Factors associated with the successful removal of indwelling urinary catheters post-operatively in the fragility hip fracture patient.

INTRODUCTION: Patients presenting to hospital with a fragility hip fracture are routinely catheterized in the emergency department. Studies have found that the duration of catheterization is the greatest and most important risk factor for developing a urinary tract infection. Whilst there is a considerable body of evidence around correct techniques for insertion of urinary catheters, there appears to be little evidence as to the timing of their removal. AIM OF THE STUDY: To describe the current practice of indwelling catheter (IDC) removal post operatively in the fragility hip fracture patient and to identify factors associated with the successful removal of IDCs post operatively in the same cohort of patients. METHODS: This study was a retrospective cohort analysis of patients admitted to a large, tertiary hospital with an established ortho-geriatric model of care. RESULTS: Aperient regime was the only factor that appeared to have a significant impact on the successful IDC removal. The patient commenced on the aperient regime was three times more likely to have an unsuccessful IDC removal than the patient on a limited or no aperient regime. CONCLUSION: This study highlights the need for redesigning care that is patient focused, evidence-based, effective and efficient. The argument that a patient's bowel is required to be emptied prior to the successful removal of an IDC appears to be false, as in this study it was not identified as a predictor of successful IDC removal. A prospective clinical trial may be the next step forward in developing a clinical guideline for the successful removal of IDCs in the fragility hip fracture patient and/or surgical patient. Nurses have a crucial role to play in contributing to evidence-based practice and are continually challenged to do so.

Impact of engaging middle management in practice interventions on staff support and learning culture: a quasi-experimental design.

AIM: This study evaluated the impact of different levels of engaging middle management in ward based strategies implemented by a project educator. BACKGROUND: The challenge for learning in practice is to develop effective teams where experienced staff engage and foster learning with students and other novice staff. DESIGN: A quasi-experimental pre- and post- intervention four group design was conducted from November 2009 to May 2010 across four general surgical and four general medical inpatient matched units in two settings in South East Queensland, Australia. METHOD: Staff survey data was used to compare control and intervention groups (one actively engaging nurse managers) before and after 'practice learning' interventions. The survey comprised demographic data and data from two validated scales (support instrument for nurses facilitating learning and clinical learning organisational culture). RESULTS: Number of surveys returned pre- and post-intervention was 336 from 713 (47%). There were significant differences across many subscales pertaining to staff perception of support in the intervention groups, with only one change in the control group. The number of significant different subscales in the learning culture was also greater when middle management supported the intervention. IMPLICATIONS FOR NURSING MANAGEMENT: Middle management should work closely with facilitators to assist embedding practice interventions.

Staff perceptions of leadership during implementation of task-shifting in three surgical units.

BACKGROUND: Registered nurses are difficult to recruit and retain. Task shifting, which involves reallocation of delegation, can reduce demand for registered nurses. Effective leadership is needed for successful task shifting. OBJECTIVE: This study explored leadership styles of three surgical nurse unit managers. Staff completed surveys before and after the implementation of task shifting. Task shifting involved the introduction of endorsed enrolled nurses (licensed nurses who must practise under registered nurse supervision) to better utilize registered nurses. METHODS: Implementation of task shifting occurred over 4 months in a 700-bed tertiary hospital, in southeast Queensland, Australia. A facilitator assisted nurse unit managers during implementation. The impact was assessed by comparison of data before (n = 49) and after (n = 72) task shifting from registered nurses and endorsed enrolled nurses (n = 121) who completed the Ward Organization Features Survey. RESULTS: Significant differences in leadership and staff organization subscales across the settings suggest that how change involving task shifting is implemented influences nurses' opinions of leadership. CONCLUSION: Leadership behaviours of nurse unit managers is a key consideration in managing change such as task shifting. IMPLICATIONS FOR NURSING MANAGEMENT: Consistent and clear messages from leaders about practice change are viewed positively by nursing staff. In the short term, incremental change possibly results in staff maintaining confidence in leadership.

Development and preliminary validation of a tool to measure nurses' support for facilitating the learning of others.

BACKGROUND: Nurses guide and support learning of students and new graduates in the workplace. A plethora of literature exists about learners needs in the workplace however nursing leadership teams also need to support experienced nurses who facilitate others' learning. AIM: This study sought to develop a tool for Registered Nurses' to report on the support they receive when they facilitate the learning of others. SCALE DEVELOPMENT: An extensive literature review identified 28 papers about support RNs need to facilitate learning. Five re-occuring themes pertaining to workload, communication, acknowledgement, teamwork and preparation for role emerged from analysis of these papers. These were verified independently through focus groups. A 30-item instrument was generated based on the themes; further RN focus groups were conducted to ensure clarity of items. TESTING OF INSTRUMENT: Data were collected from RNs working in medical and surgical areas across three acute care hospitals (ranging from 300 to 750 beds). A total of 372 registered nurses responded. Principle component analysis identified 5 distinct sub scales represented by 17 items with good reliability: workload 0.953; communication 0.847; acknowledgement 0.858; teamwork 0.852; preparation 0.942. CONCLUSION: This newly developed tool measures Registered Nurses perceptions of support they receive to fulfil their role in supporting the learning of others. The data generated from use of this tool can inform nursing leadership about the effectiveness of existing infrastructure and resources to support RNs.