Nursing - Research Publications
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ItemNurses' experiences of supporting patients requesting voluntary assisted dying: A qualitative meta-synthesis(WILEY, 2022-10)AIM: Describe the reported lived experiences of nurses who have participated at any stage of voluntary assisted dying (VAD), from the initial request to the end of life. DESIGN: A qualitative meta-synthesis. DATA SOURCES: Databases searched were CINAHL, MEDLINE, Emcare, Scopus and PsycInfo. The search was undertaken in September 2021 with no date limitations. Qualitative studies were considered if published in English, reported primary data analysis of nurses' experiences who had been involved in VAD and reported direct quotes from nurses. REVIEW METHODS: Qualitative studies meeting the selection criteria were critically appraised, then an open card-sort method was applied. Quotes from nurses were organized to group similar experiences, constructing themes and metaphors across studies as a new understanding of nurses' experiences of VAD. RESULTS: Eight studies were included. Three major themes were constructed: An orderly procedure, reflecting the need for structure to feel adequately prepared; A beautiful death, reflecting the autonomy the patient exercised when choosing VAD facilitated an exceptionally positive death; and Psychological and emotional impact, where nurses recognized the emotional and ethical weight that they carried for themselves and the team when undertaking VAD. CONCLUSION: Nurses may benefit from clear policy, supervision and communication training to support them as countries transition to providing VAD services. Policy provides nurses with confidence that they are undertaking the steps of VAD correctly and provides a layer of emotional protection. Communication training specific to VAD is necessary to prepare nurses to recognize their own emotional experiences when responding to the needs of the patient and their family. IMPACT: VAD is increasingly becoming a legal option that nurses are encountering in their professional practice. Understanding nurses' experiences of being involved in VAD is required to support nurses in countries where VAD is becoming available to prepare professionally and psychologically.
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ItemStrengthening Community End-of-Life Care through Implementing Measurement-Based Palliative Care(MDPI, 2022-07)The increasing demand for palliative care in New Zealand presents a potential threat to the quality of service delivery. One strategy to overcome this is through the implementation of valid and reliable patient-reported outcome measures. This mixed-methods study aimed to (1) implement measurement-based palliative care (MBPC) in a community palliative care service in Auckland, New Zealand; (2) evaluate the clinical utility of MBPC perceived by clinicians; (3) describe patient characteristics as measured by the Integrated Palliative Care Outcome Scale (IPOS), the Australasian Modified Karnofsky Performance Scale (AKPS), and Phase of Illness (POI); and (4) evaluate the internal consistency of the IPOS. Participants were over 18 years of age from a community outpatient palliative care service. In a phased approach to implementation, healthcare staff were educated on each instrument used for patient assessment. Uptake and internal consistency were evaluated through descriptive statistics. An interpretive descriptive methodology was used to explore the clinical utility of MBPC through semi-structured interviews with seven clinical staff members. Individual patient assessments (n = 1507) were undertaken predominantly on admission, with decreasing frequency as patients advanced through to the terminal phase of their care. Mean total IPOS scores were 17.97 (SD = 10.39, α = 0.78). The POI showed that 65% of patients were in the stable phase, 20% were in the unstable phase, 9% were in the deteriorating phase, and 2% were in the terminal phase. Clinicians reported that MBPC facilitated holistic and comprehensive assessments, as well as the development of a common interdisciplinary language. Clinicians expressed discomfort using the psychosocial and spiritual items. Measurement-based palliative care was only partially implemented but it was valued by staff and perceived to increase the quality of service delivery. Future research should determine the optimal timing of assessments, cultural responsivity for Māori and Pacific patients, and the role of MBPC in decision support for clinicians.
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ItemPredictors of Life Satisfaction in New Zealand: Analysis of a National Dataset(MDPI, 2022-05)The study aim was to determine prevalence and predictors of life satisfaction in New Zealand. In this observational cross-sectional study, a sample of 10,799 participants from NZ were drawn from the Gallup World Poll from 2006 to 2017. Data were analysed using regression analysis and ANOVA. Prevalence of life satisfaction across time varied little from a high of 7.61 (SD = 1.6) in 2007 to a low of 7.23 (SD = 1.73) in 2011 (range 0-10). Satisfaction with standards of living predicted life satisfaction regardless of age or gender. For males across all age groups and females up to age 40 years, positive experiences and satisfaction with household income were important predictors. Being married was an important predictor for males over 40 years and feeling satisfied with their current city was important for females across all ages and for men under 40. The levels of life satisfaction changed over time, possibly due to major national events. Satisfaction with standards of living was found to predict life satisfaction regardless of age or gender. These results provide a path for policy focus towards increased life satisfaction.
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ItemAn Evaluation of the Psychometric Properties of the Temporal Satisfaction With Life Scale(FRONTIERS MEDIA SA, 2022-04-14)The Temporal Satisfaction with Life Scale measures judgements of life satisfaction using 15 items, according to three temporal dimensions: past, present, and future. However, only seven studies have looked at the psychometric properties of the Temporal Satisfaction with Life Scale, and this has been individually across vastly different countries and cultures (Canada, China, Germany, Spain, Switzerland, Turkey, and United-States), and with different populations, such as undergraduate students, adults, and older adults. In addition, these studies have highlighted issues regarding the replicability of the validity of the scale structure and optimal number of items. In this study we use a large international and multicultural sample (n = 6,912) from the International Wellbeing Study and investigate the scale structure of the Temporal Satisfaction with Life Scale, resulting in the recommendation that a shortened 12-item version provides a better model fit compared to the original 15-item version. More in-depth correlates with aspects of wellbeing and illbeing, in relation to past, present, and future life satisfaction, are also presented than have been previously, which found positive correlations between the temporal dimensions of the Temporal Satisfaction with Life Scale and wellbeing, as well as negative correlations with illbeing measures.
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ItemDoing Case Study Research Collaboratively: The Benefits for Researchers(SAGE PUBLICATIONS INC, 2022-04)Collaborative research teams are an effective strategy to combine the knowledge and skills of like-minded researchers across tertiary education settings and international borders. Research collaborations have the potential to increase research capacity for both individuals and the team alike. The purpose of the study was to explore the experiences and perceptions of a team of seven Australasian nurse academics undertaking a longitudinal multi-site case study. We used a nominal group technique in this deductive qualitative exploratory study. The key findings from this study indicate establishing safe academic relationships is paramount to successful collaborative teams. Collaborative research teams offer opportunities to learn research processes from other members through sharing of expertise and skillsets, together with upholding a positive engagement with technology to ensure full research participation is achievable irrespective of geographical location. To conclude, in this study we have identified multi-site collaborative research teams provide an opportunity to leverage the strengths of individuals to enhance research outcomes across organisations. The synergistic effect of the team builds research blue skies thinking and capacity building through mentorship and support. The potential for positive change through mentorship and support, alongside the forged new relationships, are all key drivers of researcher wellbeing, never more important as we transition into new ways of working both now and into the future.
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ItemMethodological approaches to measuring the incidence of unplanned emergency department presentations by cancer patients receiving systemic anti-cancer therapy: a systematic review(BMC, 2022-03-21)BACKGROUND: The need to mitigate the volume of unplanned emergency department (ED) presentations is a priority for health systems globally. Current evidence on the incidence and risk factors associated with unplanned ED presentations is unclear because of substantial heterogeneity in methods reporting on this issue. The aim of this review was to examine the methodological approaches to measure the incidence of unplanned ED presentations by patients receiving systemic anti-cancer therapy in order to determine the strength of evidence and to inform future research. METHODS: An electronic search of Medline, Embase, CINAHL, and Cochrane was undertaken. Papers published in English language between 2000 and 2019, and papers that included patients receiving systemic anti-cancer therapy as the denominator during the study period were included. Studies were eligible if they were analytical observational studies. Data relating to the methods used to measure the incidence of ED presentations by patients receiving systemic anti-cancer therapy were extracted and assessed for methodological rigor. Findings are reported in accordance with the Synthesis Without Meta-Analysis (SWiM) guideline. RESULTS: Twenty-one articles met the inclusion criteria: 20 cohort studies, and one cross-sectional study. Overall risk of bias was moderate. There was substantial methodological and clinical heterogeneity in the papers included. Methodological rigor varied based on the description of methods such as the period of observation, loss to follow-up, reason for ED presentation and statistical methods to control for time varying events and potential confounders. CONCLUSIONS: There is considerable diversity in the population and methods used in studies that measure the incidence of unplanned ED presentations by patients receiving systemic anti-cancer therapy. Recommendations to support the development of robust evidence include enrolling participants at diagnosis or initiation of treatment, providing adequate description of regular care to support patients who experience toxicities, reporting reasons for and characteristics of participants who are lost to follow-up throughout the study period, clearly defining the outcome including the observation and follow-up period, and reporting crude numbers of ED presentations and the number of at-risk days to account for variation in the length of treatment protocols.
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ItemConceptual model for intensive care nurse work well-being: A qualitative secondary analysis(WILEY, 2020-03)BACKGROUND: There had been little focus on the well-being of intensive care nurses until a recent programme of research found work well-being to be best described as a collection of elements, a multifaceted construct. Strengtheners of intensive care nurses' work well-being were found to extend across individual, relational, and organizational resources. Actions such as simplifying their lives, giving and receiving team support, and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners. AIMS AND OBJECTIVES: To synthesize intensive care nurse perceptions of work well-being characteristics and strengtheners to identify opportunities for job crafting and redesign. DESIGN: This was a qualitative secondary analysis. METHODS: Intensive care nurse work well-being characteristics and strengtheners were explored using applied thematic analysis and pre-design, open card-sort technique. RESULTS: Five facets were identified in the analysis: (a) healthy, (b) authentic, (c) meaningful, (d) connected, and (e) innovative. These five facets were described from a theoretical perspective and illustrated as a conceptual model for intensive care nurse job crafting and redesign. CONCLUSIONS: The proposed conceptual model contributes new knowledge to be explored in meaningful discussions about intensive care nurse work well-being and empirically investigated in terms of construct validity and theory development. Furthermore, the model provides practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being across a range of levels. RELEVANCE TO CLINICAL PRACTICE: Opportunities for job crafting and redesign were identified and presented in a conceptual model of intensive care nurse work well-being. This model provides individual nurses, intensive care teams, health care organizations, and workers' well-being programme and policy developers practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being.
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ItemWhat Motivates People to Start a Graduate Entry Nursing Programme: An Interpretive Multi-Centred Case Study(SAGE PUBLICATIONS INC, 2021-04)INTRODUCTION: While graduate entry nursing programmes are well established in the United Kingdom and the United States of America (USA), they are relatively new to New Zealand and Australia. These programmes have been developed to meet the demands of the health workforce and provide graduates an alternative pathway to becoming a RN. Nursing is viewed as an attractive career option for this growing market of graduate entry students. OBJECTIVE: This study explored the motivations underpinning students choosing a graduate entry MNSc degree over a traditional undergraduate nursing programme. METHODS: A qualitative, longitudinal single case study design, informed by Yin was used. The first phase of the study is reported here. All students commencing a MNSc degree at the beginning of 2020 across four education providers (3 in New Zealand & 1 in Australia) were eligible to take part in the study. Ten students agreed to take part and undertake an interview. Braun and Clarke's approach to thematic analysis was used to analyse the interview data. RESULTS: Three key themes of motivation were identified from the data: the attraction of nursing; the clarity nursing offers in terms of career progression; and the design of the intensive programme. CONCLUSIONS: The motivations to choose a MNSc degree were deeply considered, multifaceted, and influenced by nursing role models. Students wanting to engage with a graduate entry MNSc programme did so through a reflective process of assessing their current career status and future career values. Participants in this study believed nursing would provide a secure and sustainable career path, potentially creating new horizons or possibilities beyond their previous work and life experiences. Having insight into what motivates individuals to enrol in such programmes may assist both education providers and the health sector with RN graduate recruitment and graduate entry programme enrolment.
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ItemRegistered Nurses' experiences of psychological well-being and ill-being in their first year of practice: A qualitative meta-synthesis(WILEY, 2021-03)AIM: To synthesize Registered Nurses' self-reported perceptions and experiences of psychological well-being and ill-being during their first year of practice. DESIGN: Qualitative meta-synthesis. DATA SOURCES: Databases included Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Medical Literature Analysis and Retrieval System Online and Psychological Information. Qualitative studies were considered for inclusion if published in English, from 2009-2019, reporting primary data analysis including psychological well-being and ill-being experiences of graduate nurses in first year of practice. REVIEW METHODS: Qualitative studies were systematically identified and critically appraised. A meta-synthesis was applied using an open card sort technique to organize empirical data into a matrix of graduate nurses' voices of psychological well-being and ill-being. RESULTS: Twenty-two studies were included. Analysis revealed patterns of positive experiences and emotions. These included feeling valued and part of the team and learning from and feeling supported by other nurses. Negative experiences and emotions such as feeling overwhelmed, stressed, alone and inadequately prepared were also identified. CONCLUSION: Graduate nurses' perceptions and experiences of their psychological well-being and ill-being revealed both positive and negative dimensions during this transition period. Specific examples of strategies that may promote transition nurses' well-being and prevent ill-being were identified such as social connection and support. IMPACT: Increasing the numbers of new nursing graduates world-wide is required to strengthen health systems. Developing strategies to retain these graduates in the workforce is paramount. This review found some graduate nurses experience the transition period as a time of personal growth and fulfilment, for others this period was a stressor. These findings were illustrated in a model of 'ways to well-being'. The potential for knowledge translation of this model extends from graduate nurses as individuals, to nurse entry to practice programs and graduate nurse programs, to organizational policy targeting future health workforce. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42020148812.
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ItemWhat motivates people to commence a graduate entry nursing programme: a mixed method scoping review(BMC, 2021-03-20)BACKGROUND: The global deficit of nurses demands urgent attention in the recruitment and education of this future workforce. Graduate entry nursing (GEN) programmes are one option for people with undergraduate degrees who are seeking nursing education. Determining the key motivations for enrolling in these programmes will support the development of new initiatives in the education sector to both recruit and retain this future workforce and inform future primary research. This scoping review aims to comprehensively describe what motivates graduates to enrol in GEN programmes. METHODS: Peer reviewed studies of quantitative, qualitative and mixed-method research investigating motivations to commence a graduate entry nursing programme were included, following a pre-determined protocol. Electronic databases searched included Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, ERIC, Medline and Scopus. Screening, data extraction and analysis was initially in duplicate and independent, then consensus reached. Qualitative and quantitative data was analysed and reported separately then combined thematically as a narrative synthesis in a convergent segregated approach. Reporting followed preferred reporting guidelines for scoping reviews. RESULTS: Of the 491 studies retrieved in July 2020, across the five databases and reference list search, six met the inclusion criteria. Four were qualitative studies, one mixed-methods, and one quantitative, respectively from Australia, USA, and New Zealand. Four themes of motivation were identified: 1) finding meaning and purpose through altruism and caring; 2) seeking a satisfying career, 3) looking for a change in direction and, 4) reduced financial burden due to course length and provision of scholarships. CONCLUSIONS: There is a paucity of studies specifically seeking to investigate student motivations for enrolling in a GEN programme and only limited studies giving insights into motivators for enrolling in a GEN programme, therefore this scoping review contributes new understandings on the reason's students choose GEN programmes. These are both altruistic and practical and include personal desires to help others, the need to pursue a satisfying and meaningful career and the shorter period out of the workforce offered by an accelerated programme of study.