Colorectal cancer follow-up: An intervention to support patients following treatment

With an increasing numbers of patients treated for colorectal cancer (CRC), strategies that support existing services are required. This thesis outlines a series of studies including GPs’ approaches to treating CRC problems, plus the development and trial of a self-assessment tool (SATp) to support patients who consult their GPs regarding CRC-related health problems. Overall, using SATp with general practice support is a viable method to support CRC patients with problems following cancer treatment

Physical health of people with mental illness: A snapshot of consumer engagement in the provision of care in primary care.

Primary care is crucial to the health of people with mental illness. However, there is limited information on their reported engagement in this setting. This study surveyed 100 people with mental illness who had a general practitioner or a general practitioner and a case manager from a tertiary mental health service to determine their engagement level with their GP and what interventions they received to manage their health. Forty-four per cent had their psychotropic medications primarily prescribed by their GP, and 58% reported visiting their GP for physical health problems. Ninety-four point nine percent of participants aged 50 years and over had not received government age-recommended preventive health checks. Only 62% of participants reported being screened by their GP for psychotropic side effects. Primary care plays a crucial role in providing physical and mental health care, but service users report gaps in service. The findings suggest a need to support primary care professionals further to coordinate care across primary and secondary care settings

An examination of the career decision-making self-efficacy of final-year nursing students

Background: One in four newly graduated registered nurses leave their employment positions within the first year. To reduce this attrition, nursing stakeholders could focus on the final year of nursing education because students at this stage make professional career plans, including their practice destination for the graduate year and their commitment to the profession. Previous studies provide evidence of nursing students\u27 career preferences and specialty choices. However, there is a dearth of data that focuses on the students\u27 career decision-making process. Aim: This study examined the self-efficacy or confidence of final-year nursing students in making career decisions and the factors that influence their career decision-making process. Setting and participants: Final year pre-registration nursing students (N = 222) at two public universities in Western Australia. Methods: An online survey was used to collect cross-sectional data. The Career Decision Self-Efficacy Scale – Short Form was used to investigate nursing students\u27 confidence in making career decisions. Career decision-making self-efficacy refers to the confidence to successfully complete career decision-making tasks. Descriptive statistics were used to describe the participants\u27 characteristics. The chi-square test was used to assess the significance of the difference between categorical data, and binary logistic regression was used to determine the odds of the factors that predict career decision self-efficacy. Results: Forty-seven percent of participants who answered all Career Decision Self-Efficacy Scale – Short Form questions had good confidence in making career decisions. Factors such as the setting of the final clinical placement, the intention to be employed in the specialisation or organisation of their final placement and the students\u27 assessment of their clinical experience were associated with career decision-making confidence. Conclusions: Most participants had low confidence in making career decisions. This study provides ideas for nursing stakeholders to implement measures to improve students\u27 confidence to make informed career decisions

The impact of final-year clinical placements on nursing students\u27 career planning for the graduate year and beyond

Aims: This study had three objectives: 1) to determine final-year nursing students\u27 career preferences and long-term career plans; 2) to investigate factors influencing nursing students\u27 specialty choices following their final-year clinical placement(s); and 3) to understand how final-year clinical placements can be used to develop the career interests of nursing students to different nursing specialties. Background: Clinical placement provides an insightful experience that may influence students to feel inclined to work in certain specialties. Therefore, each clinical placement should promote students\u27 learning and enhance positive experiences that could develop their career interests and encourage them to seek employment in the specialty on graduation. Design: A cross-sectional online survey. Methods: The survey was structured using the Career Decision Self-Efficacy Scale – Short Form. The questionnaire was distributed to final-year nursing students (N = 222) at two public universities in Western Australia. This study specifically reports on the Goal selection and Planning domains of the Career Decision Self-Efficacy Scale – Short Form, which were explored through additional questions prompting participants to explain their career preferences and reasons for their nursing specialty choices. Results: Most participants, fifty-three percent, had low confidence in making career decisions. The Goal Selection and Planning questions measured the students\u27 confidence in choosing a suitable practice destination and preparing for their professional careers. Overall, participants prefer employment in hospital settings both in the short- and long-term aspects of their nursing career. The factors influencing the students\u27 career decisions were classified into three main categories: the clinical environment, educational factors and individual factors. Conclusions: The nursing curriculum may encourage nursing students to work in some specialties over others. This study provides insight into factors that may promote or inhibit students\u27 career choices and how students may be motivated to pursue the less preferred nursing specialties

Staff perceptions on the effectiveness of GRiP-S, a new approach to clinical supervision incorporating safewards: An interpretive phenomenological analysis

This study explored the impact of an innovative approach to clinical supervision for mental health nurses which integrates Safewards, named Group Reflective integrated Practice with Safewards–GRiP-S. Qualitative data was collected through 10 individual semi-structured interviews with nursing staff who had participated within the clinical supervision approach. Interviews provided insights into the nursing staff’s perception and experience of the clinical supervision approach. Through interpretive phenomenological analysis six themes emerged (i) illuminating embodied practice of Safewards, (ii) building confidence through empowering connections, (iii) creating a culture of positive change, (iv) identifying internal motivation for and external barriers to supervision engagement, (v) navigating a global pandemic, and (vi) the transformative role of reflection. Findings demonstrated that the GRiP-S approach assisted mental health nurses’ adoption of Safewards interventions in practice, while supporting the development of a cohesive staff team. The impact of COVID-19 within the study setting was addressed and nurses identified how the Safewards model assisted in navigating challenges during this time. Findings further supported prior research on the role of the supervisor and supervisee relationship. This study supports the integration of Safewards within reflective clinical supervision for mental health nursing staff to assist in Safewards fidelity and nursing staff personal and professional development

The influence of individual factors on the career preferences and specialty choices of final-year nursing students

Background: Statistical evidence shows that nursing students prefer a professional career in hospital settings, leading to a lack of career interest in non-hospital settings such as community and residential aged care facilities. The lack of preference for non-hospital settings has persisted over several decades and presents a need for different approaches that may reveal new information to better understand the individual factors that influence specialty choices and preferences from the students\u27 viewpoints. Purpose: The aims of this study were to (1) explore individual factors that impact the nursing specialty choices of final-year nursing students and (2) explore how these factors influence the final-year nursing students\u27 career decision-making process. Method: A narrative inquiry approach using semi-structured interviews was carried out with purposively sampled nursing students (n = 12) who had undertaken a final-year clinical placement(s). Data was analysed using two main steps. First, the interviews were restoried and then analysed using the three-dimensional framework. Subsequently, thematic analysis was applied to generate themes. Results: Data analysis generated three main themes: demographic factors, social factors, and career goals. Participants\u27 characteristics and interactions with other individuals and systems influenced their nursing specialty preferences and professional career plans. Conclusion: Nursing students\u27 career interests are influenced by individual factors external to their nursing education, such as their age, gender, and life experiences. These student characteristics and experiences facilitated or inhibited a career in some nursing specialties, with the students gauging their ability to practice in a specialty during their CPs. Nursing education should expose and inform students about the core skills, career opportunities, and how to advance their careers in the different nursing specialties. Most importantly, final-year students may need formal career guidance to encourage nursing students\u27 positive attitudes and career interests in different nursing specialties and make realistic career decisions

Getting a grip on Safewards: The cross impact of clinical supervision and Safewards model on clinical practice

The Safewards model is used across various mental health settings to reduce incidents of conflict and containment and its efficacy in reducing the use of seclusion and restraint, improving patients\u27 experiences of care, and enhancing safety within clinical settings is well documented (Bowers, Journal of Psychiatric & Mental Health Nursing, 21, 2014, 499). However, there are barriers to successful implementation, including level of staff buy-in (Baumgardt et al., Frontiers in Psychiatry, 10, 2019, 340; Price et al., Mental Health Practice, 19, 2016, 14). This mixed-method study assessed the impact of adopting a Safewards model within a clinical supervision framework in an approach, named Group Reflective integrated Practice with Safewards (GRiP-S), which integrates Safewards theory within the clinical supervision framework. Both quantitative and qualitative data were collected using the questions derived from the Manchester Clinical Supervision Scale −26© (Winstanley & White, The Wiley International Handbook of Clinical Supervision. John Wiley & Sons Ltd, 2014). A total of 67 surveys and eight interviews were completed by nursing staff. Overall, the results showed that the GRiP-S approach improves the implementation of Safewards and nurses\u27 clinical practice. Nursing staff satisfaction with clinical supervision and Safewards improved post GRiP-S pre-GRIP-S- 69.54 (SD 16.059); post-GRIP-S 71.47 (SD 13.978). The survey also identified nursing staff\u27s perception of GRiP-S in the restorative and formative domains of clinical supervision improved. The restorative mean score pre-GRiP-S was 28.43 (SD 5.988) and post-GRiP-S 29.29 (SD 3.951). The formative mean score pre-GRiP-S was 20.10 (SD 5.617) and post-GRiP-S 20.63 (SD 13.978). The qualitative results further explained the satisfaction levels and the changes seen in perception domains. The GRiP-S approach reported (i) improved therapeutic relationships and patient centred care, (ii) improved staff communication and teamwork, (iii) barriers to GRiP-S engagement, and (iv) assistance with the change process. The results indicate that the GRiP-S approach had a positive impact on Safewards delivery and supports ongoing change of practice

Integrated clinical pathways for lower limb orthopaedic surgeries: An updated systematic review

Objective The objective of the study was to comprehensively synthesise the components of integrated clinical pathways (ICPs) and post-operative outcomes of patients undergone total hip and knee arthroplasty (THA & TKA) and hip fracture surgeries. Background Previous systematic reviews examined components and effectiveness of ICPs for lower limb joint replacement and hip fracture surgeries. Design and Methods An updated systematic review guided by the Whittemore and Knafl (2005) framework. Electronic databases, Ovid MEDLINE, EBSCOhost-CINAHL, the Cochrane Reviews and Trails, EMBASE and PubMed, were searched from 2007 to 31 January 2021. Due to the heterogeneity of the methods and data collection tools of included studies, pooling of the quantitative data was not possible. Therefore, the included studies were synthesised and presented narratively under subthemes of arthroplasty and hip fracture surgeries. The PRISMA checklist for systematic reviews was used. Results Twenty-four studies met selection criteria with 11 examined ICPs for hip fracture and 13 for the THA and TKA. Twenty-one ICPs were reviewed, and 33 components were extracted. The most frequently included components for hip fracture subgroup were ‘discharge disposition arrangement’ and ‘dedicated personnel and resources’. ‘Exercise plan’ and ‘pain management’ were for the arthroplasty subgroup. A significant reduction in the length of stay and post-operative complications were associated with the ICPs. Results were mixed for the effectiveness of ICPs in reducing unplanned hospital admissions, mortality rates, post-operative complications and hospital costs. Conclusion The number of ICP components varied across studies. This review could not recommend a one size-fits-all ICP that could be adapted for use for patients undergoing hip fracture and joint replacement surgeries. Relevance for clinical practice This review identified research evidence-based components considered as essential for the inclusion in ICP’s for hip fracture and arthroplasty surgeries. Further research is suggested to determine the patient experience and healthcare providers’ acceptance of ICPs

I changed my mind after my placement: The influence of clinical placement environment on career choices of final-year pre-registration nurses

Background: Clinical placements (CPs) in the final year of nursing education largely impact nursing students’ professional development by exposing them to nursing realities. Nursing students also use placement exposure to identify suitable career opportunities for their upcoming professional life. However, there is limited evidence on how final-year CPs may attract pre-registration nursing students into different nursing specialties, including hospital and non-hospital settings. Aim: To explore the influence of CPs in the final year of nursing education on pre-registration student nurses’ career decisions. Method: A narrative inquiry approach was utilised. A purposeful sample of 12 final-year students from two Western Australian public universities participated in the study. Data were collected through semi-structured individual interviews. This article follows the Consolidated Criteria for Reporting Qualitative Research. Findings: The final-year CPs mainly influenced nursing students’ career decisions in three ways: they helped them create new career paths, and some students refined their career plans while others reaffirmed their career choices. Four main themes were generated, including nature of the clinical environment, ward or unit culture, preceptorship, and career progression. Conclusion: The final year of study is crucial for nursing students as they make career plans in preparation for the transition to their professional roles. The students make short- and long-term career plans at this stage, which may influence their commitment to nursing. Implication for practice: The outcome of this study may assist stakeholders in nursing education and health care in developing policies for CPs and students’ career guidance. These policies may encourage pre-registration nurses to develop career interests in the less-preferable nursing specialties such as community nursing and residential aged care

Factors associated with risk of falling among younger inpatients in a mental health setting—A systematic review

Aim: To synthesise evidence related to risk factors of falls among younger mental health inpatients age ≤ 65 years old. Background: Hospitalised patients with mental illness are at increased risk of falling. Specific risk factors for falls for younger inpatients are poorly understood. Design: Systematic review. Methods: Medline, CINAHL, APA PsycINFO, Scopus and Web of Science were searched for studies published in English till December 2022. The review followed the 2020 PRISMA checklist. Odds ratios and P values of significant risk fall factors and the frequency of factors related to circumstances of falls were extracted. Results: Nine studies were included and 95 risk factors, across seven categories were extracted. These categories included socio-demographic, fall-related factors, functional status, health and mental status, psychiatric diagnosis and assessment, medication, and staff related factors. Factors related to medication, health and mental status are most reported. Majority of the patients sustained minor or no injury from the fall and circumstances of fall vary across studies. Conclusion: Factors strongly associated with risk of falls were dizziness, use of psychotropics and antihypertensive drugs. A meta-analysis of risk factors was not possible due to different dependent variables studied, controlled confounding variables and control groups used. Relevance to clinical practice: Fall prevention is relevant to all patients in mental health settings. Approaches to fall risk assessment and management need to be better tailored to younger mental health patients in the psychiatric setting. Patient and public contribution: Patient or public contribution was not possible because of the study design