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Article ; Online: Implementation of a nurse practitioner service in a rural setting: a qualitative analysis of healthcare practitioners' experiences.

Tower, Marion / Hyun, Areum / Denton, Michelle / Cottle-Quinn, Amanda

2024 , Page(s) 1–11

Abstract: Background: Nurse Practitioners work independently and collaboratively within multidisciplinary teams to fill unmet service delivery needs. Despite strong evidence of the benefits of the nurse practitioner service model, organisational support for nurse ...

Abstract	Background: Nurse Practitioners work independently and collaboratively within multidisciplinary teams to fill unmet service delivery needs. Despite strong evidence of the benefits of the nurse practitioner service model, organisational support for nurse practitioners varies in terms of resources and support from leadership and other healthcare professionals. Aims: The study aimed to explore healthcare practitioners' experiences of implementation of a NP service in a rural setting. Methods: Semi-structured interviews were conducted with ten healthcare practitioners to investigate their perspectives of a recently implemented NP service. Data were analysed inductively using thematic analysis. Findings: Themes emerged related to facilitating collaborative practice, person-centred continuity of care and positive health outcomes for the community. Challenges and limitations related to operational role clarity, scopes of practice and leadership. Conclusion: Healthcare practitioners were mostly satisfied with the service however challenges caused tension. Change management principles provide a framework to strengthen the effective clinical alignment of the service.
Language	English
Publishing date	2024-02-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1491361-6
ISSN	1839-3535 ; 1037-6178
ISSN (online)	1839-3535
ISSN	1037-6178
DOI	10.1080/10376178.2024.2316597
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Article ; Online: Invasive device-associated skin complications and mechanical dysfunctions in paediatric healthcare: A systematic review and meta-analysis.

Takashima, Mari / Hyun, Areum / Gibson, Victoria / Borello, Eloise / Ullman, Amanda

Journal of advanced nursing

2024

Abstract: Aim: This study aimed to estimate the proportion and rate of skin complications and mechanical dysfunction associated with indwelling invasive devices in paediatric healthcare.: Design: This systematic review is reported in accordance with Cochrane ... ...

Abstract	Aim: This study aimed to estimate the proportion and rate of skin complications and mechanical dysfunction associated with indwelling invasive devices in paediatric healthcare. Design: This systematic review is reported in accordance with Cochrane standards for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. Data sources: MEDLINE, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. Review methods: Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) paediatric participants admitted to a hospital, (3) reporting post-insertion device-associated skin complication and/or mechanical dysfunction, and (4) published in English, were included. Device-associated skin complication and mechanical dysfunction (infiltration, leakage, occlusion/blockage, dislodgement/malposition, breakage and others). Pooled proportion and incidence rate per 1000 device days are reported. Results: This review synthesized 114 studies (30,782 devices; 1,635,649 device-days). Skin complications were reported in 40 studies, but none exclusively reported individual device-related pressure injuries. Mechanical dysfunctions were well-reported for central venous access devices, peripheral intravenous catheters, nasogastric/gastric tubes and peritoneal dialysis catheters but less for arterial catheters, extracorporeal membrane oxygenation and ventricular assist devices. Conclusions: This systematic review highlights the need for standardized definitions and reporting methods to better surveil and benchmark device-related complications, particularly for understudied device types. Device-related pressure injuries were not reported in any of the included studies, and all devices except for vascular access devices require standardized reporting of complications. Impact: Despite the widespread use of invasive devices, comprehensive data on their prevalence, utility, and associated paediatric complications is limited. This review identified prevalent skin complications, occlusions and dislodgments in children with devices, underscoring the need for standardized reporting to enhance surveillance and understanding of paediatric device-related complications. Reporting method: MOOSE (Meta-analyses Of Observational Studies in Epidemiology) Checklist. Patient or public contribution: No Patient or Public Contribution.
Language	English
Publishing date	2024-01-23
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	197634-5
ISSN	1365-2648 ; 0309-2402
ISSN (online)	1365-2648
ISSN	0309-2402
DOI	10.1111/jan.16073
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Zs.B 1851: Show issues

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Article ; Online: Problem-solving processes for central venous catheter occlusion within pediatric cancer care: A qualitative study.

Hyun, Areum / Condon, Paula / Kleidon, Tricia / Xu, Grace / Edwards, Rachel / Gibson, Victoria / Ullman, Amanda

European journal of oncology nursing : the official journal of European Oncology Nursing Society

2024 Volume 69, Page(s) 102520

Abstract: Purpose: Central venous access devices play a crucial role in healthcare settings. However, there is concern regarding the high incidence of blockages occurring before the completion of treatments and existing guidelines for occlusion management are not ...

Abstract	Purpose: Central venous access devices play a crucial role in healthcare settings. However, there is concern regarding the high incidence of blockages occurring before the completion of treatments and existing guidelines for occlusion management are not consistently followed. To explore the decision-making and problem-solving process of occlusion management and identify enablers and barriers to implementing evidence for occlusion management in pediatric cancer care. Methods: A qualitative design with individual semi-structured interviews. Participants were selected by purposeful sampling from a tertiary-referral pediatric facility, and semi-structured interviews were conducted. Results: A total of 13 clinicians and 5 parents were interviewed. The thematic analysis revealed four main decision-making/problem-solving themes: 1) clinical reasoning and judgement for central venous access devices occlusion, 2) capability in central venous access devices occlusion management, 3) colleague collaboration in the escalation process and 4) lack of adequate support to manage the occlusion. This study identified positive and negative influences on the problem-solving process, including clinicians' psychological capabilities, social and physical resources, and beliefs about consequences. Conclusion: This study found that clinicians in pediatric cancer care were able to manage central venous access device occlusions using clinical reasoning and judgment skills, which may conflict with evidence-based practices. The study confirmed the importance of a team approach and prior experience in managing central venous access devices in pediatric oncology settings and identified potential conflicts between clinician decisions based on the patient's current and anticipated conditions and implementation of evidence-based practice. Improving documentation and providing visual aids could benefit clinicians' problem-solving processes.
MeSH term(s)	Humans ; Child ; Central Venous Catheters/adverse effects ; Neoplasms/therapy ; Medical Oncology ; Qualitative Research ; Documentation
Language	English
Publishing date	2024-02-09
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	2017117-1
ISSN	1532-2122 ; 1462-3889
ISSN (online)	1532-2122
ISSN	1462-3889
DOI	10.1016/j.ejon.2024.102520
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Article ; Online: Exploring clinicians' insertion experience with a new peripheral intravenous catheter in the emergency department.

Xu, Hui Grace / Hyun, Areum / Kang, Evelyn / Marsh, Nicole / Corley, Amanda

Australasian emergency care

2024

Abstract: Background: Hospitals frequently introduce new medical devices. However, the process of clinicians adapting to these new vascular access devices has not been well explored. The study aims to explore clinicians' experience with the insertion of a new ... ...

Abstract	Background: Hospitals frequently introduce new medical devices. However, the process of clinicians adapting to these new vascular access devices has not been well explored. The study aims to explore clinicians' experience with the insertion of a new guidewire peripheral intravenous catheter (PIVC) introduced in the emergency department (ED) setting. Methods: The study was conducted at two EDs in Queensland, Australia, utilising a qualitative explorative approach. Interviews were conducted with guidewire PIVC inserters, including ED doctors and nurses, and field notes were recorded by research nurses during insertions. Data analysis was performed using inductive content analysis, from which themes emerged. Results: The study compiled interviews from 10 participants and field notes from 191 observation episodes. Five key themes emerged, including diverse experience, barriers related to the learning process, factors influencing insertion success, and recommendations to enhance clinicians' acceptance. These themes suggest that the key to successful adoption by clinicians lies in designing user-friendly devices that align with familiar insertion techniques, facilitating a smooth transfer of learning. Conclusion: Clinician adaptation to new devices is vital for optimal patient care. Emergency nurses and doctors prefer simplicity, safety, and familiarity when it comes to new devices. Providing comprehensive device training with diverse training resources, hands-on sessions, and continuous expert support, is likely to enhance clinician acceptance and the successful adoption of new devices in ED settings.
Language	English
Publishing date	2024-03-14
Publishing country	Australia
Document type	Journal Article
ISSN	2588-994X
ISSN (online)	2588-994X
DOI	10.1016/j.auec.2024.03.001
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Article ; Online: Device Related Thrombosis and Bleeding in Pediatric Health Care: A Meta-analysis.

Ullman, Amanda / Hyun, Areum / Gibson, Victoria / Newall, Fiona / Takashima, Mari

Hospital pediatrics

2023 Volume 14, Issue 1, Page(s) e25–e41

Abstract: Context: The risk of invasive device-related thrombosis and bleeding contributes to morbidity and mortality, yet their prevalence by device-types is poorly understood.: Objectives: This study aimed to estimate pooled proportions and rates of ... ...

Abstract	Context: The risk of invasive device-related thrombosis and bleeding contributes to morbidity and mortality, yet their prevalence by device-types is poorly understood. Objectives: This study aimed to estimate pooled proportions and rates of thrombotic and bleeding complications associated with invasive devices in pediatric health care. Data sources: Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. Study selection: Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) reporting thrombotic and bleeding complications, and (4) published in English, were included. Data extraction: Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. Main outcomes and measures: Device-specific pooled thromboses (symptomatic, asymptomatic, unspecified) and bleeding (major, minor). Results: Of the 107 studies, 71 (66%) focused on central venous access devices. Symptomatic venous thromboembolism in central venous access devices was 4% (95% confidence interval [CI], 3-5; incidence rate 0.03 per 1000 device-days, 95% CI, 0.00-0.07), whereas asymptomatic was 10% (95% CI, 7-13; incidence rate 0.25 per 1000 device-days, 95% CI, 0.14-0.36). Both ventricular assist devices (28%; 95% CI, 19-39) and extracorporeal membrane oxygenation (67%; 95% CI, 52-81) were often associated with major bleeding complications. Conclusions: This comprehensive estimate of the incidence and prevalence of device-related thrombosis and bleeding complications in children can inform clinical decision-making, guide risk assessment, and surveillance.
MeSH term(s)	Child ; Humans ; Anticoagulants ; Thrombosis/epidemiology ; Thrombosis/etiology ; Hemorrhage/epidemiology ; Hemorrhage/etiology ; Hemorrhage/therapy ; Venous Thromboembolism ; Delivery of Health Care
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-11-24
Publishing country	United States
Document type	Meta-Analysis ; Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2023-007345
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Article: The Current Contexts of Newly Graduated Nurses' Competence: A Content Analysis.

Hyun, Areum / Tower, Marion / Turner, Catherine

Healthcare (Basel, Switzerland)

2022 Volume 10, Issue 6

Abstract: Producing and sustaining a competent nursing workforce is imperative to protect the public. Identifying current issues and trends in nursing competence can strengthen insights and provide direction for the future nursing workforce. A summative content ... ...

Abstract	Producing and sustaining a competent nursing workforce is imperative to protect the public. Identifying current issues and trends in nursing competence can strengthen insights and provide direction for the future nursing workforce. A summative content analysis was performed; PubMed, CINAHL, and Scopus were searched for content from the last ten years. A total of 3225 titles and abstracts regarding nursing competence were identified and analysed using the big-data analysis software Leximancer. Five themes were discovered from the analysis: (1) standardisation of nursing competencies with emerging competencies, (2) assessment competency levels, (3) graduates' expectations and achievement, (4) safe and quality practice with teamwork, and (5) competency curriculum development. This found standardised nursing competencies, which suggests prioritising which core competencies should be focused on during education to produce competent generalist professional nurses, and employers could help nursing graduates improve their competence in specialised areas. This review also suggests that further education strategies should be developed to better prepare graduates for culturally safe practice to meet the needs of diverse minority populations and for informatics competency during the COVID-19 pandemic. Competence assessment methods must be extensively investigated to measure nursing competencies both longitudinally and cross-sectionally.
Language	English
Publishing date	2022-06-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare10061071
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Article ; Online: Infection Associated With Invasive Devices in Pediatric Health Care: A Meta-analysis.

Takashima, Mari / Hyun, Areum / Xu, Grace / Lions, Adriana / Gibson, Victoria / Cruickshank, Marilyn / Ullman, Amanda

Hospital pediatrics

2023 Volume 14, Issue 1, Page(s) e42–e56

Abstract: Context: Indwelling invasive devices inserted into the body for extended are associated with infections.: Objective: This study aimed to estimate infection proportion and rates associated with invasive devices in pediatric healthcare.: Data sources! ...

Abstract	Context: Indwelling invasive devices inserted into the body for extended are associated with infections. Objective: This study aimed to estimate infection proportion and rates associated with invasive devices in pediatric healthcare. Data sources: Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. Study selection: Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) postinsertion infection complications, and (4) published in English, were included. Data extraction: Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. Main outcomes and measures: Device local, organ, and bloodstream infection (BSIs) pooled proportion and incidence rate (IR) per-1000-device-days per device type were reported. Results: A total of 116 studies (61 554 devices and 3 632 364 device-days) were included. The highest number of studies were central venous access devices associated BSI (CVAD-BSI), which had a pooled proportion of 8% (95% confidence interval [CI], 6-11; 50 studies) and IR of 0.96 per-1000-device-days (95% CI, 0.78-1.14). This was followed by ventilator-associated pneumonia in respiratory devices, which was 19% (95% CI, 14-24) and IR of 14.08 per-1000-device-days (95%CI, 10.57-17.58). Conclusions: Although CVAD-BSI and ventilator associated pneumonia are well-documented, there is a scarcity of reporting on tissue and local organ infections. Standard guidelines and compliance initiatives similar to those dedicated to CVADs should be implemented in other devices in the future.
MeSH term(s)	Child ; Humans ; Central Venous Catheters ; Sepsis ; Incidence
Language	English
Publishing date	2023-11-24
Publishing country	United States
Document type	Meta-Analysis ; Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2023-007194
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Article ; Online: Exploration of the expected and achieved competency levels of new graduate nurses.

Hyun, Areum / Tower, Marion / Turner, Catherine

Journal of nursing management

2020 Volume 28, Issue 6, Page(s) 1418–1431

Abstract: Aim: To explore the expected and achieved competency levels of new graduate nurses.: Background: There are global concerns about a perceived disconnect between the educational preparation of new graduates and the expectations of employers about their ...

Abstract	Aim: To explore the expected and achieved competency levels of new graduate nurses. Background: There are global concerns about a perceived disconnect between the educational preparation of new graduates and the expectations of employers about their work readiness. It is important to understand competency levels expected and achieved of new graduate nurses. Method(s): The study was conducted in three phases: the identification of competencies, development of a survey instrument and exploration of levels of competency from the perspectives of key stakeholders. Results: New graduates were well prepared for demonstrating respect to patients, but needed to be closely supported when providing emergency care. Results highlighted that new graduates felt less competent than graduating students in those competencies related to legal and ethical practice. Importantly, expectations about new graduates' competency varied between educators and managers. Conclusion(s): The findings provide important information about new graduates' competency levels, revealing a mismatch in the perception of key stakeholders about competency levels. This has important implications for building new graduates readiness for practice and highlights the importance of collaboration between key stakeholders to address competency gaps. Implications for nursing management: Supportive opportunities should be provided to new graduate nurses to fill gaps in beginner competency.
MeSH term(s)	Clinical Competence ; Education, Nursing, Graduate ; Humans ; Surveys and Questionnaires
Language	English
Publishing date	2020-08-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1162321-4
ISSN	1365-2834 ; 0966-0429
ISSN (online)	1365-2834
ISSN	0966-0429
DOI	10.1111/jonm.13105
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Zs.A 3805: Show issues

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Article ; Online: The effectiveness of dressings and securement devices to prevent central venous catheter-associated complications: A systematic review and meta-analysis.

Xu, Hui / Hyun, Areum / Mihala, Gabor / Rickard, Claire M / Cooke, Marie L / Lin, Frances / Mitchell, Marion / Ullman, Amanda J

International journal of nursing studies

2023 Volume 149, Page(s) 104620

Abstract: Background: Central venous catheters are commonly used in healthcare, but they come with a range of potential complications. Over the last 15 years, an influx of securement and dressing products has been released, with unknown overall effectiveness to ... ...

Abstract	Background: Central venous catheters are commonly used in healthcare, but they come with a range of potential complications. Over the last 15 years, an influx of securement and dressing products has been released, with unknown overall effectiveness to prevent these complications. Objective: To compare the effects of dressings and securement devices for central venous catheters on a range of common complications including catheter-related bloodstream infection, catheter tip colonisation, entry/exit-site infection, skin colonisation, skin irritation, failed catheter securement, dressing durability and mortality. Design: Systematic review with meta-analysis. Methods: Following standard Cochrane methods, a systematic search of Cochrane Wounds Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, EBSCO CINAHL, and multiple clinical trial registries was completed in November 2022. Randomised controlled trials evaluating the effectiveness of dressing and securement devices for all CVC types were included. A random-effects model was used during the meta-analysis. Results were expressed using risk ratio (RR), rate ratio, or mean difference (MD), with 95 % confidence intervals (CIs). Methodological quality and bias were assessed. Results: We included 46 studies involving 10,054 participants. All studies had either an unclear or high-performance bias. The blinding of outcome assessment was unclear in most studies. Chlorhexidine gluconate-impregnated dressings, compared with standard polyurethane dressings, may reduce the incidence (7 studies; N = 5816; RR 0.60, 95 % CI 0.44-0.83; low certainty evidence) and rate (4 studies; N = 4447; RR 0.51, 95 % CI 0.32-0.79; moderate certainty evidence) of catheter-related bloodstream infection and catheter tip colonisation (8 studies; N = 4788; RR 0.70, 95 % CI 0.52-0.95; very low certainty evidence). Medication-impregnated dressings may reduce the incidence of catheter-related bloodstream infection (6 studies; N = 5687; RR 0.60, 95 % CI 0.39-0.93; low certainty evidence) and catheter-tip colonisation (7 studies; N = 4769; RR 0.60, 95 % CI 0.47-0.76; low certainty evidence) relative to non-impregnated dressing types. Tissue adhesive may increase the risk of skin irritation or damage compared with integrated securement dressings (3 studies; N = 166; RR 1.88, 95 % CI 1.09-3.24; low certainty evidence) or sutureless securement devices (4 studies; N = 241; RR 1.64, 95 % CI 1.10-2.44; moderate certainty evidence). Tissue adhesive increased dressing durability compared with integrated securement dressings (MD 43.03 h, 95 % CI 4.88-81.18; moderate certainty evidence) and sutureless securement devices (MD 42.90 h, 4.64-81.16; moderate certainty evidence). Tissue adhesive increased failed catheter securement rate compared with suture (2 studies; N = 103; RR 9.33, 95 % CI 1.10-79.21; moderate certainty evidence). Conclusions: The findings of the review provide insights and guidance for clinicians in selecting the appropriate dressings and securements for catheters. Findings should be interpreted with caution due to heterogeneity in catheters and patient types. Registration: #CD010367. Tweetable abstract: Time to implement chlorhexidine gluconate-impregnated dressings to prevent catheter-related bloodstream infections; a meta-analysis by @GraceNP and team.
MeSH term(s)	Humans ; Central Venous Catheters/adverse effects ; Tissue Adhesives ; Bandages ; Sepsis
Chemical Substances	chlorhexidine gluconate (MOR84MUD8E) ; Tissue Adhesives
Language	English
Publishing date	2023-10-09
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	80148-3
ISSN	1873-491X ; 0020-7489
ISSN (online)	1873-491X
ISSN	0020-7489
DOI	10.1016/j.ijnurstu.2023.104620
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