Developing cultural competence through self-reflection in interprofessional education: Findings from an Australian university.

Interprofessional education and cultural competence are both necessary for health professionals working in interprofessional teams serving diverse populations. Using a pre-post-survey case series design, this study evaluates a novel learning activity designed to encourage self-reflection and cultural competence in an Australian interprofessional education context. Undergraduate health professional students in a large subject viewed three 7-15 minute videos featuring interviews with persons of a minority cultural, linguistic, or sexual group who were living with a disability or managing a health condition. Immediately afterwards, students in interprofessional groups completed a structured activity designed to promote interprofessional and cultural reflection. A localised version of a validated scale measured cultural competence before and after the learning activity. Results suggest the value of video-based learning activities based on real-life examples for improving cultural competence. Despite initially rating themselves highly, 64% of students (n = 273) improved their overall cultural competence, though only by M = 0.13, SD = 0.08, of a 5-point rating-scale interval. A nuanced approach to interpreting results is warranted; even slight increases may indicate improved cultural competence. Suggestions for improving the effectiveness of video-based cultural competence learning activities, based on qualitative findings, are provided. Overall the findings attest to the merit of group discussion in cultural competence learning activities in interprofessional education settings. However, the inclusion of group discussions within such learning activities should hinge on group dynamics.

Focus on Feeding! Evaluation of a framework for maximizing mealtime in aged care facilities.

Unintentional weight loss is a health risk for residents of aged care facilities, a concern for families and places demands on nursing staff. An existing weight loss framework to assess and manage residents' weight developed by a multidisciplinary team was implemented and evaluated with nurses and residents in aged care facilities within an area health service of Sydney, Australia. Thematic analysis generated seven binary concepts relating to relational, procedural, behavioural, physical, psychological, environmental and temporal aspects of feeding assistance provided by nurses to residents. Theoretical sampling was applied to the literature confirming those concepts which were organized as a model of feeding assistance labelled the Focus on Feeding! Decision Model. Nurses can play a pivotal role in the assessment of feeding difficulty and implementation of innovative mealtime programs. The Model aims to promote nurses' critical thinking and decision-making to improve nutritional intake of residents and avoid preventable weight loss.

A decision model for community nurses providing bereavement care.

Community (district) nurses play a significant role in assisting and supporting bereaved informal carers (family members and friends) of recently decease clients of palliative care. Bereavement care demands a wide range of competencies including clinical decision-making. To date, little has been known about the decision-making role of community nurses in Australia. The aim of this study was to conduct in-depth examination of an existing data set generated from semi-structured interviews of 10 community nurses providing follow-up bereavement care home visits within an area health service of a metropolitan region of Sydney, Australia. A grounded theory approach to data analysis generated a model, which highlights an interaction between 'the relationship','the circumstances' (surrounding the bereavement),'the psychosocial variant', 'the mix of nurses', 'the workload', and 'the support' available for the bereaved and for community nurses, and elements of 'the visit' (central to bereavement care). The role of community nurses in bereavement care is complex, particularly where decision-making is discretionary and contingent on multiple variables that effect the course of the family's grief. The decision model has the potential to inform community nurses in their support of informal carers, to promote reflective practice and professional accountability, ensuring continuing competence in bereavement care.

Procedural pain in neonates in Australian hospitals: a survey update of practices.

AIM: The study aims to determine whether there has been improved uptake of the evidence for the management of procedural pain in neonates throughout Australia. METHODS: An Australian-wide survey was undertaken to determine the use of breastfeeding and sucrose and whether a clinical practice guideline (CPG) or pain assessment tool was used. RESULTS: Data were available from 196 (91%) of the 215 eligible hospitals. A CPG informed the management of neonatal pain in 76 (39%) of the hospitals. There was wide variation in their use between the states, and a significantly higher use of a CPG in higher-level care units. A pain assessment tool was only used in 21 (11%) of the units with greater use in the higher level care neonatal intensive care units (50%) and surgical neonatal intensive care units (80%). Awareness of breastfeeding for procedural pain was reported by 90% of the 196 respondents while 78% reported that it was actually used. Awareness of sucrose for procedural pain was lower than breastfeeding at 79%, with 53% reporting that they used sucrose in their unit. Overall, 89% of the respondents reported that either breastfeeding or sucrose was used for the management of procedural pain in their units. CONCLUSION: There has been an increase in awareness and use of sucrose and breastfeeding for procedural pain in Australia since previous surveys were undertaken in 2004. Continued resources, local pain champions and a national interest group to promote the use of pain management for procedural pain in neonates are needed for continued uptake of the evidence.

Community palliative care nurse experiences and perceptions of follow-up bereavement support visits to carers.

Community (district) nurses (CNs) are well positioned to provide follow-up home visits to bereaved families and carers of their recently deceased palliative clients. An Australian survey of CN's (n = 58, response rate 29%) described their experiences of bereavement support visits, perceptions of their role in bereavement care and their professional support needs. Although positive experiences were commonly reported, with 95% of participants considering bereavement follow-up visits as consistent with their role, 53% found the visits difficult for reasons such as the nurse or client not understanding the purpose, the CN's excessive personal identification with the client's situation, the emotional intensity of visits, and lack of confidence or skills despite prior training. The nature and quality of the CN's prior relationship with the bereaved family was an important determinant of the visits' success. Results highlight the value of bereavement support visits, while identifying professional development needs. Managing emotionally intense episodes should receive priority in preparing CN's for this challenging role.

Participant perceptions of a community-based lifestyle intervention: the CHIP.

ISSUE ADDRESSED: The Coronary Health Improvement Project (CHIP) is a community-based educational initiative designed to improve cardiovascular fitness and other health indicators associated with common, lifestyle-related health disorders in developed societies. Evaluations of the CHIP since the late 1990s, though yielding positive statistical results for change in participant physical health indicators, have not included qualitative assessments of the CHIP experience from the perspectives of CHIP participants. METHODS: Data were obtained using a mixed methods survey design via a questionnaire completed by 79 respondents (71% female) who had participated in Australian CHIP programs. Responses were analysed using descriptive statistics and thematic analysis. RESULTS: Participants commonly undertook the CHIP to fulfil their lifestyle and health aspirations and to target specific health conditions. Improved diet, enhanced exercise and weight loss were the most commonly reported benefits. Participation in the CHIP involves a process of conviction (involving risks and motivation), connection (involving support and reinforcement), challenge (involving control and struggle) and change (involving more and less). CONCLUSION: This study offers a model of a change process generated from the perspectives of participants of the CHIP in Australia. Not all participants found CHIP lifestyle recommendations straightforward to adopt, as some encountered resistance from within themselves or from family and friends.

Nursing students' appraisal of their professional portfolios in demonstrating clinical competence.

Portfolios are increasingly used to demonstrate and assess competence in nursing practice, yet when introduced in our Australian nursing school, reactions from students were mostly negative. A follow-up survey sought students' perceptions about the portfolio. Respondents acknowledged the portfolio's intrinsic worth but reported little extrinsic value beyond passing the assessment. The authors discuss the implications and suggests strategies to improve portfolio use in undergraduate nursing education.

Challenges for professional care of advanced dementia.

Qualitative methodology based on action research identified challenges when caring for persons with advanced dementia, as perceived by key professional providers. Data collection was via five focus groups (total n = 24) and 20 follow-up individual interviews. Participants included palliative care, aged care and dementia specialist nurses, medical specialists from an area health service, residential aged care staff and general medical practitioners. Responses emphasized the need for improved knowledge and skills, and clearer policy. Concerns included accurate assessment, especially of pain, owing to the inability of people with advanced dementia to communicate their symptoms. Assessment, managing physical and behavioural symptoms, and communicating with family presented as further challenges. Conclusions are that the need for a palliative approach to care in advanced dementia should be recognized. Aged care staff can deliver palliative care to people with advanced dementia only if the staff receive relevant education and training beyond their generalist competencies.

Parental stress and satisfaction in the non-tertiary special care nursery.

AIM: This paper is a report of a study examining the effects of using headbox oxygen and continuous oxygen positive airway pressure treatments for respiratory distress on stress and satisfaction of parents with infants in a special care nursery, and the relationship between parental stress and satisfaction. BACKGROUND: Continuous positive airway pressure respiratory support is increasingly used in special care nurseries worldwide. Almost nothing is known about effects of different types of respiratory support on the stress and satisfaction of parents with babies in the special care nursery. METHOD: Questionnaires were used from August 2004 to June 2006 in five special care nurseries to measure parental stress using an adaptation of the Parental Stressor Scale: Neonatal Intensive Care Unit and 5-point scales to measure overall stress and satisfaction. FINDINGS: Questionnaires were returned from 42 parents of babies receiving headbox oxygen and 51 parents of babies receiving continuous positive airway pressure (62% response rate). High stress was commonly reported. Stress did not differ statistically significantly between the two treatments. Parents with babies receiving continuous positive airway pressure were more satisfied compared to the headbox group. Stress and satisfaction were not statistically significantly correlated. CONCLUSION: Clinicians need not favour either method of respiratory support when attempting to minimize parental experience of environmental stress. Further research is needed to test parental stress reduction strategies in the special care nursery.

The value of participatory action research in clinical nursing practice.

This paper demonstrates the value of participatory action research (PAR) and promotes its use by nurses in clinical practice. PAR has gained popularity in nursing and health-care research, offering a way of developing practice-based knowledge that can improve nursing care. PAR is described in detail: what PAR is, how to use PAR in clinical practice, and the steps in the PAR cycle as applied during an exemplar study in which nurses used PAR to address their concerns and develop, implement and evaluate a model of care in an acute medical ward. The authors advocate PAR as a collaborative means to improve the nursing care for patients in varied clinical practice settings.

A survey of role stress, coping and health in Australian and New Zealand hospital nurses.

BACKGROUND: Previous research has identified international and cultural differences in nurses' workplace stress and coping responses. We hypothesised an association between problem-focused coping and improved health, emotion-focused coping with reduced health, and more frequent workplace stress with reduced health. OBJECTIVES: Test the above hypotheses with Australian and New Zealand nurses, and compare Australian and New Zealand nurses' experience of workplace stress, coping and health status. PARTICIPANTS AND SETTINGS: Three hundred and twenty-eight New South Wales (NSW) and 190 New Zealand (NZ) volunteer acute care hospital nurses (response rate 41%) from randomly sampled nurses. DESIGN AND METHOD: Postal survey consisting of a demographic questionnaire, the Nursing Stress Scale, the WAYS of Coping Questionnaire and the SF-36 Health Survey Version 2. RESULTS: Consistent with hypotheses, more frequent workplace stress predicted lower physical and mental health. Problem-focused coping was associated with better mental health. Emotion-focused coping was associated with reduced mental health. Contrary to hypotheses, coping styles did not predict physical health. NSW and NZ scored effectively the same on sources of workplace stress, stress coping methods, and physical and mental health when controlling for relevant variables. CONCLUSIONS: Results suggest mental health benefits for nurses who use problem-solving to cope with stress by addressing the external source of the stress, rather than emotion-focused coping in which nurses try to control or manage their internal response to stress. Cultural similarities and similar hospital environments could account for equivalent findings for NSW and NZ.

A comparative study of the effect of food consumption on labour and birth outcomes in Australia.

OBJECTIVE: to explore the effect of volitional food consumption by women during labour on labour and birth outcomes. DESIGN: a comparative design using concurrent controls. SETTING: four public hospitals in Sydney, Australia. PARTICIPANTS: 217 English-speaking, nulliparous women with low-risk pregnancies. The sample was divided into four sub-groups identified post hoc from reported behaviour: (1) 82 women who chose to eat food during early labour only; (2) 10 who ate during established labour only; (3) 31 who ate during early and established labour and (4) 94 who chose to consume clear fluids only during early and established labour. INTERVENTIONS: voluntarily eating food during labour compared with voluntarily consuming clear fluids only. MEASUREMENTS: differences between the four eating groups were examined for labour progress using one-way analysis of variance (ANOVA). A hierarchical multiple regression tested the association between eating during labour and labour duration. The relationship between food intake and the incidence of medical interventions was tested using chi(2) tests. FINDINGS: eating during the early phase of the first stage of labour was associated with M=2.16 hrs longer labour (p<0.01). When women ate food during both their early and established phases of labour, M=3.5 hrs was added to their labour (p<0.01). The incidence of vomiting, medical interventions during labour or adverse birth outcomes were unaffected by food intake. CONCLUSION: the findings suggest that women should be informed that labour may take longer when they eat food. However, eating does not seem to affect other labour or birth outcomes. IMPLICATION FOR PRACTICE: the findings challenge the belief among many midwives that food intake is beneficial to labour progress. However, women should not be denied food for fear of vomiting or because it may make labour longer. Women with low-risk labours should be informed of the risk, although rare, of aspiration if general anaesthesia is required, and be allowed to respond to their natural desires for oral intake during labour.

The relationships among workplace stressors, coping methods, demographic characteristics, and health in Australian nurses.

Nursing is known to be stressful. Stress detrimentally can influence job satisfaction, psychological well-being, and physical health. There is a need for increased understanding of the stress that nurses experience and how best to manage it. Three hundred twenty Australian acute care public hospital nurses participated in a study by completing four questionnaires that examined (a) how various workplace stressors relate to ways of coping, demographic characteristics, and physical and mental health and (b) which workplace stressors, coping mechanisms, and demographic characteristics were the best predictors of physical and mental health. Significant correlations were found between stressors and physical and mental health. Multiple regression showed age to be the only significant predictor of physical health. The best coping predictors of mental health were escape-avoidance, distancing, and self-control. Other significant predictors of mental health were support in the workplace, the number of years worked in the unit, and workload. Mental health scores were higher for nurses working more years in the unit and for those who used distancing as a way of coping. Mental health scores were lower for nurses who used escape-avoidance, lacked workplace support, had high workload, and used self-control coping. The findings have implications for organizational management, particularly in terms of recommendations for stress management, social support, and workload reduction.

Natural eating behavior in latent labor and its effect on outcomes in active labor.

This study examined the effect of eating during the latent phase of labor on the hospital-estimated labor duration and birth outcomes for the mother and baby. A prospective, comparative trial with concurrent controls compared labor duration and outcomes of 176 low-risk, nulliparous women who birthed at four hospitals in Sydney, Australia. Food was voluntarily consumed by 82 women, whereas 94 consumed clear fluids only. Food intake during the latent phase of the first stage of labor was associated with a longer duration of labor (mean difference = 2.35 hours). No difference was found between eating and noneating groups for the rate of medical interventions, adverse birth outcomes, or vomiting. Results suggest that eating during the latent phase of labor may increase labor duration.