Psychometric properties of the Braden scale to assess pressure injury risk in intensive care: A systematic review.

OBJECTIVE: To analyse the psychometric properties of the Braden scale to assess pressure injury risk in adults in intensive care. DESIGN: A systematic review was conducted, with literature searches undertaken in five electronic databases. No date limits were applied. Selection, data extraction and risk of bias assessment were completed by two reviewers independently. A customised data extraction template was used, with risk of bias conducted using the COSMIN Risk of Bias checklist. Data were analysed using narrative synthesis. RESULTS: Thirty-four studies met inclusion criteria. Two studies reported internal consistency with Cronbach's alpha ranging from poor (0.43) to good (0.85). For interrater reliability, only four studies reported intraclass correlation, ranging from 0.66 to 0.96 for Braden sum score. Three studies reported convergent validity, with strong associations found between the COMHON Index (r = 0.70), Cubbin-Jackson scale (r = 0.80), and Norton scale (r = 0.77), but contrasting associations with the Waterlow score (r = 0.22 to 0.72). A large majority of studies reported predictive validity (n = 29), with wide variability. Several studies investigated optimal cut-off scores, with the majority indicating this was in the range of 12-14. CONCLUSIONS: This review demonstrates inconsistency in the psychometric properties of the Braden scale in ICU settings. Further research is needed to determine suitability of the Braden scale for ICU before it can be recommended as standard for clinical practice, including comparison with other ICU-specific risk assessment tools. IMPLICATIONS FOR CLINICAL PRACTICE: When used in ICU, the reliability, validity and reported cut-off scores of the Braden scale are variable. As a predictive tool, the scale should be used cautiously. In ICU, the value of the Braden scale resides in its ability to identify patients that are most at risk of developing a pressure injury and to implement preventative measures to mitigate identified risk factors.

Exploring intensive care nurses' perception of simulation-based learning: A systematic review and meta-synthesis.

AIM(S): To explore intensive care nurses' (ICN) perceptions of simulation-based learning (SBL). DESIGN: A systematic review and meta-synthesis. METHODS: The review followed the PRISMA guidelines for reporting a systematic review. A systematic search strategy was developed using a modified PICo framework. A comprehensive search was conducted in July 2023 in CINAHL, OVID Embase, Medline complete, Web of Science, ERIC and Scopus databases for articles published in English between 2013 and 2023. Data were extracted using the Joanna Briggs Institute QARI Data Extraction, with data synthesis guided by Braun and Clark's thematic analysis approach. Quality appraisal was assessed using the CASP tool. RESULTS: Eleven studies providing qualitative data were included for analysis. Analysis and meta-synthesis led to the construction of two themes: The learning experience and professional growth through collaboration. CONCLUSION: The review highlights the balance needed in finding the appropriate simulation approach, with the right level of fidelity, conducted at appropriately regular intervals, incorporating the correct makeup of professional team members, conducted in the right environment and facilitated by a skilled facilitator, to ensure best outcomes and return on investment for ICN's education. IMPLICATIONS FOR PRACTICE: These findings are a valuable resource for educators and organisations considering simulation-based learning initiatives in the intensive care setting. NO PATIENT OR PUBLIC CONTRIBUTION: This review involved analysis of existing literature and as such no unique patient or public involvement occurred. REPORTING METHOD: The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines.

The perspectives of internationally qualified nurses regarding their specialty skill transition to Australia: A cross-sectional survey.

AIM: To identify barriers and facilitators of speciality skill transfer for internationally qualified nurses in Australia from the nurses' perspective. DESIGN: A cross-sectional study. METHODS: A cross-sectional online survey was distributed through social media, snowballing and nursing professional organization. Data analysed using Statistical Package for the Social Sciences. DATA SOURCES: Online survey data from participants matching the inclusion criteria were collected from July to September 2022. RESULTS: Survey results reveal facilitators (competence, scope of practice, linguistic sufficiency, understanding of decision-making) and barriers (lack of opportunity, transition pathways, confidence in overseas education, financial instability) for internationally qualified nurses' speciality skill utilization in Australia. CONCLUSION: Identifying and addressing barriers and facilitators, along with developing tailored transition pathways, are crucial for maximizing speciality skill utilization among internationally qualified nurses. These findings have implications for policymakers, healthcare organizations and nurses. They highlight the need to address barriers, facilitate smooth transitions and implement proactive measures for internationally qualified nurses to effectively utilize their specialty skills. IMPACT: The study addresses maximizing skill usage for internationally qualified nurses, identifies barriers and facilitators for specialty skill transfer in Australia and will impact policymakers, healthcare organizations and nurses by guiding strategies for safe nursing service delivery and optimizing patient care. REPORTING METHOD: STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: A total of 71 internationally qualified nurses contributed their experiences and opinions. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Lack of opportunity and the lack of transition pathways inhibit the use of specialty nursing skills by internationally qualified nurses. This study's findings contradict the result of other studies that suggest language is a significant obstacle to the utilization of specialty skills of internationally qualified nurses. TRIAL AND PROTOCOL REGISTRATION: The protocol is registered on OSF. The data for this study are available for sharing with the reviewers upon request. However, it is worth noting that ethical approval has not been obtained specifically for web sharing, and therefore, the data has not been posted in any repositories or public platforms.

Roles of nurse-surgeons in global surgical care: A scoping review.

AIM: To identify the roles of nurse-surgeons in the provision of surgical care. DESIGN: Scoping review. METHODS: This scoping review adhered to the JBI guideline for scoping reviews and EQUATOR Network's PRISMA-ScR checklist. Searches were performed from May 2022 to July 2022 using a combination of MeSH headings, keywords and filters via database and hand searching based on the eligibility criteria. Keywords included nurse-surgeon, nurse endoscopist, nurse hysteroscopist and nurse cystoscopist. Data sources were CINAHL, Cochrane, Google Scholar, PubMed and Scopus. Descriptive analysis was used to report the findings. RESULTS: Ninety-six included records indicated nurse-surgeon practice in 26 countries. Forty-one nurse-surgeon titles were found, the majority of which were types of nurse practitioner. A total of 5,684,198 surgeries were performed by nurse-surgeons varying from laparotomies to biopsies. Nine records reported that nurse-surgeons perform surgeries safely and on par with physicians with zero to minimal complications. Nineteen records reported improved surgical care efficiency by nurse-surgeons in terms of patient access to surgery, waiting times, surgery times, patient show rates, patient education, physician workload and junior physicians' training. Seven records reported high patient satisfaction. Nurse-surgeons were cost-effective according to five records. Thirteen records recommended the standardization of nurse-surgeon practice. CONCLUSION: Nurse-surgeons performed millions of surgeries worldwide assisting in easing the global surgical burden. This review identified the roles and benefits nurse-surgeons play in global surgical care. Research gaps on nurse-surgeon roles were discovered including the ambiguity in nurse-surgeon titles and the need to regulate nurse-surgeon practice. IMPACT: This research addressed the clinical safety, quality, contribution to timely surgical access and cost efficiency of nurse-surgeon performed surgeries, as well as the need to standardize nurse-surgeon practice and use a more consistent nurse-surgeon title to ensure role identification and monitoring.

Strategies employed by developed countries to facilitate the transition of internationally qualified nurses specialty skills into clinical practice: An integrative review.

BACKGROUND: Recruitment of internationally qualified nurses as a labour source is a long-standing human resource strategy being implemented to address the current and increasing global nursing shortage. Internationally qualified nurses transitioning into the health workforce of developed countries following immigration often possess specialty skills. A lack of a clear pathway of specialty skill utilisation makes recognising and using these specialty skills complex for many nurses. The ability for nurses to transition between countries and maintain specialty practice demands immediate attention in the current atmosphere of the global pandemic and the predictions to recruit more specialist nurses from overseas. AIM: To identify and synthesise strategies taken by various developed countries in transitioning specialist internationally qualified nurses into practice. METHODS: An integrative review was conducted to identify common themes, patterns, and best practices in order to inform policy development and improve the successful integration of internationally qualified nurses into the healthcare systems of developed countries. The study employed the Whittemore and Knafl five-stage integrative review approach. To conduct a comprehensive search, four electronic databases, namely Medline, CINAHL Complete, ProQuest Health, and EMBASE, were systematically searched in October 2021. The search was updated in March 2022 to ensure the inclusion of the most recent literature. Additionally, Google Scholar was utilised to avoid overlooking any important articles. Prior to the full-text review, three reviewers independently evaluated titles and abstracts. The included papers' quality was determined using the JBI critical appraisal tools. RESULTS: This study included 10 papers, comprising three studies and seven reports. However, none of these documents provided information on how internationally qualified nurses could transfer their specialty skills acquired overseas to developed countries after immigrating. The guidelines and policies reviewed only offered generic advice on becoming a specialist nurse. Although some countries mentioned that post-graduate qualifications were not mandatory for nurse specialists, the majority of documents in this review emphasised the need for a national framework of education at level eight or higher (equivalent to a post-graduate level) to attain the status of a nurse specialist. Moreover, the included documents did not provide clear information on whether an international specialisation degree would be recognised during the registration process. As a result, confusion persists regarding the requirement of post-graduate qualifications for nurses aiming to specialise and the recognition of international specialisation degrees during the registration process. DISCUSSION: The lack of consistency in defining nurse specialty and the skill transferability among institutions and state borders were evident in this review. According to all the 10 documents analysed, developed countries appear to have minimum policies on the transfer of internationally qualified nurse's specialty skills. Recommendations for policymakers, employers, and aspirant migrants have been proposed. Limited research has been done on how developed countries used their internationally qualified nurses' overseas-acquired specialist skills after immigration, indicating a lack of a distinct specialist skill transition pathway. CONCLUSIONS: This review presents data to support the need for greater research in this area to better utilise the abilities that internationally qualified nurses bring from their home country and put them to constructive use in the host country, especially in the context of a global pandemic.

Patient and carer experience of living with a pressure injury: A meta-synthesis of qualitative studies.

INTRODUCTION: Pressure injuries are a significant cause of harm, contributing to increased mortality and financial burden on the healthcare system. Significant research on pressure injury risk assessment, prevention and treatment exists, but limited research exploring the patient and carer experience of living with pressure injury. AIMS: The aim of this meta-synthesis was to describe the patient and carer experience of living with a pressure injury. DESIGN: Meta-synthesis. METHODS: A prospective review protocol was registered, and systematic search conducted across five electronic databases. The PRISMA 2020 checklist for reporting systematic reviews was used. Two reviewers independently undertook screening and review of articles, using the CASP checklist for evaluating qualitative research. A meta-synthesis using thematic content analysis was undertaken. RESULTS: Twelve studies met the inclusion criteria. Meta-synthesis led to the construction of three primary themes: loss of autonomy and independence, psychological effects, and adjustment. Within these primary themes, sub-themes of dependence, social isolation and social avoidance behaviours, feelings and emotions, loss, managing, physical consequences, service provision, and functional challenges, were identified. CONCLUSION: The psychology and mindset of those involved, and support to navigate the challenges that arise are two unique and clinically relevant categorisations to guide provision of pressure injury care. Adaptation to a pressure injury is multi-faceted and contextual, challenges to adaptation create additional psychological burden. Interventions encompassing all facets of the experience are necessary. Current research into experiences is limited, and further research to support interventions is necessary.

Impact of nurse-surgeons on patient-centred outcomes: A systematic review.

Background: Nurse-surgeons have been performing surgeries for decades. Yet, their impact on perioperative clinical outcomes has not been explored in detail. Objective: To investigate the impact of nurse-surgeons on patient-centred outcomes. Design: Systematic review. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for systematic reviews were used as the screening and reporting guideline. CINAHL, Cochrane Library, MEDLINE, and PubMed databases were searched for articles that fit the review's eligibility criteria. A combination of Medical Subject Headings, keywords and filters for each database were used. Following screening and full text review, the Mixed Methods Appraisal Tool was used for quality assessment and the Grading of Recommendations, Assessment, Development and Evaluations framework for certainty and confidence assessment. Narrative synthesis was used to report the findings due to the design heterogeneity of the included studies. Results: Forty-eight (n = 48) patient-centred outcomes were identified from 25 included studies. These outcomes were grouped into four categories: patient satisfaction and experience; waiting list; perioperative complications; and quality of surgical care. Patient satisfaction and experience was rated high to very high in 16 studies; none reported patient dissatisfaction. Waiting lists improved in eight studies. Perioperative complications were none to very low in nine studies. Mortality rates in the nurse-surgeon group were better than the physician group in three studies. The quality of care in the performance of surgeries by nurse-surgeons was either similar or better than physicians in ten studies. Conclusions: Nurse-surgeons performed safe, satisfactory, and high-quality surgeries with minimal perioperative complications similar to physicians. The use of nurse-surgeons has significantly reduced waiting lists regardless of surgical speciality. Policies around nurse-surgeon practice needs to be developed at national and international levels to streamline the delivery of much needed surgical services amidst the coronavirus pandemic in the areas of cancer diagnostic surgeries, emergency surgeries, minor surgeries, and remote and rural health.

Current methods of nurse-surgeon training and education: Systematic review.

Background: The role of nurse-surgeons has recently emerged to meet patient and health system surgical demands. However, methods of nurse-surgeon training and education requirements are unclear. Objective: To identify and describe the current methods of nurse-surgeon training and education worldwide. Design: Systematic review. Method: An electronic search was conducted using Cumulative Index to Nursing and Allied Health, Cochrane Library, Medical Literature Analysis and Retrieval System Online, Public Medical Literature Analysis and Retrieval System Online, and Google Scholar databases. Key words included nurse-surgeon, training, education, and perioperative. Following screening for inclusion, a mixed methods critical appraisal tool was used to ascertain methodological rigour and the Grading of Recommendations, Assessment, Development and Evaluations framework to assess confidence in the evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for reporting systematic reviews were used. Results: A total of 18 studies was included in this review. Current methods of nurse-surgeon training were identified as surgical speciality specific (n = 18). Most training courses were at least one year in length (n = 4) with a theoretical component (n = 15). All studies included a practical requirement (n = 18), which was generally supervised by a physician (n = 16). A competency assessment was required by 15 programmes, with nine (9) using a formative assessment approach. The evidence available for this review is low in quality and certainty. Conclusions: Current methods of nurse-surgeon training have been identified to be specific to speciality areas. Overall, training has required nurse-surgeons to undergo andragogical education in theory, supervision in practice by a surgeon and assessment of competency. An implication for practice is a streamlined nursing pathway to surgical residency training which would improve global surgical health outcomes and retain young perioperative nurses.

Validation of an instrument to measure moral distress within the Australian residential and community care environments.

AIM AND OBJECTIVES: The aim of this study was to gain insight into the experience of moral distress within the aged care workforce. The objective of this study was to use and validate an existing instrument to measure moral distress within the aged care setting. BACKGROUND: Moral distress, a phenomenon associated with worker satisfaction and retention, is common within nursing. Instruments to measure moral distress exist; however, there are no validated instruments to measure moral distress within an aged care setting. DESIGN AND METHOD: An existing instrument, the Moral Distress Scale (Revised) was identified and amended. Amendments were subject to expert review for face and content validity. Data were collected from aged care nurses working in residential and community aged care, in Australia. Reliability was assessed using Cronbach's alpha with exploratory factor analysis undertaken for construct validity. RESULTS: 106 participants completed the survey, 93 (87.7%) identified as female and 13 (12.3%) male. Participants ranged in age from 21 to 73 years, with a mean time working in nursing of 20.6 years. The frequency component of the instrument demonstrated an alpha of 0.89, the intensity component 0.95 and the instrument as a whole 0.94. Three factors were identified and labelled as: Quality of Care, Capacity of Team and Professional Practice. Mean scores indicate a low occurrence of moral distress, but this distress, when experienced, was felt with a moderate level of intensity. Primary causes of moral distress were insufficient staff competency levels, poor quality care because of poor communication and delays in implementing palliation. CONCLUSION: The instrument demonstrates validity and reliability within the Australian aged care setting. Further analysis with larger populations is required to support these findings. IMPLICATIONS FOR PRACTICE: Australian aged care workers do experience moral distress. They suffer adverse consequences of this distress and quality of care is negatively impacted. This newly validated instrument can be used to quantify the occurrence of moral distress and to inform targeted interventions to reduce the occurrence and intensity of the experience.

MORAL DISTRESS.

Australia has an ageing nursing workforce with many nurses due to retire (Health Workforce Australia, 2014). Coupled with increasing service demands, the need for workers will outstrip the supply (CEPAR - ARC Centre of Excellence in Population Ageing Research, 2014).

Moral distress in nursing: contributing factors, outcomes and interventions.

Moral distress has been widely reviewed across many care contexts and among a range of disciplines. Interest in this area has produced a plethora of studies, commentary and critique. An overview of the literature around moral distress reveals a commonality about factors contributing to moral distress, the attendant outcomes of this distress and a core set of interventions recommended to address these. Interventions at both personal and organizational levels have been proposed. The relevance of this overview resides in the implications moral distress has on the nurse and the nursing workforce: particularly in regard to quality of care, diminished workplace satisfaction and physical health of staff and increased problems with staff retention.