Simulation and coaching to prevent aggressive events in aged care: A pilot study.

OBJECTIVES: Evaluation of simulation and coaching training to change the self-efficacy of aged care workers to prevent and manage workplace aggressive events. METHODS: Seventeen aged care workers from a community and residential aged care service provider completed education modules and two half-days of simulation using actors and real-life scenarios, with real-time coaching. Carer self-efficacy to identify, prevent and manage anxiety and aggression was measured before, following and six months after training. RESULTS: After training, participants reported significant improvements in preparedness to prevent and manage aggression, identify and manage triggers in their own behaviour, deflect and alter other triggers, and felt safer in the workplace. Six months after training, participants' self-efficacy remained above baseline for all measures and remained significantly improved for feeling safer in the workplace. CONCLUSION: This pilot study supports high-fidelity simulation and coaching to improve the self-efficacy of aged care workers to prevent and manage workplace aggressive events.

Evaluation of a nurse-led education program to improve cross-cultural care for older people in aged care.

BACKGROUND: Cultural diversity is significant in aged care facilities. Registered nurses play a leading role in the care setting. Nurse-led education interventions to improve the cultural competence of aged care workers are in high demand. AIM: The aims of the study were to evaluate the effect of a nurse-led cross-cultural care program on cultural competence of Australian and overseas-born care workers. DESIGN: A pre- and post-evaluation design and a sub-group analysis. SETTINGS AND PARTICIPANTS: This study was undertaken in four large-sized aged care facilities in Australia. Direct care workers were invited to participate in the study. METHODS: The intervention lasted 12 months. Data were collected at baseline, 6 months and 12 months using the Clinical Cultural Competency Questionnaire and site champion reports. One-way ANOVA was applied to determine the changes of outcomes over time for the whole group. A mixed effect linear regression model was applied in the sub-group analyses to compare the differences of outcomes between the Australian-born and overseas-born groups. RESULTS: One hundred and thirteen staff participated in the study including Australian-born (n = 62) and overseas-born (n = 51). Registered nurses were trained as site champions to lead the program. The results showed a statistically significant increase in participants' scores in Knowledge (p = .000), Skills (p = .000), Comfort Level (p = .000), Importance of awareness (p = .01) and Self-Awareness (p = .000) in a 12-month follow-up. The increased scores in the Skills (p = .02) and Comfort Level (p = .001) were higher in the Australian-born group compared to the overseas-born group. The results also showed a statistically significant increase in participants' overall satisfaction scores with the program at 12 months (p = .009). The overseas-born group demonstrated a higher score in Desire to Learn More (p = .016) and Impact of the Program on Practice (p = .014) compared to the Australian-born group. CONCLUSION: A nurse-led cross-cultural care program can improve aged care workers' cultural competence.

The applicability of community of inquiry framework to online nursing education: A cross-sectional study.

The Community of Inquiry (CoI) framework has the potential to contribute to online education by addressing the nexus of pedagogy, technology, and learners' needs. However, there has been limited investigation of the application of CoI to Australian online tertiary education, with the awareness of CoI amongst Australian nurse educators being unknown. This paper reports on a project which used an online survey to investigate the level of awareness of the CoI framework and its applicability to the design of online and blended courses in Australian higher education nursing schools. Most respondents ranked the core concepts of the CoI framework as applicable for nursing education, but only 20% of the participants were familiar with the CoI framework before they participated in the survey. While nearly 90% of the participants viewed instructional design and a theoretical framework as essential for building an online course, 70% of respondents indicated that they did not use an explicit theoretical framework to guide the design or the evaluation of their nursing teaching and learning. These results provide the impetus for further investigation of factors influencing the development of online nurse education including the specific consideration of CoI frameworks.

Using research evidence to inform staff learning needs in cross-cultural communication in aged care homes.

BACKGROUND: Developed countries worldwide are facing an unprecedented demand for aged care services, with recent migrants of diverse linguistic and cultural backgrounds increasingly recruited as care workers while at the same time there is growing cultural diversity among aged care residents. This situation is compounded by rapidly changing technology and varied educational levels of care workers from diverse backgrounds. OBJECTIVES: The objectives were threefold: to identify staff learning needs to enable them to provide high-quality cross-cultural care; to improve team cohesion; and identify preferred learning approaches. DESIGN: An interpretive qualitative study utilising focus group and interview data informed the development of an education resource. PARTICIPANTS AND SETTINGS: Fifty six care workers from four residential aged care facilities participated in either focus groups or interviews conducted in private meeting rooms within the care facilities. Participants included personal care attendants, registered and clinical nurses, managers, hospitality staff and allied health professionals. METHODS: Focus group and interview data were categorised and thematically analysed. Data relevant to cross-cultural care, team cohesion and preferred learning approaches informed education resource development, including case studies. RESULTS: Major themes identified the need to promote cultural awareness and understanding, and strategies for cross-cultural care and communication. Themes related to team cohesion demonstrated that staff were already sympathetic and sensitive to cross-cultural issues, and that culturally and linguistically diverse staff add value to the workforce and are supported by the organisation. Staff required clear, uncomplicated education resources to equip them with skills to address problematic cultural situations. Preferred learning approaches varied and highlighted the need for varied educational materials and approaches, as well as time efficient, opportunistic education strategies for the busy workplace. CONCLUSION: An education package was developed to value cultural diversity in the aged care workplace for staff and residents, and provide an exemplar for evidence informed education.

Improving socially constructed cross-cultural communication in aged care homes: A critical perspective.

Cultural diversity between residents and staff is significant in aged care homes in many developed nations in the context of international migration. This diversity can be a challenge to achieving effective cross-cultural communication. The aim of this study was to critically examine how staff and residents initiated effective cross-cultural communication and social cohesion that enabled positive changes to occur. A critical hermeneutic analysis underpinned by Giddens' Structuration Theory was applied to the study. Data were collected by interviews with residents or their family and by focus groups with staff in four aged care homes in Australia. Findings reveal that residents and staff are capable of restructuring communication via a partnership approach. They can also work in collaboration to develop communication resources. When staff demonstrate cultural humility, they empower residents from culturally and linguistically diverse backgrounds to engage in effective communication. Findings also suggest that workforce interventions are required to improve residents' experiences in cross-cultural care. This study challenges aged care homes to establish policies, criteria and procedures in cross-cultural communication. There is also the challenge to provide ongoing education and training for staff to improve their cross-cultural communication capabilities.

Strategies new graduate registered nurses require to care and advocate for themselves: A literature review.

BACKGROUND: New graduate registered nurses (NGRNs) are confronted with a complex, demanding and resource-constrained environment where gaining acceptance into the workplace culture may be difficult. Existing evidence suggests that preparing undergraduate nursing students for this reality can assist with adjustment. OBJECTIVES: To identify the strategies that NGRNs require to care and advocate for themselves during their first year of practice. METHODS: A search of the literature published between 2001 and 2016 was undertaken. Individual articles were synthesized narratively and the results entered to a summary table. RESULTS: A total of 274 articles were considered relevant to this narrative review. This paper synthesized the narrative of 80 articles. Synthesis revealed 22 resilience factors and 33 issues. Eight strategies with potential to assist NGRNs to care and advocate for themselves were identified. All of them are socioemotional in nature. CONCLUSIONS: This review of the literature provides a valuable resource that can be used to prepare nursing students for the workplace culture during their first year as a registered nurse. Scenarios can be developed for educational activities such as simulation, role play, discussion and self-reflection. Further development through research is recommended.

Resident and family member perceptions of cultural diversity in aged care homes.

Similar to many developed nations, older people living in residential aged care homes in Australia and the staff who care for them have become increasingly multicultural. This cultural diversity adds challenges for residents in adapting to the care home. This study explores: (i) residents' and family members' perceptions about staff and cultural diversity, and (ii) culturally and linguistically diverse residents' and family members' experiences. An interpretive study design employing a thematic analysis was applied. Twenty-three residents and seven family members participated in interviews. Four themes were identified from interpreting residents and family members' perceptions of the impact of cultural diversity on their adaptation to aged care homes: (i) perceiving diversity as an attraction; (ii) adapting to cross-cultural communication; (iii) adjusting to diet in the residential care home; and (iv) anticipating individualized psychosocial interactions. The findings have implications for identifying strategies to support staff from all cultural backgrounds in order to create a caring environment that facilitates positive relationships with residents and supports residents to adjust to the care home.

Competencies to enable learning-focused clinical supervision: a thematic analysis of the literature.

CONTEXT: Clinical supervision is essential for development of health professional students and widely recognised as a significant factor influencing student learning. Although considered important, delivery is often founded on personal experience or a series of predetermined steps that offer standardised behavioural approaches. Such a view may limit the capacity to promote individualised student learning in complex clinical environments. The objective of this review was to develop a comprehensive understanding of what is considered 'good' clinical supervision, within health student education. The literature provides many perspectives, so collation and interpretation were needed to aid development and understanding for all clinicians required to perform clinical supervision within their daily practice. METHOD: A comprehensive thematic literature review was carried out, which included a variety of health disciplines and geographical environments. RESULTS: Literature addressing 'good' clinical supervision consists primarily of descriptive qualitative research comprising mostly small studies that repeated descriptions of student and supervisor opinions of 'good' supervision. Synthesis and thematic analysis of the literature resulted in four 'competency' domains perceived to inform delivery of learning-focused or 'good' clinical supervision. Domains understood to promote student learning are co-dependent and include 'to partner', 'to nurture', 'to engage' and 'to facilitate meaning'. CONCLUSIONS: Clinical supervision is a complex phenomenon and establishing a comprehensive understanding across health disciplines can influence the future health workforce. The learning-focused clinical supervision domains presented here provide an alternative perspective of clinical supervision of health students. This paper is the first step in establishing a more comprehensive understanding of learning-focused clinical supervision, which may lead to development of competencies for clinical supervision.

STRATEGIES FOR FUTURE NURSING AND MIDWIFERY EDUCATION.

Major challenges can be expected for nurse education in the near future in response to changes in healthcare practice, technology, regulation and funding. The advancement of nursing and midwifery professions is largely dependent upon what occurs at the teaching-research-practice nexus.

CaseWorld™: Interactive, media rich, multidisciplinary case based learning.

Nurse educators are challenged to keep up with highly specialised clinical practice, emerging research evidence, regulation requirements and rapidly changing information technology while teaching very large numbers of diverse students in a resource constrained environment. This complex setting provides the context for the CaseWorld project, which aims to simulate those aspects of clinical practice that can be represented by e-learning. This paper describes the development, implementation and evaluation of CaseWorld, a simulated learning environment that supports case based learning. CaseWorld provides nursing students with the opportunity to view unfolding authentic cases presented in a rich multimedia context. The first round of comprehensive summative evaluation of CaseWorld is discussed in the context of earlier formative evaluation, reference group input and strategies for integration of CaseWorld with subject content. This discussion highlights the unique approach taken in this project that involved simultaneous prototype development and large scale implementation, thereby necessitating strong emphasis on staff development, uptake and engagement. The lessons learned provide an interesting basis for further discussion of broad content sharing across disciplines and universities, and the contribution that local innovations can make to global education advancement.

CaseWorld: Authentic Case-Based Learning Simulating Healthcare Practice.

Health educators in Australia are challenged by the need to provide clinically relevant education to large numbers of students across a wide range of specialties. This situation is compounded by changed student demographics, new technologies in both the workplace and university, and decreased access to clinical placement opportunities for students. This article describes an innovative response addressing nurse education priorities and implemented in the School of Nursing at Flinders University South Australia, involving the development of CaseWorld, a prototype virtual case-based learning environment. CaseWorld implementation was unique because large-scale innovation occurred as part of routine curriculum development. This was challenging as there was limited opportunity for prototype evaluation before student use, thus necessitating a flexible implementation process. The outcome was the development of scripted unfolding cases that provide students with low-fidelity simulation enhanced by multimedia. Students engage with cases based on real patient experiences, which are modified to protect confidentiality. These authentic cases provide the basis for the development of critical-thinking and decision-making skills as students problem solve issues and identify priorities for nursing care, explain the pathophysiology, and respond to simulated patient complaints. CaseWorld was modified in response to evaluation data from surveys and focus groups, and the revised version is discussed in terms of its implementation in nursing and planned use across multiple health sciences disciplines.

Gender differences among young adult cancer patients: a study of blogs.

The Internet has increasing relevance and practical use as a tool to support cancer care. For example, health support Web sites are now widely used to connect specific groups of patients who may otherwise have remained isolated, and understanding their health-related online behaviors will help in the development of more effective health support Web sites. This article examined blogs written by young adults affected by cancer and in particular examined the gender differences in these blog entries through content analysis. The results showed there is little difference in blog content between genders. This suggests that the blog environment could lessen the gender-typical behaviors often expected by society and may provide an outlet for young adult cancer patients to more freely share their cancer-related experiences, at the same time providing an opportunity for social connection. This is particularly significant for male patients who are known to inhibit their emotions as well as the expression of their health concerns.

E-learning for Critical Thinking: Using Nominal Focus Group Method to Inform Software Content and Design.

BACKGROUND: Undergraduate nursing students are often confused by multiple understandings of critical thinking. In response to this situation, the Critiique for critical thinking (CCT) project was implemented to provide consistent structured guidance about critical thinking. OBJECTIVES: This paper introduces Critiique software, describes initial validation of the content of this critical thinking tool and explores wider applications of the Critiique software. MATERIALS AND METHODS: Critiique is flexible, authorable software that guides students step-by-step through critical appraisal of research papers. The spelling of Critiique was deliberate, so as to acquire a unique web domain name and associated logo. The CCT project involved implementation of a modified nominal focus group process with academic staff working together to establish common understandings of critical thinking. Previous work established a consensus about critical thinking in nursing and provided a starting point for the focus groups. The study was conducted at an Australian university campus with the focus group guided by open ended questions. RESULTS: Focus group data established categories of content that academic staff identified as important for teaching critical thinking. This emerging focus group data was then used to inform modification of Critiique software so that students had access to consistent and structured guidance in relation to critical thinking and critical appraisal. CONCLUSIONS: The project succeeded in using focus group data from academics to inform software development while at the same time retaining the benefits of broader philosophical dimensions of critical thinking.

Anatomy and physiology for nursing students: is problem-based learning effective?

This study investigated whether problem-based learning (PBL) was an effective strategy for nursing students learning anatomy and physiology. Anatomy and physiology are subject areas that have posed long standing difficulty for nursing students. Since anatomy and physiology underpin clinical decision making it is important that nursing students are able to understand and retain this knowledge and apply it to practice. Problem-based learning offers potential advantages for teaching anatomy and physiology as clinical cases can provide the impetus for student problem solving. This project trialled a simple PBL scenario and investigated students' response to the task of problem solving in a laboratory setting adapted to simulate a hospital ward. The study found students learn better, retain the knowledge and merge theory with simulated practice when a PBL teaching mode is used. While PBL was effective, blended, web based and hybrid PBL models warrant investigation.

The experience of young adult cancer patients described through online narratives.

BACKGROUND: Young adults are often faced with challenges related to relationships, employment, housing, and emotional development. Experiencing cancer during this time complicates the developmental processes and creates a need for communicating concerns and discussing issues. OBJECTIVE: The purpose of this study was to explore the experiences and gain a better understanding of young adults affected by cancer (YAACs) by examining their online narratives (also known as Web logs or blogs). INTERVENTIONS/METHODS: Inclusion and exclusion criteria were used to identify eligible Web sites. The Web site that most corresponded to the selection criteria was chosen for analysis (Planet Cancer, http://www.planetcancer.org/). The blog content generated in July 2011 was collected. The blogs were written by a total of 34 female and 12 male writers and included 136 (by female) and 28 (by male) blog entries. Researchers conducted a descriptive qualitative examination of blogs to explore YAACs' experiences during/after cancer. RESULTS: At the end of the data analysis process, 10 main themes were identified: physical burdens, future prospects, isolation (physical and psychological), guilt, mortality, images of cancer, creating a positive attitude, healthcare, online social interaction, and cancer survivorship. CONCLUSIONS: The Internet provides young cancer patients with a space in which to express themselves and to share experiences with those who are of similar age and in similar situations. IMPLICATIONS FOR PRACTICE: Blogs can be particularly helpful when patients are isolated or physically unable to interact with other people because of treatment requirements or physical deterioration.Future studies should investigate other types of Internet cancer communities and how they can benefit the development of Internet-based support networks for YAACs.

A study of the development of critical thinking skills using an innovative web 2.0 tool.

BACKGROUND: Healthcare educators face numerous challenges including technological change, information overload, and the need to maintain clinical expertise and research knowledge across multiple specialities. Students also need to develop their capacity for critical thinking, using and discriminating between diverse sources of knowledge in order to advance their own practice. OBJECTIVES: To investigate student perceptions of the affordances of a novel web 2.0-based tool--the Web Resource Appraisal Process (WRAP), designed to support the development of critical thinking skills, and to identify how student's understanding of critical thinking and their use of web 2.0 resources might inform the cross-disciplinary development of the WRAP. DESIGN: A two phase, action research study of student perceptions of the WRAP and their ability to source and identify valid information sources. SETTINGS: Implemented at the University of South Australia, development of the WRAP is an international project with the University of Westminster, UK. PARTICIPANTS: Students from international locations participated in the project. METHODS: A mixed methods approach was adopted involving a two phase action research study. In phase one, student perceptions of the WRAP were obtained using a modified course feedback questionnaire. This informed the development of a subsequent questionnaire used to survey student perceptions of their usage of online resources, the ease of access of such resources and their approaches to determining their validity. RESULTS: Results suggest that students mainly use traditional resources when preparing work for assessment and they either do not understand the concept of, or do not exercise, critical thinking skills in such activities. However, the feedback from students using the WRAP, demonstrated that they found it instructive and useful. CONCLUSIONS: To ensure that practice developments are based on authoritative evidence, students need to develop critical thinking skills which may be facilitated by tools such as the WRAP.

Are complementary medicine practitioners implementing evidence based practice?

BACKGROUND: Over the past few decades the health professions have witnessed increasing pressure to shift from a culture of delivering care based on tradition and intuition, to a situation where decisions are guided and justified by the best available evidence. While there are concerns that many complementary and alternative medicine (CAM) practitioners may be cautious about embracing such an approach, no studies to date have effectively tested this assumption. OBJECTIVE: To identify the skills, attitude, training and use of evidence-based practice (EBP) amongst CAM practitioners. DESIGN: Descriptive survey, using the evidence-based practice attitude and utilisation survey (EBASE). SUBJECTS: Randomly selected nationwide sample of system-based, non-medically qualified CAM practitioners practicing in a clinical capacity within Australia. MAIN OUTCOME MEASURES: Practitioner skill, attitude, training and use of EBP. RESULTS: Of the 351 questionnaires successfully dispatched, 126 were returned (36%). Most practitioners believed EBP was useful (92%) and necessary (73%) in CAM practice. While the majority of clinicians (>74%) reported participation in EBP activities, albeit infrequently, only a small to moderate proportion of decisions were based on evidence from clinical trials, with most practitioners relying on traditional knowledge, textbooks and clinical practice guidelines. Lack of available evidence, time, industry support and skills were perceived as barriers to EBP uptake. CONCLUSIONS: While the small response rate limits the generalisability of these findings, the sample was considered representative of Australian CAM practitioners. What this study shows is that even though CAM practitioners may be supportive of EBP, education and training is needed to further improve clinician understanding and application of evidence-based practice.

The quality of information on websites selling St. John's wort.

BACKGROUND: Health consumers are increasingly using the Internet to access information about health care, to self-diagnose, and to purchase medication. The use of the Internet to purchase herbal products is of particular interest because of the high level of consumer expenditure on herbal medicines, and the misperception by some consumers that herbal products are natural, and thus absent of any contraindications, drug interactions and adverse effects. It is possible that consumers may purchase herbal medicines via the Internet without consulting health professionals and therefore, use these medicines in an unsafe manner. OBJECTIVES: To examine the quality of e-commerce websites that sell herbal products; specifically, websites where St. John's wort (Hypericum perforatum) can be purchased. DESIGN: Cross-sectional survey of 54 selected websites, including online pharmacies, online health food stores and manufacturers of herbal medicines. MAIN OUTCOME MEASURE: A modified version of the DISCERN instrument was used to assess the quality of websites. RESULTS: The majority of websites rated poorly with a concerning lack of information about the interaction between hypericum and warfarin, anti-depressants and oral contraceptives. Most sites also failed to provide sufficient information about the contraindications and adverse effects of hypericum treatment. CONCLUSIONS: The results of this study strongly support the need for improved consumer education about herbal medicine, as well as the application of more stringent standards to websites that sell medications.

Physiotherapy-provided operant conditioning in the management of low back pain disability: A systematic review.

BACKGROUND AND PURPOSE: Non-specific low back pain (LBP) is a leading cause of disability in developed countries. Behavioural interventions have been found efficacious in reducing disability in LBP. Operant conditioning is one type of behavioural intervention being employed by physiotherapists; however, the effectiveness of physiotherapist-provided operant conditioning (POC) in the management of LBP disability is unknown. This review aims to answer the question: is POC more effective than comparison interventions in reducing LBP disability? METHOD: A systematic review of randomized controlled trials was conducted using a qualitative analysis of effect. Participants were adults ≥18 years with non-specific LBP. The intervention was defined as a time contingent, graduated increase in activity including goal setting and the education and reinforcement of positive pain behaviours with the aim of decreasing disability. The primary outcome measure was back pain specific disability. Secondary outcomes included generic functional status, pain intensity, sick leave, fear avoidance beliefs or behaviour and adverse effects. RESULTS: Fifteen trials involving 3737 people were included. Eight studies reported a clinically significant difference. The POC intervention was not found to be inferior to any of the comparison interventions in reducing disability. Moderate evidence was found that POC is more effective than other behavioural interventions in reducing long term disability in chronic LBP. Moderate evidence showed POC may be more effective than other treatments in reducing post-treatment fear avoidance beliefs in a sub-acute population but less effective in reducing short term fear avoidance beliefs in a population with mixed LBP. Moderate evidence showed POC is more effective than a placebo intervention in reducing short term pain in sub-acute LBP. CONCLUSION: POC may be considered efficacious in the treatment of LBP. Physiotherapists may also consider POC for its additional effect of reducing long term disability in chronic LBP.