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During the emergent (ebb) phase (first 72 h), the adult person with a severe burn experiences loss of body heat, decreased metabolism, and poor tissue perfusion putting them at risk of hypothermia, increased morbidity, and mortality. Therefore, timely and targeted care is imperative. The aim of this integrative literature review was to develop a framework of the factors contributing to hypothermia in adults with a severe burn injury during the emergent (ebb) phase. An integrative review of research literature was undertaken as it provides an orderly process in the sourcing and evaluation of the literature. Only peer reviewed research articles, published in scholarly journals were selected for inclusion (n = 26). Research rigor and quality for each research article was determined using JBI Global appraisal tools relevant to the methodology of the selected study. Contributing factors were classified under three key themes: Individual, Pre-hospital, and In-hospital factors. The structured approach enabled the development of an evidence-based framework identifying factors contributing to hypothermia in adults with a severe burn injury during the emergent (ebb) phase and adds knowledge to improve standardized care of the adult person with a severe burn injury. • Post-severe burn, hypothermia risk is highest in the first 72 h or emergent phase. • Individual, pre and in-hospital factors contribute to hypothermia in the ebb phase. • Early temperature management targeting these factors can decrease complications. [ABSTRACT FROM AUTHOR]

The aim of this review was to uncover what motivates preregistration nursing students to speak up for patient safety during work integrated learning (WIL) and to develop an evidence-based safety motivation framework for use by educators, clinicians, and preregistration nursing students. This study used an integrative literature review design guided by Whittemore and Knafl's methodological framework. Five research databases, CINAHL, MEDLINE, PubMed, Scopus, and Web of Science, were searched for relevant peer reviewed research literature published in English between January 2011 and January 2024. The use of MeSH terms "undergraduate nursing student," or "preregistration nursing student" and "speaking up," "patient safety," and "motivation," resulted in 489 search returns. Following application of filters and inclusion criteria fifty-four (n = 54) studies were identified as being relevant to the research aim. The fifty-four (n = 54) research studies were reviewed using the JBI Critical Appraisal tool relevant to the study methodology. The JBI critical appraisal tools are checklists used to determine research quality, validity, results, and meaning. Following appraisal, 27 studies were included in the integrative literature review. Authentic learning, view of self as a nurse, and positive work integrated learning experiences were found to be the primary motivators for preregistration nursing students to speak up for patient safety during work integrated learning. These three motivators provided the foundation for an evidence-based framework, underpinned by self-determination theory, that can be used to enhance preregistration nursing students' motivation to speak up for patient safety. The integrative review design enabled the development of the evidence-based Safety Motivation Framework to support preregistration nursing students' during work integrated learning however missing from the literature was information about the lived experience of this group of students when speaking up for patient safety. • Preregistration nursing students are not motivated to speak up for patient safety. • The developed framework can motivate preregistration nursing students to speak up for patient safety. • Motivators are authentic learning, view of self as a nurse & positive WIL experience. • The safety motivation framework supports educators, clinicians, and preregistration nursing students. [ABSTRACT FROM AUTHOR]

Standard diagnostic criteria are not useful for identifying bloodstream infection in patients with an acute burn injury patients. The study objective was to develop and validate a tool using common laboratory, clinical, and patient parameters for early identification of bloodstream infection after acute burn injury (within 10 days after a burn). We retrospectively and prospectively reviewed for tool development the hospital course of patients with an acute burn injury (n = 156) and validated the tool in different cohorts (retrospective [ n = 26] and prospective [ n = 90]). The Pearson correlation identified independent variables associated with bloodstream infection (P <.1) in the development cohort that were then analyzed using binary logistic regression to identify the simplest model (P <.05; adjusted odds ratio >1). Classification and regression tree analysis was used to identify tool parameter breakpoints. Performance metrics were completed to evaluate and validate the tool. The best model (P <.05) was: Ln [odds of bloodstream infection] = –96.749 + 3.230 (platelet volatility) + 2.235 (max temperature [°C]) + 0.339 (% full burn) + 0.242 (% partial burn) + 0.045 (max heart rate [bpm]), with a threshold probability categorizing bloodstream infection of >48%. The sensitivity, specificity, accuracy, false positive rate, false negative rate, and positive (+) and negative (–) likelihood ratios of the tool in the developmental cohort (n = 156) were 89%, 98%, 96%, 2%, 11%, 53, and 0·11, respectively; and in the prospective validation cohort (n = 90 were 91%, 90%, 90%, 10%, 9%, 9, and 0·1, respectively (n = 90). The validated bloodstream infection screening tool in patients with acute burn injury has excellent predictive ability to assist in the identification of patients for whom blood cultures should be requested. [ABSTRACT FROM AUTHOR]

Objectives In Australia Bachelor of Nursing programmes are delivered via both internal and distance modes yet there is little knowledge of the indicators of undergraduate nursing students' satisfaction with the learning journey. This integrative review was undertaken to uncover the indicators of undergraduate nursing students' satisfaction with their learning journey. Design Integrative review. A review of key papers was undertaken. Only peer-reviewed papers published in scholarly journals from 2008 onwards were included in this integrative review. Data sources Pubmed, CINAHL, Google Scholar, Cochrane, Wiley Online and ProQuest Central databases were searched for relevant papers. Review methods 49 papers were appraised, by a minimum of two team members. CASP tools were used when evaluating qualitative research, systematic and integrated reviews while survey research was evaluated using a tool specifically developed for this purpose by the research team. All tools used to assess the quality of the research studies contained comprehensive checklists and questions relevant for the particular type of study. Data related to these checklists was extracted and the research team appraised the quality of each article based on its relevance to the topic, internal and external validity, appropriateness of data analysis technique(s), and whether ethical considerations were addressed. Seventeen papers were included in the final analysis. Data analysis involved a systematic approach using content analysis techniques. Results This integrative review sought to identify indicators of nursing students' satisfaction with their learning journey. Authentic learning, motivation, resilience, support, and collaborative learning were identified by this integrative review as being key to nursing students' satisfaction with their learning journey. Sub themes were identified within each of these themes that assist in explaining nursing students' views of their learning journey. Conclusion The findings showed that higher satisfaction levels are attained when nursing students feel included and supported during their learning journey. [ABSTRACT FROM AUTHOR]

Rationale: The impact of hospital length of stay (LOS) on the distribution and susceptibility of Gram negative bacteria (GNB) causing infection in burn patients remains unexplored. Knowledge of causative pathogens is important in guiding empiric antibiotic therapy.Objectives: To characterize the distribution of GNB causing infection and to identify changes in susceptibility with LOS in a tertiary care burn center.Methods: A retrospective review of all admissions to the Ross Tilley Burn Centre at Sunnybrook Health Sciences Centre with clinical cultures yielding GNB (duplicates excluded) between March 12, 2010 to July 17, 2013 was completed. Positive cultures were categorized into 5 clinically relevant time periods (in days) based on specimen collection date relative to the patient's date of admission: 0-7, 7-14, 14-21, 21-28, >28. Chi-square for proportions was used to compare the time periods.Results: The proportion of patients with clinical cultures for P. aeruginosa increased with hospital LOS (0-7 days: 8% vs. >28 days: 55%; p<0.05). Conversely, clinical cultures for H. influenzae occurred primarily within the first 7 days of hospitalization (0-7 days: 36% vs. >28 days: 0.7%; p<0.05). Enterobacteriaceae isolation was highest between 7 and 14 days of hospitalization (7-14 days: 62% vs. >28 days: 38%; p<0.05). Antibiotic resistance was directly proportional to hospital LOS (% patients with multidrug resistant GNB increased from 6% [LOS 0-7 days] to 44% [LOS>28 days]; p<0.05).Conclusions: This study provides objective data documenting changes in species and resistance patterns of GNB causing infection in patients admitted to a burn center as a function of hospital LOS; which may support delaying the use of broad spectrum antibiotics (e.g. carbapenems and beta-lactam/beta-lactamase inhibitors) in clinically stable patients. [ABSTRACT FROM AUTHOR]

Student learning in the clinical environment is a cornerstone of pedagogy for students undertaking a Bachelor of Nursing in Australia. Method: This paper presents the results of a survey that was conducted with registered nurses who preceptor students for universities in Australia. Findings: Findings reveal that some preceptors do not hold the qualification they are preceptoring students to obtain, that university involvement in preparation of preceptors is scant and that resource provision and communication from universities to preceptors is considered problematic. Registered nurses choose to act as preceptors for reasons that are both altruistic and professional. They are often employed in senior positions and as such find it difficult to manage time and resolve role conflict. Conclusion: This paper concludes that the registered nurses who preceptor students generally have a positive experience but require greater involvement by universities in their preparation, particularly when they are responsible for the direct assessment of students. The paper posits this may be best achieved by universities creating effective lines of communication and ongoing support. This will sustain collaborative and meaningful engagement with registered nurses who preceptor undergraduate students. [ABSTRACT FROM AUTHOR]

Abstract: Background: Pregnancy, birth and child rearing are significant life events for women and their families. The demand for services that are family friendly, women focused, safe and accessible is increasing. These demands and rights of women have led to increased government and consumer interest in continuity of care and the establishment in Australia of birth centres, and the introduction of caseload midwifery models of care. Aim: The aim of this research project was to uncover how birth centre midwives working within a caseload model care constructed their midwifery role in order to maintain a positive work–life balance. Methods: A Grounded Theory study using semi-structured individual interviews was undertaken with seven midwives who work at a regional hospital birth centre to ascertain their views as to how they construct their midwifery role while working in a caseload model of care. Findings: The results showed that caseload midwifery care enabled the midwives to practice autonomously within hospital policies and guidelines for birth centre midwifery practice and that they did not feel too restricted in regards to the eligibility of women who could give birth at the centre. Work relationships were found to be a key component in being able to construct their birth centre midwifery role. The midwives valued the flexibility that came with working in supportive partnerships with many feeling this enabled them to achieve a good work–life balance. Conclusion: The research contributes to the current body of knowledge surrounding working in a caseload model of care as it shows how the birth centre midwives construct their midwifery role. It provides information for development and improvement of these models of care to ensure that sustainability and quality of care is provided to women and their families. [Copyright &y& Elsevier]

Abstract: Burn patients are at high risk for infections; however, common indicators of infection are unreliable in this population and can lead to unnecessary use of antibiotics. The study objective was to determine if predictors of early infection in adult acute burn patients are identified to provide clinicians with a practical tool to aid in the diagnosis of infection, thereby minimizing unnecessary exposure to antimicrobials. A retrospective chart review of all adult acute burn injury patients admitted over a 1 year period to the burn centre at Sunnybrook Health Sciences Centre was conducted. Early infection was defined as one that occurred within the first 10 days after injury and in accordance with American Burn Association guidelines. Those without infection were compared to patients with infection generally and also to patients with sepsis specifically. The period prevalence of early infection and sepsis in our patients was 50% (56/111) and 16% (18/111), respectively. It was determined that heart rate ≥110bpm, systolic blood pressure ≤100mmHg and intubation were the best predictors of sepsis (p <0.05); and fraction of inhaled oxygen >25% and maximum temperature ≥39°C were the best predictors of infection (p <0.05). This pilot project identified significant predictors of early infection and sepsis in acute burns and will be validated in a prospective study. [Copyright &y& Elsevier]

Summary: Introduction: There is an abundance of literature regarding factors that influence student learning within the clinical environment. Within this discourse, there is a paucity of research on the impact of supervision models on the learning support needs of students. This paper presents the results of research that focused on nursing students' perceptions about the effectiveness of the support they received during their work integrated learning (WIL) experience. Background: The majority of students placed within health care facilities are in groups. The group model incorporates a facilitator who supervises the students who are placed across a number of wards. At the ward level students are then assigned a Registered Nurse (RN) who is their mentor. This occurs on a shift by shift basis. Another model of clinical supervision involves preceptorship. This approach is via a one-on-one supervision of students. Within the preceptorship model, students are supervised by a RN who is responsible for supporting them during their WIL experience and for completing their assessment. Methods: This study compared two models of clinical supervision to better understand the learning support needs as perceived by undergraduate nursing students during their WIL experience. Survey method using a self reporting online questionnaire developed by the researchers was used to collect data. Results: 159 undergraduate nursing students enrolled in a Bachelor level programme of study completed the on-line survey. When comparing the two models of supervision, students supervised within the facilitator model were statistically more likely to be challenged to reflect, think, build on existing skills and knowledge and to problem-solve issues. Notably, all factors integral to RN education. Overall, students considered the quality of support to be the most important facet of supervision. Conclusions: The findings of this study demonstrate that the facilitator model is the better approach for the development of critical thinking, but both models enable the development of a student's professional identity and the development of their role within nursing. This highlights the significance of clinical experiences during undergraduate nursing education. [Copyright &y& Elsevier]

Abstract: Rationale: Burned patients have altered vancomycin pharmacokinetics necessitating adjusted dosing. Published initial dosing recommendations to target troughs of 15–20mg/L for this population are lacking. Objective: This study was conducted to develop initial vancomycin dosing recommendations based on the pharmacokinetics of vancomycin in acute burn patients. Methods: A retrospective chart review of 49 vancomycin treated burn patients was conducted. Mean pharmacokinetic parameters were determined and Monte Carlo Simulation was used to develop initial vancomycin dosing recommendations that target trough concentrations between 15 and 20mg/L. Results: Vancomycin pharmacokinetic parameters were significantly (p <0.05) different for vancomycin levels obtained 48h to 14 days after burn versus >14 days after burn. Monte Carlo simulation indicated that the most commonly used empiric dosing regimen (1g iv q12h) attained targets with a probability of <10% in all burned patients. The probability of attaining targets was optimized to 20–25% by using 1.5g iv q8h, 1.75g iv q8h, 1g iv q6h, 1.25g iv q6h or 750mg iv q4h in patients 48h to 14 days after burn and 1–1.25g iv q8h or 500mg iv q4h in patients >14 days after burn. Conclusions: This study provides initial vancomycin dosing recommendations for burned patients 48h to 14 days after burn and patients >14 days after burn. However, because of the heterogeneity in pharmacokinetics and the observation that vancomycin pharmacokinetics change with time after burn, monitoring of vancomycin serum concentrations is required to ensure targets are met and maintained. [Copyright &y& Elsevier]

International research has shown that during work integrated learning (WIL) undergraduate nursing students may experience stress, self-doubt, and coping issues, however personal qualities these students bring to their WIL journey or those needed to succeed during WIL remain unknown. To describe the views of students midway through their Bachelor of Nursing program regarding personal qualities they bring to and need for WIL success. This article reports on a descriptive study that used an electronic questionnaire to collect the data. Bachelor of nursing students (n = 421), who were studying fulltime or part time equivalent, at a regional university in Queensland Australia, were invited to complete the anonymous electronic questionnaire that was developed by the research team following an extensive review of literature. Inclusion criteria required participants to have completed at least one WIL experience and be midway through their three-year Bachelor of Nursing program. Data were collected during January and February 2017. The electronic questionnaire consisted of demographic, forced choice questions, and open-ended questions. This paper presents the qualitative analysis of responses to two of the open-ended questions that focused on personal strengths and work integrated learning experiences. Data were analysed using the inductive content analysis approach. Six personal qualities were identified including: enthusiasm to succeed, commitment to learning, self-motivation, confidence, effective communication skills, and compassion. Pre-entry screening of applicants to bachelor level nursing programs and the delivery of learning opportunities that encourages both reflection and debriefing may assist in describing personal qualities needed to succeed in WIL. • Undergraduate nursing students need to be made aware of six intrinsic, personal qualities required for WIL success. • Qualities for WIL success include enthusiasm, commitment, self-motivation, confidence, effective communication & compassion. • Learning opportunities that encourage reflection and debriefing may uncover personal qualities required for WIL success. [ABSTRACT FROM AUTHOR]

• Midwifery home care is essential to successful transition to motherhood. • Cultural beliefs and family influence women's successful transition to motherhood. • Unmet needs may reduce women's ability to successfully transition to motherhood. • Lack of postnatal education for women has many risks in the early postnatal period. • Poor maternal physical and emotional health reduces involvement in postnatal care. To undertake a systematic review of available qualitative research literature to determine what women need to successfully transition to motherhood during the early postnatal period and whether postnatal home care delivered by midwives supports this process. The transition from woman to mother is a significant occurrence, one that requires adjustments on physical, psychological and social levels. A qualitative systematic review design was chosen to ensure both humanistic and interactive concepts related to what women need to successfully transition to motherhood during the early postnatal period were identified. The systematic and structured search uncovered 33 research articles for detailed review. Two team members, using the qualitative research checklist from the Critical Appraisal Skills Programme, appraised the quality of the research articles. A total of 19 articles met the quality criteria and were included in the data evaluation process. Research teams from Asia-Pacific, Europe, Middle East and North America generated the 19 qualitative journal articles. Data evaluation included identification of research aim, presence of a research question, type of methodology, data collection processes, sample information, data analysis techniques and study outcomes. Data was analysed using an inductive content analysis approach. Four themes were identified from the qualitative systematic review process including: women and midwives connecting, identification and meeting of women's individual needs, family and cultural influences and, education and support. The ability of women to connect with midwives during the early postnatal period assisted them overcome barriers and to successfully transitioning to motherhood. Although all four themes were determined to be key to effective postnatal transition, overwhelmingly the findings showed postnatal midwifery home care to be important in women's successful transition to motherhood in the early postnatal period. Strategies are needed ensure women have access to midwives in the early postnatal period. [ABSTRACT FROM AUTHOR]

Abstract There have been multiple initiatives to demonstrate a connection between patient outcomes and increased levels of baccalaureate-prepared registered nurses in the workforce. Yet, despite increasing numbers of people with bachelor of science in nursing in the workforce, negative patient outcomes continue to escalate. This editorial proposes that other system variables, particularly leadership, are contributing factors that nursing leaders must consider if the expectation is improved in patient outcomes. [ABSTRACT FROM AUTHOR]

We sought to prevent the initiation of antimicrobial therapy for asymptomatic bacteriuria (ASB) by providing audit and feedback of newly reported positive urine cultures to test whether this could empower providers to leave ASB untreated. Despite success in providing feedback before antibiotics could be initiated in most cases, these recommendations only reduced treatment duration, without affecting antibiotic initiation. This study highlights the limitations of educational initiatives in overcoming engrained beliefs about bacteriuria even when advice is provided in real time. [ABSTRACT FROM AUTHOR]