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Nurses play a vital role in pressure injury prevention (PIP) but require foundational knowledge to ensure appropriate PIP strategies are enacted. To describe and compare medical and surgical nurses' knowledge of pressure injury (PI) in a tertiary level hospital in China, and to identify predictors of PI knowledge among these groups. A cross-sectional survey was conducted between June and December 2020. Registered nurses from nine medical and fifteen surgical wards in a tertiary hospital were invited. The survey was composed of two parts; demographic and professional characteristics; and the Chinese translated version of the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0) where the total score ranged from 0 to 25; higher scores imply more knowledge. Medical and surgical nurses' knowledge test scores were compared using independent t -test. Multiple linear regression analysis was used to determine factors predictive of nurses' knowledge. In total, 423 nurses from 24 wards participated the study and 404 nurses (95.5%) completed the knowledge test (Surgical n = 236, 58.4%; Medical n = 168, 41.6%). The PUKAT 2.0 mean score was 11.6 ± 3.0 (Surgical 12.2 ± 3.0; Medical 10.7 ± 2.8) with 335 (82.9%) nurses scoring <60%. Multiple linear regression showed working in surgical wards, nurse-in-charge position and previous PI training were significant predictors of knowledge scores. Knowledge is a precursor to safe practice. Nurses demonstrated poor knowledge of PIP. Pressure injury related education may help improve nurses' knowledge but the extent to which it is used in place and impacts patients' outcome requires more investigation. • Nurses demonstrated poor knowledge of pressure injury in the Chinese hospital context. • Knowledge were impacted by nurses' professional position and previous trainings. • Bridging knowledge-practice gap by trainings is imperative to increase nurses' knowledge. [ABSTRACT FROM AUTHOR]

Research evidence and clinical practice guidelines exist on preventing central line-associated bloodstream infections. However, there is limited knowledge about the barriers and facilitators to evidence-based central venous access device care. The aim of this study was to investigate the facilitators and barriers to evidence-based central venous access device care in the adult intensive care setting. This exploratory qualitative study involved focus groups and interviews with registered nurses and physicians involved in central venous access device insertion and management in a tertiary Australian intensive care unit. Purposive sampling was used to recruit staff (n = 26) with varying years of clinical experience and clinical positions. Six focus groups and three individual interviews were conducted. Interviews were audio recorded, transcribed verbatim and analysed using content analysis. Three overarching categories emerged: work structures to support optimal performance; processes to optimise quality of care, and factors influencing staff members' behaviour. Perceived facilitators to optimal central venous access device care included explicit language use in procedure documents, work-system integrated strategies, research evidence dissemination, audit, and feedback. However, there was a lack of consistency in practices such as audit, feedback, and patient participation. To bring about effective improvement in central venous access device care, future interventions should be tailored to address identified barriers, including integrating audit and feedback into clinicians' work processes. Additionally, future research is needed to explore the role of patients and their families in central venous access device care. When developing practice policies or procedure manuals, it is important to use explicit language to ensure clear communication of evidence-based recommendations to clinicians. Strategies integrated into work processes can enhance adherence to evidence-based practice. Large departments with limited educators should explore innovative methods like online education to ensure optimal central venous access device care. [ABSTRACT FROM AUTHOR]

To evaluate the implementation of a regular Nursing Round as an educational strategy for workplace learning in an intensive care unit with a single room environment. A multiple methods design was used. Fifty-four Nursing Rounds were observed and nurses (n = 40) completed bespoke evaluative surveys. Structured observational data and open-ended survey responses were submitted to content analysis and descriptive statistics were used to analyse survey findings. Nursing Rounds involved a diverse range of participants, most frequently nurses. The content most frequently discussed included empirical clinical issues where nurses decided on nursing care actions to address these issues. The most frequently observed outcome of Nursing Rounds was knowledge translation. Nursing Rounds were perceived to positively influence application of evidence in practise, identification of areas for practise improvement and ability to communicate clinical information. Two categories emerged from analysis of open-ended survey questions; (1) 'Positive learning environment', where nurses described Nursing Rounds as a social learning experience; and (2) 'Impediments to Nursing Rounds', including difficulty attending Nursing Rounds due to competing priorities. Nursing Rounds enabled evidence-based learning that enhanced inter-disciplinary collaboration. Further investigation may be required to understand how to enable nurses to attend more frequently, and generate a more holistic, evidence-based discussion. [ABSTRACT FROM AUTHOR]

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Recovery after critical illness can be protracted and challenging. Compromise of physical, psychological, cognitive and social function is experienced by some patients and may persist for a number of years. Measurement of recovery outcomes at regular time points throughout the critical illness and recovery pathway is necessary to identify problems and guide selection of interventions to prevent, minimise or overcome that compromise. Optimisation of factors that enhance recovery, such as sleep, nutrition and memories of intensive care, will also assist with promotion of recovery. Effective assessment of recovery requires integration of assessment of outcomes into routine clinical practice by all members of the interdisciplinary team. There must be agreement of appropriate measures and measurement timeframes alongside relevant education and training to ensure optimal assessment and use of the information gained. Assessment outcomes need to be communicated to interdisciplinary team members across the critical illness and recovery trajectory. Adequate resourcing for both the assessment activities and subsequent care is essential to improve patient outcomes after critical illness. [ABSTRACT FROM AUTHOR]

Central venous catheters are often used in managing critically ill patients. Clinical practice guidelines and care bundles exist to prevent central line associated blood stream infections; however, detailed adherence to these guidelines and care bundles is unclear. This study was aimed to describe clinicians' adherence to recommended practices in central venous catheter insertion and management. A cross-sectional prospective observational study was conducted in the intensive care unit of an Australian tertiary hospital over a four-month period. We observed a total of 50 nurses during post insertion management, and 10 physicians during central venous catheter insertion using purposely designed observation tools. Our audit identified 90% adherence to recommended practices in central venous catheter insertion and 60% to post insertion management. However, there were areas where participants' practices were not congruent with evidence-based recommendations, including choice of central venous catheter insertion site, type of central venous catheters, dressing choice, aseptic technique, and documentation. Our audit showed a detailed picture of clinician's adherence to recommended practices in central venous catheter insertion and management. A clearer understanding of the barriers and facilitators of issues identified is needed to inform the design of future interventions to reduce central line related blood stream infections in the unit. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe factors senior critical care nurses identify as being important to address when introducing selective digestive tract decontamination (SDD) in the clinical setting. Background: Critically ill patients are at risk of developing ventilator-associated pneumonia (VAP). SDD is one strategy shown to prevent VAP and possibly improve survival in the critically ill. Methods: We performed a secondary analysis of qualitative data obtained from 20 interviews. An inductive thematic analysis approach was applied to data obtained from senior critical care nurses during phase two of a multi-methods study. Results: There were four primary considerations identified that should be addressed or considered prior to implementation of SDD. These considerations included education of health care professionals, patient comfort, compatibility of SDD with existing practices, and cost. Conclusions: Despite a lack of experience with, or knowledge of SDD, nurses were able to articulate factors that may influence its implementation and delivery. Organizations or researchers considering implementation of SDD should include nurses as key members of the implementation team. [Copyright &y& Elsevier]

Background and Objective: Many women do not recognize their risk for coronary heart disease, or identify and respond to cardiac symptoms by seeking medical assistance when symptoms occur. These factors contribute to delays in presentation at hospital, which means that women then have fewer treatment options. This study aimed to describe women''s symptom experiences and treatment-seeking responses to first-time acute coronary syndrome (ACS). Subjects and Methods: Ten women who had experienced their first ACS event, and who had undergone a percutaneous coronary intervention within 24 hours of presentation, consented to participate in semistructured interviews that focused on their experiences. These women''s narratives of their symptoms and treatment-seeking responses were thematically analyzed. Results and Conclusion: Women described several issues that contributed to quite complex, multifaceted decision-making processes, from symptom onset to treatment-seeking response, which often contributed to delays. These issues included the occurrence of sometimes intermittent early-warning or prodromal symptoms, the diversity of their symptom experience, beliefs in low vulnerability to coronary heart disease by the women themselves, and health professionals'' responses, which did not always match their needs. Lack of awareness may be particularly important in first-time ACS event. Effective strategies need to be developed to address these issues, including public-education campaigns, and specific education regarding women for health professionals. [Copyright &y& Elsevier]

Objective: Women who live alone are becoming an increasing proportion of our population, yet few studies have examined the experiences that these women have during recovery from an acute cardiac event. This study aims to describe women''s experiences of recovering alone from acute coronary syndrome. Methods: Women attending cardiac rehabilitation were interviewed 3 to 9 months after acute coronary syndrome using a life history approach to address their personal/social background, professional life, and work-related processes, and to acquire an in-depth narrative of their recovery from illness in relation to this background. The sample included 11 women aged from 44 to 82 years who lived alone. Results: “Being on my own” was the pervasive theme, with independence being both required and valued. One subtheme included the complexity of social support arrangements women needed for their recovery. This was particularly important because women felt vulnerable when they were alone, particularly if they had experienced a sudden cardiac event or recurrent symptoms. Recurrent cardiac symptoms were an important subtheme because of the pervasive influence on women''s lives, including their ability to work and plan ahead. Finally, the work and financial issues subtheme was a central concern for women, first because work was an important source of income and enjoyment, and second because loss of work meant loss of income. For some women, this meant selling their home or moving to another house. Conclusion: Women who live alone are an increasing proportion of patients with cardiac disease. Although they share many similar issues with other women and men who live alone, they seem to have unique concerns related to vulnerability, recurrent cardiac symptoms, social support, work, and finances. [Copyright &y& Elsevier]

Summary: Objective: This study was designed to prioritise educational outcomes for three levels of postgraduate speciality critical care nursing programmes. Background: Postgraduate speciality education has proliferated within Australia over the past 20 years. However, there is little agreement regarding the expected characteristics, or relevant priorities, of these characteristics of graduates successfully completing these programmes of study. Method: This study used a mixed-method approach comprising two phases. Initially a survey was mailed to volunteers between March and June 2005 to obtain priorities in educational outcomes for graduates of critical care programmes. This was followed by a stakeholder focus group in May 2006 to refine expected outcomes. Results: Survey respondents rated educational outcomes that described professional and legal aspects of practice to ensure safe patient care as highest priority for programme graduates. Although most educational outcome statements were considered important for graduates from all levels of courses, increasing levels of practice was described for increasingly higher levels of programmes from Graduate Certificate to Masters Degree. Conclusion: This study provides an emerging description of the priorities of critical care nursing programmes, with priority given to professional and legal aspects of practice. Further delineation of priorities is necessary to inform ongoing educational development. [Copyright &y& Elsevier]

Summary: As nursing has developed as a profession there has been a continual evolution of the scope of practice in which nurses work. Emergency nursing practice is an example where recently there has been a rapid expansion in the nature and scope of practice. This change in practice has largely resulted from increasing public demand on emergency departments, medical and nursing shortages and governmental pressure to reduced emergency department waiting times and patient length of stay. There have been a number of models worldwide in which the expansion of the Emergency Nurses role has occurred. Recently in New South Wales the Clinical Initiative Nurse role has been developed as an advanced practice role with the objective of initiating treatment based on advanced clinical assessment and to assist emergency departments to meet benchmarks and key performance indicators (KPIs). The scope of practice of this new role did not extend to that of a Nurse Practitioner who is able to discharge patients, prescribe medication and provide medical referral. The variation in advance practice nursing roles in Australia and worldwide has contributed to confusion and uncertainty. The aim of this paper is to explore the various advanced practice roles that may be encountered in emergency nursing practice and examine some of the advantages and limitations to the implementation of these roles. [Copyright &y& Elsevier]

B Conclusions: b Mammo-50 is an important trial, which demonstrated that is it feasible, acceptable to patients and clinicians and will provide clinicians with valuable risk-adjusted information to guide their future practice. More work is needed to develop an optimal management system for patients reporting symptoms and long-term side effects and Mammo-50 provides the platform to develop this management system with patients. [Extracted from the article]

Summary: Introduction: Enteral feeding is the preferred method of nutritional support for the critically ill; however, a significant number of these patients are under-fed. It is possible that common nursing practices associated with the delivery of enteral feeding may contribute to under-feeding although there is little data available describing nursing practice in this area. Method: A descriptive survey-based design was used to explore the enteral feeding practices of 376 critical care nurses (response rate 50.5%). Participants completed a 57-item survey that focused on general enteral feeding practice and the management of feeding intolerance and complications. Results: The enteral feeding practice of critical care nurses varied widely and included some practices that could contribute to under-feeding in the critically ill. Practices associated with the measurement of gastric residual volumes (GRV) were identified as the most significant potential contributor to under-feeding. GRV measurements were commonly used to assess feeding tolerance (n =338; 89.9%) and identified as a reason to delay feeding (n =246; 65.4%). Delayed gastric emptying was frequently managed by prokinetic agents (n =237; 63%) and decreasing the rate of feeding (n =247; 65.7%) while nursing measures, such as changing patient position (n =81; 21.5%) or checking tube placement (n =94; 25%) were less frequently reported. Conclusion: The findings of this survey support the contention that nursing practices associated with the delivery of enteral feeds may contribute to under-feeding in the critically ill patient population. [Copyright &y& Elsevier]