Travel health practices, behaviours and experiences of people living with type 1 diabetes.

INTRODUCTION: There is limited data regarding the international travel history and preparation, as well as glycaemic control practices, risk behaviours, and experiences of people with type 1 diabetes during travel. Our review aimed to address the research question: 'What are the health practices, behaviours, and experiences of people with type 1 diabetes when travelling?' METHODS: We conducted a mixed-methods narrative review using adapted review methods from the Centre for Reviews and Dissemination and standards developed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. MEDLINE, Scopus, PubMed and CINAHL, and the reference lists of all eligible studies were searched. RESULTS: Nine records comprising of eleven studies were included, with data heralding from various countries, published between 1990 and 2022. We identified three main themes: travel preparation (type of travel, planning, and advice seeking); issues related to air travel (airports and airport security, hypoglycaemia and hyperglycaemia, and insulin); and general travel-related issues (illness and medical treatment, type 1 diabetes management, and major concerns and barriers). CONCLUSIONS: Our findings highlighted the lack of quality data regarding type 1 diabetes and travel within the extant literature, as well the pressing need for empirical studies to be undertaken and consensus guidelines developed to improve the travel experiences of people with type 1 diabetes. Unless change is made, people with type 1 diabetes will continue to experience preventable risk and harm while travelling.

Systematic review of the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes.

BACKGROUND: Type 1 and 2 diabetes care, especially within primary health-care settings, has traditionally involved doctor-led clinics. However, with increasing chronic disease burden, there is scope for nurses to expand their role in assisting diabetes self-management. AIMS: This study aimed to determine the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes. METHODS: Methodology from the Joanna Briggs Institute Method for Systematic Review Research and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, including identifying publications, assessing study quality, summarizing evidence and interpreting findings. The search strategy involved using the Medical Subject Headings and keyword variations when searching MEDLINE (Ovid), Scopus, PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Inclusion criteria were samples with Type 1 or 2 diabetes, mean age of ≥18 years, English language studies and publication date of January 2011-December 2021. RESULTS: Overall, 34 articles from 16 countries met inclusion criteria. Though not always clinically significant, results indicated that nurse-led care had beneficial impacts on glycated haemoglobin values, with reductions from 0.03% to 2.0%. This was evident when nurses received formal training, used treatment algorithms, had limited medical support, utilized technology and offered defined culturally sensitive and appropriate diabetes care. CONCLUSIONS: Findings support nurse-led Type 1 and 2 diabetes care. Although further research is required, changes may necessitate increased recognition of nurse-led care and funding. Nurse-led care models should differ according to health-care settings.

Factors affecting ward nurses' basic life support experiences: An integrative literature review.

BACKGROUND: Performing cardiopulmonary resuscitation in non-critical care hospital wards is a stressful event for the registered nurse; stress may negatively affect performance. Delays in initiating basic life support and following current basic life support algorithms have been reported globally. AIM: The aim of this review was to investigate factors that can affect registered nurses' experiences of performing basic life support. METHODS: Using the five-step integrative literature review method from Whittemore and Knafl, this review searched articles published between January 2000 and June 2022 for qualitative and quantitative primary studies from the databases CINAHL Complete (EBSCO), Medline (Web of Science), Scopus and PubMed. RESULTS: Nine studies from eight countries met the inclusion criteria and were appraised here. Five themes relating to factors affecting the performance of basic life support were found during this review: staff interaction issues, confidence concerns, fear of harm and potential litigation, defibrillation concerns and basic life support training issues. CONCLUSIONS: This review revealed several concerns experienced by registered nurses in performing basic life support and highlights a lack of research. Factors affecting nurses' experiences need to be understood. This will allow education to focus on consideration of human factors, or non-technical skills during basic life support training, as well as technical skills, to improve outcomes for patients experiencing an in-hospital cardiopulmonary arrest.

How registered nurses are measuring respiratory rates in adult acute care health settings: An integrative review.

AIMS AND OBJECTIVES: This integrative review aimed to draw conclusions from evidence on how registered nurses are measuring respiratory rates for acute care patients. BACKGROUND: Despite the growing research supporting respiratory rate as an early indicator for clinical deterioration, respiratory rate has consistently been the least frequently measured and accurately documented vital sign. DESIGN: An integrative review. METHODS: A systematic literature search was conducted in June 2022 in four databases: CINAHL, PubMed, Medline and Scopus. Quality appraisal was undertaken using the Joanna Briggs Institute's Checklist. PRISMA guidelines were followed to ensure explicit reporting and reported in the PRISMA checklist. RESULTS: Overall, 9915 records were identified, and 19 met the inclusion criteria. Of these 19 articles, seven themes emerged: estimation and digit preference, lack of understanding and knowledge, not valuing the clinical significance of respiratory rate, oxygen saturation substitute, interobserver agreement, subjective concern and count duration. A high prevalence of bias, estimation and incorrect technique was evident. A total of 15 articles reported specifically on how registered nurses are measuring respiratory rates on general medical and surgical wards. CONCLUSIONS: Despite its importance, this integrative review has determined that respiratory rates are not being assessed correctly by nursing staff in the acute care environment. Evidence of using estimation, value bias or quick count and multiply techniques are emerging themes which urgently require further research. No patient or public contribution.

"I've had horrible things said about me": An inductive content analysis of nursing academic experiences of contra-power harassment from undergraduate nursing students.

AIM: The aim of this study was to describe the experiences of nursing academics exposure to contra-power harassment by under-graduate nursing students. BACKGROUND: Contra-power harassment by nursing students is a growing phenomenon which is defined as the harassment of those ni formal positions of power by those who are not. Harassing behaviours can include verbal, physical and sexual and digital harassment through mediums such as social media. Cited behaviours perpetrated by under-graduate nursing students are often experienced after the release of grades. DESIGN: A self-administered online questionnaire was used to elicit responses to four open-ended questions regarding nursing academics experiences of contra-power harassment and nursing student incivility. METHOD: Inductive content analysis was used to identify text patterns from the academic comments. Each of comments was read through to get a sense of the whole. Re-reading the comments allowed for open coding into broad headings which described a specified meaning. Categorising the broad headings into higher order sub-categories then made it permissible to record comments that belonged to a particular group. The development of the main category using abstraction was first undertaken by creating generic categories from the sub-categories using content-characteristic words. The development of the broad and sub-categories were assessed independently by two of the authors and after discussion, agreement was reached as to the structure of the generic categories. RESULTS: A total of 159 comments received from 82 nursing academics each describing incidents of contra-power harassment. Nursing academics were faced with several differing behaviours that were seen as aggressive, anger, manipulation and threats. These were viewed as both verbal and isolation attacks In all, four generic categories were identified - Experiencing Harassment; You're Adding to My Stress; Being Set-up to Fail; Feeling Unsafe Professionally and Academically. Nursing academics describe experiencing the behaviours of contra-power harassment as being distressing, disturbing, frustrating, saddening and disappointing. CONCLUSION: The behaviours expressed by nursing students tended to occur at the release of grades. Most academics were concerned for their own safety both emotionally and physically because of the unpredictability of student behaviour. Most academics understood the pressures nursing students faced, especially the international students. However, they were often challenged by the need to support student learning and maintaining professional standards of behaviour.

Nursing students' perceptions of clinical relevance and engagement with bioscience education: A cross-sectional study of undergraduate and postgraduate nursing students.

BACKGROUND: Bioscience in nursing education covers a broad range of disciplinary areas (anatomy, physiology, pathophysiology and pharmacology) and underpins clinical assessment and critical thinking in nursing practice. This is imperative for patient safety and favourable patient outcomes. In nursing programs for registration, most bioscience content is taught during the early phases of the program and little incorporated into postgraduate nursing programs. OBJECTIVES: The aim of this study was to explore student's perceived relationship between clinical relevance and engagement (attention and time) with bioscience content, by surveying undergraduates and postgraduate nursing students. DESIGN: This sequential mixed methods study included two phases. METHODS: The first phase comprised of focus group interviews from one Australian University. Thematic analysis of these data, coupled with existing literature, informed the second study phase; a quantitative questionnaire. PARTICIPANTS: Focus group interviews included N = 30 students from one tertiary site; 10 from each year level. The questionnaire was administered to nursing students undertaking undergraduate nursing studies (1st, 2nd & 3rd years), and postgraduate nursing studies. RESULTS: Nursing students (n = 406) across three Australian universities (four programmes) completed the questionnaire. The clinical relevance of bioscience was widely appreciated; 91.6% of undergraduate nursing students and 98.5% of postgraduate nursing students indicated that every nurse must have a good understanding of bioscience. However, there was an inverse relationship between engagement with bioscience and timing in the curriculum, as 50% of undergraduate nursing students indicated that bioscience content took up too much of their time, compared to only 20% of postgraduate nurses (odds ratio 0.27 [0.16-0.46], p < 0.001). CONCLUSION: Nursing students' perceptions of the clinical relevance of bioscience for their career strongly corresponds with their progression through their studies. Unfortunately, as students progress to the later years of their nursing education, their engagement with formal bioscience education decreases. This poses the question 'Are we delivering bioscience content to nursing students at the appropriate time?'

"Gaining a new sense of me": Mature students experiences of under-graduate nursing education.

BACKGROUND: Mature aged students bring a unique perspective to the under-graduate nursing programme. For many this will be the culmination of different career pathways or the feeling it is their time. However, mature students also experience significant changes both educationally, familial and financially. Balancing the competing demands can create a great deal of emotional and stressful challenges. AIM: To gain a better understanding of the mature aged student's educational experiences of undertaking the bachelor of nursing degree. SETTING: The setting included a regional and metropolitan campus in South East Queensland. PARTICIPANTS: A convenience sample of mature nursing students (n = 21) were asked to participate in focus group interviews. METHOD: Five focus group interviews were transcribed and analysed using inductive thematic analysis. There were three themes captured from the focus group interviews - Family Supported/Family Divided; Challenges for the Older Student and Gaining a New Sense of Me. RESULTS: Many of the mature students in this study cherished the idea of making a new start and a nursing career afford them the opportunity - it was something they had always dreamed of. They expressed the challenges associated with being a nursing student, the competing demands - financial, social and educational, but despite these they saw their future as being extremely positive and potentially rewarding. CONCLUSIONS: Mature aged students continue to experience difficult academic challenges, difficult life choices especially where family support is not forth-coming and at times financial insecurity. It would seem reasonable that ensuring the educational experience is tailored to meet the challenges of being a mature student are considered to support the additional expenditure that is created by returning to higher education.

Are we measuring nursing workflow correctly? A literature review.

When it comes to determining what constitutes nursing workload, there are a number of approaches that represent and characterise the work of nursing across the three traditional shift patterns (morning/day, afternoon/evening and night). These are observational, self-reporting and work-sampling techniques. A review of the quantitative and qualitative literature to examine workload distributions between the three nursing shifts was undertaken. Using data sourced from the CINAHL, Scopus and Medline databases, the findings suggest that there is an inadequacy in establishing nursing productivity that is perhaps representative of the methods used to decipher nursing workload. This may contribute to poor quality care, and the high cost of excess nursing time contributes to the increasingly high costs of care. Linked to this is the nurse's job satisfaction. Quality of care and job satisfaction are important factors for the sustainability of the nursing workforce. There are few high-quality nursing articles that detail the workload distributions across the three nursing shifts and this is a potential area for further research.

Nurse academics' experience of contra-power harassment from under-graduate nursing students in Australia.

BACKGROUND: There is growing concern around inappropriate behaviour being perpetrated by under-graduate nursing students towards nursing academics. Coined contra-power harassment, is defined as the harassment of individuals in formal positions of power and authority by those that are not. The type of harassment behaviours reported include: verbal and physical violence, character assassination through social media, stalking and sexually motivated behaviours. The most often cited reasons for the escalation in these behaviours are seen with course progression and the awarding of grades. AIM: The aim of this study is to better understand the extent to which nursing academics experience contra-power harassment from under-graduate nursing students. METHOD: A convenience sample of nursing academics were in Australia were contacted and provided with an introductory letter, a participant information sheet and a link to an online questionnaire. A 41-item Likert scale (Strongly agree-strongly disagree) was used to elicit responses to statements on academics' experiences of and the contributing factors associated with contra-power harassment. RESULTS: The main contributing factor identified from this study was seen as the consumerism of higher education; in particular paying for a degree gave a sense of entitlement with academics experiencing the highest levels of student harassment around grades. CONCLUSIONS: Contra-power harassment is becoming common place in higher education especially in nursing education. The competitive nature of obtaining employment post-university has meant that some nursing student's behaviours are becoming increasingly uncivil, challenging and unprofessional.

Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature.

PROBLEM: The paucity of up-to-date recommendations and evidence-based models, whether it is physician-initiated or initiated by other healthcare professionals, for humidified high flow oxygen therapy among children. ELIGIBILITY CRITERIA: The inclusion criteria included the following: 1) use of high flow oxygen therapy (≥15 L/min); 2) published studies from the year 2000 and onwards; 3) research article in a peer-reviewed journal; 4) studies conducted in a hospital setting involving paediatric patients <18 years old; 5) availability of full article online. SAMPLE: From March to April 2018, electronic databases such as PubMed, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica Database, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, SCOPUS, Ovid, Informit, and Google Scholar were accessed. The systematic search initially yielded 41 studies. RESULTS: Eventually, three eligible studies were reviewed and appraised. Overarching themes were identified: 1) the lack of weaning standards; 2) the limited focus on young population in intensive care settings; and 3) the paucity of weaning models. CONCLUSION: The lack of studies suggested that this is a fertile area for research. In this light, this paper challenged researchers, clinicians, and experts to develop evidence-based standards and models of weaning towards efficient and better quality of care. IMPLICATION: This review may lead to the development of nurse-led or nurse-initiated weaning protocols to enable timely weaning intervention for children and thus reduce the need for prolonged oxygen use. Furthermore, this may also instigate an economic evaluation of a nurse-lead weaning against current models of medically lead weaning.

"Nursing Tree Time": An inter-professional team approach to supporting student nurse learning at a regional university campus.

Providing academic and pastoral support to nursing students is important not only for ensuring success and achievement in their studies, but also to provide an inclusive environment where students have a sense of purpose and a sense of belonging. Such support is used extensively in other countries such as the United Kingdom, it is often not provided in some cases like Australia because of student cohort sizes and academic resistance to the pastoral role. The aim of this exploratory study was to evaluate the effectiveness of an inter-professional team approach to support nursing student learning. Nursing Tree Time was an academic pastoral support programme that encompassed a nursing academic, an academic skills advisor and a student welfare counsellor. For 2 h per day over two thirteen-week semesters, a nursing academic was available in the campus library to provide support and advice for any undergraduate nursing student present. Additional support was provided from an academic skills advisor and a student counsellor. A fifteen item Likert scale (1 = strongly disagree; 5 = strongly agree) with six open-ended questions was developed and administered to a convenience sample of 38 nursing students who accessed Nursing Tree Time. The results demonstrate that 80% of students were highly in favour of this type of support, 60% of students made these sessions a priority and 73% of students felt these sessions influenced them continuing with their studies. Importantly, over 94% of students agreed that the collaborative approach and access and availability this type of input improved confidence and success. A Cronbach's Alpha of 0.81 demonstrated good internal consistency. It is evident from these results that students felt there was an overwhelming need for continued academic pastoral support; however, this can prove challenging given the competing demands experienced by most nursing academics - research, teaching and governance responsibilities.

Hypocalcaemia-induced tetany secondary to total thyroidectomy: a nursing case review.

Presentations to the emergency department with a diagnosis of hypocalcaemia-induced tetany secondary to total thyroidectomy are rare. A patient presented to the emergency department of a regional Australian hospital with hypocalcaemia-induced tetany. A case study was employed to reflect on the care provided and identify knowledge practice deficits within this unusual patient presentation. Calcium plays a central role within the nervous system and is vital for both cardiac and muscular contraction. The clinical manifestations of electrolyte disturbances such as hypocalcaemia can be life threatening, and therefore, appropriate assessment, monitoring and management are essential to ensure positive patient outcomes. Understanding the importance of calcium imbalance for the emergency and critical care nurse is paramount in preventing complications associated with cardiac conduction and muscle tone, especially the potential for airway compromise. Education is central to this and may include clinical case reviews, the application of pathophysiological presentations of electrolyte imbalance and a review of electrolyte administration guidelines. Understanding the role of calcium within the body will assist emergency and critical care nurses to assess, monitor and intervene appropriately, thereby preventing the life-threatening manifestations of hypocalcaemia.

Snaps+: Peer-to-peer and academic support in developing clinical skills excellence in under-graduate nursing students: An exploratory study.

Peer to peer learning is not a new concept. It has proven to be a valuable approach to enhance deeper learning, improve critical thinking and problem solving. It has been used in the clinical environment, the classroom and the clinical skills laboratory. The aim of this study was to evaluate the effectiveness of student nurse assisted in practice sessions (SNAPS+) with the addition of an experienced nursing academic. Using an eight item Likert scale questionnaire together with three open ended questions, this study found that having a nursing academic present in supporting the peer teachers helped improve confidence in practicing clinical skills and was an effective teaching approach to support student learning and by also providing a critical eye over the skills being practiced. Content analysis revealed to central themes - 'being and feeling supported' and 'feeling more able and competent at undertaking essential nursing skills. The results suggest that overall the nursing students found the SNAPS+ supportive in allowing the time and space to practice skills in an informal manner. The implications for practice could include an evaluation as to whether there is any effect on student success in the clinical placement environment after attending SNAPS+ sessions.

Using the HALT model in an exploratory quality improvement initiative to reduce medication errors.

Medication errors can have deleterious effects on patient safety and care. Interruptions, patient acuity and time pressures have all been cited as contributing factors in the incidence of medication errors. Yet, despite the number of different strategies that can be taken to reduce the incidence of medication errors, they still occur. The strategies often focus on refining systems and processes, depending on the root cause of the error. However, less recognised as contributory elements are human factors such as anger, hunger or tiredness. The aim of this quality improvement initiative was to reduce medication errors by 25% on a medical ward, through the introduction of the hunger, angry, lonely, tired (HALT) model to address the human factors associated with medication errors. Post-implementation, the HALT model appeared to have resulted in a total reduction in medication errors over a 2-month period by 31%. Mistakes related to human error were reduced by 25%, and those linked to communication and documentation errors by 22%. While this was a small-scale study, this is a significant reduction in medication errors. However, caution should be used when addressing other contributing factors associated with medication errors as using HALT alone will not address these.

The gastro-renal effects of intra-abdominal hypertension: Implications for critical care nurses.

Intra-abdominal hypertension is classified as either primary or secondary - primary occurs due to intra-abdominal or retro-peritoneal pathophysiology, whereas secondary results in alterations in capillary fluid dynamics due to factors, such as massive fluid resuscitation and generalised inflammation. The renal and gastro-intestinal effects occur early in the progression of intra-abdominal hypertension, and may lead to poor patient outcomes if not identified. As a direct response to intra-abdominal hypertension, renal function is reduced with remarkable impairment from pressures of around 10 mmHg, oliguria developing at 15 mmHg and anuria developing at 30 mmHg. Intestinal micro-circulation is significantly reduced by up to 50% with intra-abdominal pressures as low as 15 mmHg. Mucosal and submucosal tissue hypo-perfusion causes considerable damage to the intestinal cells, potentially resulting in bacterial translocation, endotoxin release, sepsis and multiple organ failure. The critical care nurse plays an important role in the early identification of intra-abdominal hypertension however, without this essential knowledge base and comprehension of intra-abdominal hypertension, clinical signs and symptoms may go unnoticed or be misinterpreted as signs of other critical illnesses.

Using Colaizzi's method of data analysis to explore the experiences of nurse academics teaching on satellite campuses.

BACKGROUND: Phenomenology is a useful methodological approach in qualitative nursing research. It enables researchers to put aside their perceptions of a phenomenon and give meaning to a participant's experiences. Exploring the experiences of others enables previously unavailable insights to be discovered. AIM: To delineate the implementation of Colaizzi's ( 1978 ) method of data analysis in descriptive phenomenological nursing research. DISCUSSION: The use of Colaizzi's method of data analysis enabled new knowledge to be revealed and provided insights into the experiences of nurse academics teaching on satellite campuses. Local adaptation of the nursing curriculum and additional unnoticed responsibilities had not been identified previously and warrant further research. CONCLUSION: Colaizzi's ( 1978 ) method of data analysis is rigorous and robust, and therefore a qualitative method that ensures the credibility and reliability of its results. It allows researchers to reveal emergent themes and their interwoven relationships. Researchers using a descriptive phenomenological approach should consider using this method as a clear and logical process through which the fundamental structure of an experience can be explored. IMPLICATIONS FOR RESEARCH: Colaizzi's phenomenological methodology can be used reliably to understand people's experiences. This may prove beneficial in the development of therapeutic policy and the provision of patient-centred care.

An integrative review of graduate transition programmes: Developmental considerations for nursing management.

Graduate transition programmes have been developed to recruit new nursing staff and facilitate an effective transition from nursing student to Registered Nurse within the clinical environment. Therefore the aim of this paper was to explore the various elements included in nursing graduate transition programmes. An integrative review was undertaken incorporating a strict inclusion criterion, critical appraisal, and thematic analysis of 30 studies. There are numerous transition programmes available yet there remains a lack of transparency regarding their aims/objectives, course content, support timeframe and the type of support provided. This inconsistency has resulted in a lack of clarity regarding efficacy or superiority of any one programme over another. Innovative multifaceted programs may assist in supporting the graduate registered nurse to transition effectively into the clinical environment. Providing these support programmes may allow nurse managers to recruit new graduates and therefore decrease the staff budget expenditure. IMPLICATIONS FOR NURSING MANAGEMENT: No graduate programme was shown to be superior to others yet graduate programmes appear to positively influence the experience of the graduate and increase staff recruitment. Comparative research is needed to ascertain the integral components of these programmes.

The cardio-respiratory effects of intra-abdominal hypertension: Considerations for critical care nursing practice.

Intra-abdominal hypertension can be classified as either primary or secondary. Primary intra-abdominal hypertension is often associated through trauma or diseases of the abdominopelvic region such as pancreatitis or abdominal surgery, while secondary intra-abdominal hypertension is the result of extra-abdominal causes such as sepsis or burns. The critically ill patient offers some challenges in monitoring in particular secondary intra-abdominal hypertension because of the effects of fluid resuscitation, the use of inotropes and positive pressure ventilation. Recent work suggests that intensive care unit nurses are often unaware of the secondary effects of intra-abdominal pressure and therefore this is not monitored effectively. Therefore being aware of the cardio-respiratory effects may alert theintensive care nurse nurse to the development of intra-abdominal hypertension. The aim of this paper is to discuss the pathophysiology associated with the cardio-respiratory effects seen with intra-abdominal hypertension in the critically ill. In particular it will discuss how intra-abdominal hypertension can inadvertently be overlooked because of the low flow states that it produces which could be misconstrued as something else. It will also discuss how intra-abdominal hypertension impedes ventilation and respiratory mechanics which can often result in a non-cardiogenic pulmonary oedema. To close, the paper will offer some implications for critical care nursing practice.

An integrative review of absenteeism in newly graduated nurses.

Managing sickness and absenteeism in the workplace is challenging, and nurse managers must consider their various causes so they can implement effective management strategies. It is also vital to consider the factors that influence absenteeism and turnover among newly graduated registered nurses (RNs), whose retention can help to address staff shortages. This article describes a literature review that aimed to identify the potential causes of sickness absence in newly graduated RNs. It also discusses strategies that nurse managers can use to retain and maintain their workforce.