Interprofessional disaster exercises for undergraduate nursing students: a scoping review.

OBJECTIVE: The aim of this scoping review was to report on the planning and implementation of a disaster exercise for undergraduate nursing students, which included the participation of other health students, allied health students, or professionals, for the purpose of preparing them to respond to a disaster. INTRODUCTION: Recently, the world has witnessed an increasing frequency of natural disasters, emergencies, and public health events. These events often adversely influence many individuals' health, and as such, require health professionals to be prepared and ready to effectively respond. Health students, including nursing, medical, and allied health professionals, need to be provided with opportunities to learn about disasters and to practice responding to them within a team context. This scoping review examined the planning and implementation of disaster exercises that have conceptualized an interprofessional team approach inclusive of nursing students. INCLUSION CRITERIA: Quantitative studies, qualitative studies, mixed method studies, discussions, and text or opinion papers reporting a disaster simulation or drill, involving undergraduate nursing and other health students, allied health discipline students, practitioners, and non-health personnel were included. There was no limit on the publication period or languages. METHODS: MEDLINE (EBSCOhost), CINAHL (EBSCOhost), ERIC (EBSCOhost), Embase (Ovid), Web of Science Core Collection, ProQuest Nursing and Allied Health (Ovid), and PsycINFO (Ovid) were searched for relevant reports. Titles and abstracts and then full texts were screened independently by 2 reviewers. A data extraction tool developed specifically for this review was used to chart evidence pertaining to planning and implementing a disaster exercise, nursing students' roles, and measured outcomes. RESULTS: A total of 1429 titles were screened; 42 full texts were assessed against the eligibility criteria and 13 papers were selected for review. Nursing students had opportunities to practice performing a single role or a combined role as observers, triage nurses, direct care providers, or assisting health professionals, depending on their year level. Nursing students' roles were sometimes not well identified and not clearly communicated to them prior to the exercise, resulting in ambiguous expectations for some participants. By involving multiple health students and professionals, the nursing students had the opportunity to participate and perform tasks within their scope of practice while observing the roles of other disciplines. In a few studies, participants teamed up to triage, assess, and provide care for simulated patients. A variety of outcomes were categorized, such as students' knowledge, skills, attitudes, satisfaction with the learning experience, self-confidence, communication, collaboration, readiness for a disaster event, critical decision-making, and empathy. Important lessons regarding decision-making preparations (such as planning, coordinating, and implementing a disaster exercise), scheduling and sequencing for optimal times to ensure participating disciplines can attend, identification and effective communication of students' roles, plus ensuring manageable group sizes will optimize a more authentic learning opportunity for all involved in disaster exercises. CONCLUSIONS: Overall, the exercises were perceived as a positive learning opportunity for students to understand what is required in disaster responses and to practice their skills. Adequate preparation for a disaster exercise is crucial for a successful experience and should prepare nursing students and other participants for the roles they need to fulfill. SUPPLEMENTAL DIGITAL CONTENT: A Vietnamese-language version of the abstract of this review is available as Supplemental Digital Content http://links.lww.com/SRX/A24 .

The top 100 cited Nurse Practitioner publications: a bibliometric analysis.

BACKGROUND: Development of the Nurse practitioner role and the specialisation of practice is an increasing focus in healthcare. To date, a bibliometric evaluation of scholarly work referring to Nurse Practitioners, has not been located in the published literature. OBJECTIVE: With the aim of identifying the top 100 cited articles in the Nurse Practitioner domain, the Scopus™ database was searched for Nurse Practitioner studies during 2007-2021. Using bibliometric analysis we identified prolific authors; annual trend; citation rates; countries of origin; and study design. RESULTS: There were 1768 papers identified across 360 peer reviewed journals in 33 countries. CONCLUSIONS: Finding from this analysis provides evidence of an evolving research area of inquiry which contributes to knowledge of the Nurse Practitioner role and scope of practice.

Graduate nurses' capability upon entering the workforce: An integrative review.

OBJECTIVES: To clarify capability for work readiness in newly graduated registered nurses as viewed from the perspective of clinicians in practice, educators in tertiary institutions, and graduates. DESIGN: Integrative review. DATA SOURCES: Databases searched for peer-reviewed studies included PubMed, MEDLINE, ERIC, Campbell collaboration, Google Scholar, and Cochrane databases. REVIEW METHODS: Pragmatism informed this integrative review. The five-stage method described by Whittemore and Knafl was used to enable rigorous examination of the expected capability of graduate nurses. A comprehensive database search was conducted using PRISMA guidelines. Eighteen articles were appraised and analysed for this review. The capability concept was used as a framework for analysis. RESULTS: Eighteen articles met the inclusion criteria. Findings revealed that although there is no definition for graduate nurses' work readiness, there is a common theme. Graduate nurses are expected to have broad theoretical knowledge (knowing) along with practical knowledge (doing). They are also expected to demonstrate integrity, honesty, respect, compassion, and a moral compass. A list of personal attributes and organisational acumen was also reflective of graduate readiness upon entering the workforce and identified as necessary capabilities for graduates. CONCLUSIONS: A picture of the perfect employee is illustrated in the definition of work readiness by the participants of the original studies. Yet there is a lack of stakeholder consensus on the capabilities expected from a graduate nurse.

Development and psychometric testing of the gender misconceptions of men in nursing (GEMINI) scale among nursing students.

BACKGROUND: Misconceptions about men in nursing may influence recruitment and retention, further perpetuating the gender diversity imbalance in the nursing workforce. Identifying misconceptions and implementing early intervention strategies to address these deep-rooted stereotypes remain challenging but is considered critical to support students who are commencing a nursing career. OBJECTIVE: To develop and evaluate the psychometric properties of the 'Gender Misconceptions of meN in nursIng (GEMINI) Scale. DESIGN: Cross-sectional survey. METHODS: Pre-registration nursing students enrolled in undergraduate nursing programmes across 16 nursing institutions in Australia were surveyed from July to September 2021. The 17-item self-report GEMINI Scale measured the gender misconceptions of men in nursing. RESULTS: Of the 1410 completed surveys, data from 683 (45%) women were used for exploratory factor analysis showing a one factor structure, while data from 727 men (47%) were used for confirmatory factor analysis of the 17-item GEMINI Scale, which showed a good model fit. The scale demonstrated high internal consistency (Cronbach's alpha of 0.892). Men were found to have higher gender misconceptions (p < 0.001) while respondents who: (a) identified nursing as their first career choice (p = 0.002); (b) were in their final year of programme enrolment (p = 0.016); and (c) engaged in health-related paid work (p = 0.002) had lower gender misconceptions. CONCLUSION: The GEMINI Scale is a robust, valid, reliable, and easy to administer tool to assess misconceptions about men in nursing, which may potentially influence academic performance and retention. Identifying and addressing specific elements of misconceptions could inform targeted strategies to support retention and decrease attrition among these students. IMPACT STATEMENT: Genderism harms nursing, as well as the men and women working in the profession. Recruitment and retention of men into nursing is needed to cultivate male role models and diversify the workforce, however this is impeded by negative portrayals in popular culture and misconceptions entrenched in society.

Patient Expectations: Searching Websites on How to Apply to Access Medical Records.

Patients who want to know how to access their medical records from a health organization's website have certain expectations about what must be included to assist in this process. The purpose of this article is to detail patient expectations of a health care organization website when searching for information on how to apply for access to their medical records. Using expectation confirmation theory, a survey was developed to ask patients, as consumers of health care, about their expectations when accessing websites. The results revealed that patients want websites to be safe and secure and have help available if there are questions about the website or search functionality. In order to improve the patient experience, health care providers need to understand these expectations from the patient perspective about this information-seeking exercise.

Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative.

People who are homeless experience significantly poorer health than the general population and often face multifaceted challenges engaging with public healthcare services. Mission Health Nurse-led Clinic (MHNC) was established in 2019 to meet the healthcare needs of this marginalised population in Launceston, Tasmania. This study examines barriers to healthcare access amongst individuals who experience homelessness, client and staff perceptions of the MHNC services and explored opportunities for service expansion. Descriptive statistics were drawn from administrative data, and all interviews were thematically analysed. A total of 426 presentations were reported for 174 individuals experiencing homelessness over 26 months. The median client age was 42 years and 60.9% were male; A total of 38.5% were homeless or lived in a supported accommodation. The predominant reasons for clinic visits included prescription requests (25.3%) and immunisations (20.1%). A total of 10 clients and 5 City Mission staff were interviewed with three themes emerging from the findings: personal vulnerability, disconnectedness and acceptability of the MHNC. The MHNC services were reported to be highly appreciated by all clients. Mental health and allied health, extra operating hours and maintaining the flexibility of walk-in appointments were suggested as expansion areas for the service and were highlighted as ways to increase engagement for improved health outcomes. Continued partnerships with interprofessional primary healthcare providers would contribute to addressing unmet healthcare needs in this vulnerable population.

Interprofessional team coordination in disaster exercises for undergraduate nursing students: a scoping review protocol.

OBJECTIVE: This scoping review will map the literature related to interprofessional learning among undergraduate nursing, and other health and allied health students and professionals to prevent, prepare, or respond to a simulated disaster event. INTRODUCTION: The frequency of disasters has been increasing globally. Nurses constitute the largest proportion of the health workforce and play an important role in disaster response, together with other health and allied health professionals. The development and implementation of disaster exercises that are inclusive of nursing, as well as other health, and allied health students or professionals will benefit students' learning around disaster response. Therefore, it is timely to conduct a review of disaster exercises that have conceptualized and implemented an interprofessional team approach inclusive of nursing students. INCLUSION CRITERIA: Publications of quantitative, qualitative, mixed method studies, discussions, text, or opinion reporting a disaster simulation or drill involving nursing and other health, allied health discipline students, or practitioners will be included. There is no limit on the publication period or languages. All types of natural and human-induced disasters will be considered. METHODS: The search will be conducted in MEDLINE, CINAHL, ERIC, Embase, Web of Science, ProQuest Nursing and Allied Health, and PsycINFO. Two reviewers will screen titles and abstracts for potential papers, and the full texts will be examined against eligibility criteria. Data will be extracted using the tool developed for this review. Nursing roles and how nursing students have collaborated with other team members will be discussed.

Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions.

BACKGROUND: The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre. METHODS: This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data. RESULTS: Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context. CONCLUSIONS: This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.

Healthcare Professional Presenteeism during a COVID-19 Outbreak in an Australian Rural Healthcare Environment: A Case Analysis.

The recruitment and retention of health professionals in rural Australia is well documented. The COVID-19 pandemic has further exposed the precariousness of human healthcare resources within small rural communities. The external disaster of the COVID-19 outbreak described in this case analysis exacerbated the frail balance of sustaining adequate staffing levels and skill mix, which exposed behaviours of presenteeism within rural healthcare teams. An analysis of the complex of factors that led to the first nosocomial outbreak of COVID-19 within a healthcare environment in Australia demonstrates how rural healthcare environments are ill-equipped to meet the demands of unexpected external disasters. Using the Haddon Matrix to examine the factors that led to this outbreak provides us with the opportunity to learn from the case analysis. Health professional presenteeism contributed to the North West Tasmania COVID-19 outbreak and affected the hospital and health service provision within the region. Recommendations to mitigate risk for future disaster planning in rural healthcare environments include improved infection control strategies and a whole-community approach.

Moral distress in community health nursing practice.

Contemporary sociopolitical circumstance impedes the delivery of primary health care in keeping with its underlying philosophy and tenets. Skills to negotiate the maintenance of best practice and quality care in an evolving practice environment are fundamental to nursing. Nurse education needs to incorporate the ideals of best practice ideology to ensure that all are prepared to negotiate the realities of nursing practice. In this discussion paper the experience of moral distress by community health nurses is used to illustrate why skills in political advocacy and action are equally essential as clinical skills in nurse education and professional practice.

Nurse practitioner locums: a plausible solution for augmenting health care access for rural communities.

With 2020 being designated the Year of the Nurse and Midwife, it is opportune to acknowledge and recognise the role that nurses undertake in primary care environments. Nurses and midwives play a pivotal role in the delivery of high-quality health care, particularly in geographically challenged areas of Australia, where they may be the only provider of care within their communities. Rural and remote health services require strategic planning to develop and implement solutions responsive to the challenges of rural and remote communities. Maintenance of health services in rural and remote areas is a challenge, crucial to the equity of health outcomes for these communities. Many small communities rely on visiting medical officers to provide the on-call care to facility services, including emergency departments, urgent care centres, acute wards and aged care facilities. It is increasingly difficult to maintain the current rural workforce models, particularly the provision of after-hours 'on-call' care necessary in these communities. An alternative model of health care service delivery staffed by nurse practitioners (NP) is one proposed solution. NPs are educated, skilled and proven in their ability to provide an after-hours or on-call service to meet the expectations of rural and remote communities. Achievement of high-quality health care that is cost-efficient, safe and demonstrates improved patient outcomes has been reported in NP-led health care delivery impact evaluations. The value of an NP locum service model is the provision of a transparent, reliable service delivering consistent, equitable and efficient health care to rural and remote communities.

Nurse practitioner work patterns: A cross-sectional study.

AIM: The aim was to determine how nurse practitioner (NP) roles are translated into clinical practice across Victoria, Australia. This paper reports details about NP work patterns and scopes of practice across multiple clinical settings and geographic locations. DESIGN: A quantitative survey design was used. A data abstraction tool, based on previous work, was adapted for this study. METHODS: All NPs in one state of Australia were eligible to participate in the study and invited to complete an online survey about their NP practice. A previously developed data collection tool, capturing practice patterns of NPs, was adapted for online use in REDCAP. The data were exported, and descriptive statistics were analysed using SPSS. RESULTS: Participants were mostly female, with males accounting for 25%. Findings indicate several NPs working in outpatient settings, community settings and forensic care. Patterns of practice-prescribing and ordering diagnostics-are associated with clinical context and model of care of the NP work.

Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments.

OBJECTIVE: To determine whether sex differences exist in the triage, management and outcomes associated with non-traumatic chest pain presentations in the emergency department (ED). METHODS: All adults (≥18 years) with non-traumatic chest pain presentations to three EDs in Melbourne, Australia between 2009 and 2013 were retrospectively analysed. Data sources included routinely collected hospital databases. Triage scoring of the urgency of presentation, time to medical examination, cardiac troponin testing, admission to specialised care units, and in-ED and in-hospital mortality were each modelled using the generalised estimating equations approach. RESULTS: Overall 54 138 patients (48.7% women) presented with chest pain, contributing to 76 216 presentations, of which 26 282 (34.5%) were cardiac. In multivariable analyses, compared with men, women were 18% less likely to be allocated an urgency of 'immediate review' or 'within 10 min review' (OR=0.82, 95% CI 0.79 to 0.85), 16% less likely to be examined within the first hour of arrival to the ED by an emergency physician (0.84, 0.81 to 0.87), 20% less likely to have a troponin test performed (0.80, 0.77 to 0.83), 36% less likely to be admitted to a specialised care unit (0.64, 0.61 to 0.68), and 35% (p=0.039) and 36% (p=0.002) more likely to die in the ED and in the hospital, respectively. CONCLUSIONS: In the ED, systemic sex bias, to the detriment of women, exists in the early management and treatment of non-traumatic chest pain. Future studies that identify the drivers explaining why women presenting with chest pain are disadvantaged in terms of care, relative to men, are warranted.

The optimal blood glucose level for critically ill adult patients.

BACKGROUND: Glycaemic control is recognized as one of the important aspects in managing critically ill patients. Both hyperglycaemia and hypoglycaemia independently increase the risk of patient mortality. Hence, the identification of optimal glycaemic control is of paramount importance in the management of critically ill patients. AIMS AND OBJECTIVES: The aim of this literature review is to examine the current status of glycaemic control in critically ill adult patients. This literature review will focus on randomized controlled trials comparing intensive insulin therapy to conventional insulin therapy, with an objective to identify optimal blood glucose level targets for critically ill adult patients. DESIGN AND METHODS: A literature review was conducted to identify large randomized controlled trials for the optimal targeted blood glucose level for critically ill adult patients published since 2000. A total of eight studies fulfilled the selection criteria of this review. RESULTS: With current human and technology resources, the results of the studies support commencing glycaemic control once the blood glucose level of critically ill patients reaches 10 mmol/L and maintaining this level between 8 mmol/L and 10 mmol/L. CONCLUSION: This literature review provides a recommendation for targeting the optimal blood glucose level for critically ill patients within moderate blood glucose level target range (8-10 mmol/L). The need for uniformed glucometrics for unbiased reporting and further research for optimal blood glucose target is required, especially in light of new technological advancements in closed-loop insulin delivery and monitoring devices. RELEVANCE TO CLINICAL PRACTICE: This literature review has revealed a need to call for consensus in the measurement and reporting of glycaemic control using standardized glucometrics.

Guideline implementation fails to improve thrombolytic administration.

BACKGROUND: International randomised controlled trials conducted over the last two decades have consistently demonstrated improved mortality and morbidity resulting from thrombolytic therapy for patients with acute myocardial infarction (AMI). Subsequently, evidence-based guidelines have been designed and implemented to optimize thrombolytic delivery. The effect of evidence-based clinical guidelines on clinical practice is heavily influenced by strategies used to develop, disseminate and implement those guidelines. AIMS: This study evaluated the impact of a collaborative, multifaceted implementation strategy for AMI management guidelines on thrombolytic usage in the Loddon Mallee Region, Victoria, Australia. INTERVENTION: The multi-faceted implementation strategy included an inter-disciplinary team representing all treating venues contributing to the content of the "Guidelines for the Early Management of Acute Myocardial Infarction" followed by education sessions that coincided with the dissemination of the guidelines. METHODS: A retrospective medical records audit 12 weeks before and 12 weeks after the intervention was used to evaluate the impact on proportion of those patients eligible and receiving a thrombolytic and door-to-needle time. Variables of treating venue, age, gender, type of AMI, and type of transport to hospital were also measured to determine their impact on results. RESULTS AND CONCLUSIONS: A retrospective audit of 170 medical records found that the intervention appeared to have had no impact on the proportion of patients eligible and receiving a thrombolytic (74.2% vs. 62.5%: p=0.275), and door-to-needle time (67.7 min vs. 60.5 min: p=0.759). Venue specific influences produced a variety of patterns in thrombolytic delivery that require further exploration. This suggests that a single solution approach across multiple venues will have limited impact.