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Background: Cervical collars are used as standard care for neck immobilisation after cervical spine injury. Although evidence for the most effective type of collar is lacking, there is evidence regarding adverse patient outcomes when managed in a semi or rigid collar. In response to the evidence of complications and adverse effects when using a hard collar, a large Australian adult trauma hospital that specializes in spinal care, changed its policy from hard to soft collars when managing acute cervical spine injury., Objective: The aim of this study was to investigate patients' experiences and outcomes when wearing a soft collar for acute cervical spine injury management in hospital., Method: A single centre mixed method sequential study design was used., Results: Medical records from 136 patients were examined and no adverse events resulting from collar use were recorded. Interviews with 20 patients revealed that they understood the value of wearing a soft collar. The soft collars were considered supportive and well tolerated, with good adherence to recommendations for use., Conclusions: Understanding the patients' experiences informs better care management. This study suggests that soft collars are well tolerated, do not result in pressure injuries or other adverse events and are suitable for managing acute cervical spine injury., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.)

Background: Pressure injuries (PIs) are an enduring problem for patients in the intensive care unit (ICU) because of their vulnerability and numerous risk factors., Method: This study reports Australian data as a subset of data from an international 1-day point prevalence study of ICU-acquired PI in adult patients. Patients aged 18 years or older and admitted to the ICU on the study day were included. The outcome measure was the identification of a PI by direct visual skin assessment on the study day. Data collected included demographic data and clinical risk factors, PI location and stage, and PI prevention strategies used. Descriptive statistics were used to describe PI characteristics, and odds ratios (ORs) were used to identify factors associated with the development of a PI., Results: Data were collected from 288 patients from 16 Australian ICUs. ICU-acquired PI prevalence was 9.7%, with 40 PIs identified on 28 patients. Most PIs were of stage 1 and stage 2 (26/40, 65.0%). Half of the ICU-acquired PIs were found on the head and face. The odds of developing an ICU-acquired PI increased significantly with renal replacement therapy (OR: 4.25, 95% confidence interval [CI]: 1.49-12.11), impaired mobility (OR: 3.13, 95% CI: 1.08-9.12), fastest respiratory rate (OR: 1.05 [per breath per minute], 95% CI: 1.00-1.10), longer stay in the ICU (OR: 1.04 [per day], 95% CI: 1.01-1.06), and mechanical ventilation on admission (OR: 0.36, CI: 0.14-0.91)., Conclusion: This study found that Australian ICU-acquired PI prevalence was 9.7% and these PIs were associated with many risk factors. Targeted PI prevention strategies should be incorporated into routine prevention approaches to reduce the burden of PIs in the Australian adult ICU patient population., (Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

A disaster overwhelms the normal operating capacity of a health service. Minimal research exists regarding Australian hospitals' capacity to respond to chemical, biological, radiological, or nuclear (CBRN) disasters. This article, and the research supporting it, begins to fill that research gap. We conducted a descriptive quantitative study with 5 tertiary hospitals and 1 rural hospital in Queensland, Australia. The study population was the hospitals' clinical leaders for disaster preparedness. The 25-item survey consisted of questions relating to each hospital's current response capacity, physical surge capacity, and human surge capacity in response to a CBRN disaster. Data were analyzed using descriptive statistics. The survey data indicated that over the previous 12 months, each site reached operational capacity on average 66 times and that capacity to respond and create additional emergency, intensive care, or surgical beds varied greatly across the sites. In the previous 12 months, only 2 sites reported undertaking specific hospital-wide training to manage a CBRN disaster, and 3 sites reported having suitable personal protective equipment required for hazardous materials. There was a noted shortfall in all the hospitals' capacity to respond to a radiological disaster in particular. Queensland hospitals are crucial to CBRN disaster response, and they have areas for improvement in their response and capacity to surge when compared with international preparedness benchmarks. CBRN-focused education and training must be prioritized using evidence-based training approaches to better prepare hospitals to respond following a disaster event.

Background: Sleep is vital to our wellbeing. Critically ill patients are vulnerable with effects of sleep deprivation including weakened immune function, decreased glucose tolerance, and increased sympathetic activity. Intensive care unit (ICU) patients' sleep evaluation is difficult and often not reliable. The most commonly used instrument for assessing ICU patients' perspective of their sleep, Richards-Campbell Sleep Questionnaire (RCSQ), has not been reported to have undergone known-group construct validity testing or concurrent validity testing with the criterion measure of feeling refreshed., Objectives: The aim of the study was to explore the construct validity of the RCSQ with known-groups technique and concurrent validity with the criterion measure of feeling refreshed on awakening., Methods: A cross-sectional descriptive survey study using the RCSQ was conducted on people sleeping at home (n = 114) over seven nights. The results were compared with the RCSQ sleep scores of nonintubated alert oriented adult ICU patients (n = 114). Home sleepers were also asked to rate how refreshed they felt on awakening. The study was executed and reported in accordance with the STROBE checklist for observational studies., Findings: RCSQ construct validity was supported because home sleepers' and ICU sleepers' sleep evaluations differed significantly. Home sleepers rated their sleep significantly better than ICU patients in all five sleep domains of the RCSQ. Concurrent validity was supported because the item "feeling refreshed on awakening" correlated strongly with all sleep domains., Conclusions: Sleep quality may be accurately measured using the RCSQ in alert people both in the ICU and at home. This study has added to the validity discussion around the RCSQ. The RCSQ can be used for sleep evaluation in ICUs to promote wellbeing and recovery., Competing Interests: Conflict of interest None., (Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background/objective: Endotracheal suction is one of the most common and harmful procuedres performed on mechanically ventilated children. The aim of the study was to establish the feasibility of a randomised controlled trial (RCT) examining the effectiveness of normal saline instillation (NSI) and a positive end-expiratory pressure recruitment manoeuvre (RM) with endotracheal suction in the paediatric intensive care unit., Methods: Pilot 2 × 2 factorial RCT. The study was conducted at a 36-bed tertiary paediatric intensive care unit in Australia. Fifty-eight children aged less than 16 years undergoing tracheal intubation and invasive mechanical ventilation. (i) NSI or no NSI and (ii) RM or no RM with endotracheal suction . The primary outcome was feasibility; secondary outcomes were ventilator-associated pneumonia (VAP), change in end-expiratory lung volume assessed by electrical impedance tomography, dynamic compliance, and oxygen saturation-to-fraction of inspired oxygen (SpO 2 /FiO 2 ) ratio., Results/findings: Recruitment, retention, and missing data feasibility criteria were achieved. Eligibility and protocol adherence criteria were not achieved, with 818 patients eligible and 58 enrolled; cardiac surgery was the primary reason for exclusion. Approximately 30% of patients had at least one episode of nonadherence. Children who received NSI had a reduced incidence of VAP; however, this did not reach statistical significance (incidence rate ratio = 0.12, 95% confidence interval = 0.01-1.10; p = 0.06). NSI was associated with a significantly reduced SpO 2 /FiO 2 ratio up to 10 min after suction. RMs were not associated with a reduced VAP incidence (incidence rate ratio = 0.31, 95% confidence interval = 0.05-1.88), but did significantly improve end-expiratory lung volume at 2 and 5 min after suction, dynamic compliance, and SpO 2 /FiO 2 ratio., Conclusion: RMs provided short-term improvements in end-expiratory lung volume and oxygenation. NSI with suction led to a reduced incidence of VAP; however, a definitive RCT is needed to test statistical differences. A RCT of study interventions is worthwhile and may be feasible with protocol modifications including the widening of participant eligibility., Competing Interests: Conflict of Interest J.A.S., M.C., D.L., K.C., A.S., R.S.W., A.I., and M.L.M. have no conflicts of interest to disclose., (Copyright © 2021 Australian College of Critical Care Nurses Ltd. All rights reserved.)

Aim: The aim of this paper is to describe how the Invitational Theory were used to frame each of the phases of this sequential mixed methods study to provide valuable insights to the failure to fail phenomenon., Background: The assessment of student nurses in clinical courses in undergraduate programmes remains problematic, with some students passing clinical courses when they do not meet standards for practice - failure to fail. Failure to fail is the allocation of passing grades to students who do not meet standards for practice. An understanding of assessors' experiences is central to unravelling the complexities surrounding the phenomenon of failure to fail. Traditionally, such inquiry has been specific and narrow. The Invitational Theory is offered as a comprehensive approach to provide insights and understanding into the complex phenomenon of failure to fail., Design: The five domains of the Invitational Theory; people, processes, programmes, policies and places, were used to inform this sequential exploratory mixed methods study., Methodology: Phase 1 consisted of an integrative literature review. Phase 2 involved interviews and focus groups with tertiary assessors involved in assessment of students in clinical courses. Phase 3 involved the development, testing and piloting of a survey with tertiary and industry assessors. Phase 4 consisted of a meta-integration of all phases of the study., Results: Key findings of the synthesis of these study phases demonstrated that the domains of the Invitational Theory enable a comprehensive and unique viewpoint of assessment during clinical practicum. All five domains of the Invitational Theory were evident throughout this study and provided unique insights into failure to fail. This research has identified the theoretical underpinnings of the Invitational Theory and its application can be of value in the area of nurse education and specifically assessments., Conclusion: The Invitational Theory domains provides a comprehensive and unique viewpoint of assessment of nursing students and contributed to the emerging body of literature regarding failure to fail. How the theoretical framework facilitates the understanding of failure to fail is described in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Patient- and family-centred care practices are a recommended part of contemporary care for the acutely ill hospitalized adult patients. However, how patient- and family-centred care is enacted in an adult hospital setting is not well understood., Aims and Objectives: The aim of this study is to explore the perceptions of patients, family members and nurses regarding family participation and collaboration in patient care within an acute care setting, including the barriers and facilitators., Design: This study used a mixed-methods sequential design., Methods: Observer-as-participant observations and semistructured interviews were undertaken. Integration of the data was achieved through triangulation., Results: Triangulation revealed two metathemes. The first metatheme, 'continuum of family involvement', explained the central viewpoint of how family participation and collaboration in the care of acutely ill hospitalized adult patients was enacted. The second metatheme, 'nurses value family involvement', helped to explain and understand the barriers and facilitators to enacting family participation in the acute care setting., Conclusion: Promoting family participation in the acute care setting requires supporting multiple levels of engagement. Developing a relationship, clear communication and open sharing of information amongst patients, family members and nurses is critical to supporting family involvement., (© 2020 John Wiley & Sons Australia, Ltd.)

Background: Many academics and clinicians who assess nursing students as part of their work-integrated learning experiences encounter difficulties with awarding a failing grade to students who do not meet fitness for practice standards., Objectives: The aim of this study was to explore and further our understanding of assessors' experiences of failure-to-fail of nursing students within work-integrated learning., Design: This aim was achieved through an exploratory, sequential, mixed methods research project., Methods: Guided by Invitational Theory, this programme of work included an integrated systematic review, one-on-one and focus group interviews, and finished with a survey., Results: The results of each of the phases of this mixed methods study were integrated to provide a greater understanding of the enablers and barriers for assessors managing poor performing students to ameliorate failure to fail. Enablers identified included: assessor supports, programme flexibility, and organisational culture. The barriers included grade inflation, in appropriate student responses, organisational processes and workload., Conclusions: This comprehensive integration of a mixed methods study provides new and deeper understanding of the phenomenon of failure to fail. It provides clear recommendations for practical application by tertiary and clinical facilities to enhance the enablers and minimise the barriers to failure where it is warranted., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to review and critically appraise the evidence for paediatric endotracheal suction interventions., Data Sources: A systematic search for studies was undertaken in the electronic databases CENTRAL, Medline, EMBASE, and EBSCO CINAHL from 2003., Study Selection: Included studies assessed suction interventions in children (≤18 ys old) receiving mechanical ventilation. The primary outcome was defined a priori as duration of mechanical ventilation. Secondary outcomes included adverse events and measures of gas exchange and lung mechanics., Data Extraction: Data extraction were performed independently by two reviewers. Study methodological quality was assessed using Cochrane's risk of bias tool for randomised trials or the Newcastle-Ottawa Scale for observational studies. Overall assessment of the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations criteria., Results: Overall 17 studies involving 1618 children and more than 21,834 suction episodes were included in the review. The most common intervention theme was suction system (five studies; 29%). All included trials were at unclear or high risk of performance bias due to the inability to blind interventionists. Current evidence suggests that closed suction may maintain arterial saturations, normal saline leads to significant transient desaturation, and lung recruitment applied after suction offers short-term oxygenation benefit., Limitations: Lack of randomised controlled trials, inconsistencies in populations and interventions across studies, and imprecision and risk of bias in included studies precluded data pooling to provide an estimate of interventions effect., Conclusions: Based on the results of this integrative review, there is insufficient high-quality evidence to guide practice around suction interventions in mechanically ventilated children., Competing Interests: Conflicts of interest There are no conflicts of interest associated with this article., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Background: Normal saline instillation (NSI) and lung recruitment manoeuvres (RMs) are used in conjunction with endotracheal suction (ETS) in mechanically ventilated children. Practice is varied, and it is not currently understood what clinical practice guidelines (CPGs) are available to inform practice decisions., Objective: The aim of this study was to identify and systematically review the quality of existing ETS CPGs, specifically in the context of NSI and RM use., Methods: A systematic search for ETS CPGs in children (<18 years old) was conducted in Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE, and Google Scholar. Two independent assessors evaluated CPGs using the Appraisal of Guidelines for Research and Evaluation II instrument. Standardised scores were calculated for individual CPGs, and scale domain scores were calculated., Results: Four CPGs and practice recommendations from 2 literature reviews were identified and evaluated. The routine use of NSI and RMs with paediatric ETS was not recommended. Recommendations reflected the low quality and limited availability of evidence to inform NSI and RM application. Collectively, the highest scoring domain was clarity of presentation, followed by scope and purpose (78). Overall assessments ranged from 8 to 100 from a possible 100 points. Four ETS CPGs (100%) were recommended for use with modification., Conclusions: Clinical practice guidelines and practice recommendations pertaining to NSI and RM were consistent but, however, limited by the quality and volume of available evidence. Clinical practice guideline developers should focus on improving the applicability and rigour in development processes. Further consensus work and rigorous trials are needed to inform future CPGs.

Introduction: Central venous access devices (CVADs) are a vital medical device for intensive care (ICU) patients; however, complications and failure are common, yet potentially prevented through effective dressings and securement., Objectives/aims: The objective of this study was to test the feasibility of a randomised controlled trial (RCT) comparing standard care with three dressing and securement products to prevent CVAD failure. Secondary aims included comparing dressing and securement products on CVAD failure, microbial colonisation, and intervention costs., Methods: A single-centre pilot RCT of ICU adult patients requiring CVADs for >24 h were randomised to four groups: (i) sutures plus chlorhexidine gluconate (CHG) dressing (standard care); (ii) standard care plus tissue adhesive (TA); (iii) two sutureless stabilisation devices (SSD) plus CHG dressing; (iv) sutures, CHG disc plus integrated securement dressing (ISD). Descriptive statistics assessed feasibility. Incidence rates (IRs) of CVAD failure were reported, with group differences compared using the Fisher exact and log-rank tests. Cox regression explored univariable risks for failure. A substudy examined bacterial colonisation of catheter tips, dressings, and skin. Cost estimates of the intervention were compared., Results: A total of 121 participants were randomised. Study feasibility was established with no withdrawal and moderate staff acceptability; however, recruitment was low at 12%. Overall CVAD failure was seen in 14 of 114 (12%) CVADs (19 per 1000 catheter-days); highest in the SSD group (IR: 27.3 per 1000 catheter-days [95% confidence interval {CI}: 11.4-65.6]), followed by the standard care group (IR: 22.3 per 1000 catheter-days [95% CI: 8.38-59.5]) and TA group (IR: 20.6 per 1000 catheter-days [95% CI: 6.66-64.0]), and lowest in the ISD group (IR: 8.8 per 1000 catheter-days [95% CI: 2.19-35.0]). The majority of complications (11/14, 79%) were suspected central line-associated bloodstream infection (CLABSI), of which only one was laboratory confirmed (standard care group). The cost per patient was lowest in the standard care group by an average difference of AUD $14., Conclusion(s): A large multisite RCT examining forms of securement and dressing is feasible. ISD is the highest priority to test further as it had the lowest failure rate., Trial Registration: ACTRN12615000667516 PROTOCOL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 368765., (Copyright © 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Aims and Objectives: The aim of this study was to explore nurse navigators and consumers' experience of partnership., Background: The nurse navigator has recently emerged as an advanced practice role in the care of persons with complex and chronic disease states. Self-care is an important principle in chronic disease models of care, requiring healthcare practitioners to partner with clients in their care. How nurse navigators and consumers [clients and family] experience partnership has not been explored., Design: An interpretive exploratory qualitative approach was used. Semi-structured interviews were conducted with seven nurse navigators working with adults with complex disease states and eleven of their clients. Interviews were analysed using descriptive content analysis. (COREQ checklist Data S1)., Results: Five themes about partnership emerged. Three themes from nurse navigators were as follows: establishing and sustaining relationships, nurse-led planning and aligning care with clients' needs. The two consumer themes were as follows: regular contact means access to the health system and nurse presence is valued. The secondary analysis revealed two themes about partnership between the nurse and consumer: establishing relationships require nursing effort to be established and partnerships are person-focused and nurse-led., Conclusions: Partnership begins with a relationship, largely driven by the nurse navigator through regular communication and personal contact that was valued by consumers. The nurse-led partnership reduced opportunities for consumers to learn to manage their treatments, particularly how and when to access services, meaning that self-care may not be fully achieved. Client navigation occurs over long periods, which could lead to the navigators being overwhelmed, raising an issue of sustainability., Relevance to Clinical Practice: Nurse navigators establish a client relationship as a foundation for partnership. This partnership needs a focus on promoting client self-care, self-management of treatment, including when and how to access available services, to ensure the sustainability of the nurse navigator model of care., (© 2020 John Wiley & Sons Ltd.)

Objective: The objective of this study was to determine the incidence of endotracheal tube (ETT) suction-related adverse events (AEs) and to examine associations between AEs and patient and suction characteristics. Secondary objectives were to describe ETT suction practices in an Australian paediatric intensive care unit (PICU)., Methods: A prospective, observational study was undertaken in a mixed cardiac and general PICU. Children were eligible for inclusion if they were intubated and mechanically ventilated. Data on patient and suction variables (indication for ETT suction, number of suction episodes per mechanical ventilation episode, indication for normal saline instillation [NSI] and NSI dose) including potential predictive variables (age, Paediatric Index of Mortality 3 [PIM3], NSI, positive end-expiratory pressure, and hyperoxygenation) were collected. The main outcome variable was a composite measure of any AE., Main Results: A total of 955 suction episodes were recorded in 100 children. AEs occurred in 211 (22%) ETT suctions. Suction-related AEs were not associated with age, diagnostic category, or index of mortality score. Desaturation was the most common AE (180 suctions; 19%), with 69% of desaturation events requiring clinician intervention. Univariate logistic regression showed the odds of desaturation decreased as the internal diameter of the ETT increased (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.37-0.95; p = 0.028). Multivariable modelling revealed NSI was significantly associated with an increased risk of desaturation (adjusted OR [aOR]: 3.23; 95% CI: 1.99-5.40; p < 0.001) and the occurrence of an AE (aOR: 2.76; 95% CI: 1.74-4.37; p < 0.001). Presuction increases in fraction of inspired oxygen (FiO 2 ) was significantly associated with an increased risk of experiencing an AE (aOR: 2.0; 95% CI: 1.27-3.15; p = 0.003)., Conclusions: ETT suction-related AEs are common and associated with NSI and the requirement for pre-suction increases in FiO 2 . Clinical trial data are needed to identify high-risk patient groups and to develop interventions which optimise practice and reduce the occurrence of ETT suction-related AEs., (Copyright © 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Assessment of fitness for practice in the nursing student population is an essential yet challenging component of nursing education. The aim of this research was to describe the development and preliminary validation of the Assess-Safe instrument that explores assessors' experiences of grading nursing student performances in clinical courses when that performance is not a clear pass or fail. A 3 phase approach was used to develop and psychometrically test the instrument. Phase 1 involved the development of a pool of items following a literature review, coupled with findings from qualitative data. In phase 2, an expert panel rated the items for clarity and relevance, reducing the item pool. Assessors of Australian undergraduate nursing students from industry and academia were recruited for this study. A sample of 149 assessors across industry and academia completed the resultant survey to pilot test the instrument; constituting Phase 3. A high content validity index score of 0.95 was achieved through expert review. Construct validity using factor analysis revealed four factors including: assessor support; process support; assessor introspection; and student support. The Assess-Safe instrument achieved good internal reliability with an overall Cronbach's alpha coefficient of 0.77; and sub-scale scores ranging from 0.71 to 0.79. The Assess-Safe instrument demonstrated satisfactory psychometric properties and has utility for education programmes, research and policy development across a variety of practice based professions. Nonetheless, further psychometric validation is warranted., Competing Interests: Declaration of competing interest The authors wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. This article represents a component of research undertaken as part of the contact author's PhD studies. The authors are grateful to the participants for their honesty and commitment to this study which ensured its veracity. A University Post-Graduate Scholarship has been awarded to the contact author. This work has been produced without technical or financial support from any other organization, public, commercial, or not-for-profit. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship. We confirm that the order of the authors listed in the manuscript has been approved by all of us., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Failing to fail nursing students in clinical assessments is an internationally acknowledged issue that necessitates thorough examination. Despite the gravity of 'mis-grading' nursing students, current research exploring this subject is limited. Understanding the experiences of assessors when faced with an underperforming student may help illuminate some of the broad issues associated with failure to fail., Objectives: To describe both tertiary and industry based assessors' experiences of grading nursing student performances in clinical courses when that performance was not a clear pass or fail., Design: A pilot study using a descriptive survey design was employed., Setting: Participants were drawn from all states and territories in Australia., Participants: Academic and industry assessors of undergraduate nursing students across Australian universities participated in this study., Methods: A newly developed and validated survey was conducted via an online platform. Descriptive data were collected on assessors' experiences across the domains of the Invitational Theory: people; processes; programmes; policies and places., Results: Participants clearly had a strong duty of care to patients and the nursing profession. However, 23.5% of participants had given the benefit of the doubt to student performances. They reported failing student performances nevertheless reported passing students. Some participants experienced a number of coercive student behaviours. They perceived that the culture of the ward impacted on student performances in assessments. Inadequate time to assess students in clinical practice was reported by 44% of participants. Participants reported no differentiation between theoretical and clinical assessments in their organisations' assessment policies., Conclusions: Assessors reported many challenges when assessing students who were not performing at requisite standards. This study furthered the extant literature around the impact of people and processes on assessors and failure to fail. For the first time, assessors' experiences of the assessment environment, programme design and organisational policies associated with grading marginal student performances are reported., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: The complex nature of the Paediatric Intensive Care Unit (PICU) patient requires the bedside nurse to make rapid, complex decisions regarding endotracheal suction (ETS) interventions. It is not understood what influences nurses' decision making in the context of ETS, however, the actions of the clinician have a direct impact on the efficacy of the ETS event and patient outcomes., Objectives: To explore and describe the use of normal saline instillation and lung recruitment with paediatric ETS in a cohort of Australian nurses, and to identify factors that influence normal saline use with ETS., Methods: A descriptive, exploratory study. An evidence-based practice model formed the conceptual basis for the study. Semi-structured interviews were conducted with 12 nurses from an Australian tertiary referral paediatric intensive care unit. Audiotaped interviews were transcribed. Inductive thematic analysis was used to code and analyse the interview data and identify themes., Findings: Data analysis revealed three themes: patient's clinical presentation, clinician judgement and unit practice norms., Conclusions: Variability in nurses ETS practice was marked. In the absence of evidence based clinical guidelines, nurses relied on knowledge derived from clinical experience and the local setting to guide NSI and LR intervention decisions. Participants reported uncertainty regarding ETS best practice and perceived the lack of research evidence as a barrier to making informed clinical decisions at the bedside. Rigorous research evaluating the safety and efficacy of NSI and LR with ETS is urgently required for patient care; however PICU nurses rely on multiple sources of evidence to inform ETS practice decision., (Copyright © 2018 Australian College of Critical Care Nurses Ltd. All rights reserved.)

Background: Whilst there is a growing body of research exploring the effect of delirium in intensive care unit (ICU) patients, the relationship between patient delirium and long-term cognitive impairment has not been investigated in settings where low rates of delirium have been reported., Objectives: To assess the association between the incidence of delirium, duration of mechanical ventilation and long term cognitive impairment in general ICU patients., Methods: Prospective cohort study conducted in a tertiary level ICU in Queensland, Australia. Adult medical and surgical ICU patients receiving ≥12h mechanical ventilation were assessed for delirium on at least one day. Cognitive impairment was assessed at three and/or six-months using the: Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); Trail Making Test (TMT) Part A and B; and Mini-Mental State Examination (MMSE)., Results: Of 148 enrollees, 91 (61%) completed assessment at three and/or six months. Incidence of delirium was 19%, with 41% cognitively impaired at three months and 24% remaining impaired at six months. Delirium was associated with impaired cognition at six-months: mean TMT Part A scores (information processing speed) were 7.86s longer than those with no delirium (p=0.03), and mean TMT Part B scores (executive functioning) 24.0s longer (p=0.04)., Conclusions: ICU delirium was positively associated with impaired information processing speed and executive functioning at six-months post-discharge for this cohort. Testing for cognitive impairment with RBANS and TMT should be considered due to its greater sensitivity in comparison to the MMSE., (Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Introduction: Endotracheal suction (ETS) is a frequent and necessary airway intervention for the intubated child. The aim of ETS is to clear the endotracheal tube and airways of respiratory secretions; however, the methods of performing ETS are varied. Internationally a number of ETS treatments are in use. Many have not been rigorously evaluated in a randomised controlled trial setting, and it is uncertain whether any are associated with better outcomes for the critically ill child. With approximately 50% of paediatric intensive care admissions requiring intubation, ETS interventions that maximise the efficacy and minimise the complications of ETS could translate to improved health for substantial numbers of critically ill children, and significant cost savings. The primary aim of the study is to examine two ETS interventions, normal saline instillation and lung recruitment, to determine if it is feasible to conduct a full efficacy trial., Methods and Analysis: NARES (Normal saline instillation versus no normal saline instillation And lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction) is a single-centre, pilot, factorial randomised controlled trial conducted in a tertiary referral paediatric centre in Brisbane, Australia. Children (aged 0-16 years) are eligible if they are intubated with an endotracheal tube and mechanically ventilated. Two intervention pairs will be compared using a 2×2 factorial design: (1) normal saline instillation versus no normal saline instillation; and (2) lung recruitment versus no lung recruitment. The primary outcome is study feasibility measured by a composite analysis of eligibility, recruitment, retention, protocol adherence and missing data. Secondary outcomes are ventilator-associated pneumonia, SpO 2 /FiO 2 ratio, lung compliance, end expiratory level and regional tidal volume., Ethics and Dissemination: Ethical approval to conduct the research has been obtained. Dissemination of the research findings will be untaken, guided by the Consolidated Standards of Reporting Trials statement recommendations. Protocol content was guided by the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement., Trial Registration Number: ACTRN12617000609358; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Early rehabilitation has been found to prevent delirium and weakness that can hamper the recovery of intensive care unit (ICU) survivors. Integrated clinical practice guidelines for managing patient pain, agitation and delirium (PAD) have been developed. The Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle provides a strategy to implement PAD guidelines into everyday clinical practice. However, there is limited evidence on the effectiveness of the ABCDE bundle in the literature.The purpose of this study was to evaluate the feasibility of conducting a full-scale randomised controlled trial comparing the ABCDE bundle to standard care in an ICU. Trial feasibility was defined as the successful recruitment and retention of trial participants, adherence to the intervention, identification of barriers to the intervention, and the rigorous collection of outcome data., Methods: A prospective, single-centre, randomised controlled feasibility study was conducted. Thirty adult mechanically ventilated participants were recruited from an eight-bed ICU in south east Queensland, Australia, between April 2015 and December 2015. Participants were randomised to receive either the ABCDE bundle or standard routine management. The ABCDE bundle integrated prescribed awakening and breathing trials, delirium monitoring and management, and prescribed exercise and mobility regimes. Feasibility outcomes measured included recruitment and retention rates, intervention fidelity, and the feasibility of participant outcome data collection. Outcome measurement assessors were blinded to participant assignment. It was not possible to blind the research team or the participant to group assignment., Results: In total, 30 (81.1%) of 37 eligible participants consented and were randomised to the intervention group ( n  = 15) or the control group ( n  = 15). Of these, 23 (76.6%) participants successfully completed the 90-day post discharge assessment. A lengthy recruitment period of 8 months was related to overly stringent inclusion and exclusion criteria. Intervention adherence exceeded defined success rates with participation in awakening and breathing trials, delirium monitoring and exercise interventions performed on 80.2, 97.4 and 90.2% of ventilated days respectively. Outcome assessments were successfully and accurately performed at ICU and hospital discharge and 90-day post hospital discharge. Intervention participants were deemed to be delirious on 39.6% of mechanically ventilated days indicating a requirement for a scripted regime to prevent delirium., Conclusions: With minor adjustment of inclusion and exclusion criteria, the inclusion of delirium management protocols, and encouragement of family engagement and involvement, a large-scale definitive randomised controlled trial to test the impact of the ABCDEF bundle will be feasible., Trial Registration: Australian New Zealand Clinical Trials Registry 12614000763640 Date registered 17/08/2014., Competing Interests: The trial protocol was approved by the site (EC00167) and University (EC00162) Human Research Ethics Committee in Queensland, Australia. Written informed consent was obtained prior to enrolment from either the participant or their substitute decision-maker. Verbal consent from the participant was again received prior to follow-up data collection.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objective: To synthesise research findings regarding the efficacy and safety of normal saline instillation (NSI) during endotracheal suction in the paediatric intensive care unit., Data Sources: The Cochrane Library, PROSPERO, the National Health Service Centre for Reviews and Dissemination, PubMed and Cumulative Index to Nursing and Allied Health (CINAHL) databases were systematically searched. Subject headings included "suctioning, endotracheal", "suction", "sodium chloride", "normal saline" and "paediatrics". Additional references were sourced from hand searches of journal article reference lists and Google Scholar., Method: An integrative, systematic approach was used to qualitatively synthesise study results in the context of paediatric intensive care nursing practice. Data were extracted using a standardised data extraction form. Quality assessment was performed independently by two reviewers., Results: Three studies met pre-defined inclusion criteria. Quality of all study methods was 75% on the Mixed Method Appraisal Tool, although reporting quality varied. Overall, there was a scarcity of high quality evidence examining NSI and paediatric endotracheal suction. Outcome measures included oxygen saturation (SpO 2 ), serious adverse events (author/s defined) and ventilation parameters (author/s defined). Endotracheal suction with NSI was associated with a transient decrease in blood oxygen saturation; research protocols did not include interventions to mitigate alveolar derecruitment. Studies were not powered to detect differences in endotracheal tube (ETT) occlusion or ventilator associated pneumonia (VAP)., Conclusion: NSI was associated with a transient decrease in oxygen saturation. In children with obstructive mucous, NSI may have a positive effect. Practices which maximise secretion removal and mitigate the negative physiological interactions of ETS have been poorly evaluated in the paediatric population. High quality, powered, clinical trials are needed to determine the safety and efficacy of normal saline instillation and to inform clinical practice., (Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Family members could play an important role in preventing and reducing the development of delirium in Intensive Care Units (ICU) patients. This study sought to assess the feasibility of design and recruitment, and acceptability for family members and nurses of a family delivered intervention to reduce delirium in ICU patients., Method: A single centre randomised controlled trial in an Australian medical/surgical ICU was conducted. Sixty-one family members were randomised (29 in intervention and 32 in non-intervention group). Following instructions, the intervention comprised the family members providing orientation or memory clues (family photographs, orientation to surroundings) to their relative each day. In addition, family members conducted sensory checks (vision and hearing with glasses and hearing aids); and therapeutic or cognitive stimulation (discussing family life, reminiscing) daily. Eleven ICU nurses were interviewed to gain insight into the feasibility and acceptability of implementing the intervention from their perspective., Results: Recruitment rate was 28% of eligible patients (recruited n=90, attrition n=1). Following instruction by the research nurse the family member delivered the intervention which was assessed to be feasible and acceptable by family members and nurses. Protocol adherence could be improved with alternative data collection methods. Nurses considered the activities acceptable., Conclusion: The study was able to recruit, randomise and retain family member participants. Further strategies are required to assess intervention fidelity and improve data collection., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: The admission of a relative to intensive care is stressful for families. To help them support the patient, families need assurance, information and an ability to be near their sick relative. Flexible visiting enables patient access but the impact of this on patients, families and staff is not clear., Objective: To assess the impact of flexible visiting from the perspective of patients, families, and Intensive Care Unit (ICU) staff., Methods: A before-after mixed method study was used with interviews, focus groups and surveys. Patients were interviewed, family members completed the Family Satisfaction in ICU survey and ICU staff completed a survey and participated in focus groups following the introduction of 21h per day visiting in a tertiary ICU. The study was conducted within a philosophy of family-centred care., Results: All interviewed patients (n=12) positively evaluated the concept of extended visiting hours. Family members' (n=181) overall 'satisfaction with care' did not change; however 85% were 'very satisfied' with increased visiting flexibility. Seventy-six percent of family visits continued to occur within the previous visiting hours (11am-8pm) with the remaining 24% taking place during the newly available visiting hours. Families recognised the priority of patient care with their personal needs being secondary. Three-quarters of ICU staff were 'satisfied' with flexible visiting and suggested any barriers could be overcome by role modelling family inclusion., Conclusion: Patients, families and ICU staff positively evaluated flexible visiting hours in this ICU. Although only a minority of families took advantage of the increased hours they indicated appreciation for the additional opportunities. Junior staff may benefit from peer-support to develop family inclusion skills. More flexible visiting times can be incorporated into usual ICU practice in a manner that is viewed positively by all stakeholders., (Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Objectives: Patient, Family-Centred Care (PFCC) is internationally advocated as a way to improve patient care. The aim of this integrative review was to extend the knowledge and understanding by synthesising empirical evidence of PFCC interventions within the adult intensive care unit (ICU) setting., Review Method Used: An integrative review methodological framework was employed, permitting the inclusion of all research designs. A comprehensive and systematic search, selection, quality appraisal, and data extraction of research were conducted to synthesise knowledge and identify research gaps., Data Sources: A systematic search of the following databases was conducted: MEDLINE; CINHAL; PsycINFO; Cochrane Library; Web of Science-Current Contents Connect; Web of Science-Core Collection; The Joanna Briggs Institute EBP Database; ProQuest Sociological Abstracts; and ProQuest Dissertation and Theses Global. Primary research in adult ICUs was included., Review Methods: Data extracted from the studies included authors, year, country of origin, design, setting, sample, intervention, data collection strategies, main findings and limitations. Study quality was assessed using the Mixed Methods Appraisal Tool., Results: Forty-two articles met the inclusion criteria and were included in the review. Only a third of the papers stated the theory underpinning their study. Three themes emerged with interventions predominantly around Interacting with the target sample; Culture and Connection and Service Delivery interventions were also identified. Few studies integrated more than one dimension of PFCC., Conclusions: Research into PFCC interventions is diverse; however, few researchers present a multi-dimensional approach incorporating a culture shift to enact PFCC throughout the ICU trajectory. There is an opportunity for future research to describe, develop, and test instruments that measure PFCC based on its multiple dimensions and not on one component in isolation. Importantly, for PFCC to successfully individualise quality patient care, a commitment and enactment of partnerships between health care professionals, patients, and family members is imperative., (Copyright © 2016 Australian College of Critical Care Nurses Ltd. All rights reserved.)

Background: Objective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students' and clinicians' clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation., Methods: A mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students' opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources., Results: Few changes were made to the existing simulation plan and format. Students' responses from surveys ( n  = 367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice., Discussion: Similarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations., Conclusions: Findings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students' needs in rehearsing the registered nurse role.

Objectives: The aim of this review is to appraise current research which examines the impact of early rehabilitation practices on functional outcomes and quality of life in adult intensive care unit (ICU) survivors., Review Method Used: A systematic literature search was undertaken; retrieved data was evaluated against a recognised evaluation tool; research findings were analysed and categorised into themes; and a synthesis of conclusions from each theme was presented as an integrated summation of the topic., Data Sources: Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid Medline and Google Scholar were searched using key search terms 'ICU acquired weakness', 'early rehabilitation' 'early mobility' and 'functional outcomes' combined with 'intensive care' and 'critical illness'. Additional literature was sourced from reference lists of relevant original publications., Results: Five major themes related to the review objectives emerged from the analysis. These themes included: critically ill patients do not always receive physical therapy as a standard of care; ICU culture and resources determine early rehabilitation success; successful respiratory and physical rehabilitation interventions are tailored according to individual patient impairment; early exercise in the ICU prevents the neuromuscular complications of critical illness and improves functional status; early exercise in the ICU is effective, safe and feasible., Conclusions: A limited body of research supports early rehabilitation interventions to optimise the short term outcomes and long term quality of life for ICU survivors. Critical care nurses are in an excellent position to drive change within their departments ensuring that early rehabilitation practices are adopted and implemented., (Copyright © 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Objective Structured Clinical Examinations (OSCEs) are widely used in health professional education and should be based on sound pedagogical foundations., Objectives: The aim of this study is to evaluate the feasibility and utility of using Best Practice Guidelines (BPGs) within an OSCE format in a broad range of tertiary education settings with under-graduate and post-graduate nursing and midwifery students. We evaluated how feasible it was to apply the BPGs to modify OSCEs in a course; students' perspective of the OSCE; and finally, if the BPG-revised OSCEs better prepared students for clinical practice when compared with the original OSCEs., Design: A mixed method with surveys, focus groups and semi-structured interviews evaluated the BPGs within an OSCE., Settings: Four maximally different contexts across four sites in Australia were used., Participants: Participants included lecturers and undergraduate nursing students in high and low fidelity simulation settings; under-graduate midwifery students; and post-graduate rural and remote area nursing students., Results: 691 students participated in revised OSCEs. Surveys were completed by 557 students; 91 students gave further feedback through focus groups and 14 lecturers participated in interviews. At all sites the BPGs were successfully used to modify and implement OSCEs. Students valued the realistic nature of the modified OSCEs which contributed to students' confidence and preparation for clinical practice. The lecturers considered the revised OSCEs enhanced student preparedness for their clinical placements., Discussion and Conclusions: The BPGs have a broad applicability to OSCEs in a wide range of educational contexts with improved student outcomes. Students and lecturers identified the revised OSCEs enhanced student preparation for clinical practice. Subsequent examination of the BPGs saw further refinement to a set of eight BPGs that provide a sequential guide to their application in a way that is consistent with best practice curriculum design principles., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Contemporary midwifery practice needs a rigorous and standardised assessment of practical skills, and knowledge to ensure that safety is maintained for both women and neonates before, during and after childbirth., Aim: To evaluate the use of Best Practice Guidelines (BPG) for Objective Structured Clinical Examinations (OSCE) as a standardised tool to develop clinical competence of Bachelor of Midwifery students., Method: A pragmatic mixed method approach with surveys, focus groups and interviews was used to evaluate the OSCEs for first year students. Quantitative and qualitative data were combined to understand student and academic perceptions of students' confidence for clinical practice following the OSCE., Findings: Thirty-four students responded to surveys (response rate 94%); and 13 participated in focus groups. Two academic lecturers participated in an interview (100%). Two main themes emerged (1) the OSCEs improved student confidence (2) the OSCEs were relevant and prepared students for practice. Most students indicated that they practised for the OSCE using an integrated approach (70%), and that this assisted them in their approach to the assessment of the neonate or post-partum mother., Conclusion: The use of BPGs to ensure that OSCEs focus on important aspects of knowledge and practice helped students to learn and to perform well. Students' confidence in their ability for the imminent professional experience placement was high. OSCEs designed with the BPGs should be implemented broadly across midwifery education to enhance students' competence and provide rigorous meaningful assessment., (Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Aim: To develop and psychometrically test the Paediatric Intensive Care Unit-Nursing Knowledge and Skills Test - a multiple-choice test for measuring the key nursing knowledge and skills required for safe, competent practice., Background: Intensive care graduate nurse residency or orientation programmes are key strategies in the development of safe and competent practitioners. Essential to these programmes is an evaluation of knowledge and skills. Multiple-choice examinations provide a valuable way of evaluating broad knowledge and skills; however, there has been limited work in this area to date., Design: Psychometric evaluation., Methods: The instrument was administered to 79 nurses from four paediatric intensive care units in Australia and New Zealand over 18 months between 2008-2010. Internal consistency using Kuder-Richardson 20, item analysis and construct validity using the 'known groups' technique were explored., Results: Kuder-Richardson 20 reliability estimate for the 109-item test was 0·85. Instrument scores were significantly higher amongst nurses with postgraduate education and more years of paediatric intensive care experience. Item difficulty indices ranged from 0·08 to 1, with a mean item difficulty of 0·66. Item discrimination ranged from 0·2-0·8., Conclusion: Testing of the instrument demonstrated encouraging psychometric properties. With additional refinement, this tool could provide educators and managers with an instrument to assist in the assessment of knowledge and skill acquisition. The instrument requires further testing in different samples of paediatric intensive care nurses to enable validation in other settings and cross-cultural comparisons., (© 2013 John Wiley & Sons Ltd.)

Introduction: Nurses in remote areas of Australia are the primary healthcare professionals, who need to be able to deliver comprehensive and culturally sensitive care to clients, many of whom are Indigenous Australians. Adequate and specific preparation for practice is crucial to the quality of care delivered by remote area nurses (RANs). Objective structured clinical examinations (OSCE) provide an excellent opportunity for student practice in a simulated environment that is safe, authentic, fair and valid when well constructed. Seven integrated best practice guidelines (BPGs), previously developed by project team members to inform OSCEs within educational programs, provided guidance in restructuring the OSCE. This paper provides a detailed analysis of the value of BPGs used in the development, teaching and learning, and evaluation of OSCEs in a rural and remote postgraduate course for RANs., Method: A pre-site visit to the Centre for Remote Health, Alice Springs, Northern Territory, was conducted with modification of the course and previous OSCE according to BPGs. Following delivery of the course and OSCE, evaluations occurred via a mixed method approach. Student surveys (n=15) and focus groups (n=13) and staff interviews (n=5) provided an in-depth analysis of their perceptions of the revised OSCE. Descriptive statistics were used to describe the student sample. The narrative data were transcribed verbatim and analysed using content analysis. Triangulation was achieved with the convergence of the separate data sources focusing on themes and patterns within and between students and tutors., Results: All 15 students and five tutors provided feedback. The majority of student participants had limited experience in working in remote area nursing prior to participation and therefore the opportunities that availed themselves were critical in adequately equipping them with the requisite knowledge, skills and abilities. Three themes emerged from the data: (1) value of common and significant events in OSCE; (2) power of deliberate actions; and (3) learning cultural sensitivity., Discussion: OSCEs in this setting proved to be a good way for students to learn the skills required by RANs. Overwhelmingly, the modifications using the BPGs were highly valued by students and staff. Three themes emerged and were clearly linked to specific BPGs, indicating the positive impact the BPGs had on the OSCEs and student learning. The authentic content for the scenarios was seen as relevant and motivational for student learning. The practice element of the OSCEs enhanced the learning experience and feedback supported learning., Conclusions: OSCEs developed, taught and assessed using BPGs were highly valued. The BPGs provided an integrated approach with real-life scenarios with a strong cultural perspective - all important features to the RANs' future success in providing individualised care to clients in remote areas of Australia. Further use of BPGs is recommended.

The implementation framework outlined in this paper has been developed from feedback of a trial across three different nursing and midwifery programmes and is designed to assist educators to incorporate OSCEs within their curricula. There is value in flagging the pedagogical principles embodied in the framework and alerting educators to their importance for more meaningful student learning. For each step practical advice is provided contributing to the utility of this approach. Considerations are systematic ensuring that the use of OSCEs in health care curricula assures judicious use of resources to achieve desired student outcomes.

Background: One strategy to address the current nursing shortage in specialty areas has been to introduce graduate nurse programs. However introducing novice nurses to specialty areas raises concerns around education and competency which, in turn, highlights the need to identify and prioritise the elements of competent paediatric intensive care unit (PICU) nursing care considered essential to safe practice., Objectives: To determine the key knowledge, skills and attributes of competent level PICU nurses., Methods: A practice analysis survey of 15 nurse educators was conducted in all eight Australian and New Zealand PICUs during 2008. Three areas of practice essential to PICU nursing competence were explored: patients most commonly cared for; frequency and criticality of activities performed; and level of independence against critical care nursing competency standards. Data were analysed using descriptive statistics., Results: Cardiac and respiratory problems accounted for over 50% of patients cared for by competent level nurses. Cardiac and respiratory activities were therefore also ranked as the most important activities. Respondents identified that competency domains of teamwork and professional practice are performed with minimal supervision, whereas clinical problem solving requires supervision and assistance., Conclusions: PICU nurses are performing activities and caring for a breadth of complex patients within a year of entering the workforce. Using a practice analysis to define actual practice and expectations can assist in the identification and prioritisation of content for graduate and other educational programs., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Validated professional knowledge measures are limited in paediatric intensive care unit (PICU) nursing. The Basic Knowledge Assessment Tool for Pediatric Critical Care Nurses (PEDS-BKAT4) measures knowledge, however content and practice differences exist between various PICUs. The study aim was to evaluate the PEDS-BKAT4 in the Australian and New Zealand setting. A panel of 10 experts examined item and scale content validity. Items were evaluated for 31 evidence-based item writing flaws and for cognitive level, by a 4-person expert panel. Thirty-six PICU nurses completed the PEDS-BKAT4, with reliability and item analysis conducted. Mean item content validity was 0.70, and 43% of items had content validity less than 0.8. Overall (Scale) content validity was 0.71. Thirty-five percent of items were classified as flawed. Thirty-five percent of items were written at the 'knowledge' level, and 58% at 'understanding'. The mean PEDS-BKAT4 score was 60.8 (SD=9.6), KR-20 reliability 0.81. The mean item difficulty was 0.62, and the mean discrimination index was 0.23. The PEDS-BKAT4 was not a reliable and valid measure of basic PICU nursing knowledge in Australian and New Zealand. Further research into the types of knowledge and skills required of PICU nurses in this setting are needed to inform the development of a future tool., (Copyright © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Objectives: This study sought to describe families' experiences of providing physical care to their critically ill relatives with bed-side nurses' support., Methods: A qualitative research design was used and telephone interviews were conducted with 10 family members. The interviews were analysed using content analysis where data were grouped around central, recurrent ideas. A purposeful sample of family members who had performed care for their sick relative were drawn from a critical care unit in a large tertiary hospital in Australia., Findings: The data revealed three main themes in relation to the family members' perceptions of providing some fundamental care to their sick relative. The three themes included: (1) 'Enacting Care'; (2) 'Connecting with Sick Relatives' and (3) 'Partnering with Nurses'., Conclusions: This study demonstrates that family members of critically ill patients enjoyed participating in their relatives' care and critical care nurses supported them in individualizing the care. They felt useful and it improved communication and facilitated close physical and emotional contact with their relative. This partnership approach successfully incorporated family members into the daily care for their sick relative and connects patients, families and nurses in critical care within this Family Centred Care model of care., (Copyright 2010 Elsevier Ltd. All rights reserved.)

This article explores the use of the objective structured clinical examination (OSCE) in undergraduate nursing education. The advantages and limitations of this assessment approach are discussed and various applications of the OSCE are described. Attention is given to the complexities of evaluating some psychosocial competency components. The issues are considered in an endeavour to delineate the competency components, or skill sets, that best lend themselves to assessment by the OSCE. We conclude that OSCEs can be used most effectively in nurse undergraduate curricula to assess safe practice in terms of performance of psychomotor skills, as well as the declarative and schematic knowledge associated with their application. OSCEs should be integrated within a curriculum in conjunction with other relevant student evaluation methods.

This paper describes the development, implementation and evaluation of a transfer brochure for family members of patients in an intensive care unit (ICU) to improve patient transfer to a general ward. When family members fail to understand information, they respond in ways that affect patient recovery. The brochure was designed within Knowles' Adult Learning Theory framework and developed using a multidisciplinary team. A mixed design was used to collect data from families and nurses. Results indicate that the brochure helped nurses to address the individual family's issues during transfer from ICU. Furthermore, 95% of nurses (n = 33) recommended its introduction for all future transfers. Family members (n = 82) who received the brochure as part of their transfer were significantly more satisfied with all aspects of transfer than those who experienced ad hoc transfer methods (n = 80). These results provide strong support for Knowles' Adult Learning Theory as an educational foundation for adult learning.

Introduction: This intervention study examines anxiety and uncertainty in illness in families transferring from intensive care to a general ward., Methods: The pre-test, post-test design purposively allocated family members to a control (n = 80) and intervention group (n = 82). The intervention group experienced a structured individualised transfer method whereas the control group received existing ad hoc transfer methods. Families were surveyed before and after transfer., Results: Families' uncertainty was significantly related to their state anxiety (P < 0.000), the relationship to the patient (P = 0.022), and the unexpected nature of patients' admission (P < 0.000). Anxiety increased significantly with reduced social support (P = 0.002). Following transfer, anxiety reduced significantly for both groups whereas uncertainty reduced significantly for the intervention group (P = 0.03)., Conclusion: Families at the time of transfer experience uncertainty and anxiety, which are significantly related in this study. The intervention significantly reduced uncertainty scores. When the family member was a parent, when admissions were unexpected, and those with fewer social supports represent potential 'at risk' groups whose adaptation to transfer may limit their coping ability. The structured individualised method of transfer is recommended with further research of ICU families to further examine the dimension of uncertainty and how it affects patient outcomes.

When general ward registered nurses (RN) receive patients from an intensive care unit (ICU) they report that much of their time in the initial phases revolves around meeting family needs (Farvis, 2002). Families experience anxiety when leaving the security of the close monitoring seen in ICU (Leith, 1999) and their anxiety reduces their ability to play a key role in the patient's recovery (McShane, 1991; Leske, 1992) as it can impair their decision-making (Cagan, 1988; Halm et al., 1993). By reducing a family's anxiety, they may be more able to cope with the necessary transition to a general ward and support the patient's recovery. A literature search from 1990 onwards was performed within the CINAHL, Medline and Cochrane databases using the key words: intensive care, family, General System Theory, uncertainty, anxiety and transfer. Further articles were retrieved from citation references from the Web of Science or through the reference lists of retrieved literature. Library catalogues were searched using the same key words for books and book chapters. von Bertalanffy's General System Theory provides a framework for understanding the importance of family in a critical illness situation. Critical illness permits little or no time to adapt, thus reducing the family's ability to cope with the situation. Transfer out of ICU is a significant anxiety-producing event for families. Uncertainty in illness is reported in other illness situations to reduce family's adaptation to illness events, but has not been researched with an ICU cohort of families. Seven out of the top 10 needs of ICU families are information needs, highlighting the importance of communication regarding progress and future plans. Nurses require an increased awareness that transfer anxiety exists for families and to be knowledgeable about ways to reduce its occurrence. Research is required to evaluate the efficacy of interventions to reduce anxiety for families and examine the level of uncertainty in illness in this cohort.