Wendy Cross

Can We Predict Burnout among Student Nurses? An Exploration of the ICWR-1 Model of Individual Psychological Resilience.

The nature of nursing work is demanding and can be stressful. Previous studies have shown a high rate of burnout among employed nurses. Recently, efforts have been made to understand the role of resilience in determining the psychological adjustment of employed nurses. A theoretical model of resilience was proposed recently that includes several constructs identified in the literature related to resilience and to psychological functioning. As nursing students are the future of the nursing workforce it is important to advance our understanding of the determinants of resilience in this population. Student nurses who had completed their final practicum were invited to participate in an online survey measuring the key constructs of the ICWR-1 model. 422 students from across Australia and Canada completed the survey between July 2014 and July 2015. As well as several key demographics, trait negative affect, mindfulness, self-efficacy, coping, resilience, and burnout were measured. We used structural equation modeling and found support for the major pathways of the model; namely that resilience had a significant influence on the relationship between mindfulness, self-efficacy and coping, and psychological adjustment (burnout scores). Furthermore, as predicted, Neuroticism moderated the relationship between coping and burnout. Results are discussed in terms of potential approaches to supporting nursing students who may be at risk of burnout.

Occupational violence and assault in mental health nursing: a scoping project for a Victorian Mental Health Service.

The present study aimed to examine the prevalence of occupational assault against nurses at a Victorian Mental Health Service, including inpatient units and community teams. The results of this study will assist in developing strategies to minimize the occurrence of occupational assault and, more importantly, its impact for nursing staff. A survey methodology was used. All nurses from two adult acute psychiatric inpatient units as well as those from the community-based teams were invited to participate in a single survey (n = 90). The sample group for this research included all nursing staff from both inpatient units and community services. High levels of occupational violence against nurses overall and in the past year, underreporting of incidents, and high levels of staff fear are prominent findings of this study. There needs to be a total review of all policy relating to occupational violence with special focus given to the results of this study. The areas of risk management, training, sanctioning, and incident reporting should head the list, as well as addressing staff culture. Universally adopting a zero tolerance approach to occupational violence suggests that it is far from being part of the job. Further, management should consider a comprehensive orientation package that informs patients and their significant others about the role of the treating team. Communicating adequately with patients and their significant others is needed to clarify expectations and to avoid frustration and angry outbursts.

The ‘dis-ease’ of dying: Challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study

Background: Changes in health care and an ageing population have meant that more people are dying in the acute hospital setting. While palliative care principles have resulted in quality care for the dying, many patients die in an acute care, still receiving aggressive/resuscitative care. Aims: The aims were to explore nurses’ ‘recognition of’ and ‘responsiveness to’ dying patients and to understand the nurses’ influence on end-of-life care. Design: A qualitative approach was taken utilising non-participant observation to elicit rich data, followed by focus groups and individual semi-structured interviews for clarification. Setting/participants: This study was conducted in two acute medical wards in one health service, identified as having the highest rates of death, once palliative care and critical care areas were excluded. Twenty-five nurses consented to participate, and 20 episodes of observation were conducted. Results: Nurses took a passive role in recognising dying, providing active care until a medical officer’s declaration of dying. Ward design, nurse allocation and nurses’ attitude to death impacts patient care. End-of-life care in a single room can have negative consequences for the dying. Nurses demonstrated varying degrees of discomfort, indicating that they were underprepared for this role. Conclusion: When patients are terminally ill, acknowledgement of dying is essential in providing appropriate care. It should not be assumed that all nurses are adequately prepared to provide dying care. Further work is necessary to investigate how the attitudes of nurses towards caring for dying patients in the acute hospital setting may impact care of the dying patient.

Outcomes of a clinical partnership model for undergraduate nursing students

Abstract Background: Over the last decade several innovative approaches to enhance students’ transition to graduate nurse year have been implemented or piloted. This paper describes a study that investigated how the social practices of clinical partnership placement model underpin workplace learning for undergraduate students as they transitioned to graduate. Methods: A mixed method approach was utilized comprising individual interviews with students, observation of clinical workplaces across six different areas of nursing practice, student surveys of the clinical learning environment and participant workshops. Results: Three themes were identified that influenced participants’ preparedness for work and enhanced the transition into the workplace: ‘organizational familiarity’, ‘continuity’ and ‘social participation’. Conclusion: A clinical partnership model offers a degree of work readiness for novices when commencing their professional practice role. It enables individuals to participate and engage in workplace activities which are a central component of their learning.

Self-efficacy and locus of control affect management of aggression by mental health nurses.

The safe and effective management of aggression has become an increasingly critical skill for mental health nurses, particularly those working in acute inpatient settings. There is considerable evidence to suggest that the psychological constructs of self-efficacy and locus of control are closely related to work performance in a variety of occupations. By drawing upon literature published in the past 15 years, this paper highlights this evidence and draws attention to the relationship between self-efficacy and locus of control. The central argument of the paper is that there may be direct relationships among mental health nurses” self-efficacy, their degree of internality or externality in relation to locus of control, and their ability to safely and effectively manage aggressive incidents. We argue the need to further investigate these relationships and discover whether these variables can be modified through professional development activities.

Clinical supervision of general nurses in a busy medical ward of a teaching hospital

Abstract Aim: To implement and evaluate group clinical supervision (CS) for Associate Nurse Unit Managers (ANUMs) in a busy medical ward of a tertiary teaching hospital. Background: Nursing work at managerial level is characterised by high stress, depersonalisation and burnout often leading to job dissatisfaction. CS was introduced as a strategy to reduce such issues, through reflection and sharing experiences. Method: Six ANUMs from an acute medical ward participated in weekly CS. The program was evaluated by a focus group conducted after six months to gather feedback about the ANUMs’ experience of participating in CS. Results: CS was viewed positively and five main themes emerged including Dedicated Time, I’m Not The Only One experiencing problems, Getting With The Program and having consistent approaches, Positive And Constructive Feedback, and That Word ‘supervision’. Conclusions: CS provides senior nurses an opportunity to debrief, reflect and share common experiences and develop alternate approaches to problems. CS may offer managers a useful tool for retaining experienced senior nurses.

Improving services for individuals with a dual diagnosis: A qualitative study reporting on the views of service users

Individuals with high prevalence mental health (HPMH) and concurrent alcohol and/or drug disorders are vulnerable to falling ‘between the gaps’ of existing service systems. The aim of the current qualitative study was to explore service experiences (barriers to treatment and suggestions for improvements) from the perspective of those with this type of dual diagnosis. Of the individuals, 44 with a HPMH dual diagnosis participated in qualitative interviews. Thematic analysis was conducted on the data and major themes from the analysis presented. Barriers to treatment related primarily to knowledge (not knowing that services existed; breakdowns in referrals) and structure (delays in response; system inflexibility). Suggestions for improvements to services targeted barriers but took a holistic view including the need for worker and community education, addressing issues beyond the illness and the importance of relationships. The complex interaction between the disorders means that navigating either of the specialist systems has pitfalls not faced by people with a single disorder. Service user input is vital to minimise gaps and ensure service provision meets the needs of this group. These findings can now be used to inform service system redesign so that services are better able to meet the needs of this group.

End‐of‐life care in acute hospitals: an integrative literature review

bloomer mj, moss c & cross wm (2011)Journal of Nursing and Healthcare of Chronic Illness 3, 165–173 End-of-life care in acute hospitals: an integrative literature review Aim.  To explore and define the current status of published literature related to end-of-life care in the acute hospital setting. Background.  Chronic illness is now the leading cause of death in developed countries because the population is and the advances in health care delivery. In Australia, two-third of people with chronic illness who die is inpatient in an acute hospital. Whilst most of the attention regarding end-of-life care and dying has focused on palliative care settings, there is a need to consider those dying outside of specialist palliative care settings. Design.  Integrative literature review. Methods.  Using an integrative approach, electronic searches of selected databases were undertaken, using comprehensive search terms. Secondary sources were also identified through the reference lists of retrieved literature. Results.  The literature review identified a lack of high-quality scientific evidence to direct end-of-life care as delivered in the acute (non-palliative care) sector. From the literature available, five core themes/issues were generated to reflect the literature. Conclusions.  There is a need for research to investigate end-of-life care in the acute hospital setting. Care pathways are in use to varying degrees without validation, but implementation alone does not ensure quality end-of-life care. Cultural factors can impede/impact practice and the ability of clinicians to recognise ‘active dying’ has been shown to be problematic, delaying the transition to end-of-life care. Relevance to clinical practice.  Given that the majority of deaths in Australia occur in acute hospital settings, clinicians should be delivering expert life-sustaining acute care and also quality end-of-life care.

Implementing clinical supervision for ICU Outreach Nurses: A case study of their journey

INTRODUCTION Many health services with Intensive Care Units have developed ward liaison programs, managed by Outreach Nurses, to facilitate the transition for patients between the intensive care and general wards. This paper reports a case study of clinical supervision for two Outreach Nurses as they adapted to their new, largely autonomous role in an Australian tertiary hospital. METHOD Individual clinical supervision was provided fortnightly to two Outreach Nurses over 12 months by an experienced facilitator, and evaluated using a case study methodology. The Outreach Nurses completed a journal that captured their personal and professional growth and the supervisor also provided a reflective account. An interview was conducted with both Outreach Nurses to evaluate their experiences of clinical supervision. FINDINGS Key themes emerging from all the data sources included: respect for clinical supervision and the supervisor; role clarification; understanding and dealing with interpersonal issues; dedicated time for reflection; facing up to issues and letting them go. CONCLUSION The Outreach Nurses described the personal and professional benefits of clinical supervision and highlighted how it was successfully implemented for them in a busy clinical environment with limited available resources.

Australians living with and managing hepatitis C

This paper discusses the psychosocial impact of being diagnosed with hepatitis C virus (HCV). The paper clarifies some of the key misconceptions about the virus, especially the impact HCV has on people who have been recently diagnosed. An individuals reaction to the HCV diagnosis and the subsequent lifestyle challenges to maintain health, well-being, family, and social networks are discussed, particularly the issues surrounding mental health in respect to a recent chronic illness diagnosis and how to manage the trajectory of the illness in the community and individually. HCV disclosure and its effect on intimacy are also detailed. For people living with both a diagnosed mental illness and HCV, managing the illness can be complicated. Not only are these individuals concerned about their mental illness, its treatment, and the social stigma and discrimination associated with it, they also may be alarmed over their future physical health. The paper is preliminary to research using the psychotherapeutic approach of Cognitive Behavioural Therapy (CBT) in groups of persons with a dual diagnosis of mental illness and HCV.