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Aim: To describe for areas of improvement in the management of COPD and reduction in emergency department presentations in Queensland. Background: If current trends in the management of COPD do not change, the predicted 4.5 million Australians diagnosed with COPD by 2050 will place significant burdens on already over-utilised frontline ED services. Separately COPD is more costly per case than cardiovascular disease and is a more common presentation to Emergency Departments in any year than most types of cancer, road traffic accidents and heart disease. Study Design and Methods: This study used a qualitative thematic analysis methodology in which field convergent interviews were employed to generate data. Sixteen staff and nine patients across three major Southern Queensland Health acute care facilities participated in the study. The authors analysed interview data using qualitative thematic analysis. Results: This research has revealed several noteworthy concepts worthy of further exploration. Thematic analysis from both staff and patient interviews identified the following issues: 1. Nurse case management, 2. Integrated communication of patient assessment and history data, 3. Failure in COPD management, and 4. Knowledge utilisation among ED clinicians. Inherent among these key concepts is a primary goal of coordinated congruent COPD management that optimise a patient's functional status and quality of life, improving symptoms management, and avoiding recurrent exacerbations. Discussion: These insights into the experience of patients and hospital staff into the management of COPD provides valuable insight into current and desired practices that can help to minimise presentations to Emergency Departments. The findings of the research provide insights and future direction for improvements by addressing the inconsistency in disease management. The need for more accessible and consistent patient management and a more congruent centralised patient support framework was also identified. Conclusion: There is indication of support stemming from the voices of patients and hospital staff around the need for COPD case management to become the dominant method of care. Future research should consider the cost benefit and patient outcomes of the implementation of such a role and the avoidance of ED presentations. Implications for research, policy, and practice: The findings of this research imply a need to streamline the patient support and disease management discharged planning process by ensuring one health professional maintains ongoing education, support, and assessment to the patient. Future research needs to better ascertain the positive economic benefits to healthcare organisations by employing Case Managers for patients with COPD. What is already known about the topic? * Case management roles can be effective in reducing ED usage for adults with chronic illnesses. * The World Health Organization (WHO) has called for planned ongoing assessment, care and support coordinated by a proactive investment in real time solutions that address the increasing burden of this disease on the healthcare sector. * The WHO has endorsed targeted patient support strategies that coordinate care over time, addressing the physical and mental health needs of people with chronic illness. What this paper adds: * Findings from this research show that discharged planning support practices with Southern Queensland Healthcare Organisations require review and ongoing evaluation. * This may include, streamlining the patient support and disease management discharged planning; or designated case management or integration of systems to prevent ED presentations. * This research adds to the voices of patients and staff that confirm published research recommendations. [ABSTRACT FROM AUTHOR]

Introduction: Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021. Method: A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time. Results: Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC. Conclusion: The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health. [ABSTRACT FROM AUTHOR]

Aim: To explore the perceptions and experiences of nurses in communicating the care and caring in the intensive care unit (ICU). Design: A focused ethnography. Methods: This study was conducted in an Australian metropolitan hospital, in which data were gathered from multiple sources: participant observations, document reviews, interviews, and participant's additional written information ‐ over six months (April‐September, 2014). The data were analysed thematically. Findings: This study addressed inclusively communicating care and caring to patients, families, nurses and other health professionals in ICU. The findings identified main themes concerning the changing patterns of communicating the care and caring in ICU, various patterns of communication used, enablers and barriers of communicating care and caring, and significant issues in communicating care and caring in ICU. Documentation of patients' psychological and emotional needs, and nurses' caring behaviours are crucial. These findings need further consideration from all stakeholders. [ABSTRACT FROM AUTHOR]

Background: Nurses have limited time outside of work for continuing professional development. Consequently, strategies need to be explored to enable them to better maintain their competence. This article describes recent research investigating if nursing behaviours in the use of mobile technologies could be leveraged to better facilitate mobile learning. It addresses a gap in the existing literature around how nurses resource their own professional development and learning in the absence of appropriate learning resources in the workplace. Methods: The research employed a classic grounded theory methodology which was conducted with 27 registered nurses from Public and Private Hospitals in Queensland and external postgraduate nursing students from Victoria, South Australia and the Northern Territory enrolled at the University of Southern Queensland. Results: The Theory of Economising Learning describes how nurses maintain competence with limited resources. Unfavourable staffing levels and a fast-paced workplace mean that nurses rarely prioritise their professional learning while at work. Instead, it requires the nurse to contribute personal resources including time and money. Though the research revealed nurses were unconcerned about using mobile technologies, they were concerned about maintaining competence with limited resources. To counter this, nurses economised their learning by balancing personal resources against their motivation to maintain competence. The process of economising learning begins and ends with the development of the nurse's personal curriculum in response to what they identify as being the most significant knowledge deficits at work that jeopardise their competence. A learning opportunity that addresses the knowledge deficit is sought. Nurses balance the opportunity to address the deficit against the cost of personal resources, to decide if they will engage with the opportunity and update their personal curriculum accordingly. Conclusions: It is suggested that workplaces need to create reasonable expectations within nurses to address knowledge deficits and provide the resources, including time, to allow them to do so without personal cost. It is also necessary for workplaces to moderate the flow of learning opportunities so as not to overwhelm and demotivate the nurses. Currently, nurses use several strategies to optimise their learning using mobile technologies which could be leveraged in the workplace. [ABSTRACT FROM AUTHOR]

Background: Early warning systems (EWS) are most effective when clinicians monitor patients' vital signs and comply with the recommended escalation of care protocols once deterioration is recognised.Objectives: To explore sociocultural factors influencing acute care clinicians' compliance with an early warning system commonly used in Queensland public hospitals in Australia.Methods: This interpretative qualitative study utilised inductive thematic analysis to analyse data collected from semi-structured interviews conducted with 30 acute care clinicians from Queensland, Australia.Results: This study identified that individuals and teams approached compliance with EWS in the context of 1) the use of EWS for patient monitoring; and 2) the use of EWS for the escalation of patient care. Individual and team compliance with monitoring and escalation processes is facilitated by intra and inter-professional factors such as acceptance and support, clear instruction, inter-disciplinary collaboration and good communication. Noncompliance with EWS can be attributed to intra and inter-professional hierarchy and poor communication.Conclusions: The overarching organisational context including the hospital's embedded quality improvement and administrative protocols (training, resources and staffing) impact hospital-wide culture and influence clinicians' and teams' compliance or non-compliance with early warning system's monitoring and escalation processes. Successful adoption of EWS relies on effective and meaningful interactions among multidisciplinary staff. [ABSTRACT FROM AUTHOR]

Background: Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit. Methods: The study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework. Results: Six themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care. Conclusions: This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice. [ABSTRACT FROM AUTHOR]