Healing the Past by Nurturing the Future: trauma-aware, healing-informed care to improve support for Aboriginal and Torres Strait Islander families - implementation and evaluation study protocol.

INTRODUCTION: Complex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a 'critical window' for recovery and transforming cycles of trauma into cycles of healing. The Healing the Past by Nurturing the Future (HPNF) project aims to implement and evaluate a programme of strategies to improve support for Aboriginal and Torres Strait islander families experiencing complex trauma. METHOD: The HPNF programme was codesigned over 4 years to improve awareness, support, recognition and assessment of trauma. Components include (1) a trauma-aware, healing-informed training and resource package for service providers; (2) trauma-awareness resources for parents; (3) organisational readiness assessment; (4) a database for parents and service providers to identify accessible and appropriate additional support and (5) piloting safe recognition and assessment processes. The programme will be implemented in a large rural health service in Victoria, Australia, over 12 months. Evaluation using a mixed-methods approach will assess feasibility, acceptability, cost, effectiveness and sustainability. This will include service user and provider interviews; service usage and cost auditing; and an administrative linked data study of parent and infant outcomes. ANALYSIS: Qualitative data will be analysed using reflexive thematic analysis. Quantitative and service usage outcomes will be described as counts and proportions. Evaluation of health outcomes will use interrupted time series analyses. Triangulation of data will be conducted and mapped to the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks to understand factors influencing feasibility, acceptability, effectiveness, cost and sustainability. ETHICS AND DISSEMINATION: Approval granted from St Vincent's Melbourne Ethics Committee (approval no. 239/22). Data will be disseminated according to the strategy outlined in the codesign study protocol, in-line with the National Health and Medical Research Council Aboriginal and Torres Strait Islander Research Excellence criteria.

Content analysis of nurses' reflections on medication errors in a regional hospital.

BACKGROUND: Medication errors [MEs] continue to be an area of concern both nationally and internationally. METHODS: Sixty-eight reflective summaries detailing reasons for medication errors completed by nurses at an Australian regional teaching hospital during a five-year period were analysed. RESULTS: Fifteen codes emerged from the data that aligned to three main categories of the Human Factors Framework. They were: Individual characteristics such as inexperience, stress and lack of knowledge (5 codes), Nature of the work such as prescription errors, time pressure, miscommunication, poor handover and documentation errors (9 codes) and Physical environment such as distractions (1 code). Individual characteristics were the most frequently reported (51.6%) reasons for the error. CONCLUSIONS: Provision of medicine information resources and management of nurses' workload as well as enhancing graduate nurse education with simulation of 'real life' clinical settings appear to be the main targets for intervention.

Hospital medication errors: a cross-sectional study.

BACKGROUND: Medication errors (MEs) are among the most common types of incidents reported in Australian and international hospitals. There is no uniform method of reporting and reducing these errors. This study aims to identify the incidence, time trends, types and factors associated with MEs in a large regional hospital in Australia. METHODS: A 5-year cross-sectional study. RESULTS: The incidence of MEs was 1.05 per 100 admitted patients. The highest frequency of errors was observed during the colder months of May-August. When distributed by day of the week, Mondays and Tuesdays had the highest frequency of errors. When distributed by hour of the day, time intervals from 7 am to 8 am and from 7 pm to 8 pm showed a sharp increase in the frequency of errors. One thousand and eighty-eight (57.8%) MEs belonged to incidence severity rating (ISR) level 4 and 787 (41.8%) belonged to ISR level 3. There were six incidents of ISR level 2 and only one incident of ISR level 1 reported during the five-year period 2014-2018. Administration-only errors were the most common accounting for 1070 (56.8%) followed by prescribing-only errors (433, 23%). High-risk medications were associated with half the number of errors, the most common of which were narcotics (17.9%) and antimicrobials (13.2%). CONCLUSIONS: MEs continue to be a problem faced by international hospitals. Inexperience of health professionals and nurse-patient ratios might be the fundamental challenges to overcome. Specific training of junior staff in prescribing and administering medication and nurse workload management could be possible solutions to reducing MEs in hospitals.

Job satisfaction of rural medical interns: A qualitative study.

OBJECTIVE: To study reasons for job satisfaction and dissatisfaction among interns. DESIGN: Using a qualitative methodology, one-to-one interviews were conducted with interns. SETTING: The study was based at a Victorian Rural Intern Training program. PARTICIPANTS: Twelve interns from the program were interviewed during their final rotation. MAIN OUTCOME MEASURES: Reasons for job satisfaction and dissatisfaction among rural interns. RESULTS: Reasons for job satisfaction included feeling supported in the workplace as well as getting quality supervision, teaching and clinical exposure. Reasons for job dissatisfaction included poor access to administration, unduly stressful working situations, lack of support for mental health and well-being, and poorly organised teaching sessions. CONCLUSION: The internship experience, together with the people they are influenced by, can determine a doctor's future career pathway. It is therefore vital for internship coordinators and hospital managers to facilitate a positive internship experience. The findings have implications for human resource management policy and practice in rural hospitals.

Analysis of patient related violence in a regional emergency department in Victoria, Australia.

BACKGROUND: Emergency Departments (ED) have been identified as high-risk areas for patient related violence (PRV). The aim of the present study was to analyse recorded events of violence in a regional Victorian hospital ED, and examine the association these events had with substance abuse. METHODS: A retrospective cohort study was undertaken to establish the incidence of PRV. Data were obtained from the hospital's incident management system, RiskMan, over a five and a half year period for all violent events categorised as Code Grey (CG) and Code Black (CB). The Haddon Matrix attached to the individual incident record was also reviewed. RESULTS: A total of 548 violent events were analysed. The incident rate was 3.4 per 1000 ED presentations. Intoxication was the primary reason for violent escalations. There was no association between the frequency of CG events and the day of the week, month of admission, or shift of the day. Intoxicated men (110, 64.3%) were more likely to be the instigator of a violent event compared with intoxicated females (61, 35.7%) (OR 1.5, 95% CI: 1.19-2.02, p<0.001). A form of restraint, chemical, physical or both, was used in the majority of violent events (376, 68.6%). CONCLUSION: This study demonstrated an increasing frequency of violent events in the regional ED. Rates of PRV were comparable to those reported in metropolitan hospitals. Intoxication was the most frequently observed underlying factor for PRV. Regional hospitals are in need of additional resources to instigate policies and procedures that will maximise patient and staff safety.

Physical deterioration in an acute mental health unit: A quantitative retrospective analysis of medical emergencies.

Nursing management of physical deterioration of patients within acute mental health settings is observed, recorded, and actively managed with the use of standardized Adult Deterioration Detection System (ADDS) charts. Patient deterioration may require the urgent assistance of a hospital rapid response or Medical Emergency Team. A five-and-a-half-year (2011-2016) audit of hospital-wide Medical Emergency Team attendances was conducted in an acute mental health unit of a single large 250 bed regional hospital in Victoria, Australia. Data were extracted from the hospitals' quality and patient safety program, RISKMan, and entered into a statistical data program for analysis. A total of 140 patient records were analysed, and the 'Worried' category (34%, n = 47) was the principle reason for a Medical Emergency Team call in a mental health ward, followed by hypotension (23%, n = 31) and a low Glasgow Coma Score (16%, n = 22). Upon further investigation of the 'Worried' category, the most common conditions recorded were an altered conscious state (22%, n = 9), low oxygen saturation (20%, n = 8), or chest pain (17%, n = 7). Activation of Medical Emergency Team calls predominantly occurred in the daylight morning hours (6am-12md). When data were compared to the general hospital patients, the context of the physiological deterioration of the mental health patients was strikingly similar. Further research is recommended to ascertain the extent and frequency with which staff working in mental health units are performing vital signs monitoring as an essential component of detection of early signs of physiological deterioration.

Influence of perceptions and stereotypes of the nursing role on career choice in secondary students: A regional perspective.

BACKGROUND: This study examined the influence that perceptions and stereotypes of the nursing role had on future career choice of rural secondary students. OBJECTIVE: The study was undertaken to identify a method of attracting final year secondary school students to an undergraduate nursing degree at a rural University. DESIGN: A mixed method study using a pre-post-interventional design. SETTING: The rural campus of an Australian university. PARTICIPANTS: 71 secondary students attending a secondary school career development program at a rural Australian university. METHOD: Semi structured questionnaires were used for data collection. The surveys were analysed using descriptive statistics and content analysis of open-ended survey questions. RESULTS: The research supports the importance of being aware of young people's impressions about nurses and nursing as a career, to ensure the successful implementation of targeted recruitment. CONCLUSION: Targeted recruitment strategies can increase students' awareness of the wide variety of pathways within nursing, rather than leaving awareness to what family, friends or career advisers tell them, or how nurses are portrayed on television, movies and the media.

Incidence and factors associated with substance abuse and patient-related violence in the emergency department: A literature review.

BACKGROUND: The level of workplace violence in emergency departments worldwide has reached an alarming level. Substance abuse is thought to play a major part in the escalation of aggressive and violent behaviour and is suspected to be responsible for the majority of violent escalations in the emergency department. The aim of this scoping review was (1) to investigate the incidence of workplace violence in the emergency department, their association to substance abuse and (2) to identify factors associated with workplace violence such as perpetrator characteristics and environmental factors. DESIGN: Scoping review. METHODS: Literature search was conducted using electronic databases. The review of the literature extended from 1997 to 2018 to provide an understanding of the topic of interest. RESULTS: The search initially revealed 1901 articles. After comprehensive examination of the abstracts and removal of duplicates this was reduced to 14. Incidence of workplace violence accounted for 5.5 per 1000 or less of emergency department presentations. Substance abuse was closely related to workplace violence in the extracted literature. Several themes were identified in the context of substance abuse and workplace violence in the emergency department, including perpetrator characteristics, physical and psychosocial factors. CONCLUSION: Substance abuse was found to be a primary factor linked to workplace violence in the emergency departments. Interventional studies are warranted, focusing on prevention of workplace violence and management of abuse and intoxicated patients in the emergency department.

Understanding the bereavement care roles of nurses within acute care: a systematic review.

AIMS AND OBJECTIVES: To investigate nurses' roles and responsibilities in providing bereavement care during the care of dying patients within acute care hospitals. BACKGROUND: Bereavement within acute care hospitals is often sudden, unexpected and managed by nurses who may have limited access to experts. Nurses' roles and experience in the provision of bereavement care can have a significant influence on the subsequent bereavement process for families. Identifying the roles and responsibilities, nurses have in bereavement care will enhance bereavement supports within acute care environments. DESIGN: Mixed-methods systematic review. METHODS: The review was conducted using the databases Cumulative Index Nursing and Allied Health Literature Plus, Embase, Ovid MEDLINE, PsychINFO, CareSearch and Google Scholar. Included studies published between 2006-2015, identified nurse participants, and the studies were conducted in acute care hospitals. Seven studies met the inclusion criteria, and the research results were extracted and subjected to thematic synthesis. RESULTS: Nurses' role in bereavement care included patient-centred care, family-centred care, advocacy and professional development. Concerns about bereavement roles included competing clinical workload demands, limitations of physical environments in acute care hospitals and the need for further education in bereavement care. CONCLUSIONS: Further research is needed to enable more detailed clarification of the roles nurse undertake in bereavement care in acute care hospitals. There is also a need to evaluate the effectiveness of these nursing roles and how these provisions impact on the bereavement process of patients and families. RELEVANCE TO CLINICAL PRACTICE: The care provided by acute care nurses to patients and families during end-of-life care is crucial to bereavement. The bereavement roles nurses undertake are not well understood with limited evidence of how these roles are measured. Further education in bereavement care is needed for acute care nurses.

Cultural desire need not improve with cultural knowledge: A cross-sectional study of student nurses.

Cultural desire is considered to be a prerequisite for developing cultural competence. This study explored cultural desire among student nurses towards Aboriginal peoples and its association with participation in a one-semester unit on Aboriginal health through a cross-sectional survey. Our main outcome, cultural desire, was measured using two items level of agreement with Aboriginal health being an integral component of the nursing curriculum and an expressed interest in Aboriginal health. 220 (74.58%) student nurses completed the survey. Completing the Aboriginal Health and wellbeing unit did not influence students' opinions on inclusion of the unit as part of the nursing curriculum (odds ratio OR 0.73, 95% CI 0.43-1.29) or their overall cultural desire (mean difference = -0.69, 95% CI -1.29 to -0.08, p = 0.026). Students who completed the unit reported a higher understanding of Aboriginal health (OR = 2.35, 95% CI = 1.35-4.08) but lower interest levels in the subject (OR = 0.45, 95% CI: 0.24-0.84). Further research is necessary to explore how and when cultural desire might develop in nurses who are trained in cultural competence particularly in the contexts of post-colonial disparities and political conflict.

Peer learning a pedagogical approach to enhance online learning: A qualitative exploration.

BACKGROUND: Flexible online programs are becoming increasingly popular method of education for students, allowing them to complete programs in their own time and cater for lifestyle differences. A mixture of delivery modes is one way which allows for enhanced learning. Peer learning is another method of learning which is shown to foster collaboration and prepare healthcare students for their future careers. This paper reports on a project to combine peer and online learning to teach pharmacology to nursing students. OBJECTIVES: To explore undergraduate nursing student opinions of working in peer groups for online learning sessions in a pharmacology course. DESIGN: A qualitative study utilising a self-reported questionnaire. SETTING: A rural campus of an Australian university. PARTICIPANTS: Second year nursing students enrolled in a Bachelor of Nursing Program. METHODS: A hard copy questionnaire was distributed to all students who attended the final semester lecture for the course. Content analysis of open-ended survey questions was used to identify themes in the written data. RESULTS: Of the 61 students enrolled in the nursing subject, 35 students chose to complete the survey (57%). Students reported a mixed view of the benefits and disadvantages of peer online learning. Sixty 6% (66%) of students liked peer online learning, whilst 29% disliked it and 6% were undecided. Convenience and ease of completion were reported as the most common reason to like peer online learning, whilst Information Technology issues, communication and non-preferred learning method were reasons for not liking peer online learning. CONCLUSION: Peer online learning groups' acted as one further method to facilitate student learning experiences. Blending peer online learning with traditional face-to-face learning increases the variety of learning methods available to students to enhance their overall learning experience.

Preparation for high-acuity clinical placement: confidence levels of final-year nursing students.

AIM: To measure final-year nursing students' preparation for high-acuity placement with emphasis on clinical skill performance confidence. BACKGROUND: Self-confidence has been reported as being a key component for effective clinical performance, and confident students are more likely to be more effective nurses. Clinical skill performance is reported to be the most influential source of self-confidence. Student preparation and skill acquisition are therefore important aspects in ensuring students have successful clinical placements, especially in areas of high acuity. Curriculum development should aim to assist students with their theoretical and clinical preparedness for the clinical environment. METHOD: A modified pretest/posttest survey design was used to measure the confidence of third-year undergraduate nursing students (n = 318) for placement into a high-acuity clinical setting. The survey comprised four questions related to clinical placement and prospect of participating in a cardiac arrest scenario, and confidence rating levels of skills related to practice in a high-acuity setting. Content and face validity were established by an expert panel (α = 0.90) and reliability was established by the pilot study in 2009. Comparisons were made between confidence levels at the beginning and end of semester. RESULTS: Student confidence to perform individual clinical skills increased over the semester; however their feelings of preparedness for high-acuity clinical placement decreased over the same time period. Reported confidence levels improved with further exposure to clinical placement. CONCLUSION: There may be many external factors that influence students' perceptions of confidence and preparedness for practice. Further research is recommended to identify causes of poor self-confidence in final-year nursing students.