Unscrambling the egg : a muddled path to a holistic, coherent and integrated institution-wide approach to first year student transition. A Practice Report

A Third Generation approach to the first year experience and transition is widely recognised as essential and current best practice. However the significant challenges to institutions in achieving such an approach is broadly acknowledged. This Practice Report outlines the beginning attempts of one institution to recognise such a goal, and is designed to seek input and insight from workshop participants on proven strategies to progress this goal

New technologies call for new strategies for patient education

For many, electronic devices and wearables are part of everyday life. With the recent launch of the Apple iPhone 12 Series, it is necessary to consider the impact of these new technologies on cardiovascular implantable electronic devices (CIED). There are emerging case reports describing the effect of everyday technologies such as smart-phones, smart-watches, laptops, and e-cigarettes on temporary inhibition of shock therapy due to the magnetic sensitivity of these devices.1–5 Cardiovascular nurses are a consistent provider of CIED education during the trajectory of care from diagnosis, implantation, routine aftercare, and ongoing monitoring during follow-up. As the largest group of the healthcare work force with the most patient contact, we are well positioned to provide leadership and education regarding the increased risk of unintentional magnet reversion from emerging household items

Culturally and linguistically diverse general practitioners’ utilisation of practice nurses

Background: Practice nurses are primarily employed by general practitioners, however little is known about the barriers to practice nurse employment from the perspective of general practitioners (GPs). Aim: This paper seeks to explore solo, culturally and linguistically diverse (CALD) general practitioners’ perceptions of the practice nurse role, and to identify the barriers and facilitators of these doctors employing nurses within their practice. Methods: A descriptive study, using semi-structured interviews, was conducted from July to August 2010. Participants were CALD GPs working as solo practitioners who were members of a Division of General Practice in South Western Sydney. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using thematic analysis. Results: The response rate was 51%, however no demographic differences were identified between responders and non-responders. The majority of participants (73%) agreed that practice nurses could perform vital sign measurements or spirometry. Fewer participants (52—63%) believed practice nurses could perform breast checks, pap smears, or assessment of medication regimes. Perceived barriers to employing a practice nurse included lack of space or equipment, legal implications, lack of a specific job description and language communication issues. Participants identified the need for greater financial rebates, assistance with training practice nurses and assistance with business modelling as facilitators to practice nurse employment. Conclusion: The feasibility of practice nurse employment in practices with solo, culturally and linguistically diverse general practitioners remains a challenge that needs further exploration. Employment of practice nurses may be a viable option for younger practitioners who have a desire to work in collaborative multidisciplinary models

[In Press] Bundle-of-care interventions to improve self-management of patients with urinary catheters : study protocol

Background: Community-based urinary catheter-associated complications contribute to avoidable, costly hospital presentations. To minimise catheter-associated complications and improve the quality of life of patients living in the community, it is essential to improve catheter self-management through increasing patients’ and caregivers’ knowledge and self-efficacy. Aim: To co-design, develop and evaluate a bundle-of-care intervention to improve catheter self-management, reduce catheter-associated complications, and improved quality of life. Design: Mixed methods design underpinned by the principles of Appreciative Inquiry, micro- and spaced-learning pedagogies. Methods: A co-designed care bundle will be developed, to support both patients and nurses in improving catheter care in both acute and community settings. Intervention bundles for patients will be delivered using “GoShare Healthcare” and for nurses, using QStream. The underpinning pedagogical approaches of these two digital platforms focus on increasing knowledge retention and improving patient health outcomes. A process evaluation of the intervention will be undertaken using data collected from surveys, electronic medical record audits, and participant interviews. The primary outcome is improved catheter self-management, and secondary outcomes are increased self-efficacy and patients’ knowledge of catheter self-management. Discussion: The IQ-IDC study applies a two-pronged approach to co-design a bundle-of-care intervention that addresses important gaps in current catheter management. This study will contribute to new knowledge on effective implementation strategies to optimise self-management in urinary catheter care

Nursing as first choice predicts nursing program completion

Background: Attrition from nursing programs is common, costly and burdensome to individuals, nursing faculties and the health care system. Increasingly, nursing faculties are requested to monitor attrition rates as a measure of performance, but little is known of the influence of career choice on program completion. Objectives: The aim of this study was to assess the impact of nursing as a first choice for study on attrition in a baccalaureate nursing program. Design, Setting and Participants: A longitudinal, cohort design was used in this study, which involved undergraduate nursing students enrolled at a university in Australia. Of the 357 participants who completed a baseline survey in 2004 at entry to their Bachelor of Nursing program, 352 were followed up over a six-year period to the end of 2009. Results: Students who selected nursing as their first choice for study were nearly twice as likely (OR: 1.99 95% CI: 1.07–3.68) to complete their nursing program compared to those who did not. These students were also more likely to be older (mean age: 26.8 vs 20.1 years, Pb0.001), and employed in nursing-related work (35% vs 2%, Pb0.001). In addition, the study revealed that male students (OR: 1.93 95% CI: 1.07–3.46) and those who worked more than 16 h per week during semester (OR: 1.80 95% CI: 1.09–2.99) were less likely to complete than their counterparts. Conclusions: These data assist in generating realistic projections of completion and entry to the workforce. Understanding patterns of attrition and individuals' motivations to be a nurse is important not only for supporting nursing students to help them complete their studies but also for developing more targeted strategies directed toward student recruitment and retention

Diversity and demographic heterogeneity of Australian nursing students : a closer look

Background:  In the last decade, there has been a rapid growth of international students undertaking nursing studies in Australian universities. At the same time, nursing courses continue to attract local students from a diversity of backgrounds. Aim:  The aim of this study is to examine first year nursing students by enrolment classification and country of birth: i) international; ii) local, overseas-born; and iii) local, Australian-born student, and demographic differences of academic performance at the 12-month follow-up. Methods:  A prospective, correlational design was used to identify nursing student characteristics as predictors of academic performance in a large university in the western region of Sydney. Results:  Of the 806 students enrolled in the course, 540 (67%) completed the survey and consented to data linkage. Fifty-six per cent of the 540 participants were born overseas, of which 38% were local and 18% were international students. Local, overseas-born students originated from 55 different countries, in contrast to international students who were representative of only 16 different countries. International students were younger, spent less time in paid work and were more likely to have a close friend in the same course. Although age was positively related to academic performance, local, overseas-born and international enrolment classifications, and hours in paid work during semester were negatively associated to academic performance. Conclusion:  This study has taken a closer look at an important issue that requires further examination, given that international and local, overseas-born students were two distinctive groups. Although both groups underperformed academically compared with Australian-born students, the differences in characteristics between local, overseas-born students and international students suggest that these two student groups are likely to experience different challenges during their nursing studies in Australia

Predictive validity of the post-enrolment English language assessment tool for commencing undergraduate nursing students

Background: Nursing students with English as an additional language (EAL) may underperform academically. The post-enrolment English language assessment (PELA) is used in literacy support, but its predictive validity in identifying those at risk of underperformance remains unknown. Objectives: To validate a PELA, as a predictor of academic performance. Design: Prospective survey design. Setting: The study was conducted at a university located in culturally and linguistically diverse areas of western Sydney, Australia. Participants: Commencing undergraduate nursing students who were Australian-born (n = 1323, 49.6%) and born outside of Australia (n = 1346, 50.4%) were recruited for this study. The 2669 (67% of 3957) participants provided consent and completed a first year nursing unit that focussed on developing literacy skills. Method: Between 2010 and 2013, commencing students completed the PELA and English language acculturation scale (ELAS), a previously validated instrument. The grading levels of the PELA tool were: Level 1 (proficient), Level 2 (borderline), and Level 3 (poor, and requiring additional support). Results: Participants with a PELA Level 2 or 3 were more likely to be: a) non-Australian-born (χ2 : 520.6, df: 2, p b 0.001); b) spoke a language other than English at home (χ2 : 490.2, df: 2, p b 0.001); and c) an international student (χ2 : 225.6, df: 2, p b 0.001). There was an inverse relationship between participants' ELAS scores and PELA levels (r = −0.52, p b 0.001), and those graded as ‘proficient’ with a PELA Level 1 were more likely to obtain higher scores in their: i) unit essay assessment (χ2 : 40.2, df: 2, p b 0.001); ii) final unit mark (χ2 : 218.6, df: 2, p b 0.001), and attain a higher GPA (χ2 : 100.8, df: 2, p b 0.001). Conclusion: The PELA is a useful screening tool in identifying commencing nursing students who are at risk of academic underachievement

Health-related quality of life in survivors of septic shock : 6-month follow-up from the ADRENAL trial

Purpose: To investigate the impact of hydrocortisone treatment and illness severity on health-related quality of life (HRQoL) at 6 months in septic shock survivors from the ADRENAL trial. Methods: Using the EuroQol questionnaire (EQ-5D-5L) at 6 months after randomization we assessed HRQoL in patient subgroups defined by hydrocortisone or placebo treatment, gender, illness severity (APACHE II < or ≥ 25), and severity of shock (baseline peak catecholamine doses < or ≥ 15 mcg/min). Additionally, in subgroups defined by post-randomisation variables; time to shock reversal (days), treatment with renal replacement therapy (RRT), and presence of bacteremia. Results: At 6 months, there were 2521 survivors. Of these 2151 patients (85.3%-1080 hydrocortisone and 1071 placebo) completed 6-month follow-up. Overall, at 6 months the mean EQ-5D-5L visual analogue scale (VAS) was 70.8, mean utility score 59.4. Between 15% and 30% of patients reported moderate to severe problems in any given HRQoL domain. There were no differences in any EQ-5D-5L domain in patients who received hydrocortisone vs. placebo, nor in the mean VAS (p = 0.6161), or mean utility score (p = 0.7611). In all patients combined, males experienced lower pain levels compared to females [p = 0.0002). Neither higher severity of illness or shock impacted reported HRQoL. In post-randomisation subgroups, longer time to shock reversal was associated with increased problems with mobility (p = < 0.0001]; self-care (p = 0.0.0142), usual activities (p = <0.0001] and pain (p = 0.0384). Amongst those treated with RRT, more patients reported increased problems with mobility (p = 0.0307) and usual activities (p = 0.0048) compared to those not treated. Bacteraemia was not associated with worse HRQoL in any domains of the EQ-5D-5L. Conclusions: Approximately one fifth of septic shock survivors report moderate to extreme problems in HRQoL domains at 6 months. Hydrocortisone treatment for septic shock was not associated with improved HRQoL at 6 months. Female gender was associated with worse pain at 6 months