Sandra West

New Graduate Nurses Adaptation to Shift Work: Can We Help?

Shift works desynchronisation of physiologically determined circadian rhythms has a major effect on the psychobiology of every shift worker. It is also commonly perceived that the effects of shift work contribute to the current New Graduate Nurses (NGNs) attrition rate. NGNs must also adjust to work within the health care system as they adapt to shift work, but do the initial effects of shift work as experienced by NGNs get better with time? This study aimed to describe the adaptation of NGNs to shiftwork. Levels of general health, sleep, fatigue, circadian type, job satisfaction, levels of burnout and the coping processes of 150 final year undergraduate students were investigated in a questionnaire based longitudinal study conducted over their initial twelve months of clinical practice as NGNs. Correlational analysis indicates that whilst shift work initially seriously disturbs sleep and other variables associated with individual and situational differences some adaptation was evident by twelve months. Social dysfunction scores (GHQ28) remained significantly related with variables associated with burnout, job satisfaction, sleep disturbance and life disruption at the twelve month point. The presence of depression on pre-shift work scales was also significantly related to continuing experience of sleep disruption and increased levels of emotional exhaustion throughout the twelve month period. Further investigation is required to establish the effect of shiftwork on outcome measures such as levels of burnout and job satisfaction for NGNs. However, although it is possible that improved preparation for shift work may assist the adaptation of NGNs to shift work during their first year of practice it is clear that attention to the organisation of nursing shift work would also be timely.

Nutritional intake in the critically ill: Improving practice through research

Enteral feeding is the preferred method of nutritional support in the critically ill; however, evidence suggests that many critically ill patients do not meet their nutritional goals. The implementation of enteral feeding protocols has improved nutritional delivery, although protocols can be widely variable. Similarly, enteral feeding related nursing practice is also inconsistent within and between intensive care units (ICUs). These variations in enteral feeding practice can be linked to the shortage of reliable and valid research into the many issues associated with the effective delivery of enteral nutrition. In the absence of a strong research tradition and practice, rituals are embraced and rarely challenged, further contributing to the wide variations in enteral feeding practice. Of particular importance are practice issues related to the commencement of enteral feeding and the assessment of feeding tolerance. This article seeks to review the literature related to commencing enteral feeding, with particular reference to the suitability of enteral nutrition, methods of enteral feeding and adjustment of enteral feeding rates. Issues relating to feeding intolerance, including the assessment of gastric residual volume and the development of diarrhoea, will also be explored.

Clinical credibility and trustworthiness are key characteristics used to identify colleagues from whom to seek information.

AIMS AND OBJECTIVES To explore the use of information by nurses making decisions in clinically uncertain situations in one aspect of critical care nursing practice (enteral feeding). In this paper, we report the characteristics, which participants identified as important, of the people from whom they sought information for the purpose of making clinical decisions. BACKGROUND Registered nurses have a plethora of information sources available to assist them in making clinical decisions. Identifying and selecting the best information to support these decisions can be difficult and is influenced by factors such as accessibility, usefulness and variations in quality of the information. DESIGN An instrumental case study design using multiple case study analysis. METHOD Twenty-two critical care nurses from two intensive care units contributed to the data through multiple methods of data collection including concurrent verbal protocols (think aloud), retrospective probing and focus group interviews. RESULTS Nurses preferentially used colleagues as a source of information when faced with uncertainty about their clinical practice. Most participants placed greater emphasis on evaluating the individual providing the information rather than on evaluating the information itself. Key features used for identifying an individual as a source of information included experience, clinical role, trust and approachability. CONCLUSION Establishing clearly what clinical credibility means, and to what extent trustworthiness and expertise play a role in the establishment of credibility, is an important debate for nursing. We need to carefully consider what defines the construct of clinical credibility and how this aligns with the concept of clinical currency, to allow clinicians to determine in others the characteristics associated with clinical credibility to access quality information through social interaction. RELEVANCE TO CLINICAL PRACTICE Processes to focus on determining the quality of information obtained from colleagues should be emphasised. What these processes are and how they could be implemented into clinical practice remains unknown and is highlighted as an area for future research.

Building research capacity and productivity among advanced practice nurses: an evaluation of the Community of Practice model

AIM The aim of this study was to evaluate Wengers Community of Practice as a framework for building research capacity and productivity. BACKGROUND While research productivity is an expected domain in influential models of advanced nursing practice, internationally it remains largely unmet. Establishment of nursing research capacity precedes productivity and consequently, there is a strong imperative to identify successful capacity-building models for nursing-focussed research in busy clinical environments. DESIGN Prospective, longitudinal, qualitative descriptive design was used in this study. METHODS Bruyns participant observation framed evaluation of a Community of Practice comprising 25 advanced practice nurses. Data from focus groups, education evaluations, blog/email transcripts and field observations, collected between 2007 and 2014, were analysed using a qualitative descriptive method. FINDINGS The Community of Practice model invited differing levels of participation, allowed for evolution of the research community and created a rhythm of research-related interactions and enduring research relationships. Participants described the value of research for their patients and families and the significance of the developing research culture in providing richness to their practice and visibility of their work to multidisciplinary colleagues. Extensive examples of research dissemination and enrolment in doctoral programmes further confirmed this value. CONCLUSION A Community of Practice framework is a powerful model enabling research capacity and productivity evidenced by publication. In developing a solid foundation for a nursing research culture, it should be recognized that research skills, confidence and growth develop over an extended period of time and success depends on skilled coordination and leadership.

Circadian Rhythm, Shiftworks and You!

Chronobiological knowledge is increasing and the relationship between this knowledge and shiftwork is becoming clearer. This, in turn, is highlighting a need to facilitate a mix of permanent (day, evening and night) and rotational shift systems within individual wards or units. Is it perhaps time to allow greater flexibility in how individual nurses deal with the professions need to care for patients throughout the 24 hour period? This review will focus on the 24 hour day-night or circadian rhythms and the consequences of the disruption of these rhythms as nurses undertake shiftwork and other activities which demand efficient functioning at times when an individuals circadian rhythms are expecting them to be at rest. As disruption of these rhythms is essentially unavoidable when 24 hour care is required, the choice becomes one of determining a preference for tolerable rhythm desynchrony and shorter more frequently occurring episodes of night work, or some degree of rhythm synchrony and adaptation during slightly longer but less frequent episodes of rhythm disruption. By Sandra West

Management of Postembolization Syndrome Following Hepatic Transarterial Chemoembolization for Primary or Metastatic Liver Cancer.

Background: Transarterial chemoembolization (TACE) is an established treatment in managing liver primary neoplasms or liver metastases. Postembolization syndrome (PES) is a common adverse event defined as fever without associated sepsis, pain in the right upper quadrant, and nausea and/or vomiting. Objective: This integrative review aims to identify effective management strategies for PES or one of its characterizing symptoms (fever, pain, and nausea and/or vomiting). Methods: Searches of electronic databases MEDLINE, EMBASE, and CINAHL were conducted. Fifteen articles were identified for inclusion. Seven addressed all symptoms of PES, and 8 studies focused on individual symptoms of PES. Results: Interventions identified are intra-arterial lidocaine, oral and intravenous analgesics, steroids, wrist-ankle acupuncture, antibiotics, and 5-HT3 receptor antagonists. Findings are explicated according to individual symptoms of PES. Intra-arterial lidocaine, steroids, and a 5-HT3 receptor antagonist are found to offer potential benefit in the management of PES symptoms. Conclusion: A number of interventions have shown potential benefit in the management of PES. A systemic approach using combination therapy is necessary to effectively manage characterizing symptoms. Further research is needed to determine the impact of primary disease site, TACE technique, and chemotherapeutic agent on PES. Implications for Practice: Oncology nurses are uniquely placed to undertake thorough patient assessment after TACE and implement early intervention to effectively manage PES.

Patient outcomes following lower leg major amputations for peripheral arterial disease: A series review

INTRODUCTION Despite improvements in revascularization, major amputation remains a significant part of the case-mix in vascular surgical units. These patients tend to be elderly with complex pathology, resulting in poor outcomes and longer lengths of stay (LOS). AIM This series review provides a description of the patient complexities and outcomes in an Australian cohort undergoing major lower limb amputation for peripheral arterial disease. METHOD Medical records coded for major amputation between July 2012 and June 2013 in an Australian government funded, tertiary hospital were retrospectively reviewed and descriptively analyzed. FINDINGS Twenty-five patients had 29 major amputations including four conversions from below to above knee. Seventeen had multiple vascular procedures before amputation. The average LOS exceeded the national target, and there was substantial morbidity and 30-day mortality. CONCLUSION Major amputation continues to present challenges because of patient frailty and the high rate of complications. These issues need to be considered in a robust care planning framework that includes consideration of cognitive decline and other markers of frailty. Opportunities to optimize the physical condition of these patients and to reduce delays in proceeding to surgery require further investigation.

Making meaning of nursing practices in acute care

Purpose – The purpose of this paper is to consider how meaning may be made of nursing practices by contrasting the rationalistic approach commonly used in the nursing literature with Bourdieu’s theory of practice. Design/methodology/approach – The data under consideration is an account of ten to 15 minutes of a larger ethnographic study of nursing practices which asks the question: how do nurses accomplish nursing within and between patients’ needs for care in the acute hospital setting? The five main sources of data were: observations of and conversations with nurse participants, as well as hospital documentation (including facility protocols and patients’ notes) and the observer’s field diary. These were woven together to provide an account of one nurse with one patient for a few moments of her day. Findings – Although this paper makes no attempt to speak to the rest of her workload, in these few minutes the nurse accomplishes multiple moments of nursing practice. Further, while the rationalistic approa...

Blended Learning in Health Professional Education

The impact of technology in society and particularly in educational settings is extensive, challenging traditional notions of teacher-centred approaches to learning, learners and learning locations. Now embedded within the higher education sector are (a) new learning technologies including software such as learning management systems and e-portfolios, (b) collaborative learning approaches such as case- and problem-based learning, and (c) professional demands for curricula that facilitate both critical and inquiry-based learning.