The need for a new advanced nursing practice role for Australian adult critical care settings

The relationship between knowledge and self-efficacy of nurses regarding early initiation of cardiopulmonary resuscitation and automated defibrillation in Saudi Arabia

Background

Cardiopulmonary resuscitation (CPR) and early defibrillation are the most common procedures performed by nurses as the first responders to cardiac arrest patients in the hospital setting. Therefore, nurses are demanded to have high skills for effective performance. Self-efficacy and knowledge are considered significant factors affecting early initiation of CPR and automated defibrillation. However, previous studies mostly focused on nursing students instead of frontline nurses.

Objective

This research aimed to assess the relationship between nurses' knowledge and self-efficacy regarding the early initiation of CPR and automated defibrillation of cardiac arrest patients.

Methods

The study employed a cross-sectional, descriptive, correlational survey. Using convenience sampling, two hundred eighty-seven nurses working in critical areas and inpatient and outpatient departments, King Abdulaziz University Hospital (KAUH), Saudi Arabia, were selected. Resuscitation Knowledge and Self-Efficacy Scales were used for data collection (using Google Form) from November 2020 to January 2021. Descriptive statistics and Pearson correlation were used for data analysis.

Results

Overall, 61.3% of participants had moderate knowledge (13.659 ± 2.175), and 63.8% had high self-efficacy (44.627 ± 58.397). The highest domain of self-efficacy was responding and rescuing, while the lowest domain was debriefing and recording. There was a significant positive relationship between knowledge and self-efficacy (p <0.001; r = 0.207).

Conclusion

The positive relationship explained a high level of self-efficacy if there was a high level of knowledge. Thus, it is recommended that nursing programs apply CPR and automated defibrillation curricula during nurses' internships, clear policies and procedures about CPR and automated defibrillation, continual updates about CPR and automated defibrillation, and knowledge and continuance training (on-job-training) about CPR and automated defibrillation, which can enhance and improve knowledge and self-efficacy among health care workers, especially for nurses.

Competence of nurses in the intensive cardiac care unit

INTRODUCTION

Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses' competences. This study aimed to explain nurses' competence in the ICCU.

METHODS

This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012-2013. Interviews were recorded, transcribed verbatim, and analyzed by using the content-analysis method.

RESULTS

The main categories were "clinical competence," comprising subcategories of 'routine care,' 'emergency care,' 'care according to patients' needs,' 'care of non-coronary patients', as well as "professional competence," comprising 'personal development,' 'teamwork,' 'professional ethics,' and 'efficacy of nursing education.'

CONCLUSION

The finding of this study revealed dimensions of nursing competence in ICCU. Benefiting from competence leads to improved quality of patient care and satisfaction of patients and nurses and helps elevate nursing profession, improve nursing education, and clinical nursing.

Advancing nursing practice: redefining the theoretical and practical integration of knowledge

AIM

The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice.

BACKGROUND

The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge.

DESIGN

The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice.

METHOD

A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice.

CONCLUSION

There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated.

RELEVANCE TO CLINICAL PRACTICE

What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is pattern recognition, which became the focus of Benner's work on expert practice. Therefore, if this is included into the knowing-how knowing-that framework, the knowing-how becomes the knowledge that contributes to advancing and advanced practice and the knowing-that becomes the governing action based on a deeper understanding of the problem or issue.

Evaluation of a radial artery cannulation training program for intensive care nurses: a descriptive, explorative study

BACKGROUND

Radial arterial line is required for critically ill patients to provide continuous blood pressure monitoring and arterial blood sampling. A program training experienced ICU nurses to perform radial artery cannulation was introduced in a Melbourne metropolitan ICU to allow early treatment and intervention to be delivered to patients while medical staff attend to more urgent diagnostic care. The aim of this research was to evaluate the effectiveness of the training program for radial artery cannulation in the ICU.

METHOD

This descriptive explorative study involving a convenience sample of two groups of ICU nurses (11 and 10 participants) was conducted in a 20-bed multi-discipline adult ICU within this metropolitan hospital. Stage I involved data collection of all radial artery cannulation attempts made by participants for a period of 6 months from the training date. Stage II involved completion of questionnaires by participants to reflect on their experience 6 months post-training. The effectiveness of the training program was evaluated based on the success rates of cannulations, any reports of adverse events and participants' responses to questionnaires.

RESULTS

107 patients underwent a cannulation attempt of which 67 (63%) were successful with no reports of adverse events. Eleven nurses managed to achieve competency with a minimum of two successful cannulations. Sixty-seven percent (14 out of 21) responded to the questionnaire and 93% expressed that they would recommend this course to other colleagues. About half of the respondents stated that the ICU nurses' ability to perform radial artery cannulations may prevent patients from having to wait for long periods when doctors are held up.

CONCLUSION

The findings showed that ICU nurses can safely insert radial arterial lines with improvements recommended.

Competence in intensive and critical care nursing: a literature review

This literature review defines and describes the concept of competence in adult intensive care nursing, with special reference to clinical and professional competence. The aim was to see whether and how the studies reviewed defined or described the concept of competence, and which domains of competence have been investigated in intensive and critical care nursing research. The review focuses on empirical studies retrieved from the COCHRANE and MEDLINE (1994-2005) databases. The final analysis comprised 45 studies. The studies were analysed by inductive content analysis. Very few (n=7) of the studies offered any definitions or descriptions of the concept of competence. Clinical and professional competence in intensive and critical care nursing can be defined as a specific knowledge base, skill base, attitude and value base and experience base of intensive and critical care nursing. Clinical competence can be divided into three and professional competence into four constituent domains. In clinical competence, these are the principles of nursing care; clinical guidelines; and nursing interventions. In professional competence, the domains are ethical activity; decision-making; development work; and collaboration. More empirical research is needed to examine competence in intensive and critical care nursing.

Advanced nursing roles in critical care--a natural or forced evolution?

Meeting the expectation of delivering safe, effective, and timely health care services within current financial and workforce envelopes requires all health care clinicians to refine and adapt to their clinical roles. The arena of critical care is currently receiving increasing scrutiny regarding developing dedicated advanced practice roles. This is challenging to critical care nurses who historically neither have been exposed to nor have chosen to engage in such specific role developments. The critical care nursing community has, on the whole, embraced previous role expansions within the limits of existing group practices rather than an evolution of new subspecialties. International comparisons demonstrate that critical care nurses in the United States, the United Kingdom, and Australia are all facing common health policy drivers. Although there are some similarities in addressing these challenges, the solutions remain at various stages of development. The natural history framework of Bucher [Work and Occupations 1988;15:131-147] provides a useful and supportive tool to understand how it is necessary and natural for specialties within occupational groups to emerge to meet changing health care needs. A shared concern providing challenges at national and international levels involves the coordination of educational standards as well as competencies and clear articulation of the leadership component of advanced practice roles. These areas must be addressed to enable the international critical care community to naturally transform and evolve into fully established and legitimate advanced practitioners.

Critical care nurses' perceptions about their involvement in significant decisions regarding patient care

The purpose of the study was to explore and describe the perceptions of critical care nurses' (CCNs) actual and preferred levels of involvement in significant decisions regarding patient care in critical care areas. A convenience sample of CCNs was recruited from two centres (one public and one private) and a researcher generated survey distributed to participants. Of the 131 questionnaires distributed, 90 were completed, giving a response rate of 68.7%. Results showed that, although most CCNs believed that they had important information to contribute to decisions relating to patient care, less than half felt that they were actively involved in such decisions. They were aware of the legal limits to their scope of practice but, despite this, most admitted that they made decisions beyond these limits. Approximately three quarters of the respondents thought CCNs should not be making decisions beyond legal boundaries. On the whole, CCNs wanted to be more involved formally and to have more power in decisions regarding patient care. One way forward is for the CCNs to have an advanced practice role.