Lynette Cusack

Can We Predict Burnout among Student Nurses? An Exploration of the ICWR-1 Model of Individual Psychological Resilience.

The nature of nursing work is demanding and can be stressful. Previous studies have shown a high rate of burnout among employed nurses. Recently, efforts have been made to understand the role of resilience in determining the psychological adjustment of employed nurses. A theoretical model of resilience was proposed recently that includes several constructs identified in the literature related to resilience and to psychological functioning. As nursing students are the future of the nursing workforce it is important to advance our understanding of the determinants of resilience in this population. Student nurses who had completed their final practicum were invited to participate in an online survey measuring the key constructs of the ICWR-1 model. 422 students from across Australia and Canada completed the survey between July 2014 and July 2015. As well as several key demographics, trait negative affect, mindfulness, self-efficacy, coping, resilience, and burnout were measured. We used structural equation modeling and found support for the major pathways of the model; namely that resilience had a significant influence on the relationship between mindfulness, self-efficacy and coping, and psychological adjustment (burnout scores). Furthermore, as predicted, Neuroticism moderated the relationship between coping and burnout. Results are discussed in terms of potential approaches to supporting nursing students who may be at risk of burnout.

Understanding individual resilience in the workplace: The international collaboration of workforce resilience model

When not managed effectively, high levels of workplace stress can lead to several negative personal and performance outcomes. Some professional groups work in highly stressful settings and are therefore particularly at risk of conditions such as anxiety, depression, secondary traumatic stress, and burnout. However, some individuals are less affected by workplace stress and the associated negative outcomes. Such individuals have been described as “resilient.” A number of studies have found relationships between levels of individual resilience and specific negative outcomes such as burnout and compassion fatigue. However, because psychological resilience is a multi-dimensional construct it is necessary to more clearly delineate it from other related and overlapping constructs. The creation of a testable theoretical model of individual workforce resilience, which includes both stable traits (e.g., neuroticism) as well as more malleable intrapersonal factors (e.g., coping style), enables information to be derived that can eventually inform interventions aimed at enhancing individual resilience in the workplace. The purpose of this paper is to introduce a new theoretical model of individual workforce resilience that includes several intrapersonal constructs known to be central in the appraisal of and response to stressors and that also overlap with the construct of psychological resilience. We propose a model in which psychological resilience is hypothesized to mediate the relationship between neuroticism, mindfulness, self-efficacy, coping, and psychological adjustment.

Measuring disaster resilience in communities and households: Pragmatic tools developed in Australia

Purpose This paper aims to discuss the development of two toolkits that were designed to help communities and households measure their level of disaster resilience and provide practical tools to help them increase and maintain these levels. Design/methodology/approach The toolkits were developed across two studies, with the community toolkit development being undertaken first. A literature review was conducted to develop a definition and model of community disaster resilience; and a Scorecard was designed to assess levels of existing community disaster resilience. The definition and Scorecard were reviewed and refined with the help of two communities before a final version was trialled in four communities across Australia. The household toolkit project followed a similar approach, with trialling being undertaken in conjunction with two non-government organisations that carry out outreach work in the community. Findings The development and trial of the Scorecards was extremely valuable. The conclusion voiced by communities and reached by the study project teams was that the user-friendly Scorecard is a workable tool for people to assess their household and community disaster resilience and to come together to plan what might further strengthen resilience. Critical to the Scorecards’ success was an understanding of the purpose of the assessment tool and the meaning of resilience. Originality/value The toolkits take an all-hazards approach and help community members, individuals and local policymakers to set priorities, allocate funds and develop emergency and disaster management programmes that build local community resilience.

Extreme weather-related health needs of people who are homeless

To identify the extreme weather-related health needs of homeless people and the response by homeless service providers in Adelaide, South Australia, a five-phased qualitative interpretive study was undertaken. (1) Literature review, followed by semi-structured interviews with 25 homeless people to ascertain health needs during extreme weather events. (2) Identification of homeless services. (3) Semi-structured interviews with 16 homeless service providers regarding their response to the health needs of homeless people at times of extreme weather. (4) Gap analysis. (5) Suggestions for policy and planning. People experiencing homelessness describe adverse health impacts more from extreme cold, than extreme hot weather. They considered their health suffered more, because of wet bedding, clothes and shoes. They felt more depressed and less able to keep themselves well during cold, wet winters. However, homeless service providers were more focussed on planning for extra service responses during times of extreme heat rather than extreme cold. Even though a city may be considered to have a temperate climate with a history of very hot summers, primary homeless populations have health needs during winter months. The experiences and needs of homeless people should be considered in extreme weather policy and when planning responses.

‘Turning a blind eye’: denying people their right to treatment for acute alcohol, drug and mental health conditions – an act of discrimination

Background: Australians seeking health care from any public hospital have the right to non-discriminatory safe medical assessment, treatment and nursing care. The literature clearly indicates that people presenting to public hospitals with acute alcohol- or drug-related conditions are at risk of dying by being denied medical and nursing treatment. This denial of treatment is on the basis that their presumed condition is solely drug- and alcohol-related. There is often even a greater risk for Aboriginal people who present for treatment. This literature comprises reports from coronial inquiries, police incidents, safety audits, and critical incidents in health services, and anecdotal information from specialist drug and alcohol nurses. Such violation of this vulnerable populations right to safe health care has often resulted in suicide and other preventable deaths, disability and exacerbation of physical and mental illness. Method: A critique was conducted of recent available Australian ‘grey’ literature c...

A bibliographic exploration of nursing's scope of practice

AIM To conduct a bibliographic analysis of the indexed literature relating to scope of practice in nursing so as to identify underlying patterns in journal publication, volume of scholarly work over time, countries of origin, central contributors, academic affiliation and the major dimension of the studies conducted. METHODS A systematic search of the Scopus database provided data that was then extracted and utilized to undertake a bibliometric analysis of published work relating to scope of practice. In addition to identification of aggregated metrics relating to the most frequently occurring journals and most cited authors, a co-word analysis was conducted. RESULTS A total of 2730 articles with the term Scope of Practice in the Title, Abstract or Keywords were identified. Co-word analysis revealed five major themes - Changing Regulatory Environment; Health Care Drivers; Competence & Role Implementation; Policy Context; and Role Evolution & Role Differentiation. CONCLUSIONS AND POLICY IMPLICATIONS From a policy perspective, we conclude that bibliographic analysis of the indexed literature is a useful technique that can augment our understanding of key regulatory issues such as scope of practice. However, the overemphasis on advanced practice in the scope of practice literature coupled with the increased interest in task shifting to support-personnel as governments pursue the goal of universal health coverage may leave nursing inadequately prepared to inform any evidence-based policy change.

Flexibility in Competency-Based Workplace Transition Programs: An Exploratory Study of Community Child and Family Health Nursing

BACKGROUND Successful transition to practice programs that use competency-based assessment require the involvement of all staff, especially those undertaking the preceptor role. METHODS Qualitative data were collected using interview methods. Participants were 14 newly employed nurses and 7 preceptors in the child and family community health service in South Australia. Participant narratives were recorded electronically, transcribed, and thematically analyzed using the paradigm of critical social science. RESULTS Five themes were identified that describe enablers as well as barriers to applying a flexible transition to practice program using competency-based assessment. These included flexibility in the program design, flexibility on the part of preceptors, flexibility to enable recognition of previous learning, flexibility in the assessment of competencies, and flexibility in workload. CONCLUSION To ensure successful application of a transition to practice program using competency-based assessment, preceptors must understand the flexible arrangements built into the program design and have the confidence and competence to apply them.

Australia and the United States

Since assuming the Foreign Affairs and Trade portfolio, I have not given a major speech in Australia on Australias relations with the United States. I thought it was time to do so because it is a relationship, both in reality and in public perception, which looms exceedingly large in our foreign affairs and trade thinking. My recent visit to Washington, the attention that Australia-United States trade problems received in the aftermath of Vice President Quayles visit, and the publicity given to the ANZUS question by the Yale University speech of the New Zealand Prime Minister, all make it timely to offer an analysis of Australia-United States relations, and of the policy and perceptions behind those relations.

Call for national dialogue: Adapting standards of care in extreme events. We are not ready

Summary Clinical practices are based on a common understanding of nursings professional standards in all aspects of patient care, no matter what the circumstances are. Circumstances can however, change dramatically due to emergencies, disasters, or pandemics and may make it difficult to meet the standard of care in the way nurses are accustomed. The Australian nursing profession has not yet facilitated a broad discussion and debate at the professional and institutional level about adapting standards of care under extreme conditions, a dialogue which goes beyond the content of basic emergency and disaster preparedness. The purpose of this paper is to encourage discussion within the nursing profession on this important ethical and legal issue. A comprehensive review of the literature was undertaken to determine the state of the evidence in relation to adapting standards of care under extreme conditions. Content analysis of the literature identified categories related to adapting standards of care that have been considered by individuals or groups that should be considered in Australia, should a dialogue be undertaken. The categories include ethical expectations of professional practice; legal interpretation of care requirements, resource priority between hospital and public health and informing communities. Literature reviews and commentary may provide the background for a national dialogue on the nursing response in an extreme event. However, it is only with the engagement of a broadly representative segment of the professional nursing community that appropriate guidance on adapting standards of care under extreme conditions can be developed and then integrated into the professional worldview of nursing in Australia.

‘Sometimes your safety goes a bit by the wayside’ … exploring occupational health and safety (OHS) with student nurses

Because nursing is a high risk profession in terms of occupational health and safety (OHS), the topic of OHS is an important component of student nurse education and practice. Seeking ways to enhance curricular content and foster student health, safety and wellbeing is an ongoing pursuit. This pilot study explored nursing student perspectives about OHS in the clinical setting to develop an understanding of student views that could enlighten teaching about this topic within the undergraduate nursing course. Focus groups were held with pre-registration student nurses in two discrete cohort levels (first and third year). Themes were identified from the focus group discussion about trust, knowledge and responsibility. The students demonstrated a sound grasp of clinical hazards and associated administrative controls. Strengthening student awareness of higher order controls and their evaluation would augment their knowledge of legislative requirements. Students may benefit from learning about a risk management approach to OHS which would provide them with a structured basis for problem solving. This may assist them with clinical reasoning about health and safety issues and empower them in aspects of self-care.