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Connor J, Flenady T, Massey D, Dwyer T. Classic grounded theory: identifying the main concern. Res Nurs Health 2024; 47:277-288. [PMID: 38522015 DOI: 10.1002/nur.22381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/09/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
Grounded theory comprises a family of research approaches designed to support the generation of a theory explaining a phenomenon experienced by a group of participants. One style of grounded theory, Classic grounded theory, is used less often than other types of grounded theory. The less frequent use of Classic grounded theory may be attributed to the limited availability of clearly articulated processes for conducting this method. Particularly important within Classic grounded theory, and not used in other forms of grounded theory, is identifying the participants' main concern. Identifying the participants' main concern is a signature feature of Classic grounded theory and is a prerequisite for ascertaining the core category and subsequent discovery of theory. In this article we provide a detailed explanation of how to identify the participants' main concern, and in so doing, we offer an exemplar to illustrate the process involved.
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Affiliation(s)
| | | | - Deb Massey
- Edith Cowan University, Joondalup, WA, Australia
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Le Lagadec MD, Massey D, Byrne AL, Connor J, Flenady T. Nurse by numbers: The impact of early warning systems on nurses' higher-order thinking, a quantitative study. J Adv Nurs 2024. [PMID: 38733070 DOI: 10.1111/jan.16235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/27/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
AIM To evaluate registered nurses' perceptions of whether the mandated use of the early warning system vital signs tool impacts the development of nurses' higher-order thinking skills. DESIGN A concurrent mixed methods study design. METHOD Using an online survey, registered nurses' perceptions were elucidated on whether early warning system algorithmic tools affected the development of their higher-order thinking. Likert-type matrix questions with additional qualitative fields were used to obtain information on nurse's perceptions of the tool's usefulness, clinical confidence in using the tool, compliance with escalation protocols, work environment and perceived compliance barriers. RESULTS Most of the 305 (91%) participants included in the analysis had more than 5 years of nursing experience. Most nurses supported the early warning tool and were happy to comply with escalation protocols if the early warning score concurred with their assessment of the patient (63.6%). When the score and the nurse's higher-order thinking did not align, some had the confidence to override the escalation protocol (40.0%), while others omitted (69.4%) or inaccurately documented vital signs (63.3%) to achieve the desired score. Very few nurses (3.6%) believe using early warning tools did not impede the development of higher-order thinking. CONCLUSION Although experienced nurses appreciate the support of early warning tools, most value patient safety above the tools and rely on their higher-order thinking. The sustained development and use of nurses' higher-order thinking should be encouraged, possibly by adding a critical thinking criterion to existing algorithmic tools. IMPACT The study has implications for all nurses who utilize algorithmic tools, such as early warning systems, in their practice. Relying heavily on algorithmic tools risks impeding the development of higher-order thinking. Most experienced nurses prioritize their higher-order thinking in decision-making but believe early warning tools can impede higher-order thinking. PATIENT OR PUBLIC CONTRIBUTION Registered nurses participated as survey respondents.
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Affiliation(s)
| | - Deb Massey
- Edith Cowan University, Joondalup, New South Wales, Australia
| | - Amy-Louise Byrne
- School of Nursing Midwifery and Social Sciences, CQUniversity, Rockhampton, Queensland, Australia
| | - Justine Connor
- School of Nursing Midwifery and Social Sciences, CQUniversity, Rockhampton, Queensland, Australia
| | - Tracy Flenady
- School of Nursing Midwifery and Social Sciences, CQUniversity, Rockhampton, Queensland, Australia
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Flenady T, Connor J, Byrne AL, Massey D, Le Lagadec MD. The impact of mandated use early warning system tools on the development of nurses' higher-order thinking: A systematic review. J Clin Nurs 2024. [PMID: 38661093 DOI: 10.1111/jocn.17178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/17/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
AIM Ascertain the impact of mandated use of early warning systems (EWSs) on the development of registered nurses' higher-order thinking. DESIGN A systematic literature review was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist (Page et al., 2021). DATA SOURCES CINAHL, Medline, Embase, PyscInfo. REVIEW METHODS Eligible articles were quality appraised using the MMAT tool. Data extraction was conducted independently by four reviewers. Three investigators thematically analysed the data. RESULTS Our review found that EWSs can support or suppress the development of nurses' higher-order thinking. EWS supports the development of higher-order thinking in two ways; by confirming nurses' subjective clinical assessment of patients and/or by providing a rationale for the escalation of care. Of note, more experienced nurses expressed their view that junior nurses are inhibited from developing effective higher-order thinking due to reliance on the tool. CONCLUSION EWSs facilitate early identification of clinical deterioration in hospitalised patients. The impact of EWSs on the development of nurses' higher-order thinking is under-explored. We found that EWSs can support and suppress nurses' higher-order thinking. EWS as a supportive factor reinforces the development of nurses' heuristics, the mental shortcuts experienced clinicians call on when interpreting their subjective clinical assessment of patients. Conversely, EWS as a suppressive factor inhibits the development of nurses' higher-order thinking and heuristics, restricting the development of muscle memory regarding similar presentations they may encounter in the future. Clinicians' ability to refine and expand on their catalogue of heuristics is important as it endorses the future provision of safe and effective care for patients who present with similar physiological signs and symptoms. IMPACT This research impacts health services and education providers as EWS and nurses' development of higher-order thinking skills are essential aspects of delivering safe, quality care. NO PATIENT OR PUBLIC CONTRIBUTION This is a systematic review, and therefore, comprises no contribution from patients or the public.
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Affiliation(s)
- Tracy Flenady
- Central Queensland University, Rockhampton, Queensland, Australia
| | - Justine Connor
- Central Queensland University, Rockhampton, Queensland, Australia
| | - Amy-Louise Byrne
- Central Queensland University, Rockhampton, Queensland, Australia
| | - Deb Massey
- Edith Cowen University, Joondalup, Western Australia, Australia
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Le Lagadec MD, Flenady T, Cleary M. Finally, a new Early Warning Score supporting critical thinking. J Adv Nurs 2024; 80:1241-1242. [PMID: 38018021 DOI: 10.1111/jan.16001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Affiliation(s)
| | - Tracy Flenady
- School of Nursing Midwifery and Social Sciences, CQUniversity, Rockhampton, Queensland, Australia
| | - Michelle Cleary
- School of Nursing Midwifery and Social Sciences, CQUniversity, Rockhampton, Queensland, Australia
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van der Vegt AH, Campbell V, Mitchell I, Malycha J, Simpson J, Flenady T, Flabouris A, Lane PJ, Mehta N, Kalke VR, Decoyna JA, Es’haghi N, Liu CH, Scott IA. Systematic review and longitudinal analysis of implementing Artificial Intelligence to predict clinical deterioration in adult hospitals: what is known and what remains uncertain. J Am Med Inform Assoc 2024; 31:509-524. [PMID: 37964688 PMCID: PMC10797271 DOI: 10.1093/jamia/ocad220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To identify factors influencing implementation of machine learning algorithms (MLAs) that predict clinical deterioration in hospitalized adult patients and relate these to a validated implementation framework. MATERIALS AND METHODS A systematic review of studies of implemented or trialed real-time clinical deterioration prediction MLAs was undertaken, which identified: how MLA implementation was measured; impact of MLAs on clinical processes and patient outcomes; and barriers, enablers and uncertainties within the implementation process. Review findings were then mapped to the SALIENT end-to-end implementation framework to identify the implementation stages at which these factors applied. RESULTS Thirty-seven articles relating to 14 groups of MLAs were identified, each trialing or implementing a bespoke algorithm. One hundred and seven distinct implementation evaluation metrics were identified. Four groups reported decreased hospital mortality, 1 significantly. We identified 24 barriers, 40 enablers, and 14 uncertainties and mapped these to the 5 stages of the SALIENT implementation framework. DISCUSSION Algorithm performance across implementation stages decreased between in silico and trial stages. Silent plus pilot trial inclusion was associated with decreased mortality, as was the use of logistic regression algorithms that used less than 39 variables. Mitigation of alert fatigue via alert suppression and threshold configuration was commonly employed across groups. CONCLUSIONS : There is evidence that real-world implementation of clinical deterioration prediction MLAs may improve clinical outcomes. Various factors identified as influencing success or failure of implementation can be mapped to different stages of implementation, thereby providing useful and practical guidance for implementers.
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Affiliation(s)
- Anton H van der Vegt
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Victoria Campbell
- Intensive Care Unit, Sunshine Coast Hospital and Health Service, Birtynia, QLD 4575, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4222, Australia
| | - Imogen Mitchell
- Office of Research and Education, Canberra Health Services, Canberra, ACT 2601, Australia
| | - James Malycha
- Department of Critical Care Medicine, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Joanna Simpson
- Eastern Health Intensive Care Services, Eastern Health, Box Hill, VIC 3128, Australia
| | - Tracy Flenady
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
| | - Arthas Flabouris
- Intensive Care Department, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Paul J Lane
- Safety Quality & Innovation, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Naitik Mehta
- Patient Safety and Quality, Clinical Excellence Queensland, Brisbane, QLD 4001, Australia
| | - Vikrant R Kalke
- Patient Safety and Quality, Clinical Excellence Queensland, Brisbane, QLD 4001, Australia
| | - Jovie A Decoyna
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4222, Australia
| | - Nicholas Es’haghi
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4222, Australia
| | - Chun-Huei Liu
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4222, Australia
| | - Ian A Scott
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4102, Australia
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
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Horton A, Flenady T, Massey D. The factors impacting sepsis recognition in older adults in non-clinical environments - a scoping review. Int Emerg Nurs 2023; 70:101323. [PMID: 37597281 DOI: 10.1016/j.ienj.2023.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Annette Horton
- Rockhampton Hospital, Central Queensland Hospital Health Service, Rockhampton 4700, Australia.
| | - Tracy Flenady
- Central Queensland University, School of Nursing & Midwifery, Rockhampton 4701, Australia
| | - Deb Massey
- Edith Cowan University, School of Nursing & Midwifery, Joondalup 6027, Australia
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Connor J, Flenady T, Dwyer T, Massey D. Application of classic grounded theory in nursing studies: a qualitative systematic review protocol. BMJ Open 2023; 13:e068588. [PMID: 37518090 PMCID: PMC10387734 DOI: 10.1136/bmjopen-2022-068588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Classic grounded theory (CGT) is a valuable method for nursing research, but the application of CGT methodology in nursing studies has not been specifically investigated. With the increasing use of CGT in nursing research, attention is now focusing on the quality of studies using this methodology. In this systematic review, we aim to develop an understanding of the application of CGT methodology, specifically appraising the quality of the methodology's application in the field of nursing research. METHODS AND ANALYSIS The reporting of this review will be guided by the Preferred Reporting Items for Systematic and Meta-Analysis guidelines statement and data synthesis guided by the Synthesis Without Meta-analysis guideline. Publications will be uploaded to Rayyan. The quality of each article will be assessed using the Critical Appraisals Skills Programme qualitative research appraisal tool. Analysis of the selected studies will be performed using the Guideline for Reporting and Evaluating Grounded Theory Research Studies, explicitly the CGT guiding principles. ETHICS AND DISSEMINATION Ethical approval is not required because only secondary data will be used in this review. The results of the final study will be published in a peer-reviewed open-access journal. PROSPERO REGISTRATION NUMBER CRD42021281103.
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Affiliation(s)
- Justine Connor
- School of Nursing, Midwifery and Social Sciences, CQUniversity Brisbane, Brisbane, Queensland, Australia
| | - Tracy Flenady
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Rockhampton, Queensland, Australia
| | - Trudy Dwyer
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Rockhampton, Queensland, Australia
| | - Debbie Massey
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Augutis W, Flenady T, Le Lagadec D, Jefford E. How do nurses use early warning system vital signs observation charts in rural, remote and regional health care facilities: A scoping review. Aust J Rural Health 2023. [PMID: 36802114 DOI: 10.1111/ajr.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/08/2022] [Accepted: 02/03/2023] [Indexed: 02/21/2023] Open
Abstract
INTRODUCTION Physiological signs of clinical deterioration are known to occur in the hours preceding a serious adverse event. As a result, track and trigger systems known as early warning systems (EWS) were introduced and routinely implemented as patient observation tools to trigger an alert in the presence of abnormal vital signs. OBJECTIVE The objective aimed to explore the literature pertaining to EWS and their utilisation in rural, remote and regional health care facilities. DESIGN The Arksey and O'Malley's methodological framework was used to guide the scoping review. Only studies reporting on rural, remote and regional health care settings were included. All four authors participated in the screening, data extraction and analysis process. FINDINGS Our search strategy yielded 3869 peer-reviewed articles published between 2012 and 2022, with six studies ultimately included. Collectively, the studies included in this scoping review examined the complex interaction between patient vital signs observation charts and recognition of patient deterioration. DISCUSSION Whilst rural, remote and regional clinicians use EWS to recognise and respond to clinical deterioration, noncompliance dilutes the tool's effectiveness. This overarching finding is informed by three contributing factors: documentation, communication and challenges specific to the rural context. CONCLUSION The success of EWS relies on accurate documentation and effective communication within the interdisciplinary team to support appropriate responses to clinical patient decline. More research is required to understand the nuances and complexities of rural and remote nursing and to address challenges associated with the use of EWS in rural health care settings.
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Affiliation(s)
- Wendy Augutis
- School of Nursing & Midwifery, Central Queensland University, Bundaberg, Queensland, Australia
| | - Tracy Flenady
- School of Nursing & Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Danielle Le Lagadec
- School of Nursing & Midwifery, Central Queensland University, Bundaberg, Queensland, Australia
| | - Elaine Jefford
- Clinical and health Sciences, University of the Sunshine Coast, Adelaide, Queensland, Australia
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Nhongo D, Holt A, Flenady T, Rebar A, Bail K. Nurse staffing and adverse events in residential aged care: Retrospective multi-site analysis. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Connor J, Flenady T, Massey D, Dwyer T. Clinical judgement in nursing - An evolutionary concept analysis. J Clin Nurs 2022. [PMID: 35880251 DOI: 10.1111/jocn.16469] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this concept analysis was to develop a contemporary operational definition of Clinical Judgement in nursing. DESIGN Concept analysis. METHODS Rodgers' evolutionary method of concept analysis. Throughout the study, the authors followed the SRQR checklist. RESULTS This concept analysis guided the development of an operational definition of clinical judgement, within the context of nursing, articulated as Clinical judgement is a reflective and reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in the formation of a clinical conclusion. CONCLUSION The purpose of this concept analysis was to propose a detailed definition of clinical judgement in nursing, that reflected its theoretical base within today's contemporary healthcare system. Using Rodgers' evolutionary method of concept analysis, surrogate terms, attributes, antecedents and consequences were identified, and a contemporary definition was developed. No patient or public contribution was required to design or undertake this research.
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Affiliation(s)
- Justine Connor
- CQUniversity Australia, Brisbane City, Queensland, Australia
| | - Tracy Flenady
- CQUniversity Australia, Brisbane City, Queensland, Australia
| | - Deb Massey
- Southern Cross University, Lismore, New South Wales, Australia
| | - Trudy Dwyer
- CQUniversity Australia, Brisbane City, Queensland, Australia
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Ebert L, Massey D, Flenady T, Nolan S, Dwyer T, Reid-Searl K, Ferguson B, Jefford E. Midwives' recognition and response to maternal deterioration: A national cross-sectional study. Birth 2022; 50:438-448. [PMID: 35867032 DOI: 10.1111/birt.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context. METHODS Using a cross-sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25-question Likert scale survey and one open-ended question. Qualitative answers were analyzed using consensus coding. RESULTS Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision-making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily. CONCLUSIONS Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants.
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Affiliation(s)
- Lyn Ebert
- Faculty of Health, Southern Cross University, Southport, New South Wales, Australia
| | - Debbie Massey
- Faculty of Health, Southern Cross University, Southport, New South Wales, Australia
| | | | - Samantha Nolan
- Women, Newborn & Children's Health Service, Gold Coast University Hospital, GCHHS, Southport, Queensland, Australia
| | - Trudy Dwyer
- CQUniversity, Norman Gardens, Queensland, Australia
| | | | | | - Elaine Jefford
- UniSA Clinical & Health Sciences (C4-31)
- , University of South Australia, Adelaide, South Australia, Australia
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Flenady T, Dwyer T, Kahl J, Sobolewska A, Reid-Searl K, Signal T. Research Ready Grant Program (RRGP) protocol: a model for collaborative multidisciplinary practice-research partnerships. Health Res Policy Syst 2022; 20:62. [PMID: 35698128 PMCID: PMC9195363 DOI: 10.1186/s12961-022-00870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Little attention has been given to the process of implementing or evaluating a structured academic–clinician (university–health service) research capacity-building (RCB) model within healthcare settings. We have developed a model for collaborative multidisciplinary practice–research partnerships called the Research Ready Grant Program (RRGP). The RRGP is informed by Cooke’s (BMC Fam Pract 6:44, 2005) RCB framework and principles. The aim of the study outlined in this protocol is to conduct a process and outcome evaluation of the programme. We will explore how the RRGP's structured mentor model contributes to RCB of clinician-led multidisciplinary research teams. We will identify key factors at the organization, team and individual levels that affect research capacity of health professionals working in one regional health service district. This protocol describes the RRGP design and outlines the methods we will employ to evaluate an RCB programme, the RRGP, delivered in a regional health service in Australia. Methods The study will adopt an exploratory concurrent mixed-methods approach designed to evaluate the process of implementing an RCB model across one regional hospital and health service. Both quantitative and qualitative data collection methods over a 12-month period will be implemented. Data triangulation will be applied to capture the complex issues associated with implementing collaborative multidisciplinary practice–research partnerships. Discussion The RRGP is an innovative RCB model for clinicians in their workplace. It is expected that the programme will facilitate a culture of collaborative multidisciplinary research and strengthen hospital–university partnerships.
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Affiliation(s)
- Tracy Flenady
- School of Nursing and Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia.
| | - Trudy Dwyer
- School of Nursing and Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Julie Kahl
- Central Queensland Hospital and Health Services, Canning Street, Rockhampton, 4701, Australia
| | - Agnieszka Sobolewska
- School of Nursing and Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Kerry Reid-Searl
- School of Nursing and Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Tania Signal
- School of Health, Medical and Applied Sciences, Central Queensland University, Building 6, Bruce Highway, Rockhampton, 4701, Australia
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Flenady T, Dwyer T, Kahl J, Sobolewska A, Reid-Searl K, Signal T. Research capacity-building for clinicians: understanding how the research facilitator role fosters clinicians' engagement in the research process. Health Res Policy Syst 2022; 20:45. [PMID: 35477479 PMCID: PMC9044663 DOI: 10.1186/s12961-022-00849-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is evidence reporting more positive outcomes from research capacity-building (RCB) programmes that include a research facilitator role. Further, it has been suggested that research facilitator roles can be a useful strategy in building the research capacity of healthcare clinicians. However, until now, little attention has been applied to identifying the characteristics of the research facilitator role and how this role contributes to clinicians’ engagement with the research process. The aim of this present study is to explore the characteristics required of the research facilitator role in the educational workshop phase of an RCB programme. Methods This qualitative study employed an inductive approach and utilized face-to-face interviews to gather data from a purposely selected cohort. Professionally transcribed responses were thematically analysed. Results The role of the research facilitator emerged as comprising two main themes: (1) facilitating the research process and (2) engaging expert clinicians as novice researchers. Pragmatically, analysis of data led to the development of a table outlining the responsibilities, skills and attributes related to each theme. Conceptually, theme 1 encapsulates the research facilitators’ skills and experience and their role as knowledge brokers and cocreators of knowledge. Theme 2 provides insight into the clinician-centric approach the research facilitators utilized to build and foster relationships and support the clinicians through their research journey. Conclusion This study reports on the characteristics of the research facilitator role in one phase of an RCB programme in one regional health service district in Australia and explains how the role fosters clinicians’ engagement with the research process. Findings from this study will inform the development of future RCB programmes, which is important considering that clinicians’ increased engagement with the research process is vital for developing a sound evidence base to support decision-making in practice and leads to higher levels of skills and greater ability to perform useful research.
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Affiliation(s)
- Tracy Flenady
- School of Nursing & Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia.
| | - Trudy Dwyer
- School of Nursing & Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Julie Kahl
- Central Queensland Hospital and Health Services, Canning Street, Rockhampton, 4701, Australia
| | - Agnieszka Sobolewska
- School of Nursing & Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Kerry Reid-Searl
- School of Nursing & Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Tania Signal
- School of Health, Medical & Applied Sciences, Central Queensland University, Building 6, Bruce Highway, Rockhampton, 4701, Australia
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Murray Boyle C, Browne M, Rockloff M, Flenady T. Opportunity Costs or Not? Validating the Short Gambling Harm Screen against a Set of "Unimpeachable" Negative Impacts. J Clin Med 2021; 10:549. [PMID: 33540872 PMCID: PMC7867326 DOI: 10.3390/jcm10030549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
Assessing the harmful consequences of gambling is an area of active investigation. One measure intended to capture gambling-related harm is the 10-item short gambling harm screen (SGHS). Although good psychometric properties have been reported, it has been suggested that the screen's less severe probes may not represent genuinely harmful consequences, but rather may reflect rational opportunity costs. Consequently, it has been argued that the screen may lead to overestimation of the extent of gambling-related harm in the population. The current study sought to examine the psychometric performance of three less severe suspect items in the SGHS. Associations between each of these items and a specially constructed scale of relatively severe "unimpeachable" gambling harms were calculated from archival data from 5551 Australian and New Zealand gamblers. All three suspect items, both individually and upon aggregation, predicted greater endorsement of "unimpeachable" harms, and indicated the presence of gambling problems. Moreover, the SGHS as a whole is highly correlated with "unimpeachable" gambling harms. Including suspect items in the SGHS was found to improve predictions of low- and moderate-risk gambling status, but slightly decreased predictions of severe gambling problems. The results are inconsistent with the notion that SGHS harm probes capture either inconsequential consequences or opportunity costs. They confirm prior findings that harm symptomatology is unidimensional, and that the report of multiple more prevalent, but less severe, harms serves as an effective indicator of the spectrum of experienced harm.
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Affiliation(s)
- Cailem Murray Boyle
- School of Psychology, Central Queensland University, Brisbane 4000, Australia
| | - Matthew Browne
- School of Psychology, Central Queensland University, Bundaberg 4670, Australia; (M.B.); (M.R.)
| | - Matthew Rockloff
- School of Psychology, Central Queensland University, Bundaberg 4670, Australia; (M.B.); (M.R.)
| | - Tracy Flenady
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton 4701, Australia;
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15
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Ebert LM, Guilhermino M, Flenady T, Dwyer T, Jefford E. Australian Midwives' Recognition of and Response to Maternal Deterioration: A Literature Review. Int J Childbirth 2020. [DOI: 10.1891/ijcbirth-d-20-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDConfidential inquiries into maternal deaths have reported that recognition and timely interventions can reduce maternal morbidity and mortality. Although research has been undertaken that examines factors impacting registered nurses recognition of and response to the deteriorating patient, there is less literature identifying the factors impacting midwives' recognition of and response to the deteriorating maternal patient in the clinical context.OBJECTIVETo identify, summarize, and critically evaluate peer-reviewed studies that explored factors impacting clinical practice of Australian midwives in relation to maternal deterioration.DESIGNReviewers searched Maternity and Infant Care, EBSCOhost, Medline, CINAHL, SCOPUS, EMCARE, and EMBASE for published literature reporting on factors impacting Australian registered midwives' ability to recognize and respond to maternal deterioration.FINDINGSOf the articles identified and screened (n = 2,412), no studies met the inclusion criteria. This review revealed a lack of published research examining factors impacting Australian midwives' capability to recognize and respond to the deteriorating maternal patient.CONCLUSION AND IMPLICATIONS FOR PRACTICEWhile research shows, for registered nurses, that high workloads and poor skill mix can negatively impact capability to respond to the deteriorating patient, little is known of registered midwives' capability during similar health events. This review highlights a major gap in current knowledge regarding Australian registered midwives' experiences surrounding the recognition of and response to the deteriorating maternal patient. Increasing understanding in this area can inform and support the Australian midwifery education, practice, and National health policies to improve health outcomes for childbearing women. Further research in this area is therefore required.
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16
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Flenady T, Dwyer T, Sobolewska A, Lagadec DL, Connor J, Kahl J, Signal T, Browne M. Developing a sociocultural framework of compliance: an exploration of factors related to the use of early warning systems among acute care clinicians. BMC Health Serv Res 2020; 20:736. [PMID: 32782002 PMCID: PMC7422559 DOI: 10.1186/s12913-020-05615-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Early warning systems (EWS) are most effective when clinicians monitor patients’ vital signs and comply with the recommended escalation of care protocols once deterioration is recognised. Objectives To explore sociocultural factors influencing acute care clinicians’ compliance with an early warning system commonly used in Queensland public hospitals in Australia. Methods This interpretative qualitative study utilised inductive thematic analysis to analyse data collected from semi-structured interviews conducted with 30 acute care clinicians from Queensland, Australia. Results This study identified that individuals and teams approached compliance with EWS in the context of 1) the use of EWS for patient monitoring; and 2) the use of EWS for the escalation of patient care. Individual and team compliance with monitoring and escalation processes is facilitated by intra and inter-professional factors such as acceptance and support, clear instruction, inter-disciplinary collaboration and good communication. Noncompliance with EWS can be attributed to intra and inter-professional hierarchy and poor communication. Conclusions The overarching organisational context including the hospital’s embedded quality improvement and administrative protocols (training, resources and staffing) impact hospital-wide culture and influence clinicians’ and teams’ compliance or non-compliance with early warning system’s monitoring and escalation processes. Successful adoption of EWS relies on effective and meaningful interactions among multidisciplinary staff.
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Affiliation(s)
- Tracy Flenady
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia.
| | - Trudy Dwyer
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Agnieszka Sobolewska
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Danielle Le Lagadec
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Justine Connor
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Julie Kahl
- Central Queensland Hospital and Health Services, Canning Street, Rockhampton, 4701, Australia
| | - Tania Signal
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Matthew Browne
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
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17
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Dwyer TA, Levett-Jones T, Flenady T, Reid-Searl K, Andersen P, Guinea S, Heaton L, Applegarth J, Goodwin BC. Responding to the Unexpected: Tag Team Patient Safety Simulation. Clin Simul Nurs 2019. [DOI: 10.1016/j.ecns.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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18
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Guinea S, Andersen P, Reid-Searl K, Levett-Jones T, Dwyer T, Heaton L, Flenady T, Applegarth J, Bickell P. Simulation-based learning for patient safety: The development of the Tag Team Patient Safety Simulation methodology for nursing education. Collegian 2019. [DOI: 10.1016/j.colegn.2018.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Flenady T, Dwyer T, Applegarth J. Accurate respiratory rates count: So should you! ACTA ACUST UNITED AC 2017; 20:45-47. [PMID: 28073649 DOI: 10.1016/j.aenj.2016.12.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
It is well documented that the respiratory rate is the least accurately recorded vital sign. Despite nurses consistently confirming that they understand the physiological importance of the respiratory rate, more often than not, they estimate a value rather than count for an entire minute. Until recently, little has been known about why this phenomenon perpetuates. However, it has now been established that many emergency department registered nurses believe they are enhancing patients' outcomes by performing tasks other than counting a patient's respiratory rate. This discussion highlights the significance of recording accurate respiratory rates, as opposed to estimating a rate; emphasizing that just four breaths either side of the normal range could be indicative of impending clinical deterioration.
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Affiliation(s)
- Tracy Flenady
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia.
| | - Trudy Dwyer
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Judith Applegarth
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
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