Understanding presentations of children with fever to a Sydney emergency department

Background: Fever is a common childhood illness resulting in a potentially high number of presentations to local Emergency Departments (ED). This paper describes the characteristics of these presentations of children, including initial and subsequent diagnosis, disposition from ED and seasonal variations, to inform nursing and other health professionals working within these departments. Methods: The study was conducted at a metropolitan hospital in Sydney, using existing data collected by emergency staff. Data for a 12-month period were extracted from the existing database of all ED presentations. Results: This study demonstrated that the age of the majority of febrile child presentations varied between 13 months and 24 months (53%), and the number of ED visits doubled during the winter months (33%). Most of the child presentations to ED in this study were not urgent (68%). Viral illness, upper respiratory tract infections, and urinary tract infections accounted for 14.9 % of all the ED presentations, with most being discharged to home. Conclusion: This study confirms the continuing pattern of inappropriate presentations to EDs of children with fever. Public education campaigns are needed to reduce these presentations

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Measuring nurses' self-concept

Little is known of nurses’ self-concept in light of their professional identity or as working adults. This article explores the development and rigorous testing of a new self-concept instrument designed specifically for nurses. The new measure is based on the self-concept measurement theory of Shavelson, Hubner, and Stanton. An expert panel was used to critique and aid refinement of the measure. The dimensions of nurses’ self-concept were measured in six scales: General Nursing, Care, Staff Relations, Communication, Knowledge, and Leadership. Two groups participated in this study: Group 1 consisted of nursing students prior to graduation (n = 506) and Group 2 consisted of randomly selected, experienced, working nurses (n = 528). A series of exploratory and confirmatory factor analyses were conducted to test the fit of a priori models. The results indicate that all scales possess good construct validity and a satisfactory fit with the data

Psychosocial health and illness

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The self-concept of nurses and its relationship to job satisfaction

This study explores the development and rigorous testing of a new self-concept instrument designed specifically for nurses for use in a longitudinal, multicohort study on self-concept, job satisfaction and retention in nursing.The outcomes of this study are that nurses' self-concept can now be measured by a new theoretically and empirically substantiated multidimensional instrument. This will provide potential new directions for nursing research on which to build specific self-concept enhancement and retention strategies. The transitional period of student to graduate nurse can be the subject of ongoing assessment by utilising the new self-concept instrument in conjunction with a valid measure of nurses' job satisfaction. The findings of this study have raised an awareness of the importance of self-concept in the retention challenge for all nurses and in particular the newly registered graduate nurs

Modelling job support, job fit, job role and job satisfaction for school of nursing sessional academic staff

Abstract Background Sessional academic staff are an important part of nursing education. Increases in casualisation of the academic workforce continue and satisfaction with the job role is an important bench mark for quality curricula delivery and influences recruitment and retention. This study examined relations between four job constructs - organisation fit, organisation support, staff role and job satisfaction for Sessional Academic Staff at a School of Nursing by creating two path analysis models. Methods A cross-sectional correlational survey design was utilised. Participants who were currently working as sessional or casual teaching staff members were invited to complete an online anonymous survey. The data represents a convenience sample of Sessional Academic Staff in 2016 at a large school of Nursing and Midwifery in Australia. After psychometric evaluation of each of the job construct measures in this study we utilised Structural Equation Modelling to better understand the relations of the variables. Results The measures used in this study were found to be both valid and reliable for this sample. Job support and job fit are positively linked to job satisfaction. Although the hypothesised model did not meet model fit standards, a new ‘nested’ model made substantive sense. Conclusion This small study explored a new scale for measuring academic job role, and demonstrated how it promotes the constructs of job fit and job supports. All four job constructs are important in providing job satisfaction – an outcome that in turn supports staffing stability, retention, and motivation

From student to graduate : longitudinal changes in the qualities of nurses

Aims: To examine the development of perceived qualities of nursing from student to graduate nurse over time. Background: Researchers continue to explore student nurse and new graduate nurse attrition, particularly in the light of a looming crisis in nursing recruitment and retention. Qualities of nurses represent the job fit of nursing from student to graduate years. Design A prospective longitudinal design with a convenience sample was used for this study. Methods: Data were collected annually from 2009–2012 through the completion of a short on-line survey. The sample size of undergraduate nurses in year 1 was 676, with 527 in year 2, 339 in year 3 and 190 in year 4. Only 136 participants completed the survey each year forming the complete data set for analysis. Results/findings: Most qualities of nursing differed significantly across time with the qualities of Caring, Empathetic, Knowledge and Respectful demonstrating strong changes. Most declines in scores occurred on graduation. Caring, the central tenet of nursing increased during the student years and declined slightly on graduation. Conclusion: This unique longitudinal study of Australian nurses suggests that the clinical experience and theoretical grounding provided in our University programs, has resulted in an increasing cumulative effect in the third year supporting most qualities of nurses/nursing understood in year 1, that is, the career fit to perceptions, has been achieved. The decline in the 1st year of graduation, where a concept to workplace misfit is occurring, is where further nurse graduate support is urgently required

New graduate nurse self-concept and retention : a longitudinal survey

Graduate nurse attrition is an increasing phenomenon within a world of decreasing nursing numbers. The newly developed nursing self-concept of the graduate nurse may provide a key indicator for predicting graduate retention. This study explores the development of multiple dimensions of nursing self-concept and examines their relationship to graduate nurse retention plans. A descriptive survey design with repeated measures was utilised to assess nurse self-concept and retention plans. The key findings suggest that multiple dimensions of graduate nurse self-concepts rise significantly in the second half of their graduate year and that nurse general self-concept is a strong predictor of graduate nurse retention. The implications of this study are that monitoring of self-concept throughout the transitional period for new nurses can lead to early detection and appropriate intervention strategies thereby improving retention rates for new nurses

Nurses discuss bedside handover and using written handover sheets

Background The analysis of nursing errors in clinical management highlighted that clinical handover plays a pivotal role in patient safety. Changes to handover including conducting handover at the bedside and the use of written handover summary sheets were subsequently implemented. Aim The aim of the study was to explore nurses perspectives on the introduction of bedside handover and the use of written handover sheets. Method Using a qualitative approach, data were obtained from six focus groups containing 30 registered and enrolled (licensed practical) nurses. Thematic analysis revealed several major themes. Findings Themes identified included: bedside handover and the strengths and weaknesses; patient involvement in handover, and good communication is about good communicators. Finally, three sources of patient information and other issues were also identified as key aspects. Conclusions How bedside handover is delivered should be considered in relation to specific patient caseloads (patients with cognitive impairments), the shift (day, evening or night shift) and the model of service delivery (team versus patient allocation). Implications for nursing management Flexible handover methods are implicit within clinical setting issues especially in consideration to nursing teamwork. Good communication processes continue to be fundamental for successful handover processes

Measuring the qualities of nurses : development and testing of the qualities of nurses scale

This paper reports on the creation, development and testing of a new instrument to measure qualities of nurses, known as the Qualities of Nurses (QON) scale, applicable to student nurses. High attrition rates within nursing programs and during early postgraduate years are an international phenomena. Mismatches between idealized perceptions of nursing and the realities of education and clinical experiences have been identified as contributing factors. A survey method was used to elicit responses to scale items from 678 first-year nursing students at a large university. A one-factor 12-item solution explaining 47 percent of variance in the construct was demonstrated. The QON can assist in the initial assessment and ongoing monitoring of changes in students' perceptions of nurses. Using the QON, researchers and educators can identify initial student nurses' perceptions and any changes associated in educational or other events that ultimately could be manipulated to reduce attrition