Optimising the work integrated learning of student nurses

According to the Council on Higher Education (CHE, 2011:78) the term Work Integrated Learning (WIL) refers to an educational approach that aligns academic and workplace practices for the mutual benefit of students and workplaces. The CHE (2011:4) further describes WIL as an approach to career-focussed education that includes classroom-based and workplace-based forms of learning that are appropriate for the professional qualifications. WIL forms part of many training programmes for professions across the globe and is considered an important aspect of preparing the trainee or student to integrate theoretical learning into the clinical environment in which he or she will be building his or her career. WIL is considered crucial for the development of professional attributes and competencies needed to perform duties within the chosen profession once the trainee is qualified. Health care professions across the world employ WIL in clinical areas as an integral part of their curricula and nursing specifically is one of the health care professions that utilise a large component of WIL for clinical development of the student nurses. In South Africa, student nurses are currently placed in a variety of clinical settings in order to obtain the required and regulated clinical experience that work integrated learning should offer them. However, anecdotal evidence indicated that student nurses from the various Nursing Education Institutions in Nelson Mandela Bay experienced difficulty in finding adequate opportunities to develop their newly acquired skills when in the clinical areas and reported great difficulties in achieving their WIL outcomes. The aim of this study was to explore and describe the student nurses’ experiences of work integrated learning in various clinical areas in the Nelson Mandela Bay. This study followed a qualitative, exploratory, descriptive and contextual design with two phases. Thirty-five student nurses in their third and fourth-year were purposely sampled. In phase one data was collected using two steps, where the first step comprised using naïve sketches. During the second step interviews were done by means of focus groups using semi-structured questions and responsive interviewing. Data was transcribed verbatim and analysed thematically using Tesch’s method of analysis. In phase two recommendations for nurse educators to optimise WIL were formulated. The following three themes and related sub-themes emerged from the analysis: 1) Student nurses experienced a multitude of challenges in the clinical placement areas (CPA) and at the nursing education institution (NEI) that negatively impact on their morale and hinder WIL, namely lack of resources, unsupportive learning environments, a lack of belonging and workplace violence. 2) Positive experiences resulted in motivated and enthusiastic students, namely being inspired by role models, enhanced learning when support was offered and personal growth. 3) Students offered recommendations for enabling their WIL, namely adequate mentoring and clinical support, adequate financial support related to WIL and adjusting the nursing programmes to better incorporate the students’ needs. Relevant literature and recommendations offered by the student nurses were used to formulate recommendations with action steps for nurse educators to optimise work integrated learning of student nurses

Arts-Based Research in the Social and Health Sciences: Pushing for Change with an Interdisciplinary Global Arts-Based Research Initiative

The impact of current trends in technology, digitalization and mass media on our global culture raises questions regarding the responsibility and ethics of research decisions in contemporary social and health sciences. Embedded in the dominant paradigms, these trends subtly affect our worldviews, our valuation of the human condition, and the nature of socio-political discourse. In such critical post normal times (SARDAR, 2009) radical imagination (HAIVEN & KHASNABISH, 2014) and epistemic activism, embracing non-dominant modes of knowledge production in the social and health sciences, becomes a necessity. Arts-based research (ABR) is resonant with the onto-epistemological perspectives and methodologies necessary to challenge and disrupt current unilateral and hegemonic paradigms underlying decaying societal and geo-political constructs. In this article, we advocate for the development of a global network of ABR scholars and stakeholders invoking a radical imaginative philosophy and arts-based research methodologies as an approach to social activism and epistemological change.Die Wichtigkeit aktueller Trends in Technologie, Digitalisierung und Massenmedien für die globale Kultur führt zu Fragen nach der Verantwortlichkeit und Ethik forscherischer Entscheidungen in den Sozial- und Gesundheitswissenschaften. Eingebettet in die jeweils dominanten Paradigmen affizieren diese Trends subtil unsere Weltsicht, unsere Werte und den Charakter sozio-politischer Diskurse. In diesen kritischen post-normalen Zeiten (SARDAR 2009) werden radikale Imagination (HAIVEN & KHASNABISH 2014) und epistemischer Aktivismus, verbunden mit nicht-dominanten Weisen der Wissensproduktion, zu einer Notwendigkeit. Kunstbasierte Forschung (KBF) beinhaltet onto-epistemologische Perspektiven und Methodologien, die erforderlich sind, um die gegenwärtigen unilateralen und hegemonialen Paradigmen herauszufordern und zu stören, die den überkommenen gesellschaftlichen und geo-politischen Konstrukten unterliegen. In diesem Beitrag vertreten wir die Etablierung eines globalen Netzwerks von KBF-Wissenschaftler*innen und Stakeholdern und die Nutzung einer radikal-imaginativen Philosophie und von kunstbasierten Verfahren als Ausgangspunkte für sozialen Aktivismus und einen epistemologischen Wechsel

Adult malnutrition: prevalence and use of nutrition-related quality indicators in South African public-sector hospitals

Objectives: The aim of this study was to describe the prevalence of malnutrition among adult hospitalised patients in three South African public hospitals and to determine the availability of nutrition-related quality indicators at ward and institutional level. Method: A descriptive, cross-sectional, multi-centre study was used to determine the prevalence of malnutrition, whilst a descriptive exploratory design was used to determine the use of nutrition-related quality indicators for the identification and treatment of malnutrition. A total of 141 adult hospitalised patients in three public hospitals in an urban setting participated. Mid-upper arm circumference (MUAC), body mass index (BMI), and malnutrition universal screening tool (MUST) were used to determine the prevalence of malnutrition or malnutrition risk. A Hospital Nutrition Review Tool (HNRT) determined the use of nutrition-related quality indicators. Results: The overall malnutrition risk according to MUST was 72.3% (48.2% high risk and 24.1% medium risk), whilst 45.4% were malnourished based on MUAC. No routine nutritional screening was conducted in any of the wards to identify patients at nutritional risk. The majority of nurses reported inadequate training or knowledge to calculate patients’ BMI or percentage weight loss, or to perform nutritional screening. Conclusion: Both malnutrition prevalence and malnutrition risk among adult hospitalised patients are high in the public sector. Inadequate resources may lead to delays in malnutrition identification and appropriate nutritional intervention, which may adversely affect both the patient and the institution. This study contributes to baseline data on adult malnutrition in the South African public hospital setting

The funding of specialised paediatric palliative care in Switzerland: a conceptualisation and modified Delphi study on obstacles and priorities

BACKGROUND: Effective funding models are key for implementing and sustaining critical care delivery programmes such as specialised paediatric palliative care (SPPC). In Switzerland, funding concerns have frequently been raised as primary barriers to providing SPPC in dedicated settings. However, systematic evidence on existing models of funding as well as primary challenges faced by stakeholders remains scarce. AIMS: The present study’s first aim was to investigate and conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. Its second aim was to identify obstacles to and priorities for funding these programmes sustainably. METHODS: A 4-step process, including a document analysis, was used to conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. In consultation with a purposefully selected panel of experts in the subject, a 3-round modified Delphi study was conducted to identify funding-relevant obstacles and priorities regarding SPPC. RESULTS: Current funding of hospital-based consultative specialised paediatric palliative care programmes is complex and fragmented, combining funding from public, private and charitable sources. Overall, 21 experts participated in the first round of the modified Delphi study, 19 in round two and 15 in round three. They identified 23 obstacles and 29 priorities. Consensus (>70%) was obtained for 12 obstacles and 22 priorities. The highest level of consensus (>90%) was achieved for three priorities: the development of financing solutions to ensure long-term funding of SPPC programmes; the provision of funding and support for integrated palliative care; and sufficient reimbursement of inpatient service costs in the context of high-deficit palliative care patients. CONCLUSION: Decision- and policy-makers hoping to further develop and expand SPPC in Switzerland should be aware that current funding models are highly complex and that SPPC funding is impeded by many obstacles. Considering the steadily rising prevalence of children with life-limiting conditions and the proven benefits of SPPC, improvements in funding models are urgently needed to ensure that the needs of this highly vulnerable population are adequately met

Extent of post-traumatic stress disorder among Eastern Cape emergency care workers in the public health care sector

Background: Pre-hospital emergency care workers (PECWs) often struggle to cope with an increasingly hostile environment while on duty. As a result, the prevalence of post-traumatic stress disorder (PTSD) amongst PECWs is on the rise and negatively affects their ability to treat patients. Further, PTSD could cloud PECWs’ clinical decision-making and judgement. This ultimately places strain on emergency care departments’ resources and directly affects patient care and service delivery. The aim of the study was to determine the extent to which PECWs experience PTSD symptoms in Nelson Mandela Bay (NMB). Methods: A quantitative design and convenience sampling method were used. The research population for this study was all operational PECWs employed by the Eastern Cape Department of Health within the emergency medical services (EMS) in NMB. Data were collected by means of a self-administered questionnaire comprising two sections; the first section focused on respondents’ demographic information, and the second section was a validated PTSD questionnaire. Descriptive and inferential statistics were reviewed using Microsoft Excel. Results: Sixty-eight PECWs took part in the study. It was identified that of the 68 respondents, 41 (60.3%) showed symptoms of PTSD and could possibly be diagnosed with PTSD. The mean PTSD score was 42.01±17.354, ranging in the category of ‘possible diagnosis of PTSD’. The highest mean PTSD scores were reported among respondents who identified themselves as female (p<0.001). Those within the age category of 51–60 years, those who were Advanced Life Support (ALS) practitioners, and those with 20 years or more work experience also had high mean PTSD scores. Conclusion: PTSD remains a burden on both the individual and the organisation employing the individual. This study highlighted that many PECWs employed in the Eastern Cape public health care sector showed symptoms and could be diagnosed with PTSD, with female PECWs being at the highest risk

Work-related quality of life in professionals involved in pediatric palliative care: a repeated cross-sectional comparative effectiveness study

Background: Working in pediatric palliative care (PPC) impacts healthcare and allied professionals’ work-related quality of life (QoL). Professionals who lack specific PPC training but who regularly provide services to the affected children have articulated their need for support from specialized PPC (SPPC) teams. Objectives: This study had two objectives: (1) to evaluate whether the availability of a SPPC team impacted the work-related QoL of professionals not specialized in PPC; and (2) to explore the work-related QoL of professionals working in PPC without specialized training. Design: Repeated cross-sectional comparative effectiveness design. Methods: One hospital with an established SPPC program and affiliated institutions provided the intervention group (IG). Three hospitals and affiliated institutions where generalist PPC was offered provided the comparison group (CG). Data were collected by paper-pencil questionnaire in 2021 and 2022. The Professional Quality of Life (ProQOL 5) questionnaire was used to assess work-related QoL, yielding separate scores for burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS). A descriptive statistical analysis was performed and general estimation equations were modelled. To increase the comparability of the IG and CG, participants were matched by propensity scores. Results: The 301 participating non-PPC-specialized professionals had overall low to moderate levels of BO and STS and moderate to high levels of CS. However, none of these scores (BO: p = 0.36; STS: p = 0.20; CS: p = 0.65) correlated significantly with support from an SPPC team. Compared to nurses, physicians showed higher levels of BO (1.70; p = 0.02) and STS (2.69; p ⩽ 0.001). Conclusion: Although the study sample’s overall work-related QoL was satisfactory, it showed a considerable proportion of moderate BO and STS, as well as moderate CS. To provide tailored support to professionals working in PPC, evidence regarding key SPPC support elements and their effectiveness is needed. Trial registration: ClinicalTrials.gov ID, NCT04236180

GREGOR: Optics Redesign and Updates from 2018-2020

The GREGOR telescope was inaugurated in 2012. In 2018, we started a complete upgrade, involving optics, alignment, instrumentation, mechanical upgrades for vibration reduction, updated control systems, and building enhancements and, in addition, adapted management and policies. This paper describes all major updates performed during this time. Since 2012, all powered mirrors except for M1 were exchanged. Starting from 2020, GREGOR observes with diffraction-limited performance and a new optics and instrument layout.Comment: Accepted by A&A, 10 page

Culture-based prescribing to improve mental health: a scoping review protocol

Objective: The objective of this review is to investigate what is known about culture-based prescribing to improve mental health and well-being. Introduction: Culture-based prescribing, where a person is referred by a clinical professional to an arts or cultural activity aimed at improving mental health and well-being, is increasingly used as a community-based source of support. Although culture-based prescribing seems promising, the field is heterogeneous with respect to definition, underlying hypotheses, and cultural activity, and this hampers its further development and implementation. Inclusion criteria: We will consider publications that report on or explore culture-based prescribing to improve mental health and well-being for adults suffering from symptoms related to mental health conditions who are seeking care from any clinical professional. Methods: We will search 8 electronic literature databases for published or unpublished reports on culture-based prescribing, without time limits. We will also search for gray literature and screen reference lists of relevant reviews. No language restrictions will be applied during the screening process, but for data extraction, we will only extract studies in languages our team has proficiency in. The screening and data extraction will be performed by 2 reviewers, independently. Data analysis will be descriptive, with results tabulated separately for each subquestion. The results will be complemented with a narrative summary

‘Doing the best we can’: Registered Nurses' experiences and perceptions of patient safety in intensive care during COVID-19

Aims: To explore registered nurses' experiences of patient safety in intensive care during COVID-19. Design: A qualitative interview study informed by constructivism. Method: Semi-structured interviews were conducted and audio-recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework. Results: Two key themes were identified. ‘On a war footing’—an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. ‘Doing the best we can’—Safe Delivery of Care which describes the ramifications of the actions taken on short- and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer Support. Conclusion: Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an understanding of the holistic and long-term impacts on patient safety and recovery from critical illness. Impact: This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing workforce modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals

Numerical modeling of a MEMS actuator considering several magnetic force calculation methods

Purpose: The purpose of this paper is to investigate the accuracy of different force calculation methods and their impact on mechanical deformations. For this purpose, a micrometer scaled actuator is considered, which consists of a micro-coil and of a permanent magnet (PM) embedded in a deformable elastomeric layer. Design/methodology/approach: For the magnetic field evaluation a hybrid numerical approach (finite element method/boundary element method (FEM/BEM) coupling and a FEM/BEM/Biot-Savart approach) is used, whereas FEM is implemented for the mechanical deformation analysis. Furthermore, for the magneto-mechanical coupling several force calculation methods, namely the Maxwell stress tensor, the virtual work approach and the equivalent magnetic sources methods, are considered and compared to each other and to laboratory measurements. Findings: The numerically evaluated magnetic forces and the measured ones are in good accordance with each other with respect to the normal force acting on the PM. Nevertheless, depending on the used method the tangential force components differ from each other, which leads to slightly different mechanical deformations. Research limitations/implications: Since the force calculations are compared to measurement data, it is possible to give a suggestion about their applicability. The mechanical behavior of the actuator due to the acting forces is solely calculated and therefore only an assumption concerning the deformation can be given. Originality/value: A new kind of micrometer scaled actuator is numerically investigated by using two different hybrid approaches for the magnetic field evaluation. Based on those, the results of several force calculation methods are compared to measurement data. Furthermore, a subsequent structural analysis is performed, which shows slightly different mechanical deformations depending on the used force calculation method. © Emerald Group Publishing Limited