Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses

publisher: Elsevier articletitle: Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses journaltitle: Australian Critical Care articlelink: http://dx.doi.org/10.1016/j.aucc.2016.08.006 content_type: article copyright: © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved

The effectiveness of education in the recognition and management of deteriorating patients: A systematic review

publisher: Elsevier articletitle: The effectiveness of education in the recognition and management of deteriorating patients: A systematic review journaltitle: Nurse Education Today articlelink: http://dx.doi.org/10.1016/j.nedt.2016.06.001 content_type: article copyright: © 2016 Elsevier Ltd. All rights reserved

Learning to nurse: combining simulation with key theory.

Following a recent Nursing and Midwifery Council revalidation of a university undergraduate nursing programme, simulation skills sessions and anatomy and physiology theory were integrated into one unit (module). This was done in order to integrate the basis for patient assessment and care provision with the anatomical and physiological theory and thereby enhance student learning and nursing practice. Students evaluated the new unit well and valued the close link between theory and practice simulation. Improvements were seen in the simulation skills sessions as students were better able to apply their underlying theory to their actions. Learning was enhanced as both simulation and theory were seen as more meaningful to practice and patient care

An integrative review of how families are prepared for, and supported during withdrawal of life-sustaining treatment in intensive care

AIM: To conduct an integrative review on how nurses prepare families for and support families during withdrawal of life-sustaining treatments in intensive care. BACKGROUND: End-of-life care is widely acknowledged as integral to the practice of intensive care. However, little is known about what happens after the decision to withdraw life-sustaining treatments has been made and how families are prepared for death and the dying process. DESIGN: Integrative literature review. DATA SOURCES: MEDLINE, CINAHL Plus, PsychINFO, PUBMED, Scopus, EMBASE and Web of Knowledge were searched for papers published between 2000 - May 2015. REVIEW METHODS: A five stage review process, informed by Whittemore and Knafl\u27s methodology was conducted. All papers were reviewed and quality assessment performed. Data were extracted, organised and analysed. Convergent qualitative thematic synthesis was used. RESULTS: From an identified 479 papers, 24 papers were included in this review with a range of research approaches: qualitative (n=15); quantitative (n=4); mixed methods (n=2); case study (n=2); and discourse analysis (n=1). Thematic analysis revealed the nurses: equipped families for end of life through information provision and communication; managed the withdrawal of life-sustaining treatments to meet family need; and continued care to build memories. CONCLUSION: Greater understanding is needed of the language that can be used with families to describe death and dying in intensive care. Clearer conceptualisation of the relationship between the medically focussed withdrawal of life-sustaining treatments and patient/family centred end-of-life care is required making the nursing contribution at this time more visible

Homogeneity and heterogeneity in disciplinary discourse: tracking the management of intertextuality in undergraduate academic lectures

Using a corpus of twenty-four lectures drawn from The BASE corpus*, this study is an analysis and inter-disciplinary comparison of the management of Intertextuality in the genre of the undergraduate lecture. Theorising Intertextuality as central within the discursive (re-)construction of disciplinary knowledge, the investigation of Intertextuality is viewed as the investigation of the discursively-mediated interaction(s) of a current lecturer with original knowledge-constituting discourses, and with their agents too, of an academic community. As there is no holistic and comprehensive methodology for assessing the management of Intertextuality in academic discourse both qualitatively and quantitatively, this study uses two further lectures to devise such a methodology. This involves segregating lecture discourse into consistent independent units and then coding each unit according both to its function in the discourse and the participant voice(s) behind it. Applying this comprehensive scheme shows that independent units in lecture discourse are classifiable under three broad functional areas, Intertextuality (units realising propositional input), Intratextuality (units realising the mechanics of text and discursive interaction), and Metatextuality (units realising unit-length evaluation of emerging discourse). These functional areas and the functions within them are manageable via different participant voice(s), the manifestations and pragmatic effects of which in discourse vary, meaning the management of Intertextuality can be assessed qualitatively and quantitatively using the coherent, consistent and data-driven coding scheme derived from these analyses. This methodology, applied qualitatively and quantitatively to the corpus, reveals management similarities broadly between Arts & Humanities and Social Sciences lectures, typically a dialogic management, and management differences broadly between these two groupings and Physical Sciences lectures, typically a monophonic management. These management choices are understood as both constituted by and as reconstitutive of the social and epistemological landscapes behind lectures, meaning the management of Intertextuality is viewed as the dominant influence in shaping disciplinary discourse. * The BASE (British Academic Spoken English) corpus is a corpus of authentic academic speech events currently being developed at the universities of Warwick and Reading in The UK with funding from the Arts and Humanities Research Board

The Experiences of Specialist Nurses Working Within the Uro-oncology Multidisciplinary Team in the United Kingdom.

PURPOSE: United Kingdom prostate cancer nursing care is provided by a variety of urology and uro-oncology nurses. The experience of working in multidisciplinary teams (MDT) was investigated in a national study. DESIGN: The study consisted of a national survey with descriptive statistics and thematic analysis. METHODS: A secondary analysis of a data subset from a UK whole population survey was undertaken (n = 285) of the specialist nursing workforce and the services they provide. Data were collected on the experience of working in the MDT. RESULTS: Forty-five percent of the respondents felt that they worked in a functional MDT, 12% felt that they worked in a dysfunctional MDT, and 3.5% found the MDT meeting intimidating. Furthermore, 34% of the nurses felt that they could constructively challenge all members of the MDT in meetings. Themes emerging from open-ended questions were lack of interest in nonmedical concerns by other team members, ability to constructively challenge decisions or views within the meeting, and little opportunity for patients' wishes to be expressed. CONCLUSIONS: Despite expertise and experience, nurses had a variable, often negative, experience of the MDT. It is necessary to ensure that all participants can contribute and are heard and valued. More emphasis should be given to patients' nonmedical needs

Navigating communication with families during withdrawal of life-sustaining treatment in intensive care: a qualitative descriptive study in Australia and New Zealand

Aims and objectives. To explore how nurses navigate communication with families during withdrawal of life-sustaining treatment in intensive care. Background. Death in the intensive care unit is seldom unexpected and often happens following the withdrawal of life-sustaining treatment. A family-centred approach to care relies on the development of a therapeutic relationship and understanding of what is happening to the patient. Whilst previous research has focused on the transition from cure to palliation and the nurse’s role in supporting families, less is known about how nurses navigate communication with families during treatment withdrawal. Design. A qualitative descriptive approach was used. Semi-structured focus groups were conducted with adult critical care nurses from four intensive care units, two in Australia and two in New Zealand. Results. Twenty-one nurses participated in the study. Inductive content analysis revealed five key themes relating to how nurses navigate family communication: (1) establishing the WHO; (2) working out HOW; (3) judging WHEN; (4) assessing the WHAT; and (5) WHERE these skills were learnt. Conclusions. Navigating an approach to family communication during treatment withdrawal is a complex and multifaceted nursing activity that is known to contribute to family satisfaction with care. There is need for support and ongoing education opportunities that develop the art of communication in this frequently encountered aspect of end-of-life care. Relevance to clinical practice. How nurses navigate communication with families during treatment withdrawal is just as important as what is communicated. Nurses need access to supports and education opportunities in order to be able to perform this vital role.No Full Tex

Roles and functions of enrolled nurses in Australia: Perspectives of enrolled nurses and registered nurses

Aims and objectives: To determine, from the perspectives of enrolled nurses and registered nurses, the current scope of enrolled nurse practice and to identify the activities that most enrolled nurses frequently performed in their workplace. Background: Enrolled nurse scope of practice in Australia has evolved and expanded over the past decade. However, the unclear role, function and competency differentiation between enrolled nurse and registered nurse leads to role confusion and ongoing professional debate. Design: Exploratory Descriptive Study. Methods: A cross-sectional online survey of enrolled nurses and registered nurses across Australia was conducted examining their levels of agreement on statements related to the scope of practice and the clinical and nonclinical activities that enrolled nurses were required to perform in their workplace. Results: Valid responses were received from 892 enrolled nurses and 1,198 registered nurses. Enrolled nurses mostly agreed that they understood their scope of practice; did not undertake roles for which they were unprepared; sometimes undertook activities other than direct patient care; and believed that they operated equally to many registered nurses. The majority of enrolled nurses reported that they performed tasks mostly related to basic patient care in their workplace. There were a number of significant differences between perspectives of registered nurses and enrolled nurses. Conclusions: Clarifying the roles and scope of practice between the registered nurse and the enrolled nurse is important, and explicit differences in responsibility and accountability between their roles must be clearly articulated to harmonise perceptions about role and capability. Health service providers, policymakers and education providers need to work collaboratively to ensure that facets of enrolled nurse education and scope of practice in line with regulation are affirmed by all concerned. Relevance to clinical practice: Health service providers, policymakers and education providers need to work collaboratively to ensure that facets of enrolled nurse education and scope of practice in line with regulation are affirmed by all concerned

Homogeneity and heterogeneity in disciplinary discourse : tracking the management of intertextuality in undergraduate academic lectures

Using a corpus of twenty-four lectures drawn from The BASE corpus, this study is an analysis and inter-disciplinary comparison of the management of Intertextuality in the genre of the undergraduate lecture. Theorising Intertextuality as central within the discursive (re-)construction of disciplinary knowledge, the investigation of Intertextuality is viewed as the investigation of the discursively-mediated interaction(s) of a current lecturer with original knowledge-constituting discourses, and with their agents too, of an academic community. As there is no holistic and comprehensive methodology for assessing the management of Intertextuality in academic discourse both qualitatively and quantitatively, this study uses two further lectures to devise such a methodology. This involves segregating lecture discourse into consistent independent units and then coding each unit according both to its function in the discourse and the participant voice(s) behind it. Applying this comprehensive scheme shows that independent units in lecture discourse are classifiable under three broad functional areas, Intertextuality (units realising propositional input), Intratextuality (units realising the mechanics of text and discursive interaction), and Metatextuality (units realising unit-length evaluation of emerging discourse). These functional areas and the functions within them are manageable via different participant voice(s), the manifestations and pragmatic effects of which in discourse vary, meaning the management of Intertextuality can be assessed qualitatively and quantitatively using the coherent, consistent and data-driven coding scheme derived from these analyses. This methodology, applied qualitatively and quantitatively to the corpus, reveals management similarities broadly between Arts & Humanities and Social Sciences lectures, typically a dialogic management, and management differences broadly between these two groupings and Physical Sciences lectures, typically a monophonic management. These management choices are understood as both constituted by and as reconstitutive of the social and epistemological landscapes behind lectures, meaning the management of Intertextuality is viewed as the dominant influence in shaping disciplinary discourse