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Team L, Bloomer MJ, Redley B. Nurses' roles and responsibilities in cardiac advanced life support: A single-site eDelphi study. Nurs Crit Care 2024; 29:466-476. [PMID: 36938931 DOI: 10.1111/nicc.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Nurses are often the first responders to in-hospital cardiac arrest in postoperative cardiac surgical patients. Poor clarity about role expectations and responsibilities can hinder nurses' performance during cardiac advanced life support (CALS) procedures. AIM To seek expert consensus on nurses' roles and responsibilities in CALS for patients in postoperative cardiac surgical patients. STUDY DESIGN A two-round modified eDelphi survey. Delphi items were informed by guideline literature, an audit of resuscitation records and expert interviews. Panellists, drawn from a single site of a large tertiary health service in metropolitan Melbourne, included nurses, doctors and surgeons familiar with the management of cardiac arrest in post-operative cardiac surgical patients. RESULTS The two rounds of the modified eDelphi generated 55 responses. A consensus of >80% agreement was reached for 24 of the 41 statements in Round 2. All items related to nurses' roles and responsibilities during nurses pre- and post-arrest phases reached consensus. In contrast, only 29% (n = 4/14) of items related to peri-arrest, and 36% of those related to nurse scope of practise in CALS arrest (n = 4/11) reached consensus. CONCLUSION The study's aim was only partially achieved. Findings indicate high agreement about nurses' roles and responsibilities before and immediately after a cardiac arrest, but limited clarity about nurses' roles when implementing the CALS protocol, such as resternotomy and internal cardiac massage. There is an urgent need to address uncertainty about nurses' roles and scope of practice in CALS, which is essential to the recognition of nurses' contribution to the cardiac specialty workforce. RELEVANCE TO CLINICAL PRACTISE Uncertainty about nurses 'roles and responsibilities when implementing the CALS protocol may hinder their performance to their full scope of practice, leading to poor patient outcomes.
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Affiliation(s)
- Lydia Team
- Monash Health, Clayton, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
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Beasleigh S, Bish M, Mahoney AM. The learning needs and clinical requirements of post graduate critical care nursing students in rural and regional contexts: A scoping review. Aust Crit Care 2024; 37:326-337. [PMID: 37541909 DOI: 10.1016/j.aucc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES The objective of this review was to establish the learning needs and clinical requirements of postgraduate critical care nursing students preparing for clinical practice in rural and regional contexts. REVIEW METHOD USED Scoping review. DATA SOURCES Published and unpublished empirical studies. REVIEW METHODS A scoping review based on database searches (CINAHL and Medline) using Aromataris and Munn's four-step search strategy, plus subsequent forward reference search strategy was undertaken, applying predetermined selection criteria. The review aligned to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Review. Studies were uploaded into Endnote 20© for storage and into Covidence 2.0© for data extraction. Screening was undertaken by a primary reviewer, with a secondary reviewer evaluating the studies identified as relevant by the first reviewer. Qualitative codes were derived, and reflexive thematic analysis synthesised the results of the review, using Braun and Clarke's six-phase process. RESULTS Nine foundational learning needs for critical care nursing students were extracted from the literature. The nine established foundational learning needs were: behavioural attributes/personal base; critical thinking and analysis; ethical practice; identification of risk; leadership, collaboration, and management; professional practice; provision and coordination of clinical care; research knowledge, standards of care, and policy development; and the health consumer experience. Discerning learning needs specific to rural and regional critical care nursing students was difficult. Only one study that met the inclusion criteria was identified. This study identified some instances of interest in relation to rural and regional learning needs. These instances were related to preparation of rural students for low-volume, high-stake situations; transfer of critically ill patients; stabilisation and preparation of critically ill patients; and care of specific patient groups such as, critically ill, bariatric, paediatric, obstetric, trauma, and patients with behavioural issues. CONCLUSIONS Limited literature exists within the rural and regional critical care nursing educational context, making it difficult to determine the unique learning needs of students within this group. This scoping review lays the groundwork for further research into the needs of critical care nursing students situated within the rural and regional context.
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Affiliation(s)
- Sarah Beasleigh
- La Trobe Rural Health School, La Trobe University, Australia.
| | - Melanie Bish
- La Trobe Rural Health School, La Trobe University, Australia
| | - Anne-Marie Mahoney
- La Trobe Rural Health School, La Trobe University; Australian Centre for Evidence Based Aged Care (ACEBAC), Australia
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Cox Y, Bilszta JLC, Massey D. Implementation and utilisation of Australian critical care practice standards: What do we know? Aust Crit Care 2023; 36:1004-1010. [PMID: 37210306 DOI: 10.1016/j.aucc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/19/2023] [Accepted: 02/26/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND The Australian College of Critical Care Nurses published the third edition of practice standards (PSs) for specialist critical care nurses in 2015. Higher-education providers currently use these standards to inform critical care curricula; however, how critical care nurses perceive and use PSs in clinical practice is unknown. OBJECTIVES The objective of this study was to explore critical care nurses' perceptions about the Australian College of Critical Care Nurses PS for specialty critical care nursing, to understand how the PSs are used in clinical practice, and what opportunities exist to support their implementation. METHODS An exploratory qualitative descriptive design was used. A purposive sampling strategy was used, with 12 critical care specialist nurses consenting to participate in semistructured interviews. The interviews were recorded and transcribed verbatim. Transcripts were analysed thematically using an inductive coding approach. FINDINGS Three main themes were identified: (i) lack of awareness of the PS; (ii) minimal to no utilisation of the PS in clinical practice and the challenges contributing to this; and (iii) improving the implementation and utilisation of the PS in clinical practice. CONCLUSIONS There is a significant lack of awareness and utilisation of the PS in clinical practice. To overcome this, increasing recognition, endorsement, and valuation of the PSs to stakeholders at an individual, health service, and legislative level are suggested. Further research is required to establish relevance of the PS in clinical practice and understand how clinicians use the PS to promote and develop critical care nursing.
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Affiliation(s)
- Yolanda Cox
- Victorian Heart Hospital, 631 Blackburn Road, Clayton, VIC, 3168, Australia; Department of Medical Education, Melbourne Medical School, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Justin L C Bilszta
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Debbie Massey
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
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Williams G, Pirret A, Credland N, Odell M, Raftery C, Smith D, Winterbottom F, Massey D. A practical approach to establishing a critical care outreach service: An expert panel research design. Aust Crit Care 2023; 36:151-158. [PMID: 35341667 DOI: 10.1016/j.aucc.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 12/18/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND For over two decades, nurse-led critical care outreach services have improved the recognition, response, and management of deteriorating patients in general hospital wards, yet variation in terms, design, implementation, and evaluation of such services continue. For those establishing a critical care outreach service, these factors make the literature difficult to interpret and translate to the real-world setting. AIM The aim of this study was to provide a practical approach to establishing a critical care outreach service in the hospital setting. METHOD An international expert panel of clinicians, managers, and academics with experience in implementing, developing, operationalising, educating, and evaluating critical care outreach services collaborated to synthesise evidence, experience, and clinical judgment to develop a practical approach for those establishing a critical care outreach service. A rapid review of the literature identified publications relevant to the study. A modified Delphi technique was used to achieve expert panel consensus particularly in areas where insufficient published literature or ambiguities existed. FINDINGS There were 502 publications sourced from the rapid review, of which 104 were relevant and reviewed. Using the modified Delphi technique, the expert panel identified five key components needed to establish a critical care outreach service: (i) approaches to service delivery, (ii) education and training, (iii) organisational engagement, (iv) clinical governance, and (v) monitoring and evaluation. CONCLUSION An expert panel research design successfully synthesised evidence, experience, and clinical judgement to provide a practical approach for those establishing a critical care outreach service. This method of research will likely be valuable in other areas of practice where terms are used interchangeably, and the literature is diverse and lacking a single approach to practice.
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Affiliation(s)
- Ged Williams
- School of Nursing & Midwifery, Griffith University, Australia; South Metropolitan Health Service, Perth, Australia.
| | - Alison Pirret
- Critical Care Complex, Middlemore Hospital, Auckland, New Zealand; Massey University, Auckland, New Zealand
| | - Nicki Credland
- Reader in Critical Care Education, University of Hull, United Kingdom; Chair British Association of Critical Care Nurses (BACCN), United Kingdom
| | - Mandy Odell
- Critical Care, Royal Berkshire Hospital, NHS FT, Reading, United Kingdom
| | - Chris Raftery
- School of Nursing, Queensland University of Technology, Australia; Gold Coast Health, Queensland, Australia
| | - Duncan Smith
- City, University of London, Northampton Square, London, UK; Honorary Charge Nurse - Patient Emergency Response & Resuscitation Team, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Debbie Massey
- Southern Cross University, Australia; Intensive Care Unit John Flynn Hospital, Tugun, Australia
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Hunter S, Considine J, Manias E. The influence of intensive care unit culture and environment on nurse decision‐making when managing vasoactive medications: A qualitative exploratory study. J Clin Nurs 2022. [DOI: 10.1111/jocn.16561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Stephanie Hunter
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation Deakin University Geelong Victoria Australia
- Eastern Health Centre for Quality and Patient Safety Research – Eastern Health Partnership Box Hill Victoria Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation Deakin University Geelong Victoria Australia
- Eastern Health Centre for Quality and Patient Safety Research – Eastern Health Partnership Box Hill Victoria Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation Deakin University Geelong Victoria Australia
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Lepre B, Palermo C, Mansfield KJ, Beck EJ. Stakeholder Engagement in Competency Framework Development in Health Professions: A Systematic Review. Front Med (Lausanne) 2021; 8:759848. [PMID: 34869461 PMCID: PMC8632936 DOI: 10.3389/fmed.2021.759848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Competency framework development in health professions has downstream implications for all relevant stakeholders, from the professionals themselves, to organisations, and most importantly end users of services. However, there is little guidance related to what stakeholders might be involved in the competency development process, and when. This review aimed to systematically review literature related to competency framework development methodology in health, to identify the breadth and purpose of key stakeholders commonly involved in the process. Studies were identified using five electronic databases (MEDLINE, PubMed, CINAHL, EMBASE, and ERIC) and a search of websites of organisations involved in curriculum or regulation using keywords related to competency frameworks. The total yield from all databases was 10,625 results, with 73 articles included in the final review. Most articles were from Australia (30%) and were conducted in the nursing (34%) profession. Unsurprisingly, practitioners (86%) and academics (75%) were typically engaged as stakeholders in competency framework development. While many competency frameworks were described as patient-focused, only 14 (19%) studies elected to include service users as stakeholders. Similarly, despite the multi-disciplinary focus described in some frameworks, only nine (12%) studies involved practitioners from other professions. Limiting the conceptualisation of competence to that determined by members of the profession itself may not provide the depth of insight required to capture the complexity of healthcare and address the needs of important stakeholder groups. Future methodology should attempt to engage a variety of relevant stakeholders such as external health professions and the community to match professional education to health service demands. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=128350.
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Affiliation(s)
- Breanna Lepre
- School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, VIC, Australia
| | - Kylie J. Mansfield
- School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Eleanor J. Beck
- School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Belita E, Schofield R, Currie G, Dietrich Leurer M, Dosani A, Cusack C, Danaher A, Dilworth K, Etowa J, Filion F, Joseph C, Lukewich J, MacDonald JA, Reid-Haughian C. Advancing Excellence in Community Health Nursing Through Evidence-Based National Standards of Practice. J Contin Educ Nurs 2021; 52:168-175. [PMID: 34038234 DOI: 10.3928/00220124-20210315-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current standards of practice are necessary to ensure safe nursing practice in Canada and across the world. This article aimed to describe and present findings from the rigorous review process undertaken to update the 2011 Canadian Community Health Nursing Standards of Practice. METHOD A revision process included a scoping review of the literature, focus groups, and a modified Delphi method. RESULTS Through the inclusive consultation process, 495 community health nurses enhanced the content of the standards with respect to cultural safety, cultural humility, Indigenous health and ways of knowing, health equity, and evidence-informed practice. CONCLUSION This comprehensive revision process can guide other nursing specialty groups developing or revising specialized practice standards in Canada and across the world. [J Contin Educ Nurs. 2021;52(4):168-175.].
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8
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Zhang X, Meng K, Chen S. Competency framework for specialist critical care nurses: A modified Delphi study. Nurs Crit Care 2019; 25:45-52. [PMID: 31373155 DOI: 10.1111/nicc.12467] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/28/2019] [Accepted: 07/05/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The specialist critical care nurse plays a vital role in the delivery of evidence-based practice, and specific competency guidance has been established to facilitate critical care nursing practice and education development in many developed countries. However, no research has been conducted to develop a competency framework for specialist critical care nurses in China. AIMS AND OBJECTIVES To construct a competency framework specific to specialist critical care nurses in China. DESIGN AND METHODS A two-phased procedure was implemented. In phase 1, a literature review and four focus groups were used to develop the initial competency framework, which consisted of 101 statements. During phase 2, three rounds of a modified Delphi process were conducted and involved a national panel of 30 experts, including physicians, specialist critical care nurses, managers, and educators, who responded to the survey using a 5-point Likert-type scale to indicate their level of agreement with the competency framework. A 75% threshold for each competency was used to achieve panel consensus. RESULTS Experts in the field of critical care responded to rounds 1 (n = 29), 2 (n = 28), and 3 (n = 28). Seventy-eight competencies were agreed upon after round 1, increasing to 88 after round 2 and 92 after round 3. The final competency framework was classified into six domains: evidence-based practice, complex decisions, professionalism, communication and co-operation, education and development, and leadership. CONCLUSION The output of this study is an expert consensus competency framework that provides a sound foundation for the assessment and training of specialist critical care nurses. RELEVANCE TO CLINICAL PRACTICE The proposed competency framework should be used to assess nursing performance, promote continuing professional development, and further improve the delivery of quality health care and optimal patient outcomes.
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Affiliation(s)
- Xiaoning Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Kun Meng
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Shuang Chen
- School of Nursing, Xuzhou Medical University, Xuzhou, China
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Gullick J, Lin F, Massey D, Wilson L, Greenwood M, Skylas K, Woodard M, Tembo AC, Mitchell M, Gill FJ. Structures, processes and outcomes of specialist critical care nurse education: An integrative review. Aust Crit Care 2019; 32:331-345. [DOI: 10.1016/j.aucc.2018.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/05/2018] [Accepted: 09/26/2018] [Indexed: 12/16/2022] Open
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Green E, Gill F. Implementation of the Practice Standards for Specialist Critical Care Nurses in Australia. Aust Crit Care 2019; 30:241. [PMID: 28911886 DOI: 10.1016/j.aucc.2017.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 07/25/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Elyce Green
- Clinical Nurse Educator, Intensive Care Unit, Wagga Wagga Rural Referral Hospital, Wagga Wagga NSW, Australia; Senior Research Fellow, School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Curtin University.
| | - Fenella Gill
- Clinical Nurse Educator, Intensive Care Unit, Wagga Wagga Rural Referral Hospital, Wagga Wagga NSW, Australia; Senior Research Fellow, School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Curtin University.
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Marshall A. Response to "Implementation of the Practice Standards for Specialist Critical Care Nurses in Australia". Aust Crit Care 2019; 30:242. [PMID: 28911887 DOI: 10.1016/j.aucc.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Currey J. Combining critical care nurses decision making with human and technological resources for patient safety: Do we fulfil our obligations? Aust Crit Care 2019; 30:187-188. [PMID: 28606612 DOI: 10.1016/s1036-7314(17)30216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Judy Currey
- School of Nursing and Midwifery, Faculty of Health Deakin University, Burwood Victoria
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