Factors affecting speech-language pathologists' language assessment procedures and tools - challenges and future directions in Sweden

Purpose: National surveys of speech-language pathologists' (SLP) practices play an important role in professional development, and previous research show that many challenges faced by the profession are similar across the globe. This study aims to describe Swedish SLP assessment practices, examine factors that may affect this practice, and discuss the results in the light of international studies.Methods: Data from 584 SLPs were collected through an online questionnaire with multiple choice and open-ended questions. A mixed-method design was deployed where a deductive qualitative analysis of free-text responses complemented quantitative data.Results: In line with previous results from English-speaking countries, both standardized discrete skill tests and contextualized assessments were used by the respondents but fewer used language sample analysis and dynamic assessment procedures, despite international recommendations. There were few differences based on experience, work setting, proportion of multilingual assessments and socio-economic status of the health catchment area. Main challenges reported were lack of time and difficulty prioritizing, and assessment and/or diagnosis of multilingual/L2 children, which is similar to challenges faced by SLPs in other countries. Swedish SLPs also reported lack of national clinical guidelines as a main challenge. Factors contributing to better assessments included experience, and the combination of many sources of information, including professional and interprofessional discussions.Conclusions: The accumulated evidence from this and previous studies show that to address challenges and build on strengths, changes on a systemic level are needed. This includes more time and resources for continuing education and implementation of recommended assessment methods, as well as professional and interprofessional collaborations.

Independent prescribing for a child with a first diagnosis of asthma: a case study

Asthma is a chronic condition of varying intensity that is characterised by symptoms including coughing, wheezing, chest tightness and breathlessness. The article details a case study outlining the consultation and prescribing practice for a five-year-old girl who presented with a cough and breathlessness, and who was subsequently diagnosed with asthma. The author assessed and treated this patient while undertaking her non-medical prescribing qualification, and she outlines the diagnostic and prescribing decision-making process. The author also examines the potential drug interactions and adverse drug reactions relevant to the patient's age and comorbidities.

Reflecting on the development of a band 5 nurse coordinators' competency pathway in a children's hospital

Taking charge of a clinical shift on a ward or department is daunting for newly qualified nurses. To support band 5 nurses in this development a coordinators' competency pathway was devised at a children's hospital NHS trust in 2012. The pathway consists of a competency-based document, used to guide and assess nurses, and a simulation-based training day. Since it was devised, approximately 200 nurses at the trust have undertaken the pathway. This article reflects on a service evaluation, which used a mixed-methods approach involving quantitative and qualitative data collection undertaken in three data sets over five years, to assess the effectiveness of the pathway and training. It is not possible within the space limitations of this article to present all the results, therefore the main themes from the data analysis are summarised. Overall, respondents felt supported and considered the pathway to be delivered well and the training effective. Most appraised simulation positively as a teaching and learning method. The pathway, which could be replicated anywhere, has been embedded in the trust.

A School Nurse and a Technology Specialist: Partnering for Improved Processes During COVID-19

School nurses have worked tirelessly during the COVID-19 pandemic. At times, the workload has been unsustainable and there were not enough hours in the day for school nurses to complete their duties. In one school district, the high school nurse and instructional technology specialist collaborated on improving the process of collecting COVID-19 information. This resulted in dramatically reducing the amount of time it took to process information and improved the way the data were collected and shared. This article describes the steps in pandemic-related data collection and communication used before and after implementation of the improved tools and processes. The authors also provide forms, email templates, and the resulting district COVID-19 metric figures helpful to school nurses desiring to replicate the process.

State of DNP education: Lessons learned from a novel academic fellowship in teaching and education

OBJECTIVE

We examine the gap between the current and desired state of Doctor of Nursing Practice (DNP) education from the perspective of postdoctoral (DNP) teaching and education fellows.

OBSERVATIONS

In the assessment of the DNP Essentials framework, command of scholarly and scientific writing, ability to demonstrate critical thought, and significant variation in clinical experience among DNP graduates are top concerns.

DISCUSSION

These inconsistencies are problematic to the professional and public value of this terminal degree in nursing.

How to undertake annual appraisals and ongoing performance reviews

Annual appraisals, which are mandatory in most healthcare organisations, are crucial for enhancing staff performance and embedding a culture of continuous improvement within teams. Appraisals can be usefully complemented by ongoing performance reviews, which support nurse managers and staff to identify and address issues in a timely manner. The term 'performance management' often has negative connotations, but it can be a powerful tool for staff development and positive learning experiences. This article supports nurse managers to understand how to adequately prepare for and conduct appraisals and performance reviews. Reflective activity 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of.

Supporting the well-being of nursing students and student midwives during the COVID-19 pandemic

Throughout the coronavirus disease 2019 (COVID-19) pandemic the Queen's University Belfast Connections (QUB Connections) project has provided online well-being support to nursing students and student midwives. The project, which was co-designed and led by students and academic staff, provided an online well-being service for students who took on front-line roles during the early part of the pandemic and for those who had to pause their studies. Insights gained from responses to an evaluation of the support sessions suggested that some students felt stigmatised, frightened, lost, isolated and abandoned during this period, but that QUB Connections gave them a sense of 'being held' and 'attended to' in a time of uncertainty. The evaluation findings are a reminder of the need to continue to help nursing and midwifery students and newly qualified staff develop self-care and support mechanisms. QUB Connections is now embedded in the university's school of nursing and midwifery pre-registration programmes to support students and those new to nursing and midwifery practice.

Innovation in speech-language pathology research and writing: Transdisciplinary theoretical and ethical perspectives on cultural responsiveness

In this paper, we offer three paths for the development of innovation in speech-language pathology (SLP), which enhance the discipline's capacity to address issues of diversity, inclusion and cultural responsiveness: transdisciplinary theoretical research, researcher reflexivity, and changes in ethical standards. First, we engage in a reflective conversation to identify facilitators and barriers to innovation we have encountered as academics who speak and write from personal and professional positionings that move between the privileged and the marginalised. Second, we present the results of a critical discourse analysis of the 2020 revisions to Speech Pathology Australia's Code of Ethics and characterise recent changes in the field's expanding understanding of ethical research and clinical practices. Third, we discuss how speech-language pathologists might reconsider their modes of engagement with clients and research populations in our shared area of specialisation-transgender voice. Together, these insights can support speech-language pathologists in further developing a contemporary, self-reflective, culturally humble and responsive professional culture.

Moral distress in advanced practice nurses during the COVID-19 pandemic

BACKGROUND

Moral distress arises when a person is aware of the right course to take but is prevented from acting on it by institutional constraints. While this concept has been considered by nursing ethicists for many years, it has been particularly associated with the unprecedented healthcare conditions caused by the coronavirus disease 2019 (COVID-19) pandemic.

AIM

To investigate the level of moral distress affecting advanced practice nurses (APNs) in the UK during the COVID-19 pandemic.

METHOD

This was a mixed-methods study in which a bespoke cross-sectional survey was sent to 243 APNs from across the UK who had been recruited to a broader longitudinal cohort study. The survey asked about their experiences, well-being and moral distress. Open-ended questions asked about their concerns regarding the health and well-being of their patients and colleagues.

FINDINGS

A total of 97 APNs completed the survey, yielding a 40% response rate. Levels of moral distress were significantly higher among APNs working in secondary care (P=0.026) compared with those working in primary care. All of the respondents expressed concerns about patients due to delayed care and about the mental well-being of their colleagues, particularly those who were redeployed to COVID-19 wards.

CONCLUSION

The COVID-19 pandemic has caused moral and psychological distress for APNs. However, the type of distress and its direct causes varied among these practitioners. Tailored support is required to address moral distress and subsequently improve staff retention.

Supporting nurse leaders to recognise and mitigate the effects of moral injury

The concept of moral injury has been around for several decades, yet its effect on nurses remains under-recognised. Moral injury is defined as the biopsychosocial harm that arises from a violation of one's moral code, meaning that a person is powerless to uphold and enact what they believe is morally right. The coronavirus disease 2019 (COVID-19) pandemic has brought the issue of moral injury into focus because many nurses and other healthcare professionals have encountered potentially morally injurious events, resulting in increased pressure and emotional demands. It is essential that nurse leaders recognise moral injury if its effects are to be addressed. This article describes moral injury and its effects on nurses, and offers nurse leaders a practical framework for mitigating this issue. The framework aims to support nurse leaders to increase their understanding of moral injury, address any ethical challenges, ensure they are adequately prepared to provide support to nurses, and enhance their awareness of various interventions that can mitigate moral injury.

Supporting children's nurses to deliver trauma-informed care

World events, such as the conflict in Ukraine, the humanitarian crisis in Afghanistan and the coronavirus disease 2019 pandemic, have highlighted the effects of trauma and adverse childhood experiences on children and young people. Adverse childhood experiences can lead to suboptimal health and risk-taking behaviours during adolescence and adulthood, while multiple adverse childhood experiences can manifest as complex trauma, toxic stress, anxiety or depression across a person's lifespan. This article discusses adverse childhood experiences and the concept of trauma-informed care, which involves recognising and understanding the negative events that have affected a person and how these relate to suboptimal health. The author suggests that developing resilience and using self-care strategies can support nurses to adopt a trauma-informed approach to care. This can assist them to recognise, understand and reflect on the effects of adverse childhood experiences in themselves as well as in their patients. The author also outlines a hybrid approach to debrief that can support staff to manage stressful situations and challenging workplace experiences.

Development and evaluation of an electronic medical device training passport to identify nurses' training needs

BACKGROUND

All nurses, particularly those working in critical care settings, are required to use medical devices when providing patient care. However, inconsistent practice and variations in documentation can make it challenging for nurses and nurse managers to identify what medical device training is required and when.

AIM

To develop and evaluate the use of an electronic medical device training passport to identify the training needs of nurses in intensive care units (ICUs).

METHOD

A pilot study was conducted in a multi-unit critical care department in London, England, to determine if the passport could make it easier to identify ICU nurses' medical device training needs compared with existing practice. Nine participants were first asked to identify their needs using existing spreadsheets or paper records, then asked to identify them using the passport. The participants were also interviewed to identify their training requirements before and after using the passport. The data were analysed quantitatively and qualitatively.

FINDINGS

The electronic passport significantly improved identification of medical device training needs compared with paperwork or spreadsheets for all device groups, except for medical devices used on high dependency units ( P ≤0.005). However, there may be issues related to nurses' behaviours and expectations, particularly that staff do not always recognise their need for training.

CONCLUSION

The findings of this pilot study suggest that the use of an electronic medical device training passport has many benefits and could make it easier to identify ICU nurses' training needs in clinical practice.

Our Work Outside the Birthing Space: Advocating to Improve Outcomes

In this column, the authors discuss the vital role birth workers can play in shaping policy that affect the birthing people and families they serve. The authors review recent policy changes that have tremendous potential to improve maternal child health outcomes. Additionally, they provide concrete suggestions regarding how birth workers can actively engage in government affairs at the local and state levels.

Determinants and consequences of workplace violence against hospital-based nurses: a rapid review and synthesis of international evidence

Workplace violence against nurses is an international public health issue with likely detrimental consequences for individuals, systems and societies. To effectively address workplace violence against nurses, its root causes must be understood and its effect on nurse outcomes quantified. In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors rapidly reviewed the international literature to identify determinants of workplace violence against hospital-based nurses and the effects of workplace violence on nurse outcomes. Twenty-one studies (22 articles) formed the final sample - 16 quantitative, three qualitative and two mixed-methods studies. Supervisors, other nurses and physicians were the major perpetrators of workplace violence against nurses. Perpetrators of workplace violence were other nurses or physicians, the workplace, patients, and organisational management. Workplace violence was linked to deficits in nurses' health, job satisfaction and intention to stay in their role. To address workplace violence, evidence-based zero-tolerance policies, preventive interventions and appropriate disciplinary actions must be implemented at organisational and national level.

'Guiding Lights for effective workplace cultures': enhancing the care environment for staff and patients in older people's care settings

While much attention has been given to organisational culture, there has been less focus on workplace culture. Yet workplace culture strongly influences the way care is delivered, received and experienced. An effective workplace culture is crucial for the well-being of individual staff members and teams as well as for patients' experiences and outcomes of care. This article describes the 'Guiding Lights for effective workplace cultures' which were developed by the authors and provide a framework to assist in understanding and promoting effective workplace cultures and creating environments where staff and patients feel safe and valued. There are four Guiding Lights: 'collective leadership', 'living shared values', 'safe, critical, creative learning environments' and 'change for good that makes a difference'. Each one articulates what good workplace cultures are through descriptors and intermediate outcomes and together produce a set of ultimate outcomes. The Guiding Lights provide nurses working in older people's care settings with an opportunity to learn from, and celebrate, what is going well in their workplaces and to consider areas that require further development.

NASN's Medication Administration Clinical Guideline

Despite the volume of medications that are administered in schools, school nurse guidelines for administering medications in schools lacked the support of empirical literature to guide best practices. Some states issue guidelines that summarize state regulations or dictate the standards and processes. However, state school nursing manuals rely on tradition and professional judgment for suggested medication practices. Medication practices may vary significantly from building to building within a school district. The National Association of School Nurses commissioned a uniform clinical practice guideline (CPG) for the administration of medications in schools based on a systematic review of the literature. The CPG for medications administered in schools provides direction for state school nurse consultants, school districts, and nurses working independently in schools by creating the structure and processes of care to lead to optimal outcomes including increased medication adherence, fewer errors, and decreased morbidity and mortality. The School Nursing Evidence-Based Clinical Practice Guideline: Medication Administration in Schools guide school policy and provide evidence for policy changes for state legislation.

Factors that affect nurses' triage decisions in the emergency department: a literature review

Accurate triaging of patients in emergency departments (EDs) is crucial, since triage determines how quickly patients are assessed and treated. Understanding the factors that influence ED nurses' triage decisions is important to ensure that patients are prioritised appropriately and cared for in a timely manner. This article reports and discusses the findings of a literature review on the factors that affect nurses' triage decisions in the ED. Triage decisions by nurses in EDs are influenced by several factors relating to the patient, the nurse, the triage algorithm and the environment where triage takes place. Nurses' ability to triage patients accurately is negatively affected by high patient numbers, inadequate staffing levels, lack of privacy and lack of training.

Care home uniforms: exploring stakeholders' views on clothing options for staff

BACKGROUND

Views in the care home community are divided regarding whether or not staff should wear a uniform. There is little research on the topic and the views of care home residents and their relatives are rarely sought.

AIM

To capture the views of staff, residents, relatives and visiting professionals in two care homes on the use of uniforms.

METHODS

This small-scale exploratory study used photographs showing three clothing options: a formal option, a polo shirt option and an 'own clothes' option. Each option was modelled in two different poses, one 'approachable' and the other 'unapproachable'. Staff, relatives, the wider care home team and visiting professionals expressed their preferences by replying to a short survey. Residents, all of whom had dementia, expressed their preferences through a table-top activity.

FINDINGS

Overall, the formal clothing option was preferred for formal care activities and the 'own clothes' option was preferred for social activities. The polo shirt option often obtained the second-highest number of preferences. The photographs featuring the 'unapproachable' pose were rarely selected.

CONCLUSION

The approachability of staff is just as important as the clothes they wear. An alternative to formal uniforms could be for staff to wear polo shirts, possibly as an interim measure to explore the effects of changing the care home's staff uniform policy.

Special education staff well-being and the effectiveness of remote services during the COVID-19 pandemic

Since March 2020, many school districts across the country have employed remote learning procedures in response to the COVID-19 pandemic. During the pandemic, schools continued to provide special education services, yet little is known about how services were adapted for remote or hybrid learning during the height of the pandemic in the United States. In the current study, 332 respondents completed a web-based survey that asked what special education services were provided remotely, whether services were deemed effective, and how remote learning has influenced their well-being. Most respondents identified as White (79.5%), females (92.4%), and worked as special education teachers (52.9%) and school psychologists (35.4%). In compliance with federal guidelines, most respondents continued to hold individualized education plan meetings, conduct assessments, and provide interventions and related services. There was a significant decrease in respondents' reports of efficacy and sense of school connectedness during remote and hybrid learning. Respondents' identification as a person of color, along with reports of higher school connectedness and self-efficacy were positive predictors of their perceived effectiveness of remote special education service delivery. Recommendations are made for school districts to inform decisions regarding their approach to special education services and staff support during remote or hybrid learning.

Recognising logical fallacies in nursing practice to support effective clinical decision-making

Logical fallacies can affect routine and complex decision-making, potentially leading to a reduction in the efficacy or application of robust evidence to care. Experienced and inexperienced nurses may inadvertently integrate fallacious reasoning into their clinical decisions due to the inherent deceptiveness of logical fallacies and the effect of cognitive biases. By gaining an understanding of logical fallacies, nurses may be able to identify them during clinical reasoning processes, thereby mitigating their effects on clinical outcomes. This article considers six of the most common logical fallacies and provides examples of how they might manifest in clinical practice.

Confidentiality breaches in hospital: the experiences of young people and parents

BACKGROUND

Healthcare professionals, including nurses, have a vital role in protecting patient confidentiality. However, evidence shows that breaches of confidentiality are common in hospitals for various reasons, including the ward design and issues related to healthcare staff's professionalism. The situation can be complicated further in paediatric care because of the age range of patients and their associated needs and rights about information sharing, confidentiality and consent.

AIM

To explore the views and experiences of young people admitted to hospital, and their parents and related caregivers, about the effects of confidentiality breaches.

METHOD

A descriptive questionnaire-based survey was conducted in 2018 in two regional hospitals in Denmark over two weeks. A total of 214 surveys were completed by parents and related caregivers (n=173) and by young people (n=41).

FINDINGS

Many parents and young people reported that they had overheard healthcare professionals discussing care, including information about named patients, test results, personal disclosures and various comments or opinions. In many cases these breaches of confidentiality affected patients' overall experience of hospital and led some to withhold important information.

CONCLUSION

This study demonstrates the challenges of preserving confidentiality in children's wards. Situations in which confidentiality breaches were reported appear to have been affected by the physical environment, such as ward design, as well as staff behaviour and attitudes. Therefore, nurses and other healthcare professionals need to enhance their understanding of issues related to confidentiality and pay attention to how and where information about patients is shared.

Ensuring effective intercultural communication in the emergency department

Globalisation and migration trends are reflected in emergency departments (EDs), which increasingly care for patients and employ staff from diverse cultural and/or ethnic backgrounds. EDs are busy, pressured and unpredictable environments where effective communication with patients and families is challenging at the best of times. This is compounded by language and cultural barriers experienced by patients and families whose background differs from the prevailing culture. Cultural differences and language comprehension may also be a challenge for overseas nurses recruited to the ED, who may need support from colleagues and organisations. ED nurses therefore need to be competent in intercultural communication. This involves combining optimal interpersonal skills with cultural awareness, knowledge and sensitivity.

Engaging with research: practical advice for nurses at every level

Nurses at every level can reflect on their active engagement with clinical research. This article aims to support nurses to understand how they can facilitate and lead research. It provides practical advice to support the integration of research evidence into care delivery and increase the opportunities for patients to participate in clinical research. This is important because patients can benefit from nurses who are knowledgeable, confident and supported in applying research evidence. Furthermore, nurses can support and inform patient choice through increased confidence and competence in engaging with research and implementing research findings. Organisational culture and leadership are also important elements in fostering environments where evidence and research are promoted throughout the nursing workforce.

Exploring the psychological effects of sharps injuries sustained by healthcare workers

Much of the research into sharps injuries sustained by healthcare workers focuses on prevalence and incidence and to a lesser extent the financial implications of such injuries. An under-researched area is the psychological effects of such injuries. This article reports the findings of a narrative literature review that aimed to synthesise the evidence on this subject. Electronic databases and the grey literature were searched with no date limits set and 27 articles were included in the review. Findings suggested that healthcare workers may experience a range of psychological issues following a sharps injury, including post-traumatic stress disorder, anxiety and depression. There was also evidence to suggest that the necessary psychological follow-up care is often inadequate, so improvements are required in this area. Further research is necessary to enhance understanding of the psychological effects of sharps injuries on healthcare workers and to ensure they receive appropriate support.

Using coaching and action learning to support staff leadership development

During the coronavirus disease 2019 pandemic, nurse leaders and managers have been compelled to prioritise immediate issues in their clinical areas and put aside the professional development of staff. However, leadership development for individuals and teams is essential to ensure nurses feel valued and develop the skills required for team cohesion, problem-solving, decision-making and innovation. Simple and effective approaches to staff leadership development are needed. Two such approaches are coaching and action learning. This article provides an introduction to coaching and action learning as approaches nurse leaders and managers can use to promote leadership development among individual team members and within the team. It describes how coaching and action learning work and their potential benefits and challenges. It explains how the two approaches can be used to underpin effective problem-solving and goal setting, and support nurses in their professional development, the ultimate aim being to deliver safe and effective patient care.