Mary FitzGerald

Reasons for physically restraining patients and residents: a systematic review and content analysis

OBJECTIVE The purpose of this systematic review was to determine why people are physically restrained in the acute and residential care settings. METHOD A comprehensive search was undertaken of electronic databases to identify studies addressing the reasons for using physical restraint. Findings were synthesised using content analysis. RESULTS Twenty-three studies were identified. The most common reason for using restraints related to patient-oriented issues such as ensuring the safety of people. However, they are also commonly used to facilitate treatment, maintain the social environment and because of issues such as understaffing.

Quality clinical placements for undergraduate nursing students: a cross-sectional survey of undergraduates and supervising nurses.

AIM   This article is a report of a mixed method study of the quality of clinical placements for second year undergraduate nursing students in an acute care hospital. BACKGROUND   In response to the current and predicted workforce shortages, greater numbers of nursing undergraduate places are being offered at tertiary institutions. This means that requests for clinical places in hospitals to support undergraduate students has risen. Little is known about the impact of increased numbers on the quality of clinical placement as a learning experience and this is of concern as demand grows and the means of assessing capacity is still unknown. METHODS   A 5-point Likert Scale questionnaire, including free text fields, was administered to undergraduates (n = 178), clinical facilitators (n = 22) and supervising ward nurses (n = 163) at two time points in 2009. The survey targeted the quality of the clinical placement in four domains: welcoming and belongingness; teaching and learning; feedback; confidence and competence. Findings.  The findings demonstrated consistently high scoring of the clinical placement experience by both undergraduates and registered nurses. There were higher ratings of levels of support from clinical facilitators compared to supervising ward nurses evident in data associated with the items on the questionnaire relating to teaching and learning. CONCLUSION   The results are indicative of the professional commitment of nursing staff to support the next generation of nurses. The findings also give a mechanism to communicate outcomes of undergraduate support to nurses in practice, and highlight steps which can be taken to ensure high quality clinical placement continues.

The experience of physical restraint: a systematic review of qualitative research.

Abstract The objective of this review was to summarise the experience of physical restraint from the perspectives of the person subject to restraint and of their family. A review of interpretive and descriptive research was undertaken that entailed a comprehensive literature search. Studies were included in the review if they provided qualitative data on this experience. An interpretive data synthesis was undertaken to generate a composite description of the experience of restraint. Findings highlight the predominantly negative impact of physical restraint on the person restrained and their family. These findings support the most minimal use of restraint in health care and give voice to a relatively powerless and vulnerable group of people.

Nurses' views on competency indicators for Australian Nursing

This paper reports on a project commissioned by the Australian Nursing Council Inc that sought to develop an approach to the maintenance of continuing competence in nursing broadly acceptable to nurses in all states and territories. This project involved extensive consultation with nurses, consumers and key stakeholders on appropriate competence indicators. Findings suggest that a majority of nurses support the development of competence indicators but most are confused about the nature of competence.

The Immediate Needs of Relatives during the Hospitalisation of Acutely Ill Older Relatives

The main aim of this study was to explore the immediate needs of the relatives of acutely ill older people during hospitalisation. The research question posed was: ‘What are the immediate needs of the relatives of acutely ill older people in the hospital setting?’ A descriptive qualitative approach was utilized, with ethnographic data collection methods and thematic data analysis. Unstructured interviews were conducted with relatives of older people who were admitted for acute care. The setting for the study included two large tertiary referral hospitals located in two area health services in New South Wales, Australia. Analysis of data revealed two themes: being informed and being there. Being informed describes the nature of the information that relatives need and why this is so important to them. Being there illustrates how relatives perceive their roles and responsibility during hospitalisation. It highlights the importance of this and the impact it has on individuals The findings highlight the importance of appreciating the family’s experiences in relation to the care of their older family member. They point to the need for education of stakeholders to focus on relatives as well as the older patient, improved assessment incorporating a whole of family approach on admission to hospital, and finally, facilitating positive relationships between ward staff and families.

The Invisible Nurse—Behind the Scenes in an Australian OR

THE DWINDLING NUMBER of RNs choosing to work in the OR has been caused by many factors, such as restricted undergraduate exposure to the perioperative experience and fewer postgraduate opportunities. PRESSURE TO IDENTIFY alternative health care workers to replace RNs in the OR is escalating to a point where the role of the perioperative RN, as currently understood, is threatened. FINDINGS from an Australian ethnographic study suggest that both patients and non-nursing colleagues have limited appreciation of the contribution that perioperative nurses make. THE NEED FOR NURSES to take a proactive stance on this subject is discussed within the context of professional and structural change.

Delirium Dichotomy: A review of recent literature.

Delirium remains a commonly occurring problem for older people and staff in acute care settings. The aim of this review of current literature is to find contemporary evidence on which to base practice modalities. Although the literature provides an exposition of the concerns with which practitioners are currently faced and highlights the consistent themes identified, there is little research evidence regarding the effectiveness of treatment protocols for the management of older people with delirium in acute care setting.

Clinical practice development in Central Coast Health

Engagement in clinical practice development may be achieved in a range of ways. In this paper we describe the formation of a strategic plan for clinical practice development for Central Coast Health. The plan specifically builds on the work that has already been achieved by clinicians and is inclusive of the multi-disciplinary team. In order to clarify the strategic direction, three levels of clinical practice development are offered as examples of increasingly intensive clinical practice development. In the strategic plan senior personnel are recruited to support area-wide developments. At the same time clinicians are supported to work on specific local projects creating a simultaneous top-down and bottom-up approach. Preparation of clinicians for the challenges of team building and change in practice ensures that people choosing to engage in clinical practice have realistic expectations of the commitment and rewards that may be expected.

Renegotiating roles as part of developing collaborative practice: Australian nurses in general practice and cervical screening

This paper reports the findings from an action research study that used a reflective group method to work with nurses in general practice recently credentialed as cervical screeners. The research aimed to develop a new model of practice nurse service delivery within a multidisciplinary team. Findings demonstrated that poor interdisciplinary collaboration created barriers to changing the role of the practice nurse. Key themes identified were: renegotiating their roles, identifying and negotiating gendered patterns of cervical screening, and the effect of multidisciplinary teams and interdisciplinary collaboration on practice nurse retention. Recommendations from this study address the need for improved piloting of new initiatives and an increase in continuing professional development for practice managers who are potential change agents.

Development and reliability testing of the quality clinical placement evaluation tool

AIMS AND OBJECTIVES To develop and test the content and face validity, and reliability of the quality clinical placement evaluation tool. BACKGROUND The importance of clinical experience during undergraduate nursing degrees is undisputed. To date, tools available to measure quality of clinical placements have focused on single perspectives, that of the undergraduate or that of the supervising nurse. The quality clinical placement evaluation tool was proposed to provide an assessment of clinical placement experiences informed by supervising ward nurses and undergraduate stakeholders. DESIGN The study employed a cross-sectional design. METHODS The internal validity of an existing instrument was evaluated by an expert panel and modified for use in the acute care sector. Surveys were completed by undergraduate students (n = 48) and supervising ward nurses (n = 47). Factor analysis was used to identify themes drawn from the literature and explore redundancy of items. Reliability was assessed using Cronbachs alpha for internal consistency and test-retest (five to seven days apart). RESULTS Reliability testing showed good internal consistency for the tool; test-retest reliability testing results were moderate to good for students and fair to moderate for nurses. Factor analysis identified three core themes related to supervising ward nurse responses that could also be applied to undergraduate nurses. The domains identified were the following: welcome and belonging; support to meet learning needs; and confidence and competence: reflections on learning. CONCLUSIONS The quality clinical placement evaluation has shown statistically acceptable levels of reliability and validity for measuring the quality of clinical placement from perspectives of undergraduates and supervising ward nurses. RELEVANCE TO CLINICAL PRACTICE The tool provides tertiary institutions, acute care facilities, wards and individuals with the means to capture views of the quality of clinical placement which can also be used to undertake comparisons over time and between sites.