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Care of the dying is an essential part of holistic cancer nursing. Improving nurses’ attitudes and behaviors regarding care of the dying is one of the critical factors in increasing the quality of nursing service. This study aims to examine the impact of an educational program based on the CARES tool on nurses’ attitudes and behaviors toward care of the dying.
Methods
A quasi-experimental study with pre- and post-intervention measures was conducted. A total of 222 oncology nurses from 14 hospitals in Beijing, China, were enrolled using a convenient sampling method. This online educational course developed based on the CARES framework comprised 7 modules and 10 sessions. Each session was carried out twice a week over 30–60 min. Data were collected using a sociodemographic characteristics questionnaire, the Frommelt Attitude Towards Care of the Dying Scale (FATCOD) and the Nurses’ Practice Behavior Toward Care of the Dying Questionnaire (NPBTCOD). Reassessment of attitudes and behaviors was conducted when completed the learning and 6 months after the learning, respectively. The sociodemographic characteristics of the nurses were analyzed using descriptive statistics, and differences in attitudes and behaviors were reported and compared by the paired t-test.
Results
All the 222 oncology nurses completed educational courses, and 218 nurses (98.20%) completed the pre- and post-attitudes evaluation and 213 (95.9%) nurses completed the pre- and post-behaviors evaluation. The mean (SD) FATCOD score before and after the educational program was 108.83 (12.07) versus 115.09 (14.91), respectively (t = −8.546, p ≥ 0.001). The mean (SD) NPBTCOD score before and after the educational program was 69.14 (17.56) versus 73.40 (18.96), respectively (t = −3.231, p = 0.001).
Significance of results
This educational intervention was found to be an effective method for improving oncology nurses’ attitudes and behaviors toward caring for dying patients.
To explore the association between the implementation of a new model of supervision and the impact of undergraduate nursing students’ interest in working in primary health care.
Background:
There is a need for more nurses in primary health care. To influence undergraduate nursing students to work in primary health care after graduation, the experience of their clinical practice in primary health care must be rewarding. In this study, we have implemented an alternative model of supervision for undergraduate nursing students in clinical practice, called ‘strengthened supervision during clinical practice’. In this model, lectures from the university are responsible for giving support and tutoring the nurse supervisor in primary health care.
Method:
Undergraduate nursing students in Norway (69) participated in an implementation of a new model for supervision in clinical practice. Thirty-one completed a questionnaire consisting of 15 questions. The questionnaire was analyzed using descriptive analyses.
Finding:
Undergraduate nursing students positively evaluated interactions with their fellow undergraduate nursing students in the primary health care setting. The undergraduate nursing students reported the nurse supervisor as most important for their perception of the practice site, followed by the work environment and their peers. When asked where they planned to work after graduation, very few undergraduate nursing students selected primary health care. It seems like aspects of the new model, ‘strengthened supervision during clinical practice’ are successful, but further research must be undertaken to explore whether this new model continues to be successful.
Neuromonitoring is a shared responsibility in the ICU with several key roles for bedside nursing staff, including the identification and reporting of trends. Nursing staff should be familiar with equipment and supplies needed for neuromonitoring as well as troubleshooting common artifacts and problems. Guideline development and ongoing education are essential to the success of any neuromonitoring program. This chapter provides suggested pathways for integrating bedside neuromonitoring into clinical practice and discussion of day-to-day nursing roles and responsibilities related to bedside monitoring. Multiple modalities, including EEG, aEEG, QEEG, and NIRS, are discussed.
Being an effective and well-rounded nurse in Australia is not just about technical skills - it's also about thinking like a nurse. The Road to Nursing helps students develop clinical reasoning and critical reflection skills, understand the philosophical and ethical considerations necessary to care for clients and reflect on how to provide care that meets the unique needs of clients. This edition retains three parts which guide students through their transition to university, formation of a professional identity and progression to professional practice. A revised chapter order improves the transition between topics and a new chapter explores the ever-changing Australian health landscape, including recent technological innovations. Each chapter includes definitions of key terms, reflection questions, perspectives from nurses, end-of-chapter review questions, research topics and resources that connect students with the real-world practice of nursing. Written by healthcare experts, The Road to Nursing is a fundamental resource for students beginning a nursing career.
What do you expect the first year of professional nursing practice to be like for you, personally and professionally? This chapter encourages you to consider how you will manage the change, the skills you need to refine and self-support strategies you need to develop in your final year so that you are well placed for a successful transition to professional registered nursing practice. There are many things you can do to prepare yourself for this journey of transition to the role of registered nurse. This chapter focuses on preparing you to enter the nursing workforce. For the beginning registered nurse, this process is known as the transition to professional practice. Key concepts related to professional socialisation and the reality shock that can occur for new graduate nurses are examined to help you understand what you may experience during this journey. The expectations of new graduates regarding identity, autonomy and professionalism as they enter the nursing workforce are also investigated. Finally, this chapter explores preparing for the graduate year through professional portfolios and resumes, refinement and preparing applications for graduate nurse positions.
What does it actually mean to be professional? How can students develop their own sense of self, and how might this interact with their professional identify and performance? This chapter explains self-awareness and the importance of understanding your own values, beliefs and motivations in order to better understand the diverse experiences of others, and to nurture the therapeutic and professional relationships that are essential for quality nursing practice.
The role of emotional and social intelligence in understanding ourselves and others is also explored, as this concept is closely linked to self-awareness. Critical reflection and mindfulness are suggested as two strategies for fostering the development of greater self-awareness and better self-care, which may assist in caring for others with empathy, compassion and ‘intelligent kindness’. In essence, enhancing your self-awareness,self-care, understanding and compassion for others will help you interact and communicate more effectively, reconcile any differences or conflicts that may arise, and better cope with the emotional demands inherent in healthcare practice (Foster et al. 2015, Kelly, Runge & Spencer 2015).
A ‘nursing philosophy’ underpinning the curriculum is mandated by the accrediting body, the Australian Nursing and Midwifery Accreditation Council (ANMAC). We believe that a rigorous philosophical position underpinning nursing theory and practice can provide a focus for the discipline in terms of practical reasoning and moral commitment.
This chapter introduces the concept of gratitude as an example of a virtuous character trait. Aristotle recognised the importance of properly trained emotions for acquiring the virtues; thus his account is consistent with our emphasis on emotional intelligence and self-awareness. We show how excellent practice as a nurse aligns with doing well as a human being. The main point argued in this chapter is that Aristotle’s conception of virtue can provide a philosophical ‘basis for nursing that focuses on moral competence in a robust, coherent and systematic way, while at the same time accommodates the demand for discipline-specific knowledge and high levels of technical skill’ (Bliss et al. 2017, p. 1). We contend that this underpinning philosophy allows the knowledge and caring aspects of nursing to be united.
Critical thinking and problem-solving, clinical reasoning, self-reflection and self-awareness are valued attributes of the contemporary nurse. These skills are essential for the provision of safe and competent person-centred care to clients with ever-increasing acuity and multiple, often complex comorbidities. This chapter focuses on critical thinking, clinical reasoning and reflective practice, and personal documentation using e-portfolios, along with strategies to assist beginning nurses in the development of these specific skills, which should be honed, practised and adapted to everyday clinical practice. The chapter also assists the professional nurse to develop methods to demonstrate their personal and professional development through the use of e-portfolios.
The challenges associated with delivering quality client care within healthcare systems and environments are characterised by increasing complexity and acuity in client needs, rising consumer (and public) expectations, and increasingly constrained human and financial resources, all of which are everyday realities for many nurses (Courtney et al. 2015). In this context, empowering nurses with the skills, attributes and confidence needed to have control and influence over their own practice is critical. This chapter makes explicit the notions of leadership and empowerment inherent in other chapters, with a particular emphasis on the responsibility we all have to advance the quality and excellence of nursing practice and also to be a voice for our profession and leaders in the changes and improvements necessary to promote optimal health outcomes for local and global communities (Grossman & Valiga 2021, Komives, Wagner, & Associates 2016). This chapter presents various perspectives on leadership and empowerment in nursing, and proposes some strategies and ideas for developing your own leadership potential.
The traditional stereotypical image of a nurse is closely linked to that of Florence Nightingale, the founder of modern nursing who established a training system to teach nurses how to be completely dedicated to the tasks of care, regardless of personal needs; to be dependent upon and deferential to authorities such as medical doctors and matron supervisors; and how to comport with modesty and femininity. Of course, contemporary nursing is no longer a profession exclusively female, nor does nursing work predominantly involve dependent actions. However, these outdated ideas remain strong in the minds of the public and are often repeated in popular culture.
The portrayal of nurses in the media has a powerful effect on perception by the public, clients and within themselves (Stanley et al. 2019). Sadly, their public image may not correspond with personal reality (Rauen et al. 2016), and this is the central argument in this chapter.
Luckily for nursing, we have overwhelmingly been imaged as good – helpful, caring, ethical and practical. This chapter explored the evolution of the nursing profession and consider the effect of image on contemporary nursing. It invites you to reflect on whether these public perceptions have influenced you, your decision to be a nurse and your future actions.
Communication is recognised as an important factor in interprofessional collaboration and teamwork. The delivery of optimal person-centred care ‘requires healthcare professionals to effectively communicate, cooperate and collaborate with each other’ (Stanley & Stanley 2019). Interprofessional communication can ensure that information is shared with a collective purpose and clearly defined goals. Thomson and colleageues(2015) demonstrated that having a shared purpose to pursue quality improvement as well as collaboration provides a framework for interprofessional, person-centred care that is highly dependent on effective communication. This chapter outlines the principles of interprofessional communication as well as five competencies that can contribute to collaborative practice. Handover frameworks are explored, along with the value of teamwork. The chapter also examines how nurses and other health professionals recognise and understand conflict as it discusses strategies for managing difficult situations. Finally, professional development is explored through peer learning, mentoring and supervision, with some examples of how this can be achieved.
Becoming a nurse is more than just being able to demonstrate clinical skills or understand disease processes. It is about critical thinking – understanding why we do what we do and how to do it in ways that optimise quality and safety. Achieving the best outcomes for clients is always paramount. This chapter explores the foundational principles of contemporary nursing practice: evidence-based practice, person-centred care, and therapeutic and professional communication; all contributing to a safe practice environment. It also introduces the growing role of technology in health care and looks at how numerous factors come together to influence health outcomes for the individual client.
All regulated health practitioners need to be aware of the standards imposed on them by their regulatory body in order for them to be able to practise and keep the public safe. In Australia, the standards for nurses and midwives have been developed by the Australian Health Practitioner Regulation Agency (AHPRA), which regulates the Australian workforce through the Nursing and Midwifery Board of Australia (NMBA).
This chapter helps you understand your obligations to obtain and maintain your nursing or midwifery registration, and your legal, regulatory and moral obligations both as a professional and as an individual. It differentiates the scope of practice for the registered nurse, enrolled nurse and midwife.
The first section discusses general legal and regulatory requirements for nurses. Next, we turn to the Professional Practice Framework that constitutes a key part of nurses’ legal and regulatory obligations. This framework forms the overarching statement of nursing’s values contained in a number of codes and standards. The next section covers professional boundaries before we make some brief remarks relating to scope of practice.
In this chapter, you will learn how to plan your study around your existing commitments. You are encouraged to build on your strengths and improve in areas that may hold you back. You will learn how to find time to study and be kind to your future self. This chapter gives you an idea of the different kinds of academic support you may be able to access and provides some hints for using the online study environment to your advantage.
Learning at university is often self-directed, and the skills developed and employed in your nursing education can help to ensure you have acquired the graduate attributes needed to continue learning while you practice as a nurse.
This chapter provides you with strategies to enhance your study and to be successful in your learning endeavours. You will discover that you learn from your teachers and educators as well as from your peers and networks. You will be provided with hints for making both formal and informal peer support and group work function effectively for you. Finally, you will be given suggestions for using social media to help feel connected while simultaneously avoiding common pitfalls in your journey to become the best nurse you can.
In accordance with the standards for nursing and midwifery education, training and assessment, the Australian Nursing and Midwifery Accreditation Council (ANMAC) requires students to engage in professional placement experiences as part of an accredited program of undergraduate study, with mandatory hours of activity linked to successful learning outcomes and registration to practise as a nurse in Australia (ANMAC 2017, Ford et al. 2016, Schwartz 2019). Clinical placements are therefore a central component of nursing education, complementing the theoretical foundations and simulation-based learning provided at university.
Preparing you for professional practice is the overarching goal of nursing education. Your success in professional experience placements depends on your ability to effectively draw upon and translate your learning to the clinical practice context and environment. This chapter provides specific information and strategies to help you to better understand and succeed in the clinical practice component of your degree program. The chapter also introduces the rapidly expanding role of social media in nursing education and practice.
The heart of nursing is intrinsically linked to what you do as a nurse and why you do it, but it is also about how you do it – the ways in which you represent and enact the core values and intent of the profession.
While some of your views and beliefs are likely to be shared with other students and experienced nurses, your reasons for wanting to be a nurse, and what you consider to be at the heart of nursing, will vary depending on your personal perspectives and experiences. This chapter begins by considering some of the common perspectives on nursing, noting how your own perspective is likely to change as you progress through your studies and into practice. We look at why people choose nursing, the different views and influences they are likely to encounter and the diverse range of roles and settings in which they may work. We then discuss how this informs what it means to be a nurse and your emerging sense of professional identity. The chapter concludes by exploring caring, compassion and kindness – concepts that lie at the heart of nursing, even though they are likely to be understood, applied and experienced differently in the context of each nurse’s own practice.
Being a safe and ethical nurse in health care requires an understanding of the frameworks that underpin and guide nursing practice. A generalised healthcare safety system known as clinical governance is implemented to ensure the wellbeing of all those in the healthcare system.
In addition to a clinical governance framework, healthcare staff also work within ethical and legal frameworks that underpin and govern their practice. In a nurse’s daily practice, every action is based on the need to make informed decisions, which are based on the nurse’s moral and ethical principles, their knowledge and understanding of different clinical situations and the legal accountabilities underpinning nursing practice. To make informed decisions, nurses must be aware of their own ethical stance and consider this, together with legal and professional requirements such as the codes of ethics and professional conduct (ICN, 2012, NMBA 2018), and the Registered Nurse Standards for Practice (NMBA 2016).
This chapter discusses the frameworks that guide practice. It introduces the concepts of quality and safety, clinical governance, clinical risk, ethical issues and the tenets of professionalism.
Most people are familiar with the World Health Organization's (WHO) definition of health, which was incorporated in the WHO Constitution in 1946: ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ Despite this decades-old definition, many governments and health services continue to take a ‘sick care’ view of health rather than focusing on wellness. In this chapter, we examine models of health and discuss the principles of primary health care in relation to the concept of health. We explore health and illness as culturally constructed experiences which reinforce the need for nurses to practice person-centred care.
A range of healthcare services are considered as the healthcare continuum is explored. We introduce the components of the Australian healthcare system and explain the fundamental aspects of Australia’s ‘universal’ healthcare coverage provided by Medicare. The concepts of primary, secondary and tertiary care are introduced and differentiated from primary, secondary and tertiary levels of health care. The chapter concludes with a discussion of the contribution of nurses and nursing to our healthcare system.
Health care in Australia is delivered through a large, diverse and complex system (or set of systems) that is constantly evolving and changing. The system is often considered to be in a state of perpetual change, with frequent restructuring of healthcare priorities and how services are organised, funded and governed (Reynolds, Willis & Rudge 2020).Within this dynamic system and reform agenda, a chapter on contemporary health care can describe how things currently stand but these existing roles and services need to be considered in the context of the frequent changes as noted. Even similarly named roles and services can differ in design and implementation based on local needs and priorities and the varied strategic, policy and operating contexts of different organisations and settings.
We begin the chapter by briefly revisiting some of the key concepts from Chapter 4 and examining the current health landscape. We then turn to some of the current and emerging issues, trends and opportunities in health care, and explore how these might influence and shape the ways in which health, social and community services are designed, prioritised and delivered in Australia.
This final chapter weaves together some of the key focus areas that have made up this ‘journey’, using stories from practice that may provide you with some further insights to guide you on your path to becoming a skilled and experienced nurse.
The second part of this chapter focuses on the fact that, once you enter the profession as a beginning-level nurse, this is not the end of your journey; it is only the first stage of your career. There are many options and learning opportunities that can further your career and assist you to develop into an expert nurse across a range of settings.
The last part of this chapter focuses on how you can contribute to the further development of the nursing profession by role-modelling and promoting nursing, mentoring and supporting others, and developing and sharing your skills and knowledge with new generations of nurses.
Nursing is a diverse and varied profession that is at times rewarding, challenging, happy and sad. Nurses are the most vital cog in the development, delivery and leadership of health services to meet the current and future health needs of society. You have chosen a rewarding and exciting career!