Enrolled Nurses Research Articles

Experiences and challenges of enrolled nurses undertaking a Bachelor of Nursing Science programme in Namibia.

Globally, enrolled nurses (ENs) are embarking on an educational journey to become registered nurses (RNs) in order to enhance their knowledge and career opportunities. However, their aspiration is not without challenges. In Namibia, the experiences of these nurses have not been extensively researched. This study aims to explore and describe the experiences and challenges of ENs undertaking a Bachelor of Nursing Science at the University of Namibia. A qualitative, exploratory, descriptive and contextual research strategy was followed as the basis of conducting the study. A sample of 15 nursing students was purposively selected from the target population of 73 nursing students. This sample size was determined by the saturation of data as reflected in repeating themes. The collected data were analysed thematically using an inductive approach. Three main themes subsequently emerged from the study: ENs' positive experiences advancing in the Bachelor of Nursing Science (BNSc) programme; nurses' negative experiences advancing in the BNSc programme; and recommendations to ensure effective advancement in the BNSc programmeConclusion:The findings of this study revealed that ENs positively experience becoming a RN when it comes to self-development; however, they have negative experiences such as not receiving exemptions for prior learning and having to learn a new curriculum.Contribution:These findings may be used by the Faculty of Health Sciences, School of Nursing and Public Health management in order to develop targeted interventions and ongoing strategies during their curriculum review cycles to ensure positive student experiences and success within the programme.

Learning in the workplace: Development of a simple language statement assessment tool that supports second-level nurse practice

AimTo focus learning through clarity of the enrolled nurse (EN) role (a second tier nurse position) through development of a user-friendly workplace performance assessment tool commensurate with EN standards for practice. BackgroundInternationally, the nursing workforce comprises regulated and unregulated staff. In Australia, similar to other western countries, there are two tiers of regulated workforce, namely Registered Nurses (RNs) and Enrolled Nurses (ENs). Differences in RN and EN standards based on the education preparation are not always clearly differentiated in workplace practice. Roles are often seen as interchangeable: Improved clarity of both regulated and unregulated roles, when numbers of healthcare workers are burgeoning, assists performance assessment that guides further learning and safe practice. DesignTwo phase sequential, non-experimental design. MethodsPhase one used focus groups (n=48), expert reference panel (n=8) and end-users (n=16) to develop simple language statements. Phase two involved field testing of the statements. FindingsA 30-item, criterion-based workplace performance tool was developed. Principal component analysis of completed tools indicated work could be organised around three key areas of practice, namely, higher order thinking and problem solving, routine daily activities of care and personal and social attributes. DiscussionParticipants reported the statement items assisted in determining suitable activities and accompanying cues in discussing learning needs. Analysis assisted with discriminating broader elements of EN workplace performance. ConclusionsWorkplace learning is important for nurses to continue to build their capacity to deliver optimum care. Assessment tools that describe professional capability in plain language statements and provide examples of supportive behavioural cues help guide on-going learning through improving the validity and thereby consistency of assessment processes. Furthermore, comprehensible and meaningful statements and cues can readily be adopted by students and educators to target learning and feedback thereby enhancing clarity of the EN role, to distinguish from other nursing roles.

Working effectively with consumers: Perspectives from students, teachers, nurses, and consumers.

Preparing enrolled nurses (ENs) to effectively work with mental health consumers is crucial to meeting Australia's healthcare demands. This qualitative study aimed to explore various stakeholders' perceptions regarding the mental health knowledge, skills, and attributes (KSAs) required by ENs to engage with individuals experiencing mental health issues, thus guiding future training priorities. The sample comprised 44 participants including 18 students, 3 graduate ENs, 5 experienced ENs, 5 registered nurses (RNs), 4 nurse unit managers (NUMs), 5 teachers, and 5 consumers of mental health services. Focus groups were used to collect data from the students, whilst individual interviews were conducted with all other participants. A thematic analysis revealed communication was the most vital skill for effectively working with mental health consumers. Skills such as critical thinking and clinical reasoning were also deemed crucial, given the volatile nature of the mental health inpatient environment, necessitating effective responses to acute escalations to prevent adverse outcomes for both staff and consumers. Essential knowledge components included understanding mental health disorders, symptoms, and treatments, particularly medications used for mental health issues. Participants also emphasised the importance of attributes like confidence and empathy in supporting and caring for consumers, who often experienced trauma and vulnerability. These findings provide valuable insights into the content that should be incorporated into the diploma of nursing (DN) training to produce competent graduate ENs.

Environments that promote recovery in acute care mental health: nursing perspectives explored through interpretative description

Background A significant change in mental health care has involved the need to implement recovery-oriented practices and services. However, recovery-oriented care has been poorly defined within acute care mental health settings. Objectives The central aims of the study were to increase knowledge about what constitutes a recovery-oriented environment within contemporary acute care units and to inform recovery-oriented nursing practice. Methods Interpretative description was applied to answer the question: What strategies and resources do nurses identify as being most conducive to fostering a recovery-oriented environment in acute care mental health units? Purposive sampling was used to recruit 11 nurses from 6 acute care units. The inclusion criteria included a minimum of 1-year patients and holding active nursing registration. Nursing experience in community-based or chronic care settings and with children and adolescents were exclusion criteria. Six nurses also participated in a focus group. Results: Key aspects of a recovery-oriented acute care environment included understanding the needs of individual patients along with the dynamics of the healthcare team. Nurses had important roles in promoting recovery-oriented environments and reported a need for increased resources to move beyond the bio-medical model and align practice with personal recovery. Conclusion: A recovery-oriented environment was described as a safe, peaceful and holistic environment with adequate space to balance needs for privacy, interaction and activity. This environment is fostered through respectful communication and healthy relationships among team members, patients, family and formal supports. These nurses had the knowledge, skill and desire to promote recovery-oriented environments, yet resources such as leisure activities and group therapy were required to promote personal recovery.

Whakarōpū: An Exemplar Fostering Professional Development and Cultural Growth With a Collective Grouping of Māori, and Pacific, Nurses

The path to increasing and fostering the Māori and Pacific nursing workforce in Aotearoa New Zealand is multifaceted and requires Indigenous solutions. As part of a national workforce programme to increase Māori and Pacific enrolled nurses in primary healthcare, the workforce team developed and supported a whakarōpū (collective grouping) to attend and present at the National Enrolled Nurse Conference. This paper reports on the experiences of five Māori and two Pacific nurses, together with three senior Indigenous nurse leaders, as a whakarōpū. Ongoing kōrerorero (conversations), both face-to-face and online, was the primary data source; however, participants also provided written and verbal feedback. Through kaupapa kōrero, a collective analysis of the data was conducted. To mitigate the barriers created by a dominant Western-centric learning culture, whakarōpū is a successful example of how to foster flourishing learning experiences for Māori and Pacific nurses. Keeping Māori and Pacific nurses connected, participating, and maintaining dialogue is essential for their collective professional development and cultural growth. The whakataukī, waiho i te toipoto, kaua i te toiroa (let us keep close together, not wide apart), describes the weaving of people, and their aspirations as Māori and Pacific nurses who feel prepared to lead and provide culturally responsive care for their communities. Supporting whakarōpū is essential for Māori and Pacific nurses to develop cultural connections, enable clinically and culturally safe spaces, and feel empowered and prepared for leadership. Te reo Māori translation Ko te Whakarōpū, he Tauira Whai Painga Poipoi i te Whakapakaritanga Ngaio me te Tupunga Ahurea me tētahi Rōpū Tapuhi Māori, Moana-nui-a-Kiwa hoki Ngā Ariā Matua He tini ngā pekanga o te ara whakapiki, poipoi hoki i te ohu kaimahi tapuhi Māori, Moana-nui-a-Kiwa hoki, ā, me kimi hoki he rongoā nā ngā iwi taketake i te tuatahi. I whakawhanaketia e te tira kāhui kaimahi tētahi ohu whakarōpū (collective grouping) kia tae atu, kia tāpae kōrero hoki ki te Hui ā-Motu o ngā Tapuhi Rēhita, hei wāhanga o tētahi hōtaka ohu kaimahi ā-motu e whai nei ki te whakapiki i ngā tapuhi Māori, me ō Te Moana-nui-a-Kiwa. E tāpae kōrero ana tēnei tuhinga mō ngā kitenga a ētahi tapuhi Māori, Moana-nui-a-Kiwa hoki e rima, tae atu ki ētahi kaihautū tapuhi taketake mātāmua tokotoru, hei ohu whakarōpū. I noho ko ngā kōrerorero ā-kanohi, tuihono hoki hei puna raraunga tuatahi; ahakoa rā, i tāpaetia hoki e ngā tāngata whai wāhi mai ētahi whakaaro ā-tuhi, ā-kōrero hoki. I kawea ngā tātaritanga tōpū nā roto i ngā kaupapa kōrero. Hei kaupare i ngā maioro nā te ahurea akoranga o whenua kē i whakaara, he mea pai te ohu whakarōpū hei penapena i ngā wheako akoranga mō ngā tapuhi Māori, ō Te Moana-nui-a-Kiwa hoki. He mea taketake te whai kia honohono ngā tapuhi Māori, me ō Te Moana-nui-a-Kiwa, kia whai wāhi tonu, kia kōrerorero tonu mō tō rātou mahi whakapakari ngaio, tupunga ahurea hoki. E ai rā te whakataukī, waiho i te toipoto, kaua i te toiroa (let us keep close together, not wide apart), kei reira te tauira o te whakapipiri i te tangata, me ō rātou wawata hei tapuhi Māori, Te Moana-nui-a-Kiwa hoki, kua oti te whakangungu hei kaiarataki, hei kaikawe taurimatanga tika ā-ahurea hoki mō ō rātou hapori. He mea taketake te tautoko i ngā ohu whakarōpū mā ngā tapuhi Māori, me ō Te Moana-nui-a-Kiwa hei whakawhanake i ngā hononga ahurea, hei whakarite wāhi haumaru ā-tiakinga tūroro, ā-ahurea hoki, kia piki anō tō rātou mana, kia tika te tū ki te ārahi i ētahi atu.

333 Artificial Intelligence to Predict Emergency Department Workups From Nurse Triage Notes and Registration Data

333 Artificial Intelligence to Predict Emergency Department Workups From Nurse Triage Notes and Registration Data

University Competency-based Courses for Internationally Educated Nurses (IENs) in Ontario: A Pilot Education Pathway to Registered Nurse (RN) Licensure

In 2014, a team of nurse educators and champions of internationally educated nurses (IENs) in Ontario, Canada, came together to address the issue of supporting IEN transition to practice as one route to help address nursing shortages. Courses were developed with funding from the Government of Ontario, and policy and coordination support from the Council of Ontario Universities, to pilot an educational bridging pathway for IENs. The faculty team across four Ontario universities used a consortium approach to coalesce province-wide expertise in IEN education. What began as a selection of targeted, competency-based courses has since evolved into a full Competency-Bridging Program of Study for Internationally Educated Nurses in Ontario, aligned with other IEN bridging program offerings across the province. This paper describes the initial process of the group, from 2015 to 2018, to create foundational learning and competency-based courses to meet targeted entry-to-practice (ETP) competencies for Registered Nurse (RN) registration with the College of Nurses of Ontario (CNO). The barriers to IENs in meeting ETP requirements and how the gap in the existing Ontario IEN bridging to a Bachelor of Science in Nursing (BScN) education to meet regulatory requirements are also addressed. This article explores how Ontario may respond to the increasing nursing shortages and the need to engage ethically and retain IENs in practice. Lessons learned from competency-course development add to the growing body of knowledge about IEN program experiences in Canada to enable more IENs to enter the Ontario nursing workforce.

An audit review of midwifery qualifications and distribution in Zambia

Background In Zambia, the last decade has seen the development of multiple midwifery qualification, including direct-entry midwifery, an advanced diploma in nursing and midwifery, or a Bachelor of Science, Master of Science or Doctor of Philosophy in midwifery programme. Despite advancements in midwifery training, there is no research on different categories of midwifery qualifications in Zambia and their competencies. Therefore, there is a need to review midwifery qualifications and the distribution of midwives in Zambia. The aim of this audit review was to evaluate qualification categories of midwives currently registered with the General Nursing and Midwifery Council of Zambia and the distribution of midwives across Zambia. Methods An audit review of midwifery qualifications and their distribution across Zambia was undertaken using the General Nursing and Midwifery Council of Zambia's register of nurses and midwives 2020. Data were extracted from the report and presented as frequencies. Results A total of 6112 midwives were registered by the General Nursing and Midwifery Council of Zambia at the time of data collection, of which the majority (87.6%) were women and registered nurse midwives (52.7%). The most common place of practice was a hospital (41.5%) and the greatest proportion of midwives worked in Lusaka (24.6%). Conclusions This audit review provides insights into midwifery qualification categories in Zambia and their distribution, and indicates that levels of practice should be clearly defined in terms of their competencies. With advancements in midwifery training, the authors believe there will be an increase in midwives' autonomy and their involvement in decision making at all levels of care.

An online questionnaire exploring how recruiting organisations support international nurses and midwives undertake the OSCE and gain UK professional registration.

BACKGROUND There is an active strategy to recruit international nurses and midwives to help manage vacancy gaps in the United Kingdom's healthcare system. International recruits need to pass a two-stage test of competence in order to gain required professional registration with the Nursing and Midwifery Council: a Computer Based Test followed by an Objective Structured Clinical Exam. There is little evidence detailing how recruiting organisations prepare new recruits for these tests, and no set standards govern the support provision deemed necessary. AIMS AND OBJECTIVES To gather and analyse feedback from recruiting organisations on the preparation offered to international nurses and midwives on arrival in the United Kingdom, prior to undertaking an Objective Structured Clinical Exam (OSCE) in order to gain Nursing and Midwifery Council professional registration. DESIGN AND METHODS An online cross-sectional questionnaire was developed, using themes taken from a systematic literature search. This questionnaire was completed by 17 organisations involved in the recruitment of international nurses and/or midwives to the UK. The data was analysed using thematic analysis. This research was quality assessed using the STROBE observational research checklist. RESULTS Four main themes emerged from thematic analysis of the qualitative data: SAME IDEAS DIFFERENT PRACTICE; PASSING THE OSCE; INDIVIDUALISED SUPPORT; SUPPORT NETWORKS. The limited response rate inhibited inferential analysis of the quantitative data. Descriptive analysis showed higher median reported OSCE pass rates when recruiters were grouped by shared characteristics (e.g., those offering less clinical practice). CONCLUSION Differences in how organisations prepare and support international nurses and midwives to undertake the OSCE suggest standardised approaches could benefit new recruits. These standardised approaches should be based on shared practice and scientific evidence. Broader assistance transitioning to working and living in the UK should also be addressed. This could be in the form of specific preceptorship programs following success of the OSCE. IMPACT STATEMENT Addressing an evidence gap, this research suggests recruits may benefit from standardised support around working and living in the UK.

Hannah Claire Haines, 1891–1974: Not the Average “Militant Female”

Hannah Claire Haines, 1891–1974: Not the Average “Militant Female”

Margaret Sanger, “The Unrecorded Battle” (1912)

Margaret Sanger, “The Unrecorded Battle” (1912)

Duties and Responsibilities of Staff Nurse- A Study

Abstract: Nursing has come a very, very long way in the past century. However, some of the challenges highlighted by nurse leaders in the late 1800’s to early 1900’s, still face the profession a century later even though their exact nature might be somewhat different. Throughout the history of nursing, most of the challenges can be linked to the gender and class barriers faced by women in society and the ever-present economic demands of the healthcare industry.The Staff Nurse is the first level professional Nurse in the hospital set up. Therefore by appearance and by word she will be professional at all time. Taking a walk through the history of nursing, the shortage of nurses appears to have been a problem from the time when the value of trained nurses in hospitals and the community was recognized. From the mid-1800’s, when scientific developments in Western medicine increasingly led to successful treatment, hospitals changed from places where the sick and destitute were cared for to institutions where the ill were admitted for treatment. The time was ripe when Florence Nightingale introduced formal training of nurses, and since then, it appears that the demand for qualified nurses increased exponentially. The objective of obtaining state registration for nurses was the priority issue for nurse activists from the 1880’s. At the Chicago World’s Fair, British nurses introduced the nurse leaders from all over the world to the idea of state registration for nurses as well as the issue of standards for nurse training schools, which would satisfy a requirement to introduce registration. The struggle for state registration was at the time also the main driving force behind the establishment of nursing organizations in various countries. Keywords: Staff Nurse, Hospital Stress, Tolerance Adjustment, Florence Nightigale. Demand, Shipt System.

Stakeholder perspectives on the clinical placement appraisal process in undergraduate nurse education: A qualitative study

<h2>ABSTRACT</h2><h3>Background</h3> Clinical placements are integral components of undergraduate nurse education. Assessment of student performance routinely involves formative and summative appraisals. Understanding how appraisals are used to promote student learning in undergraduate nurse education and into professional nursing registration is important. <h3>Aim</h3> To describe the experience of clinical appraisal on student learning during clinical placements through the lens of the undergraduate nursing student, the clinical assessor, and university academic staff. <h3>Methods</h3> Descriptive-exploratory-qualitative study using semi-structured interviews with eight undergraduate nursing students, three health service clinical nurses and six university staff were performed. Data were analysed using NVivo. Qualitative content analysis was performed. <h3>Results</h3> Two categories emerged: continuum of learning; and assessment versus learning. Participants reported the formative and summative appraisals promoted student learning and development within the clinical placement and on their journey becoming nurses. The experience of the appraisal process was influenced by the tension between assessment and learning. Factors influencing the experience of the appraisal process for student learning included: the assessment tool, the clinical support model, and expectations of student and assessor role. <h3>Conclusion</h3> Clinical placements are integral to a student's continuum of learning into professional registration. To facilitate positive learning experiences, orientation programs prior to the commencement of clinical placements for assessors and undergraduate students, could be included. Formal training in assessment and feedback may also be beneficial for clinical assessors. Clear expectations for models of clinical support and the process for appraisal assessment, may facilitate a more positive learning experience to promote better student outcomes.

Nurses' Perceptions and Attitudes toward Family-Centered Care in Acute Pediatric Care Settings in Jordan

PurposePerceptions and attitudes toward working with parents may influence nurses' family-centered clinical care practices. There is a paucity of research measuring family-centered care among nurses working with children and their parents in Jordan. The purpose of this study was to explore nurses' perceptions of family-centered care by examining nurses' attitudes toward working with children and their parents, as well as toward family-centeredness. Also investigated was the extent to which the selected demographic characteristics of nurses explain the discrepancies between their child- and parent-focused attitudes. Design and methodsUsing a cross-sectional descriptive study, 246 nurses completed the ‘Working with families’ questionnaire. A paired t-test used to compare the working with children versus working with parents' attitude scores, and independent t-test and ANOVA to explore the influence of nurses' demographic characteristics attitude scores. ResultsThe nurses scored higher for working with children than with parents, suggesting more positive attitudes toward the former than the latter (p < 0.001). The family-centeredness scores varied with nurses' years of clinical experience (p < 0.001) and years of employment (p < 0.005). ConclusionsThe applicability of the family-centered care model in Jordan's hospitals is challenged by the fact that pediatric nurses register more positive attitudes for working with children than with parents. Practice implicationsNurses' attitude toward working with children's families requires more evaluation prior to implementing family-centered care in practice. Further research is needed to explore factors contributing to discrepancies between child- and parent-focused attitudes among nurses.

Intraprofessional collaboration between enrolled and registered nurses in the care of clinically deteriorating ward patients: A qualitative study

BackgroundNurses' role in vital signs monitoring places them in an ideal position to recognise and respond to clinical deterioration in general wards. However, enrolled nurses (ENs) and registered nurses (RNs) do not always work collaboratively, and this can lead to delays in recognition and escalation of clinical deterioration in general wards. ObjectivesThe aim of the study was to explore the collaboration experiences between ENs and RNs in recognising and responding to clinical deterioration in general ward settings. MethodsA qualitative descriptive study involving 12 ENs and 11 RNs was conducted in a 1250-bed tertiary hospital in Singapore using semistructured interviews. Interviews were transcribed and thematically analysed. FindingsThree main themes emerged from the data analysis. The first, “reaching a collective understanding of patients' conditions’, identifies nursing shift handover as the primary method of obtaining patient information essential for ENs and RNs to work collaboratively to deliver safe patient care. However, the dissociation of ENs during the handover process created information gaps on patients at risk of clinical deterioration. The second, “role expectations of each other”, describes expectations that both groups of nurses had for each other's functions and responsibilities and the importance of mutual support in the nursing teamwork process. The third, “lacking in shared decision-making”, depicts a top-down approach in decision-making, wherein ENs were often not engaged in the decision-making process related to patient care. ConclusionsA less-than-optimal collaborative EN–RN relationship was observed in this study, which sometimes caused delays in recognising and responding to deteriorating ward patients. This study illuminates the need for intraprofessional learning opportunities in prelicensure nursing programmes and the workplace to foster effective EN–RN collaborative practice. Nurse managers and educators are instrumental in fostering EN–RN collaboration and providing ongoing education on nursing teamwork skills and competencies.

Documenting patient risk and nursing interventions: record audit

Objective: The aim was to explore and compare documentation of the nursing process for patient safety in two nursing documentation systems: paper and digital records. Background: The ‘nursing process’ (assessment, planning, intervention, and evaluation) is recommended by professional nursing registration and health service accreditation bodies as a key component of understanding nurses’ clinical reasoning. Nurses’ responsibility for patient safety must be supported by comprehensive documentation practices. Study design and methods: A retrospective audit of twenty clinical care records (N = 20) randomly selected from a single acute medical ward at a tertiary hospital in Australia; ten from a digital trial that replicated selected paper forms and ten paper records as controls. The audit was conducted by two nurse researchers using a purpose built data extraction tool. Results: Patient age, gender and primary diagnoses were similar for the digital and paper care records. Documentation of the full nursing process was low in both record types, and comprehensiveness of nursing documentation was similar across the paper and digital records. Compared to the paper documents, the digital documents were more often rated as ‘complete’ (p<0.05). Documentation of risk to skin integrity (p<0.05) and evidence of completed nursing interventions to address risks were more frequent (p<0.05) in digital records. Discussion: The findings of this study highlight an important gap in comprehensive documentation of the nursing process that supports and informs the clinical reasoning of nurses for patient safety. Improvements in digital documents reflect future opportunity to enhance the quality of nurse documentation using technology specific strategies such as prompts, visualisation and nudge. Conclusion: This research identifies that both paper and digital systems of hospital documentation may fail to capture and communicate the clinical reasoning of nurses. Digital systems have the potential to improve capture of the clinical reasoning and nursing process. What is already known about the topic? Professional registration and healthcare accreditation bodies recommend nurses’ clinical decision making is underpinned by processes of assessment, planning, intervention and evaluation. Poor capture of nurses’ clinical decision making in their documentation has negative consequences for the continuity, quality and safety of care; including inadequate detection of deterioration and escalation of care. Electronic systems are expected to enhance capture of nurse decision making in documentation. What this paper adds: Nurses’ clinical reasoning was poorly captured in both paper and digital documentation systems. Nurses documented their intervention responses to identified patient risks more often in the digital system compared to paper records. Digital systems offer an opportunity to proactively nudge nurses towards improved documentation of nursing processes.

Reforming nursing registration: Lessons from pandemics

A nimble and flexible regulatory response regarding the nursing workforce is essential to a fully integrated public health approach to national crises and pandemics. The COVID-19 pandemic has drawn many comparisons to the 1918 Flu Pandemic. Some of them are well-reasoned and grounded in evidence. Other are not. This study provides a historically contextualized analysis of how the 1918 flu pandemic helped shape Pennsylvania nursing's current regulatory apparatus. We conclude that the state-based solutions that nursing registration represents are inadequate to deal with pandemics and crises with national, if not global, reach. We need to move immediately toward the national COMPACT system, while mindful of how regulatory processes and procedures can reinforce structural inequities.

Compassion Fatigue among Nurses: The Cost of Having a Relationship with HIV-Positive Patients

In the public healthcare sector in South Africa, nurses treat a large number of patients who are infected with the human immunodeficiency virus (HIV) on an outpatient basis. Many patients consult the nurses only when they experience symptoms due to the delayed onset of antiretroviral (ARV) treatment. The large number of patients and often poor outcome of treatment could result in compassion fatigue in the nurses. The aim of the current study was to describe the cost of having a relationship with HIV-positive patients on nurses who work in outpatient ARV clinics. A qualitative, single, embedded case study design was used, and six registered nurses (RNs) and one enrolled nurse (EN) were individually interviewed. The data analysis revealed two themes, namely: (1) the risk of developing compassion fatigue; and (2) the manifestation of compassion fatigue. The themes were discussed with reference to the extant literature. Many research reports have focused on compassion fatigue in nurses in hospital-based settings, but few on the manifestation of compassion fatigue in nurses who work in outpatient settings. The authors concluded that nurses who take care of HIV-positive patients on an outpatient basis are at risk of developing and do manifest compassion fatigue, and it is thus recommended that programmes be instituted to support them.

Nursing teamwork in general ward settings: A mixed-methods exploratory study among enrolled and registered nurses.

To examine the perceived level of nursing teamwork and factors influencing teamwork among enrolled nurses (ENs) and registered nurses (RNs) in general ward settings. The nursing care delivery model includes RNs, ENs and others who work as a team to deliver patient care. The potential impact of teamwork on nursing care highlights the need to explore the work of nursing teams. A mixed-methods exploratory study. Quantitative and qualitative data were collected concurrently from ENs and RNs in 2018. Two hundred and forty-eight (n=248) nurses completed the Nursing Teamwork Survey. Sixteen nurses participated in focus group discussions. Qualitative data were reported following COREQ guidelines, while quantitative data followed the STROBE guidelines. Both ENs and RNs scored highest for the shared mental model subscale but lowest for the team orientation subscale. Factors including qualification level, years of working experience, perceived job staffing adequacy and job satisfaction were found to influence teamwork. Three themes emerged from the qualitative findings: expectations of each other's role, delegation practices and interpersonal relationships. ENs and RNs differed in their expectations of their role in basic patient care activities and faced power struggles related to delegation practices. Open and structured communication was deemed essential in building interpersonal relationships. The ENs and RNs have clear understanding of their personal roles and responsibilities towards achieving a common goal. However, teamwork may be improved with a shared mental model in performing basic nursing care tasks, mutual support for workload management, better delegation practices, effective communication, enhanced interpersonal relationships and better team orientation. Nurse managers and educators need to work collaboratively to foster positive delegation practices in clinical practice supported by applicable team training that enhances mutual trust, backup behaviours and collective orientation in nursing teams.

Factors affecting Australian aged care facility workers in administering oral medication to residents with swallowing difficulties.

Swallowing difficulties are common in older people and can complicate the administration of oral medications. The aim of this study was to explore factors affecting healthcare workers in their practices of oral medication administration to aged care residents with swallowing difficulties. A purposeful sample of 17 healthcare workers composed of clinical/care managers, registered nurses (RNs), enrolled nurses (ENs), and assistants in nursing (AINs) from three aged care facilities in Queensland, Australia participated in semi-structured interviews. Leximancer was used for quantitative content analysis. The responses centered on three main factors. Participants discussed workprocess-related factors including time, workload, and stress and frustrations resulting from work processes. Medication-related factors included strategies to facilitate medication administration, uncertainties around modifying medications, availability/cost of alternatives, multidisciplinary medication management, prescribing considerations, and polypharmacy. Resident-related factors were discussed around individualized needs of residents especially those with dementia-associated swallowing difficulties. Ideas differed among the four groups of participants. Managers discussed workprocess-related factors pertaining to staff and facility. RNs focused on how clinical aspects of the medication practices were affected by work processes. ENs were task-oriented and their responses focused on work processes. AIN responses centered on reliance on RNs in performing medication tasks. The findings suggest that healthcare workers' practices of medication administration to residents with swallowing difficulties are affected by various factors associated with work processes, medications, and resident characteristics. Although these factors affect all levels of healthcare workers, the needs of each group vary depending on their level of training and responsibilities.