Victoria J. Kain

Neonatal palliative care attitude scale: development of an instrument to measure the barriers to and facilitators of palliative care in neonatal nursing.

OBJECTIVE. The aim of this research project was to obtain an understanding of the barriers to and facilitators of providing palliative care in neonatal nursing. This article reports the first phase of this research: to develop and administer an instrument to measure the attitudes of neonatal nurses to palliative care. METHODS. The instrument developed for this research (the Neonatal Palliative Care Attitude Scale) underwent face and content validity testing with an expert panel and was pilot tested to establish temporal stability. It was then administered to a population sample of 1285 neonatal nurses in Australian NICUs, with a response rate of 50% (N = 645). Exploratory factor-analysis techniques were conducted to identify scales and subscales of the instrument. RESULTS. Data-reduction techniques using principal components analysis were used. Using the criteria of eigenvalues being >1, the items in the Neonatal Palliative Care Attitude Scale extracted 6 factors, which accounted for 48.1% of the variance among the items. By further examining the questions within each factor and the Cronbachs α of items loading on each factor, factors were accepted or rejected. This resulted in acceptance of 3 factors indicating the barriers to and facilitators of palliative care practice. The constructs represented by these factors indicated barriers to and facilitators of palliative care practice relating to (1) the organization in which the nurse practices, (2) the available resources to support a palliative model of care, and (3) the technological imperatives and parental demands. CONCLUSIONS. The subscales identified by this analysis identified items that measured both barriers to and facilitators of palliative care practice in neonatal nursing. While establishing preliminary reliability of the instrument by using exploratory factor-analysis techniques, further testing of this instrument with different samples of neonatal nurses is necessary using a confirmatory factor-analysis approach.

Palliative Care Delivery in the NICU: What Barriers Do Neonatal Nurses Face?

Despite the existence of a universal protocol in palliative care for dying babies and their families, provision of this type of care remains ad hoc in contemporary neonatal settings. Influential bodies such as the American Academy of Pediatrics and the World Health Organization support palliative care to this patient population, so why are such measures not universally adopted? Are there barriers that prevent neonatal nurses from delivering this type of care? A search of the literature reveals that such barriers may be significant and that they have the potential to prevent dying babies from receiving the care they deserve. The goal of this literature review is to identify these barriers to providing palliative care in neonatal nursing. Results of the research have been used to determine item content for a survey to conceptualize and address these barriers.

The Effects of a Multimodal Intervention Trial to Promote Lifestyle Factors Associated With the Prevention of Cardiovascular Disease in Menopausal and Postmenopausal Australian Women

The purpose of this study was to test the efficacy of a multimodal intervention (Womens Wellness Program) to improve womens cardiovascular risk factors. This 12-week randomized experiment with a control group targeted women 50–65 years living in the general population. Women in the intervention group were provided with a consultation with a registered nurse at which time biophysical cardiovascular risk measures were taken and health education was provided in both verbal and written form. Women were encouraged to review their smoking, nutrition, and water intakes and to commence an exercise program that included aerobic fitness exercises. Women in the control group continued their normal activities. The sample consisted of 90 women aged 50–65 years. Pre- and postintervention assessment utilized seven measures of cardiovascular risk factors: waist-to-hip ratio (WHR), body mass index (BMI), blood pressure, heart rate, weight, exercise levels, and smoking. Analysis of covariance indicated that the intervention was effective in improving womens aerobic exercise activity and decreasing smoking. The data from all five biophysical outcome measures supported the efficacy of the intervention, with significant decreases seen in the womens WHR, BMI, blood pressure, and measured weight. Study implications suggest that this type of intervention may provide an effective, clinically manageable therapy for women who prefer a self-directed approach to preventing and decreasing cardiovascular risk factors.

Managing patient deterioration: a protocol for enhancing undergraduate nursing students' competence through web-based simulation and feedback techniques

AimsTo describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients.BackgroundThere are international concerns regarding the management of deteriorating patients with issues around the ‘failure to rescue’. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders.Design/MethodsA mixed methods triangulated convergent design.In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase.ConclusionThis project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program.

Neonatal palliative care in action: moving beyond the rhetoric and influencing policy

The purpose of this paper is to move beyond the rhetoric of espousing the importance and timeliness of palliative care for the neonatal population, and to explore how what is known can influence health and social policy. A recent Commonwealth of Australia Senate enquiry into palliative care raised concerns about the current lack of specialist perinatal and neonatal palliative care in Australia. Inherent to the difficulties of moving a neonatal palliative care model forwards are the identified barriers to palliative care practice in the clinical setting, which have been well defined. To inform policy, it is imperative that health professionals in the neonatal discipline are knowledgeable about legislative priorities and the public concerns regarding palliative care for neonates. This paper argues that there are several priorities for moving this model of care forwards, which include legislation that supports access to care such as development and funding support of perinatal hospices, continuity of care, caregiver support, research and in particular education for the health care professionals caring for dying babies and their families. To achieve this, we need to set national research priorities that reflect a truly collaborative partnership. It is time to move beyond the rhetoric.

Pilot study of an instrument to measure attitudes to palliative care practice in neonatal intensive care nursing

This paper reports the processes involved in the pilot testing of an instrument – The Neonatal Palliative Care Attitude Scale (NiPCAS). This instrument was developed to explore a context of nursing practice about which little is known – attitudes to palliative care practice in neonatal intensive care nursing. A two phased approach was undertaken to determine face and content validity and reliability of this instrument. Face and content validity was achieved by assembling an international panel of experts to ensure that wording of the items, and the development of the scale, were both appropriate and comprehensible to the sampling frame for this research. Reliability testing was achieved by employing test-retest procedures to determine temporal stability using intraclass correlation with a sample of neonatal intensive care nurses. Internal consistency was determined using Cronbachs alpha. This instrument has been pilot-tested by administration to a convenience sample of neonatal intensive care nurses at a site in South-east Queensland. The results of the pilot study provided the basis for refinement of the instrument. Based upon the outcome of validity and reliability testing for stability reliability of the instrument, items for the final tool were identified, and the instrument has been administered to a national population sample of neonatal intensive care nurses.

Quality predictors of parental satisfaction after birth of infants with life-limiting conditions

This study examines parental satisfaction with care received in the context of a life‐limiting foetal diagnosis and subsequent birth.

Internationalisation of the Curriculum in an Undergraduate Nursing Degree

In this chapter, I discuss internationalisation of curriculum (IoC) in the context of an undergraduate nursing curriculum. As the previous Program Director of the undergraduate nursing program at the University of Queensland, Australia (a role I occupied for over two years), I explore the individual elements of the curriculum such as content, assessment, the teaching and learning processes in relation to internationalisation, and explain how as a teaching team, our readiness for internationalisation caused us to look inwards at our own curriculum.

Babies Born Dying: Just Bad Karma? A Discussion Paper

The paper examines the notion of being born dying and karma. Karma is a belief upheld by Buddhists and non-Buddhists: That is, karma follows people from their previous lives into their current lives. This raises a difficult question: Does karma mean that a baby’s death is its own fault? While great peace can be found from a belief in karma, the notion of a baby’s karma returning in some sort of retributive, universal justice can be de-emphasized and is considered “un-Buddhist.” Having an understanding of karma is intrinsic to the spiritual care for the dying baby, not only from the perspective of parents and families who have these beliefs, but also for reconciling one’s own beliefs as a healthcare practitioner.

Corrigendum to "Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: An Australian multi-centre study" [Nurse Educ. Today 34(5) (May 2014) 691-696]doi: 10.1016/j.nedt.2013.09.015.

The authors regret that the original text: The SAGAT instrument has been previously validated (Bell et al., 2006) is incorrect and should read: The SAGAT technique has been demonstrated as valid, sensitive and reliable measure of situation awareness in diverse applications (Endsley, 2000). Endsley, M. R. (2000) Direct measurement of situation awareness: Validity and use of SAGAT. In Endsley, M.R. & Garland, D.J. (Eds.), Situation awareness analysis and measurement (pp 147–173). New Jersey: Lawrence Erlbaum Associates. The authors would like to apologise for any inconvenience caused.