Barriers and facilitators to evidence-based perioperative hypothermia management for orthopaedic patients: A systematic review.

AIM: To assess barriers and facilitators to the implementation of guidelines for the prevention of inadvertent perioperative hypothermia in orthopaedic patients. DESIGN: Systematic review. DATA SOURCES: Nine databases: PubMed, Embase, CINAHL, Cochrane CENTRAL, PsycINFO, ProQuest Dissertations and Theses, Scopus, Web of Science and Trip Clinical Evidence Database. METHODS: Primary studies published in English between January 2008 to July 2022 were screened. Study selection, quality assessment, and data extraction were completed independently by researchers. Data were extracted using the Consolidated Framework for Implementation Research and mapped to the Expert Recommendations for Implementing Change strategies. RESULTS: Eighty-seven studies were included in the review. The most frequently reported barriers and facilitators related to evidence strength, relative advantage, and cost of implementing perioperative hypothermia prevention guidelines. The top four ERIC strategies were: Identify and prepare champions; Conduct educational meetings; Assess for readiness and identify barriers and facilitators; and Inform local opinion leaders. CONCLUSION: This review provides synthesized evidence regarding barriers and facilitators to perioperative hypothermia guidelines for patients undergoing orthopaedic surgery. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Our work provides theory guided strategies to promote implementation of perioperative hypothermia prevention to assist nurses caring for patients undergoing orthopaedic surgery. IMPACT: Findings provide professionals caring for patients undergoing orthopaedic surgery with theory-informed strategies to improve perioperative hypothermia prevention. Reducing perioperative hypothermia will improve outcomes for patients undergoing orthopaedic surgery. REPORTING METHOD: The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. NO PATIENT OR PUBLIC CONSULTATION: Due to the study design, no patient or public consultation took place.

Factors influencing Australian nursing and midwifery students COVID-19 vaccination intentions.

Background: Vaccination for COVID-19 has become a cornerstone management plan for many countries. Australian state governments made vaccinations mandatory for all healthcare workers. Despite evidence on the important role vaccines hold in preventing or decreasing serious disease, there have been many nurses and midwives who have demonstrated vaccine hesitancy. This hesitancy has also been present in undergraduate nursing and midwifery students. The aim of this study was to explore factors influencing Australian nursing and midwifery students' intentions towards receiving the COVID-19 vaccine; identify the barriers and facilitators to obtaining the COVID-19 vaccine; and understand students' perceptions of mandating the COVID-19 vaccine and identify any impact on their studies.. Methods: Cross-sectional mixed method study utilising an online survey platform. Data were analysed using binomial and multinomial logistic regression through Statistical Package for the Social Sciences. A content analysis was completed for the qualitative data. Results: There were 715 participants and 556 who completed the survey in full. Nurses made up the majority of participants (n = 409), 133 participants were midwives and 30 were in dual nursing/midwifery programs. Education and communication were identified as two major factors that facilitate vaccine acceptance. Conclusions: Vaccines are integral in the prevention of contracting COVID-19 or reducing the severity of the symptoms. However, many nursing and midwifery students have shown reluctance towards getting vaccinated. The mandate to be vaccinated to attend clinical placement has led to the inability of some students to complete their course. The findings from this study are valuable in informing the future COVID-19 vaccination strategies and improving vaccine acceptance. COVID-19 remains a global health risk and therefore further research is needed of vaccine acceptance amongst the future health workforces. It is crucial knowledge for policy makers and healthcare services as they plan for any future pandemics and implement Australia's national vaccine strategy.

Perioperative temperature monitoring for patient safety: A period prevalence study of five hospitals.

BACKGROUND: Monitoring body temperature is essential for safe perioperative care. Without patient monitoring during each surgical phase, alterations in core body temperature will not be recognised, prevented, or treated. Safe use of warming interventions also depends on monitoring. Yet there has been limited evaluation of temperature monitoring practices as the primary endpoint. OBJECTIVE: To investigate temperature monitoring practices during all stages of perioperative care. We examined what patient characteristics are associated with the rate of temperature monitoring, along with clinical variables such as warming intervention or exposure to hypothermia. DESIGN: An observational period-prevalence study over seven days across five Australian hospitals. SETTINGS: Four metropolitan, tertiary hospitals and one regional hospital. PARTICIPANTS: We selected all adult patients (N = 1690) undergoing any surgical procedure and any mode of anaesthesia during the study period. METHODS: Patient characteristics, perioperative temperature data, warming interventions and exposure to hypothermia were retrospectively collected from patient charts. We describe the frequencies and distribution of temperature data at each perioperative stage, including adherence to minimum temperature monitoring based on clinical guidelines. To examine associations with clinical variables, we also modelled the rate of temperature monitoring using each patient's count of recorded temperature measurements within their calculated time interval from anaesthetic induction to postanaesthetic care unit discharge. All analyses adjusted 95% confidence intervals (CI) for patient clustering by hospital. RESULTS: There were low levels of temperature monitoring, with most temperature data clustered around admission to postanaesthetic care. Over half of patients (51.8%) had two or less temperatures recorded during perioperative care and one-third (32.7%) had no temperature data at all prior to admission to postanaesthetic care. Of all patients that received active warming intervention during surgery, over two-thirds (68.5%) had no temperature monitoring recorded. In our adjusted model, associations between clinical variables and the rate of temperature monitoring often did not reflect clinical risk or need: rates were decreased for those with greatest operative risk (American Society of Anesthesiologists Classification IV: rate ratio (RR) 0.78, 95% CI 0.68-0.89; emergency surgery: RR 0.89, 0.80-0.98), and neither warming interventions (intraoperative warming: RR 1.01, 0.93-1.10; postanaesthetic care unit warming: RR 1.02, 0.98-1.07) nor hypothermia at postanaesthetic care unit admission (RR 1.12, 0.98-1.28) were associated with monitoring rate. CONCLUSIONS: Our findings point to the need for systems-level change to enable proactive temperature monitoring over all phases of perioperative care to enhance patient safety outcomes. REGISTRATION: Not a clinical trial.

Associations between health behaviors and mental health in Australian nursing students.

AIM: Nursing students experience high levels of stress, anxiety and depression. This study examined associations between health behaviors and stress, anxiety and depression in Australian nursing students. DESIGN: this was a cross-sectional study. METHODS: Participants completed an online survey providing demographic information and responses to the 21-item Depression Anxiety Stress Scale, Fagerström Test for Nicotine Dependence, short Food Frequency Questionnaire, Alcohol Use Disorders Identification Test, International Physical Activity Questionnaire and Workforce Sitting Questionnaire. Associations were evaluated using multivariate linear regression. RESULTS: Mild to extremely severe stress (46.6%), anxiety (52.8%) and depression (42.2%) were prevalent. Intake of snack-foods was associated with higher depression (ß = 8.66, p < 0.05) and stress (ß = 3.92, p = 0.055) scores. More time spent sitting was associated with higher depression (ß = 0.48, p < 0.001) and stress (ß = 0.28, p < 0.05) scores. Skipping meals correlated with higher stress, anxiety and depression scores. CONCLUSION: More support must be provided to nursing students to manage psychological distress and mental health during university study.

Associations between health-related quality of life and health behaviors in Australian nursing students.

Health-related quality of life (HRQoL) is being increasingly studied as an indicator of wellbeing. This study evaluated the HRQoL of nursing students and relationships between lifestyle behaviors including smoking, diet, alcohol intake and physical activity. A cross-sectional study was conducted in 2018 using the Short-Form 12V2 to measure the HRQoL of 475 students from both regional and metropolitan universities in Queensland, Australia. z-scores were aggregated into a Physical Composite Score (PCS) and a Mental Composite Score (MCS). Multivariate linear regression was used to explore the associations. Nursing students (94.5% female) had lower HRQoL scores relative to the general Australian population. Students enrolled at the regional university, with higher income; higher intakes of vitamin A, calcium, and iodine; and more physical activity had a higher Mental Composite Score, but those with health conditions and high intakes of meat, fat, carbohydrates, and sugar reported lower Physical Composite Score compared to their counterparts. Skipping breakfast, physical inactivity, and alcohol score were inversely associated with HRQoL. This study highlights the need for strategies to address the poor lifestyle and HRQoL in nursing students to support their physical and mental health.

Barriers to healthy lifestyle behaviors in Australian nursing students: A qualitative study.

Studying at university is stressful, which can lead to unhealthy lifestyle behaviors. This study aimed to explore perceived reasons and barriers preventing Australian nursing students from engaging in a healthy lifestyle and strategies to overcome barriers. Fifty-four bachelor of nursing students participated in seven focus groups between July and November 2018. Participants defined healthy lifestyle behaviors as eating well; regular physical activity; regular water consumption; limiting alcohol, caffeine, and nicotine; good sleep quality; stress management and relaxation; and regular social interaction and support. They identified individual (lack of motivation, existing bad habits, lack of knowledge), environmental (time, finances, limited access to healthy food and physical activity resources), and psychosocial (competing priorities, increased learning cognitive load, lack of social interaction and support, compassion fatigue, and shift work) barriers preventing healthy lifestyle. Participants proposed several individual and system-related strategies to overcome barriers. Despite portraying a comprehensive understanding of healthy lifestyle behaviors, students reported finding difficulty in attaining healthy lifestyles. Strategies proposed by students may inform targeted interventions aiming to increase overall health of students, reduce attrition rates, and promote workforce retention post-graduation.

Association between dietary patterns and sociodemographics: A cross-sectional study of Australian nursing students.

Lack of time, financial issues, and stressful clinical and educational environments in nursing studies promote higher intakes of convenience and fast foods loaded with fat and sugar, which are linked to reduced mental and physical health. In this study, we examined the dietary patterns of nursing students and their associated sociodemographic factors to inform the development of future health-promotion interventions. A total of 548 Bachelor of Nursing students were invited to complete a survey. Associations were explored using χ2 and logistic regression. Three dietary patterns were identified: healthy (fruit, vegetables, and legumes), Western (loaded with fat, sugar, and salt), and unbalanced. Only 21% of participants were classified as following a healthy dietary pattern, and more likely to be older (>35 years old) and have a personal annual income between $AUD20 000-$59 999 and $60 000-$99 999. Students with one to two and three or more children were more likely to follow a Western dietary pattern. There is a need to develop interventions to improve the dietary behaviors of nursing students by health-promoting activities and the provision of online health resources.

Use of healthcare consumer voices to increase empathy in nursing students.

Nurses need to be well prepared to address the needs of a diverse population and facilitate positive experiences in an equitable and inclusive approach to care. The aim of the study was to determine whether the integration of consumer lived experience interviews into the content of a first-year course influenced empathy in nursing students. A one group pre-test, post-test design was used. A convenience sample of first-year undergraduate nursing students (N = 32) from a regional Australian university was recruited for the study. The pre and post tests were conducted using the Kiersma Chen Empathy Scale and t-tests performed to analyse the data. Results showed overall that nursing students demonstrated moderate levels of empathy; pre-test score of (M = 75.53; SD = 5.76). After the intervention the post-test results showed that there was a statistically significant increase in students' empathy towards vulnerable, disadvantaged and stigmatised population groups. The healthcare consumer voice has the potential to strengthen current teaching practices that promote caring behaviours in nursing students.