Nurses who made a difference

Leadership, according to De Pree (2004), is the art of motivating a groupof people to act toward achieving a common goal. Even though this isnot a history book, what better way to illustrate the leadership skills weare talking about than to show you the evidence from stories of nursing'spast? Storytelling is a powerful way to communicate insights. Good storiesare usually far more memorable than disembodied lists or protocols.Further, the meanings that can be made from stories are not fixed orstatic. The lessons that you or others find important within this chaptermight vary considerably from the lessons we uncovered because thereading of a story is an active meaning-making process

Looking Forward

Chapter 12 in The Resilient Nurse: Empowering Your Practic

Preparing for practice : becoming resilient

Nursing involves complex caring work and the self can flourish in thisaltruistic experience, but it can also suffer. If you aren't prepared for theemotional and cognitive labour involved with caring, then nursing workcan become a burden, leading to stress, burnout, and neglectful care.Let's take a closer look at the causes of workplace stress, and how youcan prepare yourself, so that you don't wind up as a casualty. We willfind that the quality of resilience is vitally important

The World Masters Games (1994) injury study: Final report

A report on injury rates and survey outcomes of athletes from the 1994 World Masters Games held in Brisbane. The study was funded by the Australian Sports Commission's Applied Sports Research Program

A strengths-based group program on self-harm : a feasibility study

Every day in Queensland, Australia, student services within schools are responding to children who have deliberately self-injured. Although school nurses are in a prime position to effectively intervene, mitigate risk, and promote healthy self-caring behaviors, no programs that focus specifically on self-harm currently exist. This feasibility study of a program to assist young people find safer alternatives to self-harm canvassed opinions of 12 school nurses in secondary schools on the Sunshine Coast in 2009. Participants showed strong support and reported that the program was much needed; had an innovative, strengths-oriented approach; incorporated an essential training component; would likely be engaging for young people; and was in appropriate format. Perceived challenges to implementation included garnering support from the school community and educational stakeholders and recruiting young people most likely to benefit. Suggested changes included providing a youth-friendly name for the programa nd formalizing inclusion criteria to select appropriate group members

A mountain not too high to climb : a qualitative study exploring facilitators and barriers to smoking cessation in a regional mental health service

Tobacco smoking is the largest single preventable cause of death and disease in Australia. Reports suggest that up to 88% of people who have mental health problems of any kind continue to smoke, even when in acute mental health units. Some organisations have adopted smoking free policies; however, implementation of smoking cessation programs in acute mental health units has had varied levels of success. This qualitative study examined the second attempt to implement a smoke-free policy in an acute mental health service in Queensland, Australia, to explore the facilitators and barriers to change. Post-process interviews conducted with ten clinicians and consumers revealed facilitators and barriers within themes of Culture, Wellbeing and Strategy. Key barriers included a negative institutional culture, fear and inconsistent application of the policy (associated with staff attrition, workloads, policy loopholes and resistance). Key facilitators were positive leadership, adequate resources, staff and consumer engagement, supportive formal policy, and staff unity. Analysis also suggested benefits in cultivating a non-restrictive, healthy and respectful environment, and deploying a clear, consistent strategy that includes planning, preparation, implementation and maintenance phases

Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial

Background Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. Methods In this multicentre, open-label, randomised controlled trial, we recruited women aged 18–40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527. Findings Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference −0·19%; 95% CI −0·34 to −0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy). Interpretation Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use