Exploring registered nurses’ attitudes towards postgraduate education in Australia: an overview of literature

Background: Nursing education is designed to prepare competent nurses to meet the current and future health care needs of society. Changes to nursing education, especially at post graduate level, will therefore likely be influenced by the on-going developments in healthcare and socio-economic factors. Objective: The main purpose of this study is to develop and validate an instrument that explores the beliefs of Registered Nurses about Postgraduate education in the context of specialist nursing practice in Australia (specialty education). Methods: The Nurses Attitudes Towards Post Graduate Education (NATPGE) instrument was sent to an expert panel to undertake judgment-quantification (content validity testing). Content Validity Index (CVI) based on expert ratings of relevance was used as a method of quantifying content validity for the NATPGE instrument. A convenience sample of 25 Registered Nurses (RN) was selected from four major Queensland tertiary hospitals to assess the face validity of the instrument. A random sample of 100 RN from the Nurses and Midwives e-Cohort Study (NMeS) were invited to participate in a test-retest pilot as part of the process of assessing the reliability of the online NATPGE. To gauge the test-retest reliability, the instrument was administered at two different time points, 3 weeks apart, under similar conditions. Results: The content and face validity was assessed using descriptive statistics. For the test-retest reliability, the NATPGE instrument were analysed on an item by item basis to calculate the intra rater reliability using the weighted kappa (kw) statistic. The NATPGE instrument attained moderate test-retest reliability. 80% of the items on the instrument reached a fair to moderate agreement between the test and retest. Conclusions: There is a need for development of a robust psychometric instrument to explore Registered Nurses’ Attitudes Towards Post Graduate Education (NATPGE)

Facilitators and Barriers Affecting Implementation of Neonatal Palliative Care by Nurses in Mainland China

Neonatal nurses in mainland China encounter various challenges when it comes to delivering palliative care to neonates. The aim of this study was to determine the barriers and facilitators of neonatal nurses' attitudes to palliative care for neonates in mainland China. A simplified Chinese version of the Neonatal Palliative Care Attitude Scale was piloted, administered, and analyzed using survey methods. Nurses in neonatal intensive care units in mainland China regardless of experience in the field were invited to take part in. Over a five-month period in 2019, we surveyed neonatal nurses from 40 hospitals in five provinces of China. The response rate was 92.5% (N = 550). This study identified eight facilitators and four barriers to neonatal palliative care implementation. In terms of nurses' attitudes on providing palliative care, younger and older nurses were more positive, whereas middle-aged nurses were less so. Nurses' emotional wellbeing was rarely impacted by neonatal death. They considered neonatal palliative care, particularly pain management, to be just as important as curative treatment. Parents were invited to participate in decision-making by nurses. Nurses reported having access to professional counseling and talking about their concerns with other healthcare professionals. The following barriers to neonatal palliative care were identified in this study that were not observed in the original English version scale research in 2009: a lack of clinicians, time, clinical skills, systematic education, neonatal palliative care experience, and social acceptance. Future research is required to investigate each barrier in order to improve the implementation of neonatal palliative care in mainland China

Development of the Simplified Chinese version of neonatal palliative care attitude scale

Background The provision of palliative care for neonates who are not expected to survive has been slow in mainland China, and this model of care remains in its early stages. Evaluating nurses' attitudes toward neonatal palliative care (NPC) has the potential to provide valuable insight into barriers impeding NPC implementation. This study aimed to translate and adapt the traditional Chinese version of the Neonatal Palliative Care Attitude Scale (NiPCAS) into Simplified Chinese to assess its psychometric properties. Methods The NiPCAS is a valid and reliable instrument to measure nurses' attitudes for evidence-based practice. To date, the scale has not been used largely in mainland China. With translation and cultural adaptation, the traditional Chinese version of the NiPCAS was developed into a Simplified Chinese version. Its reliability was tested using internal consistency and test-retest reliability, and its validity was measured using the content validity index and exploratory factor analysis. Results A total of 595 neonatal nurses from mainland China were recruited. Twenty-six items in the scale were translated into Simplified Chinese. The scale demonstrated excellent reliability with a Cronbach's α coefficient of 0.87 and a test-retest reliability of 0.88. To support the Simplified Chinese version of NiPCAS, the scale content validity score was 0.98, and the exploratory factor analysis revealed five factors representing the conceptual dimensions of the scale. Conclusion This study demonstrated the psychometric properties of the Simplified Chinese version of NiPCAS, validated its use as a viable tool for measuring neonatal nurses' attitudes toward NPC, and identified facilitators and barriers to NPC adoption. Our findings suggested supported clinical application in the context of mainland China. A confirmatory factor-analysis approach with a different sample of neonatal nurses is required for further testing of the instrument in the future

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Babies born dying: just bad karma? A discussion paper

The paper examines the notion of being born dying and karma. Karma is a belief upheld by Buddhists and non-Buddhists: That is, karma follows people from their previous lives into their current lives. This raises a difficult question: Does karma mean that a baby's death is its own fault? While great peace can be found from a belief in karma, the notion of a baby's karma returning in some sort of retributive, universal justice can be de-emphasized and is considered "un-Buddhist." Having an understanding of karma is intrinsic to the spiritual care for the dying baby, not only from the perspective of parents and families who have these beliefs, but also for reconciling one's own beliefs as a healthcare practitioner

An exploration of the grief experiences of neonatal nurses: a focus group study

Aim: To explore the grief reactions of neonatal nurses caring for dying babies. Methods: This study utilises a qualitative research design. Focus group methods explored neonatal nurses' beliefs, perceptions and experiences of death, dying, grief and loss associated with clinical practice in the neonatal intensive care unit. A deductive data analysis framework was employed to catalogue participant responses into corresponding constructs. Results: Data collected from the focus group interviews were aggregated in deductive analysis against three constructs: Acknowledgement of loss; recognition of the relationship; and inclusion of the griever. Conclusion: The findings from this research contribute to a definition of grief as a pervasive, highly individualized, dynamic process that often is discussed normatively within professional healthcare disciplines. Neonatal nurses routinely deal with grief and feelings of loss. It is important that a framework be developed to help understand the process and to guide appropriate interventions for ongoing support

Developing palliative care models in neonatal nursing : an investigation of barriers and parameters for practice

The neonatal intensive care unit (NICU) is frequently occupied by newborns who are marginally viable, or critically unwell, and could be considered terminally ill. It is a busy, highly technical environment with an arsenal of life-saving medical equipment at its disposal, and advances in technology used in this field stretch the boundaries of viability. Despite technological advances, increases in the margins of viability and highly skilled healthcare delivery, some newborns will still die in the NICU. In recent years, palliative care for the neonatal population has become increasingly topical and part of the lexicon of contemporary neonatal practice. Evidence-based protocols are available to inform this model of care, yet in reality, provision of palliative care to newborns is ad hoc. The reasons why implementing a palliative model of care have been problematic are unclear. The purpose of this study was to identify the barriers and facilitators to palliative care practice in neonatal nursing, and to develop policy recommendations to improve this area of practice. This exploratory research was conducted to answer two research questions: 1) What are the barriers and facilitators to palliative care practice in neonatal nursing? 2) How can the identified issues be addressed to inform policy and clinical guidelines in the practice environment? Phase one of this investigation developed, pilot tested, and administered an instrument to identify the barriers and facilitators to practice. Data analysis identified three subscales that indicated facilitators and barriers to palliative care practice. The second phase of this study used a translational research approach, utilizing interpretive methods to explore and contextualise the population study findings to inform policy development to improve palliative care practice in neonatal nursing. This research has identified that the facilitators that do exist for palliative care practice are subject to caveats that impinge markedly upon these facilitators. Furthermore, the barriers that were identified pose threats to the integration of a palliative model of care into Australian neonatal nursing practice. Thus, the overall results from this research have lead to a composite understanding of the barriers and facilitators to palliative care practice in Australian neonatal nursing, which may account for the gap between support of palliative care for marginally viable and critically ill newborns, and the application of this model of care in clinical practice. Translating the survey findings into policy directives that are applicable to the clinical environment has resulted in the development of recommendations that are aimed at improving palliative care practice in the NICU

Moral distress and providing care to dying babies in neonatal nursing

Moral distress in nursing is a prevalent theme in the literature. Although this issue has been investigated in other nursing disciplines, it has not been investigated by empirical research in the emotionally and ethically sensitive area of providing care to dying babies. Moral distress occurs when nurses are prevented from translating moral choices into moral action. The response to moral distress is anger, resentment, guilt, frustration, sorrow and powerlessness. If not addressed, self-worth may be jeopardised, affecting personal and professional relationships. A review of the literature was conducted to explore moral distress in neonatal nursing when providing care to dying babies. This literature review provides a basis for the direction of further research and hypothesis testing. Further focused research is necessary in this under-theorised area of nursing practice to clarify the significance of moral distress for neonatal nurses caring for dying babies