AJAN : Australian Journal of Advanced Nursing (An international peer reviewed journal of nursing research and practice) September 2015 - November 2015 Volume 33 Issue 1

Chao, Yu‑Mei (Yu), Courtney, Mary, Francis, Karen, Hegney, Desley, Kristjanson, Linda, McMurray, Anne, Torrance, Collin and Wilkes, Lesley (2015) AJAN : Australian Journal of Advanced Nursing (An international peer reviewed journal of nursing research and practice) September 2015 - November 2015 Volume 33 Issue 1. AJAN (Australian Journal of Advanced Nursing), 33 (1). pp. 1-52. ISSN 1447-3428

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	Text 1. Specialist nurses’ experiences of using ‘The Viewer’,.pdf - Published Version Restricted to Registered users only Download (205kB) | Request a copy
	Text 2. Exploring values in nursing generating new.pdf - Published Version Restricted to Registered users only Download (158kB) | Request a copy
	Text 3. The clinical environment – do student nurses.pdf - Published Version Restricted to Registered users only Download (135kB) | Request a copy
	Text 4. Prevention of postnatal mental health problems.pdf - Published Version Restricted to Registered users only Download (384kB) | Request a copy
	Text 5. Literature review “Are you ok there” The.pdf - Published Version Restricted to Registered users only Download (135kB) | Request a copy
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Abstract

Objective Evaluate changes in specialty areas nurses’ knowledge and perceptions of a consolidated electronic medical record (EMR) system before and after implementation. Design A survey deployed pre- and six months post-implementation of ‘The Viewer’. Setting Regional Hospital and Health Service, Queensland. Subjects Nurses working in specialist areas including community health, palliative care, discharge planning, wound and stoma care, diabetes education and renal dialysis satellite services (n=110) were invited to participate in the study. Response rate of the pre-implementation survey (n=42, 38%) was much higher than the post-implementation subset (n=10, 24%). A major health service restructure that included losses of nursing positions in specialist areas significantly affected postimplementation results. Intervention An EMR system called ‘The Viewer’ to access consolidated electronic medical records of patient information produced by different parts of the organisation. Main Outcome Measures Changes in participants’ knowledge and perceptions of ‘The Viewer’, and their satisfaction with the quality, ease of use and access to patient information. Results Pre-implementation, specialist nurses reported dissatisfaction with most aspects of the current patient information system but high confidence and comfort in using electronic systems. Post implementation satisfaction scores either remained the same or increased. Satisfaction with ease of access to consolidated patient data (U = 125.0, p = 0.038, r = 0.29) and usefulness of electronic systems (U = 115.0, p = 0.031, r = 0.30) increased significantly post-implementation of ‘The Viewer’. Conclusion Specialist nurses are positive about the possibilities EMRs offer to centralise, consolidate and improve access to patient Objective The ‘Essentials of Care’ (EoC) program seeks to develop a shared vision amongst nurses within particular workplace teams. The purpose of this study was to describe the experiences of nurses during the process of exploring their values and developing these into a shared vision at both an individual level and as a team. Design A qualitative, focus group design was used to provide an accurate representation of the nurses experiences in reflecting on their values and developing these into individual ward/unit vision statements. Six focus groups were conducted by independent researchers. The focus group discussions were recorded and transcribed by an independent researcher. The transcription provided the data for thematic analysis. Setting This study was conducted in two tertiary hospitals from the same Local Health District in New South Wales, Australia. Subjects Forty-two nurses from fourteen hospital wards or units participated in the study. Seventeen were facilitators of the program and the remainder were nursing staff who had undertaken the program. Main outcome measures The authors independently interpreted the transcripts using inductive qualitative analysis, reaching consensus on emergent themes. Representative quotations were chosen for each theme. Results Six themes emerged which describe the experiences of nurses during the exploration of individual and team workplace values which were then developed into shared visions. The emergent themes were: shared values and commitment to patient care; empowerment and ownership for cultural change; real and observable outcomes; the meaning of the team; different active learning approaches equalling the same outcome; and culture change results in new perspectives. Conclusion This study supports the benefits of value-based programs. Exploring values led to new perspectives on clinical practice, both individually and collectively by the nursing teams. Objectives To investigate Maternal and Child Health (MCH) nurses’ views on what contributes to mental health problems among new mothers, and their current practices regarding risk factors for maternal mental health problems that are potentially modifiable in primary care. Design Cross-sectional, online survey. Setting Universal MCH service offered free to all new parents in Victoria, Australia. Subjects All MCH nurses employed in full or part-time clinical practice were invited to participate. Main outcome measures MCH nurses’ views on risk factors for maternal mental health problems and for unsettled infant behaviour; and their current practice regarding addressing unsettled infant behaviour and inclusion of fathers in services. Results Surveys were completed by 343/1051 eligible MCH nurses (32.6%). Respondents identified social factors as major determinants of postnatal mental health problems among women, including: parents having limited knowledge about infant sleep needs and skills to manage unsettled infant behaviour; and lack of support, including from intimate partners. Respondents offered widely divergent advice to mothers about management of unsettled infant behaviour. They regarded the inclusion of fathers in routine services as valuable, but acknowledged practical barriers, including difficulties in offering services and programs outside conventional office hours. Conclusions MCH nurses identified risks to maternal mental health that are potentially modifiable in primary care, but face barriers in addressing these. To facilitate more consistent advice to new parents about management of unsettled infant behaviours, evidence-based guidelines and training programs should be developed. Inclusion of men in routine services would require practical barriers to be overcome. Objective To determine the effectiveness of the current socialisation processes for student and graduate nurses, into the clinical practice setting. Setting The clinical nursing environment, with underlying links and reference to the academic setting of nurse education. Subjects The sole focal subjects of this literature review are student/undergraduate and graduate/new nurses. Primary argument Internationally, attrition rates of new graduate nurses in their first year of practice ranges between 30-60%. Undergraduate and new nurses enter the nursing profession with a beginning skill set, reflective of their education, coupled with preceded values and ideas about the profession itself. Recognition of an adjustment period undergraduate and new nurses require, is paramount to meeting the anticipated socialisation of these new professionals. Socialisation in the profession of nursing is an ongoing and complex interactive process by which the professional role, incorporating skills, knowledge, and behaviours, is learned and the individual consciously and subconsciously seeks their sense of occupational identity, and perfecting this process is crucial. Conclusion Newcomers to the nursing profession have expressed that learning how to behave appropriately in the workplace is more difficult than bridging the gap between theory and practice. Intentional measures implemented by organisations, is paramount in enabling newcomers to adjust to the workplace, and it is unsafe to assume the process of socialisation is good, and underestimation of this socialisation process, would be negligent. Objective This paper reviews existing literature on delirium that arises during mechanical ventilation in the Intensive Care Unit (ICU). It looks at the physiology of delirium, its subtypes and risk factors. It further considers the impact of delirium on cognitive and psychosocial function of patients after their discharge from acute care. The aim of this paper was to increase awareness of ICU delirium, accentuate the potential link between different sedation agents and the development of delirium, and inform practitioners, especially nurses, about this common neurocognitive disorder that appears in the Intensive Care Unit (ICU). Setting Intensive Care Unit (of any acute hospital) where is ICU located. Subjects Mechanically ventilated patients. Primary argument This paper argues for the awareness of delirium in the Intensive Care Unit and examines sedation during mechanical ventilation with its potential role in promoting this disorder. Conclusion Delirium is the most common neurobehavioral disorder in patients who are critically ill and mechanically ventilated in ICU. It frequently generates psychiatric and psychological outcomes such as depressed mood, anxiety and/ or Post Traumatic Stress Disorder (PTSD). Cognitive and psychological dysfunction following delirium seems to be overlooked, under recognised, and misdiagnosed in the ICU. These impairments are often incorrectly attributed to other processes, such as concurrent psychoactive medication use, substance use, or psychiatric disorders, in particular depression, rather than delirium. Although it is generally accepted that providing sedation for a patient’s comfort is an essential part of bedside care for nearly every patient in ICU, an increasing number of researchers hypothesise there is a strong link between sedation practice and long-term patient centred outcomes, such as quality of life (Dimopoulou et al 2004) and cognitive and psychosocial functioning. Increasing nurses’ awareness of this potential link is exceptionally important, as they are instrumental in administration and observing subsequent side effects of any medication, including sedatives. Objective In Victoria, Australia, a unique referral process exists for families who require investigation for possible inherited cardiac disease. This is spearheaded by a team of specialist nurses located at the Royal Children’s Hospital Melbourne (RCH), the Royal Melbourne Hospital (RMH) and the Victorian Institute of Forensic Medicine (VIFM), who ensure that all potentially at-risk families are offered the opportunity for clinical assessment and consultation. Setting In Victoria, approximately 5,500 deaths are reported to the Coroner each year. Where there is a suspicion of a causative heritable cardiac condition, the surviving relatives are offered referral to a tertiary centre for assessment and screening. Subjects A specialist nurse employed by the VIFM is the focal point for forensic pathologists to flag families requiring referral. Concurrently, specialist nurses within the cardiac genetic services of RMH and RCH accept, review, triage and action these referrals. All three services work closely to create a seamless model of care, which is age appropriate and provides ease and equity of access to consistent care. Primary argument The nurse specialists are a critical part of the multidisciplinary team, providing the first entry point into the hospital system. Their background experience encompasses intensive care and cardiology nursing. This is essential to the provision of professional and empathetic care in which families can approach the difficult issues surrounding post mortem consideration of a diagnosis. Conclusion The Victorian nurse led system is an effective model, which could be trialled in other jurisdictions, and other disorders, where multidisciplinary care is required.

Item Type:	Article
Uncontrolled Keywords:	prevention, postnatal depression, risk factors, primary care student nurses, clinical environments, sense of belonging practice development, culture change, essentials of care, nursing, practice computerised medical records system; computerised patient medical records; electronic medical records; evaluation; socialisation, nurses, student nurse, undergraduates, graduate nurse, literature review intensive care, delirium, sedation, cognitive function, outcomes partnerships; cardiac genetics; sudden unexplained death; screening; specialist nurse
Subjects:	R Medicine > RT Nursing
Divisions:	Journal Publication
Depositing User:	Repository STIKES ICME Jombang
Date Deposited:	16 Oct 2020 13:52
Last Modified:	16 Oct 2020 13:52
URI:	http://repository.itskesicme.ac.id/id/eprint/4221

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