Alannah Cooper

Aim
To identify and critically appraise instruments that have been used to measure nurse resilience.

Design
A scoping review.

Data Sources
Comprehensive literature searches were conducted using four electronic databases CINAHL Ultimate, MEDLINE, PsycINFO and Emcare from the year 2012 to December 2024.

Methods
The titles, then abstracts, of retrieved articles were screened by the authors against inclusion and exclusion criteria, then full-text screening was performed using Rayyan. Data about the study characteristics and the instruments used to measure nurse resilience were extracted. Copies of the instruments used to measure resilience were obtained and appraised.

Results
Of the n = 4694 publications identified in the initial search n = 386 were included in the scoping review. Studies originated in n = 45 countries, the majority were conducted in China (n = 119) and the United States of America (n = 53). Across the n = 386 included studies, n = 15 instruments to measure resilience were identified and critically appraised. The scores for the instruments critically appraised ranged from 0 to 6 out of a total possible score of 11. Synthesis of results examined instrument development, instrument features and application of instruments.

Conclusion
Critical appraisal of the instruments used to measure nurse resilience revealed significant deficiencies. None of the instruments included all of the key attributes and factors that influence nurse resilience. There was a predominant focus on individual factors and little consideration of the influence of nursing work environments. Due to the shortcomings of the existing instruments, there are currently substantial limitations in our understanding of nurse resilience and how to measure it.

Implications for the Profession
A profession-specific comprehensive measure of nurse resilience needs to be developed to better capture the attributes of nurse resilience.

Impact
This review highlights the limitations of instruments applied to measure nurse resilience.

Reporting Method
The JBI scoping review framework.

Patient or Public Contribution
No patient or public contribution.

Objective
To examine midwife and nurse satisfaction pre- and post- an intervention designed to decrease documentation burden in a maternity setting.

Background
The burden imposed on nurses and midwives by documentation demands are a source of dissatisfaction, resulting in missed care, worsening job dissatisfaction.

Study design and methods
A convergent mixed-methods design (QUAN + Qual). Satisfaction was examined using a survey to collect quantitative data and focus groups to collect qualitative data. The intervention reviewed documentation for duplication, redundancy, and modification, resulting in the creation of streamlined, and user-friendly documentation. Data were collected using a validated tool developed to measure nursing and midwifery documentation burden, and via focus groups to explore satisfaction pre- and post-intervention and changes to documentation.

Results
Following integration of the data, feedback from the focus groups (n = 17) confirmed the survey results from n = 28 post-intervention respondents; participants were satisfied with many elements of the new documentation. The focus groups also highlighted areas where further refinements to the new documentation could be made. The intervention improved midwives' satisfaction with documentation with respect to ease, complexity, and relevance of the documentation. Issues with the time needed to complete documentation following the intervention remain.

Conclusion
Satisfaction with many elements of documentation was achieved, indicating that the focus on removing known sources of dissatisfaction with documentation, including duplication and unnecessary documentation, was effective in a maternity setting. Intervening to reduce duplication and redundancy, and modifying patient clinical documentation, can improve nurse and midwife satisfaction with this aspect of their job.

The work mental health nurses undertake is widely acknowledged as being challenging. Stressors encountered in the workplace can negatively impact nurses' psychological wellbeing and contribute to issues with retaining nurses in the profession. There is limited interventional research that focuses on external factors that foster nurse wellbeing. This study aimed to evaluate a peer group intervention to promote nurse wellbeing. A longitudinal mixed-methods study with an equal status concurrent design was undertaken. Qualitative and quantitative data were collected via semi-structured interviews and surveys across three timepoints, baseline, mid-intervention, and post-intervention. Qualitative data were collected to explore interviewees' experiences of participating in the intervention, and quantitative data were obtained to assess for any measurable effect on wellbeing outcomes. Fifteen peer group participants completed semi-structured interviews. There were n = 28 responses to the baseline survey, n = 27 returned the mid-intervention survey, and n = 25 responded to the post-intervention survey. Qualitative data analysis identified four main themes: Attending Peer Group, Participating in Peer Group, Impact on the Individual, and Unrelated Workplace Change. Wellbeing scores were found to be significantly modified by the number of peer group sessions attended for depression (p = 0.006), stress (p = 0.004), and emotional exhaustion (p = 0.02) By the post-intervention survey, more favourable scores were significantly associated with higher attendance levels for all three measures. Integration of the qualitative findings and quantitative results demonstrated potential benefits of peer groups for nurse wellbeing. Given that greater exposure to the intervention was associated with better outcomes, facilitating attendance is essential to realise the benefits of peer groups.

Aim
To gain an understanding of palliative care need and provision in adult medical and surgical inpatients.

Design
An observational point prevalence study was conducted across four study sites in Western Australia.

Methods
All data were collected directly from patient medical records by Registered Nurses. Potential palliative care need was assessed using disease-specific indicators for the 12 conditions outlined in the Gold Standards Framework Proactive Indicator Guidance.

Results
A total of 865 medical and surgical inpatients met study inclusion criteria. Across the four study sites, 38% (n = 331) of adult inpatients reviewed could have potentially benefitted from palliative care. Of the n = 331 patients assessed as having indicators for palliative care, there was evidence that 27% (n = 90) were currently receiving some form of palliative care, while 3% (n = 9) had been referred for specialist palliative care. For the majority of patients (70%, n = 232) there was no evidence of them receiving any form of palliative care or awaiting specialist palliative care.

Conclusion
This study identified high levels of potential palliative care need among adult medical and surgical inpatients. The majority of the patients identified as having indicators for palliative care were not receiving any form of palliative care.

Implications for the Profession and/or Patient Care
The high prevalence of palliative care need found in this study highlights that recognising and addressing palliative care is essential for high-quality care for medical and surgical inpatients. To address the high level of need identified all nurses require basic palliative care training to provide optimal patient care.

Impact
Knowledge about the level of palliative care need and provision of palliative care in public hospitals was limited. This study identified a high prevalence of potential palliative care need in medical and surgical inpatients. The majority of patients with indicators for palliative care were not receiving any form of palliative care. This research demonstrates that palliative care needs should be considered by all registered nurses and other health professionals caring for medical and surgical inpatients.

Reporting Method
The study is reported using the STROBE guidelines.

Patient or Public Contribution
No patient or public contribution.

Background
Advanced chronic kidney disease is a life-limiting disease that is known to benefit from palliative care. Unmet palliative care need in patients with kidney failure is commonly reported but the level of need among patients receiving haemodialysis is unknown.

Methods
A period prevalence study of adult patients attending two hospital-based dialysis units was conducted. Patient medical records were reviewed using the Gold Standards Framework Proactive Indication Guidance to assess for potential palliative care need.

Results
A total of 128 patient medical records were reviewed, 45% (n = 58) of patients could have potentially benefitted from palliative care. Of the patients with indicators for palliative care, 72% (n = 42) had no evidence of receiving or awaiting any form of palliative care. High levels of palliative care need were found in patients who identified as Aboriginal or Torres Strait Islander and non-Indigenous patients.

Conclusions
This study found high levels of palliative care need among adult patients attending hospital-based dialysis units. The majority of patients with indicators were not receiving any form of palliative care.
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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 post-intervention 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.

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.

Introduction
The challenging work environments mental health nurses (MHNs) encounter can negatively impact their mental health, psychological well-being and physical health. While these impacts have been investigated in quantitative research, little is known about work-related stress from the perspective of MHNs.

Aim
To explore the stresses faced by nurses working in mental health settings and to gain an understanding of the underlying workplace context.

Method
A descriptive qualitative study with data collected via semi-structured individual telephone interviews conducted with n = 21 Western Australian MHNs. Data were analysed using reflexive thematic analysis.

Results
A total of 85 codes were generated that led to the identification of 13 subthemes and 4 main themes: (1) mental health nursing context, (2) work environment stressors, (3) factors that alleviate stress and (4) the impact of workplace stress.

Discussion
Many of the stressors MHNs were exposed to are modifiable, such as understaffing and poor skill mix. Modifiable stressors increased risk for MHNs, impeded patient care and exacerbated inherent stressors such as patient acuity and complexity.

Implications for Practice
This study collected data that provide rich descriptions of the experiences of MHNs and identify modifiable work-related stressors that could be alleviated through effective leadership and management.

Background
The ESCALATION system is a novel paediatric Early Warning System that incorporates family involvement and sepsis recognition. This study aimed to assess the feasibility and iteratively refine the ESCALATION system in a variety of hospital settings in preparation for full-service implementation.

Methods
A series of four multi-methods studies using an Implementation Science and co-design approach were conducted. We examined concepts of implementation, context, and mechanisms of action across a variety of hospitals. Data collected included practice and chart audits, surveys (health professionals), interviews (families) and focus groups (health professionals). Quantitative data were analysed descriptively with qualitative findings assessed by content analysis or thematic analysis.

Results
There were 650 audits (Study I–IV), 205 health professional survey responses (Study I), 154 health professionals participated in focus groups (Study II–IV), 13 parents of hospitalised children interviewed (Study I), and 107 parents reported their involvement in the ESCALATION system (Study III–IV). Each of the studies further refined and confirmed the feasibility, specifically the components of family involvement and the sepsis recognition pathway.

Conclusion
The Implementation Science evaluation of the ESCALATION system resulted in a uniform approach that was feasible and acceptable to users and appropriate for full-service implementation.

Aim: The aim of the study was to assess the suitability of an online education package to prepare health professionals to use a new paediatric early warning system. Design: Quasi-experimental mixed methods using co-production.

Methods: Participants completed the Package and participated in up to four clinical scenarios. Data were collected using self-report surveys, and during clinical scenarios; escalation of care, documentation, family involvement, communication handovers were assessed, and recorded debriefings were thematically analysed. Data were integrated using tabulated joint displays.

Results: Eleven nurses and three doctors were recruited from three mixed adult and paediatric hospitals. Following completion of the Package and clinical scenarios 13/14 (93%) participants agreed preparedness and confidence to use the ESCALATION System had increased. For 53% handovers, the communication framework was followed, for 79% charts, documentation was complete. Participants engaged with the parent (actor) for 97% scenario interactions. The Package was effective and participation in clinical scenarios appeared to enhance learning.

Patient or public contribution: Consumers participated in the steering group overseeing the study and in the expert panel who reviewed the education package and clinical scenarios.