Utilizing the 2022 Oncology Navigation Standards of Practice to Revise a Mixed Oncology Navigation Practice Model

OBJECTIVES

The 2022 Oncology Nursing Society Oncology Navigation Standards of Professional Practice offer a framework for role delineation in oncology navigation. The goal of completing a job task analysis using the standards with four independent navigation teams was to identify a core map of work which would align skills, experience and knowledge with clinical nurse navigators, social work navigators, and patient navigators. Role delineation reduces suboptimal use of resources and inconsistent navigation services.

METHODS

An independent job task analysis was conducted with each of the four oncology navigation teams. Patient navigators and clinical nurse navigators were asked to report on each requested task over a 2-week period. The team discussed and determined alignment or misalignment with the standards. This discussion included the request and skill level of each navigator.

RESULTS

Sixty percent of the tasks identified in the job task analysis were in alignment with the standards for role and level of care. Thirty percent of the tasks aligned for role, but not for level of care, with nurse navigators performing a high number of non-nursing/clerical tasks. Ten percent were outside the scope of navigation.

CONCLUSIONS

Four enterprise opportunities were identified: (1) formalize standards for Tumor Board management, (2) create a core model for essential metrics, (3) establish standardized process for medical record retrieval for new oncology patients, and (4) explore alternative staffing models.

IMPLICATIONS FOR NURSING PRACTICE

Using a job task analysis allows time for meaningful exploration of roles and scope of work completed by the team. High work volume for navigation teams often leads to a "this is the way we've always done it" mentality. A job task analysis provides a structured approach with dedicated time and a safe space for navigators to "think critically" about their daily work, identify opportunities for change, and progress using this framework.

Implementation and utilisation of Australian critical care practice standards: What do we know?

BACKGROUND

The Australian College of Critical Care Nurses published the third edition of practice standards (PSs) for specialist critical care nurses in 2015. Higher-education providers currently use these standards to inform critical care curricula; however, how critical care nurses perceive and use PSs in clinical practice is unknown.

OBJECTIVES

The objective of this study was to explore critical care nurses' perceptions about the Australian College of Critical Care Nurses PS for specialty critical care nursing, to understand how the PSs are used in clinical practice, and what opportunities exist to support their implementation.

METHODS

An exploratory qualitative descriptive design was used. A purposive sampling strategy was used, with 12 critical care specialist nurses consenting to participate in semistructured interviews. The interviews were recorded and transcribed verbatim. Transcripts were analysed thematically using an inductive coding approach.

FINDINGS

Three main themes were identified: (i) lack of awareness of the PS; (ii) minimal to no utilisation of the PS in clinical practice and the challenges contributing to this; and (iii) improving the implementation and utilisation of the PS in clinical practice.

CONCLUSIONS

There is a significant lack of awareness and utilisation of the PS in clinical practice. To overcome this, increasing recognition, endorsement, and valuation of the PSs to stakeholders at an individual, health service, and legislative level are suggested. Further research is required to establish relevance of the PS in clinical practice and understand how clinicians use the PS to promote and develop critical care nursing.

The development of practice standards for patient education in nurse-led clinics: a mixed-method study

INTRODUCTION

Educating patients and families about self-care is one of the important roles of nurses in Nurse-led clinics (NLCs). NLCs need standards for guiding the practice of nurses. A standard is an authoritative statement that sets out the legal and professional basis of nursing practice. This paper seeks to report the development of practice standards for patient and family education in NLCs.

METHODS

This project used a Sequential-Exploratory mixed methods design. Before the study, we conducted a literature review to identify gaps. Directed content analysis was used in phase 1. The second phase involved two focus groups. The third phase involves two rounds of modified Delphi.

RESULTS

Twenty-nine participants were interviewed, and 1816 preliminary codes were formed in phase 1. 95 standards were grouped into three main categories (structure, process, and outcome). In the first focus group, experts eliminate 32 standards. Experts eliminate 8 standards after the second stage of the focus group. After two rounds of Delphi, the final version of the standard consists of 46 standards (13 structure, 28 process and 5 outcome).

CONCLUSIONS

Nurses and institutions could benefit from practice standards for patient education in the NLCs, which consist of 46 statements in three domains, as a guide for clinical activities and a tool to gauge the quality of patient education in NLCs. The developed standards in this study can guide new and existing NLCs and help them evaluate ongoing activities. Providing patient education in NLCs based on standards can improve patients' outcomes and promote their health.

Towards defining and supporting pharmacists' professional role associated with traditional and complementary medicines - A systematic literature review

BACKGROUND

A review conducted in 2015 reported community pharmacists are willing to adopt a professional role in counselling consumers about the appropriate and safe use of traditional and complementary medicines (T&CM) but faced multiple barriers in doing so; including the role being poorly defined. This current review aimed to update and extend these findings, by identifying studies published since 2015 that reported on pharmacists across any setting.

METHODS

Eligible studies published between January 01, 2016 and December 31, 2021 were identified across six databases (PubMed, Scopus, Web of Science, EMBASE, ScienceDirect and MEDLINE). A grounded theory approach was used to thematically synthesize the data extracted.

FINDINGS

A total 64 studies representing pharmacists across 30 countries were included for review. Study designs varied including cross-sectional surveys (n = 36), qualitative studies (n = 14), and pseudo-patient studies (n = 3). Eight studies reported on practice and/or bioethical responsibilities and 19 studies reported on factors that would enable pharmacists to fulfill these responsibilities, while 37 studies reported about both.

CONCLUSION

These findings indicate research about pharmacists' responsibilities associated with T&CM is evolving from gap analysis towards research that is proactive in advocating for change in multiple areas. These findings can be used to inform a consensus discussion among pharmacists and key stakeholders regarding a set of professional responsibilities that would serve in the development of: a clearly defined role and associated practice standards, and competency requirements that inform educational learning objectives for inclusion in undergraduate, post-graduate and continuing professional pharmacy education.

Evaluation of a model of online, facilitated, peer group supervision for dietitians working in eating disorders

BACKGROUND

The recently published Australia and New Zealand Academy of Eating Disorders (ANZAED) practice and training standards for dietitians providing eating disorder treatment recommended dietitians working in eating disorders (EDs) seek further clinical experience, training, and supervision to provide effective evidence-informed treatment. Access to dietetic clinical supervision is problematic, secondary to limited trained supervisors, location, cost, and lack of organizational support. Demand for clinical supervision increased with the 2022 introduction of ANZAED credentialing for eating disorder (ED) clinicians in Australia and addition of the Eating Disorder Management Plan to the Medicare Benefits Scheme. In 2018, QuEDS piloted a model of online peer group supervision with the goal of increasing service capacity to provide ED-specific clinical supervision to dietitians. Positive evaluation of the pilot led to the rollout of QuEDS Facilitated Peer Supervision (QuEDS FPS) program which was evaluated for utility and acceptability.

METHODS

By August 2021 five QuEDS FPS groups were established each with a maximum of 10 Queensland-based dietitians from public hospital, community, or private practice plus an additional Facilitator and Co-facilitator. A total of 76 participants enrolled in the program over the study period in addition to the 10 participants from the pilot program. Participant experience was evaluated with anonymous, voluntary surveys at baseline (59 responses), 6 months follow-up (37 responses), plus a one-off survey in August 2021 (50 responses). Pilot participant's Baseline and Follow-up surveys were not included in this evaluation.

RESULTS

Survey responses were positive across the four Kirkpatrick training evaluation domains of reaction, learning, behavior, and results. Respondents reported positive change to clinical practice (98%), including increased confidence to implement evidence-informed guidelines, and improved engagement with, and advocacy for, ED clients. Service capacity to provide supervision was increased by high participant to Facilitator ratios (10 participants to one Facilitator and one Co-facilitator) and recruitment of external Facilitators. Respondents indicated they would recommend QuEDS FPS to other dietitians and 96% planned to continue with the program.

CONCLUSIONS

QuEDS FPS program increases capacity to provide supervision with demonstrated positive impacts on dietitians' confidence and ability to deliver dietetic interventions in the ED arena and, by inference, the dietetic care of people with an ED.

Do pharmacy practice standards effectively describe behaviour? Reviewing practice standards using a behavioural specificity framework

Background

Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is important that they describe behaviours explicitly so they can be interpreted, enacted and measured with ease. The AACTT framework specifies behaviour in terms of the: Action to be performed, Actor who performs the action, Context where the action occurs, Target who the action is performed with/for and Time when the action is performed (AACTT). It provides the most up to date framework for specifying behaviours and is particularly relevant to complex behavioural problems that involve sequences of behaviours performed by different people. Behavioural specificity within pharmacy practice standards has not been explored.

Aim

To determine if behaviours described in the Professional Practice Standards for Australian Pharmacists specify Action, Actor, Context, Target and Time.

Methods

Two researchers independently reviewed the scope and structure of the practice standards and one extracted action statements (behaviours) verbatim. Through an iterative process, the researchers modified and developed the existing AACTT definitions to operationalise them for application to review of the action statements in the practice standards. The operational definitions, decision criteria and curated examples were combined in a codebook. The definitions were consistently applied through a directed content analysis approach to evaluate all extracted action statements by one researcher. For consistency 20% was independently checked for agreement by a second researcher.

Results

A novel codebook to apply AACTT criteria to evaluate practice standards was developed. Application of this codebook identified 768 independent behaviours. Of these, 300 (39%) described at least one discrete observable action, none specified an actor, 25 (3%) specified context, 131 (17%) specified target and 88 (11%) specified time.

Conclusion(s)

The behaviours detailed in practice standards for Australian pharmacists do not consistently specify behaviours in terms of Action, Actor, Context, Target and Time. Developers in the pharmacy profession, and beyond, should consider the behavioural specificity of their documents to improve interpretability, usability and adherence to the behaviours detailed. This also has implications for the development and evaluation of interventions to change such behaviours and improve quality of care.

Use of professional practice guidance resources in pharmacy: a cross-sectional nationwide survey of pharmacists, intern pharmacists, and pharmacy students

Background

Variations in practice are commonplace in healthcare where health professionals, such as pharmacists act as autonomous practitioners. This is evident in simulated patient studies, where pharmacists practice does not meet widely accepted standards for medicines supply or treatment of an ailment. To promote best pharmacy practice a myriad of guidance resources including practice guidelines, codes and standards are produced by professional organisations. These resources provide a framework for pharmacy practice and endeavour to facilitate consistency in provision of pharmacy-based services to consumers. Despite their role in specifying essential pharmacist behaviours, there is limited research exploring if and how these resources are used in practice.

Objective

To characterise Australian pharmacists’ use of the Pharmaceutical Society of Australia’s Code of Ethics, Professional Practice Guidelines and Professional Practice Standards.

Methods

A cross-sectional, self-administered, electronic survey of registered pharmacists, intern pharmacists and pharmacy students living in Australia was conducted in July 2020. Questions considered use of professional practice resources (by resource group) in the preceding 12 months. Data were analysed descriptively.

Results

Of 601 responses included in the analysis 462 (76.9%) of respondents were registered pharmacists, 88 (14.6%) pharmacy students and 51 (8.5%) intern pharmacists. Interns and students accessed overarching practice resources, such as the Professional Practice Standards, Code of Ethics and Dispensing Practice Guidelines more frequently than practising pharmacists. Pharmacists accessed professional practice guidelines, such as Practice Guidelines for the Provision of Immunisation Services Within Pharmacy, more often than students. More pharmacists than interns and students indicated that they would access guidelines to resolve practice and patient care issues. All resources except the Professional Practice Standards for Pharmacists (67.4%) were accessed by less than 50% of respondents in the preceding 12-month period. Reasons for not accessing resources varied between participant and resource groups, and generally were due to a lack of awareness of the resource or not considering them necessary for the individual’s practice.

Conclusion(s)

Access and use patterns for professional practice guidance resources change with experience. Professional organisations responsible for developing resources should consider these patterns when designing and reviewing resources and related policies. To ensure resources are meeting the needs of the profession, students, interns, and pharmacists should be involved in the review of and design of further resources.

Pharmacy students access core guidance resources more than practising pharmacists.

Pharmacists and interns access service specific resources more than students.

Most resources were accessed by less than half of respondents in a 12-month period.

Resources used to update knowledge, check practice and improve resource familiarity.

Irrelevant content, no perceived need for information and poor awareness limited use.

Practice expectations for Australian graduate emergency nursing programs: A Delphi study

BACKGROUND

Practice standards in nursing provide minimum expectations to enable the provision of high quality and safe care. There are currently no practice standards for post-registration graduate emergency nursing programs in Australia, leading to variation in graduate attributes and clinical expectations on completion of their program.

OBJECTIVES

The aim of this study was to establish consensus-based practice standards for graduate emergency nursing programs in Australia.

DESIGN

Delphi approach.

PARTICIPANTS

Australian nurses who identified as an emergency nurse and currently worked, or previously worked, in an emergency care environment.

METHODS

A modified two-round Delphi method was used. The survey was divided into four sections of data collection, including demographics, graduate emergency nursing course entry requirements, graduate expectations, and clinical care capabilities. Data were analysed using descriptive statistics including calculation of content validity index (CVI).

RESULTS

There were 204 respondents in Round One and 153 respondents in Round Two. Respondents agreed that nurses wanting to undertake graduate studies in emergency nursing require prior experience in the emergency care environment and should be working a minimum of 0.5 full time equivalent (FTE) whilst completing their studies. Thirty-nine statements presented under graduate attributes achieved a CVI of >0.8. All 70 clinical care capability statements presented in Round Two achieved a CVI of >0.8.

CONCLUSION

This study generated the evidence to establish minimum practice standards for Australian graduate emergency nursing programs. The standards centre around three key areas: graduate entry requirements, graduate attributes and clinical care capabilities. The standards provide a clear guide for employers, educators and clinicians, and inform capabilities for early career emergency nurses.

ANZAED practice and training standards for dietitians providing eating disorder treatment

INTRODUCTION

Dietitians involved in eating disorder treatment are viewed as important members of the multidisciplinary team. However, the skills and knowledge that they require are not well characterised. Therefore, as part of a broader project to identify the key principles and clinical practice and training standards for mental health professionals and dietitians providing eating disorder treatment, the Australia & New Zealand Academy for Eating Disorders (ANZAED) sought to identify the key practice and training standards specific to dietitians. An expert working group of dietitians was convened to draft the initial dietetic standards. After expert review, feedback on the revised standards was then provided by 100 health professionals working within the eating disorder sector. This was collated into a revised version made available online for public consultation, with input received from treatment professionals, professional bodies and consumer/carer organisations.

RECOMMENDATIONS

Dietitians providing treatment to individuals with an eating disorder should follow ANZAED's general principles and clinical practice standards for mental health professionals and dietitians. In addition, they should also be competent in the present eating disorder-specific standards based around the core dietetic skills of screening, professional responsibility, assessment, nutrition diagnosis, intervention, monitoring and evaluation.

CONCLUSIONS

These standards provide guidance on the expectations of dietetic management to ensure the safe and effective treatment of individuals with an eating disorder. Implications for professional development content and training providers are discussed, as well as the importance of clinical supervision to support professional self-care and evidence-informed and safe practice for individuals with an eating disorder.

ANZAED practice and training standards for mental health professionals providing eating disorder treatment

INTRODUCTION

The Australia & New Zealand Academy for Eating Disorders (ANZAED) recently developed general principles and clinical practice standards recommended for mental health clinicians and dietitians providing treatment for people with eating disorders. Separate mental health practice and training standards were then devised as a foundation for strengthening the workforce and providing guidance to professional training programs and service providers on the minimal standards required for practice in the eating disorder field.

RECOMMENDATIONS

The present recommendations for mental health professionals providing eating disorder treatment describe the following practice and training standards: eating disorder treatment foundations (including co-ordination of services, establishing a positive therapeutic alliance, professional responsibility and knowledge of levels of care), assessment, diagnosis, intervention (including evidence-based intervention, managing psychiatric risk and managing co-morbid mental health problems), and monitoring and evaluation.

CONCLUSIONS

Further work is required to disseminate these standards to clinicians providing services across Australia to people with eating disorders, and to support adherence in the clinic room where they can translate to improved outcomes for clients. Pathways to supporting adherence include expert supervision of practice, incorporation in training and supervised practice in university settings, and support with checklists that can be used by consumers and referring professionals.

Credentialing for eating disorder clinicians: a pathway for implementation of clinical practice standards

Advances are needed to ensure safe and effective treatment is available for people with eating disorders. Recently developed clinical practice and training standards for mental health professionals and dietitians represent a significant step in this direction by providing a consensus statement on eating disorder treatment as a foundation on which to build competent practice. This commentary argues that a credentialing system could promote implementation of these practice standards through formal recognition of qualifications, knowledge, training and professional activities to meet minimum standards for delivery of safe and effective eating disorder treatment. Drivers for credentialing include the imperative to provide safe and effective care, promotion of workforce development in eating disorder practice and, importantly, readily available and transparent information for referrers, consumers, and carers to identify health professionals credentialed to provide eating disorder treatment. However, a number of factors must be considered to ensure that credentialing does not restrict access to care, such as prohibitively narrow criteria to become credentialed, absence of pathways for education, training, or professional development opportunities, and lack of consultation with or endorsement by stakeholders of the credentialing criteria, application and approval processes, and ways of identifying credentialed practitioners. Further work, including development of credentialing criteria and aligned training opportunities, currently being undertaken by the Australia & New Zealand Academy for Eating Disorders and the National Eating Disorders Collaboration in consultation with stakeholders in the eating disorders sector and health professions will advance understanding of the feasibility of a system of credentialing for eating disorders within Australia and New Zealand. The availability of clinical practice and training standards, supported by implementation pathways, including credentialing of eating disorders practitioners, aim to improve quality of life, reduce financial burden, and close the treatment gap.

Teleneurology during the COVID-19 pandemic: A step forward in modernizing medical care

BACKGROUND

The COVID-19 pandemic mandated rapid transition from face-to-face encounters to teleneurology visits. While teleneurology is regularly used in acute stroke care, its application in other branches of neurology was limited. Here we review how the recent pandemic has created a paradigm shift in caring for patients with chronic neurological disorders and how academic institutions have responded to the present need.

METHOD

Literature review was performed to examine the recent changes in health policies. Number of outpatient visits and televisits in the Department of Neurology was reviewed from Yale University School of Medicine and Johns Hopkins School of Medicine to examine the road to transition to televisit.

RESULTS

The federal government and the insurance providers extended their supports during the COVID-19 pandemic. Several rules and regulations regarding teleneurology were revised and relaxed to address the current need. New technologies for video conferencing were incorporated. The transition to televisits went smoothly in both the institutions and number of face-to-face encounters decreased dramatically along with a rapid rise in televisits within 2 weeks of the declaration of national emergency.

CONCLUSION AND RELEVANCE

The need for "social distancing" during the COVID-19 pandemic has created a major surge in the number of teleneurology visits, which will probably continue for the next few months. It may have initiated a more permanent transition to virtual technology incorporated medical care.

Consensus Statement of Standards for Interventional Cardiovascular Nursing Practice

Interventional cardiovascular nursing is a critical care nursing specialty providing complex nursing interventions to patients prone to clinical deterioration, through the combined risks of the pathophysiology of their illness and undergoing technically complex interventional cardiovascular procedures. No guidelines were identified worldwide to assist health care providers and educational institutions in workforce development and education guidelines to minimise patients' risk of adverse events. The Interventional Nurses Council (INC) developed a definition and scope of practice for interventional cardiac nursing (ICN's) in 2013. The INC executive committee established a working party of seven representatives from Australia and New Zealand. Selection was based on expertise in interventional cardiovascular nursing and experience providing education and mentoring in the clinical and postgraduate environment. A literature search of the electronic databases Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Health Source was performed, using the search terms: clinical deterioration, ST elevation myocardial infarction, vital signs, primary percutaneous coronary intervention, PCI, AMI, STEMI, acute coronary syndrome, peri-procedural care, unstable angina, PCI complications, structural heart disease, TAVI, TAVR, cardiac rhythm management, pacing, electrophysiology studies, vascular access, procedural sedation. Articles were limited to the cardiac catheterisation laboratory and relevance to nursing based outcomes. Reference lists were examined to identify relevant articles missed in the initial search. The literature was compared with national competency standards, quality and safety documents and the INC definition and scope of practice. Consensus of common themes, a taxonomy of education and seven competency domains were achieved via frequent teleconferences and two face-to-face meetings. The working party finalised the standards on 14 July 2017, following endorsement from the CSANZ, INC, Heart Rhythm Council, CSANZ Quality Standards Committee and the Australian College of Critical Care Nurses (ACCCN). The resulting document provides clinical practice and education standards for interventional cardiac nursing practice.

Towards Substantive Standardization: Ethical Rules as Ethical Presumptions

This paper argues that substantive ethical rules serve a critical ethical function, even in those cases where we should deviate from those rules. Assuming that the rules are valid provides decision-makers with the context essential to reaching a well-justified decision. Recognizing this helps to reconcile two attractive but incompatible positions regarding the evaluation of healthcare ethics consultants. The first position is that ethical rules can validly be used to evaluate the quality of consultants' advice, ensuring conformity to standards promoted by a significant portion of medical ethicists. The second position-the message of ethical particularism-is that we should not evaluate consultants according to strict rules, since good ethical advice may deviate from even the most carefully wrought moral rules. Steering a path between these extremes, I argue that we should evaluate the quality of consultations by examining whether consultants have communicated the relevant ethical rules to participants as ethical presumptions. In communicating presumptions, a consultant provides an indispensable ingredient to ethical decision-making, while leaving open the possibility that the ethical course of action involves violating the very ethical rules that one should presume.

A two phase study to revise the Australian Practice Standards for Specialist Critical Care Nurses

BACKGROUND

Observational work to develop the ACCCN Competency Standards was undertaken more than 20 years ago. Since then the landscape of critical care nursing as a specialty has changed and it is not known if the Competency Standards reflected contemporary practice.

OBJECTIVES

To revise the ACCCN Competency Standards for Specialist Critical Care Nurses to ensure they continue to meet the needs of critical care nurses and reflect current practice.

METHODS

A two-phased project was undertaken. In Phase I focus groups were held in all states. Thematic analysis was conducted using two techniques. The standards were revised based on the main themes. Phase II consisted of an eDelphi technique. A national panel of critical care nurses responded to three survey rounds using a 7 point likert-type scale to indicate their level of agreement with the revised standards. A 70% agreement level for each statement was determined a priori.

RESULTS

Phase I: 12 focus groups (79 participants) were conducted. Phase II: A panel of specialist critical care nurses (research, management, clinical practice and education) responded to round 1 (n=64), round 2 (n=56), and round 3 (n=40). Fifteen practice standards with elements and performance criteria were grouped into four domains (professional practice, provision and coordination of care, critical thinking and analysis, collaboration and leadership). The revised Practice Standards for Specialist Critical Care Nurses build upon and are additional to the Nursing & Midwifery Board of Australia National Competency Standards for Registered Nurses. The standards reflect contemporary critical care nurse practices using an expanded range of technologies to care for complex critically ill patients across the lifespan in diverse settings.

CONCLUSION

The national study has resulted in the 3rd edition of the Practice Standards for Specialist Critical Care Nurses. There was input from stakeholders and agreement that the revised standards capture contemporary Australian critical care nursing practice.

The consequences of English language testing for international health professionals and students: An Australian case study

AIM

To discuss the perceptions about the International English Language Testing System (IELTS) and its impact on migration and practice of migrant health professionals in Australia.

METHODS

Thematic analysis of interviews with 14 health industry participants and 35 migrated health professionals in Australia.

RESULTS AND DISCUSSION

Language testing is a barrier to health professional registration for migrant health workers in Australia. While two English language tests are recognised by the registration authorities in Australia, it is the International English Language Testing System that is most commonly used. This paper reports that study participants had underlying negative perceptions of the International English Language Testing System which they report, affect their move to Australia. These negative perceptions are caused by: frustration due to changes to processes for migration and registration; challenges regarding the structure of IELTS including timing of when test results expire, scoring requirements, cost, and suitability; and the resulting feelings of inadequacy caused by the test itself.

CONCLUSION

This study has shown that some respondents have experienced difficulties in relation to the International English Language Testing System as part of their migration process. It was found that there is very little research into the effectiveness of the IELTS as it is currently administered for overseas health care professionals. Several recommendations are provided including areas for further research.