Sally Lima

'I don't want to hurt him.' Parents' experiences of learning to administer clotting factor to their child.

To explore the experiences and educational needs of parents learning to use an Implanted Central Venous Access Device (IVAD) to administer clotting factor to their child with haemophilia. Parents of children with haemophilia who had learnt to administer clotting factor via IVAD attended focus groups to discuss their experiences of the learning process. Data were transcribed and analyzed thematically. Parents described distress and trauma in dealing with the diagnosis and treatment of their childs haemophilia. It was within this context that parents began the IVAD education process. Four major themes emerged from the data: dealing with fear and anxiety; a supportive learning environment; establishing a ritual and empowerment and liberation. Parents identified a supportive learning environment as their critical need rather than a specific learning process. In addition, the concept of ritual emerged both as a mechanism for increasing the childs comfort with the procedure and as a valuable learning tool for their parents. This study highlights the importance of consulting consumers to understand their experience of illness and their educational needs. Patient and family education programs should not be limited to the provision of information, but must establish and incorporate the needs of the learner.

The experiences and needs of mothers supporting young adolescents with intellectual disabilities through puberty and emerging sexuality

The aim of this study was to describe the experiences and needs of mothers supporting young adolescents with intellectual disabilities through puberty and emerging sexuality. A qualitative descriptive study design was utilised. Six mothers of adolescents with intellectual disabilities were interviewed, using a semi-structured format. Thematic analysis was used to organise the data. Two core themes were identified: the first theme described the reactions of mothers to adolescent development, which included the sub-themes of acceptance, anxiety, and avoidance; the second theme was parental support needs, which included the sub-themes of preparing parents, individualising information, seeking support, and exploring ethics. By describing and understanding mothers’ experiences of supporting young adolescents with intellectual disabilities, this study has highlighted a clear role for professionals in providing individual and family education. It has also suggested the need for a safe forum for parents to explor...

Employing a clinical governance framework to engage nurses in research.

The theoretical benefits of engaging in quality and research activities are readily apparent; however, engagement of clinical nurses in these pursuits remains challenging. In addition, the separation of quality improvement and research as distinct endeavors can impair desired improvements in patient outcomes. We propose that employing a clinical governance framework to inform nursing research in the clinical setting enhances the engagement of nurses in the generation and utilization of evidence to improve the quality of care.

Empirical evolution of a framework that supports the development of nursing competence

AIM The aim of this study was to refine a framework for developing competence, for graduate nurses new to paediatric nursing in a transition programme. BACKGROUND A competent healthcare workforce is essential to ensuring quality care. There are strong professional and societal expectations that nurses will be competent. Despite the importance of the topic, the most effective means through which competence develops remains elusive. DESIGN A qualitative explanatory method was applied as part of a mixed methods design. METHODS Twenty-one graduate nurses taking part in a 12-month transition programme participated in semi-structured interviews between October and November 2013. Interviews were informed by data analysed during a preceding quantitative phase. Participants were provided with their quantitative results and a preliminary model for development of competence and asked to explain why their competence had developed as it had. RESULTS The findings from the interviews, considered in combination with the preliminary model and quantitative results, enabled conceptualization of a Framework for Developing Competence. Key elements include: the individual in the team, identification and interpretation of standards, asking questions, guidance and engaging in endeavours, all taking place in a particular context. CONCLUSION Much time and resources are directed at supporting the development of nursing competence, with little evidence as to the most effective means. This study led to conceptualization of a theory thought to underpin the development of nursing competence, particularly in a paediatric setting for graduate nurses. Future research should be directed at investigating the framework in other settings.

PEDIATRIC PRESSURE INJURIES: DOES MODIFYING A TOOL ALTER THE RISK ASSESSMENT OUTCOME?

The aim of this study was to determine whether assessing patient risk of developing pressure injuries in Pediatric Intensive Care (PICU) and Neonatal Units (NNU) using a modification of the Glamorgan Scale (mGS) would alter the risk identification when compared to the Glamorgan Scale (GS). Prospective data were collected from a convenience sample of patients admitted to PICU or NNU during a 2-month period. The patients’ pressure injury risk score using both instruments was collected by observing patients, reviewing patient records, and clarifying information with bedside nurses. Chi square analysis was used to compare the risk category allocations. A total of 133 patients were assessed with complete data available for 112 (PICU = 68, NNU = 65). The total number of admissions during the data collection period was 202 in PICU and 100 in NNU. There was an extensive spread of patients allocated to the “High Risk” and “Very High Risk” categories in both units. Only one was in the lower “At Risk” category. There was little difference in allocated risk category between the mGS and the GS (p = 0.982). Only one patient was not allocated to the same risk category by both tools. In addition to identifying little difference in risk identification the mGS was found to be easier to complete. The mGS delivered the same risk rating as the GS when applied to patients in the PICU and NNU. It is not clear if a similar agreement exists in the general pediatric population. When modifying a validated tool for local use consideration should be given as to how those modifications might alter outcomes.

The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session

Inadequate resuscitation leads to death or brain injury. Recent recommendations for resuscitation team training to complement knowledge and skills training highlighted the need for development of an effective team resuscitation training session. This study aimed to evaluate and revise an interprofessional team training session which addressed roles and performance during provision of paediatric resuscitation, through incorporation of real-time, real team simulated training episodes. This study was conducted applying the principles of action research. Two cycles of data collection, evaluation and refinement of a 30-40 minute resuscitation training session for doctors and nurses occurred. Doctors and nurses made up 4 groups of training session participants. Their responses to the training were evaluated through thematic analysis of rich qualitative data gathered in focus groups held immediately after each training session. Major themes included the importance of realism, teamwork, and reflective learning. Findings informed important training session changes. These included; committed in-situ training; team diversity; realistic resources; role flexibility, definition and leadership; increased debriefing time and the addition of a team goal. In conclusion, incorporation of interprofessional resuscitation training which addresses team roles and responsibilities into standard medical and nursing training will enhance preparedness for participation in paediatric resuscitation.

Engaging a Nursing Workforce in Evidence‐Based Practice: Introduction of a Nursing Clinical Effectiveness Committee

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

G37(P) An element of competition can improve journal club engagement

Background Journal clubs (JC) can increase critical appraisal skills and aid in promoting evidence based practice.1 Often, after an initial flourish, a JCs popularity wanes.2,3 Innovative approaches to improving JC participation are required2 but few have been described. In 2013, to increase nurse’s engagement with a hospital-wide nursing JC, a competition format was convened. Aim To obtain an understanding of a competition elements impact on paediatric nurses JC engagement. Method Twelve departments, of a dedicated paediatric hospital, were randomly assigned a month to present JC. Departmental nurses were supported to evaluate an article according to a framework.4 A predetermined rubric guided marking. Post competition, with ethics committee approval (HREC-33167), all hospital nurses received an anonymous online survey invitation. Demographic, Likert scale and freeform information was collected. Questions elicited attitudes and perceived barriers or facilitators to JC. Freeform data was themed. Survey completers could provide separate details to win a voucher. Results Compared to the previous year there was a significant increase in JC attendance (2013 mean = 22 vs. 2012 mean=10, t-test p = 0.00001). Full online survey responses were received from 289/1674 (response rate 17.3%) of sent invitations (non-attendees n = 224, attendees n = 65 (18 presenters). Overall, attendees reported JC had a positive impact on their professional engagement, as shown in Figure 1. Presenters rated highly the JC format as it developed skills and increased JC confidence, as shown in Figure 2. Freeform themes indicated issues of time, session location, JC advertising and increased topic variety. Abstract G37 Figure 1 Engagement by attendees with the nursing journal club (n = 65) Abstract G37 Figure 2 Process of presenting at the nursing journal club (n = 18) Conclusion A competition format can increase nurses JC engagement and participation. Further work is required to establish applicability of this format to other settings. References Harris J, Kearley K, Heneghan C, et al. Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16. Med Teacher 2011;33:9–23. Swift G. How to make journal clubs interesting. Adv Psychiatr Treat. 2004;10:67–72. Silversides A. Journal clubs: A forum for discussion and professional development. Can Nurse 2011;107:18–23. Schwartz MD, Dowell D, Aperi J, Kalet AL. Improving journal club presentations, or, I can present that paper in under 10 minutes. Evid Based Med. 2007;12:66–8.