Nurse managers’ support of fundamental care in the hospital setting. An interpretive description of nurse managers’ experiences across Australia, Denmark, and New Zealand

Clinical nurse managers play a vital role in the healthcare system. They are responsible for the day to day running of departments and ensuring that patients are safely cared for. The leadership behaviour and practices of a clinical nurse manager are fundamental for establishing and maintaining positive workplace culture, which is important for nurse performance and quality patient outcomes. This research sought to understand how clinical nurse managers build positive culture in their workplace and to identify leadership attributes and actions that they perceive to be important for generating positive workplace culture. Furthermore, it aimed to identify the challenges of creating positive workplace culture in Aotearoa New Zealand. A qualitative descriptive design was used to capture rich in-depth understanding and insight into clinical nurse manager experiences of positive workplace culture from their position in nursing leadership. Ten clinical nurse managers from one secondary hospital within the North Island of Aotearoa participated in semi structured face-to-face interviews. Data was transcribed and analysed using thematic analysis with assistance of NVIVO 12 coding software to manage the process of analysing transcripts. Findings demonstrated that clinical nurse managers deliberately engage in strategies to build positive workplace culture and the more prepared they were for their role, the better equipped they were to do so. Three themes were identified: role preparation, achieving perspective, and intentionality. The theme of role preparation describes the actions clinical nurse managers use to cope with realities of the job, build good teams, and manage uncertainty. The second theme achieving perspective represents the internal processes clinical nurse managers use to understand situations and make decisions. The final theme intentionality describes the leadership strategies clinical nurse managers use to enhance collaborative behaviour and positive relationships within the team. To prepare and develop nurses into leadership positions, organisations and executive leadership teams must actively invest in the preparation of this workforce. Establishing educational prerequisites and having structured orientation and mentoring programmes will build a clinical nurse manager workforce that is equipped to foster positive workplace culture in Aotearoa. Furthermore, conducting performance appraisals habitually will provide a foundation for training and development that is needed to keep nurses motivated and engaged in their workplace.

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The Older Nurse in the Workplace Retention or Retirement

10.26686/wgtn.16973854.v1 ◽

2021 ◽

Author(s):

◽

Samantha Powell

Keyword(s):

New Zealand ◽

Nurse Managers ◽

Healthcare Sector ◽

Nursing Workforce ◽

Work Place ◽

International Literature ◽

District Health ◽

Retention Strategies ◽

Charge Nurse ◽

Workplace Retention

The nursing workforce, as with other health professionals, is aging with 50% aged over 47 years. In combination with predictions of continuing nursing workforce shortages, an aging population and increasingly complex health environment, this presents a unique set of challenges to the healthcare sector as both the population and nursing workforce continue to age. A review of the international literature suggests that the majority of older nurses in the workplace (50 years and over), are highly experienced and have extensive knowledge and practice wisdom from their years of nursing. What is also clear is that the current environment does not always support this cohort of nurses and that they often feel less valued. As a consequence, in a time of unprecedented shortages, we are at risk of losing this valuable experience from the workplace prematurely. Some suggested strategies to support this group of nurses include consideration of health and safety issues, flexibility with rosters and shift pattern, options for part time work, continuing professional development and ensuring their experience and knowledge continues to be valued in the work place. This research was carried out to explore the understanding of the issues facing the older nurse in a New Zealand context. There is a significant gap in literature as to the experience in the workplace of older nurses in New Zealand. In relation to health workforce retention, strategies are described from a general workforce perspective. Specific strategies in relation to the retention of the older nurse are not addressed or described. The international literature describes both the older nurses' experiences and strategies that can be used to retain them in the workforce, which have relevance to the local healthcare environment. Using a descriptive survey design two groups of Clinical/Charge Nurse Managers in two separate District Health Boards were asked about their awareness of the issues facing older nurses and what strategies they were using to address them. It was the assumption that as a group they were very aware of the issues facing older nurses and were often using informal strategies in an attempt to retain this group of nurses. The aim of this research was to raise awareness of the needs of the older nurse in the workplace and to capture and describe the strategies being used. Results indicated that indeed the Clinical/Charge Nurse Managers were very aware of the issues facing older nurses in the workplace and were innovative in their attempts to retain them in the workplace, and these retention strategies were similar to those discussed in the international literature. The need for national direction and organisational policy in place to support the Clinical/Charge Nurse Managers' retention efforts was also raised in the literature and I believe also needs consideration in the New Zealand context.

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Quality use of antipsychotic medicines inresidential aged care facilities in New Zealand

Journal of Primary Health Care ◽

10.1071/hc15054 ◽

2016 ◽

Vol 8 (4) ◽

pp. 335 ◽

Cited By ~ 1

Author(s):

Henry C. Ndukwe ◽

Prasad S. Nishtala ◽

Ting Wang ◽

June M. Tordoff

Keyword(s):

New Zealand ◽

Adverse Effects ◽

Nurse Managers ◽

Aged Care ◽

Assessment Tools ◽

Residential Aged Care ◽

Staff Education ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

ABSTRACT INTRODUCTION Antipsychotic medicines are used regularly or when required in residential aged care facilities to treat symptoms of dementia, but have been associated with several adverse effects. AIM The aim of this study was to examine ‘quality use’ of antipsychotic medicines in residential aged care facilities in New Zealand, by surveying nurse managers. METHODS A cross-sectional survey was mailed to 318 nurse managers working in a nationally representative sample of aged care facilities. A purpose-developed, pre-tested, 22-item structured questionnaire was used to explore practice related to the quality use of antipsychotic medicines. RESULTS Overall, 31.4% of nurse managers responded to the survey. They mostly (88%) had ≥ 1 year’s relevant work experience and 83% of facilities provided care for those within the range of 21 to 100 residents. Respondents reported that staff education on dementia management occurred early in employment. Two-thirds of participants reported non-pharmacological interventions were commonly used for managing challenging behaviours, while less than half (45%) cited administering antipsychotic medicine. Respondents reported ‘managing behavioural symptoms’ (81%) as one of the main indications for antipsychotic use. Frequently identified adverse effects of antipsychotic medicines were drowsiness or sedation (64%) and falls (61%). Over 90% reported general practitioners reviewed antipsychotic use with respect to residents’ target behaviour 3-monthly, and two-thirds used an assessment tool to appraise residents’ behaviour. DISCUSSION Staff education on dementia management soon after employment and resident 3-monthly antipsychotic medicine reviews were positive findings. However, a wider use of behavioural assessment tools might improve the care of residents with dementia and the quality use of antipsychotic medicines.

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Nurses' Expectations of an Inpatient Portal for Hospitalized Patients and Caregivers

Applied Clinical Informatics ◽

10.1055/s-0039-1694750 ◽

2019 ◽

Vol 10 (04) ◽

pp. 625-633 ◽

Cited By ~ 1

Author(s):

Peter L. T. Hoonakker ◽

Rebecca J. Rankin ◽

Jennifer C. Passini ◽

Jenny A. Bunton ◽

Bradley D. Ehlenfeldt ◽

...

Keyword(s):

Nurse Managers ◽

Hospital Setting ◽

Cross Sectional Study ◽

Support Staff ◽

Patient Portals ◽

Implementation Barriers ◽

Patient Centered ◽

Cross Sectional ◽

High Expectations ◽

Job Roles

Background Patient portals are intended to engage patients and enhance patient-centered care. Recent studies suggest that the information within portals could provide benefits to patients and their caregivers during hospitalization; however, few studies have examined nurse and staff expectations of portals when used in the hospital setting. Objective This article examines inpatient nurse and support staff expectations of a commercially available inpatient portal prior to its hospital-wide implementation. Methods In this cross-sectional study, nurses and support staff were surveyed 1 month prior to the implementation of an inpatient portal for patients. Items included respondent characteristics, satisfaction with online inpatient portal training, expectations of the effects of portal use on patients, caregivers, and staff, overall acceptance, and barriers to its implementation. Results Of 881 respondents, 73.0% were staff nurses, 18.4% nurse assistants, 4.3% unit coordinators, and 1.2% nurse managers. Respondents were generally satisfied with the portal information they received from online training. A majority liked the portal to some extent prior to its use (66.7%); however, they noted multiple implementation barriers, including: tablets would get lost/damaged (66.2% of respondents), patients and/or caregivers would have too many questions (48.5%), and staff would have problems integrating it into their workflow (44.7%). Respondents working on medical units had higher expectations (p < 0.001) and acceptance (p < 0.01) of the portal than those on surgical and intensive care units. Nurse managers were more positive than respondents with other job roles were (all p < 0.001). Conclusion Overall, nurse and support staff had high expectations of the effects of inpatient portal use prior to its hospital-wide implementation. They thought it would benefit patients and/or their caregivers; however, they also perceived several barriers to its implementation. These results will be used in conjunction with patient and caregiver perspectives to inform future efforts to evaluate and improve upon inpatient portal implementation and dissemination across health systems.

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Families of victims of homicide: qualitative study of their experiences with mental health inquiries

BJPsych Open ◽

10.1192/bjo.2020.84 ◽

2020 ◽

Vol 6 (5) ◽

Author(s):

Lillian Ng ◽

Alan F. Merry ◽

Ron Paterson ◽

Sally N. Merry

Keyword(s):

Mental Health ◽

New Zealand ◽

Qualitative Study ◽

Healthcare Providers ◽

Mental Healthcare ◽

Interpretive Description ◽

Structured Interviews ◽

Mental Health Patient ◽

Loved One ◽

Inquiry Process

Background Investigations may be undertaken into mental healthcare related homicides to ascertain if lessons can be learned to prevent the chance of recurrence. Families of victims are variably involved in serious incident reviews. Their perspectives on the inquiry process have rarely been studied. Aims To explore the experiences of investigative processes from the perspectives of family members of homicide victims killed by a mental health patient to better inform the process of conducting inquiries. Method The study design was informed by interpretive description methodology. Semi-structured interviews were conducted with five families whose loved one had been killed by a mental health patient and where there had been a subsequent inquiry process in New Zealand. Data were analysed using an inductive approach. Results Families in this study felt excluded, marginalised and disempowered by mental health inquires. The data highlight these families’ perspectives, particularly on the importance of a clear process of inquiry, and of actions by healthcare providers that indicate restorative intent. Conclusions Families in this study were united in reporting that they felt excluded from mental health inquiries. We suggest that the inclusion of families’ perspectives should be a key consideration in the conduct of mental health inquiries. There may be benefit from inquiries that communicate a clear process of investigation that reflects restorative intent, acknowledges victims, provides appropriate apologies and gives families opportunities to contribute.

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Survey of Cuff Management Practices in Intensive Care Units in Australia and New Zealand

American Journal of Critical Care ◽

10.4037/ajcc2008.17.5.428 ◽

2008 ◽

Vol 17 (5) ◽

pp. 428-435 ◽

Cited By ~ 8

Author(s):

Louise Rose ◽

Leanne Redl

Keyword(s):

Intensive Care ◽

New Zealand ◽

North America ◽

Intensive Care Units ◽

Pressure Measurement ◽

Management Practices ◽

Current Practice ◽

Nurse Managers ◽

Cuff Pressure ◽

Pilot Balloon

Background Cuff management varies widely in Europe and North America. Little is known about current practice in Australia and New Zealand. Objective To characterize important aspects of cuff management in intensive care units in Australia and New Zealand to compare with international reports. Methods A questionnaire was sent to all nurse managers of adult intensive care units in Australia and New Zealand. Results Survey response was 53% (92/175). After intubation, most units (50/92, 54%) used both minimal occlusive volume technique and cuff pressure measurement; 5 (5.5%) used these methods along with pilot balloon palpation. Twenty units (22%) used cuff pressure measurement exclusively and 16 units (17.5%) used the minimal occlusive volume technique exclusively. Only 1 unit (1%) used the minimal leak technique after intubation. For ongoing management, cuff pressure measurement was the preferred method, used exclusively in 42 units (46%), with the minimal occlusive volume technique used in 40 units (43%; sole method in 6 units [7%]) and palpation in 4 units (4%). In most units (65/92, 71%), cuffs were monitored once per nursing shift. In units using the minimal occlusive volume technique, oropharyngeal suctioning (74%) and semirecumbent positioning (58%) were routinely incorporated; sigh breaths (6%), discontinuation of enteral feeding (10%), and nasogastric tube aspiration (26%) were uncommon. Cuff management protocols (37%) and subglottic suctioning (12%) were used infrequently. Conclusions Cuff pressure measurement was the preferred method, used exclusively or in combination with other methods. The minimal occlusive volume technique was used more often after intubation than for ongoing management.

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Abstract WP181: Incidence of Transient Ischemic Attack in Auckland, New Zealand, in 2011-2012

Stroke ◽

10.1161/str.47.suppl_1.wp181 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Peter A Barber ◽

Rita Krishnamurthi ◽

Priya Parmar ◽

Varsha Parag ◽

Valery L Feigin ◽

...

Keyword(s):

Risk Factor ◽

New Zealand ◽

Ethnic Groups ◽

Pacific Islands ◽

Hospital Setting ◽

Vascular Risk Factor ◽

Lipid Lowering ◽

Medical Attention ◽

Lipid Lowering Therapy ◽

Vascular Risk

Introduction: There have been few recent population studies reporting the burden of TIA. We aimed to determine the incidence (first ever in a lifetime) of TIA in an ethnically diverse population. Hypothesis: The incidence of TIA may vary by different ethnic group. Methods: The fourth Auckland Regional Community Stroke study (ARCOS IV) used multiple overlapping ascertainment methods to identify all hospitalized and non-hospitalized cases of definite TIA in people ≥16 years of age usually resident in Auckland (population ≥16 years was 1.12 million), over 12 months from March 2011. TIA was defined as an acute loss of focal cerebral or ocular function with symptoms lasting <24 hours, of presumed vascular cause. Patients with isolated vertigo, diplopia and non-focal symptoms were excluded. Results: There were 785 people with TIA [402 (51.2%) women, mean (SD) age 71.5 (13.8) years]. Of these, 614 (78%) were European, 32 (4.1%) Maori (indigenous people of New Zealand), 62 (8%) Pasifika (originating from the Pacific Islands) and 75 (10%) Asian/Others. Most (82%) TIA patients were seen in a hospital setting (emergency room, outpatient clinic or admitted). The annual age-standardized incidence of TIA was 40 (95% CI 36-43) per 100,000 people. The annual age-standardized incidence per 100,000 people of TIA was less in Maori (27; 95% CI 8-40) and Asian/Others (21; 95% CI 16-27) than in Europeans (45; 95% CI 41-50). Vascular risk factor profiles and treatment at presentation varied between the different ethnic groups. For example, non-Europeans were more likely to be diabetic (p<0.01), and Maori and Pasifika were less likely to be taking lipid-lowering therapy (p<0.01), than other groups. Conclusions: This study has demonstrated ethnic differences in the burden of TIA in an era of aggressive primary and secondary vascular risk factor management. We speculate that that the lower incidence of TIA seen in ethnic minorities may reflect a failure to seek medical attention as opposed to a true difference in incidence. If confirmed, programs targeting different ethnic groups, particularly those of lower socioeconomic status, and aimed at improving health literacy around vascular disease and reducing barriers to accessing health care, will be required.

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