Skills in Clinical Nursing

The first Australian edition of Skills in Clinical Nursing is a definitive resource that has been designed as a practical and easy-to-navigate reference for both the classroom and clinical practice settings. This text includes 95 of the most important skills performed by nursing students and graduates, organised from simple to complex and written to reflect current evidence-based practice guidelines

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

A conceptual framework for simulation in healthcare education - the need

This study used a social constructivist approach to explore the literature in relation to the acknowledgment and application of models and frameworks in simulation based learning and teaching activities in health care education. This paper addresses the data collection phases in the research design in developing a Conceptual Framework for Simulation in Healthcare Education. Background -Two literature review activities occurred in the study. The first literature review explored the challenges in the literature for further research in relation to the educational factors that have an impact upon simulation as a learning and teaching modality. This part of the research process was to identify the publications that address simulation as a learning and teaching modality and uncover evidence to justify the study. The literature revealed that there were limited publications in relation to simulation as a learning and teaching modality that was underpinned by a conceptual framework. Design - The study research design employed Evaluation Research to conduct a further intensive review of the literature as part of phase one of data collection. The second part of phase one of data collection was the surveying of randomly selected simulation education centres around the world to ascertain their employment of a conceptual framework in the application of simulation as a learning and teaching modality. Phase two was the genesis of the conceptual framework and Phase three was the evaluation of the draft framework by simulation experts, who were selected by a modified Delphi Technique. Results - The intensive literature review highlighted that authors acknowledged education-based theories but this did not extend to the application of a conceptual framework to simulation as a learning and teaching modality. The survey provided the evidence to support the development of a Conceptual Framework for Simulation in Healthcare Education for the conceptualisation, design, development and delivery of simulation teaching and learning activities in health care education. The simulation experts provided valuable data and commentary in the final formation of the conceptual framework. Conclusion – Based on the outcomes of the literature review, questionnaire and modified Delphi Technique the need for the development, and subsequent structure and utility of the Conceptual Framework for Simulation in Healthcare Education was verified

Supporting Nursing Services through a Research Framework and Reference Model

Nursing services represent a large part of health service resources that trigger health care costs and incomes. Conservative estimates suggest that nurses represent 30% of total hospital expenditures without investments. Currently, clinical nursing knowledge management is not supported by the most appropriate supportive business and technical solutions. Improvement to nursing services, through collaborative research activity that engages both academics and clinicians, should be underpinned by a conceptual framework to facilitate knowledge capture and sharing. We propose a nursing services research framework to guide and improve the delivery of nursing services to achieve a sustainable health system. The framework supports development of interdisciplinary research and development activities through clinical and academic partnerships

Clinical assessment and the benefit of the doubt: What is the doubt?

ABSTRACT Introduction Clinical education and associated assessment is an important component of nurse education. A range of factors contribute to a culture that makes the assessment of clinical competence difficult. These factors are environmental, educational, cultural and linguistic diversity amongst students, student expectation, a diverse range of clinical education models. All of which contribute to the variable quality of the clinical education experience and the outcome of clinical assessment

Nurses' documentation of falls prevention in a patient centred care plan in a medical ward

Objective: To evaluate the consistency of nurses' documentation in the falls prevention assessment tool, and to ascertain whether patients identified as high risk of falling had falls preventative strategies implemented. Background: Falls are one of the leading causes of adverse events for patients in the hospital setting. The current practice of implementing falls prevention strategies for patients has not been able to be sustained, which remains a challenge for healthcare providers. Among the falls prevention strategies, falls risk assessment tools have been identified as a crucial element in falls prevention so as the number of falls are minimised. Study design and methods: Descriptive Cohort design, with the auditing of falls assessment documentation on the Patient Centred Care Plan. Results: The Patient Centred Care Plan audit revealed that 60.8% of patients (n=508) were identified as high risk of falls by the principal investigator. For the cohort of patients identified as by the nurses as having a high risk of falling (53.4%), 53.7% of patients had falls prevention strategies implemented, and only 17.5% of patients were engaged with their falls prevention plan. The strategies that were documented by the nurses on the care plan for the high-risk cohort were not implemented for 16.8% of the patients, and 29.5% of high risk of falls patients did not have documentation on the plan indicating their falls status. Discussion: The findings show that there is a significant gap in the identification of high falls risk patients and the documentation and implementation of falls prevention strategies, between nursing staff records on the Patient Centred Care Plan and the audit conducted by the principal investigator for patients who are identified as high falls risk. As part of the audit patient engagement in their falls prevention plan revealed that patients were not informed of their falls risk status by the nursing staff. Conclusion: The outcome from this audit signifies that not all high falls risk patients were identified as a high falls risk, and most of the high falls risk patients were not engaged in their falls prevention plan. Implications for research, policy and practice: Understanding the current practices of falls prevention and raising nursing staff awareness of the identified variance in the implementation of falls prevention strategies will improve the quality, efficiency of healthcare and the patient safety

Limitations of Hospital Ward Quality Monitoring Reporting in Australia: A Discussion Paper

The limitations of hospital ward quality monitoring and reporting and factors contributing to the limitations are identified and discussed in this paper. In general, the limitations comprise a lack of standardisation in hospital ward quality monitoring reports, absence of nursing informatics in the hospital information system, inadequate development of nurse sensitive indicators and a lack of input from frontline nurses. Moreover, the nursing practice environment (NPE) is poorly conceptualized and there are competing and conflicting viewpoints about the parameters of the NPE. These limitations have contributed to the current state of ward quality monitoring and reporting. As a result, frontline nurses in the acute ward setting cannot receive meaningful and sensitive information to support their endeavours to monitor and enhance nursing care quality. In order to address challenges of the NPE and meet specific requirements of frontline nurses to support their quality improvement activities and decision-making processes, further research should be developed to explore, describe and examine quality monitoring processes

Educating the educators: Implementing cultural safety in the nursing and midwifery curriculum

Background: The Australian Nursing and Midwifery Accreditation Council mandates the teaching of cultural safety in Bachelor of Nursing and Midwifery programs in Australia. However nursing and midwifery academics may lack the awareness and knowledge required to share and develop cultural safety practices with their students. Specific cultural safety professional development for academics may be needed. Objectives: This research explores how nursing and midwifery academics at an Australian university understand cultural safety and whether they are equipped to embed it in the curriculum. It also examines whether professional development workshops can support academics to prepare for cultural safety. Methods: An intervention involving three cultural safety professional development workshops was offered to nursing academics at an Australian university. The authors used qualitative surveys to consider whether the workshops deepened participants’ understanding of cultural safety and developed the self-reflection required to embed cultural safety in teaching. Results: The workshops contributed to participants’ improved understandings of culture, colonisation, white privilege and the need for self-reflection, but not all participants developed a working knowledge of cultural safety practice. Conclusion: Professional development workshops can assist nursing and midwifery academics to develop their knowledge of cultural safety, but detailed, contextual understanding is likely to need more than three sessions. Academics’ motivations to include cultural safety in their teaching may be linked to their desire for patient-driven and equitable services and a desire to meet accreditation requirements

Photographic evidence of interchange between East Australia (BS E-1) and West Australia (BS-D) humpback whale breeding populations

Documentation of humpback whale movements between east and west Australian breeding grounds have been restricted to limited historical data from ‘Discovery’ marks, and implied from song analysis and molecular data. We report on the first inter-ocean movement of a humpback whale between the Pacific Ocean, east Australia (BS-E1) and the Indian Ocean, west Australia (BS-D) confirmed by photo-ID. A single humpback whale from BS-E1 (1987) was re-sighted to BS-D (1995) breeding grounds. The identification photographs of this single whale were then compared to fifteen fluke ID catalogues containing 15,011 fluke identifications (not reconciled for duplications between catalogues) collected from 1981 - 2011, and one catalogue containing 3,555 left and 3,572 right lateral body images collected from 1990 – 2010. Catalogues searched represent individual humpback whale fluke IDs from Breeding Stocks A, B, B1, B2, C1, C2, C3, D, E1, E2, E3, F, F2, G; New Zealand (migratory corridor); and feeding areas of Antarctic Peninsula, Areas I-VI and Chile, and lateral body IDs from BS-D. This re-sight record across breeding stocks provides further evidence of longitudinal movement of humpback whales in the southern hemisphere and highlights the value of both opportunistic data collection and the importance of comparing identified individuals among catalogue holders working in adjacent and non-adjacent breeding regions