Kristen Ranse

An exploratory study of first year nursing students' learning in the clinical workplace.

Abstract This study explored how first year undergraduate nursing students learn in clinical placements as part of a program informed by Wenger’s (1998) social theory of learning. Forty-nine written student narrative accounts of a learning experience were analysed and three triggers for learning were identified. The first trigger is that participation (or observation) of a task or procedure leads students into a complex, dramatic reading of nursing work. The second is that when students are personally (emotionally) confronted by the work, it presents a high challenge situation, recognized by students as a significant learning opportunity. The third trigger is encounters with different nurses assist students to construct an image of what they want to be as a nurse. These three triggers appear to align with Wenger’s Communities of Practice constructs for identity, engagement, imagination, and alignment, and provides preliminary evidence supportive of the social theory of learning for nursing students on clinical placement.

Factors influencing the provision of end-of-life care in critical care settings: development and testing of a survey instrument.

AIM To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses. BACKGROUND Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses. DESIGN A cross-sectional survey of critical care nurses. METHOD An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience sample of critical care nurses (n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics. RESULTS Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting. CONCLUSION This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of end-of-life care and improve the care that patients and their families receive.

End-of-life care practices of critical care nurses: A national cross-sectional survey

BACKGROUND The critical care context presents important opportunities for nurses to deliver skilled, comprehensive care to patients at the end of life and their families. Limited research has identified the actual end-of-life care practices of critical care nurses. OBJECTIVE To identify the end-of-life care practices of critical care nurses. DESIGN A national cross-sectional online survey. METHODS The survey was distributed to members of an Australian critical care nursing association and 392 critical care nurses (response rate 25%) completed the survey. Exploratory factor analysis using principal axis factoring with oblique rotation was undertaken on survey responses to identify the domains of end-of-life care practice. Descriptive statistics were calculated for individual survey items. RESULTS Exploratory factor analysis identified six domains of end-of-life care practice: information sharing, environmental modification, emotional support, patient and family centred decision-making, symptom management and spiritual support. Descriptive statistics identified a high level of engagement in information sharing and environmental modification practices and less frequent engagement in items from the emotional support and symptom management practice areas. CONCLUSIONS The findings of this study identified domains of end-of-life care practice, and critical care nurse engagement in these practices. The findings highlight future training and practice development opportunities, including the need for experiential learning targeting the emotional support practice domain. Further research is needed to enhance knowledge of symptom management practices during the provision of end-of-life care to inform and improve practice in this area.

Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses

BACKGROUND A core component of family-centred nursing care during the provision of end-of-life care in intensive care settings is information sharing with families. Yet little is known about information provided in these circumstances. OBJECTIVE To identify information most frequently given by critical care nurses to families in preparation for and during withdrawal of life-sustaining treatment. DESIGN An online cross-sectional survey. METHODS During May 2015, critical care nurses in Australia and New Zealand were invited to complete the Preparing Families for Treatment Withdrawal questionnaire. Data analysis included descriptive statistics to identify areas of information most and least frequently shared with families. Cross tabulations with demographic data were used to explore any associations in the data. RESULTS From the responses of 159 critical care nurses, information related to the emotional care and support of the family was most frequently provided to families in preparation for and during withdrawal of life-sustaining treatment. Variation was noted in the frequency of provision of information across body systems and their associated physical changes during the dying process. Significant associations (p<0.05) were identified between the variables gender, nursing experience and critical care experiences and some of the information items most and least frequently provided. CONCLUSIONS The provision of information during end-of-life care reflects a family-centred care approach by critical care nurses with information pertaining to emotional care and support of the family paramount. The findings of this study provide a useful framework for the development of interventions to improve practice and support nurses in communicating with families at this time.

Assessing ageist behaviours in undergraduate nursing students using the Relating to Older People Evaluation (ROPE) survey

To describe the prevalence of ageist behaviours amongst first‐year undergraduate nursing students.

Navigating communication with families during withdrawal of life‐sustaining treatment in intensive care: A qualitative descriptive study in Australia and New Zealand

AIMS AND OBJECTIVES To explore how nurses navigate communication with families during withdrawal of life-sustaining treatment in intensive care. BACKGROUND Death in the intensive care unit is seldom unexpected and often happens following the withdrawal of life-sustaining treatment. A family-centred approach to care relies on the development of a therapeutic relationship and understanding of what is happening to the patient. Whilst previous research has focused on the transition from cure to palliation and the nurses role in supporting families, less is known about how nurses navigate communication with families during treatment withdrawal. DESIGN A qualitative descriptive approach was used. Semi-structured focus groups were conducted with adult critical care nurses from four intensive care units, two in Australia and two in New Zealand. RESULTS Twenty-one nurses participated in the study. Inductive content analysis revealed five key themes relating to how nurses navigate family communication: (1) establishing the WHO; (2) working out HOW; (3) judging WHEN; (4) assessing the WHAT; and (5) WHERE these skills were learnt. CONCLUSIONS Navigating an approach to family communication during treatment withdrawal is a complex and multifaceted nursing activity that is known to contribute to family satisfaction with care. There is need for support and ongoing education opportunities that develop the art of communication in this frequently encountered aspect of end-of-life care. RELEVANCE TO CLINICAL PRACTICE How nurses navigate communication with families during treatment withdrawal is just as important as what is communicated. Nurses need access to supports and education opportunities in order to be able to perform this vital role.

In-hospital experiences of families of potential organ donors: A systematic review and qualitative synthesis

Information and compassion assist families of potential organ donors to make informed decisions. However, psychological implications of the in-hospital process are not well described with past research focusing on decision-making. To enhance understanding and improve service delivery, a systematic review was conducted. Inductive analysis and synthesis utilised Grounded Theory Methodology within a systems theory framework and contributed to a model proposing that family and staff form a System of Systems with shared responsibility for process outcomes. This model can guide evaluation and improvement of care and will be tested by means of a longitudinal study of family experiences.

A novel approach to studying co-evolution of understanding and research: Family bereavement and the potential for organ donation as a case study:

A novel approach to data extraction and synthesis was used to explore the connections between research priorities, understanding and practice improvement associated with family bereavement in the context of the potential for organ donation. Conducting the review as a qualitative longitudinal study highlighted changes over time, and extraction of citation-related data facilitated an analysis of the interaction in this field. It was found that lack of ‘communication’ between researchers contributes to information being ‘lost’ and then later ‘rediscovered’. It is recommended that researchers should plan early for dissemination and practice improvement to ensure that research contributes to change.

Third-year nursing students’ lived experience of caring for the dying: a hermeneutic phenomenological approach

Background: In preparation for practice as a Registered Nurse, it is essential that students are equipped to care for the dying patient and their family. Aim: To explore nursing students’ lived experience of caring for a dying patient and their family. Design: Hermeneutic phenomenology. Methods: Students who had cared for a dying patient in their final year of study were invited to participate in an interview. Participants’ narratives (n = 6) were thematically analysed. Findings: Analysis revealed three themes: being caring, unexpectedness in witnessing an expected death and experiencing loss. Students demonstrated family-centred care but recounted unexpectedness in both the dying trajectory and physical changes in the dying patient. When reflecting on experiencing loss, students questioned their own actions, acknowledged the value of relationships and identified ways to cope. Conclusions: Engaging students in the care of dying patients and providing appropriate preparation/support can influence their experience and the care they provide in the future.

The development of a narrative describing the bereavement of families of potential organ donors: A systematic review:

Families of potential post-mortem organ donors face various challenges in the unfamiliar hospital context and after returning home. This review of sources published between 1968 and 2017 seeks to understand their journey as a bereavement experience with a number of unique features. Grief theory was used to identify ways that staff can assist family members to tolerate ambiguities and vulnerabilities while contributing to an environment characterised by compassion and social inclusion. Staff can guide families and create opportunities for meaningful participation, building resilience and developing bereavement-related skills that could assist them in the months that follow.