Nursing - Research Publications
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ItemExploring the impact of the COVID-19 environment on nursing delivery of family-centred care in a paediatric hospital(WILEY, 2023-01)AIMS AND OBJECTIVES: To understand how the pandemic environment impacted the delivery of FCC of children and families from a nursing perspective in a major tertiary paediatric hospital. BACKGROUND: Family-centred care (FCC) is a well-established framework to promote parental involvement in every aspect of a child's hospitalization, however, rules and restrictions in place during the COVID-19 pandemic affected the ways in which Family-centred Care could be delivered in practice. DESIGN: This is a qualitative exploratory descriptive study to elicit the perspective of paediatric nurses delivering care to children in a hospital during the COVID-19 pandemic in Victoria, Australia. METHODS: Nurses from all subspecialties in a tertiary paediatric hospital were invited to participate in virtual focus groups to discuss their experience of delivering FCC during the COVID-19 pandemic. Focus groups were recorded and transcribed, then analysed using Framework Analysis. RESULTS: Nineteen nurses participated across seven focus groups during June and July 2020. The four themes-Advocating with empathy, Enabling communication, Responding with flexibility, and Balancing competing considerations-and the eight subthemes that were generated, outline how nurses deliver FCC, and how these FCC actions were impacted by the COVID-19 environment and the related hospital restrictions. CONCLUSION: This study documents the experiences, resilience and resourcefulness of paediatric nurses in Australia during the COVID-19 pandemic as well as moving Family-centred Care from a theoretical framework into a practical reality. IMPACT: The findings from this study should inform consideration of the impacts of public health policies during infectious disease outbreaks moving forward. In addition by describing the core actions of Family-centred Care, this study has implications for educational interventions on how to translate FCC theory into practice. No public or patient contribution as this study explored nursing perceptions only.
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ItemMedication communication between nurses and doctors for paediatric acute care: An ethnographic study(WILEY, 2017-07)AIMS AND OBJECTIVES: To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. BACKGROUND: Communication between health professionals influences medication incidents' occurrence and safe care. DESIGN: An ethnographic study was undertaken. METHODS: Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. RESULTS: The actual communication act revealed health professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. CONCLUSIONS: Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in interdisciplinary communication impacted on potential and actual medication incidents. RELEVANCE TO CLINICAL PRACTICE: Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure interprofessional respect for each other's roles and inherent demands. Interdisciplinary education delivered in healthcare organisations would facilitate greater clarity in communication related to medications. Encouraging the use of concise, clear words in communication would help to promote improved understanding between parties, and accuracy and efficacy of medication management.
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ItemDevelopment of competence in the first year of graduate nursing practice: a longitudinal study(WILEY, 2016-04)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.
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ItemMedication error trends and effects of person-related, environment-related and communication-related factors on medication errors in a paediatric hospital(WILEY, 2019-03)AIM: This study aimed to examine reported medication error trends in an Australian paediatric hospital over a 5-year period and to determine the effects of person-related, environment-related and communication-related factors on the severity of medication outcomes. In particular, the focus was on the influence of changes to a hospital site and structure on the severity of medication errors. METHODS: A retrospective clinical audit was undertaken over a 5-year period of paediatric medication errors submitted to an online voluntary reporting system of an Australian, tertiary, public teaching paediatric hospital. All medication errors submitted to the online system between 1 July 2010 and 30 June 2015 were included. RESULTS: A total of 3340 medication errors was reported, which corresponded to 0.56% medication errors per combined admissions and presentations or 5.73 medication errors per 1000 bed days. The most common patient outcomes related to errors requiring monitoring or an intervention to ensure no harm occurred (n = 1631, 48.8%). A new hospital site and structure had 0.354 reduced odds of producing medication errors causing possible or probable harm (95% confidence interval 0.298-0.421, P < 0.0001). Patient and family involvement had 1.270 increased odds of identifying medication errors associated with possible or probable harm compared with those causing no harm (95% confidence interval 1.028-1.568, P = 0.027). Interrupted time series analyses showed that moving to a new hospital site and structure was associated with a reduction in reported medication errors. CONCLUSION: Encouraging child and family involvement, facilitating hospital redesign and improving communication could help to reduce the harm associated with medication errors.
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ItemDifficulties with assessment and management of an infant's distress in the postoperative period: Optimising opportunities for interdisciplinary information-sharing(SAGE PUBLICATIONS INC, 2016)OBJECTIVES: The importance of accurate paediatric patient assessment is well established but under-utilised in managing postoperative medication regimens. METHODS: Data for this case report were collected through observations of clinical practice, conduct of interviews, and retrieval of information from the medical record. This case report involving a hospitalised 1-year-old boy demonstrates the difficulties associated with assessing and managing postoperative distress, including pain and other clinical conditions related to the surgical procedure. RESULTS: Postoperatively, there were difficulties in managing pain and an episode of over-sedation, occasioning opiate reversal with naloxone. In addition, he had decreasing oxygen saturation and increased work of breathing. X-ray showed changes consistent with either atelectasis or aspiration, and he was commenced on antibiotics. The patient experienced respiratory distress and required intervention from the medical emergency team. CONCLUSION: This case demonstrated the importance of comprehensive assessment and careful consideration of alternative causes of an infant's distress using the results of assessment tools to aid decision-making. Communication moderates effective patient care, and more favourable outcomes could be achieved by optimising interdisciplinary information-sharing.