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Aims and objectives: To develop a communication app to support nursing staff during the provision of standard care of patients from non‐English‐speaking backgrounds (NESBs), when an interpreter is not available. This paper reports on the user needs analysis phase that informed the development, content and functionality of the app. Background: In 2014 we developed CALD Assist, a communication app to support patient interactions with allied health clinicians when interpreters are not present. It includes 95 commonly used phrases professionally interpreted into 10 languages and grouped by discipline. This work expands upon our previous app to meet the needs of the nursing workforce. Design: Qualitative through focus groups, observations and interviews, with a quantitative component from observational data and staff surveys. Methods: Four focus groups with hospital staff, ten interviews with patients from NESBs and 85 observation sessions of everyday patient–staff interactions followed by staff surveys (n = 85) were held between January and June 2017. Results: Baseline data prior to app development revealed that staff confidence of the patients’ level of understanding and the success of the interaction were significantly greater for English‐speaking (ES) patients, than for non‐English‐speaking patients. A total of 143 phrases were identified and subdivided into 16 categories for inclusion in the new app. Conclusion: Staff participants highlighted that patients from NESBs are a challenging patient group to interact with. Patient and staff participants identified a range of areas where the nursing app could benefit, including pain management, mobility, hygiene and nutrition. Relevance to clinical practice: The proposed app can be used to reduce variances in practice and provide a timely and positive patient experience for patients from NESBs who are unable to communicate in English during hospital admissions. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of the study was to enhance understanding about dignified care from older peoples' and their carers' perspectives. The information will contribute to the development of a tool to measure older peoples' dignity during hospitalisation. Background: Older people are a vulnerable cohort at risk of loss of dignity during acute hospitalisation arising from environmental, behavioural and patient factors. It is not clear how older people and their relatives define dignified care in acute care settings. Design: An interpretative descriptive method was used. Methods: A purposive sample of older people (at least 65 years) who had been hospitalised in acute care and subsequently transferred to sub‐acute care, and their relatives, were invited to participate. The study was undertaken in one sub‐acute ward in a regional healthcare organisation in Victoria, Australia. Individual interviews were audio‐recorded then transcribed. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. Results: Individual interviews were conducted: 24 patients and 12 relatives. Three main themes were identified: "Involve me in decisions about my care and treatment," "Keep me safe when I am vulnerable" and "Treat me as an individual and with respect." Older people want to be involved in decisions about their care and treatment and to receive adequate, suitable information. They feel vulnerable during hospitalisation and want to feel safe when speaking up about concerns. Individual acknowledgement is an important aspect of dignity. Conclusions: Older people and their relatives identified specific elements of care that uphold or threaten dignity during acute hospitalisation. Nurses play a major role in upholding dignity for older people in hospital. Relevance to clinical practice: Clinicians may benefit from systematic dignity‐related training. Specific strategies to enhance older persons' dignity, including communication skills training and continence management need to be developed, implemented and evaluated. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study is to report on a key finding of a larger study investigating the 'gaps' in patient care that registered nurses encounter during the course of their practice. A key finding of this larger study was that 'cutting corners' was a gap discerned by nurses. Background 'Cutting corners' has been characterised as a 'violation' and threat to patient safety, although there is a paucity of research on this issue. Design Naturalistic inquiry using a qualitative exploratory descriptive approach. Methods Data were collected from a purposeful sample of 71 registered nurses from emergency department, critical care, perioperative, rehabilitation and transitional care and neurosciences settings in Australia and analysed using content and thematic analysis strategies. Results Cutting corners was a common practice that encompassed (1) the partial or complete omission of patient care, (2) delays in providing care and (3) the failure to do things correctly. Corners were cut in patient assessment, essential nursing care, the care of central venous catheters and medication administration. The practice of cutting corners was perceived as contributing to preventable adverse events. Conclusions The study found that cutting corners created gaps that contributed to unfinished nursing care and preventable adverse events. The findings of the study raise the possibility that cutting corners is a salient but underinvestigated characteristic of nursing practice. Further research and inquiry are needed to deepen understanding of cutting corners and its impact on patient safety. Relevance to clinical practice Identifying the nature and implications of cutting corners when providing nursing care is an important contributing factor to improving patient safety and quality care. [ABSTRACT FROM AUTHOR]

Aims To understand the barriers and enablers to fertility-awareness education in general practice. Background Most women along with their primary care practitioners - general practitioners and practice nurses - believe that women should be educated about fertility-awareness when first reporting trouble conceiving. To date, no in-depth study has examined the enablers and challenges of this type of education in general practice. Design A descriptive exploratory qualitative study using deductive content analysis. Methods General practitioners ( N = 11) and practice nurses ( N = 20) were recruited from general practices in three socioculturally diverse areas in Victoria, Australia. Data were collected through semistructured interviews based on the 12 domains of a theoretical behaviour change framework from April-August 2012. The participants' responses were organized into themes that fall under the framework domains. Findings The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The biggest enablers were a greater use of nurses trained in fertility-awareness in a collaborative team care arrangement with general practitioners. Conclusion This study has identified several important barriers and enablers to fertility-awareness education in general practice. Translation into practice of our findings is imperative as the first step in establishing a primary care model in fertility-awareness. This would fill an important gap in the primary care of infertile women and build capacity in general practice to reduce infertility through women's enhanced fertility knowledge. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine carers' views on patient self-care in chronic heart failure (CHF). Background. Self-care, a key strategy in the long-term management of CHF, can be complex and difficult to master. Carers play a key role in supporting patients in self-care, yet their views on it are rarely sought. Design. A qualitative approach was adopted with a purposeful sample of carers of patients with CHF residing in Australia. Methods. Carers who identified themselves as providing informal care to a person diagnosed with chronic heart failure were interviewed about their views on patient self-care. Data were collected by face-to-face interviews with a semi-structured interview guide. Qualitative content analysis of the interviews was undertaken by two nurses and one psychologist. Results. Four key themes were identified pertaining to CHF patient self-care: hindrance to engagement; roles and relationships; social support and community engagement and competency. Most carers viewed patients' fatigue and inactivity, mood and coping, and memory loss as major challenges to engagement in self-care. They viewed emotional support and encouragement, independence and organised routines as important aspects of their relationship with the patient and as facilitators of self-care, but also required for themselves support from their families, communities and healthcare professionals. They also viewed patient and carer experience and knowledge as being essential to successful self-care. Conclusion. Carers viewed self-care as an important issue for patients with CHF and indicated that they could play an enhanced role with the provision of better support and knowledge from their families, communities and health care professionals. Relevance to clinical practice. Carers are closely involved in supporting patients in CHF self-care, even though their views are rarely considered in the organisation and delivery of heart failure management programmes. Therefore, their important contribution should be acknowledged and supported in contemporary heart failure health services. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study was to investigate the experiences of relatives who had a family member in an aged care facility subsequently transferred to an emergency department. Background. The provision of timely and relevant patient information is vital for assessment and management of older patients presenting to the emergency department from aged care facilities. Older people are commonly accompanied by relatives who are an important resource for emergency department staff, providing medical information and assisting with treatment decisions. Investigating the experiences of relatives may provide key information to enable improvements in the delivery of emergency department care. Design. This study used a descriptive qualitative design. Methods. Semi-structured interviews were undertaken with 24 relatives of residents who were transferred from an aged care facility to an emergency department in Victoria, Australia in the previous three years. Inductive content analysis was used to analyse the transcripts. Results. Relatives reflected on four main themes following their emergency department visit: The need for clear communication; The role of relatives in emergency department care; How older people are perceived in the health care system and an Ability to provide specialised care. Conclusions. Many people link their emergency department experience to the quality of communication with emergency department staff, and participants in this study felt satisfied with their visit when they were included in discussions about treatment, and their role was recognised by staff members. In contrast, participants were dissatisfied with the care provided to their family member when staff members failed to communicate with them, or recognise their role in the care of the family member. Relevance to clinical practice. The findings of this study emphasise the importance of effective communication between emergency department staff and family members, in relation to treatment and end-of-life care. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore emergency department ( ED) nurses' perceptions of current practices and essential components of effective change of shift nursing handover. Background Ineffective nursing handover can negatively impact on patient outcomes. Evidence suggests that nursing handover in ED is highly variable. Proposed handover models in the literature are structured for inpatient settings and may not be suitable for ED settings. Design A mixed methods study (survey and group interviews) was conducted in a metropolitan ED in Melbourne, Australia. Methods During February- June 2011, a survey ( n = 63) investigated perceptions of current practices and preferences for handover structure. Analyses are descriptive. In the same period, group interviews ( n = 41) explored nurses' opinions about essential features and information of an effective nursing handover in the ED environment. A modified nominal group technique generated data that were analysed using content analysis. Results Most nurses (96%) perceived receiving adequate information during handover; however, gaps were identified, including omission of important information regarding medications, vital signs and nursing care needs. Group interviews identified five essential features of effective handover: systematic approach, treatment, appropriate environment, reference to documentation/charts and efficient communication. Essential information included patient details, presenting problem, future care/disposition plan, treatment and nursing observations. Conclusion Handover structures in the ED may not provide essential information to ensure adequate continuity of nursing care. ED nurses consider optimal handover to be specific for patients for whom they are caring, conducted at the bedside, structured and containing key elements (patient details, presenting problem, treatment, nursing observations, plan). Relevance to clinical practice Provision of a handover framework incorporating key features and essential information has the potential to improve the efficiency of handover. Use of this framework may enhance the transfer of accurate and essential information to enable safe and high standards of nursing care in the ED. [ABSTRACT FROM AUTHOR]

blackford j. & street a. (2012) Is an advance care planning model feasible in community palliative care? A multi-site action research approach. Journal of Advanced Nursing 68(9), 2021-2033. Abstract Aim. This article reports a study to determine the feasibility of an advance care planning model developed with Australian community palliative care services. Background. An effective advance care planning programme involves an organizational wide commitment and preparedness for health service reform to embed advance care planning into routine practice. Internationally, such programmes have been implemented predominantly in aged and acute care with more recent work in primary care. Methods. A multi-site action research was conducted over a 16-month period in 2007-2009 with three Victorian community palliative care services. Using mixed method data collection strategies to assess feasibility, we conducted a baseline audit of staff and clients; analysed relevant documents (client records, policies, procedures and quality improvement strategies) pre-implementation and post-implementation and conducted key informant interviews ( n = 9). Settings and participants. Three community palliative care services: one regional and two metropolitan services in Victoria, Australia. Results. The services demonstrated that it was feasible to embed the Model into their organizational structures. Advance care planning conversations and involvement of family was an important outcome measure rather than completion rate of advance care planning documents in community settings. Services adapted and applied their own concept of community, which widened the impact of the Model. Changes to quality audit processes were essential to consolidate the Model into routine palliative care practice. Conclusion. An advance care planning model is feasible for community palliative care services. Quality audit processes are an essential component of the Model with documentation of advance care planning discussion established as an important outcome measure. [ABSTRACT FROM AUTHOR]

The aim of this study was to gain an understanding of the experiences and perspectives of intensive care nurses caring for critically ill obstetric patients. Current literature suggests critically ill obstetric patients need specialised, technically appropriate care to meet their specific needs with which many intensive care nurses are unfamiliar. Furthermore, there is little research and evidence to guide the care of this distinct patient group. This study used a descriptive qualitative design. Two focus groups were used to collect data from 10 Australian intensive care units nurses in May 2007. Open-ended questions were used to guide the discussion. Latent content analysis was used to analyse the data set. Each interview lasted no longer than 60 minutes and was recorded using audio tape. The full interviews were transcribed prior to in-depth analysis to identify major themes. The themes identified from the focus group interviews were competence with knowledge and skills for managing obstetric patients in the intensive care unit, confidence in caring for obstetric patients admitted to the intensive care unit and acceptance of an expanded scope of practice perceived to include fundamental midwifery knowledge and skills. The expressed lack of confidence and competence in meeting the obstetric and support needs of critically ill obstetric women indicates a clear need for greater assistance and education of intensive care nurses. This in turn may encourage critical care nurses to accept an expanded role of clinical practice in caring for critically ill obstetric patients. Recognition of the issues for nurses in successfully caring for obstetric patients admitted to an adult intensive care setting provides direction for designing education packages, ensuring specific carepaths and guidelines are in place and that support from a multidisciplinary team is available including midwifery staff. [ABSTRACT FROM AUTHOR]

Aims and objectives. The study aim was to develop a service evaluation tool for an advance care planning model implemented in community palliative care. Background. Internationally, advance care planning programmes usually measure success by completion rate of advance directives or plans. This outcome measure provides little information to assist nurse managers to embed advance care planning into usual care and measure their performance and quality over time. An evaluation tool was developed to address this need in Australian community palliative care services. Design. Multisite action research approach. Methods. Three community palliative care services located in Victoria, Australia, participated. Qualitative and quantitative data collection strategies were used to develop the Advance Care Planning-Service Evaluation Tool. Results. The Advance Care Planning-Service Evaluation Tool identified advance care planning progress over time across three stages of Establishment, Consolidation and Sustainability within previously established Model domains of governance, documentation, practice, education, quality improvement and community engagement. The tool was used by nurses either as a peer-assessment or self-assessment tool that assisted services to track their implementation progress as well as plan further change strategies. Conclusion. The Advance Care Planning-Service Evaluation Tool was useful to nurse managers in community palliative care. It provided a clear outline of service progress, level of achievement and provided clear direction for planning future changes. Relevance to clinical practice. The Advance Care Planning-Service Evaluation Tool enables nurses in community palliative care to monitor, evaluate and plan quality improvement of their advance care planning model to improve end-of-life care. As the tool describes generic healthcare processes, there is potential transferability of the tool to other types of services. [ABSTRACT FROM AUTHOR]