Aggression and violence in healthcare and its impact on nursing students: A narrative review of the literature

Aggression and violence is a significant social problem in many countries and an increasing problem in healthcare settings in which nurses are particularly vulnerable. The literature suggests that aggression and violence has a significant negative impact upon nurses and potentially upon nursing students and can result in these staff members experiencing stress as a direct result of these adverse events. The literature suggests that there is confusion over what constitutes aggression and violence in the workplace and therefore a true lack of understanding of the scale of the problem relating to nursing students. This review proposes that nursing students are indeed at significant risk of aggression and violence in the clinical setting which has the potential to significantly impact their role as a novice carer. Furthermore, aggression and violence can manifest negative stress responses in individuals, therefore, the potential for nursing students to cope with stressful situations shall be presented

Masters degree an Australian first

Murdoch University in Western Australia is offering a Masters of Midwifery, for midwives and child health nurses who wish to specialise in providing care to breastfeeding mothers and their babies. This is the first Masters degree of its kind in Australia and is due to begin in second semester 2011. It is currently available internally with a view to providing an online study option in 2012

Severity of mastitis symptoms as a predictor of C-reactive protein in milk and blood during lactation

OBJECTIVE: To investigate the presence of C-reactive protein (CRP) in breast milk and any relationship between changes in CRP in breast milk and blood, and the severity of systemic and breast symptoms experienced during mastitis. METHODS: Mothers (n = 26) were followed prospectively from day 5 postpartum to the end of their lactation. Milk from each breast, blood, 24-hour urine samples and data on breast and systemic pathologies were collected at reference intervals during the first 3 months postpartum, daily during the occurrence of any breast inflammation and at 7 days after resolution of symptoms. RESULTS: CRP in blood was significantly increased during mastitis (p < 0.001, df:1,81; F = 31) and severity of systemic symptoms was a significant predictor for changes of CRP in blood (p < 0.01; df:3,42; F = 9.6). During mastitis both the symptomatic breast (p < 0.001; df:1,79; F = 19) and the contralateral asymptomatic breast (p < 0.004; df:1,75; F = 8.7) had a significantly higher milk CRP when compared with women with no mastitis. CONCLUSIONS: Although an increasing severity of breast and systemic symptoms in mastitis was predictive of an increasing CRP in milk and blood, respectively, the presence of CRP in similar concentrations in the mastitis and asymptomatic breast suggests it is of little use in making a differential diagnosis between infective verses noninfective forms of mastitis

Recurrent blocked duct(s) in a mother with immunoglobulin A deficiency

Secretory immunoglobulin A (sIgA) is the dominant immunoglobulin in human milk, and apart from the obvious contribution it makes towards the protection of the infant, sIgA may also form an important part of the defense of the mammary gland. This report involves a mother (M8) who participated in a research study investigating the relationships between symptoms and changes in the physiology of the lactating breast during mastitis. Breastmilk samples were collected on Days 14, 30, 60, and 90 postpartum, to establish the normal reference range of biochemical markers, and during periods of breast inflammation. M8 experienced seven episodes of blocked duct(s) during the first 19 weeks, five of which occurred within the 90-day reference sample collection period. On analysis, it was found there was no detectable sIgA present in her milk samples. Medical referral and further testing resulted in a diagnosis of selective IgA deficiency, of which the mother had not been previously aware. M8 showed little variation in her milk composition even when suffering with blocked duct(s), although there was an increase in the concentration of lactoferrin in both breasts at reference collection days 14-90. Lactoferrin concentration was also unusually high at Day 14 (15 g/L) in the left breast and continued to be increased in this breast until Day 60. The absence of sIgA in this mother's breastmilk may have been a contributing factor in her experiencing recurrent blocked ducts

Relationships between symptoms and changes in breast physiology during lactation mastitis

OBJECTIVE: The objective was to investigate changes in milk composition that reflect variations in breast permeability, milk synthesis, and immune response in women before, during, and after mastitis. METHODS: Mothers (n = 26) were followed prospectively from day 5 postpartum to the end of their lactation. Milk from each breast, blood, 24-hour urine samples, and data on breast and systemic pathologies were collected at reference intervals during the first 3 months postpartum, daily during the occurrence of any breast inflammation, and 7 days after resolution of symptoms, and was analyzed using mixed-model analysis (repeated measures). RESULTS: There was a significant difference in sodium (p < 0.001), chloride (p < 0.001), serum albumin (p < 0.02) and lactose (p < 0.003) in the breast with mastitis when compared with both the contralateral asymptomatic breast and "healthy" breasts. Inflammation of the whole breast was a significant predictor for a decreased glucose (p < 0.01) and hyperacute systemic symptoms predicted a decrease in milk glucose (p < 0.03) and an increased lactoferrin (p < 0.05) and sIgA (p < 0.03). CONCLUSIONS: There is an increased breast permeability, reduced milk synthesis, and increased concentration of the immune components sIgA and lactoferrin with increasing severity of breast and systemic symptoms. The changes observed in milk composition during periods of increased breast permeability cannot be solely explained by the current theory of permeability of the paracellular pathway and further research in this area is required

How do we facilitate international clinical placements for nursing students: A cross-sectional exploration of the structure, aims and objectives of placements

Background International clinical placements provide undergraduate students with a unique and complex clinical learning environment, to explore cultural awareness, experience different health care settings and achieve clinical competencies. Higher education institutions need to consider how to structure these placements to ensure appropriate and achievable aims and learning outcomes. Objectives In this study we described the structure, aims and learning outcomes associated with international clinical placement opportunities currently undertaken by Australian undergraduate nursing students in the Asia region. Participants Forty eight percent (n = 18) of the institutions invited responded. Eight institutions met the inclusion criteria, one of which offered three placements in the region, resulting in 10 international placements for which data were provided. Methods An online survey tool was used to collect data during August and September 2015 on international clinical placements conducted by the participating universities. Descriptive data on type and numbers of placements is presented, along with results from the content analysis conducted to explore data from open ended questions on learning aims and outcomes. Results One hundred students undertook 10 International Clinical Placements offered in the Asian region by eight universities. Variations across placements were found in the length of placement, the number of students participating, facilitator to student ratios and assessment techniques used. Five categories related to the aims of the programs were identified: ‘becoming culturally aware through immersion’, ‘working with the community to promote health’, ‘understanding the role of nursing within the health care setting’, ‘translating theory into professional clinical practice’, and ‘developing relationships in international learning environments’. Four categories related to learning outcomes were identified: ‘understanding healthcare and determinants of health’, ‘managing challenges’, ‘understanding the role of culture within healthcare’ and ‘demonstrating professional knowledge, skills and behaviour’. Conclusions International clinical placements in the Asia region appear to vary greatly from one education institution to the next with no clear consensus from either this study's findings or the literature on which structure, support and assessments lead to greater student learning

International clinical placements for Australian undergraduate nursing students: A systematic thematic synthesis of the literature

Objectives: International clinical placements provide undergraduate nursing students with the opportunity to experience or practice nursing care in diverse countries, settings, and cultures. This systematic review aims to ascertain the current knowledge on international clinical placements offered by undergraduate nursing programs in Australia. It seeks to explore three questions: (1) How have previous experiences of nursing students’ international clinical placements been described? (2) How have participants and stakeholders determined if the placement has been successful? And (3) What benefits or challenges have been identified by stakeholders as a result of participating in international clinical placements? Design: A systematic thematic synthesis was undertaken. Data Sources: A search of electronic databases including CINAHL, Proquest Central, Scopus, PubMed, and Health Collection was undertaken between September and October 2014. Review Methods: Key terms including ‘international clinical placement’, ‘study abroad’, ‘international exchange’, ‘nursing’, and ‘Australia’ were used to identify articles that appeared in peer-reviewed English language journals and that explored international clinical placements offered to undergraduate nursing students by Australian universities. Results: Eight studies were identified that meet the inclusion criteria, and through thematic analysis, five key themes were identified including developing cultural awareness and competence, providing a global perspective on health care, translation of theory to practice, growing personally through reflection, and overcoming apprehension to successfully meet the challenge. A comparison search of literature from Canada and the United Kingdom revealed that similar themes occurred internationally. Conclusions: Although personal successes were identified by students undertaking international clinical placement, further research is required to identify all stakeholder experiences including those of the educators, the educational institutions, and travel providers supporting these placements and the communities where the placements take place

Enhancing student understanding of nursing inherent requirements using assessment for learning

Problem Where misperceptions and a lack of understanding of the realities of the Nursing profession exist, this can result in students entering into Nursing degrees without understanding the academic knowledge, behavioural and physical attributes and other inherent requirements necessary to undertake and succeed in their studies and subsequent career. Question Can an ‘Assessment for Learning’ approach result in enhanced student understanding of inherent requirements and their relationship to registered nurse attributes? Methods This interpretive study analysed students’ written reflections on two Bachelor of Nursing inherent requirement statements using latent content analysis. Purposive sampling of all 165 students enrolled in an introductory professional nursing unit was undertaken with 162 (98.2%) consenting to provide demographic data and have their reflections analysed following completion of their unit. Findings Four themes were identified: Eye opening, responding to self-examination, setting goals and effecting change, and affirming beliefs and attributes. Discussion Analysis of the students’ reflections on the nursing inherent requirements showed they exhibited enhanced awareness, understanding and acknowledgement of personal areas to be addressed, as well as goal setting and the beginnings of acculturation and movement along the pre-professional identity to professional identity continuum. Conclusion An assessment for learning approach enhanced beginning students understanding of requirements inherent in undertaking a Bachelor of Nursing degree, enabling them to set goals for their development as they linked the BNIRs to the attributes required of a registered nurse

The benefits of tai chi as a self management strategy to improve health in people with chronic conditions

Aim.  To provide health professionals with information regarding the phenomenon of tai chi, which has now become a world-wide activity with the potential to improve health and well-being in a broad range of chronic illnesses. Background.  Mind-body approaches to health, such as tai chi, are gaining in popularity, particularly amongst people with chronic illness who are seeking self management health strategies that have the capacity to address multiple health needs across both physical and psychological spectrums. Method.  This article has been informed by a broad computerized systematic literature search. Conclusions.  An ever increasing body of research indicates that tai chi has beneficial effects in people with a range of medical conditions in varying populations. Its potential benefits include enhancing cardio-respiratory fitness, reducing blood pressure, improving glucose control in diabetic patients, increasing immune response, alleviating pain, assisting in the rehabilitation of people experiencing chronic health conditions, and promoting psychological well-being. Tai chi’s wide range of reported benefits makes it an ideal self management strategy, for both the elderly and people with chronic conditions, to improve their psychological and physical well-being in a community setting. Relevance to clinical practice.  Knowledge regarding indications for, and effects of, this popular self management intervention will enable health professionals to provide up to date information and advice to patients on the appropriateness of including tai chi in their self management health plans

Renewal of an entry to practice baccalaureate nursing curriculum: Adapting to complexity

Curriculum re-design in entry to practice nursing degrees requires a rigorous and multifaceted approach to align the needs of students, professional and industry stakeholders, community needs, the faculty’s vision and university and regulator requirements. This paper relates the initial steps in the process taken to achieve this re-design in one Australian university’s Bachelor of Nursing program, and describes our experiences in two parts. The first part outlines the context in which the need for curriculum renewal was triggered and the ensuing processes undertaken in the development of our new course aim, course outcomes and graduate attributes. The second part discusses how undertaking these activities then came to influence the adoption of Complexity Thinking in the design of our conceptual model, which then guided our program structure and overarching learning and teaching approaches. We share these experiences to illustrate the steps we undertook on this journey, to outline and example the program we created, and to continue the scholarly discussions around the design of baccalaureate nursing program structures, especially those that implement pedagogies inspired by the concepts related to Complexity Theory. The choice of complexity thinking as a guiding theory was key in providing the lens through which we were inspired to graduate nurses with the skills to provide care in complex situations and value the learning that comes through uncertainty, reflection, adaptation and emergence