Factors influencing the implementation of best practice in burn care in Western Australia.

AIMS AND OBJECTIVES: The study aimed to determine the factors which influence clinician behaviour and adherence to best practice when clinicians provide the initial care for paediatric burn patients admitted to a burns unit. BACKGROUND: Optimal initial care of burn patients influences morbidity and mortality. Non-burn specialist clinician adherence to best practice is influenced by previously unexplored factors. DESIGN: General inductive qualitative methods were used to explore factors which influenced clinicians providing acute pre-admission burn care for children in Western Australia. METHODS: Interviews of nineteen clinicians using standardised open-ended questions based on the Gilbert Behaviour Engineering Model were used to collect data. RESULTS: The main influencing factors identified were the telehealth service which supported practice, whilst IT issues provided challenges to clinicians. CONCLUSION: Telehealth services support clinicians when providing burn care, however IT issues are an major barrier to both best practice and accessing the telehealth service and should be optimised to support clinical care IMPACT STATEMENT: What does this paper contribute to the wider global community? It provides burn clinicians with an insight into the factors which facilitate optimal care for patients prior to transfer to burn units, as well as the barriers faced by non-burn specialist clinicians when patients initially present for care. Models of care which acknowledge these factors can help facilitate optimal patient care.

Policies to sustain the nursing workforce: an international perspective.

AIM: Examine metrics and policies regarding nurse workforce across four countries. BACKGROUND: International comparisons inform health policy makers. METHODS: Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom (UK) and the United States (US). Workforce policy context was explored. RESULTS: Public spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US is the most developed in the use of nurses in advanced practice roles. Ageing of the workforce is likely to drive projected shortages in all countries. LIMITATIONS: There are differences as well as variation in the overall impact of the global financial crisis in these countries. CONCLUSION: Future supply of nurses in all four countries is vulnerable. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Work force planning is absent or restricted in three of the countries. Scope for improved productivity through use of advanced nurse roles exists in all countries.

Patient satisfaction with nursing care: a measurement conundrum.

Patient satisfaction is a major indicator of quality care. There are several theories on the types of concepts that should be measured concerning patient satisfaction with nursing care. Given the different theories of patient satisfaction, the issue of accurate measurement of this concept presents nurse researchers, clinicians and leaders with a challenge. This paper will discuss the findings of a patient satisfaction survey that was conducted in two acute care surgical wards, using the revised 28-item La Monica-Oberst patient satisfaction scale and telephone interviews. Data were analysed using descriptive statistics. Textual data were managed using NUD*IST and analysed for common emerging themes and categories. The findings of the quantitative and qualitative data were compared in order to determine similarities and differences. The survey results revealed very high levels of patient satisfaction; however, the qualitative data revealed some anomalies. Specifically, due to the numbers of nurses involved in the care, some patients had difficulties answering the questionnaire. Moreover, they were unable to discriminate nursing care from the rest of their overall patient experience. Within this study, it seemed that patients' perceptions of nurses influenced the way patients rated quality nursing care. Based on this information, the authors question the accuracy of the measurement of patient satisfaction and raise issues that need to be considered in order to further clarify the measurement of this concept.