Kerri Holzhauser

Nurses' Moral Sensitivity and Hospital Ethical Climate: a Literature Review

Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This article reports on the findings of a systematic review of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement.

A comparison of activities undertaken by enrolled and registered nurses on medical wards in Australia: An observational study

BACKGROUND The past decade has seen increasing patient acuity and shortening lengths of stays in acute care hospitals, which has implications for how nursing staff organise and provide care to patients. OBJECTIVE The aim of this study was to describe the activities undertaken by enrolled nurses (ENs) and registered nurses (RNs) on acute medical wards in two Australian hospitals. DESIGN This study used structured observation, employing a work sampling technique, to identify the activities undertaken by nursing staff in four wards in two hospitals. Nursing staff were observed for two weeks. The data collection instrument identified 25 activities grouped into four categories, direct patient care, indirect care, unit related activities and personal activities. SETTING Two hospitals in Queensland, Australia. RESULTS A total of 114 nursing staff were observed undertaking 14,528 activities during 482h of data collection. In total, 6870 (47.3%) indirect, 4826 (33.2%) direct, 1960 (13.5%) personal and 872 (6.0%) unit related activities were recorded. Within the direct patient care activities, the five most frequently observed activities (out of a total of 10 activities) for all classifications of nursing staff were quite similar (admission and assessment, hygiene and patient/family interaction, medication and IV administration and procedures), however the absolute proportion of Level 2 RN activities were much lower than the other two groups. In terms of indirect care, three of the four most commonly occurring activities (out of a total of eight activities) were similar among groups (patient rounds and team meetings, verbal report/handover and care planning and clinical pathways). The six unit related activities occurred rarely for all groups of nurses. CONCLUSION This study suggests that similarities exist in the activities undertaken by ENs and Level 1 RNs, supporting the contention that role boundaries are no longer clearly delineated.

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.

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.

Leadership: the critical success factor in the rise or fall of useful research activity

AIM To describe how momentum towards building research capacity has developed through aligning research activity with executive responsibility via strategic planning processes that direct operational structures and processes for research activity. BACKGROUND Reflecting on the development of research capacity over many years at complex tertiary referral hospitals reveals that building nursing knowledge is too important to be left to chance or whim but needs a strategic focus, appropriate resourcing and long-term sustainability through infrastructure. KEY ISSUES A number of key approaches we uncovered as successful include: (i) articulation of questions consistent with the strategic direction of the health context that can be addressed through research evidence; (ii) engagement and dissemination through making research meaningful; and (iii) feedback that informs the executive about the contribution of research activity to guide policy and practice decisions. CONCLUSIONS Leadership teams need to ensure that the development of research knowledge is a strategic priority. The focus also needs to be more broadly on creating research capacity than focussing on small operational issues. IMPLICATIONS FOR NURSING MANAGEMENT Research capacity is developed when it is initiated, supported and monitored by leadership.

Improving pain management of abdominal pain in children presenting to the paediatric emergency department: A pre–post interventional study

BACKGROUND In 2007, the Mater Childrens Hospital Emergency Department participated in the Emergency Care Pain Management Initiative funded by the National Health and Medical Research Council National Institute of Clinical Studies (NHMRC-NICS). The findings of this NHMRC-NICS research across eleven paediatric emergency departments highlighted deficits in pain management of abdominal pain. Specifically pain assessment, timeliness of analgesia, and pain management guidelines were found to be lacking. METHODS In response to the NICS report local practice was reviewed and a pilot research project undertaken to develop a clinical guideline for the pain management of abdominal pain in children presenting to the emergency department. The guideline was developed by an expert panel and trialled using a pre and post intervention design. RESULTS The results demonstrated improved compliance to assessment and documentation of pain scores and assimilation of the best practice principles recommended in the guideline. CONCLUSIONS This project raised local awareness in the pain management of abdominal pain and provides baseline information for future improvement. The guideline has been trialled in the clinical setting of paediatric emergency and has the potential to improve pain management practices in children presenting to the emergency department with abdominal pain.

Developing a Research-Active Clinical Environment Within the Emergency Department: A Case Study

Historically, nursing research undertaken in the clinical setting has been problematic. Problems included small samples, weak methodology, poorly designed tools, limited analyses, and little dissemination. These issues have made it difficult to apply some of the research within an evidence-based framework. A visiting scholar program was developed to link experienced researchers with clinicians for them to undertake more rigorous nursing research in the clinical setting. An example of the application of the visiting scholar program within an emergency department setting illustrates positive research outcomes for both clinical staff and academic scholars.