The challenges of conducting a nurse-led intervention in a randomized controlled trial with vulnerable participants

This paper discusses the challenges encountered by researchers while conducting a randomized controlled trial (RCT) testing the efficacy of a healthy lifestyle educational and exercise intervention for people with serious mental illness. RCTs, even though considered the “gold standard” of research designs, are still prone to risks of potential bias and threats to their validity. Based on researcher reflexivity, the combination of reflection and action, during the conduct of the study, this paper outlines a number of challenges faced by the researchers. These included managing the need of participants to tell their story and be heard, reluctance of participants to remain in allocated groups, participant literacy, dual role of the nurse nurse-researcher, and reporting the benefits of nonstatistical results of a quantitative research project. Recommendations for conducting future behaviour intervention studies of this type include the incorporation of a reflexive component for the nurse nurse-researcher, highlighting the importance of taking a reflexive stance in both qualitative and quantitative research designs

If You Knew the End of the Story, Would you Still Want to Hear It?: The Importance of Narrative Time for Mental Health Care

The origins of this paper lie in our experiences of having heard too many stories with the same outcome or ending in the field of inquiry and practice described as “Aboriginal Mental Health.” This paper was written in an attempt to make sense of these experiences. It does so by focussing on another type of outcome or story ending in mental health care/research contexts more widely known as [Recovery]. Not to be confused with the term recovery as it is used in addiction studies, the concept of [Recovery] currently underpinning mental health care policies and reform is at once a philosophy, a practice orientation, and a guiding value and principle. This paper emerged from a range of discussions about [Recovery] as a practice orientation and a particular type of story-ending told by those who receive and provide Aboriginal mental health care in North Queensland. Poetic inquiry was used as a way to respond to the questions that arose from these discussions. In the research projects and discussions that foreground and underpin this paper, the use of poetic reasoning and writing, evolved from using poetry as a reflective tool, to a being used as a method of data collection, data construction, analysis and interpretation (even though none of these words appropriately inscribe these aspects of research within Arts informed research practices). It is also posited as an aesthetic and ethical way of (re)presenting the results of inquiring. This paper (re)presents and unpacks a particular generated poem to demonstrate the approach (as it is and was) used. As an arts-informed approach to social inquiry and to writing, the purpose of this text is to open or introduce an awkward pause in an ongoing dialogue or conversation about Aboriginal people in mental health care and to amplify the Aboriginal voices informing the development of this text

Terminology used to describe health care teams: an integrative review of the literature

Purpose: Health systems around the world are struggling to meet the needs of aging populations and increasing numbers of clients with complex health conditions. Faced with multiple health system challenges, governments are advocating for team-based approaches to health care. Key descriptors used to describe health care teams include "interprofessional," "multiprofessional," "interdisciplinary," and "multidisciplinary." Until now there has been no review of the use of terminology relating to health care teams. The purpose of this integrative review is to provide a descriptive analysis of terminology used to describe health care teams. Methods: An integrative review of the literature was conducted because it allows for the inclusion of literature related to studies using diverse methodologies. The authors searched the literature using the terms interprofessional, multiprofessional, interdisciplinary, and multidisciplinary combined with “health teams” and “health care teams.” Refining strategies included a requirement that journal articles define the term used to describe health care teams and include a list of health care team members. The literature selection process resulted in the inclusion of 17 journal articles in this review. Results: Multidisciplinary is more frequently used than other terminology to describe health care teams. The findings in this review relate to frequency of terminology usage, justifications for use of specific terminology, commonalities and patterns related to country of origin of research studies and health care areas, ways in which terminology is used, structure of team membership, and perspectives of definitions used. Conclusion: Stakeholders across the health care continuum share responsibility for developing and consistently using terminology that is both common and meaningful. Notwithstanding some congruence in terminology usage, this review highlights inconsistencies in the literature and suggests that broad debate among policy makers, clinicians, educators, researchers, and consumers is still required to reach useful consensus

Complexity, safety and challenges: Emergency responders’ experience of people affected by methamphetamines

Providing care to methamphetamine‐related callout events in the prehospital environment is often complex and resource‐intensive, requiring staff to manage agitation and violence‐related side effects of methamphetamines. In Australia, emergency responders are increasingly required to attend events related to methamphetamines, even though reports suggest methamphetamine use across Australia has declined. The aim of the study was to explore Australian police and paramedic experiences attending methamphetamine‐related events. A qualitative descriptive phenomenology design was employed using semi‐structured interviews with employed police (10) and paramedics (8) from Australia. Data were analyzed using thematic analysis. Participants described the complexities associated with providing prehospital care to people affected by methamphetamines. Participants described associated domestic/family violence, increased levels of violence, challenges with communication, and responder emotional and psychological distress and physical injury. Violence associated with methamphetamine use is a critical factor in prehospital care. Workplace violence and family/domestic violence are important issues that require further research to ensure families and staff are well supported and have the services they need to continue responding to people affected by methamphetamine use

Applying a simulation based teaching strategy to promote professional skills development amongst first year nursing students

This presentation will provide an overview of how a teaching team addressed the degree of 'reality shock' experienced amongst first year nursing students via the development of an innovative teaching strategy that embedded simulation into its curriculum. In 2013, Professional Experience Workshops (PEWs) were introduced to the undergraduate nursing curriculum. These workshops combined previously siloed theory based tutorial classes with clinical skills laboratories, thereby, overtly linking theory to practice with the view to minimise the 'reality shock' experienced by students whilst on clinical placement (Mills, West, Langtree, Usher, Henry, Chamberlain-Salaun & Mason, 2014). Despite this positive initiative, feedback from students following their first clinical placement revealed 'reality shock' was not necessarily lessened. Upon reflection about why this issue prevailed, it was discovered by the teaching team that a key component in creating the realism of a dynamic, pressured clinical environment was lacking in the PEWs: students were rarely required to 'think and act on their feet' (Houghton, Casey, Shaw & Murphy, 2013). Furthermore, resilience-building professional skills such as prioritisation, delegation, advocacy and teamwork were not necessarily being developed within the students

Potential challenges of using narrative inquiry with at-risk young people

Aim: To present an overview of several challenges that arose when conducting narrative research with at-risk young people. Background: Being identified as 'at-risk' places an individual in danger of future negative outcomes. Conducting qualitative research such as narrative inquiry with 'at-risk' individuals has the potential for challenges to arise for participants and/or researchers. Discussion: Five main challenges identified and discussed were trauma disclosure, pre-existing relationships, insider/outsider perspective, power relationships and researcher and participant emotional safety. Conclusions: It is imperative that potential challenges be identified prior to the commencement of studies and plans made to address the challenges. Implication for practice: Difficulties can arise with any type of research involving vulnerable participants; hence as researchers we must always plan to ensure these challenges are managed appropriately

COVID-19: Resilience and the Nursing Workforce

As we write this editorial, the world is battling the deadly COVID-19 pandemic. Nurses across the world have been in the front line for many weeks now. Over the course of the pandemic we have seen nurses from all corners of the globe continue to provide the very best of care possible, while in many settings, struggling with issues such as a lack of staff and adequate personal protective equipment (PPE), and dealing with previously unseen levels of critical illness and death

Precarious ICE: Patterns and features of methamphetamine-related presentations to emergency departments and police and paramedic experiences of escorting patients under the influence of methamphetamines-a mixed methods study

Background: Acute behavioural disturbance (violence and aggression) and mental health illness (psychosis and paranoia) are negative side effects of methamphetamine use. In general, illicit use of methamphetamines in Australia has reportedly decreased but there has been a change in the use of methamphetamines with an increase noted in the use of the crystallised form of methamphetamines (also known as 'ICE'). Illicit methamphetamine use, particularly "ICE", leads to erratic and unpredictable behaviour in some people. Aim: The first aim of this study was to explore the patterns and features of methamphetamine-related presentations to emergency department (ED) and callout events attended by police and paramedics. The second aim was to understand the nature and pattern of methamphetamine-related callouts attended by police and paramedics by exploring their perceptions of deservingness and their experiences of interacting with persons under the influence of methamphetamines. Methods: A mixed methods explanatory sequential design was conducted. Quantitative data collection followed a convenience sampling approach and utilised both large datasets and a survey. Quantitative data were entered into a statistical software package (SPSS version 25) and analysed using descriptive and bivariate statistics. Quantitative findings guided the development of interview questions. Qualitative data collection adopted purposeful sampling and semi-structured interviews. Data were analysed using a thematic analytic approach. The pillar integration process was utilised in the final stage to integrate and interpret the overall study findings. Results: This dissertation uniquely explored methamphetamine-related presentations and callout events using a mixed methods approach. To our knowledge this is the first study to look at this issue using this methodology, including ED's, police and paramedics as an area of focus. The pillar integration process identified six main themes to interpret the separate streams of inquiry. Acuity, complexity of care, coordinated approach, deservingness and compassion, rural care, and prevalence of presentations/callouts. Features of presentations to ED had a higher acuity and mainly presented for poisoning/toxic effect. Interview data explored the features of presentations further, reporting methamphetamine-related callout events were complex, involved traumatic situations, and increased risk to safety of staff, patients and families. Complexity of care was affected by an inability to communicate effectively with the patient, acute behavioural disturbances, co-occurring mental health issues, ineffectiveness of de-escalation techniques, and patients presenting in a state of crisis. The study reported a significant increase in presentations to ED which was confirmed by Victorian (VIC) ambulance data reporting an increase in methamphetamine-related callout events requiring transport to ED and a significant increase in co-attendance (police and paramedics) responding to methamphetamine-related callout events. Interview participants highlighted when co-responding to persons under the influence of methamphetamine, a standardised approach was lacking. The standardised approach needed to include a co-ordinated approach between police, paramedics and EDs to improve management and care provided, and streamline services. Survey results reported perceptions of deservingness provided an understanding of police and paramedics current perceptions and attitudes towards people who use methamphetamines. Interview participants reported despite complexity of care and the negative experience, participants expressed compassion towards persons under the influence of methamphetamines. Conclusion: Methamphetamine-related callout events are increasing and there is an increased need for police and paramedics to transport patients to an ED for assessment. A standardised approach to coordinating care between police and paramedics in the pre-hospital environment and the emergency department is required to help improve care between services and streamline processes. It is important to ensure debriefing and support services are available to mitigate the dysfunctional affect methamphetamine use has on families (i.e. early recognition and support services), the traumatic effect on police and paramedics managing dangerous and unpredictable situations, and for patients who are presenting in states of crisis. In addition, the use of low stimulant, safe rooms or areas in EDs for fast tracking triage and rapid assessment of acute behavioural disturbance and patients experiencing psychosis could help to streamline care provided between pre-hospital and ED environments

Global patient experience of paramedic practice

Paramedics occupy an ever-increasing role within healthcare and the development of this role should be informed by the voice of patients. This systematic literature review seeks to explore patient experience during a paramedic intervention. Methods: Using a ‘state of the art’ review style, a systematic search was conducted of the literature published between 2006 and 2018. Following PRISMA guidelines, a total of seven articles meeting the inclusion criteria were identified. A definition of experience which incorporates several dimensions was used to frame the search. Results: Three themes were identified, with the available literature focusing mainly on satisfaction. Satisfaction is improved through certainty and clarity of the progression through treatment and is high among patients of paramedics. Conclusion: Our understanding of patient experience in paramedic interventions is largely limited to an understanding of satisfaction. While this may provide some useful insights, other facets such as the lived experience and physiologic aspects are underrepresented in the current evidence base