The power of story: Narrative inquiry as a methodology in nursing research

The aim of this paper is to explore the essential elements and value of narrative inquiry in nursing research. We propose that understanding a previous experience allows the nurse researcher an insider view and hence a deeper understanding of the issues that arise in the relationship between participant and researcher. We suggest that narrative inquiry in nursing research offers a particular way of caring about how knowledge is produced. Nursing science would benefit from the understanding that health and nursing practices are dynamic processes characterized by the continuous interaction of human thought and behaviour that continuously \u27pumps\u27 into personal, social and material environments. Narrative inquiry as a methodology in nursing research is exceptionally useful to uncover nuance and detail of previous experiences

Nurses - are we disaster ready?

Australia is not considered by most to be a disaster prone country. However, in January 2009, 347 people were killed by extreme temperatures; in 2010 175,000 people were affected by floods; in 2013 13,000 people were affected by floods and 98,000 by bush fire. Heat waves and flooding will not only continue in Australia but are likely to increase (UNISDR, 2014)

A feasibility study on disaster preparedness in regional and rural emergency departments in New South Wales : Nurses self-assessment of knowledge, skills and preparation for disaster management

Background Nurses who work in regional and rural hospitals face unique challenges to disaster preparedness and response. Geographical location and isolation, decreased resources and subsequent workforce, along with organizational and financial restraints are some of the hurdles these individuals and communities face [1,2]. Method The Disaster Preparedness Evaluation Tool was applied a population of Regional and Rural Emergency Nurses in New South Wales. Result Thirty-two nurses participated in this study. Their level of disaster preparedness was at a moderate level for knowledge, skills and preparation for disaster management. Their experiences broadly mirrored those found in earlier research. Conclusion Results highlighted the nature of and delivery of continuing professional development in relation to disaster preparedness; mechanisms to encourage emergency department nurses to develop personal and family preparedness plans (to improved disaster preparedness); increased training in relation to psychological assessment of patients, and identification of biological agent signs and symptoms

Introduction of patient electronic medical records (EMR) into undergraduate nursing education : An integrated literature review

Background To prepare student nurses for clinical practice where patient electronic medical records (EMR) competence is required, nursing undergraduate curricula must provide simulation access to developing this skill set. At this stage, however, the integration of electronic documentation into the Australian undergraduate nursing curriculum has been piecemeal. Aim The aim of this integrated literature review was to identify benefits and challenges for faculty nursing staff and nursing students in relation to the integration, use and evaluation of EMR in an undergraduate nursing program. Methods A systematic search of relevant peer-reviewed research and project report articles was conducted in the electronic databases. Generic qualitative thematic analysis was then undertaken with themes generated from the data itself. Results Fifty eight articles were identified, of these 23 were found to meet the inclusion criteria. Three major themes were identified: 1) Advantages of using EMR in academic settings, 2) Identified Challenges and Limitations of EMR programs; and 3) Developing an academic EMR program and implementing EMR education program in stages. All papers acknowledged that EMR will be standard in healthcare and should be viewed as an ‘essential tool’ for inclusion in undergraduate nursing programs. Conclusion and implications for practice There is a significant increase of electronic technology in healthcare settings, especially relating to patient documentation. Therefore, teaching the use of EMR in the simulated clinical learning environment for new healthcare providers such as nursing students is essential. The papers reviewed identified an urgent need for higher education nursing programs to support undergraduate nursing students and faculty staff to ensure EMR can be implemented effectively into the undergraduate nursing curriculum

Care pathways in atopic dermatitis : a retrospective population-based cohort study

Background Atopic dermatitis (AD) is a complex disease with variations in severity and healthcare utilization. Examining patient pathways through analyses of longitudinal patient data provides an opportunity to describe real-world clinical patient care and evaluate healthcare access and treatment. Objective To describe longitudinal care pathways including health care management, treatment patterns and disease progression (by proxy measures) in patients with AD. Materials and methods This was a longitudinal observational study, which used linked data from national and regional healthcare registers in Sweden. Patients with AD were identified through diagnosis in primary or secondary care or by dispensed medications. Descriptive statistics for number of healthcare visits, type of dispensed drug class, rate of - and time to - referral to secondary care and treatment escalation were calculated. Results A total of 341 866 patients with AD distributed as 197 959 paediatric (age < 12), 36 133 adolescent (age >= 12- < 18) and 107 774 adult (age >= 18) patients were included in this study. Healthcare visits to primary and secondary care and dispensation of AD-indicated treatments were more common during the year in which managed AD care was initiated. Topical corticosteroids (TCSs) and emollients were the most frequently used treatments across all age cohorts while systemic treatment was uncommon in all age cohorts. Among patients who initiated treatment with TCSs, 18.2% escalated to TCSs with higher potency following the start of managed AD care. Conclusions We found that healthcare contacts and use of AD-indicated treatments were concentrated in the year during which managed AD care was initiated and decreased significantly thereafter. Since a significant proportion of patients with AD have flares and persistent AD, our results suggest that patients with AD may be monitored infrequently and are undertreated. There is a need to inform practitioners about adequate treatment options to provide individualized care, in particular for patients with persistent severe AD

Regional Differences in the Prescription of Biologics for Psoriasis in Sweden : A Register-Based Study of 4168 Patients

Background: Observational studies suggest an inequitable prescription of biologics in psoriasis care, which may be attributed to geographical differences in treatment access. Sweden regularly ranks high in international comparisons of equitable healthcare, and is, in connection with established national registries, an ideal country to investigate potential inequitable access. Objective: The aim was to determine whether the opportunity for patients to receive biologics depends on where they receive care. Methods: Biologic-naïve patients enrolled in the Swedish National Register for Systemic Treatment of Psoriasis (PsoReg) from 2008 to 2015 (n = 4168) were included. The association between the likelihood of initiating a biologic and the region where patients received care was analyzed. The strength of the association was adjusted for patient and clinical characteristics, as well as disease severity using logistic regression analysis. The proportion of patients that switched to a biologic (switch rate) and the probability of switch to a biologic was calculated in 2-year periods. Results: The national switch rate increased marginally over time from 9.7 to 11.0%, though the uptake varied across regions. Adjusted odds ratios for at least one region were significantly different from the reference region in every 2-year period. During the latest period (2014–2015), the average patient in the lowest prescribing region was nearly 2.5 times less likely to switch as a similar patient in the highest prescribing region. Conclusions: Geographical differences in biologics prescription persist after adjusting for patient characteristics and disease severity. The Swedish example calls for further improvements in delivering equitable psoriasis care