TO ACTION A variety of practice models and calling criteria were reported to either directly activate an existing rapid response team or trigger a separate response to patient- or family-initiated calls. The broader calling criteria and more comprehensive implementation strategies were associated with more patient- and family-initiated escalation of care calls. There is no systematically researched evidence to assess the value of family-initiated calls for deteriorating patients.Background Rapid response systems incorporate concepts of early recognition of patient deterioration, prompt reporting, and response which result in escalation of patient care. The ability to initiate escalation of care is now being extended to families of hospitalized patients. Research Aims To identify the impact of implementation of family-initiated escalation of care for the deteriorating patient in hospital? Methods A systematic review of peer-reviewed publications was conducted. Databases were searched from January 2005 to May 2015 for articles reporting the implementation and evaluation of family involvement programs. Reference lists of retrieved articles were searched. Results Ten articles (all descriptive studies) reported implementation and evaluation of response systems for patients and families to trigger an alert for help; five described a triaged response; five reported systems for families to directly activate the rapid response team. Five articles reported implementation in the pediatric setting. There were a total of 426 family-initiated calls, range 0.17 to 11 per month, with no deaths reported. All calls were deemed to be appropriate and three calls resulted in intensive care unit admissions. The basis of patient- or family-initiated calls stemmed from communication or systems breakdown. The large range in frequency of calls was associated with the process implemented, the strategies used and the calling criteria (up to four). Feedback from families was positive. There appeared to be a level of staff stress associated with introducing this process. Linking Evidence to Action A variety of practice models and calling criteria were reported to either directly activate an existing rapid response team or trigger a separate response to patient- or family-initiated calls. The broader calling criteria and more comprehensive implementation strategies were associated with more patient- and family-initiated escalation of care calls. There is no systematically researched evidence to assess the value of family-initiated calls for deteriorating patients.

Developing and testing the standard of practice and evaluation of critical-care-nursing tool (SPECT) for critical care nursing practice

BACKGROUND Nurses working in critical care often undertake specialty education. There are no uniform practice outcomes for critical care programs, and consumer input to practice standards has been lacking. METHODS A structured multiphase project was undertaken to develop practice standards and an assessment tool informed by critical care nursing stakeholders as well as patients and families-the Standards of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT). RESULTS Testing of the SPECT revealed adequate content validity index (CVI), domain CVI (range, 0.772 to 0.887), and statement CVI (range, 0.66 to 1.00). Reliability was adequate in terms of internal consistency (Cronbachs α > 0.864) and test-retest Spearman rank correlation (range, 0.772 to 0.887); intra-rater kappa agreement was significant for 102 of 104 statements with moderate agreement for 94.2% of statements. CONCLUSION The SPECT appears to have clinical feasibility, preliminary validity and reliability, and provides a clear definition for the expected practice level for graduates of a critical care education program.

A two phase study to revise the Australian Practice Standards for Specialist Critical Care Nurses

BACKGROUND Observational work to develop the ACCCN Competency Standards was undertaken more than 20 years ago. Since then the landscape of critical care nursing as a specialty has changed and it is not known if the Competency Standards reflected contemporary practice. OBJECTIVES To revise the ACCCN Competency Standards for Specialist Critical Care Nurses to ensure they continue to meet the needs of critical care nurses and reflect current practice. METHODS A two-phased project was undertaken. In Phase I focus groups were held in all states. Thematic analysis was conducted using two techniques. The standards were revised based on the main themes. Phase II consisted of an eDelphi technique. A national panel of critical care nurses responded to three survey rounds using a 7 point likert-type scale to indicate their level of agreement with the revised standards. A 70% agreement level for each statement was determined a priori. RESULTS Phase I: 12 focus groups (79 participants) were conducted. Phase II: A panel of specialist critical care nurses (research, management, clinical practice and education) responded to round 1 (n=64), round 2 (n=56), and round 3 (n=40). Fifteen practice standards with elements and performance criteria were grouped into four domains (professional practice, provision and coordination of care, critical thinking and analysis, collaboration and leadership). The revised Practice Standards for Specialist Critical Care Nurses build upon and are additional to the Nursing & Midwifery Board of Australia National Competency Standards for Registered Nurses. The standards reflect contemporary critical care nurse practices using an expanded range of technologies to care for complex critically ill patients across the lifespan in diverse settings. CONCLUSION The national study has resulted in the 3rd edition of the Practice Standards for Specialist Critical Care Nurses. There was input from stakeholders and agreement that the revised standards capture contemporary Australian critical care nursing practice.

What nurses and midwives want: Findings from the national survey on workplace climate and well-being

AIM A discussion of the findings from a nationwide study of workplace and well-being issues of Australian nurses and midwives. BACKGROUND Current discourse only provides a fragmented understanding of a multifaceted nature of working conditions and well-being, necessitating a more holistic investigation to identify critical workplace issues within these professions. DESIGN Discussion paper. DATA SOURCES A national survey conducted in July 2016 involving Australian Nursing and Midwifery Federation members. The literature supporting this paper focuses on the nursing and midwifery workforce and studies on attraction and retention issues. IMPLICATIONS FOR NURSING AND MIDWIFERY Workplace policies and practices in place in health care organizations that are within the control of management are key factors in the negative issues associated with the profession from the survey. Proactive and targeted interventions particularly aimed at salient issues of work intensification, declining engagement, and effective voice mechanisms are needed to address these crucial issues if the attrition of individuals from nursing and midwifery occupations is going to be ameliorated. CONCLUSION To alleviate workforce issues pushing nurses and midwives to the tipping point of exiting the professions, health care organizations need to take a proactive stance in addressing issues under the control of management.

Implementation of the Practice Standards for Specialist Critical Care Nurses in Australia

The publication of the third edition of the Australian College of Critical Care Nurses’ (ACCCN) Practice Standards for Specialist Critical Care Nurses1 is a significant achievement and confirmed the expected standards for the specialist critical care nurse in Australia. Although it has been reported that critical care course providers utilise the Practice Standards2, there does not appear to be obvious reasons for critical care units to do the same. As a result, some critical care nurses’ performance reviews are only based on the generic Registered Nurse Standards for Practice3 and broad capability measures such as the NSW Public Sector Capability Framework4, rather than the specialty Standards. Gill et al.’s article reporting the revision of the Standards emphasised the need to identify resources to facilitate their implementation into practice5. It is also important at an individual level that critical care nurses have access to the Standards and understand how they can be utilised in practice. How can we ensure that critical care nurses are being measured against our ‘gold standard’ ACCCN Practice Standards? Although the newest version of the Standards was only recently released, the absence of a clear plan for their implementation needs to be addressed. The revision project identified that the non-availability of the ACCCN Practice Standards during the twoyear revision period had already resulted in decreased visibility in the workplace5. Other potential barriers for implementation of the Standards may be a perception that the purpose of the Standards is only to guide critical care education curricula or perhaps there is a lack of engagement between critical care practitioners and the College. Whatever barriers exist it is essential that active and targeted dissemination strategies are developed6. We suggest that the College could start by communicating to the target audiences about the existence of the Practice Standards. It is imperative the Practice Standards are visible for those who play key roles in the education and management of the critical care nursing workforce in hospitals and higher education institutions6. Dissemination strategies for the Practice Standards should focus on making them accessible and user-friendly6,7. Targeting members and nonmembers alike may also result in increasing ACCCN membership numbers by promoting the College. It is also important that data regarding the reach and adoption of the Practice Standards are evaluated to measure the impact of the Standards7. Application of these strategies as part of an implementation plan would ensure greater uptake of the Standards and therefore consistent measurement of the performance of specialist critical care nurses. Elyce Green RN, BN, B Clin Prac, MN (Crit Care), PhD Candidate Fenella Gill PhD, RN, BN, MN (Research), Paed Cert, Grad Cert Tertiary Teaching, FACCCN References

Barriers and facilitators to implementing a process to enable parent escalation of care for the deteriorating child in hospital

To identify barriers and facilitators to implementing a parent escalation of care process: Calling for Help (C4H).

Development of a position statement for Australian critical care nurse education

Position statements are used by large organisations such as the Australian College of Critical Care Nurses to publically present an official philosophy or beliefs and to propose recommendations. Position statements are increasingly used by health departments and healthcare facilities to allocate resources and to guide and audit nursing practice, yet there are limited resources on the process of their development. A position statement should help readers better understand the issue, communicate solutions to problems, and inform decision-making. It should be supported by the highest level of evidence available and reflect the organisations governing objectives and goals. In this article, we describe the structured approach used to develop a position statement for Australian critical care nurse education. The formation of an expert advisory panel, synthesis of available evidence using Whittemore and Knafls integrative review methodology, use of Donabedians structure-process-outcomes quality framework as a theoretical approach, and multiple layers of consensus building and consultation enabled the development of an important critical care document and informed an implementation plan. The framework and processes we have outlined in this discussion article may provide a useful starting point for other professional organisations wishing to develop similar position statements.

Empowering Parents of Australian Infants and Children in Hospital

Objectives: To translate, culturally adapt, and psychometrically test the EMpowerment of PArents in The Intensive Care-30 questionnaire in Australian pediatric critical care, neonatal, and pediatric ward settings. Design: Cross-sectional, descriptive, multicenter study conducted in two phases; 1) translation and cultural adaptation and 2) validation of the EMpowerment of PArents in The Intensive Care-30 questionnaire. Settings: Two Western Australian sites, the PICU and two pediatric wards of a children’s hospital and the neonatal unit of a women’s and newborn hospital. Participants: Parents whose baby or child was admitted to the participating wards or units with a length of hospital stay greater than 24 hours. Intervention: None. Measurements and Main Results: Phase 1: A structured 10-step translation process adhered to international principles of good practice for translation and cultural adaptation of patient-reported outcomes. Thirty parents participated in cognitive debriefing. Phase 2: A total of 328 parents responded to the EMpowerment of PArents in The Intensive Care-30-AUS questionnaire. Reliability was sufficient (Cronbach &agr; at domain level 0.70 –0.82, for each clinical area 0.56–0.86). Congruent validity was adequate between the domains and three general satisfaction items (rs 0.38–0.69). Nondifferential validity showed no significant effect size between three patient or parent demographic characteristics and the domains (Cohen’s d < 0.36). Between the different clinical areas, significant differences in responses were found in all domains. Conclusions: The translated and culturally adapted EMpowerment of PArents in The Intensive Care-30-AUS is a reliable and valid questionnaire to measure parent-reported outcomes in pediatric critical care, pediatric ward, and neonatal hospital settings. Using this questionnaire can provide a framework for a standardized quality improvement approach and identification of best practices across specialties, hospital services and for benchmarking similar health services worldwide.

Regarding “Development of a postgraduate interventional cardiac nursing curriculum” by Currey et al.

publisher: Elsevier articletitle: Regarding “Development of a postgraduate interventional cardiac nursing curriculum” by Currey et al. journaltitle: Australian Critical Care articlelink: http://dx.doi.org/10.1016/j.aucc.2015.12.038 content_type: simple-article copyright: