Explore potential education and clinical pathways for nurses entering the profession through a Graduate Entry Nursing programme to transition to advanced practice roles.
Self-care is not necessarily or solely about the 'self' caring for the 'self'. Greater self-care can be accomplished and be more sustainable by consideration and enactment of the systems within which one finds oneself in academia. Capitalising on, reframing, and integrating relationships with known others (We) and the university system (Us) also provide direct mechanisms for improved self-care. In this chapter we outline Me (individual), We (relational), and to a lesser extent Us (organisational) strategies, all based on empirical literature, that are useful and that we have successfully used over our 30+ years in academia. Examples of approaches discussed include a breathing focusing technique and simplifying (Me), job crafting and strengths spotting (We), and Appreciative Inquiry summits and policy advocacy (Us) amongst others.
Intensive care nursing is a professionally challenging role, elucidated in the body of research focusing on nurses' ill-being, including burnout, stress, moral distress and compassion fatigue. Although scant, research is growing in relation to the elements contributing to critical care nurses' workplace well-being. Little is currently known about how intensive care nurse well-being is strengthened in the workplace, particularly from the intensive care nurse perspective.Identify intensive care nurses' perspectives of strategies that strengthen their workplace well-being.An inductive descriptive qualitative approach was used to explore intensive care nurses' perspectives of strengthening work well-being.New Zealand intensive care nurses were asked to report strategies strengthening their workplace well-being in two free-text response items within a larger online survey of well-being.Sixty-five intensive care nurses identified 69 unique strengtheners of workplace well-being. Strengtheners included nurses drawing from personal resources, such as mindfulness and yoga. Both relational and organizational systems' strengtheners were also evident, including peer supervision, formal debriefing and working as a team to support each other.Strengtheners of intensive care nurses' workplace well-being extended across individual, relational and organizational resources. Actions such as simplifying their lives, giving and receiving team support and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners. These findings inform future strategic workplace well-being programmes, creating opportunities for positive change.Intensive care nurses have a highly developed understanding of workplace well-being strengtheners. These strengtheners extend from the personal to inter-professional to organizational. The extensive range of strengtheners the nurses have identified provides a rich source for the development of future workplace well-being programmes for critical care.
<p>Background: Enteral nutrition is one method of delivering nutrition to intubated patients. There are several issues that prevent optimal delivery of the prescribed enteral nutrition goal rates. The measurement of the patient's gastric residual volume (GRV) may demonstrate tolerability, or intolerability, of enteral nutrition. Identifying a safe GRV, at which to accept and continue enteral nutrition delivery, is essential to ensure the delivery of enteral nutrition adequately achieves the nutritional requirements of patients, and to mitigate the risks associated with the delivery of enteral nutrition. Objectives: This systematic review sought to answer the research question: what is the maximum GRV to accept in order to continue the delivery of enteral nutrition in the Intensive Care Unit (ICU) adult patient? This is specifically related to the primary outcome measures indicative of accepting a specified GRV that is too high or too low. Accepting a GRV that is too high would put the patient at risk of vomiting, regurgitation, aspiration of gastric contents and potentially aspiration pneumonia. Conversely, accepting a GRV that is too low would put the patient at risk of not achieving caloric needs, potentially placing the patient at risk of malnutrition and increased morbidity. Search methods: Databases searched included: CCTR, CLCMR, CLTA, CLEED, OVID MEDLINE (R) (Ovid SP), EMBASE, CINAHL Plus with Full Text (EBSCO host via helicon), AMED, Ovid Nursing Full Text plus, CDSR, ACP Journal Club, DARE, Proquest via helicon (advanced search), Pubmed via helicon (limits "all adult", "humans", "abstract", "title"), all EBM reviews, and the reference lists of articles. Selection criteria: The types of studies eligible for inclusion were published randomised controlled trials, case controlled studies, cohort studies and observational studies. Interventions considered were a comparison of two or more GRV measures. The participants eligible were adult ICU or critical care patients receiving enteral nutrition. The primary outcome measures for study inclusion were caloric requirement met, and specified potential adverse events including vomiting, regurgitation, or aspiration. Data collection and analysis: Data was extracted using a data extraction tool created by the researcher. Risk of bias was assessed by the author using two risk of bias assessment tools. Main results: Three studies met the inclusion criteria for the systematic review (McClave et al., 2005; Metheny, Schallom, Oliver, & Clouse, 2008; Pinilla, Samphire, Arnold, Liu, & Thiessen, 2001). Each of these studies contained methodological risks of bias and limitations related to their study designs. McClave et al.'s study was a prospective study (n = 40), Metheny et al.'s study was a prospective descriptive study (n = 206), and Pinilla et al.'s study was a randomised controlled trial (n = 80). No one study, or a combination of studies, provided conclusive evidence to support the use of one particular GRV over another. Author's conclusion: No recommendation for a definitive GRV was made in this systematic review due to the lack of strong evidentiary support for one GRV over another. There remain opportunities for enhancing practice through developing a consistent, multidisciplinary approach to managing GRVs. There are future research opportunities related to improving the management of GRVs in the enterally fed ICU patient, and achieving optimal volumes of nutrition delivered.</p>
The Symptom and Urgent Review Clinic was a service improvement initiative, which consisted of the implementation and evaluation of a nurse-led emergency department (ED) avoidance model of care. The clinic was developed for patients experiencing symptoms associated with systemic anti-cancer therapy in ambulatory cancer settings.The clinic was implemented in four health services in Melbourne, Australia across a six-month period in 2018. Evaluation was by prospective data collection of the frequency and characteristics of patients who used the service, pre- and post-survey of patient reported experience, and a post-implementation survey of clinician engagement and experience.There were 3095 patient encounters in the six-month implementation period; 136 patients were directly admitted to inpatient healthcare services after clinic utilization. Of patients who contacted SURC (n = 2174), a quarter (n = 553) stated they would have otherwise presented to the emergency department and 51% (n = 1108) reported they would have otherwise called the Day Oncology Unit. After implementation, more patients reported having a dedicated point of contact (OR 14.3; 95% CI 5.8-37.7) and ease of contacting the nurse (OR 5.5; 95% CI 2.6-12.1). Clinician reported experience and engagement with the clinic was highly favorable.The nurse-led emergency department avoidance model of care addressed a gap in service delivery, while optimizing service utilization by reducing ED presentations. Patients reported improved levels of satisfaction with ease of access to a dedicated nurse and advice provided.
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