Nursing/midwifery students' perceptions of caring pedagogy and online learning during the COVID-19 pandemic.

AIM: This study aimed to gain a better understanding of nursing/midwifery students' perspectives on a pedagogy of caring and online learning during the COVID-19 pandemic. In addition, it aimed to determine if the COVID-19 pandemic impacted students' perceptions and experience of online learning and students' desire to enter the nursing/midwifery workforce. DESIGN: Mixed methods. METHODS: A multi-centre cross-sectional survey of Australian nursing and midwifery students was undertaken to explore students' experience of learning during the COVID-19 pandemic. RESULTS: There are several key findings from this study that may be relevant for the future delivery of undergraduate health education, students transitioning to practice and healthcare workforce retention. The study found that although students were somewhat satisfied with online learning during COVID-19, students reported significant issues with knowledge/skill acquisition and barriers to the learning process. The students reported feeling less prepared for practice and identified how clinical staff were unable to provide additional guidance and support due to increased workloads and stress. The textual responses of participants highlighted that connection/disconnection, empathy and engagement/disengagement had an impact on learning during COVID-19. CONCLUSION: Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. In addition, graduates entering the workforce felt less prepared for entry into practice due to changes in education delivery during COVID-19 that they perceived impacted their level of clinical skills, confidence and ability to practice as new graduate nurses/midwives. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. IMPACT: Attention must be given to the transition of new graduate nurses and midwives whose education was impacted by pandemic restrictions, to support their professional career development and to ensure retention of future healthcare workforce. Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. Educators should consider how connection and engagement can be actively embedded in the online learning environment.

Medical and surgical nurses' experiences of modifying and implementing contextually suitable Safewards interventions into medical and surgical hospital wards.

AIM: To explore general nurses' experiences of modifying and implementing contextually suitable Safewards interventions into medical and surgical hospital wards. DESIGN: Qualitative action research was used working with nurses as co-researchers. METHODS: Pre-implementation focus groups were conducted in April 2022 to understand and explore the current strategies nurses utilized to avert, respond to or decrease violence. Following this, two Safewards interventions were modified by the nurses on the wards. Post-implementation focus groups were conducted in October 2022, to explore the nurses' experience of implementing Safewards interventions and the effect on their nursing practice. Data were analysed using Braun and Clarke's framework for thematic analysis. RESULTS: Three themes emerged from the analysis of the pre-implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred: 'the space is hectic'; 'it can feel like a battlefield'; and 'the aftermath'. These themes encompass the nurses' experience of violence from patients and their visitors. Following the implementation of two modified Safewards interventions, the analysis of the focus groups reflected a change in nursing skills to avert or respond to violence: 'Safewards in action'; 'empathy and self-reflection'; and 'moving forward'. CONCLUSION: Safewards interventions can be successfully modified and used in general hospital wards and influence nursing practice to manage patient and visitor violence. IMPLICATIONS FOR THE PROFESSION: In the interests of safety, successful interventions to reduce violence towards general hospital nurses should be a priority for managers and healthcare organizations. Averting, mitigating and managing violence can decrease the negative professional and personal effect on nurses and ultimately improve well-being, job satisfaction and retention rates. Furthermore, decreasing violence or aggressive incidents leads to a safer patient experience and decreased number of nursing errors ultimately improving patient experiences and outcomes. Understanding nurses' experiences of violence and working with them to explore and develop contextually relevant solutions increases their capacity to respond to and avert violent incidents. Contextually modified Safewards interventions offer one such solution and potentially has wider implications for healthcare settings beyond the specific wards studied. IMPACT: This study addressed the implementation of modified Safewards strategies in medical and surgical wards to prevent violence. Three themes emerged from the analysis of the pre-implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred. Following the implementation of two modified Safewards interventions, the post-implementation focus groups reported positive changes to their practices using the modified resources to prevent violence from patients and their visitors. Mental health interventions, such as those used in the Safewards model can be modified and provide a tool kit of interventions that can be used by medical and surgical nurses. REPORTING METHOD: This paper has adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This paper outlines and discusses the action research approach undertaken to work with general hospital nurses to modify mental health nurses' Safewards interventions into their clinical practice. This paper provides evidence of the 'real world' application of Safewards interventions by medical and surgical nurses in general hospital wards. This paper presents qualitative findings based on focus group methods to highlight the narratives of general nurses and their experiences of violence.

"You don't want to know just about my lungs, you want to know more about me". Patients and their caregivers' evaluation of a nurse-led COPD supportive care service.

AIM: To evaluate a nurse-led model of supportive care in a COPD outpatient service from patient and caregiver perspectives. DESIGN: Case study methodology. METHODS: Data were collected from semi-structured interviews with patients (n = 12) and caregivers (n = 7) conducted between April 2020 and September 2022. A purposive sampling strategy was used. Interviews were transcribed verbatim and analysed using content analysis with an inductive approach. COREQ guidelines informed reporting of this study. RESULTS: Eight categories were identified from the data evaluating of the model of care relating to the most helpful aspects of COPD supportive care and suggested improvements to the model of care. The categories were: guidance with managing symptoms; participating in advance care planning; home visiting; expert advice; continuity and trust; caring; caregiver support and improvements to the model of care. CONCLUSION: In a nurse-led model of COPD supportive care, what patients and caregivers valued most was expert advice and guidance with symptom management, flexible home visiting, participation in advance care planning, caring and continuity within an ongoing trusted therapeutic relationship. Understanding what patients and caregivers value most is essential in designing and delivering models of care that meet the needs of patients living with chronic, life-limiting illness. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses can lead effective models of supportive care that offer valuable support to patients living with COPD and their caregivers.

Erasure of the young trans person: A critical discursive review of contemporary health care literature.

INTRODUCTION: Trans youth experience significantly higher rates of societal violence and ill-health compared to their cisgender peers. Although recent clinical guidelines for trans young people in health have paved the way for revolutionizing care, many trans young people still experience adversity in clinical settings. This discursive literature review provides a novel approach in exploring why trans young people experience violence in health care despite the availability of evidence-based resources and guidelines. DESIGN: Databases (CINAHL and Scopus) were systematically searched to identify qualitative literature on the experiences of trans young people (<18 years) in health care settings. METHOD: Rather than synthesizing and presenting the literature, Fairclough's (2001) CDA methodology was used to critically analyze the literature as texts in a data corpus. The authors engaged with the data from a critical social theory perspective. RESULTS: Fifteen qualitative articles and one report (n = 16) on the experiences of trans young people (3-24 years) in health care settings were included. Two key discourses were identified in the literature. First, discourses that constituted the trans young person were identified in the definitions of 'trans' as a pathological incongruence and as alternate, self-determined ways of being. Further discourses were identified in the constitution of trans young people as victims, extra-pathological, and alternatively problematised as socially dysphoric. Second, discourses in health provider responses were identified in dismissive, gatekeeping, regulatory, and respectful practices. DISCUSSION: The discursive constitution of the trans young person as incongruent, vulnerable, and pathological is constituted and generated by dismissive, gatekeeping, and regulatory practices of health care providers. The analysis reveals how trans young people are considered pathological and deemed treatable (at the site of the body), in the interest of 'protecting' them from a perceived abject future of trans adulthood. The logic and violence of cisgenderism is uncovered as the foundation of these dominant discourses, whereby growing up cisgender is often presented as the only option in health care settings. The dominant discourses that constitute the trans young person in health care as incongruent, pathological, and vulnerable, alongside the reifying health care responses of dismissal, gatekeeping, and regulation contribute to the erasure of the young trans person. CONCLUSION: This paper identified key discourses in the literature in how trans young people are constituted and regulated in health care. This review highlights an urgent need for further critical scholarship in trans health by trans researchers, from critical perspectives. Furthermore, it provides a starting point for critical reflection of health care provider and researcher practices and the re-imagination of trans-futurity for all young people in health care. CLINICAL RELEVANCE: Nurses are situated at the forefront of health care delivery and play a crucial role in the advocacy and provision of culturally safe care. With this ideal proximity to clients, nurses can powerfully affect change through better understanding and reflecting on how regulatory practices constitute and position trans young people in health care. Nursing knowledge, such as cultural safety, can offer novel approaches in working towards safer ways of meeting the needs of trans young people.

Nurses' experiences when conducting the mental state examination (MSE): A scoping review.

The Mental State Examination (MSE) is an assessment framework used to facilitate the collection of subjective and objective data about a person's current mental state. There is a lack of understanding of nurses' experiences when conducting the MSE. The aim of this scoping review is to identify, examine and summarize the available literature relating to nurses' experiences when conducting the MSE. A scoping review was conducted using Arksey and O'Malley (2005) framework to review, examine and synthesize the available literature on nurses' experiences with the MSE. A PRISMA flow diagram was used to describe the systematic literature search. Six databases (APA PsycInfo, CINAHL, MEDLINE, PubMed, ProQuest, and Scopus) were searched including reference lists of eligible sources. Google Scholar, Trove and Proquest Dissertation and Thesis were searched for grey literature. Twelve articles included in this scoping review considered nurses experiences when conducting the MSE. The principles of thematic analysis were used to synthesize the studies. Three distinct themes were identified from the literature: (i) Nurses' role and the MSE, (ii) Nurses' competence and knowledge when conducting the MSE, and (iii) Nurses' confidence when conducting the MSE. The results of this scoping review identified the MSE as a component of the mental health nursing role and a core competency of mental health telephone triage services. The MSE was used by nurses in the Emergency department (ED), acute in-patient and community mental health settings, including mental health telephone triage services. Nurses working in EDs and acute in-patient mental health settings experienced a lack of confidence and competence, including a knowledge deficit in conducting the MSE in comparison to nurses working in community mental health settings. Community mental health nurses identified the importance of conducting an MSE higher than acute in-patient mental health nurses. This review identified the need for evidence-based research related to the MSE and its application in nursing practice. Evidence-based research will inform the development of MSE guidelines and policies, thus, enhance mental health nursing practice related to the MSE, including improving and strengthening consumer-nurse therapeutic alliance in acute in-patient mental health settings.

Workplace gender discrimination in the nursing workforce-An integrative review.

AIM: To critically synthesise the literature that explores the experiences of workplace gender discrimination from the perspective of registered nurses. DESIGN: Integrative review. REVIEW METHODS: Primary research articles reporting on the experience of workplace gender discrimination towards registered nurses in any setting were eligible for inclusion. Studies were critically appraised for methodological quality using a modified Critical Appraisal Skills Program list. The six phases of thematic analysis proposed by Braun and Clarke (2006) were used to guide the analysis. Data were extracted and coded, and themes were identified according to the review aims and significant findings of each study. DATA SOURCES: CINAHL, MEDLINE, SCOPUS, Cochrane Library, published between January 2012 and June 2022. RESULTS: Twenty studies met the inclusion criteria. Major themes identified were (1) career progression, (2) career interruption, (3) positioning of men in nursing and (4) positioning of women in nursing. CONCLUSION: This review shows that both men and women in nursing experience workplace gender discrimination; however, the forms and consequences of this discrimination differ substantially by gender. IMPLICATIONS FOR THE PROFESSION: It is important that the pursuit of greater numerical representation of men in nursing does not result in further reinforcing patriarchal advantage. Professional development for nurse leaders in managing gender issues is recommended. IMPACT: This integrative review presents current issues on workplace gender discrimination for men and women in nursing. The findings suggest gender roles and norms have an effect on the careers of both men and women in nursing. The time has come to alter restrictive gender norms and to challenge notions of hegemonic masculinity and femininity. REPORTING METHOD: We have adhered to relevant EQUATOR guidelines-PRISMA. NO PATIENT OR PUBLIC CONTRIBUTION: For this literature review on workplace gender discrimination for registered nurses, we did not engage members of the patient population, nor the general public.

Embedding nurse-led supportive care in an outpatient service for patients with Chronic Obstructive Pulmonary Disease.

AIM: To describe a small multidisciplinary team's experience of the process of embedding nurse-led supportive care into an existing Chronic Obstructive Pulmonary Disease outpatient service. DESIGN: Case study methodology METHODS: Data were collected from multiple sources including key documents and semi-structured interviews with healthcare professionals (n = 6) conducted between June and July 2021. A purposive sampling strategy was used. Content analysis was applied to key documents. Interviews were transcribed verbatim and analysed using an inductive approach. RESULTS: Subcategories under the four-stage process were identified from the data. ASSESSMENT: evidence of needs of patients with Chronic Obstructive Pulmonary Disease; gaps in care and evidence of other models of supportive care. Planning: setting the supportive care service structure and intention; resources and funding; leadership, specialization and respiratory/palliative care roles. IMPLEMENTATION: relationships and trust; embedding supportive care and communication. EVALUATION: benefits and positive outcomes for staff and patients, and, improvements and future considerations for supportive care in the COPD service. CONCLUSION: A collaboration between respiratory and palliative care services resulted in successfully embedding nurse-led supportive care in a small outpatient service for patients with Chronic Obstructive Pulmonary Disease. Nurses are well placed to lead new models of care that aim to address unmet biopsychosocial-spiritual needs of patients. More research is needed to evaluate nurse-led supportive care in Chronic Obstructive Pulmonary Disease and other chronic illness settings; the effectiveness of nurse-led supportive care from the perspective of patients and caregivers and the impact of nurse-led supportive care on health service usage. PATIENT OR PUBLIC CONTRIBUTION: The development of the model of care is informed by ongoing discussions with patients with COPD and their caregivers. Data availability statement: Research data are not shared (due to ethical restrictions). IMPACT: Embedding nurse-led supportive care in an existing Chronic Obstructive Pulmonary Disease outpatient service is achievable. Nurses with clinical expertise can lead innovative models of care that address the unmet biopsychosocial-spiritual needs of patients with conditions such as Chronic Obstructive Pulmonary Disease. Nurse-led supportive care may have utility and relevance in other chronic disease contexts.

Chronic obstructive pulmonary disease and advance care planning: A synthesis of qualitative literature on patients' experiences.

OBJECTIVE: Advance Care Planning supports patients to share their personal values, goals, and preferences for future medical care with their family members and healthcare professionals. The aim of this review was to uncover what is known about patients with Chronic Obstructive Pulmonary Disease and their experiences with Advance Care Planning. METHODS: A systematic review and thematic synthesis of qualitative studies was undertaken. Five databases were searched for qualitative articles published between 2009-2019. The review was guided by the PRISMA framework and seven studies met the eligibility criteria. Thematic synthesis of descriptive themes in each article was undertaken to develop overarching analytical themes, related to the experience of patients with Chronic Obstructive Pulmonary Disease and Advance Care Planning. RESULTS: Four analytical themes emerged from the review of the articles that met the inclusion criteria: patient readiness and willingness for Advance Care Planning discussions; considering the future; trusted relationships with healthcare professionals; and shared decision making. DISCUSSION: Patients with Chronic Obstructive Pulmonary Disease are generally open to Advance Care Planning discussions with healthcare professionals who are well-informed, and trusted by the patient. Models of care that integrate Advance Care Planning are beneficial in other non-malignant settings, and may be a way forward to support Advance Care Planning as part of routine care for patients with Chronic Obstructive Pulmonary Disease.

Spirituality and Standards for Practice: A Critical Discourse Analysis.

Research Objective: The aim of this article is to report a study that explores how spirituality is understood to be represented in the current Australian Nursing and Midwifery Board of Australia (NMBA) Registered Nurse (RN) standards for practice. Research Design: Fairclough's approach to critical discourse analysis was applied in the examination of participant interview texts for the language used in relation to spirituality as well as power mechanisms which influenced the way the participants viewed spirituality's representation in the RN Standards for Practice. Participants: Three members of the RN Standards for Practice research and development team. Results: Findings indicate three discourses shaped the way participants viewed how spirituality is presently represented in the RN Standards for Practice. Discourses are (1) spirituality as part of holistic care, (2) spirituality as part of person-centered care, and (3) the professionalization of nursing. Conclusions: Participant interviews revealed these discourses exerted power over how spirituality was represented within the RN Standards for Practice. This has implications for the inclusion of spirituality in the practice standards and the practice of spiritual care.

What is the practice of spiritual care? A critical discourse analysis of registered nurses' understanding of spirituality.

Spirituality has been a part of nursing for many centuries and represents an essential value for people, including nurses and patients. Cumulative evidence points to the positive contribution of spiritually on health and wellbeing. However, there is little clarity about what spirituality means. The literature reveals that nurses have ascribed a diversity of interpretations to spirituality. However, no studies have investigated how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Therefore, the aim of this study was to uncover how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Twenty registered nurses from a non-denominational public hospital and a faith-based private hospital were interviewed about their understanding of spirituality and practice of spiritual care. A critical discourse analysis approach was used in the examination of the interview texts to uncover underlying social and power features. Links were made between the linguistic features the registered nurses used in their interviews and the broader social context of the study. Three discourses emerged from the interview texts. These include constructing spirituality through personal religious beliefs discourse, holistic discourse and empathetic care discourse. The findings of this study have implications for nurse education and policy makers.

How Nurses Understand Spirituality and Spiritual Care: A Critical Synthesis.

Aims: To discover how nurses understand spirituality and spiritual care and what affects nurses' understanding of these terms. Method: A literature search was conducted in CINAHL Plus, MEDLINE, and Google Scholar for research articles dated between 2010 and 2018 that were published in English. Using the Critical Appraisal Skills Program checklist for systematic reviews, nine articles met the inclusion criteria for this review. Most of these articles reported quantitative studies. Results: Although nurses recognize the importance of spirituality and spiritual care in nursing and have ascribed a diversity of meanings, there remains some confusion about what these terms mean. Several influences have been identified as shaping nurses understanding of spirituality and spiritual care, including education, nurses' own spirituality or religious beliefs, age, years of clinical experience, and place of employment. Conclusions: This review identifies the need for further studies using qualitative approaches to investigate how nurses' construct their understanding of spirituality and spiritual care and the dominant discourses nurses draw from to inform their understanding using qualitative approaches. Relevance to Clinical Practice: The insights gained by this review may be of value to nurse educators, managers, and policy makers in nursing education and the development of policies and practice guidelines.

Challenges in adapting a survey: ensuring cross-cultural equivalence.

BACKGROUND: The increase in the number of international research studies means more surveys need to be adapted for use in different languages. To obtain valid cross-cultural study results, researchers often use translated surveys. AIM: To describe the translation process used, and lessons learned by a bilingual English/Mandarin PhD student and her three English-speaking supervisors when developing and translating an English-language survey for use in a study in Taiwan. DISCUSSION: In evaluating the translation process in this study, the three criteria of content equivalence, semantic equivalence and conceptual equivalence are discussed in relation to the challenges these presented to the research team. Some of the ways the team addressed these challenges are also considered. CONCLUSION: The time available for the research and the ability of translators need to be assessed when adapting surveys for use in different languages and cultures. Sharing experiences and lessons learned in the translation process was worthwhile, as all members of the research team came away with new knowledge and an understanding of the need to ensure the final version of a translated survey is culturally congruent. IMPLICATIONS FOR PRACTICE: To accurately translate a survey into another language, it is essential that one of the researchers be fluent in that language. This guarantees the closest fit of content and semantic and conceptual meaning.

Nurses as participants in research: an evaluation of recruitment techniques.

BACKGROUND: Recruitment and retention of participants, as well as response rates, can be challenging in nursing research. This can be because of the questions asked; the choice of methodology; the methods used to collect data; the characteristics of potential participants; the sample size required; and the duration of the study. Additionally, conducting research with nurses as participants presents several issues for them, including the time needed to participate in the research, the competing commitments for clinical practice, the political and environmental climate, and recruitment itself. AIM: To report on research studies conducted by the authors at a tertiary teaching hospital, to show the lessons learned when recruiting nurses to participate in nursing research. DISCUSSION: The authors discuss factors that supported recruitment of nurses in these studies, including the use of the personal touch and multiple recruitment strategies in a single study. CONCLUSION: Videos and photography facilitate interdisciplinary research and can be a valuable means of non-verbal data collection, especially with participants affected by disabilities, and can support research methods, such as the use of questionnaires. IMPLICATIONS FOR PRACTICE: Recruiting nurses for research can be challenging. We suggest that researchers consider using more than one recruitment strategy when recruiting nurse participants. Recruitment is more successful if researchers align the aim(s) of the research with nurse's concerns and contexts.

The role of the breast care nurse in patient and family care.

AIMS AND OBJECTIVES: To describe the role of the breast care nurse in caring for patients and families. BACKGROUND: The breast care nurse is an expert clinical nurse who plays a significant role in the care of women/men and their families with breast cancer. The role of these nurses has expanded since the 1990s in Australia. DESIGN: Descriptive study. METHODS: An online survey was sent to breast care nurses using peak body databases (n = 100). The survey consisted of nineteen nurse roles and functions from a previous Delphi technique study. Nurses rated the importance and frequency of role elements using a five-point Likert scale and four open-ended questions relating to role. RESULTS: There were 89 respondents. Most of the sample were from remote (n = 37, 41%) and rural areas (n = 47, 52%). The majority of responses regarding importance and frequency of the BCN role had a mean score above 4, which corresponds to 'moderately important' and 'occasionally as needed'. There were significant differences between the level of importance and frequency on 10 items. Four role themes arose from the thematic analysis: Breast care nurses as patient advocates, patient educators, care coordinators and clinical experts. CONCLUSIONS: This study delineated the important nurses role in caring for patients and families during a critical time of their life. Further, it details the important nursing roles and functions undertaken by these nurses and compared this to the frequency with which these nurses perform these aspects of their role. RELEVANCE TO CLINICAL PRACTICE: This study further delineates the important role that the nurses play in caring for patients and families during a critical time of their life. It extends further the frequency and importance of the supportive care and the need to educate their nurses on their role in providing spiritual care and research.

Some strategies to address the challenges of collecting observational data in a busy clinical environment.

Studies drawing on observational methods can provide vital data to enhance healthcare. However, collecting observational data in clinical settings is replete with challenges, particularly where multiple data-collecting observers are used. Observers collecting data require shared understanding and training to ensure data quality, and particularly, to confirm accurate and consistent identification, discrimination and recording of data. The aim of this paper is to describe strategies for preparing and supporting multiple researchers tasked with collecting observational data in a busy, and often unpredictable, hospital environment. We hope our insights might assist future researchers undertaking research in similar settings.

Treading the clinical pathway: a qualitative study of advanced practice nurses in a local health district in Australia.

BACKGROUND: Career planning in nursing is often haphazard, with many studies showing that nurses need personal motivation, education, and the support of workplaces, which are often dominated by political and fiscal agendas. Nurses often need institutional and personal support to plan their careers and make decisions regarding their career aspirations. METHOD: A descriptive qualitative design was used. Data were gathered using semi-structured digitally recorded interviews and analysed for common categories. Twenty seven (n = 27) participants were interviewed. RESULTS: There were four categories revealed by the participants who described their career progression experiences: moving up the ladder, changing jobs for career progression, self-driven and the effects of institutional environments. CONCLUSION: Many of the participants' careers had been shaped serendipitously. Similar to other studies, these nurses felt political, institutional and financial factors impacted on their career opportunities. There are implications for nursing managers with more support required for nurses to plan their career trajectories. In addition to an organisation centred approach to career planning, nurse leaders and managers must take into account the personal and professional requirements of their nurses. Nurses themselves also need to take personal responsibility for career development. Greater support for nurses' career planning and personal drive will help organisations to plan their future workforce needs.

The role of a clinical nurse consultant in an Australian Health District: a quantitative survey.

BACKGROUND: This study replicates previous research undertaken in 2013 that explored the role of the Clinical Nurse Consultant in a metropolitan health district in Sydney, Australia. METHODS: A descriptive survey, using Likert scales, was used to collect data from Clinical Nurse Consultants. RESULTS: Clinical Nurse Consultants are well informed about the domains and functions of their role, as stipulated in the relevant award. They identified clinical service and consultancy as the area in which they predominantly practice. CONCLUSION: Despite the clarity of the domains and functions as outlined in the relevant legislated award, the activities undertaken by these clinical nurses are institutionally, individually and contextually constructed.

Determining the frequency, kinds and cues of violence displayed by patients in an acute older person ward environment: findings from an observational study.

BACKGROUND: Workplace violence is one of the most complex and significant occupational hazards experienced by nurses in healthcare settings. Verbal abuse and physical violence are particularly prevalent in older person assessment wards, owing to the prevalence of illnesses involving cognitive dysfunction; the high frequency and nature of contact with staff; and the frustration caused by high levels of disability. AIM: To determine the frequency, kinds and cues of violence displayed by patients towards nurses in an acute older person assessment ward environment using a structured observational tool - the Violence Assessment Tool (VAT). DESIGN: Observational study. METHOD: Non-participant structured observations of behavioural cues for violence towards nurses in an acute older person hospital ward were gathered and analysed. RESULTS: One hundred and twelve hours of observations were undertaken, resulting in 95 behavioural cues for violence in 19 patients. Four of these patients subsequently escalated to physical violence. Pacing around the bed was the only commonality in the behavioural cues of patients who became violent. All patients who became violent had previously demonstrated showing. CONCLUSIONS: To date, the assessment of potentially violent older patients has not been adequately addressed. The VAT may be one way of addressing this challenge through early identification of the more subtle behavioural cues that could indicate potential for violence. Further research on the VAT using a larger data set could determine its predictability for physically violent acts displayed by older people.

Cues that predict violence in the hospital setting: findings from an observational study.

BACKGROUND: The prevalence of violent acts in the health care environment has been the cause of increasing concern. Several cues associated with violence towards nurses in the acute care setting have been identified qualitatively. However, larger scale observational studies to determine the potential of these cues to predict physical violence, are lacking in the acute health setting. PURPOSE: To report an observational study determining whether particular behavioural cues are predictive of patient-to-nurse physical violence. METHOD: Non-participant structured observations. DISCUSSION: Clinical observation (n = 1150 h) resulted in 1501 observed cues for violence in 220 patients; 36 of whom were observed to become violent. Five (5) behavioural cues were found to predict violent acts. CONCLUSIONS: Findings suggest five behavioural cues could be used to assess potential physical violence. Additional research needs to be undertaken to further validate the efficacy of these cues in the acute hospital setting.

Understanding avoidant leadership in health care: findings from a secondary analysis of two qualitative studies.

AIM: To illuminate ways that avoidant leadership can be enacted in contemporary clinical settings. BACKGROUND: Avoidance is identified in relation to laissez-faire leadership and passive avoidant leadership. However, the nature and characteristics of avoidance and how it can be enacted in a clinical environment are not detailed. METHODS: This paper applied secondary analysis to data from two qualitative studies. RESULTS: We have identified three forms of avoidant leader response: placating avoidance, where leaders affirmed concerns but abstained from action; equivocal avoidance, where leaders were ambivalent in their response; and hostile avoidance, where the failure of leaders to address concerns escalated hostility towards the complainant. CONCLUSIONS: Through secondary analysis of two existing sets of data, we have shed new light on avoidant leaderships and how it can be enacted in contemporary clinical settings. Further work needs to be undertaken to better understand this leadership style. IMPLICATIONS FOR NURSING MANAGEMENT: We recommend that organizations ensure that all nurse leaders are aware of how best to respond to concerns of wrongdoing and that mechanisms are created to ensure timely feedback is provided about the actions taken.