Nurses' responses to adolescent distress in an acute child and adolescent mental health inpatient unit: A qualitative interpretive descriptive study.

PURPOSE: To describe observed nursing responses and interventions to adolescent inpatients experiencing distress. METHODS: Thorne's interpretive descriptive approach guided data collection and analysis of nonparticipant observations of a purposive sample of adolescents, and nurses. FINDINGS: Three major themes are presented: engagement: responses and interventions for working with distress; adolescent reactions and nurses' clinical decision making to manage distress; and outcomes: escalation or resolution of distress. CONCLUSIONS: The TAR3 conceptual model developed from this study can guide nurses' responses to distressed adolescents and promote safety, enhance positive outcomes, and reduce the use of coercive interventions.

Adolescents' experiences of distress on an acute mental health inpatient unit: A qualitative study.

Adolescents admitted to acute mental health inpatient units can experience episodes of distress for numerous reasons. Little is known about how they attempt to cope with this distress. This paper explores adolescent experiences of distress in an acute mental health inpatient unit. Fifty hours of non-participant observations were conducted and documented using a critical incident technique (CIT) framework. An interpretive descriptive approach was used to analyse the observation data collected. Nineteen episodes of adolescent distress were observed and five themes emerged, of which two will be explored in this paper: clinical contexts and triggers, and coping or help-seeking actions. The findings of this study will help mental health nurses working on acute adolescent units understand how adolescents attempt to cope with, and seek help for, episodes of distress, and enhance early responses to prevent escalation of distress.

Translation and Adaptation of a Nursing Swearing Impact Questionnaire Into Chinese.

BACKGROUND: Verbal aggression and swearing are the most frequently encountered violence in the health care industry. Nurses are the most frequent victims. Not known is the incidence and impact of swearing against nurses in China. OBJECTIVES: (a) Develop a Chinese version of the Nursing Swearing Impact Questionnaire; (b) report the preliminary findings from the use of the tool. METHOD: Using a translation-back translation procedure, focus groups and expert review, followed by a survey of 32 participants. RESULTS: The Chinese version of the Nursing Swearing Impact Questionnaire has been developed, and cultural differences and different attitudes toward verbal aggression and swearing in disparate groups and workplaces have been highlighted. CONCLUSIONS: This is the first Chinese tool to research nurses' perspectives and experiences of swearing in the workplace. Nurses in China face serious challenges, and the impact of swearing on nurses requires more attention.

Nursing in an imperfect world: Storytelling as preparation for mental health nursing practice.

Storytelling is a valuable adjunctive method of preparing undergraduate mental health nursing students for practice. To explore the possibilities of this method of teaching, 100 stories were collected from experienced nurses working in mental health and analysed using a case study methodology. The aim was to explore the purpose of clinical anecdotes told by experienced nurses working in mental health settings to undergraduates and new recruits, with an ancillary purpose of looking at the implications of these anecdotes for the exploration of contemporary mental health practice and education. A framework for student discussion of stories is provided. The insights gained illuminate not only the history of mental health nursing and the daily activities of nurses working in mental health, but also some of the deep-level skills developed and used by these nurses as they work in the complexity and ambiguity of an imperfect world where the job requires managing the unexpected every shift, and where there might not always be a textbook-perfect solution to clinical situations.

'An exploration of the health beliefs of Chinese nurses' and nurse academics' health beliefs: A Q-methodology study'.

Q-methodology was used to investigate the health beliefs of Chinese clinical nurses and nurse academics. Twenty-eight participants from one hospital and nursing school in China were involved. The four stages of this study included: (i) concourse development from literature review, Internet searches, and key informant interviews; (ii) A pilot study to develop the Q-sample from the concourse; (iii) participants sorted the Q-sample statements along a continuum of preference (Q-sorting); and (iv) PQ data analysis using principal component analysis and varimax rotation. Five viewpoints were revealed: (i) factor 1--health management and the importance of evidence; (ii) factor 2--challenging local cultural belief, and Eastern and Western influences; (iii) factor 3--commonsense; (iv) factor 4--health and clinical practice; and (v) factor 5--health and nursing education. This study presents a need for nurses and nurse academics to think critically, examine their long-held health beliefs, and promote the use of evidence-based practice.

Long-term outcomes of patients on the 1988 West of Scotland renal transplant waiting list.

BACKGROUND: The prevalent population with established renal failure continues to grow. METHOD: Using the Renal Electronic Patient Record, we assess the long-term outcomes of the adult population in the West of Scotland who were awaiting kidney transplantation in 1988 (n = 219), and compare the demographics to the 2011 transplant waiting list (n = 409). RESULTS: Comparing the 2011 transplant waiting list, there are now more patients, but they are older, more likely to be female, and are more likely to have diabetes as a cause of renal failure. Seventy-four percent received a transplant; of these, 41% of the transplants ultimately failed and the patient returned to dialysis; 39% of patients died with a functioning graft and 20% remain alive with continuing transplant function. Life expectancy for those with renal failure was less than 60 years, significantly lower than the general population, though 29% survived for 20 years, half of these with a functioning kidney transplant and half having returned to dialysis. CONCLUSION: As survival with a transplant improves, attention is required to reduce the causes of mortality, in particular cardiovascular disease, and malignancy and infection associated with immunosuppression.

A Narrative in Search of a Methodology.

PURPOSE: Research papers present us with the summaries of scholars' work; what we readers do not see are the struggles behind the decision to choose one methodology over another. DESIGN AND METHODS: A student's mental health portfolio contained a narrative that led to an exploration of the most appropriate methodology for a projected study of clinical anecdotes told by nurses who work in mental health settings to undergraduates and new recruits about mental health nursing. This paper describes the process of struggle, beginning with the student's account, before posing a number of questions needing answers before the choice of the most appropriate methodology. FINDINGS: We argue, after discussing the case for the use of literary analysis, discourse analysis, symbolic interactionism, hermeneutics, and narrative research, that case study research is the methodology of choice. PRACTICE IMPLICATIONS: Case study is frequently used in educational research and is sufficiently flexible to allow for an exploration of the phenomenon.

Organizational support in the recruitment and transition of overseas-qualified nurses: lessons learnt from a study tour.

The migration of nurses has been a global phenomenon, and the integration of overseas-qualified nurses within host countries has led to debate worldwide. Evidence suggests that support provided by organizations can vary and that there is minimal information on the nature and extent of organizational support required to enhance a smooth transition of overseas-qualified nurses into nursing practice. This explorative study tour examined the organizational support provided to enhance overseas-qualified nurses' transition into the nursing workforce in two countries. The various support mechanisms provided to overseas-qualified nurses in different organizations include transition, acculturation, mentoring programs, and initial settlement assistance. The successful transition of overseas-qualified nurses into a host country is a complex issue. A robust support system for these nurses should be based on ethical considerations and a team approach that is linked to strong leadership. In addition, education and support for existing staff is essential for a successful transition of overseas-qualified nurses into practice. Lessons learnt from this study tour might also be relevant to the transition of other overseas-qualified health professionals, such as doctors and allied health professionals, in host countries.

New graduate nurses' experiences in their first year of practice.

AIMS: This study aimed to explore new graduates' experiences of entering the nursing workforce in NSW, Australia, and to identify factors that impact on their transition to the workforce, satisfaction and likelihood of retention. BACKGROUND: The nature of new graduates' experiences in their first year of employment has been shown to have a significant impact on their future career directions. It is well reported that often these experiences are stressful and unsatisfying. METHODS: A mixed method cross sectional design was used combining quantitative and qualitative approaches. Data was gathered by online survey and focus groups. RESULTS: A total of 282 new graduates, aged 21 to 54, responded to the online survey (response rate 24%). Overall, respondents were satisfied with their recruitment process (mean 3.54) and support for professional development (mean 3.37) but job satisfaction was rated lower (mean 2.91). Qualitative findings from focus groups and survey comments revealed a number of key factors impacting on the experience of transition for new graduates. These are; the nature of the workplace environment, the level and nature of support available to new graduates, together with their propensity to learn and adapt to workplace cultures and to accommodate their own expectations and the expectations of others, and to a lesser degree, the amount of prior experience. CONCLUSION: There is an urgent need to develop and test a range of evidence based approaches that will both empower nurses and embed systematic approaches that enable equitable and contextually relevant stewardship of new graduate nurses into the future.

Drivers for renewal and reform of contemporary nursing curricula: a blueprint for change.

The creation of a curriculum blueprint appropriate to the development of a professional nurse who is practice-ready for the current and future context of health service delivery must take account of the extant context as well as an unpredictable and sometimes ambiguous future. The curriculum renewal process itself ought to challenge existing long held ideals, practices, and sacred cows within the health and higher education sectors. There is much to consider and importantly curriculum developers need to be mindful of reform within the health sector and health workforce education, as well as the concomitant vision and requirements of the nursing profession. Curriculum must develop more than discipline knowledge and skills: it must provide an infrastructure for generic abilities both social and intellectual in order to better prepare students for the registered nurse role. This paper discusses a number of forces that are essential to consider in curriculum development in undergraduate nursing education.

Five-year outcomes after a change from a cyclosporin-based to a 'low-dose' tacrolimus-based primary immunosuppression regimen for incident kidney transplants--the Glasgow experience.

In January 2007, our centre changed from a cyclosporin (CyA)/azathioprine (Aza)/ prednisolone (Pred) primary immunosuppression regimen (with basiliximab induction and mycophenolate mofetil [MMF] for those at immunologically high risk) to a tacrolimus (Tac) (low dose)/MMF/Pred regimen with basiliximab induction, following presentation of Symphony trial results. This analysis assesses the impact of this change on 5-year outcomes. Three hundred consecutive renal-only transplants were identified: 140 from the 2005-06 era and 160 from the 2007-08 era. The proportions of living donor (37.5 vs. 22.9%; p = 0.04) and donors after circulatory death (11.9 vs. 5.0%; p = 0.03) were higher in the 2007-08 cohort. Five-year actuarial patient survival was higher in the 2007-08 cohort (96.8 vs. 87.1%; p = 0.003), with a trend toward higher 5-year transplant survival (84.7 vs. 76.3%; p = 0.08). Estimated glomerular filtration rate (eGFR) was higher than in the 2005-06 era at 1 (53.5 vs. 44.5 ml/min/1.73m2; p = 0.0006) and 3 years (50.9 vs. 43.4 ml/min/1.73m2; p = 0.02), with a trend toward higher eGFR at 5 years (41.8 vs. 49.6 ml/min/1.73m2; p = 0.09). Differences were consistent when living donor and deceased donor transplants were analysed separately. In a "real world" population, a change from a CyA-based to a Tac (low-dose)/MMF/Pred primary immunosuppression regimen has been associated with better 5-year outcomes.

Experiences with advance care planning: nurses' perspective.

AIMS AND OBJECTIVES: The aim of this paper is to report the findings of a case study that explored the phenomenon of advanced care planning and advance care directives in residential care settings in Australia. In particular, this paper focuses on the experiences of Registered Nurses with advanced care planning and advance care directives. BACKGROUND: Nurses need to know how to engage with residents and families when they invest time and effort on advanced care planning and documentation of advance care directives. METHODS: A case-study design involving participant observation, field note recording, semi structured interviews and document analysis was used. Data were collected over 7 months. Data analysis involved thematic content analysis. FINDINGS: The factors that enhanced and inhibited the experiences of the Registered Nurses with advanced care planning were identified. The enhancing factors include; 'it is their essence of who they are', and 'back-up from family members and other nursing staff'. The inhibiting factors are 'lack of time', 'a culture of do everything and don't go there', and 'lack of family involvement'. CONCLUSION: The findings of the current study provided nurses with evidence of the positive nature of experiences of older people, family members, and nurses themselves with advanced care planning in an attempt to better implement and practise advanced care planning.

Wounding words: swearing and verbal aggression in an inpatient setting.

PURPOSE: The aim of the research was to investigate swearing and verbal aggression in Australian inpatient settings, including incidence, gender, patient motivation, and nursing interventions. DESIGN AND METHODS: A mixed methods approach utilizing the Overt Aggression Scale and a survey of 107 nurses' perceptions of their experience of swearing was used. FINDINGS: High levels of swearing and verbal aggression were found, with differing patterns for male and female patients. Nurses subjected to swearing experienced high levels of distress, especially females. All nurses appeared to use a limited range of interventions to deal with patient aggression. PRACTICAL IMPLICATIONS: In order to provide optimal care for patients, there is a clear need to improve nurses' ability to predict and prevent aggression.

Determining frameworks for interprofessional education and core competencies through collaborative consultancy: the CARE experience.

It is claimed that an interprofessional approach to health care aims to provide optimal client care, reduce duplication of services, address gaps in service delivery and prevent adverse consequences to patients. Hence there is widespread international interest in interprofessional education in undergraduate programs. However, after employment in the Australian health care workforce, there is limited opportunity for this. The continued education and training of health professionals and other care workers frequently occurs in a climate where professional development is dominated by the existence of professional demarcations. In order to enhance interprofessional collaboration in health care practice and education, mechanisms to guide individual performance within a multi-professional health team are required. This paper presents both the process and outcomes of a consultancy undertaken in order to determine core competencies for collaborative interprofessional practice in a community and aged care service.

The essentials of Advance Care Planning for end-of-life care for older people.

AIMS AND OBJECTIVES: The aim of the study was to investigate the phenomenon of Advance Care Planning and the use of Advance Care Directives in residential aged care facilities in Australia. The objectives were to: investigate the implementation process of Advance Care Planning and the use of Advance Care Directives; investigate the outcomes of Advance Care Planning and experiences of people involved in Advance Care Planning and Advance Care Directives, including residents, families and nursing staff. BACKGROUND: Benefits of Advance Care Planning for older residents are considerable given their degenerative health-breakdown and minimal chance of recovery. To date, the use of Advance Care Planning and Advance Care Directives is limited and models of service delivery and processes are needed to enhance best practice with Advance Care Planning and positive outcomes for older Australians. DESIGN: Case study. METHODS: The study conducted using multiple sources of evidence to enrich understanding of the phenomenon of Advance Care Planning. The researcher engaged in data collection over six months involving participant observation, field notes, semi-structured interviews and document analysis. The findings contribute to the limited knowledge of options currently available to older adults and their families in their decision-making about end-of-life care options. PERMISSION TO CONDUCT THE STUDY: Prior to commencement of the data collection, ethics clearances from the University of Newcastle and the regional Area Health Service were achieved. Permission to access the residential aged care facilities to undertake the study was obtained from the relevant residential aged care facility ethics committees or designated authorities. The researcher undertook several strategies to ensure all the ethical principles were considered and adhered to while conducting the project. RESULTS: The research identified the components and factors involved in the Advance Care Planning process and in attaining desired outcomes. The conceptual framework developed elaborates how Advance Care Planning should be implemented and what may constitute successful implementation of Advance Care Planning in residential aged care facilities. The four main elements (input, throughput, output, feedback), and 20 sub-elements were requisites for nurses to initiate and implement the Advance Care Planning. CONCLUSION: The essential components for end-of-life care are identified in the implementation processes of Advance Care Planning in residential aged care facilities. The study contributes to greater awareness of the processes needed for 'dying well' and highlights the need to explore experiences of 'successful dying' and the way nurses contribute to these events. RELEVANCE TO CLINICAL PRACTICE: The case study identified four determinative requisites for successful implementation of Advance Care Planning in aged care facilities: the expert nurse, discussion, education and involvement of a multidisciplinary team. Nurses should take these factors into account and use person-centred approach in formalised processes to encourage participation in plans for end-of-life care.

Management of flood victims: Chainat Province, central Thailand.

This article focuses on the processes of flood management and the experiences of flood victims in Chainat Province, central Thailand, so as to develop knowledge about the future handling of such disasters. A phenomenological qualitative approach was used to describe the processes of providing assistance to flood victims. In-depth interviews and observation were used to collect the data. Criterion sampling was used to select 23 participants. Content analysis of the data revealed that some flood victims could predict flooding based on prior experiences, so they prepared themselves. The data revealed six themes that demonstrated that those who could not predict how floods would impact on them were unprepared and suffered losses and disruption to their daily life. Damaged routes meant people could not go to work, resulting in the loss of income. There was a lack of sanitary appliances and clean drinking water, people were sick, and experienced stress. At the community level, people helped one another, making sandbags and building walls as a defense against water. They formed support groups to enable the processing of stressful experiences. However, later, the water became stagnant and contaminated, creating an offensive smell. The government provided assistance to cut off electricity services, food and water, toilets and health services, and water drainage. In the recovery phase, the victims needed money for investment, employment opportunities, books for children, extra time to pay off loans, reconnection of electricity, surveys of damage, and pensions to deal with damage and recovery.

The workplace and nurses with a mental illness.

A qualitative approach was used to explore workplace experiences of nurses who have a mental illness. Interview transcripts from 29 nurses in New South Wales, Australia were subjected to discourse analysis. One significant finding was a theme depicting the need for support and trust. This superordinate theme encompassed four subelements: declaring mental illnesses, collegial support, managerial support, and enhancing support. Most of the participants portrayed their workplace as an unsupportive and negative environment. A number of colleagues were depicted as having little regard for the codes for professional nursing practice. This paper shows how nurses in the study dealt with the workplace support associated with mental illness.

Development and psychometric testing of the Belongingness Scale-Clinical Placement Experience: an international comparative study.

AIM: This paper reports the development and psychometric testing of the Belongingness Scale-Clinical Placement Experience, an instrument designed to measure the extent to which nursing students experience belongingness related to their clinical placements. BACKGROUND: The need to belong is a global concept that exerts a powerful influence on cognitive processes, emotional patterns, behavioural responses, health and well-being. Diminished belongingness impedes students' motivation to learn. Measuring belongingness specific to the clinical environment and comparing different cohorts requires valid and reliable instruments. METHOD: Scales for measuring belongingness were identified following a critical review of the literature. From these a new 34-item instrument was developed. During 2006 the instrument was tested with students (n = 362) from two Australian universities and one university in the south of England. Principal component analysis with varimax rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability. RESULTS: Differences in belongingness scores were statistically significant, with the British cohort scoring higher than either of the Australian sites. The scale demonstrated high internal consistency (alpha 0.92). Principal component analysis yielded a three-component structure termed Esteem, Connectedness and Efficacy and each subscale demonstrated high internal consistency: 0.9; 0.82; 0.8 respectively. CONCLUSION: The scale was reliable and valid for the three cohorts. Results indicated that the instrument is capable of differentiating between respondents and cohorts. Further research in different contexts would be valuable in taking this work forward.

Staff-student relationships and their impact on nursing students' belongingness and learning.

AIM: This paper is a report of selected findings from a study exploring the relationship between belongingness and placement experiences of preregistration nursing students. BACKGROUND: Staff-student relationships are an important influence on students' experiences of belongingness and their clinical learning. The need to belong is universal and pervasive, exerting a powerful influence on thought processes, emotions, behaviour, health and happiness. People deprived of belongingness are more likely to experience diminished self-esteem, increased stress and anxiety, depression and a decrease in general well-being. Nursing students' motivation and capacity to learn, self-concept, confidence, the extent to which they are willing to question or conform to poor practice and their future career decisions are influenced by the extent to which they experience belongingness. METHOD: During 2006, 18 third year students from two Australian universities and one United Kingdom university participated in in-depth semi-structured interviews. Data were analysed thematically. FINDINGS: Participants described placement experiences spanning a continuum from those promoting a high degree of belongingness to those provoking intense feelings of alienation. Staff-student relationships (including receptiveness, inclusion/exclusion, legitimization of the student role, recognition and appreciation, challenge and support) were the most important influence on students' sense of belonging and learning. Similarities between sites were remarkable, despite the differences in healthcare and higher education systems. CONCLUSION: Staff-student relationships are key to students' experience of belongingness. Understanding the types of interactions and behaviours that facilitate or impede students' belongingness and learning are essential to the creation of positive clinical experiences.

Beyond barriers. The challenge of cultural diversity for nurse academics in the Australian context.

In spite of the increasing significance of cultural diversity for nursing, some Australian nurse teachers are not well prepared for the challenges they face, nor have nursing curricula been re-conceptualized to meet the changing needs of society and more specifically nursing students. Although numerous teaching and Learning programmes for inclusion of diversity are reported in the literature, both within Australia and overseas, there appears to be little commitment to the adoption of a more fundamental change in curricula and teaching and learning practices. In particular there appears to be little attention to how teachers negotiate meaningful social dynamics within multicultural learning contexts. This article reports on the findings of a study carried out across two Schools of Nursing in Australia. The purpose of the study was to explore why schools have been reluctant to move to more culturally diverse models of teaching and learning. This paper reports on the findings of focus groups with teachers about their experiences of teaching in the context of cultural diversity. Study findings explore teachers' perceptions of cultural diversity and its impact on teaching and learning nursing. Teachers reported a range of tensions arising from lack of a shared philosophical view about curricula generally, lack of consideration of diversity as a significant issue for both teachers and students, limited perceptions of community as a key driver of curricula and a reluctance to address the difficult and contentious issues arising from diversity in the classroom.