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BackgroundClinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the detection of and response to abnormal vital signs. ObjectiveTo describe the study protocol for the clinical testing of these observation and response charts (ORCs). MethodsWe propose a two-phase multisite multiple-methods design to test the initial clinical utility of the charts in 10 hospitals of differing types and sizes across state jurisdictions in Australia. Data collection in the first phase includes user surveys, observations and field notes by project officers, handover de-briefs (short interviews with small groups of staff), and an audit of ORC documentation completion compared to the site’s existing observation chart. For the second phase, data will be collected using a retrospective audit of observation documentation from the previous hospital observation chart, prospective audit of observation documentation following implementation of the selected ORC, user focus groups, observational field notes, and patient outcome data from routinely collected organizational data sources. ResultsSite selection and preparation, project officer training, chart selection and implementation, participant recruitment, and data collection has been completed and the analysis of these results are in progress. ConclusionsThis detailed description of these study methods and data collection approaches will enable a comprehensive assessment of the clinical utility of these newly developed track and trigger charts and will be useful for clinicians and researchers when planning and implementing similar studies. Potential methodological limitations are also noted.

Background: Internationally, the nursing workforce is ageing. Chronic conditions are becoming more prevalent amongst the ageing nursing workforce. With an increase in chronic conditions and an ageing nursing workforce, understanding environmental influences on nurses' health and work capacity is vital to supporting this workforce. Aim: A scoping review was conducted to explore the influence of a critical care environment on nurses' health and work capacity. Design: A scoping review was conducted according to PRISMA-ScR guidelines. Methods: Database extraction occurred in June 2023 and included MEDLINE Complete, PubMed, Scopus, CINAHL, and Embase. Results: Eight studies met the inclusion criteria. Studies were conducted internationally with sample sizes from 20 to 500 critical care nurses (CCNs). Conclusions: Findings identified the critical care environment had an impact on nurses' health and working capacity. Many CCNs self-reported having a chronic condition that influenced their nursing practice. Further research is needed to explore how to mitigate the influence of a chronic condition to support this valuable workforce. [ABSTRACT FROM AUTHOR]

Purpose: Busyness as a construct within modern healthcare is complex and multidimensional. To date, few studies have sought to explore how busyness influences family‐centred care. This study explored the influence of busyness on the delivery of family‐centred care for nurses and parents. Design and Method: Ethnography was selected as the research design. The study site was a metropolitan tertiary hospital inpatient paediatric unit in Sydney, Australia. Semi‐structured interview and non‐participant observation techniques were used for data collection. Ten paediatric nurses and 10 parents were interviewed and 40 h of non‐participant observations were undertaken. The COREQ was used to report the study. Results: The findings are presented as three key themes: (i) 'Supporting family‐centred care' in which participants detail beliefs about the nurse‐parent relationships and how despite busyness nurses sought out moments to engage with parents; (ii) 'Being present at the bedside' identified the challenges in optimising safety and how parents adapted their way of being and interacting on the unit; and (iii) 'The emotional cost of busyness' and how this influenced nurse‐parent interactions, care delivery and family‐centred care. Conclusions: The ethnography has given shape to social understandings of busyness, the complexities of paediatric nursing and family‐centred care. The culture of care changed in moments of busyness and transformed parent and nursing roles, expectations and collaborative care that at time generated internal emotional conflict and tension. Practice implications: Given the increasing work demands across health systems, new agile ways of working need to ensure maintenance of a family‐centred approach. Strategies need to be developed during periods of busyness to better support collaborative connections and the well‐being of paediatric nurses and parents. At an organisational level, fostering a positive workplace culture that shares a vision for family‐centred care and collaboration is essential. Patient or Public Contribution: Parents of sick children admitted to an acute paediatric inpatient ward were invited to be a participant in a single interview. Parents were aware of the study through ward advertisement and informal discussions with the researchers or senior clinical staff. Engagement with parents was important as healthcare delivery in paediatrics is focused on the delivery of family‐centred care. To minimise the risk of child distress and separation anxiety, children were present during the parent interview. Whist children and young people voices were not silenced during the interview process, for this study the parent's voice remained the focus. While important, due to limited resources, parents were not involved in the design analysis or interpretation of the data or in the preparation of this manuscript. Data sharing: The data that support the findings of this study are available from the corresponding author upon reasonable request. [ABSTRACT FROM AUTHOR]

Background: Intensive care settings have high rates of medication administration errors. Medications are often administered by nurses and midwives using a specified process (the '5 rights'). Understanding where medication errors occur, the contributing factors and how best practice is delivered may assist in developing interventions to improve medication safety. Aims: To identify medication administration errors and context specific barriers and enablers for best practice in an adult and a neonatal intensive care unit. Secondary aims were to identify intervention functions (through the Behaviour Change Wheel). Study Design: A dual methods exploratory descriptive study was conducted (May to June 2021) in a mixed 56‐bedded adult intensive care unit and a 6‐bedded neonatal intensive care unit in Sydney, Australia. Incident monitoring data were examined. Direct semi‐covert observational medication administration audits using the 5 rights (n = 39) were conducted. Brief interviews with patients, parents and nurses were conducted. Data were mapped to the Behaviour Change Wheel. Results: No medication administration incidents were recorded. Audits (n = 3) for the neonatal intensive care unit revealed no areas for improvement. Adult intensive care unit nurses (n = 36) performed checks for the right medication 35 times (97%) and patient identity 25 times (69%). Sixteen administrations (44%) were interrupted. Four themes were synthesized from the interview data: Trust in the nursing profession; Availability of policies and procedures; Adherence to the '5 rights' and departmental culture; and Adequate staffing. The interventional functions most likely to bring about behaviour change were environmental restructuring, enablement, restrictions, education, persuasion and modelling. Conclusions: This study reveals insights about the medication administration practices of nurses in intensive care. Although there were areas for improvement there was widespread awareness among nurses regarding their responsibilities to safely administer medications. Interview data indicated high levels of trust among patients and parents in the nurses. Relevance to clinical practice: This novel study indicated that nurses in intensive care are aware of their responsibilities to safely administer medications. Mapping of contextual data to the Behaviour Change Wheel resulted in the identification of Intervention functions most likely to change medication administration practices in the adult intensive care setting that is environmental restructuring, enablement, restrictions, education, persuasion and modelling. [ABSTRACT FROM AUTHOR]