Hospice nurses’ views on single nurse administration of controlled drugs

noBackground: The involvement of two nurses to dispense and administer controlled drugs is routine practice in most clinical areas despite there being no legal or evidence-based rationale. Indeed, evidence suggests this practice enhances neither safety nor care. Registered nurses at two hospices agreed to change practice to single nurse dispensing and administration of controlled drugs (SNAD). Participants’ views on SNAD were evaluated before and after implementation. The aim of this study was to explore the views and experiences of nurses who had implemented SNAD and to identify the views and concerns of those who had not yet experienced SNAD. Method: Data was obtained through semi-structured interviews. Results: Qualitative thematic analysis of interview transcripts identified three key themes: practice to enhance patient benefit and care; practice to enhance nursing care and satisfaction; and practice to enhance organisational safety. Conclusion: The findings have implications for the understanding of influences on medicines safety in clinical practice and for hospice policy makers

Implementation of an evidence-based practice nursing handover tool in intensive care using the knowledge-to-action framework

Background Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, s tandardised handover tools for nursing team leader s in intensive care are limited. Aims The study aim was to implement and evaluate an evidence- based electronic minimum dataset for nursing team leader shift -to-shift handover in the intensive care unit using the k nowledge- to-action framework. Methods This study was conducted in a 21- bed medical/surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in team leader handover were recruited. Three phases of the knowledge- to-action framework (select, tailor and implement interventions, monitor knowledge use and evaluate outcomes ) guided the implementation and evaluation process. A post -implementation practice audit and survey were carried out to determine nursing team leader use and perceptions of the electronic minimum dataset three months after implementation. Results are presented using descriptive statistics ( median, IQR, frequency and percentage) . Results Overall (86%, n=49) , team leader s used the electronic minimum dataset for handover and communication regarding patient plan increased . K ey content items however were absent from handovers and additional documentation was required alongside the minimum dataset to conduct handover. Of the team leader s surveyed (n=35), those receiving handover perceived the electronic minimum dataset more Page 4 of 24 positive ly than team leader s giving handover (n=35) . Benefits to using the electronic minimum dataset included the pat ient content (48%), suitability for short -stay patients (16%), decreased time updating (12%) and print ing the tool (12%) . Almost half of the participants however, found the minimum dataset contained irrelevant information, reported difficulties navigating and locating relevant information and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface. Linking evidence to action Prior to developing and implementing electronic handover tools , adequate infrastructure is required to support knowledge translation and ensure clinician and organisational needs are met

Is nurses’ self‐esteem interwoven with patients’ achievements? : the concept of patient‐invested contingent self‐esteem

OBJECTIVES: To explore the notion of Patient-invested Contingent Self-Esteem (Pa-CSE) and investigate its association to nurses' self-reported engagement in controlling or autonomy-supportive interactions with chronic care patients. BACKGROUND: Considering the high number of patients sub-optimally managing their chronic condition, nurses might experience a drop and rise in self-worth when patients fail and succeed, respectively, in managing their chronic condition. This dynamic has not received prior research attention. DESIGN: Multivariate analysis employing cross-sectional data according to STROBE guidelines. METHODS: Self-reports among nurses employed in chronic care (N=394) from eight randomly selected hospitals in Belgium. Exploratory factor analysis and stepwise linear regression analyses were conducted. RESULTS: Success-based and failure-based orientations could be distinguished and refer to nurses' tendency to associate, respectively, patients' successes with feelings of professional success and self-worth and patients' failures with feelings of professional failure, shame, and inadequacy. Nurses' self-esteem is fairly interwoven with patients' achievements in the management of their chronic condition. A success-based orientation was positively related to autonomy-supportive care in case a failure-based orientation was low. Nurses with a simultaneous success-based and failure-based orientation interacted in a more controlling way. CONCLUSIONS: The findings of this study suggest that basing one's self-worth on patients' accomplishments may be a double-edged sword. Although tying one's personal glory to the successes of one's patient is related to greater patient participation and support of autonomy, these effects only emerge if nurses' self-worth is not interwoven with patients' failures. In fact, having both success- and failure-oriented contingent self-worth is related to a more pressuring approach. RELEVANCE TO CLINICAL PRACTICE: To prevent nurses from developing inferior professional feelings when their patients fail to manage their condition, a reflective stance towards the impact of patients' behaviour on the nurses' professional feeling of (in)adequacy is an important step to deal with such situations

Where do graduates Develop their Enterprise Skills? The Value of the Contribution of Higher Education Institutions’ Context

This study investigates the value of the contribution of HEIs’ context in developing graduates enterprise skills. HEIs are under pressure to develop more enterprising graduates, particularly with the increasing numbers of graduates seeking employment and the growing dissatisfaction of employers. This study explores where graduates develop enterprise skills through investigating the impact of HE and employment contexts on their development. The paper draws on a qualitative study in the social constructionist paradigm within the pharmacy context, where interviews were conducted with pharmacy academics and employers. Results show that ability to demonstrate skills in one context does not necessarily mean ability to demonstrate them in another since the development and demonstration of enterprise skills is impacted by the contexts in which they are developed and demonstrated. The study adds value by highlighting the significant role of both HE and employment contexts in developing enterprise skills, while emphasising that these skills become more transferable through exposure to more contexts

Comparison of the Conceptual Map and Traditional Lecture Methods on Students’ Learning Based on the VARK Learning Style Model: A Randomized Controlled Trial

Developing skills and knowledge in nursing education remains a considerable challenge. Nurse instructors need to be aware of students' learning styles so as to meet students' individual learning preferences and optimize knowledge and understanding. The aim of this study was to compare the effects of the conceptual map and the traditional lecture methods on students' learning based on the VARK learning styles model. In this randomized controlled trial, 160 students from nursing, nurse anesthetics, and midwifery disciplines with four different learning styles of visual, auditory, reading/writing, and kinesthetic were selected using the convenience sampling method. Participants were randomly assigned to the intervention (conceptual map method) or control (traditional lecture method) groups. A medical-surgical nursing course was taught to the students in both groups over 6 weeks. Data collection tools consisted of the VARK questionnaire and pre-and postassessments. Data were analyzed using descriptive and inferential statistics via the SPSS software. Teaching using the conceptual map method had different effects on the students' learning outcomes based on their learning styles. The conceptual map method had a statistically significant impact on the students' learning in the intervention group compared with the control group in the students with a visual learning style (p ¼ .036). No statistically significant differences were reported between the groups in other three learning styles. Nurse instructors should assess students' learning styles based on the VARK model before the application of a particular teaching method to improve the quality of nursing education and facilitate deeper learning

Nurses’ identification and reporting of medication errors

Aims and objectives To investigate hospital nurses' involvement in the identification and reporting of medication errors in Turkey. Background Medication safety is an international priority, and medication error identification and reporting are essential for patient safety. Design A descriptive survey design consistent with the STROBE guidelines was used. Methods The participants were 135 nurses employed in a university hospital in Turkey. The survey instrument included 18 sample cases and respondents identified whether errors had been made and how they should be reported. Descriptive statistics were analysed using the chi-square and Fisher's exact tests. Results The sample case of "Patient given 10 mg morphine sulphate instead of 1.0 mg of morphine sulphate" was defined as a medication error by 97% of respondents, whereas the sample case of "Omitting oral/IV antibiotics because of the need to take the patient out for X-rays for 3 hr" was defined as a medication error by only 32.1%. It was found that eight sample cases (omitting antibiotics, diluting norodol drops with saline, giving aspirin preprandially, injecting clexane before colonoscopy, giving an analgesic at the nurse's discretion, dispensing undiluted morphine, preparing dobutamine instead of dopamine and administering enteral nutrition intravenously) were assessed as errors and reported, although there were significant statistical differences between the identification and reporting of these errors. Conclusion Nurses are able to identify medication errors, but are reluctant to report them. Fear of the consequences was the main reason given for not reporting medication errors. When errors are reported, it is likely to be to physicians. Relevance to clinical practice The development of a commonly agreed definition of a medication error, along with clear and robust reporting mechanisms, would be a positive step towards increasing patient safety. Staff reporting medication errors should be supported, not punished, and the information provided used to improve the system

'20 days protected learning' - students' experiences of an Overseas Nurses Programme - 4 years on: A retrospective survey

Background From September 2005 the Nursing and Midwifery Council (NMC) introduced new arrangements for the registration of non-EU overseas nurses which requires all applicants to undertake '20 days of protected learning' time in the UK and for some, a period of supervised practice. A survey was undertaken at Bournemouth University, which offers a '20 days protected learning only' programme, to elicit overseas nurses' demographic details, experiences in completing the programme and their 'final destinations' once registered. Methods An online survey was devised which contained a mixture of tick box and open ended questions which covered demographic details, views on the programme and final destinations This was uploaded to www.SurveyMonkey.com and sent out to nurses who had completed the Overseas Nurses Programme (ONP) with Bournemouth University (n=1050). Quantiative data were analysed using descriptive statistics and the qualitative data were coded and analysed using content analysis . Results There were 251 respondents (27.7% response rate). The typical 'profile' of a nurse who responded to the survey was female, aged 25-40 years and had been qualified for more than 5 years with a bachelors degree. The majority came from Australia on a 2 year working holiday visa and the key final destination in the UK, on registration with the NMC, was working for an agency. There were five key findings regarding experience of the programe. Of those surveyed 61.2% did not feel it necessary to undergo an ONP; 71.6% felt that they should be able to complete the programme on-line in their own country; 64.2% that the ONP should only contain information about delivery of healthcare in UK and Legal and professional (NMC) issues; 57% that European nurses should also undergo the same programme and sit an IELTS test; and 68.2% that the programme was too theory orientated; and should have links to practice (21%). Conclusions The NMC set the admissions criteria for entry to the register and Standards for an ONP. The findings of this survey raise issues regarding the percieved value and use of this approach for overseas nurses, and it may be helpful to take this into account when considering future policy

Traumatic brain injury patients' family members' evaluations of the social support provided by healthcare professionals in acute care hospitals

Aims and objectives The study aimed to examine traumatic brain injury (TBI) patient family members' (FMs) experiences of the support they received from healthcare professionals in acute care hospitals. Background The length of hospitalisation following TBI is constantly decreasing, and patients may return home with several problems. FMs care for the patients at home although they may not be prepared for the patient's medical needs or financial burden of the illness. The burden which some FMs experience can impair patient care and rehabilitation outcomes. Therefore, FMs require support during acute phases of TBI treatment. Design A structured questionnaire was sent to 216 TBI patients FMs. The response rate was 47% (n = 102). Methods A structured questionnaire-based on a systematic literature review and a previous questionnaire on TBI patient FMs' perceptions of support-was developed and used in the data collection. The questionnaire included 46 statements and 11 background questions. Data were collected via an electronic questionnaire. The STROBE checklist was followed in reporting the study. Results A factor analysis identified five factors that describe the guidance of TBI patient FMs: guidance of TBI patients' symptoms and survival; benefits of guidance; needs-based guidance; guidance for use of services; and guidance methods. Most of the FMs (51%-88%) felt that they had not received enough guidance from healthcare professionals in acute care hospitals across all five aspects of support. Conclusions The content of guidance should be developed, and healthcare staff should be trained to consider a FM's starting point when providing guidance. A calm environment, proper timing, sufficient information in different forms and professional healthcare staff were found to be key factors to comprehensive guidance. Involving FMs in the discharge process and rehabilitation of their loved ones both supports the abilities of caregivers and promotes the outcome of the patient's rehabilitation. Relevance to clinical practice This study provides varied information on the need for social support of TBI patients FMs in the early stages of treatment from the FMs' perspective. This research adopted the FM's perspective to identify various areas of social support that need to be developed so that the FMs of TBI patients receive enough support during the early stages of TBI treatment.Peer reviewe