The safe administration of medication: Nursing behaviours beyond the five-rights.

This paper discusses the findings from the observation phase of a more extensive, appreciative inquiry qualitative study exploring registered nurses' experiences of administering medications. The observations aimed to explore the participants' application of the five-rights of medication administration in practice. Twenty registered nurses working in inpatient medical/surgical units at a regional Australian hospital were observed administering medications from the commencement to the completion of their shift. A data collection tool based on the five-rights of medication administration was used. The findings indicated that medication administration was not as routine as the rights framework suggests. Indeed, what was observed rarely reflected all the criteria of the rights framework. Notably, in practice, some of the rights were unable to be observed because the critical thinking that underpins the rights are implicit. However, the participants were observed to implement strategies beyond those described by the rights framework that ensured safe and timely medication administration. In brief, medication administration in contemporary healthcare settings is more complicated than the linear process suggested by the rights framework. So more attention is warranted, to the safe practice strategies of nurses who, to deal with complex clinical contexts. Their person-centred strategies respond to patient circumstances and maintain safety.

Safe medication administration: Perspectives from an appreciative inquiry of the practice of registered nurses in regional Australia.

Registered Nurses (RNs) are regulated health professionals who are educated and accountable for safe medication administration (MA). Binding their practice are standards, policies, procedure and legislation. MA competence is taught and assessed during professional pre-registration education programs. However, different philosophies, theories and models are used by education providers making curriculum content disparate and competency frameworks diverse. Additionally, healthcare contexts are increasingly complex and clinical environments unpredictable. Competency models must respect contemporary practice. This paper focusses on the outcomes of Australian PhD research that combined Appreciative Inquiry (AI) principles with a qualitative study to identify MA safety strategies. In this 2-phase descriptive study, twenty RNs were observed then interviewed about their MA experiences. This paper discusses the interview findings. The participants explained how they assessed patient's needs and implemented strategies to administer medications safely. They presented their actions as being underpinned by a desire to do 'the right thing for the patient' despite their practice going beyond traditional procedural frameworks and not reflecting organisational protocols. Instead, they developed common strategies to enhance safe MA. The participants' described using clinical reasoning and patient-centredness during MA. This study contributes to the knowledge needed for future practice development by highlighting what works.

Knowledge and awareness of diabetes mellitus and its risk factors in Saudi Arabia.

OBJECTIVES: To summarize available peer-reviewed publications about public knowledge and awareness of diabetes mellitus (DM) among the population of Saudi Arabia. METHODS: We followed the standard reporting guidelines outlined in the PRISMA statement for the preparation of this systematic review. In February 2018 we conducted literature searches of PubMed, Scopus, BIOSIS Citation Index, and Web of Science using the following keywords: "Knowledge" OR "Awareness" AND "Diabetes Mellitus" AND "Saudi Arabia." Records were screened, and relevant studies were selected and synthesized narratively. RESULTS: Nineteen articles are included in our systematic review. These studies included the following populations: DM patients (n=13), healthcare workers (n=3), medical students (n=1), secondary school students (n=1), and general population (n=1). Most studies found a lack of public awareness of the risk factors and complications of DM. Among medical students and healthcare workers, knowledge about the epidemiology of the disease and angle of insulin injection was deficient. CONCLUSION: This review highlights the need for increased knowledge and awareness of DM among the Saudi population. The means of improving knowledge and awareness of DM needs to be integrated into existing healthcare systems and processes to better inform patients, families and communities about this chronic disease.

The translation of sports injury prevention and safety promotion knowledge: insights from key intermediary organisations.

BACKGROUND: A recognised research-to-practice gap exists in the health research field of sports injury prevention and safety promotion. There is a need for improved insight into increasing the relevancy, accessibility and legitimacy of injury prevention and safety promotion research knowledge for sport settings. The role of key organisations as intermediaries in the process of health knowledge translation for sports settings remains under-explored, and this paper aims to determine, and describe, the processes of knowledge translation undertaken by a set of key organisations in developing and distributing injury prevention and safety promotion resources. METHODS: The National Guidance for Australian Football Partnerships and Safety (NoGAPS) project provided the context for this study. Representatives from five key NoGAPS organisations participated in individual face-to-face interviews about organisational processes of knowledge translation. A qualitative descriptive methodology was used to analyse participants' descriptions of knowledge translation activities undertaken at their respective organisations. RESULTS: Several themes emerged around health knowledge translation processes and considerations, including (1) identifying a need for knowledge translation, (2) developing and disseminating resources, and (3) barriers and enablers to knowledge translation. CONCLUSIONS: This study provides insight into the processes that key organisations employ when developing and disseminating injury prevention and safety promotion resources within sport settings. The relevancy, accessibility and legitimacy of health research knowledge is foregrounded, with a view to increasing the influence of research on the development of health-related resources suitable for community sport settings.

Learning from clinical placement experience: Analysing nursing students' final reflections in a digital storytelling activity.

This paper reports on the learning potential of a reflective activity undertaken by final year nursing students, in which they were asked to recount two meaningful events that occurred during their clinical placements over the duration of their 3-year nursing degree program and reflect on how these events contributed to their learning to become beginning level Registered Nurses (RNs). This descriptive qualitative study gathered narratives from 92 students as individual postings in an online forum created within the University's learning management system. An analysis of the students' reflections are the focus of this paper particularly in relation to the value of reflecting on the identified events. Four themes emerged that clearly highlight the way in which these students interpreted and learned from both positive and negative clinical experiences, their strong desire to fit into their new role and their ability to re-imagine how they might respond to clinical events when they become Registered Nurses. The findings of this study may contribute to developing nursing curricula that better prepares final year students for the realities of practice.

Venous access: the patient experience.

INTRODUCTION: The evolution of venous access via peripheral cannulation, particularly in relation to the risks and the benefits of this procedure, is reported widely in the literature. However, there is limited research specific to the patient experience of undergoing venous access. AIM: The intent of this qualitative study was to understand patients' experience of venous access, with the aim of bringing forth their voices about the experiences of repeated venous access/cannulation attempts. METHODOLOGY: This qualitative study used a hermeneutic phenomenological approach to explore the experiences of 15 participants in two rural oncology units in Australia. The participants had experienced repeated peripheral cannulation in order to receive chemotherapy. Study participants were asked to describe what it was like for them to be repeatedly cannulated. Data were collected via audiotaped individual interviews, the participants' stories were transcribed and analysed thematically. OUTCOMES: Themes emerged from the participants' stories that provided insights into their perceptions of the experience of being cannulated and the decision-making processes regarding how and where the procedure occurred. The findings suggest that a holistic approach to care was often missing causing the participants to feel vulnerable. Gaining insight into their experiences led to a greater understanding of the impact of this procedure on patients and the need to improve care through encouraging more collaborative decision-making processes between clinicians and patients. CONCLUSION: The implications for policy and practice focus on improving patient outcomes via procedural governance and education, with the intent of translating the findings from this research into evidence-based practice.

Factors that affect the job satisfaction of Saudi Arabian nurses.

AIM: To determine factors that influence the job satisfaction of Saudi nurses. BACKGROUND: Saudi Arabia has a chronic shortage of Saudi national nurses. This research contributes to a greater understanding of how job satisfaction influences the recruitment and retention of Saudi nationals within the nursing profession. METHODS: Qualitative data were gathered from Saudi nurses and content analysis was used to identify themes in the written responses. RESULTS: Four main themes emerged from the data: lack of educational opportunities and support and the poor image of the nursing profession, perceptions of favouritism, high workloads and stressful work environment and the effect of religion on job satisfaction. CONCLUSIONS: Saudi nurses would be more satisfied with their jobs if they had greater access to educational opportunities and if there was a reduction in workload and the perceived favouritism in the workplace was addressed. Religion was also found to play a significant role in supporting job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: These findings suggest the development of educational scholarships, as well as policies that better support equity in the workplace, to address Saudi nurses' level of job satisfaction. The generally positive impact of cultural and religious beliefs is also highlighted in this study.

The development and evaluation of online stories to enhance clinical learning experiences across health professions in rural Australia.

Clinical placement learning experiences are integral to all health and medical curricula as a means of integrating theory into practice and preparing graduates to deliver safe, high-quality care to health consumers. A growing challenge for education providers is to access sufficient clinical placements with experienced supervisors who are skilled at maximising learning opportunities for students. This paper reports on the development and evaluation of an innovative online learning program aimed at enhancing student and clinical supervisors' preparedness for effective workplace-based learning. The evidence-based learning program used 'story-telling' as the learning framework. The stories, which were supported by a range of resources, aimed to engage the learners in understanding student and supervisor responsibilities, as well as the expectations and competencies needed to support effective learning in the clinical environment. Evaluation of this program by the learners and stakeholders clearly indicated that they felt authentically 'connected' with the characters in the stories and developed insights that suggested effective learning had occurred.

'Right' for publication: strategies for supporting novice writers across health and medical disciplines.

The idea that scholarly writing is an integral part of academic and clinical work is not new; however, increasing expectations that health professionals contribute to research output through publication, regardless of level of employment or experience, creates anxiety and dissonance for many novice and sometimes not-so-novice writers. Publications and the impact of scholarly work have become the key indicators not only of the performance of individual health academics, but also of health disciplines and universities more broadly. In Australia, as in many other countries, publications as the measure of research impact and outputs are expected in professional disciplines, universities and schools. Research impact is assessed and rated against other institutions and used as a means of allocating scarce research funding. Publishing has become a matter of professional reputation and sustainability. This paper reports on a project designed to enhance publication rates across health disciplines based at a rural university, where many staff members combine academic work with ongoing clinical roles. Without deliberate and focused support to enhance skills and confidence in writing it was unlikely that these academics and clinical staff members would be able to develop the kind of track record required for a successful academic career or promotion. This paper outlines the development, delivery and outcomes of this university-funded project, which drew on evidence in the literature to increase the publication rates across two Schools (Health and Medicine) at a rural university.

Looking after yourself: Clinical understandings of chronic-care self-management strategies in rural and urban contexts of the United Kingdom and Australia.

OBJECTIVES: This article reports on the outcomes of two similar projects undertaken during 2011-2012 in Australia (Rural Northern New South Wales) and the United Kingdom (Urban Northern United Kingdom) that sought to identify the strategies that health professionals employ to actively involve patients with chronic conditions in the planning and delivery of their care. In particular, this study explored understandings and contexts of care that impacted on the participants' practices. This study was informed by the global shift to partnership approaches in health policy and the growing imperative to deliver patient or client-centred care. METHODS: An ethnomethodological design was used, as ethnomethodology does not dictate a set of research methods or procedures, but rather is congruent with any method that seeks to explore what people do in their routine everyday lives. Focus groups and interviews were employed to explore the strategies used by a range of primary health-care providers, such as general practitioners, nurses, social workers, diabetes educators, dieticians and occupational therapists, to support clients to effectively manage their own chronic conditions. RESULTS: Data from both studies were synthesised and analysed thematically, with the themes reflecting the context, similarities and differences of the two studies that the participants felt had either facilitated or blocked their efforts to support their clients to adopt self-care strategies. CONCLUSION: Supporting patients/clients to engage in actively self-managing their health-care needs requires changes to clients' and clinicians' traditional perspectives on their roles. The barriers and enablers to supporting clients to manage their own health needs were similar across both locations and included tensions in role identity and functions, the discourse of health-care professionals as 'experts' who deliver care and their level of confidence in being facilitators who 'educate' clients to effectively manage their health-care needs, rather than only the 'providers' of care.

Nurse managers don't get the corner office.

AIM: To provide an original perspective on the power and status of first-line nurse managers by observing their working environment. BACKGROUND: The role of first-line nurse managers includes clinical, administrative and managerial components, with their responsibilities not always reflected in their level of organizational power. The business literature suggests that an appropriately resourced workspace is not merely functional, it also confers power and status. METHOD: Twenty Australian rural nurse managers' workspaces were observed, as part of a larger qualitative study that explored their role and organizational power using semi-structured interviews. The observational data consisted of detailed researcher notes that were analysed thematically. RESULTS: The nurse managers' workspaces were suboptimal and did not provide sufficient physical space or resources for the participants' to manage tasks effectively. These results were considered using Kanter's theory of organizational power. IMPLICATIONS FOR NURSING MANAGEMENT: The findings support those reported in the business literature that inadequate physical workspaces are counterproductive in terms of both functionality and organizational power. Suggestions are made regarding the workspace needs of first-line nurse managers, based on a closer alignment between the work environment and their role responsibilities. These findings have implications for decisions regarding organizational support of first-line nurse managers.

The challenges confronting clinicians in rural acute care settings: a participatory research project.

INTRODUCTION: In Australia, as in many other developed countries, the current healthcare environment is characterised by increasing differentiation and patient acuity, aging of patients and workforce, staff shortages and a varied professional skills mix, and this is particularly so in rural areas. Rural healthcare clinicians are confronted with a broad range of challenges in their daily practice. Within this context, the challenges faced by rural acute care clinicians were explored and innovative strategies suggested. This article reports the findings of a study that explored these challenges across disciplines in acute healthcare facilities in rural New South Wales (NSW), Australia. METHODS: A mixed method approach, involving a consultative, participatory 3 stage data collection process was employed to engage with a range of healthcare clinicians from rural acute care facilities in NSW. Participants were invited to complete a survey, followed by focus group discussions and finally facilitated workshops using nominal group technique. RESULTS: The survey findings identified the respondents' top ranked challenges. These were organised into four categories: (1) workforce issues; (2) access, equity and opportunity; (3) resources; and (4) contextual issues. Participants in the focus groups were provided with a summary of the survey findings to prompt discussion about the challenges identified and impact of these on their professional and personal lives. The results of the final workshop stage of the study used nominal group process to focus the discussion on identifying strategies to address identified challenges. CONCLUSIONS: This study builds on research conducted in a large metropolitan tertiary referral hospital. While it was found that rural clinicians share some of the challenges identified by their metropolitan counterparts, some identified challenges and solutions were unique to the rural context and require the innovative solutions suggested by the participants. This article provides insight into the working world of rural healthcare clinicians and offers practical solutions to some of the identified issues. The findings of this study may assist rurally based healthcare services to attract and retain clinical staff.

(W)riting across and within: Providing a vehicle for sharing local nursing and midwifery projects and innovation.

INTRODUCTION: This paper describes the development and outcomes of a locally-based journal that is contributed to and managed by nurses, midwives and academics within an area health service (AHS) in NSW, Australia. BACKGROUND: Nurses and midwives are often engaged in scholarly and rigorous activities aimed at improving practice and patient outcomes. However, often these endeavours remain unreported, unpublished and hence not shared for the benefit of others. Reasons given for nurses' and midwives' persistent reluctance to publish are well documented in the literature. Lack of expertise and understanding of the publication process, together with lack of confidence and opportunity are the reasons most often cited. To overcome these barriers we developed a local journal called Handover that provides a non-threatening, supportive opportunity for nurses and midwives to develop skills in writing and reviewing articles for publication. Handover was established and is managed by editorial committee members from the area health service and the two local universities. Each institution agreed to co-fund the journal which is published twice yearly. Two editions of the journal have been published with wide ranging content and contributions from across the AHS. Writing mentorship and support systems have been established. Reviewers workshop have been conducted and novice reviewers mentored by experienced reviewers. CONCLUSION: Our experience indicates that a locally based and owned journal can motivate and support novice writers and offers one solution to many of the barriers to publication identified in the literature.

Using a voice-centered relational method of data analysis in a feminist study exploring the working world of nursing unit managers.

In this article, we discuss the application of a data analysis method used in a feminist study that explored the working world of nursing unit managers in Australia. The decision to use a voice-centered relational approach to the data was based on a desire to delve into the working world of nursing unit managers and uncover the layers within the narratives that specifically related to their perceptions of themselves, their world, and the context in which they work. Throughout this article, the focus is on how this method was applied to uncover multiple layers of meaning within the data, rather than on the researchers' and participants' roles in the coconstruction of interview data. An excerpt from an interview transcript is used to illustrate how the stories of the participants were explored using this method.

The lure of the bush: do rural placements influence student nurses to seek employment in rural settings?

The aim of this study was to investigate whether rural clinical placements for student nurses at a rural university in New South Wales influence their decision to join the rural and remote Registered Nurse workforce. The study utilised a convenience sample of final year Bachelor of Nursing students at a rural university campus, and consisted of two stages of data collection. Stage One employed a pre- and post-clinical placement survey design that elicited both demographic and qualitative data. Stage Two consisted of individual interviews with a sample of final year nursing students while they were on a rural clinical placement. The findings highlight the factors that influence final year students' decisions to seek employment in rural healthcare facilities. These findings will be of interest to nurse academics concerned with ensuring that undergraduate nursing curricula relate to rural nursing practice in Australia and to those involved in recruitment of new graduate RN's to rural nursing practice.

Caring for each other: how do nurse managers 'manage' their role?

AIM: This article will report on one aspect of a larger study that explored the working lives of nursing unit managers in Australia. The support of nursing unit managers is the focus of this article. BACKGROUND: There is evidence in the recent literature that nurses are not generally supportive of each other and that nursing unit managers are not adequately supported to manage their expanding administrative and managerial responsibilities. METHOD: A qualitative feminist approach was used to conduct individual interviews with 20 nursing unit managers employed in the public healthcare system in Australia. RESULTS: The results indicated that participants did not feel supported by the wider organization, but gained support from within their own ranks. CONCLUSIONS: The results showed a strong support system within the participant group, despite evidence in the literature that nurses, generally, are not supportive of each other. The results of this study may be used in the development of more effective support mechanisms for nurse managers.

Rural nursing unit managers: education and support for the role.

INTRODUCTION: Nursing unit managers (NUMs) occupy the often unenviable position of first-line management in many health services in Australia. As such, their role is complex and multifaceted requiring an intertwining of their clinical and managerial responsibilities. While there is an abundance of studies that explore and describe the various management roles in many professions and industries, little is known about the experiences of nurses as managers, particularly in rural settings. This article focuses on the education and support needs of rural nursing unit managers. METHODS: A qualitative study design was used to explore the stories of a number of nursing unit managers in rural New South Wales, Australia. Data was collected using semi-structured individual interviews. Data was analysed using a voice-relational method as a framework for more clearly hearing the voices of participants. This method of data analysis is particularly useful for hearing from those who do not usually have a 'strong' voice, for gaining an understanding of the context of the interviews, and for acknowledging the role of the researcher in the research process. All NUMs employed in a single regional health authority in rural Australia were invited to participate. RESULTS: Out of 42 NUMs in the region, 20 agreed to be interviewed. Nursing unit managers were asked to reflect on their experiences prior to and during the early days within the position. In summary, all the NUMs: believed they were promoted because of their clinical expertise; felt unprepared for the managerial and administrative aspects of their role; continued to identify as nurses rather than as managers; found the role isolated them from their former peer group. Those employed in small facilities had limited opportunities for education and peer support. CONCLUSIONS: Based on the NUMs' experiences and suggestions, the following information would have helped them to cope with the demands of their new role: information and discussions about the role expectations of first-line manager, from both an employee and employer perspective; human resource and financial management skill development; leadership skills; negotiation and conflict resolution; a clear and realistic role description.

Implementing family-centred care: an exploration of the beliefs and practices of paediatric nurses.

OBJECTIVE: This study explored paediatric nurses' perceptions of how they include and involve parents in the care of hospitalised children. DESIGN: This qualitative study used individual unstructured interviews to gather data, the data was analysed using thematic coding. SETTING: Paediatric wards within two regional area health services of New South Wales, Australia. SUBJECTS: Fourteen paediatric nurses were asked to describe their beliefs and practices regarding the clinical application of family-centred care. MAIN OUTCOME MEASURE: Paediatric nurses' beliefs and practices about family-centred care were explored in an effort to explain how the concept was implemented. RESULTS: The findings are presented as four interconnected themes. The first describes how participants either allocated tasks to parents or retained them, the second relates to the nurses' professional identity, the third theme identifies barriers and constraints to the implementation of family-centred care, while the fourth describes the nurses' beliefs about their responsibilities when delivering family-centred care. CONCLUSIONS: Together these findings suggest that while nurses endorse the concept of family-centred care, the implementation into practice is more problematic. While it is not possible to generalise these findings to other paediatric nurses, the authors believe the insight gained will resonate with paediatric nurses internationally. The findings from this study are being used as the basis for the development of clinical practice guidelines to assist paediatric nurses to more consistently apply the concepts of family-centred care to their practice.