Trudy Dwyer

Nurses' behaviour regarding CPR and the theories of reasoned action and planned behaviour.

Cardiopulmonary resuscitation (CPR) has been used in hospitals for approximately 40 years. Nurses are generally the first responders to a cardiac arrest and initiate basic life support while waiting for the advanced cardiac life support team to arrive. Speed and competence of the first responder are factors contributing to the initial survival of a person following a cardiac arrest. Attitudes of individual nurses may influence the speed and level of involvement in true emergency situations. This paper uses the theories of reasoned action and planned behaviour to examine some behavioural issues with CPR involvement.

Psychological factors inhibit family members' confidence to initiate CPR.

Introduction. A minority of bystanders will initiate cardiopulmonary (CPR) when a family member collapses in the home. This study sought to better understand the psychological barriers to family-initiated CPR andto determine whether sociodemographic variables are influential. Methods. Twelve hundred andeight people were contacted via telephone andasked about their experience with CPR experiences andattitudes toward initiating CPR on a family member. Results. Seventy-four percent of participants had learnt CPR and68 percent were confident to initiate CPR on a family member. Men, people who had learnt CPR, andpeople with more than 11 years of education were the most confident groups. People older than 65 were the group least likely to have learnt CPR andleast confident to initiate CPR. Participants confident to initiate CPR expressed concerns about fear of failing (37%) or indicated they had no concerns (30%). In contrast, those not confident were most concerned about performing CPR correctly (55%) and30% were afraid of failing. Conclusion CPR courses are not reaching those most likely to be called upon to use this skill. Moreover, even among those with CPR training, the desire to “get it right” andfear of failing impair confidence. Psychological barriers to performing CPR should be addressed in training courses, particularly for those groups with the least confidence, such as older people.

A Comparison of Face-to-Face or Internet-Delivered Physical Activity Intervention on Targeted Determinants

This article describes the equivalency testing results of a 12-week behavior change program on targeted determinates of physical activity (PA) and self-reported health status. Participants (n = 192) were randomized to face-to-face, combined Internet and face-to-face, and Internet-only groups. Equivalency testing was used to examine differences and statistical equivalency across groups for all outcome measures (social support, self-efficacy, perceived health status, and motivational readiness for PA). Participants were assessed at baseline, postintervention, and 2 and 5 months postintervention. Motivational readiness for PA increased across all groups. The face-to-face and combined groups showed changes in social support; however, they were not statistically different and were equivalent. There were no changes in self-efficacy or physical health status. Overall face-to-face and the Internet delivery modes show similar results. If Internet-based programs can be shown to be as effective as face-to-face, they may in turn be a more efficient and cost-effective delivery method.

Supporting bachelor of nursing students within the clinical environment: Perspectives of preceptors

UNLABELLED Student learning in the clinical environment is a cornerstone of pedagogy for students undertaking a Bachelor of Nursing in Australia. METHOD This paper presents the results of a survey that was conducted with registered nurses who preceptor students for universities in Australia. FINDINGS Findings reveal that some preceptors do not hold the qualification they are preceptoring students to obtain, that university involvement in preparation of preceptors is scant and that resource provision and communication from universities to preceptors is considered problematic. Registered nurses choose to act as preceptors for reasons that are both altruistic and professional. They are often employed in senior positions and as such find it difficult to manage time and resolve role conflict. CONCLUSION This paper concludes that the registered nurses who preceptor students generally have a positive experience but require greater involvement by universities in their preparation, particularly when they are responsible for the direct assessment of students. The paper posits this may be best achieved by universities creating effective lines of communication and ongoing support. This will sustain collaborative and meaningful engagement with registered nurses who preceptor undergraduate students.

Examination of program exposure across intervention delivery modes: face-to-face versus internet

BackgroundThere has been increasing interest in the ability of the internet to produce behaviour change. The focus of this study was to describe program exposure across three intervention groups from a randomised trial (RT) comparing traditional face-to-face, internet-mediated (combined internet plus face-to-face), and internet-only program delivery.MethodsBaseline and immediately post-intervention survey data, and exposure rates from participants that commenced the RT were included (n = 192). Exposure was defined as either face-to-face attendance, website usage, or a combination of both for the internet-mediated group. Characteristics of participants who were exposed to at least 75% of the program material were explored. Descriptive analysis and logistical regression were used to examine differences between groups for program exposure.ResultsAll groups showed decrease in program exposure over time. Differences were also observed (χ2 = 10.37, p < 0.05), between intervention groups. The internet-mediated (OR = 2.4, 95% CI 1.13–5.1) and internet-only (OR = 2.96, 95% CI 1.38–6.3) groups were more likely to have been exposed to at least 75% of the program compared to the face-to-face group. Participants with high physical activity self-efficacy were 1.82 (95% CI 1.15–2.88) times more likely to have been exposed to 75% of the program, and those allocated to the face-to-face group were less likely to have attended 75% of the face-to-face sessions if they were classified as obese (OR = 0.21 95% CI 0.04–0.96).ConclusionThese results suggest that the internet groups were as effective as the face-to-face delivery mode in engaging participants in the program material. However, different delivery methods may be more useful to different sub-populations. It is important to explore which target groups that internet-based programs are best suited, in order to increase their impact.

Human resource management strategies for the retention of nurses in acute care settings in hospitals in Australia

It is paramount that there is an adequate nursing workforce supply for now and in the future, to achieve equitable and quality health outcomes and consumer access to healthcare, regardless of geographic location. Nursing forms the largest body of employees in the health care system, spanning all segments of care. A shortage of nurses, particularly in the acute care settings in hospitals, jeopardizes the provision of quality health care to consumers. This article provides a literature review of Australian State and Federal Government reports into nurse retention. All reports discuss staff turnover rates; the average age of nurses; enrolment numbers in nursing courses; workloads; nursing workforce shortfalls and the effect on the work environment; leadership and management styles; organizational culture; change management; the mobility of nursing qualifications both locally and internationally and the critical need to value nurses. Then why has the situation of nurse retention not improved? Possible reasons for the continued nurse shortage and the promise of strategic HRM in addressing nurse retention are discussed.

The impact of medical emergency teams on ICU admission rates, cardiopulmonary arrests and mortality in a regional hospital.

CONTEXT In-hospital cardiac arrests are commonly associated with poor outcomes and preceded by observable signs of clinical deterioration. Medical emergency teams (METs) have emerged to provide early specialist care intervention to critically ill patients. OBJECTIVE To determine the effect of MET implementation on hospital-wide mortality rates, cardiopulmonary arrests and admissions to the intensive care unit (ICU) in a regional Queensland hospital. METHOD A prospective cohort before and after interventional trial was conducted on adult and paediatric inpatients admitted in 2004-2008 at a 150 bed regional teaching hospital in Australia. MET was introduced in 2006 and attended clinically unstable patients. Response was activated by the bedside nurse or doctor according to predefined criteria. RESULTS There were a total of 296 MET activations. After MET implementation, mean hospital-wide mortality rates decreased from 9.9 to 7.5 per 1000 admissions (relative risk reduction, RRR: 24.2%; p = 0.003). Similarly, ICU admissions decreased from 22.4 to 17.6 per 1000 admissions (RRR: 21.4%; p < 0.0001). There was also a significant decline in hospital-wide cardiopulmonary arrests post intervention (77 versus 42, RRR: 45.5%; p = 0.0025) however this may be explained by the increase in the number of patients deemed not for resuscitation by the MET. Secondary analysis revealed evidence of MET underuse that may have affected the mortality findings. CONCLUSION Implementation of the MET in a regional hospital was associated with statistically significant reductions in hospital-wide mortality rates, ICU admissions and cardiopulmonary arrests.

The development of an internet-based outpatient cardiac rehabilitation intervention: a Delphi study

BackgroundFace-to-face outpatient cardiac rehabilitation (OCR) programs are an important and effective component in the management of cardiovascular disease. However, these programs have low participation rates, especially among patients who live rural or remote. Hence, there is a need to develop OCR programs that provide an alternative to face-to-face contact such as by using the Internet. Only a very limited number of Internet-based OCR programs have been developed and evaluated. Therefore, the purpose of this study was to identify issues that are relevant to the development of an Internet-based OCR intervention.MethodsA three-round Delphi study among cardiac rehabilitation experts was conducted. In the first round, 43 experts outlined opinions they had on the development of an online ORC platform into an open-ended electronic questionnaire. In the second round, 42 experts completed a structured (five-point scale) electronic questionnaire based on first round results, in which they scored items on their relevance. In the third round, the same experts were asked to re-rate the same items after feedback was given about the group median relevance score to establish a level of consensus.ResultsAfter the third round, high consensus was reached in 120 of 162 (74%) questionnaire items, of which 93 (57% of 162 items) also had high relevance according to the experts. The results indicate that experts strongly agreed on desired website content, data obtained from the patient, and level of interaction with patients that should be part of an Internet-based OCR intervention.ConclusionThe high rates of consensus and relevance observed among cardiac rehabilitation experts are an indication that they perceived the development and implementation of an Internet-based ORC intervention as feasible, and as a valuable alternative to face-to-face programs. In many ways the experts indicated that an Internet-based ORC program should mimic a traditional face-to-face program, and emphasize the crucial role of the cardiac rehabilitation manager who interacts with patients from a distance. The present study revealed practical insights into how Internet OCR interventions should be designed and opens the door for the development of such an intervention to be subsequently examined in a longitudinal and experimental study.

Constructing a nursing identity within the clinical environment: The student nurse experience

Abstract Background: Nursing identity is an important element of being a nurse. Student nurses begin the construction of their nursing identity during their clinical placements. Aim: The aim of this research was to examine how the student nurses of a regional Australian university construct their identity when on off-campus clinical placement. Methods/ Design: Using a constructivist approach an online survey was used to elicit data in response to the question ‘What elements are needed during the work integrated learning experience to enable undergraduate nursing students to construct their nursing identity?’ Results/Findings: Findings reveal five key elements to the construction of students’ nursing identity; positive role models, belonging, peer support, critical thinking abilities and confidence. Conclusion: Such findings are important as they provide information for student nurses, preceptors and educators in guiding clinical placement experiences that are able to facilitate the development of the nursing identity.

Graduate nurses and nursing student's behaviour: Knowledge and attitudes toward smoking cessation

BACKGROUND Smoking remains the largest single cause of preventable mortality. In rural Australia where the incidence of smoking is higher, health is substantially worse than other Australians. Smoking cessation is difficult with many attempts made before success. Health professionals are in a prime position to assist smoking cessation but are failing to consistently assess tobacco use and assist patients quit. Nurses who form the largest cohort of health care professionals, should play a part in smoking cessation yet their influential role is hugely underutilised. Given the strategic place of nurses to advance the anti-smoking message during clinical interactions, data was needed on smoking rates as well as on smoking attitudes and behaviours. OBJECTIVES To determine the smoking rates and behaviour as well as attitudes of nurses toward assisting hospitalised patients to cease smoking. DESIGN Descriptive survey research design. PARTICIPANTS Non-probability sampling of undergraduate nursing students (n=153) and graduate nursing students (n=64) from a regional nursing school in an Australian university. METHODS Survey. RESULTS Factor analysis revealed four clearly differentiated factors, non-smokers rights, cessation beliefs, cessation attitudes and therapeutic relationships. Significant differences were present in nurses perceptions of smoking rights across age categories but not for other factors, no significant gender differences were noted across categories, nor were significant differences noted between levels of nursing qualifications across categories however smoking status revealed significant differences in perceptions of rights. CONCLUSIONS Student and graduate nurses are aware that they are role models and that they have an influential role in modifying patient behaviour. When it comes to assisting patients to cease tobacco use, age and smoking status of nurses influence their actions. Nursing curriculums need to emphasise the role nurses play in smoking cessation and give them the tools they need to help patients QUIT.