Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record.

OBJECTIVES: To establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record, using the example of RA. METHODS: The Remote Monitoring of RA smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the electronic health record of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over 3 months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarized descriptively, and qualitative data were analysed thematically. RESULTS: Patients submitted data on a median of 91% days over 3 months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. The themes demonstrated that the system helped render patients' RA more visible by providing the 'bigger picture', identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans. CONCLUSION: Remote Monitoring of RA has uniquely integrated daily PGHD from smartphones into the electronic health record. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.

New Graduate Registered Nurses and the Spectrum of Comfort in Clinical Practice.

The comfort zone is where a person consistently performs his or her role in an affective state devoid of anxiety and without a feeling of risk. This study challenges the notion of a singular comfort zone and suggests that a spectrum of comfort is a more accurate reflection of the new graduate experience. A grounded theory methodology was used to identify and explain the spectrum of comfort considerations helpful to nine new graduates amid their transition to professional practice. Emerging from the data were themes that encompassed both the positive and negative regions of the spectrum of comfort. Negative themes were: Feeling Abandoned, Sometimes I Get Frightened, and Feeling Betrayed-Catching Hold. The more positive themes were: Moderation of Emotions, and Letting Go. Each of these themes requires an appropriate response from new graduates and experienced staff. The spectrum of comfort model and practical considerations of support could accomplish this. [J Contin Educ Nurs. 2019;50(12):563-571.].

Using a sedimentation scanner to determine mangrove health responses to sedimentation derived from dredging. An example from northwestern Australia.

A sedimentation scanner was used to measure daily sediment height at 10 sites associated with a 14 million cubic metre dredging project in Port Hedland harbour, Western Australia, between July 2011 and May 2012. Data were collected from seven potential impact sites, where up to 35 mm of additional sedimentation was predicted via modelling to result from dredging and at three reference sites, where background variation was monitored. A variety of mangrove habitat health indices from each site (including leaf area and health, pneumatophore and faunal burrow density) were collected before, during and after dredging. Despite predictions, most impact sites received between 0 and 10 mm over the dredging period, with one site experiencing a gain of 28 mm. Reference sites received between 2 and 28 mm which was attributed to natural processes. It was concluded that the health of Avicennia marina (Forssk.) Vierh. and Rhizophora stylosa Griff., the most common mangroves, were neither affected by a net sedimentation up to 28 mm of over a period of 11 months (i.e. 30.5 mm y-1) nor rapid changes over shorter time periods such as 14 mm over two days. This technology could be deployed in any tidally influenced sedimentary environment where short-term processes were of interest.

Strategies new graduate registered nurses require to care and advocate for themselves: A literature review.

BACKGROUND: New graduate registered nurses (NGRNs) are confronted with a complex, demanding and resource-constrained environment where gaining acceptance into the workplace culture may be difficult. Existing evidence suggests that preparing undergraduate nursing students for this reality can assist with adjustment. OBJECTIVES: To identify the strategies that NGRNs require to care and advocate for themselves during their first year of practice. METHODS: A search of the literature published between 2001 and 2016 was undertaken. Individual articles were synthesized narratively and the results entered to a summary table. RESULTS: A total of 274 articles were considered relevant to this narrative review. This paper synthesized the narrative of 80 articles. Synthesis revealed 22 resilience factors and 33 issues. Eight strategies with potential to assist NGRNs to care and advocate for themselves were identified. All of them are socioemotional in nature. CONCLUSIONS: This review of the literature provides a valuable resource that can be used to prepare nursing students for the workplace culture during their first year as a registered nurse. Scenarios can be developed for educational activities such as simulation, role play, discussion and self-reflection. Further development through research is recommended.

Involving healthcare professionals and family carers in setting research priorities for end-of-life care.

It is important to ensure regional variances are considered when setting future end-of-life research priorities, given the differing demographics and service provision. This project sought to identify end-of-life research priorities within Greater Manchester (United Kingdom). Following an initial scoping exercise, six topics within the 10 national priorities outlined by The Palliative and end-of-life care Priority Setting Partnership were selected for exploration. A workshop involving 32 healthcare professionals and a consultation process with 26 family carers was conducted. Healthcare professionals and carers selected and discussed the topics important to them. The topics selected most frequently by both healthcare professionals and carers were 'Access to 24 hour care', 'Planning end-of-life care in advance' and 'Staff and carer education'. Healthcare professionals also developed research questions for their topics of choice which were refined to incorporate carers' views. These questions are an important starting point for future end-of-life research within Greater Manchester.

Dispositional mindfulness and employment status as predictors of resilience in third year nursing students: a quantitative study.

BACKGROUND: Nursing students will graduate into stressful workplace environments and resilience is an essential acquired ability for surviving the workplace. Few studies have explored the relationship between resilience and the degree of innate dispositional mindfulness, compassion, compassion fatigue and burnout in nursing students, including those who find themselves in the position of needing to work in addition to their academic responsibilities. AIM: This paper investigates the predictors of resilience, including dispositional mindfulness and employment status of third year nursing students from three Australian universities. DESIGN: Participants were 240 undergraduate, third year, nursing students. Participants completed a resilience measure (Connor-Davidson Resilience Scale, CD-RISC), measures of dispositional mindfulness (Cognitive and Affective Mindfulness Scale Revised, CAMS-R) and professional quality of life (The Professional Quality of Life Scale version 5, PROQOL5), such as compassion satisfaction, compassion fatigue and burnout. METHOD: An observational quantitative successive independent samples survey design was employed. A stepwise linear regression was used to evaluate the extent to which predictive variables were related each to resilience. RESULTS: The predictive model explained 57% of the variance in resilience. Dispositional mindfulness subset acceptance made the strongest contribution, followed by the expectation of a graduate nurse transition programme acceptance, with dispositional mindfulness total score and employment greater than 20 hours per week making the smallest contribution. This was a resilient group of nursing students who rated high with dispositional mindfulness and exhibited hopeful and positive aspirations for obtaining a position in a competitive graduate nurse transition programme after graduation.

Ways of Being: Preparing Nursing Students for Transition to Professional Practice.

BACKGROUND: The new graduate registered nurse (NGRN) does not work in isolation but within an organizational environment. Unfortunately for the NGRN, transition-to-practice programs are often variable and underresourced, which means that promised support is unlikely to eventuate. Many NGRNs learn the skills required to navigate the nursing culture on the job without support and by trial and error. METHOD: A grounded theory method was used to identify the strategies used by nine NGRNs to thrive during their transition to professional practice. RESULTS: Ways of being emerged from the data to explain the social and emotional strategies NGRNs use during the first year of practice. The ways of being model includes ways of feeling, ways of relating, and ways of doing. CONCLUSION: University preparation needs to ensure that the NGRN is provided with the skills to successfully navigate the workplace. Use of the ways of being model could help achieve this. J Contin Educ Nurs. 2016;47(7):330-340.

A patient safety focused registered nurse transition to practice program.

New graduate registered nurses (NGRN's) have an expectation of clinical support as they make the transition from novice to advanced beginner. In this 2008-2009 study of three rural transition to practice programs we found that clinical support did not eventuate. Consequently, NGRN's reported feeling underprepared for practice, overwhelmed by responsibility and often abandoned. Against this background, many were concerned that their inexperience had implications for safe patient care. Graduate nurse transition programs need to have the physical and human resources necessary to deliver the clinical support as promised in their prospectus, to ensure patient safety. This grounded theory study identified three essential core elements - leadership support, clinical supervision, and effective interprofessional relationships. Recommendation is made to address these deficits by mandating their inclusion in all transition to professional practice programs.

A patient safety focused registered nurse transition to practice program.

Abstract As undergraduate rural nursing students approach completion of their degree and become eligible for registration as a nurse they anticipate becoming part of a transition to practice program. Promises of clinical support, guidance and being welcomed into the profession are provided. Unfortunately the reality for new graduate registered nurses is often quite different. Promised clinical support does not eventuate and patient safety is often compromised. Graduate nurse transition programs need to have the physical and human resources to deliver the clinical support that was promised in their prospectus. This paper describes the nature of professional support experienced by participants of transition to practice programs. Three core elements are recommended to ensure patient safety.