Nursing - Research Publications

Permanent URI for this collection

Search Results

Now showing 1 - 10 of 21
  • Item
    Thumbnail Image
    Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement
    Fletcher, J ; Spittal, M ; Brophy, L ; Tibble, H ; Kinner, S ; Elsom, S ; Hamilton, B (WILEY, 2017-10-01)
    Restrictive practices are used in response to conflict and aggression in psychiatric inpatient settings. Reducing such practices is the focus internationally of policy and legislative change, many initiatives, and a growing body of research. Safewards is a model and a set of 10 interventions designed to reduce conflict and containment in inpatient services. In the current study, we aimed to assess the impact of implementing Safewards on seclusion in Victorian inpatient mental health services in Australia. The study used a before-and-after design, with a comparison group matched for service type. Thirteen wards opted into a 12-week trial to implement Safewards and 1-year follow up. The comparison group was all other wards (n = 31) with seclusion facilities in the jurisdiction, matched to service type. Mandatorily-reported seclusion event data for all 44 wards over a 15-month period were analysed using negative binomial regression. Adherence to Safewards was measured via fidelity checklists at four time points: twice during the trial, post-trial, and at 1-year follow up. Seclusion rates were reduced by 36% in Safewards trial wards by the 12-month follow-up period (incidence rate ratios (IRR) = 0.64,) but in the comparison wards seclusion rates did not differ from baseline to post-trial (IRR = 1.17) or to follow-up period (IRR = 1.35). Fidelity analysis revealed a trajectory of increased use of Safewards interventions after the trial phase to follow up. The findings suggest that Safewards is appropriate for practice change in Victorian inpatient mental health services more broadly than adult acute wards, and is effective in reducing the use of seclusion.
  • Item
    Thumbnail Image
    Nurses' shift reports: a systematic literature search and critical review of qualitative field studies
    Buus, N ; Hoeck, B ; Hamilton, BE (WILEY, 2017-10-01)
    AIMS AND OBJECTIVES: To identify reporting practices that feature in studies of nurses' shift reports across diverse nursing specialities. The objectives were to perform an exhaustive systematic literature search and to critically review the quality and findings of qualitative field studies of nurses' shift reports. BACKGROUND: Nurses' shift reports are routine occurrences in healthcare organisations that are viewed as crucial for patient outcomes, patient safety and continuity of care. Studies of communication between nurses attend primarily to 1:1 communication and analyse the adequacy and accuracy of patient information and feature handovers at the bedside. Still, verbal reports between groups of nurses about patients are commonplace. Shift reports are obvious sites for studying the situated accomplishment of professional nursing at the group level. This review is focused exclusively on qualitative field research for nuanced and contextualised insights into nurses' everyday shift reporting practices. DESIGN: The study is a systematic literature search and critical review of qualitative field analyses of nurses' shift reports. We searched in the databases CIHAHL, PubMed and PsycINFO and identified and reviewed 19 articles published 1992-2014. Data were systematically extracted using criteria for the evaluation of qualitative research reports. RESULTS: The studies described shift report practices and identified several factors contributing to distribution of clinical knowledge. Shift report practices were described as highly conventionalised and locally situated, but with occasional opportunities for improvisation and negotiation between nurses. Finally, shift reports were described as multifunctional meetings, with individual and social effects for nurses and teams. CONCLUSION: Innovations in between-shift communications can benefit from this analysis, by providing for the many functions of handovers that are revealed in field studies. RELEVANCE TO CLINICAL PRACTICE: Leaders and practising nurses may consider what are the best opportunities for nurses to work up clinical knowledge and negotiate care.
  • Item
    Thumbnail Image
    Interventions to improve patient understanding of cancer clinical trial participation: a systematic review
    Kao, CY ; Aranda, S ; Krishnasamy, M ; Hamilton, B (WILEY, 2017-03-01)
    Patient misunderstanding of cancer clinical trial participation is identified as a critical issue and researchers have developed and tested a variety of interventions to improve patient understanding. This systematic review identified nine papers published between 2000 and 2013, to evaluate the effects of interventions to improve patient understanding of cancer clinical trial participation. Types of interventions included audio-visual information, revised written information and a communication training workshop. Interventions were conducted alone or in combination with other forms of information provision. The nine papers, all with methodological limitations, reported mixed effects on a small range of outcomes regarding improved patient understanding of cancer clinical trial participation. The methodological limitations included: (1) the intervention development process was poorly described; (2) only a small element of the communication process was addressed; (3) studies lacked evidence regarding what information is essential and critical to enable informed consent; (4) studies lacked reliable and valid outcome measures to show that patients are sufficiently informed to provide consent; and (5) the intervention development process lacked a theoretical framework. Future research needs to consider these factors when developing interventions to improve communication and patient understanding during the informed consent process.
  • Item
    Thumbnail Image
    Development of competence in the first year of graduate nursing practice: a longitudinal study
    Lima, S ; Newall, F ; Jordan, HL ; Hamilton, B ; Kinney, S (WILEY, 2016-04-01)
    AIM: To determine the extent to which competence develops in the first year of nursing practice in a paediatric setting. BACKGROUND: Among all the literature related to nursing competence, there have been few studies that have used a standardized tool to determine the development of professional nursing competence in the first year of practice. DESIGN: A quantitative longitudinal design was applied as part of a mixed methods study. METHODS: Forty seven nurses commencing a 12-month graduate nurse programme were invited to undertake a self-assessment of their level of competence at four time points; commencement, 3 months, 6 months and 12 months, between January 2013-February 2014. The assessment was completed using the Nurse Competence Scale; a questionnaire with 73 items across seven domains of competence. Each item is scored along a visual analogue scale (0-100). Response rates varied from 100% at commencement to 68% at 12 months. RESULTS: At commencement, the self-assessed level of overall competence was 41·4, 61·1 at 3 months, 72·9 at 6 months and 76·7 at 12 months. Similar patterns were seen for each domain. Mixed effects model analysis for longitudinal data revealed gains in competence for each of the domains and overall, was statistically significant from commencement to 3 months and 3 months to 6 months. While gains were made between 6-12 months, the results were not statistically significant. CONCLUSION: Graduate nurses showed significant gains in competence in the first 6 months of transition from nursing students to Registered Nurses.
  • Item
    Thumbnail Image
    The unheard voice of the clinician: Perspectives on the key features of an adolescent inpatient model of care
    Hayes, C ; Simmons, M ; Palmer, VJ ; Hamilton, B ; Simons, C ; Hopwood, M (WILEY, 2019-08-01)
    PROBLEM: Little has been reported from clinicians about the operations, interventions, and outcomes of inpatient units and how these comprise models of care in such units. The aim of this study was to explore an inpatient model of care in operation at the study site by defining key features of the model from the perspectives of clinicians. METHODS: Semi-structured face to face interviews were conducted with ten clinicians working in a private inpatient unit in Melbourne, Australia. Interview data were analyzed using thematic analysis. FINDINGS: Analysis resulted in the identification of three thematic features relating to containment, engagement, and therapy. These included (a) an environment conducive to containment, (b) adolescent engagement through shared experiences, and (c) dialectical behavior therapy embedded culture. CONCLUSIONS: The findings provide insights into often unheard clinician perspectives on what the key features of an adolescent inpatient model of care are. These features relate to the interventions that are currently offered on the unit and ways of working as informed by philosophies and practices. These findings should be used to improve clinical services and inform research aiming to articulate exemplary adolescent inpatient models of care. Furthermore, the findings provide guidance and practical information to commissioners, clinicians, and policy makers implementing models of care.
  • Item
    Thumbnail Image
    Ward-Based Nurses' Knowledge and Attitudes Toward Clinical Trials: A Survey Study in Taiwan
    Kao, C-Y ; Hamilton, B ; Lin, Y-F ; Hu, W-Y (WILEY, 2019-07-01)
    PURPOSES: Clinical trial education has not been extensively integrated into nursing education systems. Acute care nurses may lack sufficient knowledge when caring for admitted trial patients, which may negatively influence their attitudes toward clinical trials. The aim of this study was to explore ward-based nurses' knowledge and attitudes toward clinical trials. DESIGN AND METHODS: Ward-based nurses working in medical, surgical, and intensive care units in a medical center in Taiwan were approached to complete a questionnaire. The questionnaire was developed by the research team and included four parts: demographics, experience with clinical trials, clinical trial knowledge, and attitudes toward clinical trials. FINDINGS: A total of 161 nurses responded. Nearly 90% of the nurses accessed trial information in their workplace. Nearly 80% of the respondents had experience with caring for trial patients, but the mean score of clinical trial knowledge was 4.5 out of a possible score of 10. For attitudes toward clinical trials, the mean score for positive beliefs was 39.7, and the mean score for negative expectations was 42.5, both out of a possible score of 55. The results indicated that respondents typically tended to hold a negative attitude toward clinical trials, especially in regard to the side effects of study drugs and communication with investigators. CONCLUSIONS: Knowledge deficits of ward-based nurses concerning trial participation is apparent. Continuing education for ward-based nurses is necessary to promote implementation of clinical trials and reduce negative expectations related to clinical trials. CLINICAL RELEVANCE: One way to improve nurses' knowledge is to integrate clinical trial education into nursing education systems, which will provide more channels through which nurses can understand how a trial works, including the risks, benefits, and participant protection. Through such educational initiatives, ward-based nurses may develop more positive beliefs regarding clinical trials and provide higher quality clinical trial care to participants.
  • Item
    Thumbnail Image
    What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review
    Hayes, C ; Palmer, V ; Hamilton, B ; Simons, C ; Hopwood, M (WILEY, 2019-06-01)
    Limited research exists regarding the therapeutic operations of adolescent mental health inpatient units, particularly in terms of nonpharmacological therapeutic interventions. This review collates what is known about reported nonpharmacological therapeutic interventions for young people admitted to general or non-disorder-specific adolescent mental health inpatient settings. A descriptive review of this nature was not located in the literature. The aim was to identify what is currently known about reported nonpharmacological therapeutic interventions. The purpose was to consider gaps and contribute to further work being undertaken in describing an exemplary inpatient model of care for adolescents. Sources included CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO. Studies included were those published in English, between the years 2000 and 2018. Exclusions included residential, community, outpatient, forensic settings, and studies detailing pharmacological interventions. Ten studies were identified. This descriptive review provides an objective foundation to inform an exemplary inpatient model of care currently being investigated. There is a critical need to understand these interventions to identify key components of an inpatient model of care. Such knowledge will provide guidance for future services seeking to create an exemplary model of care. Furthermore, these results can influence current practice by improving quality and delivery of inpatient care.
  • Item
    Thumbnail Image
    Consumer recommendations for enhancing the Safewards model and interventions
    Kennedy, H ; Roper, C ; Randall, R ; Pintado, D ; Buchanan-Hagen, S ; Fletcher, J ; Hamilton, B (WILEY, 2019-04-01)
    This paper critiques the Safewards model through the lens of lived experiences of psychiatric hospitalization, diagnosis of mental illness, and distress. Special focus is given to the model's tested 10 interventions and to five lesser known interventions, identifying the impact they can have on hospitalized consumers. We highlight the role and prevalence of trauma, as well as the need to prevent harm in hospital settings. We draw upon notions of hospital as a sanctuary for people and the importance of providing a safe ward. 'Sanctuary harm' and 'Sanctuary trauma' are thus defined, with emphasis placed on the Safewards interventions as means by which sanctuary can be achieved. Finally, the consumer-perspective authors propose expansions to the model, critiquing the defining literature and moving towards a consumer experience of safety that is beyond the model's original intention: to reduce seclusion and restraint practices. Throughout the paper, the term 'consumer' is used in this context to mean people who have experienced or are experiencing psychiatric inpatient care.
  • Item
    Thumbnail Image
    Working towards least restrictive environments in acute mental health wards in the context of locked door policy and practice
    Fletcher, J ; Hamilton, B ; Kinner, S ; Sutherland, G ; King, K ; Tellez, JJ ; Harvey, C ; Brophy, L (WILEY, 2019-04-01)
    There has been a shift towards provision of mental health care in community-based settings in Australia. However, hospitals continue to care for people in acute mental health wards. An increasing proportion of the people in wards are admitted involuntarily, subject to restrictions of movement to minimize risk of harm to self and others. In response to concerns about the safety of people absconding from care, Queensland Health introduced a policy requiring all acute mental health wards in the State to be locked. In response, the Queensland Mental Health Commission funded a project to understand the impact of this policy and develop evidence-based recommendations regarding provision of least restrictive, recovery-oriented practices in acute wards. Facilitated forums were conducted with 35 purposively selected participants who identified as consumers, carers, or staff of acute mental health hospital wards, to test the acceptability, feasibility, and face validity of a set of evidence-informed recommendations for providing least restrictive, recovery-oriented practices. Participant responses were recorded, and data were analysed through an inductive, thematic approach. A recovery-oriented approach was supported by all stakeholders. Reducing boredom and increasing availability of peer support workers were considered key to achieving this. Focusing less on risk aversion was reported as central to enabling true Recovery Orientation. This project enabled recognition of the perspectives of consumers, carers, and staff in the consideration of evidence-informed recommendations that could be implemented to provide least restrictive care in the context of locked doors.
  • Item
    Thumbnail Image
    Identifying essential information to support patient decision-making regarding participation in cancer clinical trials: A Delphi study
    Kao, C-Y ; Aranda, S ; Krishnasamy, M ; Hamilton, B (WILEY, 2018-11-01)
    PURPOSES: This research set out to contribute to ongoing efforts to improve the quality of informed consent information provided to patients by specifically focusing on establishing consensus with regard to essential information to enhance the informed consent process. DESIGN AND METHODS: A Delphi consensus method was used to conduct three rounds of online surveys. Five groups of experts directly or indirectly involved in the informed consent process were invited to participate: patients, family members/friends, physicians, other health professionals and other key informants, including ethicists, contract research staff and pharmaceutical company staff. FINDINGS: Of 156 eligible participants, 101 participants (64.7%) completed all three rounds. In round 1, 994 information items were reported and generated into 74 statements. These were grouped under eight headings essential to the informed consent process. In rounds 2 and 3, the list was reduced to 15 statements representing consensus on essential information to be included in a summarised patient information document to support decision-making regarding trial participation. Risks and discomforts, participation requirements and trial governance were identified as important considerations. CONCLUSIONS: The 15 essential statements identified in this study could be used as components of a summarised information sheet given to potential cancer clinical trial participants, as an adjunct to the informed consent process. A robust evaluation of the impact of these statements on the quality of the informed consent process is needed.