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Development of the quality improvement collaborative questionnaire (QuIC) to explore quality improvement partnerships to teach pre-registration nursing students

Background Quality improvement partnerships between healthcare organisations and higher education require further research to explore their potential to provide a valuable education experience for pre-registration nursing students. Aims Develop and validate a questionnaire for nurse academics to evaluate quality improvement content in pre-registration nursing curricula and the extent of partnership with higher education providers in developing this content. Conduct a pilot test of the questionnaire. Study design Use a content validity approach. Methods The Australian higher education sector was the setting and participants were nurse academics with knowledge of the quality improvement content taught in pre-registration nursing courses. The quality improvement collaboration (QuIC) questionnaire was informed by the literature and sent to ten quality improvement and higher education experts for content validation. Each question was scored on a Likert scale for relevance and clarity. The QuIC questionnaire was distributed by email to the 37 higher education organisations offering pre-registration programmes in Australia. Descriptive statistics were used to analyse the questionnaire data. Results Eight experts completed the content validity questionnaire in full, with the QuIC questionnaire achieving an excellent content validity score of 0.94 for relevance and clarity. The QuIC questionnaire was completed by 24 participants. The results indicated that quality improvement education partnerships are only used occasionally in Australia. The education methods used to teach this content were case studies (online cases n = 11, 46%; patient cases n = 9, 38%) and the development of quality improvement education materials (n = 7, 29%). Conclusions The QuIC questionnaire demonstrates excellent relevance and clarity, and is the first in the literature to address the constructs of quality improvement education and partnerships. The pilot results provide insight into quality improvement education methods used in Australia and the presence of partnerships. These results may be used to assist in the implementation of quality improvement education partnerships into curricula across the health professions.

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What is the state of play? A nursing and midwifery workplace satisfaction survey across five local health districts

Background The COVID-19 pandemic and recovery period have exacerbated workforce challenges for nurses and midwives. The increasingly complex nature of healthcare, combined with rising workloads and staff attrition highlights the need for initiatives that improve workplace satisfaction and retention. In response, mentoring programs aimed at enhancing job satisfaction and retention are being increasingly implemented. Aims This study sought to measure the workplace satisfaction of nurses and midwives across five New South Wales local health districts, utilising data captured from a wider study investigating the implementation of the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring program. Design An exploratory, mixed methods study using purposive sampling was employed. Methods A secondary analysis of a modified version of the Nursing Workplace Satisfaction Questionnaire, was used to quantify intrinsic, extrinsic, and relational workplace satisfaction constructs among nursing and midwifery staff. Open ended questions included in the survey were thematically analysed using methods developed by Braun and Clarke (2022). Results Between June–October 2023, n = 106 participants returned the survey. Differences between intrinsic (items 2 & 5), extrinsic (item 9) relational (items 13-15) constructs were observed for health districts, Aboriginality, age, and professional role characteristics (P < 0.05). Five qualitative themes emerged from the data: Helping people is the priority; Teams make a difference to my workplace satisfaction; Managers impact my satisfaction; Scope and recognition; and Organisational factors. Conclusions Overall, our findings indicate noticeable differences in workforce satisfaction and retention across various factors, including workforce areas, Aboriginality, age, and professional roles. For these groups, initiatives aimed at improving satisfaction and retention should prioritise fostering teamwork and a sense of belonging, as these elements have significant impact on job satisfaction for nurses and midwives and provide valuable guidance for nursing leaders. Impact statement This study identifies that teamwork and belongingness impact workplace satisfaction for nurses and midwives.

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Kindness beyond care: an integrative review of kindness in the nursing profession

Background: In the nursing profession, it is concerning to witness frequent occurrences of incivility in the workplace. Therefore, it is imperative to foster a shift in interpersonal interactions. One effective strategy to cultivate a culture of civility is through the practice of Kindness. Objectives: This review explored the role of kindness in nursing beyond bedside care, incorporating insights from psychology and social sciences to define and apply kindness in practice. The goal was to identify ways for nurses to use kindness to reduce workplace incivility and promote a thriving environment. Design: The authors conducted an integrative review to synthesize data from various sources, including experimental and non-experimental studies, to enhance understanding and offer diverse perspectives on the subject. Data Sources: The authors systematically searched CINAHL, PubMed, Embase, and APA Psych Info for peer-reviewed papers on “kindness” and “nursing” published between 2012 and 2024, excluding opinion articles, letters, reviews, commentaries, and papers focused on kindness in the context of therapeutic care. Methods: The authors followed Whittmore and Kafl’s (2005) structured date extraction protocol steps and performed comparative analysis of extracted data tables to verify content uniformity. Results: Seven articles met inclusion criteria, and several key themes were identified: (1) Definition of kindness, (2) Examples of kindness in Action, illustrating how these behaviors manifest in everyday interactions, (3) Interpretation of kindness from multiple perspectives. Conclusions: Acts of intentional kindness are potent tools that can mitigate workplace incivility and cultivate a culture of kindness among nurses and, by extension, positively impact the broader society. Further research is essential to establish a unified definition of kindness in nursing, identify its antecedents and attributes, and conduct empirical studies to substantiate these concepts.

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The professional quality of life of flight nurses: a cross-sectional study

Background The role of a Flight Nurse is specialised; they must have both education and experience to fulfil the requirements of the role. Mastering these skills takes time, thus long-term retention is essential. When nurses experience their work as more fulfilling, they are more inclined to remain within a role for an extended period. One of the ways to determine the lived experience of nurses is to measure their Professional Quality of Life. This is the first study to look at the Professional Quality of Life of Flight Nurses who work in public sector Aeromedical Retrieval Services in New Zealand. Aims The aim of this study was to determine the Professional Quality of Life of Flight Nurses working in the public sector in New Zealand. Design A survey based cross-sectional design was employed, using the Professional Quality of Life (ProQOL) V Health survey tool. Methods Online survey data was collected from a convenience sample of 169 Flight Nurses working in public sector Aeromedical Retrieval services in New Zealand. Results Of the 88 respondents, all reported either high or average levels of Compassion Satisfaction (High 48.86%, Average 51.13%) and Perceived support (High 44.31%, Average 55.68%). The majority reported Low to Average scores for Secondary Traumatic Stress (Low 30.68%, Average 67.04% and High 2.27%), Burnout (Low 4.54%, Average 89.77% and High 5.68%) and Moral Distress (Low 23.86% and Average 76.13%). Conclusion This study highlights that Flight Nurses in New Zealand’s public sector generally experience a positive Professional Quality of Life, but that there are also instances of Burnout and Secondary Traumatic stress. Impact statement The finding of this study indicates that Flight Nurses who work in the public sector in New Zealand, have an average to high degree of the positive Professional Quality of Life – Compassion Satisfaction and Perceived Support, and a lower degree of the negative aspects of their work – Burnout, Secondary Traumatic Stress and Moral Distress.

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Multifactorial fall interventions for people over 65 years in the acute hospital setting: pre–post-test design

Background: Falls are the most reported patient safety incident for patients >65 years in acute hospital settings worldwide. While multifactorial fall interventions reduce the number of falls in subacute and rehabilitation settings, fall interventions in acute hospital settings are unknown. Aim: To evaluate the effectiveness of multifactorial fall interventions on the number of falls using codesigned education targeting staff and the patient and review the environment in acute hospital settings in NSW, Australia for patients over 65 years of age. Method: A pre–post-test design with a non-equivalent group was conducted. All acute hospital inpatient falls occurring both pre- and post-intervention within one health district were included in this study. The use of Quality Improvement methodology identified gaps in risk screening and assessment, education and information, communication of risk, and standardised fall prevention equipment. Codesigned interventions to address these gaps were undertaken. Results: The number of falls (p = 0.038) and injurious falls (p < 0.001) significantly decreased in the post-intervention group. There was a significant improvement in fall assessments (p < 0.001), delirium risk screening (p < 0.001), the provision of fall information (p < 0.001) and fall risk discussed at shift handover (p < 0.001) in the post-intervention group. Following the intervention, staff were significantly more likely to undertake fall education modules (p < 0.001) and develop a fall management plan (p < 0.001). Conclusion: Falls continue to have a significant economic impact on the acute hospital setting. Our findings highlight multifactorial fall interventions that included staff and patients in the development phases reduced the number of falls. Multifactorial fall interventions targeting staff, patients and the environment may influence a reduction in the number of falls and the severity of falls in the acute hospital setting.

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Communicating health information to children: is a child-rights-based approach being adopted by nurses? An integrative review

Background Childhood is a time when health behaviours are established and the foundations for health literacy are cemented. In Aotearoa New Zealand nurses are responsible for communicating health messages to children at key stages in children’s lives. Objectives/Aims This review explores the ways in which nurses communicate health messages to children and adolescents in Aotearoa New Zealand. It evaluates whether current approaches to health communication are in-line with a child’s rights-based approach. Design An integrative review using a systematic literature search strategy. Data sources In July 2022, 9 databases were searched including: Medline (Ovid), Embase (Ovid), Scopus (Elsevier), Cochrane Library, EBSCO (host), Web of Science Core Collection, CINHIAL plus, psychINFO and PsychEXTRA. Methods Following title and abstract screening 41 articles went through to full-text screening. These were uploaded into NVivo v.12 for analysis. Results were analysed using content analysis with a deductive coding framework informed by the UN Convention on the Rights of the Child. A total of 20 articles met all inclusion criteria and were assessed of high quality using the Mixed Methods Appraisal Tool. Results Nurses communicate health messages using a variety of strategies, some of which align with the rights of the child. No evidence was found of nurses communicating health messages through play or creative activities or by adopting principles and practice of continuity of care, including health communication beyond the paediatric context. Conclusion Opportunities exist for improvements to the rights of children and adolescents within nursing practice. Further research about the rights of children in healthcare services including not only identifying the barriers but research that includes interventions and proposes solutions is necessary .

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Open Access
Trauma Connect Clinic: Continuing the trauma case management model for patients affected by traumatic injuries: A quality improvement initiative

Background: A case-management model of care is frequently used in acute-care settings for patients with major traumatic injuries; however, its application to trauma follow-up care after hospital discharge remains unclear. Aim: To describe the services provided by the Trauma Connect Clinic (TCC): a NP- led case management model, in trauma follow-up care. Methods: An exploratory descriptive study design was used. Data collected included patient and injury characteristics, clinic activities, attendance rates, referral patterns and complications. Results: Three-hundred and twenty-four TCC appointments were scheduled for 194 patients (n = 302) with an attendance rate of 93% (n = 302). Ongoing health issues included pain (n = 22, 37%), thrombotic events (n = 8, 13%) and infection (n = 7, 12%). Clinic activity included 77 referrals to the wider MDT (n = 77), radiology reviews (n = 225) and 39 prescribing events, consisting mainly of analgesia. Conclusion: A case management model can successfully deliver trauma follow-up care and efficiently use limited resources. Key elements involve careful assessment and management of patients’ physical and emotional needs. Evaluation of longer-term outcomes of this model of care in trauma settings is required.

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Nurse performed bladder ultrasound: a clinical quality improvement initiative

Background: Bladder ultrasound (BUS) provides an accurate measurement of post-void residual (PVR) volume and bladder assessment. Access to BUS is dependent on practitioner availability with delays resulting in poor symptom management, delayed discharge and dissatisfaction. Developing nursing practice to perform BUS can address these patient’s needs. Aims: Through a quality improvement initiative the aims were (1) to develop theoretical knowledge and practical competence of nurses to perform BUS, (2) to evaluate nursing activity in relation to BUS, (3) to evaluate stakeholders perceptions of the initiative. Methods: Based on the Deming Plan-Do-Study-Act (PDSA) cycle, an interprofessional team was created and a theoretical/practical based education program was devised. Activity in relation to the nurse-performed BUS was collected and analysed descriptively. Stakeholder perceptions were evaluated via patient and physician questionnaires subject to descriptive analysis and a focus group with nurses analysed descriptively. Results: The team developed a training program to perform BUS, certifying 11 nurses. Investigation of nursing activity related to BUS (n = 202) showed its use for PVR evaluation, and symptom and catheter assessment. It aided decision-making and nurse-physician communication. Stakeholders were satisfied with the initiative. Patients (n = 30) felt nurses were competent, clearly explaining the procedure, results and inspiring confidence. Physicians (n = 2) saw BUS as enhancing efficiency and care quality, while nurses (n = 7) felt this new skill enhanced nursing care providing a more holistic approach. Team reflection on the results of the evaluation confirmed BUS utility and activity, while nurses requested continuing education and a post-certification refresher course. Conclusion: Through reflection on clinical practice areas for improvement to enhance patient care were identified by the nursing team. Application of the PDSA cycle provided a structured approach to guide the quality improvement initiative. Improvements in nursing care and patient care processes have been observed and this has been a positive experience for stakeholders.

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