The effect of nursing interventions on thermoregulation and neuromotor function in very low birthweight infants

The prone position is used routinely in neonatal intensive care units worldwide in the nursing of preterm infants because of reported beneficial psychological effects This position can, however, lead to development of flattened posture very low birthweight (VLBW) infants and contributes to both short and longer term implications for functional motor development of upper and lower extremities. To date limited research has been undertaken to investigate methods of reducing flattened posture and its related negative outcomes temperature instability is also a problem for VLBW infants and no nappy exists that meets postural size and thermoregulation requirements. The purpose of this study was to demonstrate the effect of a nursing care model designed for the primary prevention of neuromotor problems and temperature instability in VLBW infants. The theoretical framework was based on two bodies of knowledge thermoregulation and neuromotor development. A two phase study was used to test two hypotheses: (1) use of a cloth postural support nappy (N) with an inner absorbent nappy liner would improve temperature stability in VLBW infants nursed in incubators on infant servo control (ISC): and (2) use of a postural support roll (R) with or without a N would improve neuromotor development in the short and longer term. In Phase1 a sample of 23 infants \u3c 31 weeks gestation nursed in incubators on ISC was recruited over two months to a randomised, observer blind, crossover trial infants were randomised to commence wearing either a N with or without an inner absorbent liner and alternated wearing each nappy for a 24 hour period over four days. Eight hourly per axilla (PA) temperatures and hourly measurements of infant handling, skin and incubator temperatures were recorded. lnfants in both groups were well matched for birth and postnatal variables. Findings showed that nursing infants in a N with an inner absorbent liner experienced clinically and statistically significant higher skin and lower incubator temperatures. In addition, a prediction model for PA temperature was developed that showed it was possible to predict PA temperatures from skin temperatures. In Phase 2. a sample of 123 infants \u3c 31 weeks gestation was recruited to a randomised, observer blind, controlled trial. Infants were randomised to one of three treatment groups (i.e., N only, N and R, or R only). Measurements of neuromotor development were performed at three assessment periods (i.e., from birth to term conceptional age, then at four and eight months conceptional age). Randomisation was effective. Findings confirmed previous study findings that use of a N improves hip posture up to term conceptional age. The major finding was that use of a R while VLBW infants are nursed in the prone position in a NICU improved hip and shoulder posture up to eight months conceptional age. In addition, an Infant Posture Evaluation Tool (IPAT) was developed that will enhance the clinical skills of health Professionals involved in the care of these infants. The findings contribute to neonatal nursing theory development in thermoregulation and neuromotor development and function in VLBW infants. Practice implications focus on promoting temperature stability and normal neuromotor function in VLBW infants up until eight months conceptional age. Longer term research will determine the effect of postural interventions on gait and foot progression angles. Testing and validation of the IPAT will facilitate future research related to infant posture

Qualitative results from a phase II pilot randomised controlled trial of a lymphoma nurse-led model of survivorship care

Purpose: To explore and describe lymphoma survivors’ thoughts and perceptions of the components of a nurse led lymphoma survivorship clinic intervention. Methods: An exploratory, qualitative descriptive study using interviews from 10 participants who had transitioned post-treatment into the survivorship phase via a nurse-led lymphoma survivorship clinic intervention. Results: Thematic analysis revealed three major themes: Reassurance and individualised care; Information and support; and Empowerment. Participants described the reassurance they gained from having contact with a health professional post-treatment who individualised information and support. A survivorship care plan and treatment summary was developed for this study and was believed to be very patient-centred and helpful. This enabled participants to take back control of their health and well-being and to rebuild confidence. Conclusions: In this study, participants expressed a need for patient-centred follow-up care that addressed their concerns and supported them in the survivorship phase to get their life back on track. Nurse-led follow-up may offer a viable model of post-treatment survivorship care to lymphoma cancer survivors

Towards a conceptual framework for preceptorship in the clinical education of undergraduate nursing students

A recent study undertaken by the authors (2007) highlighted that undergraduate nursing students were subjected to varying experiences in clinical practice, which were mediated by a number of factors. Mediating factors included continuity of preceptors, student attitudes, the clinical setting environment, student and preceptor expectations of the clinical practice experience and interactions between the student and preceptor. Of note, interactions with preceptors were seen to \u27make or break\u27 the practical experience. Therefore, the relationship that is forged between preceptor and student is vital in shaping the student\u27s experience of the clinical area and of the real world of nursing work. Early positive socialisation experiences have been shown to improve retention rates of new nurses (Greene & Puetzer 2002), which are issues of prime concern in an era of worsening nursing shortages at all levels of the profession. A conceptual framework designed to guide preceptorship may help alleviate some of the difficulties experienced by undergraduate nurses in building relationships within the complex interactions of the nursing environment. The framework proposed in this paper offers a conceptual model that links positive preceptor leadership qualities (such as compassion, care and empathy) with student characteristics. This model proposes that synergistic interactions between nursing students and preceptors results in positive implications for the nursing workforce. This framework also has the potential for further development to fill the void created by a lack of conceptual guidance for supervisory interactions within the undergraduate clinical context

Systematic review and meta-analysis of patient reported outcomes for nurse-led models of survivorship care for adult cancer patients

Purpose: This systematic review aimed to determine the effectiveness of nurse-led cancer survivorship care, compared with existing models of care, on patient reported outcomes for cancer survivors. Methods: Randomised and non-randomised controlled trials and controlled before-after studies published in English between 1 January 2007 and 28 July 2017 were identified in bibliographic databases including Medline, Pubmed and PsychINFO. Included studies described nurse-led cancer care after treatment to adults (age ≥18 years) \u3c2 years post treatment completion. Risk of bias was assessed using Joanna Briggs Institute’s tools and meta-analysis was undertaken. Results: Twenty one publications were included describing 15 tumour-specific trials involving 3278 survivors of breast (n = 5), gynecological (n = 3), head and neck (n = 2), colorectal (n = 2), upper gastrointestinal (n = 2) and prostate (n = 1) cancers. Seven trials reported quality of life (QoL) using the EORTC QLQ-C30; participants receiving nurse-led care (4–6 months) had better cognitive (4 trials, 463 participants; mean difference [MD] = 4.04 [95% CI, 0.59–7.50]; p = 0.02) and social functioning (4 trials, 463 participants; MD = 3.06 [0.14–5.97]; p = 0.04) but worse appetite loss (3 trials, 354 participants; MD = 4.43 [0.08–8.78]; p = 0.05). After intervention completion, intervention participants had reduced fatigue (4 trials, 647 participants; MD = −4.45 [−7.93 to −0.97]; p = 0.01). Conclusion: This systematic review synthesised outcomes of models of nurse-led survivorship care and contributes a meta-analysis of patient QoL to survivorship evidence. This review was limited by the risk of bias in many included studies for blinding of treatment personnel and outcome assessors. Nurse-led care appears beneficial for cancer survivors for some QoL domains

Test-retest reliability of the short-form survivor unmet needs survey

Objective: Reliable and valid needs assessment measures are important assessment tools in cancer survivorship care. A new 30-item short-form version of the Survivor Unmet Needs Survey (SF-SUNS) was developed and validated with cancer survivors, including hematology cancer survivors; however, test-retest reliability has not been established. The objective of this study was to assess the test-retest reliability of the SF-SUNS with a cohort of lymphoma survivors (n = 40). Methods: Test-retest reliability of the SF-SUNS was conducted at two time points: baseline (time 1) and 5 days later (time 2). Test-retest data were collected from lymphoma cancer survivors (n = 40) in a large tertiary cancer center in Western Australia. Intraclass correlation analyses compared data at time 1 (baseline) and time 2 (5 days later). Cronbach\u27s alpha analyses were performed to assess the internal consistency at both time points. Results: The majority (23/30, 77%) of items achieved test-retest reliability scores 0.45-0.74 (fair to good). A high degree of overall internal consistency was demonstrated (time 1 = 0.92, time 2 = 0.95), with scores 0.65-0.94 across subscales for both time points. Conclusions: Mixed test-retest reliability of the SF-SUNS was established. Our results indicate the SF-SUNS is responsive to the changing needs of lymphoma cancer survivors. Routine use of cancer survivorship specific needs-based assessments is required in oncology care today. Nurses are well placed to administer these assessments and provide tailored information and resources. Further assessment of test-retest reliability in hematology and other cancer cohorts is warranted

Developing a Research Agenda for Nursing and Midwifery: A Modified Delphi Study

Aim: We sought to ascertain the nursing and midwifery research priorities at a large private tertiary hospital in Australia. Design: A modified Delphi technique with two rounds of questionnaires. Methods: The first round survey was distributed to 448 nurses and midwives with a 19.2% (n = 86) response rate. Due to a low response rate in some specialties, the second round of the Delphi was only sent to nurses in the Learning and Organisational Development speciality who were asked to rank 10 identified topics specific to Learning and Organisational Development using a five point Likert-type scale. Results: Two hundred and fifty seven topics were identified in Round One and were condensed to 181 topics. Each topic was assigned to one of four categories: clinical audit; existing evidence base; research; or other topics which fell beyond the bounds of nursing or midwifery research. Twenty three research topics were identified with priorities focusing on learning and development and workforce issues. Conclusion: Priorities were congruent with the organisation\u27s strategic workforce focus. Topics identified in this study will ensure that the nursing and midwifery research conducted at the study setting is relevant and reflects priorities as determined by clinical nurses and midwives

Standardisation of systemic anti-cancer therapy (SACT) prescription forms: A pre–post audit evaluation

Introduction Clinical practice guidelines based on best available evidence and national safety and quality standards promote high quality and safe care. Aim To review and standardise systemic anti-cancer therapy (SACT) forms in a 20-chair cancer centre to reflect Australian and international clinical practice guidelines. Method A pre–post audit design based on Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy underpinned the project. The pre-audit (47 forms) provided a benchmark for SACT form improvements: 177 new forms were then developed over 18 months and implemented. Results Pre-audit: 9/19 criteria were \u3e70% compliant with best practice guidelines. Post-SACT implementation audit: 15/19 criteria were \u3e70% compliant. The recent 2018 audit: improvements shown in 18/19 criteria. Conclusion This nurse-led multidisciplinary initiative effectively standardised SACT charts with best practice guidelines, potentially reducing serious medication errors and facilitating a high standard of multidisciplinary patient care

Paediatric palliative and supportive care: caring for life: the needs of children and families in Western Australia

Palliative care is the relief of symptoms, regardless of their impact on the underlying disease process. The philosophical underpinning of current international paediatric palliative and supportive care models is that palliative and supportive care should be offered to all children with life threatening or chronic illnesses/disabilities with complex care needs. This approach allows the integration of cure-directed treatment and palliative care. allowing children to benefit from both philosophies of care. In Australia, there is increasing recognition of the need for the development of appropriate paediatric palliative care services, especially in Western Australia where supportive care services for children with life-limiting conditions are significantly underdeveloped. The needs of children with life threatening conditions and their families are unique and require special consideration to enable the appropriate delivery of multidisciplinary care that aims to relieve suffering and improve quality of life. Although traditionally skills and knowledge base were developed for end-of-life care for adults, palliative care for children with life-threatening illnesses may be combined with curative or disease-modifying therapy. In addition, a child\u27s progressive, life-threatening illness has a profound effect on all dimensions of family life. Families are affected emotionally, psychologically, and financially as family structure and organisation become permanently altered. Only recently have the specific palliative care needs of children and their families been recognised..

Bowel management post major joint arthroplasty: a randomised controlled trial to test two pre-admission bowel regimens

Background: The length of stay for patients undergoing joint arthroplasty has reduced but there is a paucity of knowledge relating to bowel management within this enhanced recovery framework. Aim: The study\u27s primary aim was to determine which of two dosage regimens of macrogol (Movicol®) commenced pre-operatively is most effective in facilitating a return to normal bowel function. Procedure: Ninety-one eligible patients were randomised to one of three groups: 1) commence macrogol one sachet in the morning for two days prior to surgery; 2) commence macrogol one sachet, morning and evening of the day prior to surgery; or 3) control group. Results: Seventy-seven percent of patients in group one, and 83% of group two had returned to normal bowel function by one-week post discharge compared to 70% of control patients (p = .470). Participants in group one required less aperients in the week following discharge compared with the other two groups although the result was not statistically significant (p = .060). Conclusion: Despite not reaching statistical significance, the results are considered clinically significant. The authors recommend patients commence macrogol one sachet in the morning for the two days prior to admission for major joint arthroplasty and the Murdoch Bowel Protocol® continue to be followed for inpatients

Nursing student experiences of death and dying during a palliative care clinical placement: Teaching and learning implications

The Building Capacity in Palliative Care Clinical Training project commenced in 2012 and is providing a dedicated palliative care clinical learning experience for nursing and medical students as part of preparation for palliative care practice in future workplaces. Many students fear death on a clinical placement. This paper reports on a pilot study as part the broader project evaluation that examined nursing students’ experiences of death and how the project driven teaching and learning supported students’ learning experiences