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shacklock k. & brunetto y. (2012) The intention to continue nursing: work variables affecting three nurse generations in Australia. Journal of Advanced Nursing 68(1), 36-46. Abstract Aims. The aims of the study were to examine how seven variables impacted upon the intention of hospital nurses to continue working as nurses and to investigate whether there are generational differences in these impacts. Background. There is a critical shortage of trained nurses working as nurses in Australia, as in many other Organisation for Economic Co-operation and Development member countries. The retention of nurses has been examined from the traditional management perspectives; however, this paper presents a different approach (Meaning of Working theory). Methods. A self-report survey of 900 nurses employed across four states of Australia was completed in 2008. The sample was hospital nurses in Australia from three generational cohorts - Baby Boomers (born in Australia between 1946 and 1964), Generation X (1965-1979) and Generation Y (1980-2000). Results. Six variables were found to influence the combined nurses' intentions to continue working as nurses: work-family conflict, perceptions of autonomy, attachment to work, importance of working to the individual, supervisor-subordinate relationship and interpersonal relationships at work. There were differences in the variables affecting the three generations, but attachment to work was the only common variable across all generations, affecting GenYs the strongest. Conclusion. The shortage of nurses is conceptualized differently in this paper to assist in finding solutions. However, the results varied for the three generations, suggesting the need to tailor different retention strategies to each age group. Implications for management and policy planning are discussed. [ABSTRACT FROM AUTHOR]

mcinnes e., seers k. & tutton l. (2011) Older people's views in relation to risk of falling and need for intervention: a meta-ethnography. Journal of Advanced Nursing 67(12), 2525-2536. Abstract Aim. This paper is a report of a meta-ethnography of qualitative studies of older peoples' views on risk of falling and need for intervention. Background. Falls and falls-related injuries in older people are worldwide problems. A conceptual understanding of older people's views about falls risk and need for intervention is useful for understanding factors likely to impact on acceptance of risk and recommended interventions. Data Sources. Seven electronic databases were searched 1999-2009. Reference lists of included articles were screened for eligible papers. Review Methods. Assessment of quality was carried out. Themes and concepts were extracted using a meta-ethnographic approach to compare similarities and differences across the retrieved studies. A line of argument was developed to produce an explanatory framework of the extracted themes and concepts. Results. Eleven relevant qualitative research articles of reasonable quality were identified. Six key concepts were identified: beyond personal control; rationalizing; salience; life-change and identity; taking control and self-management. A line of argument synthesis describes how older people approach self-appraisal of falls risk and intervention need, and how they cope and adapt to falls risk and intervention need. Conclusion. In response to having an elevated risk status and perceived associations with frailty and impact on an independent life-style, some prefer to adapt to this reality by taking control and implementing self-management strategies. Healthcare professionals should take into account beliefs about risk and negotiate choices for intervention, recognizing that some individuals prefer to drive the decision-making process to preserve identity as a competent and independent person. [ABSTRACT FROM AUTHOR]

Aims This study aimed to compare the findings of the quality of nursing doctoral education survey across seven countries and discuss the strategic directions for improving quality. Background No comparative evaluation of global quality of nursing doctoral education has been reported to date despite the rapid increase in the number of nursing doctoral programmes. Design A descriptive, cross-country, comparative design was employed. Methods Data were collected from 2007-2010 from nursing schools in seven countries: Australia, Japan, Korea, South Africa, Thailand, UK and USA. An online questionnaire was used to evaluate quality of nursing doctoral education except for Japan, where a paper version was used. Korea and South Africa used e-mails quality of nursing doctoral education was evaluated using four domains: Programme, Faculty (referring to academic staff), Resource and Evaluation. Descriptive statistics, correlational and ordinal logistic regression were employed. Results A total of 105 deans/schools, 414 faculty and 1149 students/graduates participated. The perceptions of faculty and students/graduates about the quality of nursing doctoral education across the seven countries were mostly favourable on all four domains. The faculty domain score had the largest estimated coefficient for relative importance. As the overall quality level of doctoral education rose from fair to good, the resource domain showed an increased effect. Conclusions Both faculty and students/graduates groups rated the overall quality of nursing doctoral education favourably. The faculty domain had the greatest importance for quality, followed by the programme domain. However, the importance of the resource domain gained significance as the overall quality of nursing doctoral education increased, indicating the needs for more attention to resources if the quality of nursing doctoral education is to improve. [ABSTRACT FROM AUTHOR]

salamonson y., bourgeois s., everett b., weaver r., peters k. & jackson d. (2011) Psychometric testing of the abbreviated Clinical Learning Environment Inventory (CLEI-19). Journal of Advanced Nursing 67(12), 2668-2676. Abstract Aim. This paper is a report of a test of the psychometric properties of a 19-item version of the Clinical Learning Environment Inventory. Background. Although the clinical learning environment provides the 'real-life' context essential for preparing nursing students for their professional role, the quality of student learning is influenced by the quality of the clinical placement. Methods. Nursing students completed an abbreviated (19-item) form of the Clinical Learning Environment Inventory to rate their perception of the clinical learning environment. Descriptive statistics, principal component analysis, discriminant validity and Cronbach's alpha reliabilities were computed. Results. Between March and December 2009, 231 online surveys were submitted. The mean age of participants was 30·3 years ( sd: 10·4) and 87% were female. All 19 items loaded on two factors, 'Clinical Facilitator Support of Learning' and 'Satisfaction with Clinical Placement', with factor loadings above the 0·4 threshold. Cronbach's alpha coefficient was 0·93 for the total Clinical Learning Environment Inventory-19, with subscales ranging from 0·92 to 0·94. Multiple regression uncovered that participants who engaged in health-related paid work were independently and significantly more positive on the 'Clinical Facilitator Support of Learning' subscale, whereas those who worked >16 hours a week, or allocated the afternoon shift were independently and significantly more negative on the 'Satisfaction with Clinical Placement' subscale. Conclusion. Providing an effective and productive clinical experience is vital in preparing nursing students to become competent clinicians. The Clinical Learning Environment Inventory-19 offers a useful measure to explore nursing students' satisfaction with two aspects of this clinical experience - clinical facilitator support of learning and the clinical learning environment. [ABSTRACT FROM AUTHOR]

gardner g., gardner a., middleton s., della p., kain v. & doubrovsky a. (2010) The work of nurse practitioners. Journal of Advanced Nursing 66(10), 2160–2169. Aim. This paper is a report of a study of variations in the pattern of nurse practitioner work in a range of service fields and geographical locations, across direct patient care, indirect patient care and service-related activities. Background. The nurse practitioner role has been implemented internationally as a service reform model to improve the access and timeliness of health care. There is a substantial body of research into the nurse practitioner role and service outcomes, but scant information on the pattern of nurse practitioner work and how this is influenced by different service models. Methods. We used work sampling methods. Data were collected between July 2008 and January 2009. Observations were recorded from a random sample of 30 nurse practitioners at 10-minute intervals in 2-hour blocks randomly generated to cover 2 weeks of work time from a sampling frame of 6 weeks. Results. A total of 12,189 individual observations were conducted with nurse practitioners across Australia. Thirty individual activities were identified as describing nurse practitioner work, and these were distributed across three categories. Direct care accounted for 36·1% of how nurse practitioners spend their time, indirect care accounted for 32·0% and service-related activities made up 31·9%. Conclusion. These findings provide useful baseline data for evaluation of nurse practitioner positions and the service effect of these positions. However, the study also raises questions about the best use of nurse practitioner time and the influences of barriers to and facilitators of this model of service innovation. [ABSTRACT FROM AUTHOR]

Aim To determine whether applying forced air warming attenuates the impact of sedation-induced impairment of thermoregulation on body temperature of patients who are sedated during interventional procedures in the cardiac catheterization laboratory. Background A moderate proportion of sedated patients who undergo procedures in the cardiac catheterization laboratory with only passive warming become hypothermic. Hypothermia in the surgical population is associated with increased risk of adverse cardiac events, infections, thrombotic and haemorrhagic complications and prolonged hospital stay. For this reason, investigation of the clinical benefits of preventing hypothermia in sedated patients using active warming is required. Design Randomized controlled trial. Methods A total of 140 participants undergoing elective interventional procedures with sedation in a cardiac catheterization laboratory will be recruited from two hospitals in Australia. Participants will be randomized to receive forced air warming (active warming) or usual care (passive warming with heated cotton blankets) throughout procedures. The primary outcome is hypothermia (defined as temperature less than 36°C) at the conclusion of the procedure. Secondary outcomes are postprocedure temperature, postprocedural shivering, thermal discomfort, major complications, disability-free survival to 30 days postprocedure, cost-effectiveness and feasibility of conducting a larger clinical trial. Discussion The results from this study will provide high-level evidence for practice in an area where there is currently no guidance. Findings will be easily translatable into clinical practice because most hospitals already have forced air warming equipment available for use during general anaesthesia. Registration number: ACTRN12616000013460. [ABSTRACT FROM AUTHOR]

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 the concept of workplace misfit is occurring, is where further nurse graduate support is urgently required. [ABSTRACT FROM AUTHOR]

Aim To develop and psychometrically test the Barriers to Nurses' use of Physical Assessment Scale. Background There is growing evidence of failure to recognize hospitalized patients at risk of clinical deterioration, in part due to inadequate physical assessment by nurses. Yet, little is known about the barriers to nurses' use of physical assessment in the acute hospital setting and no validated scales have been published. Design Instrument development study. Method Scale development was based on a comprehensive literature review, focus groups, expert review and psychometric evaluation. The scale was administered to 434 acute care Registered Nurses working at a large Australian teaching hospital between June and July 2013. Psychometric analysis included factor analysis, model fit statistics and reliability testing. Results The final scale was reduced to 38 items representing seven factors, together accounting for 57·7% of the variance: (1) reliance on others and technology; (2) lack of time and interruptions; (3) ward culture; (4) lack of confidence; (5) lack of nursing role models; (6) lack of influence on patient care; and (7) specialty area. Internal reliability ranged from 0·70-0·86. Conclusion Findings provide initial evidence for the validity and reliability of the Barriers to Nurses' use of Physical Assessment Scale and point to the importance of understanding the organizational determinants of nurses' assessment practices. The new scale has potential clinical and research applications to support nursing assessment in acute care settings. [ABSTRACT FROM AUTHOR]

Aim To investigate whether overlapping blood pressure and heart rate graphs improve chart-users' ability to recognize derangements in these vital signs on hospital observation charts. Background Many health professionals prefer blood pressure and heart rate graphs to overlap. One justification is the use of a visual cue called the 'Seagull Sign' to detect physiological abnormalities. Design A 3 × 2 × 2 mixed-design experiment, with three independent variables: participant group, graph format (separate vs. overlapping) and alerting system (integrated colour-based track-and-trigger system present vs. absent). Methods Over 64 experimental trials, 'Seagull-trained' nurses and novices randomly assigned to receive 'Seagull training' or remain untrained, viewed sequences of blood pressure and heart rate observations recorded on four different chart design extracts. The designs represented a crossing of the graph format and alerting system variables. For each design, eight cases contained normal data and eight contained an abnormal systolic blood pressure or heart rate observation (half of which yielded a Seagull Sign on overlapping plots). Participants (tested between January-May 2011) judged whether observations were physiologically normal or abnormal. Results Across all cases, participants from all groups responded faster and made fewer errors when blood pressure and heart rate observations were graphed separately, especially when a track-and-trigger system was present. Even for 'Seagull-trained' participants viewing 'Seagull Sign available' cases, no advantage of overlapping graphs was found. Conclusions These findings suggest that overlapping graphs do not yield the performance advantage that many health professionals assume, either for novices or experienced nurses, even when the Seagull Sign is used. [ABSTRACT FROM AUTHOR]

courtney-pratt h., fitzgerald m., ford k., marsden k. & marlow a. (2012) Quality clinical placements for undergraduate nursing students: a cross-sectional survey of undergraduates and supervising nurses. Journal of Advanced Nursing 68(6), 1391-1401. Abstract Aim. This article reports a generational cohort and leader-member exchange theoretical frameworks-guided study of the influence of the supervisor-subordinate relationship on three generational nurse cohorts' use of intuition, perceptions of empowerment and affective commitment. Background. Within a global context of nurse shortages, knowledge about factors influencing nurse retention is urgently sought. We postulated that nurses' use of intuition is the key to their empowerment and consequent commitment to the organization, and that impact would vary among the three large nurse generations. Methods. A self-report survey was used to gather data in 2008, which were then analysed using correlations, regression analysis, manova and path analysis. Data were obtained from 900 Baby Boomer and Generations X and Y nurses, randomly chosen from seven private hospitals across Australia. Results. The findings confirm the important impact of supervisor-nurse relationships upon all three generations' use of intuition. The findings add new knowledge about the differing importance of using intuition for Generation X, Generation Y and Baby Boomer nurses' perceptions of empowerment, suggesting it is more important to Baby Boomers and Generation X than to Generation Y. Further, the impact of using intuition differs significantly among the generational cohorts. Conclusions. The findings suggest the need for a more differentiated tailored style - sensitive to varying needs of the generations. Improving supervisor-nurse relationships is also critical, because of their impact upon nurses' use of intuition, perceptions of empowerment and affective commitment. Poor relationships lead to increased nurse replacement costs. [ABSTRACT FROM AUTHOR]

wilson l., whitehead l. & burrell b. (2011) Learning to live well with chronic fatigue: the personal perspective. Journal of Advanced Nursing 67(9), 2161-2169. Abstract Background. Persistent fatigue is recognized as an integral and significantly disabling aspect of the experience of living with a long-term health condition. Acute medical care models have limited applicability when seeking to provide health care to meet the needs of those living with chronic fatigue. Aims. This article is a report of a study that sought to understand how people can live well in spite of the presence of chronic fatigue. Methods. A thematic analysis was conducted on 43 narratives provided by people living with chronic fatigue during 2007 as part of an internet-based study. Findings. This report focuses on the two themes that appeared of most relevance to participants: managing energy and redefining self. Two particular approaches to energy management were noted. In the first, the focus is upon moderating and avoiding excess to manage energy. In the second approach, the body was conceptualized as a machine so that energy becomes a limited resource to be managed. Work to redefine the sense of self appeared to be focused upon the desire to seek normality, to see oneself as rational and come to terms with change. Conclusion. People can and do find ways to live well with chronic fatigue. Understanding how the person with chronic fatigue has come to conceptualize his/her experiences will be a more fruitful starting point than providing recipes for successful living if nurses are to work effectively with this group of people. [ABSTRACT FROM AUTHOR]

munyisia e.n., yu p. & hailey d. (2011) How nursing staff spend their time on activities in a nursing home: an observational study. Journal of Advanced Nursing 67(9), 1908-1917. Abstract Aim. This article is a report of a study to examine how nursing staff spend their time on activities in a nursing home. Background. Few studies have investigated how nursing staff spend their time on activities in a nursing home. Such information is important for nurse managers in deciding on staff deployment, and for evaluating the effects of changes in nursing practice. Method. A work sampling study with an observational component was undertaken in 2009 with nursing staff at a nursing home. Results. A total of 430 activities were recorded for Registered Nurses, 331 for Endorsed Enrolled Nurses, 5276 for Personal Carers, and 501 for Recreational Activity Officers. Registered Nurses spent 48·4% of their time on communication and 18·1% on medication management. Endorsed Enrolled Nurses spent 37·7% on communication and 29·0% on documentation tasks. Communication was the most time-consuming activity for Recreational Activity Officers and Personal Carers, except that Personal Carers in a high care house spent more time on direct care duties. Hygiene duties and resident interaction were more frequently multitasked by the nursing staff in high care than in low care house. Conclusion. Nursing staff value their face-to-face interaction for successful care delivery. There is need, however, to investigate the effects of this form of communication on quality of care given to residents. Differences in multi-tasked activities between high care and low care houses should be considered when deploying staff in a nursing home. [ABSTRACT FROM AUTHOR]

Aim. The aim of the study was to determine current national urinary incontinence management practices in Australian acute stroke units and their concordance with the National Stroke Foundation guidelines. Background. Urinary incontinence is a common consequence after stroke and a statistically significant indicator of poor outcome, including disability and admission to institutional care. The National Stroke Foundation has produced guidelines for the acute and post-acute phase of care, offering Australian nurses evidence-based recommendations regarding stroke management including the management of urinary incontinence. Method. In 2007-2008, dedicated acute stroke units in Australia were identified and a senior nurse from each unit was invited to participate in a 10-minute telephone survey to ascertain their current urinary continence management practices. Results. Representatives from 41 acute stroke units participated in the survey (response rate 98%). Participants from less than half of the units reported that they had a formal plan for urinary incontinence management (n = 19, 46%), and the majority of those who did not would find a formal plan useful (n = 15, 79%). Two-thirds of respondents stated that they would manage urinary incontinence with indwelling catheterization (n = 25, 61%). Only 30% (n = 12) were 'satisfied' or 'very satisfied' with urinary continence management in their acute stroke unit. Conclusion. A large proportion of acute stroke units were yet to establish formal urinary incontinence management plans. The implementation of evidence-based urinary incontinence management plans after stroke is integral to improving patient outcomes. An increase in resources for professional development in the assessment, treatment and management of urinary incontinence is essential to improve and maintain skills in after-stroke care. [ABSTRACT FROM AUTHOR]