Chemical, Biological, Radiological, or Nuclear Response in Queensland Emergency Services: A Multisite Study.

A disaster overwhelms the normal operating capacity of a health service. Minimal research exists regarding Australian hospitals' capacity to respond to chemical, biological, radiological, or nuclear (CBRN) disasters. This article, and the research supporting it, begins to fill that research gap. We conducted a descriptive quantitative study with 5 tertiary hospitals and 1 rural hospital in Queensland, Australia. The study population was the hospitals' clinical leaders for disaster preparedness. The 25-item survey consisted of questions relating to each hospital's current response capacity, physical surge capacity, and human surge capacity in response to a CBRN disaster. Data were analyzed using descriptive statistics. The survey data indicated that over the previous 12 months, each site reached operational capacity on average 66 times and that capacity to respond and create additional emergency, intensive care, or surgical beds varied greatly across the sites. In the previous 12 months, only 2 sites reported undertaking specific hospital-wide training to manage a CBRN disaster, and 3 sites reported having suitable personal protective equipment required for hazardous materials. There was a noted shortfall in all the hospitals' capacity to respond to a radiological disaster in particular. Queensland hospitals are crucial to CBRN disaster response, and they have areas for improvement in their response and capacity to surge when compared with international preparedness benchmarks. CBRN-focused education and training must be prioritized using evidence-based training approaches to better prepare hospitals to respond following a disaster event.

Exploring family participation in patient care on acute care wards: A mixed-methods study.

BACKGROUND: Patient- and family-centred care practices are a recommended part of contemporary care for the acutely ill hospitalized adult patients. However, how patient- and family-centred care is enacted in an adult hospital setting is not well understood. AIMS AND OBJECTIVES: The aim of this study is to explore the perceptions of patients, family members and nurses regarding family participation and collaboration in patient care within an acute care setting, including the barriers and facilitators. DESIGN: This study used a mixed-methods sequential design. METHODS: Observer-as-participant observations and semistructured interviews were undertaken. Integration of the data was achieved through triangulation. RESULTS: Triangulation revealed two metathemes. The first metatheme, 'continuum of family involvement', explained the central viewpoint of how family participation and collaboration in the care of acutely ill hospitalized adult patients was enacted. The second metatheme, 'nurses value family involvement', helped to explain and understand the barriers and facilitators to enacting family participation in the acute care setting. CONCLUSION: Promoting family participation in the acute care setting requires supporting multiple levels of engagement. Developing a relationship, clear communication and open sharing of information amongst patients, family members and nurses is critical to supporting family involvement.

Application of the READY framework supports effective communication between health care providers and family members in intensive care.

Effective communication between intensive care health care providers and family is crucial to support surrogate or shared decision-making and to individualise care. Despite its importance in health care standards and policy, the quality of communication with families in intensive care is regarded as suboptimal. Furthermore, an intensive care admission is an extremely stressful event for families, which may impact their understanding and subsequent decision-making. Communicating with family members is a routine practice in intensive care; however, health care providers often receive no formal communication training. To date, family-focused communication interventions in intensive care have targeted end-of-life care and are not generalisable across all types of family-health care provider communication interactions. Mugweni et al. recently reported the results of a multiprofessional training intervention involving 26 health care professionals to improve the delivery of different news to families during pregnancy and at birth. A critique of this article has been undertaken to inform routine communication with critically ill family members and optimise the delivery of care in intensive care units.

Routine activities in the intensive care unit provide opportunities for family engagement.

Manias, E., et al., Communicating with patients, families and health professionals about managing medications in intensive care: A qualitative observational study. Intensive and Critical Care Nursing, 2019. 54: p. 15-22.

Patient and family members' perceptions of family participation in care on acute care wards.

BACKGROUND: Hospital leaders, policymakers and healthcare professionals are realising the benefits of delivering care that promotes family participation because it is known to enhance the quality of care, and improve patient satisfaction. AIM: The aim of this study was to explore, from the perspective of patients and family members within an adult acute care ward: (a) their beliefs and attitudes towards family participation in patient care and (b) staff behaviours that support or hinder family participation in patient care. DESIGN AND METHODS: A naturalistic approach with an exploratory sequential design was used in a medical assessment and planning unit of a regional referral hospital in Australia. Purposeful maximum variation sampling was used to recruit patients and family members who differed in age, ethnicity, relationship to patient and gender. Observer-as-participant observation data and semi-structured interviews were undertaken. Following separate inductive content analysis, data were triangulated. RESULTS: Thirty-two patients and 26 family members were recruited. Thirty hours of observational data were gathered. Eighteen patients and 15 family members were interviewed. Analysis uncovered two contrasting categories: (a) disconnected communication and (b) family influence quality. CONCLUSION: The findings of our study demonstrated that most patients and families perceived staff communication as disconnected and inadequate, which constrained them from engaging in care processes or decision-making. However, when family felt empowered and participated in patient care, the quality of health care was enhanced. Healthcare professionals can use these findings to make informed evidence-based changes to the way they practice and communicate to ensure family participation in patient care is optimised in the acute care setting.

Psychometric testing of the revised "Families' Importance in Nursing Care-Nurses' Attitudes instrument".

BACKGROUND: The validity of instruments is crucial in ensuring that data collected are sound and that these data represent what the instrument claims to measure. When an instrument is revised or used in a different population, it is useful to re-examine its construct validity. AIM: To test the psychometrics properties of an instrument-the revised Families' Importance In Nursing Care-Nurses' Attitudes, designed to measure nurse' attitudes towards involving family in nursing care in an adult acute care setting. DESIGN AND METHODOLOGY: A cross-sectional survey design was used in April-May 2016 with a sample of Enrolled and Registered Nurses (N = 212) to test the factor structure of the revised Families' Importance In Nursing-Nurses' Attitudes instrument. The instrument had 26 items with a five-point Likert response scale. Principle components analysis and exploratory factor analysis were performed with oblique rotations to assess the internal structure of the instrument. SETTING: A regional referral hospital in Queensland, Australia. RESULTS: Using Principal Components Analysis and Principal Axis Factoring, we obtained the same factor structure to that originally identified for the instrument. Our results suggested the removal of six items to refine the instrument and achieve simple structure. CONCLUSION: The removal of several items, relabeling of factors and residual cross-loading issues suggest that further revisions to the instrument are needed.

Acute care nurses' views on family participation and collaboration in fundamental care.

AIMS AND OBJECTIVES: To understand the beliefs, attitudes and perceptions of nurses regarding family participation and collaboration in the care of their hospitalized adult relative. BACKGROUND: Family participation in care is known to enhance the quality of patient care. Nurses are uniquely placed to support such participation, including the delivery of fundamental care. However, nurses' attitudes and beliefs may help or hinder participation. DESIGN: A mixed methods approach with an exploratory sequential design was used. SETTING: A regional referral hospital in Australia. PARTICIPANTS: Nurses were eligible to participate in the study if they were permanent staff of the hospital, and who in their day-to-day work had direct contact with adult patients and their families on acute care wards. METHODS: Observer-as-participant observation data and semi-structured interviews were undertaken. 30 hr of observational data were gathered, and 14 nurses were interviewed. Data collection occurred between September and December 2016. Following separate analysis, data were triangulated. RESULTS: Analysis uncovered two contrasting categories: (i) enacting family participation (four themes); and (ii) hindering family participation (five themes). CONCLUSION: The findings of our study demonstrated that the practices of nurses do not always align with healthcare policies, and strategies to support nurses to enact patient- and family-centred practices are needed. RELEVANCE TO CLINICAL PRACTICE: Nurses can use these findings to make informed evidence-based changes to the way they practice and communicate with families to ensure fundamental care is delivered.