The impact of automated medicine dispensing units on nursing workflow: A cross-sectional study.

BACKGROUND: Automated medication dispensing cabinets are ubiquitous in hospitals in the United States and prevalent in Canada, but they are still relatively new to health services elsewhere. The automation of medication management using distributed dispensing units is aimed at improving stock management and patient safety; however, the evidence for the latter remains equivocal, and the impact on nursing workflow is poorly understood. OBJECTIVE: This study evaluated the impact on the nursing workflow of a distributed automated medication dispensing system. The research aimed to explore the acceptability and utility of this system in a variety of clinical settings and to investigate similarities and differences in the use of the dispensing cabinets across different clinical areas. DESIGN: A cross-sectional design was employed. SETTING: The setting was a newly constructed 450-bed regional Australian tertiary hospital. PARTICIPANTS: The study involved 174 registered nurses and 12 pharmacy assistant staff from general ward and specialty areas who were using the automated medication dispensing cabinets. METHODS: Methods included a hospital-wide survey of users and an observation study of nursing workflow around the automated medication cabinets in specific clinical areas. RESULTS: The majority of staff were satisfied with the system and were positive about the overall safety and security. Key concerns related to access delays, and increased time needed due to walking distance and interruptions from other staff. Staff perceived that the automated medication dispensing cabinet use slowed medication administration processes as a result of queueing, and it also had other impacts on workflow. The system was found to expedite processes around controlled/narcotic drug administration. Re-stocking requirements presented operational issues; pharmacy assistants were observed waiting for opportunities to complete re-stocking tasks in the face of competing clinical requirements. Nurses from general wards were more satisfied with the system than those from specialty areas. CONCLUSIONS: Automated medication dispensing cabinets were widely accepted by nurses in a large newly opened hospital in a variety of acute clinical areas despite disruptions to workflow. Adaptations for access were more acceptable to nurses in general wards than those in specialty areas prompting consideration of redesign to improve suitability. Tweetable abstract: Automated medication cabinets change nursing workflow because of queueing, interruptions from other staff and increased walking. Ward nurses are more accepting of such workflow disruptions than speciality area nurses #medicationsafety #nurseworkflow #nursesatisfaction (268 char).

The Capabilities of Nurse Educators (CONE) questionnaire: Development and evaluation.

BACKGROUND: To inspire excellent clinicians to become educators, the role of the nurse educator needs to be more fully defined. Capabilities rather than competencies may better describe advanced professional practice. OBJECTIVES: To develop an effective measure of the multifaceted complexity of the nurse educator role, which will enable nurse educators to (1) self-assess their capability set, (2) identify areas for professional development, and (3) evaluate professional development interventions. METHOD: A questionnaire (with 6 subsets) interrogating nurse educator capabilities was developed through wide professional consultation and an expert working group, and evaluated. Statistical analyses investigated internal consistency, internal correlation of items, relationship to professional practice data (also collected via questionnaire), and test-retest reliability of the questionnaire and subsets. PARTICIPANTS: Nurse educators (266) working within universities and health services in Australia and New Zealand. RESULTS: Analyses resulted in a 93-item Capabilities of Nurse Educators (CONE) questionnaire, with six subsets measuring Teaching Knowledge and Practice, Drawing from Nursing Knowledge, Teaching Relationships, Leadership, Research Orientation and Research Action. The questionnaire and subsets demonstrated internal validity (Cronbach's α ≥ .9). Reliability in this population was supported via significant differences between ranked questionnaire scores in ordinal categories of data collected about professional practice. The 8-week test-retest analysis supported the reliability of the CONE over time and suggested the questionnaire could be useful to evaluate the success of professional development activities. CONCLUSIONS: The CONE questionnaire proved useful for measuring the complex capabilities of nurse educators in the academic and health service contexts studied and may assist educators to self-assess their capability sets and identify areas for professional development. It also shows promise as an evaluation tool for professional development. The utility of CONE as a self-diagnostic tool in career advancement, particularly in novice educators and educators outside Australia, requires further confirmation.

Learning essentials: what graduates of mental health nursing programmes need to know from an industry perspective.

AIMS AND OBJECTIVES: To explore the perspectives of nursing directors in mental health in Queensland, Australia, regarding the skills and attributes of graduates of comprehensive nursing programme to provide an industry perspective and thus augment knowledge from theoretical and professional dimensions. BACKGROUND: There is a worldwide shortage of appropriately qualified nurses with the knowledge, skills and attitudes to work effectively in mental health services. Within Australia, this has been well documented since the introduction of comprehensive nursing education. The underrepresentation of mental health content in undergraduate curricula has been identified as the primary reason for nursing graduates not being adequately prepared for practice in this field. To date, this issue has primarily been addressed from the perspective of university academics, with the voice of industry relatively silent in the published literature. DESIGN: Qualitative exploratory. METHOD: In-depth telephone interviews with Director of Nursing (Mental Health) in Queensland, Australia. RESULTS: The concerns of participants were expressed in six main themes: (1) foundational knowledge of mental health and disorders, (2) recovery-oriented skills, (3) physical as well as mental health skills, (4) therapeutic strategies, (5) resilience and self-development and (6) advanced knowledge and skills. CONCLUSIONS: The education of comprehensive nursing education needs to be reviewed as a matter of priority to ensure graduates with the attributes required to provide high-quality care for consumers of mental health services. RELEVANCE TO CLINICAL PRACTICE: A skilled and knowledgeable workforce is an essential component of high-quality mental health services. Research highlighting the current deficits and issues is therefore of the highest priority.

Things you can learn from books: exploring the therapeutic potential of eating disorder memoirs.

This paper explores the potential benefits that books, and specifically memoirs, might offer mental health students, positing that first-person testimonials might make the complex experiences of a mental health challenge, in this case, eating disorders, accessible to learners. The paper presents a pedagogical approach, based on transformative learning, to assist in encouraging the development of a recovery approach in students. Transformative learning is a pedagogy that is interested in problematic practices that keep afflicting an area, such as the imbalanced focus on learning illness, rather than well-being, and in pondering and revising the educational solutions. The paper proposes that forward movement in this area will be based on considering and developing such innovative curricula, and researching its impact. By virtue of their accessibility, memoirs could offer to a large audience the benefits of universality, empathy, hope, and guidance. Teachers and learners could be making use of these books in face-to-face or online activities. This paper explores the groundwork that is needed before eating disorder memoirs can be confidently recommended as a therapeutic tool.