The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis.

AIM: Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety. METHODS: A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies. DATA SOURCES: Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023. RESULTS: The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety. CONCLUSION: Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT: This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility. REPORTING METHOD: This report adheres to PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.

Coaching in nursing: An integrative literature review.

AIM: To understand the current application and benefits of coaching practice in nursing and identify potential areas for future research. DESIGN: An integrative literature review was conducted using Whittemore and Knalf integrative review methods. DATA SOURCES: A search of the literature from Medline (PubMed) and CINHAL platform for abstracts and/or full-text articles from 2012 to 2022. METHODS: A systematic approach was used to screen and analyse the literature. Inclusion and exclusion criteria were applied, a quality appraisal of the literature was undertaken and summarised into themes. Eighteen articles were selected, two articles were different aspects of the same studies. Coaching was found to have benefits to the individual related to performance, role effectiveness, role transitions and confidence in performing in the role. The outcomes for individuals add to the overall organisational benefits with performance, support, teamwork, communication and culture. RESULTS: This literature review sought to understand the current use of coaching in nursing and identify any gaps in the application of coaching within the discipline. Supporting, developing staff knowledge and skills and nurturing nursing staff into the profession has occurred in several ways and evolved to include coaching. Coaching provides capabilities to enhance nursing leadership, performance improvement and to provide support to staff. The findings from this literature review found a need to conceptually define coaching in nursing and the opportunity to explore the use of coaching to support both the clinical and managerial workforce (job satisfaction, intention to stay and building resilience). The benefits of coaching in nursing extend beyond the leadership level and there is opportunity to extend the operationalisation of coaching practice and coaching training within the discipline of nursing. This integrative review explains how coaching has been utilised in nursing to be a valuable tool in developing nurse leaders and clinical staff.

"Teaching Through Your Fingertips": A Descriptive Study to Understand the Experiences and Needs of Online Educators in Postgraduate Nursing Education in Australia.

Introduction: Even before COVID-19, enrolments in online postgraduate nursing and midwifery courses were growing globally. Teaching into planned online courses requires pedagogical considerations unique to the context. Objective: The objective of this descriptive mixed methods study was to understand the experiences and needs of Australian online educators who taught into planned online postgraduate nursing or midwifery courses. Methods: A 55-item online survey captured the experiences and needs of participants. This paper reports on the analysis of participants' qualitative responses in this survey, analyzed using a thematic analysis approach. Forty-nine postgraduate educators participated in this study. Results: Five core themes were identified: time is precious; redefining the educator role; understanding the pedagogical shift; online and alone; and learning to teach online. Many educators report lacking the skills and confidence to deliver high-quality education to postgraduate students through their fingertips. Conclusion: This research highlighted that online educators need support through resources, education, and professional development.

Nursing informatics in undergraduate nursing education in Australia before COVID-19: A scoping review.

Background: Technology can support transformational outcomes of high quality and evidenced-based care and education. Embedding nursing informatics into the undergraduate nursing curriculum enhances nursing students' digital health literacy, whilst preparing them to use health information systems and technological innovations to support their learning both at university and in the clinical environment. Aim: This scoping review aimed to provide an overview of the published literature on how nursing informatics was embedded and integrated into the undergraduate nursing curriculum in Australia before coronavirus disease (COVID-19). Methodology: A scoping review approach guided this study using the Levac, Colquhoun, and O'Brien framework, and the following databases were searched: CINAHL Plus, EMCARE, MEDLINE Ovid, Scopus, ERIC ProQuest, and Web of Science. A total of 26 articles were included: Five quantitative studies, eight qualitative studies and 13 mixed-methods studies. Findings: Few studies focused on the concept of nursing informatics itself, and only two studies described the process of developing curricula that contain nursing informatics competencies and their implementation: the educational scaffolding and modular development approach and a Community of Inquiry Framework (COI). Most studies centred on nursing informatics tools to facilitate teaching and learning in classrooms and skills laboratories. The reported pedagogical strategies were online learning, blended learning, and technology-enabled simulations. Hindrances to nursing informatics being integrated into undergraduate curricula were disparities of the informatics content, a lack of guidelines and/or frameworks, and poor digital literacy. Conclusion: This study provided a baseline perspective of how nursing informatics was embedded and integrated into nursing education in Australia before COVID-19. Overwhelmingly, the focus of research to date was found to be mainly on the utilisation of technological tools to support learning and teaching.

"What a nurse suffers": Care left undone in seventeenth-century Madrid.

Care left undone, interchangeably referred to as missed care, unfinished nursing care and task incompletion, is pervasive in contemporary healthcare systems. Care left undone can result in adverse outcomes for the patient, nurse and organization. The rhetoric that surrounds care left undone infers it is a contemporary nursing phenomenon; however, a seventeenth-century Spanish nursing treatise, Instruccion de Enfermeros (Instructions for Nurses), challenges this assumption. Instruccion de Enfermeros was an instructional guide that was written for members of the Congregation of Bernardino de Obregon who worked as nurses at the Madrid General Hospital. The treatise provides a historical commentary on the daily roles, responsibilities and working conditions of the Obregonian nurses. Its content and context suggest the Obregonian nursing resource was consistently time poor due to a confluence of internal and external stressors. Consequently, the Obregonians were under considerable role strain resulting in inferior patient care. This article explores the antecedents of care left undone through a historical lens using exemplars from the 1625 edition of Instruccion de Enfermeros. Factors contributing to care left undone in Obregonian nursing will then be examined to offer insights into the similarities between what a nurse suffered 400 years ago and what exists in contemporary nursing practice.

The use of Facebook for virtual asynchronous focus groups in qualitative research.

The Internet and the development of more user-engaging applications have opened a whole new world for researchers as a means of recruitment and data collection source. This paper describes the methodological approach of a research study that explored the experiences of Australian military spouses who packed up their family and home to accompany their spouse on an overseas posting. The study used Facebook as a recruitment tool and then as a data source through the conduct of an asynchronous virtual focus group. This paper outlines the advantages and disadvantages of this unique data source as a means of capturing the voices of a hard-to-reach population.

Family presence during resuscitation (FPDR): A qualitative study of implementation experiences and opinions of emergency personnel.

AIM: To explore the experiences of nurses and doctors on the implementation of family presence during resuscitation (FPDR) in Victorian emergency departments. METHODS: An interpretative qualitative study design was utilized which incorporated the open ended responses on a state wide Victorian survey of emergency department nurses and doctors. A thematic analysis of the responses was conducted involving data reduction, identification of key words, phrases and themes. RESULTS: A total of 18 emergency departments consented to participate with a mean participant age of 41 years, made up of 91 (81) nurses and 21(19) doctors. The participants came from both metropolitan (64 (57), hospitals 300 - >500 beds) and regional (48 (43), hospitals <80 - 300 beds) health services. There were four emerging themes from the analysis; Depends on the day, impact family have on staff, organisational considerations and incorporating family centred care. CONCLUSION: There remain a number of variables which have been identified as continuing to create barriers to implementation of family presence during resuscitation that need to be investigated further in order to ensure emergency personnel have consistency of FPDR practice.

"Don't forget your cotton underwear girls": femininity and Australian Army nurses in the Vietnam War (1967-1971).

War and nursing are unequivocally linked and the impact that this type of nursing has had upon the nursing profession in indisputable. However, a review of the Australian scholarly nursing literature revealed that the contribution and experiences of Australian nurses in the Vietnam War has not been widely published. The direct involvement of Australian women in the Vietnam War was limited and, as female nurses, they were unquestionably a minority. This paper describes the gender issues that confronted the nurses who worked within the confines of war.

Experiences of Australian Army theatre nurses.

As battles have raged throughout the centuries, nurses have cared for ill and wounded soldiers. One nursing role during war is theatre (i.e., OR) nursing. This article describes the role of Australian Army theatre nurses during the Vietnam War. It is based on information collected in a study of the experiences of Australian Army nurses who worked in operating theatres in Vietnam between 1967 and 1971. As nurses today focus on the future to find new ways to meet the demands of nursing ahead, it is important to reflect on the past, as they can learn from history and from other nurses' experiences.