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High levels of unmet palliative care need are reported globally. There is limited research that investigates unmet palliative care need in outpatient contexts. Early access to palliative care services is associated with better symptom management and reduced healthcare costs. This semi-replication study aimed to gain an understanding of palliative care need and service utilisation in adult outpatients attending a hospital outpatient day treatment unit. An observational period prevalence study was conducted using the Gold Standard Framework Proactive Indication Guidance to assess for palliative care need. Data were collected directly from the electronic medical records of patients who attended an outpatient day treatment unit, at a private-not-for-profit hospital over five days in January 2022. The indicators for the 12 conditions outlined in the Gold Standards Framework Proactive Indication Guidance were used to assess for palliative care need. Based on the review 41% (n = 115) of adult outpatients may have benefitted from palliative care. Of these, 13% (n = 15) were currently receiving palliative care, and most patients (87%, n = 100) were not receiving palliative care. There was evidence of high levels of unmet palliative care need, with most patients who could benefit from not receiving palliative care. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care. Design: A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines. Methods: An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity. Results: Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete postintervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced. Conclusion: The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care. Implications for the profession and/or patient care: Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care. Impact: • This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, • The intervention reduced time spent on clinical documentation and increased time for direct patient care, • This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care. Reporting Method: The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines. Patient or Public Contribution: The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Purpose: To explore levels of Navigator resilience, well‐being, burnout, and turnover intent. Design: A longitudinal, multi‐methods study concurrently collected quantitative and qualitative data over three years. Methods: A survey and Action Learning Groups. Findings: No statistically significant change in resilience, well‐being, burnout, or turnover intent. Supports, self‐care and leaving the position, were used to maintain well‐being. Conclusions: While quantitative measures did not change, qualitative data demonstrated how adaptive coping mechanisms maintain well‐being. Recommendations for nurses working in Navigator, or similar community/public health roles include work‐based programs targeting support, good leadership, governance systems including their impact on turnover intent. Clinical evidence: Job turnover intent can be used as a mechanism to monitor resilience and well‐being. [ABSTRACT FROM AUTHOR]

In the context of pressures faced by the nursing profession including increasing patient acuity and global nursing shortages, the importance of nurse resilience has gained attention in research and practice. Resilience is viewed as a protective factor that enables individuals to avoid psychological harm and continue in their work. There is limited evidence on the impact of external factors such as work conditions on nurse resilience. This study aimed to explore how external factors influence nurse resilience and to incorporate this knowledge into an updated definition of nurse resilience. As part of a two‐phase mixed methods study, focus groups were conducted to obtain qualitative data to explore nurse's perceptions of resilience and factors they felt affected their resilience. Data analysis identified three main themes derived from 10 subthemes: Perceptions of Resilience, Pressures and Challenges, and Support and Strategies contributed to understanding how external factors can affect nurse resilience. A range of factors emerged including the impact of workplace conditions, organizational philosophy, the performance of managers, and the teams nurses work within, which were not reflected in an earlier definition of nurse resilience derived through a concept analysis. These factors were incorporated in an updated definition of nurse resilience. Understanding resilience in the nursing profession and the external factors that affect it is critical to the development of effective research, policies, interventions, and work environments to protect nurse well‐being, promote nurse retention, and ensure the provision of quality patient care. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of organisational values on nurse resilience. Background: Nurses encounter significant occupational adversity, which can result in negative psychological consequences. Investigating the role of resilience as a protective factor focuses on what enables some nurses to positively adapt in challenging work environments. Comparatively, little attention has been paid to organisational factors and nurse resilience. Method: A two‐phase mixed‐methods design comprising a cross‐sectional survey and focus groups. Results: Three hundred and ninety‐four nurses responded to the survey with 25 participating in four follow‐up focus groups. Significant associations were found between resilience levels and agreement with organisational values (p =.022) and agreement about the importance of values (p =.018). Three themes relating to organisational values were identified: pressures and challenges; supports and strategies; and impact of organisational values. Conclusions: Organisational values may positively impact resilience if nurses concur with those values and believe they are shared by their employer. Implications for Nursing Management: To promote nurse resilience, organisations and nurse leaders should consider developing, implementing and operating with a set of employee‐adopted values, which need to be demonstrably upheld across the organisation. [ABSTRACT FROM AUTHOR]

Aim: To develop a validated tool to measure nursing and midwifery documentation burden. Background: While an important record of care, documentation can be burdensome for nurses and midwives and may remove them from direct patient care, resulting in decreased job satisfaction, associated with decreased patient satisfaction. The amount of documentation is increasing at a time where staff rationalisation results in decreasing numbers of clinicians at the bedside. No instrument is available to measure staff perceptions of the burden of clinical documentation. Design: Survey development, followed by rwo rounds of content validation (April and May 2019). Methods: Based on the literature a 28 item survey, with items in 6 subscales, representing key areas of documentation burden was developed. Item (I‐CVI), subscale (S‐CVI/Ave by subscale) and overall content validity indexes (S‐CVI/Ave) were calculated following two review rounds by an expert panel of clinical and academic nurses and midwives. Results: Level of agreement for the first iteration of the survey was low, with many items failing to reach the critical I‐CVI threshold of 0.78. No subscale reached a S‐CVI/Ave above 0.8 and the overall scale only achieved a S‐CVI/Ave score of 0.67. Thirteen items were removed, seven were edited and five new items added, based on the expert panel feedback, substantially improving the content validity. All individual items achieved an I‐CVI ≥0.78, the S‐CVI/Ave was above 0.85 for all subscales and the total S‐CVI/Ave was 0.94. Conclusion: The Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey can be considered as content valid, according to the content validity analysis by an expert panel. Impact: The BurDoNsaM survey may be used by nurse leaders and researchers to measure the burden of documentation, providing the opportunity to review practice and implement strategies to decrease documentation burden, potentially improving patient satisfaction with the care received. [ABSTRACT FROM AUTHOR]

Background: Patients with complex chronic conditions experience fragmentation of care, unnecessary hospitalization and reduced quality of life, with an increased incidence of poor health outcomes. Aim(s): The aim of this paper was to explore how nurse navigators manage client care. This was achieved through an examination of narratives provided by the nurse navigator that evaluated their scope of practice. Method(s): All nurse navigators employed by Queensland Health were invited to participate in a study evaluating the effectiveness of the service. Eighty‐four self‐reported vignettes were thematically analysed to understand the work from the nurses' perspectives. Results: Two themes emerged from the vignettes. Theme 1, the layers of complexity, is comprised of three sub‐themes: the complex patient, the complex system and patient outcomes. Theme 2, professional attributes, has two sub‐themes: person‐centred care and clinical excellence. Conclusion: Navigators innovatively integrate services and address the fragmented nature of the health system. They apply expert clinical and social skills, through consistent and robust communication, to meet the needs of those with multiple chronic conditions. Implications for nursing management: Results provide insight into the new role, illuminating the work they achieve, despite system complexities. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards. Background Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital-acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people. Design Observational, point prevalence study. Methods Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24 hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail. Results Approximately one-quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24 hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one-third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one-third of these were receiving intravenous fluids. Conclusions There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids. Relevance to clinical practice Vigilance is required in the use of peripheral intravenous cannulae. Consider transition of medication administration to oral intake where possible to minimise risks associated with the use of invasive devices and increased fluid intake. [ABSTRACT FROM AUTHOR]

Aims and objectives To compare two methods of calculating interrater agreement while determining content validity of the Paediatric Pain Knowledge and Attitudes Questionnaire for use with Australian nurses. Background Paediatric pain assessment and management documentation was found to be suboptimal revealing a need to assess paediatric nurses' knowledge and attitude to pain. The Paediatric Pain Knowledge and Attitudes Questionnaire was selected as it had been reported as valid and reliable in the United Kingdom with student nurses. The questionnaire required content validity determination prior to use in the Australian context. Design A two phase process of expert review. Methods Ten paediatric nurses completed a relevancy rating of all 68 questionnaire items. In phase two, five pain experts reviewed the items of the questionnaire that scored an unacceptable item level content validity. Item and scale level content validity indices and intraclass correlation coefficients were calculated. Results In phase one, 31 items received an item level content validity index <0·78 and the scale level content validity index average was 0·80 which were below levels required for acceptable validity. The intraclass correlation coefficient was 0·47. In phase two, 10 items were amended and four items deleted. The revised questionnaire provided a scale level content validity index average >0·90 and an intraclass correlation coefficient of 0·94 demonstrating excellent agreement between raters therefore acceptable content validity. Conclusion Equivalent outcomes were achieved using the content validity index and the intraclass correlation coefficient. Relevance to clinical practice To assess content validity the content validity index has the advantage of providing an item level score and is a simple calculation. The intraclass correlation coefficient requires statistical knowledge, or support, and has the advantage of accounting for the possibility of chance agreement. [ABSTRACT FROM AUTHOR]