Nurse education leaders' perspectives on the teaching of numeracy to undergraduate nursing students : a qualitative research study

Aim The aim of this study was to explore the perspectives of nurse education leaders of Australian undergraduate nursing degrees on the teaching of nursing numeracy and how the Australian Nursing & Midwifery Accreditation Standards influence curriculum development. Background Nurses’ numeracy skills are reportedly deficient worldwide, posing a significant threat to patient safety. This is an issue for the education of undergraduate nurses and thus for the nursing profession. The international literature reveals a heterogeneous blend of learning approaches, but it is unclear which approaches are best suited to improve the numerical calculation ability of nurses. In the Australian context, there are no accreditation standards referring to numeracy, therefore, it is important to discover how nurse education leaders’ design and implement the teaching of numeracy. Design A qualitative approach using thematic analysis was employed. The setting was Australian universities that delivered an accredited undergraduate nursing degree leading to nursing registration. Methods Purposive sampling was used to recruit 17 nurse education leaders of Australian undergraduate nursing degrees. Individual, semi-structured virtual interviews were conducted between November 2022 and January 2023. Interview data were analysed using Braun and Clarke’s (2006) six phases of thematic analysis. Findings Five themes emerged from the analysis: (i) indistinct accreditation standards, (ii) teaching basic maths for clinical applications, (iii) a range of bespoke teaching approaches (iv) we’re nurses, not numeracy educators and (v) assumptions about an unprepared cohort. Conclusion The leaders of undergraduate nursing degrees assumed that nursing students would have proficiency in numeracy skills on entering university. However, this was not the case, hence numeracy was an essential skill that needed to be taught to the undergraduate nursing students. Lack of direction from the accreditation council led to the existence of various curricula and an array of approaches to teaching numeracy and medication calculations, which challenged nursing academics who did not consider themselves numeracy educators. This study makes a novel contribution to knowledge, teaching and practice in undergraduate nursing numeracy curricula

Nursing students' clinical performance on placement : voices from clinical facilitators

The clinical learning environment experienced by undergraduate nursing students during clinical placements form an integral component of nursing education (Bisholt et al. 2014), to connect theory with practice, and develop the clinical skills necessary to transition into graduate practice as a registered nurse (Cooper et al. 2015). The clinical facilitator, also known as clinical instructor, supervisor or preceptor plays a pivotal role in this learning experience by supporting, supervising and monitoring students’ clinical capabilities by benchmarking against industry standards and expectations

Two hats, one aim : nurses in partnership for better Indigenous health

As nurses and academics working in separate areas and contexts of health care, but with similar aims of improving Aboriginal and Torres Strait Islander health, we knew the need for connecting with each other as well as with the wider Indigenous community

Predictors of negative attitudes toward Indigenous Australians and a unit of study among undergraduate nursing students : a mixed-methods study

Indigenous people are the most disadvantaged population within Australia. The Bachelor of Nursing program at a large university in Western Sydney embedded Indigenous health into the undergraduate teaching program. This paper reviews the negative responses received towards course content on evaluation of the Indigenous health unit and explores the predictors for the negative attitudes towards Indigenous Australians. Two surveys were used (baseline and follow-up) to: 1. Determine the main predictors for negative attitudes towards Indigenous people and; 2. Explore students’ perceptions of the educational quality of the Indigenous health unit. The surveys allowed collection of socio-demographic, academic data and included the 18 item ‘Attitude Toward Indigenous Australians’ (ATIA) scale and open-ended responses. Students who were: 1. Overseas born, 2. Enrolment category: International student and; 3. Whose primary source of information about Indigenous Australians were the media and school were significantly more likely to have higher negative attitudes towards Indigenous Australians. Qualitative data revealed some unfavourable comments dismissing the value and educational quality of the content within the Indigenous health unit. Community engagement is paramount to enhancing the student experience. Movement away from media driven ‘hype’ to an educated perspective is necessary to create an accurate portrayal of the Indigenous community

Daily intra-abdominal pressure, sequential organ failure score and fluid balance predict duration of mechanical ventilation

Background: Elevated intra-abdominal pressure (IAP) is a common occurrence in mechanically ventilated patients in the intensive care unit (ICU). This study was undertaken to determine the relationship between IAP, pulmonary compliance and the duration of mechanical ventilation. Methods: A prospective study of 220 consecutively enrolled mechanically ventilated patients admitted to a mixed surgical-medical ICU in a tertiary referral hospital. The IAP was measured at least twice daily, benchmarked against consensus guidelines. Dynamic pulmonary compliance was calculated together with admission Acute Physiology and Chronic Health Evaluation (APACHE III) score and daily Sequential Organ Failure Assessment (SOFA) score. Results: No relationship between highest IAP for the day and pulmonary compliance (P=0.61) was found. For each 5mm Hg increase in IAP, the risk of remaining intubated increased 19% (HR=1.19, 95% CI: 0.98-1.44); for each standard deviation increase in SOFA score (3.7 points), the risk of remaining intubated increased by 14% (HR=1.14, 95% CI: 0.98-1.33); and for each 1 L increase in fluid balance, the risk of remaining intubated increased by 11% (HR=1.11, 95% CI: 1.04-1.19). A nomogram was developed to predict the probability of extubation based on daily highest IAP for the day, SOFA score and fluid balance. Conclusion: IAPs did not correlate with pulmonary compliance in critically ill patients. Increased IAP was associated with a longer duration of mechanical ventilation. A nomogram integrating daily IAP, SOFA score and fluid balance may be used to predict the duration of mechanical ventilation

Nursing in Australia : nurse education, divisions and professional standards

The nursing profession in Australia is regulated; nursing education is regulated by a system of accreditation and nursing practice by a system of registration. This dual regulation provides the structure for this chapter. In Part 1, we describe the accreditation of nurse education by the Australian Nursing and Midwifery Accreditation Council. This part explains how health care providers and consumers can be assured that the courses undertaken in order to enable a person to apply for nursing registration will actually qualify that person for registration. We then describe how nursing education came to be delivered in universities rather than in hospitals, as it was until the 1980s. In Part 2, we describe the registration process and what it means for nursing practice. Registration through the Nursing and Midwifery Board of Australia (NMBA) is required to enable nurses to practice legally; however, we also describe some of the associations that promote nursing as a profession apart from the legal requirements of registration

Intra-abdominal hypertension and the open abdomen : nursing guidelines from the Abdominal Compartment Society

Intra-abdominal hypertension has been identified as an independent risk factor for death in critically ill patients. Known risk factors for intra-abdominal hypertension indicate that intra-abdominal pressures should be measured and monitored. The Abdominal Compartment Society has identified medical and surgical interventions to relieve intra-abdominal hypertension or to manage the open abdomen if abdominal compartment syndrome occurs. The purpose of this article is to describe assessments and interventions for managing intra-abdominal hypertension and open abdomen that are within the scope of practice for direct-care nurses. These guidelines provide direction to critical care nurses caring for these patients

Nursing in Australia: Contemporary Professional and Practice Insights

Graduate nurses are expected to 'hit the ground running', taking on complex care challenges in a stressful and fast-paced environment. This comprehensive yet accessible textbook provides expert guidance for students and commencing nurses on the contexts for their practice. Part 1 presents a pragmatic insight into the intersection, tensions and complexities of practice and professional issues for Australian nurses. It outlines the nature of nursing roles and professional codes of conduct, national health priority areas and legal and ethical issues including the growing use of health informatics. There is an examination of the diverse career paths available in nursing, a focus on nurses' mental health and well-being and a special examination of Aboriginal and Torres Strait Islander health issues. Part 2 unpacks key issues across a range of clinical contexts that will be a key resource for clinical practicums. Contexts covered include acute care, community nursing, paediatric nursing, mental health nursing and aged care. Part 3 examines the professional and practice issues of nursing in diverse, distinctive and emergent practice areas including aesthetic nursing, military nursing and international nursing with case studies and vignettes highlighting common issues and challenges. Drawing on the expertise of a wide range of Australian clinical and academic nursing professionals, this text is a key reference for all nursing undergraduates seeking to enter successfully into the profession

Nursing students' clinical performance issues and the facilitator's perspective : a scoping review

Clinical placement experience is an integral component of nursing education as students acquire the essential knowledge and skills through learning in a supervised clinical environment. The role of the facilitator is pivotal to ensure students are practising safely and competently. The aim of this review was to explore the clinical performance issues identified by clinical facilitators, examine the relationship between students' academic and clinical performance, and factors influencing performance and attrition. A scoping review was undertaken to identify relevant literature, emerging themes and gaps in the literature, searching five electronic databases for primary and secondary papers, and the grey literature. No date limit was set for the review. Fifteen papers met the inclusion criteria. The top three themes relating to clinical performance issues included: i) Poor communication skills, ii) Inadequate knowledge or clinical incompetence and, iii) Unprofessional behaviour. The review also identified the relationship between academic and clinical performance, and negative experiences influencing students’ decisions to leave the course. This scoping review highlighted the paucity of literature relating to clinical performance from the perspective of the facilitator, as well as the relationship between student characteristics and clinical performance and attrition

Undergraduate nursing curricula : numeracy and accreditation

Background: Services where patients and family members (consumers) are incorporated as responders in the reporting of patient deterioration is becoming a growing global strategy in healthcare. These services are designed to complement rapid response systems where reporting of patient deterioration is undertaken by health professionals such as nursing staff. Yet research studies report limited consumer participation in the development of consumer-activated response services. The aim of this study was to investigate consumers’ views on their reporting of patient deterioration prior to the development of a new consumer-activated response service in a healthcare organisation. Methods: A qualitative, focus group methodology was utilised. Ten consumers, previous patients or family members/carers from two acute hospitals, were interviewed. The focus group interviews were audio-recorded, transcribed and analysed using Attride-Stirling's (2001) thematic networks analysis framework. The COREQ criteria for reporting of qualitative research was used to guide this study (Tong et al., 2007). Findings: Three themes emerged: “reassurance is natural”, “a response service is necessary” and “meaningful promotion is critical”. Health professionals’ reassurance motivated consumers’ reporting of their concerns. A list of clinical symptoms of deterioration was not important to consumers. Patient advocates were seen as useful to consumers’ decision-making to report deterioration. Routine messaging on the reporting process would encourage use of a consumer-activated response service. Conclusion: This study confirmed that consumers perceived the need for a consumer-activated response service. It also demonstrated the necessity of consumer involvement in the development of a response service so that the steps made sense to them. Consumers’ perspectives were seen as integral to the development of educational materials related to the consumer-activated response service to maximise its effectiveness. The consumers’ need for support and education to effectively utilise a consumer-activated response service was also highlighted. Nurses have a critical role in introducing and educating consumers on the consumer-activated response service when patients are in hospital