Aggression on haemodialysis units: a mixed method study

Background Aggression on haemodialysis units is a growing problem internationally that has received little research attention to date. Aggressive behaviour by patients or their relatives can compromise the safety and well-being of staff and other patients sharing a haemodialysis session. Objectives The objectives of the study were twofold: First, to identify the prevalance and nature of aggression on haemodialysis units; and second, to investigate factors that contribute to aggressive behaviour on haemodialysis units. Design and Methods A cross-sectional, sequential mixed method research design was adopted, with two research methods utilised. Incidents of aggressive behaviour were recorded over a 12-month period, using a renal version of the Staff Observation Aggression Scale. Six months after the incident data collection had commenced, semi-structured qualitative interviews were conducted with 29 multidisciplinary members of staff. Results Over 12 months, 74 aggressive incidents were recorded. The majority of incidents involved verbal aggression, and the perpetrators were a minority of patients, relatives and staff. Two patients were responsible for 38% of all incidents; both patients had mental health problems. Distinct temporal patterns to the aggressive behaviour were observed according to the day of the week and time of day. Conclusion This study demonstrates that aggression is a significant problem on haemodialysis units, with verbal aggression most prevalent. The temporal patterns to aggression observed are related to the uniqueness of the haemodialysis setting, with a distinctly different treatment environment compared with other healthcare settings

Evidence‐informed practice versus evidence‐based practice educational interventions for improving knowledge, attitudes, understanding, and behavior toward the application of evidence into practice:A comprehensive systematic review of undergraduate students

Over the past three decades, there has been increasing attention on improving healthcare quality, reliability, and ultimately, patient outcomes, through the provision of healthcare that that is influenced by the best available evidence, and devoid of rituals and tradition (Andre, Aune, & Brænd, 2016; Melnyk, Gallagher‐Ford, Long, & Fineout‐Overholt, 2014; Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). There is an expectation by professional regulators such as the Nursing and Midwifery Council, United Kingdom (NMC, 2015) and the Health and Care Professions Council (HCPC, 2012) that the professional, as part of their accountability applies the best available evidence to inform their clinical decision‐making, roles and responsibilities. This is imperative for several reasons. Firstly, it enhances the delivery of healthcare and improves efficiency. Secondly, it produces better intervention outcomes and promotes transparency. Thirdly, it enhances co‐operation and knowledge sharing among professionals and service users, and ultimately, it improves patient outcomes and enhances job satisfaction. Indeed, the need to guide healthcare practice with evidence has been emphasized by several authors, including Kelly, Heath, Howick, & Greenhalgh, 2015; Nevo & Slonim‐Nevo, 2011; Scott & McSherry, 2009; Shlonsky & Stern, 2007; Smith & Rennie, 2014; Straus, Glasziou, Richardson, & Haynes, 2011; Tickle‐Degnen & Bedell, 2003; and Sackett et al., 1996. According to these authors, the effective and consistent application of evidence into healthcare practice helps practitioners to deliver the best care for their patients and patient relatives. Nevertheless, there is often an ineffective and inconsistent application of evidence into healthcare practice (McSherry, 2007; Melnyk, 2017; Nevo & Slonim‐Nevo, 2011)

Prácticas del enfermero en el contexto de la atención básica: scoping review

Objective: to identify and categorize the practices performed by nurses working in Primary Health Care and Family Health Strategy Units in light of responsibilities established by the profession’s legal and programmatic frameworks and by the Brazilian Unified Health System. Method: a scoping review was conducted in the following databases: LILACS, IBECS, BDENF, CINAHL and MEDLINE, and the Cochrane and SciELO libraries. Original research papers written by nurses addressing nursing practices in the primary health care context were included. Results: the review comprised 30 studies published between 2005 and 2014. Three categories emerged from the analysis: practices in the service; practices in the community; and management and education practices. Conclusion: the challenges faced by nurses are complex, as care should be centered on the population’s health needs, which requires actions at other levels of clinical and health responsibility. Brazilian nursing has achieved important advancements since the implementation of policies intended to reorganize work. There is, however, a need to shift work processes from being focused on individual procedures to being focused on patients so that an enlarged clinic is the ethical-political imperative guiding the organization of services and professional intervention.Objetivo: identificar e categorizar as práticas exercidas pelos enfermeiros junto às Unidades Básicas e às Equipes de Saúde da Família, à luz das atribuições previstas pelos marcos legais e programáticos da profissão e do Sistema Único de Saúde. Método: realizou-se uma revisão da literatura com o método scoping review, nas bases LILACS, IBECS, BDENF, CINAHL e MEDLINE, e nas bibliotecas Cochrane e SciELO. Incluíram-se artigos de pesquisa original, produzidos com enfermeiros, sobre as práticas de enfermagem no contexto dos cuidados de saúde primários. Resultados: a revisão abrangeu trinta estudos publicados entre 2005 e 2014. Da análise, resultaram três categorias: práticas no serviço, práticas na comunidade e práticas de gestão e formação. Conclusão: os desafios dos enfermeiros são complexos, posto que o cuidado deve estar centrado nas necessidades de saúde da população, o que remete à ação para outros níveis de responsabilidade clínica e sanitária. A enfermagem brasileira mostra importantes avanços desde a implantação das políticas de reorganização do trabalho. Necessita, entretanto, avançar no que se refere ao deslocamento dos processos de trabalho, focados em procedimentos individuais, para um processo mais voltado aos usuários, onde a clínica ampliada seja o imperativo ético-político da organização dos serviços e da intervenção profissional.Objetivo: identificar y categorizar las prácticas ejercidas por los enfermeros en las Unidades Básicas y los Equipos de Salud de la Familia, desde el punto de vista de las atribuciones previstas por los marcos legales y programáticos de la profesión y del Sistema Único de la Salud. Método: se realizó una revisión de la literatura con el método scoping review, en las bases LILACS, IBECS, BDENF, CINAHL y MEDLINE, y en las bibliotecas Cochrane y SciELO. Se incluyeron artículos de investigación original, producidos con enfermeros, sobre las prácticas de enfermería en el contexto de los cuidados de salud primarios. Resultados: la revisión abarcó treinta estudios publicados entre 2005 y 2014. Del análisis, resultaron tres categorías: prácticas en el servicio; prácticas en la comunidad; y, prácticas de administración y formación. Conclusión: los desafíos de los enfermeros son complejos, ya que el cuidado debe estar centrado en las necesidades de salud de la población, lo que conduce a la acción para otros niveles de responsabilidad clínica y sanitaria. La enfermería brasileña muestra importantes avances a partir de la implantación de las políticas de reorganización del trabajo. Necesita, entre tanto, avanzar en lo que se refiere al desplazamiento de los procesos de trabajo, enfocados en procedimientos individuales, para un proceso más dirigido a los usuarios, en donde la clínica ampliada sea el imperativo ético político de la organización de los servicios y de la intervención profesional.info:eu-repo/semantics/publishedVersio

Collaboration between teachers and speech and language therapists: Services for primary school children with speech, language and communication needs

Speech, language and communication needs (SLCN) are prevalent among primary school-aged children. Collaboration between speech and language therapists (SLTs) and teachers is beneficial for supporting children’s communication skills. The aim of this study was to investigate the needs of both professional groups and their preferences for service delivery when working with mainstream, primary school-aged children with SLCN. This study was undertaken within one education region in New South Wales, Australia, using a mixed-methods research design. In Phase 1, all teachers (schools n = 156) and all SLTs (n = 36) working within the region were invited to complete a questionnaire. Responses were obtained from 14 teachers and 6 SLTs. In Phase 2, a subsample of participants (n = 4) contributed to a focus group. Within the study sample, minimal collaborative practice was reportedly occurring. Teachers and SLTs expressed a desire for increased training and knowledge and more collaborative practice. Teachers and SLTs also expressed frustration at perceived systemic inadequacies with regard to funding, personnel and resources. Findings from this study suggest that change to service delivery needs to be considered at an individual, interpersonal and organizational level to enable better outcomes for children with SLCN and increased support for their families and the professionals who work with them

Antecedents and Consequences of Intragroup Conflict Among Nurses in Acute Care Settings

One of the contributing factors to the current nursing shortage is job dissatisfaction due to conflict in the workplace. In order to develop strategies to reduce conflict, research is needed to understand the causes and outcomes of conflict in nursing work environments. This study tested a theoretical model linking antecedent variables (core self-evaluation, complexity of nursing care, unit size, interactional justice, managerial support, unit morale) to intragroup conflict, followed by conflict management, and ultimately, job stress and job satisfaction. A predictive, non-experimental design was used in a random sample of 277 acute care nurses in Ontario. Structural equation modeling techniques were used to analyze the hypothesized model. Final analysis revealed relatively good fit of data to the hypothesized model (Chi-square = 211.7, df = 80, CFI = .92, RMSEA=0.07). Lower core self-evaluation, higher complexity of nursing care, lower interactional justice, and poor unit morale resulted in higher intragroup relationship conflict, and ultimately a less ‘agreeable’ conflict management style, higher stress and job dissatisfaction. Conflict management style partially mediated the relationship between conflict and job satisfaction. Job stress also had a direct effect on job satisfaction and core self-evaluation had a direct effect on job stress. The study results suggest that conflict and its associated outcomes is a complex process, affected by dispositional, contextual and interpersonal factors. Nurses’ core self-evaluations, complexity of nursing care and relationships with managers and nursing colleagues influences the level of conflict they experience. How nurses manage conflict may not prevent the negative effects of conflict on job stress and job satisfaction, however learning to manage conflict using collaboration and accommodation may help nurses feel more satisfied with their jobs. In addition, education programs that contribute to an individual’s ability to feel more confident about their ability to manage conflict may help them cope more effectively with the stress generated by conflict.Ph