Nursing - Research Publications

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    Knowledge and Power Relations in Older Patients' Communication About Medications Across Transitions of Care
    Ozavci, G ; Bucknall, T ; Woodward-Kron, R ; Hughes, C ; Jorm, C ; Joseph, K ; Manias, E (SAGE PUBLICATIONS INC, 2021-10-16)
    Communicating about medications across transitions of care is a challenging process for older patients. In this article, we examined communication processes between older patients, family members, and health professionals about managing medications across transitions of care, focusing on older patients' experiences. A focused ethnographic design was employed across two metropolitan hospitals. Data collection methods included interviews, observations, and focus groups. Following thematic analysis, data were analyzed using Fairclough's Critical Discourse Analysis and Medication Communication Model. Older patients' medication knowledge and family members' advocacy challenged unequal power relations between clinicians and patients and families. Doctors' use of authoritative discourse impeded older patients' participation in the medication communication. Older patients perceived that nurses' involvement in medication communication was limited due to their task-related routines. To reduce the unequal power relations, health professionals should be more proactive in sharing information about medications with older patients across transitions of care.
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    Perioperative Nurses' Perceptions Pre-Implementation of an Electronic Medical Record System.
    Njane, A ; Jedwab, R ; Calvo, R ; Dobroff, N ; Glozier, N ; Hutchinson, A ; Leiter, M ; Manias, E ; Nankervis, K ; Rawson, H ; Redley, B (IOS Press, 2021-12-15)
    The use of electronic medical record (EMR) systems is transforming health care delivery in hospitals. Perioperative nurses work in a unique high-risk health setting, hence require specific considerations for EMR implementation. This research explored perioperative nurses' perceptions of facilitators and barriers to the implementation of an EMR in their workplace to make context-specific recommendations about strategies to optimise EMR adoption. Using a qualitative exploratory descriptive design, focus group data were collected from 27 perioperative nurses across three hospital sites. Thematic analyses revealed three themes: 1) The world is going to change; 2) What does it mean for me? and 3) We can do it, but we have some reservations. Mapping coded data to the Theoretical Domains Framework identified prominent facilitators and barriers, and informed recommended implementation strategies for EMR adoption by perioperative nurses.
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    Facilitators and Barriers to the Adoption of an Electronic Medical Record System by Intensive Care Nurses.
    Osajiuba, SA ; Jedwab, R ; Calvo, R ; Dobroff, N ; Glozier, N ; Hutchinson, A ; Leiter, M ; Nankervis, K ; Rawson, H ; Redley, B ; Manias, E (IOS Press, 2021-12-15)
    Introducing new technology, such as an electronic medical record (EMR) into an Intensive Care Unit (ICU), can contribute to nurses' stress and negative consequences for patient safety. The aim of this study was to explore ICU nurses' perceptions of factors expected to influence their adoption of an EMR in their workplace. The objectives were to: 1) measure psychological factors expected to influence ICU nurses' adoption of EMR, and 2) explore perceptions of facilitators and barriers to the implementation of an EMR in their workplace. Using an explanatory sequential mixed method approach, data were collected using surveys and focus groups. ICU nurses reported high scores for motivation, work engagement and wellbeing. Focus group analyses revealed two themes: Hope the EMR will bring a new world and Fear of unintended consequences. Recommendations relate to strategies for education and training, environmental restructuring and enablement. Overall, ICU nurses were optimistic about EMR implementation.
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    Development of a Complex Intervention for Effective Management of Type 2 Diabetes in a Developing Country
    Desse, TA ; Namara, KM ; Yifter, H ; Manias, E (MDPI, 2022-03-01)
    There has been little focus on designing tailored diabetes management strategies in developing countries. The aim of this study is to develop a theory-driven, tailored and context-specific complex intervention for the effective management of type 2 diabetes at a tertiary care setting of a developing country. We conducted interviews and focus groups with patients, health professionals, and policymakers and undertook thematic analysis to identify gaps in diabetes management. The results of our previously completed systematic review informed data collection. We used the United Kingdom Medical Research Council framework to guide the development of the intervention. Results comprised 48 interviews, two focus groups with 11 participants and three co-design panels with 24 participants. We identified a lack of structured type 2 diabetes education, counselling, and collaborative care of type 2 diabetes. Through triangulation of the evidence obtained from data collection, we developed an intervention called VICKY (patient-centred collaborative care and structured diabetes education and counselling) for effective management of type 2 diabetes. VICKY comprised five components: (1) patient-centred collaborative care; (2) referral system for patients across transitions of care between different health professionals of the diabetes care team; (3) tools for the provision of collaborative care and documentation of care; (4) diabetes education and counselling by trained diabetes educators; and (5) contextualised diabetes education curriculum, educational materials, and documentation tools for diabetes education and counselling. Implementation of the intervention may help to promote evidence-based, patient-centred, and contextualised diabetes care for improved patient outcomes in a developing country.
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    Older Nurses' Perceptions of an Electronic Medical Record Implementation.
    Tissera, S ; Jedwab, R ; Calvo, R ; Dobroff, N ; Glozier, N ; Hutchinson, A ; Leiter, M ; Manias, E ; Nankervis, K ; Rawson, H ; Redley, B (IOS Press, 2021-12-15)
    In Australia, almost 40% of nurses are aged 50 years and older. These nurses may be vulnerable to leaving the workforce due to challenges experienced during electronic medical record (EMR) implementations. This research explored older nurses' perceptions of factors expected to influence their adoption of an EMR, to inform recommendations to support implementation. The objectives were to: 1) measure psychological factors expected to influence older nurses' adoption of the EMR; and 2) explore older nurses' perceptions of facilitators and barriers to EMR adoption. An explanatory sequential mixed methods design was used to collect survey and focus group data from older nurses, prior to introducing an EMR system. These nurses were highly engaged with their work; 79.3% reported high wellbeing scores. However, their motivation appeared to be predominantly governed by external rather than internal influences. Themes reflecting barriers to EMR and resistance to adoption emerged in the qualitative data.
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    Associations of person-related, environment-related and communication-related factors on medication errors in public and private hospitals: a retrospective clinical audit
    Manias, E ; Street, M ; Lowe, G ; Low, JK ; Gray, K ; Botti, M (BMC, 2021-09-28)
    BACKGROUND: Efforts to ensure safe and optimal medication management are crucial in reducing the prevalence of medication errors. The aim of this study was to determine the associations of person-related, environment-related and communication-related factors on the severity of medication errors occurring in two health services. METHODS: A retrospective clinical audit of medication errors was undertaken over an 18-month period at two Australian health services comprising 16 hospitals. Descriptive statistical analysis, and univariate and multivariable regression analysis were undertaken. RESULTS: There were 11,540 medication errors reported to the online facility of both health services. Medication errors caused by doctors (Odds Ratio (OR) 0.690, 95% CI 0.618-0.771), or by pharmacists (OR 0.327, 95% CI 0.267-0.401), or by patients or families (OR 0.641, 95% CI 0.472-0.870) compared to those caused by nurses or midwives were significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of double-checking of medication orders compared to single-checking (OR 0.905, 95% CI 0.826-0.991) was significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of electronic systems for prescribing (OR 0.580, 95% CI 0.480-0.705) and dispensing (OR 0.350, 95% CI 0.199-0.618) were significantly associated with reduced odds of possibly or probably harmful medication errors compared to the absence of these systems. Conversely, insufficient counselling of patients (OR 3.511, 95% CI 2.512-4.908), movement across transitions of care (OR 1.461, 95% CI 1.190-1.793), presence of interruptions (OR 1.432, 95% CI 1.012-2.027), presence of covering personnel (OR 1.490, 95% 1.113-1.995), misread or unread orders (OR 2.411, 95% CI 2.162-2.690), informal bedside conversations (OR 1.221, 95% CI 1.085-1.373), and problems with clinical handovers (OR 1.559, 95% CI 1.136-2.139) were associated with increased odds of medication errors causing possible or probable harm. Patients or families were involved in the detection of 1100 (9.5%) medication errors. CONCLUSIONS: Patients and families need to be engaged in discussions about medications, and health professionals need to provide teachable opportunities during bedside conversations, admission and discharge consultations, and medication administration activities. Patient counselling needs to be more targeted in effort to reduce medication errors associated with possible or probable harm.
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    How does implementation of an electronic medical record system impact nurses' work motivation, engagement, satisfaction and well-being? A realist review protocol
    Jedwab, RM ; Redley, B ; Manias, E ; Dobroff, N ; Hutchinson, AM (BMJ PUBLISHING GROUP, 2021-10-01)
    INTRODUCTION: Electronic medical record (EMR) systems are used worldwide as repositories for patients' clinical information, providing clinical decision support and increasing visibility of and access to clinical information. While EMR systems facilitate improved healthcare delivery, emerging reports suggest potential detrimental effects on clinician well-being. EMR system implementation influences on nurses' work motivation, engagement, satisfaction and well-being (including burnout) are not well understood, nor have they been examined in relation to contextual factors and mechanisms of action. This paper presents a realist review protocol to examine causal explanations to address the question: How, why and under what circumstances does the implementation of a new hospital EMR system or similar technology impact nurses' work motivation, engagement, satisfaction or well-being? METHODS AND ANALYSIS: The five-step method for realist review will be used to identify causal relationships, how the relationships work, for whom and under what circumstances: (1) defining the review scope; (2) developing initial program theories; (3) searching the evidence; (4) selecting and appraising the evidence; (5) extracting and synthesising the data. Initial program theories were developed using scoping review findings and qualitative data collected from nurses pre-EMR and post-EMR. Five databases will be systematically searched from 1 January 2000 to 31 October 2021 (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete), and forward and backward citation searching, grey literature searching and literature recommended by the research team. Search results will be screened by two research team members. Data extracted will assist in refining program theories to develop a conceptual model that synthesises how work motivation, engagement, satisfaction and well-being may influence, or be influenced by, an EMR implementation. ETHICS AND DISSEMINATION: The larger project has previously obtained low-risk ethics approval. The review will be published in a peer-reviewed journal and reported as per RAMESES guidelines. PROSPERO REGISTRATION NUMBER: CRD42020131875.
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    Self-management of medication during hospitalisation: Healthcare providers' and patients' perspectives
    Vanwesemael, T ; Boussery, K ; Manias, E ; Petrovic, M ; Fraeyman, J ; Dilles, T (WILEY, 2018-02-01)
    AIMS AND OBJECTIVES: To explore healthcare providers' and patients' perspectives on self-management of medication during the patients' hospital stay. BACKGROUND: Self-administration of medications relates to the process in which hospitalised patients-instead of healthcare professionals-prepare and consume medications by themselves. Literature suggests possible advantages of medication self-management such as increased patient satisfaction, adherence to pharmacotherapy and self-care competence. DESIGN: A qualitative descriptive study design was adopted, using semistructured interviews and qualitative content analysis to examine data. METHODS: Six physicians, 11 nurses, six hospital pharmacists and seven patients were recruited from one regional hospital and two university hospitals, situated in Belgium. Interviews were conducted between October 2014-January 2015. RESULTS: Strengths of medication self-management were described by participants, relating to benefits of self-management for patients, time-saving benefits for nurses and benefits for better collaboration between patients and healthcare providers. Weaknesses were also apparent for patients as well as for nurses and physicians. Opportunities for self-management of medication were described, relating to the organisation, the patient and the process for implementing self-management. Threats for self-management of medication included obstacles related to implementation of self-managed medications and the actual process of providing medication self-management. A structured overview of conditions that should be fulfilled before allowing self-management of medication concerned patient-related conditions, the self-managed medication and the organisation of self-management of medication. CONCLUSIONS: This study provides new insights on the strengths, weaknesses, opportunities and threats from the perspectives of key stakeholders. Interpretation of these findings resulted in an overview of adaptations in the medication management process to facilitate implementation of self-management of medication. RELEVANCE TO CLINICAL PRACTICE: A medication management process for self-management of medication was proposed. Further interventional studies are needed to test and refine this process before implementing it in daily practice.
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    The impact of interruptions on medication errors in hospitals: an observational study of nurses
    Johnson, M ; Sanchez, P ; Langdon, R ; Manias, E ; Levett-Jones, T ; Weidemann, G ; Aguilar, V ; Everett, B (WILEY, 2017-10-01)
    AIM: To explore interruptions during medication preparation and administration and their consequences. BACKGROUND: Although not all interruptions in nursing have a negative impact, interruptions during medication rounds have been associated with medication errors. METHOD: A non-participant observational study was undertaken of nurses conducting medication rounds. RESULTS: Fifty-six medication events (including 101 interruptions) were observed. Most medication events (99%) were interrupted, resulting in nurses stopping medication preparation or administration to address the interruption (mean 2.5 minutes). The mean number of interruptions was 1.79 (SD 1.04). Thirty-four percent of medication events had at least one procedural failure, while 3.6% resulted in a clinical error. CONCLUSIONS: Our study confirmed that interruptions occur frequently during medication preparation and administration, and these interruptions were associated with procedural failures and clinical errors. Nurses were the primary source of interruptions with interruptions often being unrelated to patient care. IMPLICATIONS FOR NURSING MANAGEMENT: This study has confirmed that interruptions are frequent and result in clinical errors and procedural failures, compromising patient safety. These interruptions contribute a substantial additional workload to medication tasks. Various interventions should be implemented to reduce non-patient-related interruptions. Medication systems and procedures are advocated, that reduce the need for joint double-checking of medications, indirectly avoiding interruptions.
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    Stressors and coping resources of Australian kidney transplant recipients related to medication taking: a qualitative study
    Low, JK ; Crawford, K ; Manias, E ; Williams, A (WILEY, 2017-06-01)
    AIM AND OBJECTIVE: To understand the stressors related to life post kidney transplantation, with a focus on medication adherence, and the coping resources people use to deal with these stressors. BACKGROUND: Although kidney transplantation offers enhanced quality and years of life for patients, the management of a kidney transplant post surgery is a complex process. DESIGN: A descriptive exploratory study. METHOD: Participants were recruited from five kidney transplant units in Victoria, Australia. From March-May 2014, patients who had either maintained their kidney transplant for ≥8 months or had experienced a kidney graft loss due to medication nonadherence were interviewed. All audio-recordings of interviews were transcribed verbatim and underwent Ritchie and Spencer's framework analysis. RESULTS: Participants consisted of 15 men and 10 women aged 26-72 years old. All identified themes were categorised into: (1) Causes of distress and (2) Coping resources. Post kidney transplantation, causes of distress included the regimented routine necessary for graft maintenance, and the everlasting fear of potential graft rejection, contracting infections and developing cancer. Coping resources used to manage the stressors were first, a shift in perspective about how easy it was to manage a kidney transplant than to be dialysis-dependent and second, receiving external help from fellow patients, family members and health care professionals in addition to using electronic reminders. CONCLUSION: An individual well-equipped with coping resources is able to deal with stressors better. It is recommended that changes, such as providing regular reminders about the lifestyle benefits of kidney transplantation, creating opportunities for patients to share their experiences and promoting the usage of a reminder alarm to take medications, will reduce the stress of managing a kidney transplant. RELEVANCE TO CLINICAL PRACTICE: Using these findings to make informed changes to the usual care of a kidney transplant recipient is likely to result in better patient outcomes.