Interventions to support graduate nurse transition to practice and associated outcomes: A systematic review.

OBJECTIVE: The aim of this mixed methods systematic review was to: i) document the interventions that support and facilitate graduate nurse transition from university to practice in a diversity of healthcare settings and ii) to identify outcomes from graduate nurse transition interventions for the graduate, patient or client, and health service. DESIGN: This mixed methods systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All quantitative, qualitative, and mixed methods studies were included if they met the inclusion criteria. DATA SOURCES: Primary research studies located in Medline, EmBase, CINAHL, Prospero, Cochrane Library, PsycInfo, and Web of Science (Social Science Citation Index). All quantitative, qualitative, and mixed methods studies were included if they met the inclusion criteria. REVIEW METHODS: Using a comprehensive search strategy, retrieved articles were screened by two reviewers at the title, abstract, and full-text stage. Reviewer disagreements were discussed until consensus was achieved. The well-validated Mixed-Methods Appraisal Tool was used to assess quality of the quantitative, qualitative, and mixed methods studies. RESULTS: A total of 130 studies were included as the review dataset. There was a myriad of terms used to describe transition interventions, and programme length and settings varied. The content of transition interventions was not well defined, and there was a lack of studies outside acute hospital settings. Data collection methods varied widely. The majority of authors reported outcomes for the graduate or the graduate and service, with only one reporting outcomes for the patient or client. There was a significant variation in quality across the studies. CONCLUSIONS: This review addresses a significant gap in the literature by documenting transition interventions in a diversity of health settings and outcomes from these interventions. Interest in transition to practice continues to rise, but there is an urgent need to conduct well designed, robust, and larger-scale studies at the national and transnational levels.

A Systematic Review of the Impact of Educational Programs on Factors That Affect Nurses' Post-Operative Pain Management for Children.

Despite extensive research in the international arena into pain and its management, there is, as yet, little research on the topic of pain in children in Saudi Arabia and in the Gulf countries generally. A systematic review was conducted to explore the impact of education programs on factors affecting paediatric nurses' postoperative pain management practice. This was done in order to advise the creation of an educational program for nurses in Saudi Arabia. Knowledge about pain, attitudes towards pain, beliefs about children's pain, perceptions of children's reports of pain, self-efficacy with regard to pain management, and perceptions of barriers to optimal practice were all considered to be relevant factors. The review was restricted to randomized controlled trials and quasi-experimental designs, excluding studies focussed on chronic pain or populations other than solely children. Studies published in English between 2000 and 2016 were identified using CINAHL, MEDLINE, Ovid SP, The Cochrane Library, ProQuest, and Google Scholar databases. Of 499 published studies identified by the search, 14 met the inclusion criteria and were included in the review. There was evidence of educational programs exerting a postive impact on enhancing pediatric nurses' knowledge of pain and modifing their attitudes towards it, but only limited evidence was available about the impact on nurses' beliefs and perceptions of children's reports of pain, nurses' self-efficacy, or barriers to optimal practice. None of the studies was conducted in Saudi Arabia. Studies were needed to address additional aspects of preparedness for effective postperative pain management. Details of educational programs used as experimental intervention must be included in reports.

Factors enabling implementation of integrated health and social care: a systematic review.

BACKGROUND: In spite of ongoing UK Government recommendations for integrated health and social care, the implementation has been slow. While there are pockets of integration happening across England, many services remain isolated and fragmented. AIM: This review aims to critically review existing evidence to identify if there are any factors enabling successful implementation of integrated health and social care for people with long-term conditions in the community. METHOD: A review was conducted following the principles of a systematic review. Relevant data was extracted from the identified papers and the papers were quality appraised. RESULTS: A total of seven studies were included in the review. Data analysis and synthesis identified a number of themes in relation to enablers of integrated care, including co-location of teams, communication, integrated organisations, management and leadership, capacity and resources, and information technology. CONCLUSION: There is a limited amount of evidence regarding integrated health and social care teams. Although there are some consistencies within the findings, further research is needed to enhance the validity of the body of evidence available.

A different world? The transition experiences of newly qualified children's nurses taking up first destination posts within children's community nursing teams in England.

The concept of transition is of fundamental concern to those seeking to prepare, recruit, and retain newly qualified staff. The pioneering work of researchers such as Kramer (1974) who explored the transition experiences of nurses has transcended international boundaries (Whitehead & Holmes, 2011) to influence the educational preparation of nurses worldwide. However, much of what we know about the transition experiences of newly qualified nurses is based on research with adult nurses and in the acute care settings. This article outlines the findings from a qualitative study about the experiences of a group of newly qualified children's nurses in England who had taken up first destination posts in community children's nursing teams at a time when such posts were novel, and had previously been met with some resistance. Data were collected using semi-structured interviews and fieldwork observation, and analyzed using a combination of thematic analysis (Braun & Clarke, 2006) and the framework approach (Ritchie & Lewis 2003; Smith & Firth 2011). The findings are outlined under the broad headings of "Shadowing," "The Visits," and "Emerging Identity" and support previous research that highlights how good formal support and the physical presence of a preceptor is valued by newly qualified nurses since it reduces occupational stress. However, the study also highlights the downside of such support which occurred because some accepted practices inadvertently reduced confidence and therefore inhibited a smooth transition. The ideal transition experience therefore necessitated a more individual approach, allowing for different rates of progression. The primary care environment allowed for such individuality which may account for the significant finding that the nurses in this study did not report feelings of reality shock (Kramer, 1974) as experienced by those in acute care settings. The study therefore highlights how the development of a new professional identity as a community children's nurse is not just dependent on the actions of the newly qualified nurse, but also of those with whom they work.

Plethora or paucity: a systematic search and bibliometric study of the application and design of qualitative methods in nursing research 2008-2010.

Qualitative methodology has increased in application and acceptability in all research disciplines. In nursing, it is appropriate that a plethora of qualitative methods can be found as nurses pose real-world questions to clinical, cultural and ethical issues of patient care (Johnson, 2007; Long and Johnson, 2007), yet the methods nurses readily use in pursuit of answers remains under intense scrutiny. One of the problems with qualitative methodology for nursing research is its place in the hierarchy of evidence (HOE); another is its comparison to the positivist constructs of what constitutes good research and the measurement of qualitative research against this. In order to position and strengthen its evidence base, nursing may well seek to distance itself from a qualitative perspective and utilise methods at the top of the HOE; yet given the relation of qualitative methods to nursing this would constrain rather than broaden the profession in search of answers and an evidence base. The comparison between qualitative and quantitative can be both mutually exclusive and rhetorical, by shifting the comparison this study takes a more reflexive position and critically appraises qualitative methods against the standards set by qualitative researchers. By comparing the design and application of qualitative methods in nursing over a two year period, the study examined how qualitative stands up to independent rather than comparative scrutiny. For the methods, a four-step mixed methods approach newly constructed by the first author was used to define the scope of the research question and develop inclusion criteria. 2. Synthesis tables were constructed to organise data, 3. Bibliometrics configured data. 4. Studies selected for inclusion in the review were critically appraised using a critical interpretive synthesis (Dixon-Woods et al., 2006). The paper outlines the research process as well as findings. Results showed of the 240 papers analysed, 27% used ad hoc or no references to qualitative; methodological terms such as thematic analysis or constant comparative methods were used inconsistently; qualitative was a catch-all panacea rather than a methodology with well-argued terms or contextual definition.

Peeling back the layers of learning: a classroom model for problem-based learning.

This paper aims to provide an informative discussion with underpinning rationales about the use of a problem-based learning (PBL) classroom model, supported by a structured process for undertaking PBL. PBL was implemented as a main teaching and learning strategy for a diploma in nursing programme as advised by the Department of Health [Department of Health., 1999. Making a difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Health Care. Department of Health, London.] and the United Kingdom Central Council for nurses, midwifes and health visitors [United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1999. Fitness for Practice. UKCC, London.]. The implementation and change to the PBL approach is not without challenges, and so it was considered important to facilitate this change effectively. Through ongoing reflection, peer discussions and continuous review of the literature following studies at Masters Level, it was identified that the design of a model may guide students and facilitators who were new to the PBL process to help students identify relevant learning needs and thus enable them to achieve the learning outcomes of a dynamic curriculum [Darvill, A., 2000. Developing Problem-based Learning in the Nursing Education Curriculum: A Case Study. Unpublished MSc Dissertation, University of Huddersfield, Huddersfield; McLoughlin, M., 2002. An Exploration of the Role of the Problem-based Learning Facilitator: An Ethnographic Study of Role Transition in a Higher Education Institution 'Paradigm Shift or New Ways of Working'. Unpublished MSc Dissertation. University of Huddersfield, Huddersfield.]. In this paper the key components of the model will be described.

Mesangial autoantigens in IgA nephropathy: matrix synthesis and localization.

Primary IgA nephropathy, a chronic nephritis with variable prognosis, is characterized by mesangial immunoglobulin A, frequently with codeposition of other immunoglobulin isotypes and complement components accompanying matrix expansion typically preceding glomerular scarring. Glomerular immunoglobulin G, when present, is localized to the mesangial periphery found variably in repeat biopsies. IgG anti-mesangial cell autoantibodies (IgG-MESCA) in sera of patients with IgA nephropathy, specific by F(ab')(2) binding to 48- and 55-kD autoantigen(s) could account for these deposits, but their in vivo localization, and the functional role in promoting scarring is unknown. A specific monoclonal antibody raised previously to these human mesangial cell autoantigen fractions, in this study localized to similar glomerular sites, reinforcing the view that immunoglobulin G deposition in vivo is a result of antibody-autoantigen binding. The propensity for immunoglobulin G more than other isotypes to enhance inflammation prompted study of its functional role in vitro. Using cultured human mesangial cells in a complement-free tritiated glycosaminoglycan synthesis single outcome assay, purified IgG fractions from patient sera increased matrix production in a dose-dependent manner compared with controls. At a constant total IgG concentration, matrix synthesis was proportional to the titre of IgG-MESCA. Autoreactive IgG stimulated matrix synthesis when compared with controls or IgA fractions. These findings are consistent with IgG-MESCA autoantibodies enhancing mesangial matrix synthesis in vitro, which suggests that in IgA nephropathy, similar prosclerotic autoimmune mechanisms might operate. Recombinant TGFbeta(1) also induced matrix synthesis, raising the possibility that both autoimmune mechanisms and those TGFbeta(1)-dependent are functional or inter-related. The pathogenesis of glomerular scarring and loss in IgA nephropathy may include, in part, these mechanisms.

Testing the water - problem-based learning and the cultural dimension.

This study reports the findings of a small case study using problem-based learning (PBL) as a teaching and learning strategy in a cultural awareness module, which forms part of a pre-registration diploma in nursing course. The study was carried out using a qualitative research methodology. It aimed to describe and explore 20 diplomat student nurses and their lecturers' experience of undertaking PBL. The categories that emerged from the analysis were: knowledge development and PBL process. A selection of these categories and their sub-categories are described and discussed in relation to the literature on problem-based learning. The study concluded that undergoing PBL as a teaching and learning strategy had positive outcomes for the students. Prior knowledge was utilised in knowledge development in relation to the problem and was seen as beneficial. Students reported that they felt more confident and used the knowledge gained to care for patients' cultural needs in practice. Students also identified lack of knowledge amongst staff in the clinical area in relation to cultural awareness. There were however some challenges in the transition to a PBL strategy from the perspective of the students and lecturers. Issues that were found to be difficult include the change to a different teaching and learning strategy, the implications of self-direction for the student and the role of the facilitator as a non-directive guide. The study recommends that the findings may be of use for other nurse educators implementing PBL as a teaching and learning strategy.