Nursing - Research Publications
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ItemNo Preview AvailableKnowledge and Power Relations in Older Patients' Communication About Medications Across Transitions of Care(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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ItemPerioperative Nurses' Perceptions Pre-Implementation of an Electronic Medical Record System.(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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ItemFacilitators and Barriers to the Adoption of an Electronic Medical Record System by Intensive Care Nurses.(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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ItemOlder Nurses' Perceptions of an Electronic Medical Record Implementation.(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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ItemAssociations of person-related, environment-related and communication-related factors on medication errors in public and private hospitals: a retrospective clinical audit(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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ItemHow does implementation of an electronic medical record system impact nurses' work motivation, engagement, satisfaction and well-being? A realist review protocol(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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ItemDo patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety.(Wiley, 2021-12)BACKGROUND: Patients are increasingly being asked for feedback about their healthcare and treatment, including safety, despite little evidence to support this trend. This review identifies the strategies used to engage patients in safety during direct care, explores who is engaged and determines the mechanisms that impact effectiveness. METHODS: A systematic review was performed of seven databases (CINAHL, Cochrane, Cochrane-Central, Embase, ISI Web of Science, Medline, PsycINFO) that included research published between 2010 and 2020 focused on patient engagement interventions to increase safety during direct care and reported using PRISMA. All research designs were eligible; two reviewers applied criteria independently to determine eligibility and quality. A narrative review and realist synthesis were conducted. RESULTS: Twenty-six papers reporting on twenty-seven patient engagement strategies were included and classified as consultation (9), involvement (7) and partnership (11). The definitions of 'patient engagement' varied, and we found limited details about participant characteristics or interactions between people utilizing strategies. Collaborative strategy development, a user-friendly design, proactive messaging and agency sponsorship were identified as mechanisms to improve engagement about safety at the point of direct care. CONCLUSIONS: Agency sponsorship of collaboration between staff and patients is essential in the development and implementation of strategies to keep patients safe during direct care. Insufficient details about participant characteristics and patient-provider interactions limit recommendations for practice change. More needs to be learned about how patients are engaged in discussions about safety, particularly minority groups unable to engage with standard information. PATIENT OR PUBLIC CONTRIBUTION: Review progress was reported to the CanEngage team, including the consumer steering group, to inform project priorities (PROSPERO CRD42020196453).
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ItemHow do health services engage culturally and linguistically diverse consumers? An analysis of consumer engagement frameworks in Australia.(Wiley, 2021-10)BACKGROUND: Engagement frameworks provide the conceptual structure for consumer engagement in healthcare decision making, but the level to which these frameworks support culturally and linguistically diverse (CALD) consumer engagement is not known. OBJECTIVE: This study aimed to investigate how consumer engagement is conceptualised and operationalized and to determine the implications of current consumer engagement frameworks for engagement with CALD consumers. METHOD: Altheide's document analysis approach was used to guide a systematic search, selection and analytic process. Australian Government health department websites were searched for eligible publicly available engagement frameworks. A narrative synthesis was conducted. RESULTS: Eleven engagement frameworks published between 2007 and 2019 were identified and analysed. Only four frameworks discussed engagement with CALD consumers distinctly. Organisational prerequisites to enhance engagement opportunities and approaches to enable activities of engagement were highlighted to improve CALD consumers' active participation in decision making; however, these largely focused on language, with limited exploration of culturally sensitive services. CONCLUSION: There is limited discussion of what culturally sensitive services look like and what resources are needed to enhance CALD consumer engagement in high-level decision making. Health services and policy makers can enhance opportunities for engagement with CALD consumers by being flexible in their approach, implementing policies for reimbursement for participation and evaluating and adapting the activities of engagement in collaboration with CALD consumers. PATIENT/PUBLIC CONTRIBUTION: This study is part of a wider 'CanEngage' project, which includes a consumer investigator, and is supported by a consumer advisory group. The study was conceived with inputs from the consumer advisory group, which continued to meet regularly with the project team to discuss the methodology and emerging findings.
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ItemNo Preview AvailablePreparing nurses for COVID-19 response efforts through involvement in antimicrobial stewardship programmes(W B SAUNDERS CO LTD, 2020-09-01)
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ItemCodesigning consumer engagement strategies with ethnic minority consumers in Australian cancer services: the CanEngage Project protocol(BMJ PUBLISHING GROUP, 2021-01-01)INTRODUCTION: Consumer engagement is central to high-quality cancer service delivery and is a recognised strategy to minimise healthcare-associated harm. Strategies developed to enhance consumer engagement specifically in relation to preventing healthcare harm include questioning health professionals, raising concerns about possible mistakes or risks in care and encouraging patients and caregivers to report suspected errors. Patients from ethnic minority backgrounds are particularly vulnerable to unsafe care, but current engagement strategies have not been developed specifically for (and with) this population. Using an adapted approach to experience-based codesign (EBCD) to support the target population, the aim of the project is to codesign consumer engagement interventions to increase consumer engagement and safety in New South Wales and Victorian cancer inpatient, outpatient and day procedure services. METHODS AND ANALYSIS: A mixed-method project will be undertaken at six study sites. Our EBCD approach includes a preparatory phase in which we will provide training and support to the codesign participants, in addition to recruiting and training consumer cofacilitators for the codesign workshops. The project will follow the EBCD process of gathering and synthesising observational data from each cancer service, with interview data from consumers and staff. With the resulting in-depth understanding of the safety threats commonly experienced by ethnic minority consumers in each site, we will work through feedback events and codesign groups with consumers and staff to determine how they can be more involved with their care to minimise the potential for patient harm. Consumer engagement interventions will be coproduced in each of the six participating services that are tailored to the ethnic minority populations served. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee. The project will provide strategies for ethnic minority consumers to engage with cancer services to minimise healthcare-associated harm that may be applied to diverse healthcare settings.