Journal Club: Factors influencing nurses’ intentions to leave adult critical care

Journal Club Article: Khan, N., Jackson, D., Stayt, L., & Walthall, H. (2018). Factors influencing nurses’ intentions to leave adult critical care settingsNursing in critical care.



“Nurse retention is a global problem across all specialities but is exacerbated in critical care areas where elevated nurse–patient ratios and the use of advance technologies require greater numbers of highly educated and specialized nurses impacting costs and quality of patient care.”

Factors identified in previous research such as working conditions, burnout syndrome, organisational climate, staffing levels, empowerment, personal health and work pressure.

Relevance to practice:

“The shortage of critical care nurses is currently a global issue impacting costs and quality of patient care.”


A systematic mixed-method literature review.


3 themes identified were quality of the work environment, nature of working relationships and traumatic/stressful workplace experiences.

  1. Quality of the work environment

Empowerment and professional development opportunities. Having enough time to recover from night shifts and the impact of inflexible rotations on work–life balance.

2. Nature of working relationships

When conflict occurs with families and relatives. Poor relationships between nurse to manager and nurse to physician, especially not being involved in the decision making process.

3. Traumatic/stressful workplace experiences

Futility in the level of care being provided, caring for the dying patient and decisions to forego life‐sustaining treatments.


High nursing turnover is a global issue and nurse leaders in critical care areas need to take these findings into consideration when developing strategies to improve turnover and support strategies.

Keywords: Burnout; Culture: Nurse Retention; Stress; Teamwork.


Eye Gazing

Do we interact and engage with our phones more than we do with our fellow humans? Interesting question, and this is where eye gazing comes in to remind us of the connection and interactions we make though our eyes. These are important questions as we spend our lives connected through work and play in an online world and in particular social media platforms. As the real world becomes entwined with virtual reality and robots, what will our lives look like in the future and how will humans connect? If technology increases in healthcare, what will the nurse-patient relationship look like?

Keywords: Trust, connection, healing, bonding, sacred, relaxing, spiritual.

Where Has Human Connection Gone?


Eye Gazing With Strangers



Kajimura, S., & Nomura, M. (2016). When we cannot speak: Eye contact disrupts resources available to cognitive control processes during verb generation. Cognition157, 352-357.  [abstract]

Nursing Education Network. (2018). Meet The Avatars: Virtual Reality and Virtual Humans.

SBS. (2018). Look Me In The Eye.

Meet The Avatars: Virtual Reality and Virtual Humans

Virtual Reality and Virtual Humans

This great video shows some of the complexities of technology, especially around virtual reality and how to combine with humans. The emotions when we get down to relationships from the humanistic aspect are amazing, a little lump in the throat. Have a watch, and take the time to think if you could interact with a friend or family who is no longer alive, firstly would you use VR to connect and how would you prepare for the feelings and experience? This great piece shows the difficulty in entwining technology around what makes us human.  Not forgetting history is important too, and VR can help save memories from the people experiencing them like no history book every could. This is human endeavour pushing the boundaries.

“A people without the knowledge of their past history, origin and culture is like a tree without roots” quote by Marcus Garvey.

Meet The Avatars

Some additional resources from Meet The Avatars

  • Follow Dr. Jordan Nguyen on Twitter

Light Stage

Eye Gazing

The Rise of eSports


Moving from the bedroom to filling out stadiums, welcome to eSports. Think this is just a hobby? Think again. With increasing sponsorship and media interest, this a rising sporting extravaganza. Take a read of this great review on the atmosphere and experience attending an eSports event by MishManners.

A little About eSports 

FIFA Interactive World Cup


The following is a list of eSports resources and tournaments.

ESPN. (2018). eSports. (2018). FIFA eWorld Cup 2018.

MishManners. (2018). Australia takes Esports to the Next Level. Hackathon Queen.

Red Bull eSports. (2018). eSports.

Wikipedia. (2018). eSports.

Wikipedia. (2018). Lists of eSports leagues and tournaments.

From the Premier League, Manchester City and West Ham United have signed up an eSports player as member of their squad to represent them in eSports competitions.


The Celebrity Millionaires of Competitive Gaming


Resus Days

Practice Saving Lives While Playing a Game

Resus Days is a resuscitation game to help healthcare professionals practice some quick-thinking needed for care of cardiopulmonary emergencies. Using gamification to deliver a simulation game for cardiopulmonary resuscitation. Check the below resources, the first level is free to try it out.

The Blurb

Rehearse life-saving decision-making in a fun, game environment. Resus Days is a simulation game for healthcare professionals to practice some quick-thinking needed for care of cardiopulmonary emergencies. You are the team leader in the resuscitation team. Your task is resuscitate the patient until he is back to a normal heart rhythm (normal sinus rhythm). The game includes 7 levels covering cardiac arrest, bradycardia, tachycardia, and simulated megacode. The first level (cardiac arrest) is free to play. If you like it, an in-app purchase will unlock six additional levels.

Keywords: #resuscitology #gamification

The game homepage is:




Nursing & Democratic People’s Republic of Korea

This post is one of curiosity and interest in a socialist country that is largely a mystery of what occurs in everyday life. How is the healthcare system, what sort of technology and resources are available, what training do the nurses receive, is it hospital or university based? This post is not based on any knowledge other than searches from the internet and healthcare databases (Cinahl, Embase and Medline). It is also not a political post, so please add helpful and insightful resources focusing on healthcare into the comment’s section to build on the below resources. If anyone has any links to nursing schools in North Korea it would be amazing to hear about nurse training.

Search terms: Nursing and (North Korea or Democratic People’s Republic of Korea).

The formal searches yielded only one relevant article. Many articles exist but they focus on ethical and political viewpoints. Google search was more successful, but it is the unknown of the quality or true picture they provide. See below for resources.

WHO Stats:

  • Health System: Free access for all
  • Life Expectancy: Male 67/Female 74

Remember its very easy to get caught up in ‘our health system is the best’ mentality. When we look outside our own walls, there are some healthcare systems where the principles of ‘healthcare for all’ exist. An example is the Cuban healthcare system and also the work they do in training healthcare professionals in other nations. DPRK 360 provide a different perspective to North Korea, than portrayed in the media.

BBC Panorama: Inside North Korea (2017)


Barrett, J. (2011). The North Korean Healthcare System: On the Fine Line Between Resilience and Vulnerability.

Cha, J. (2015). Scenes from a North Korean Hospital. The Guardian.

DPRK 360. (2018) A different perspective to North Korea.

Kim, H. K., Lee, O. J., & Baumann, S. L. (2011). Nursing Practice with Families Without a Country. Nursing science quarterly, 24(3), 273-278. [abstract]

Kim, S. (2016). Comparison of North and South Korea Nursing Workforce Training System and Integration Plan. Advanced Science and Technology Letters. Vol.132 (Healthcare and Nursing 2016), pp.233-236.

Wikipedia (2017). Health in North Korea.

Wikipedia (2017). Pyongyang Maternity Hospital.

World Health Organisation. (2018). Democratic People’s Republic of Korea.

NNEC2018 Notes & Thoughts (Day 3)

3 days of education theory- lots of ideas, networking and moving into info overload territory.

Session: Building a Culturally Capable Nursing and Midwifery Workforce

Health For All: Inequalities for Indigenous Peoples

Cultural capability in healthcare and higher education for nursing.

Transformative unlearning and learning.

First Peoples Health Unit

The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) 

International Council of Nurses: Ethics and Human Rights

Australian Human Rights Commission

Aboriginal and Torres Strait Islander Health Strategy Group

‘gettin em n keepin em’ by the Indigenous Nursing Education Working Group 

Fact sheet- The health of Indigenous Peoples: a concern for nursing

Cultural capability framework



Synergies Between Education and Healthcare

Focus: Using Educational Leadership Models in Nursing

Leadership framework (Drysdale & Gurr, 2012) – resources from the school sector.

  • Influencing others
  • Setting direction
  • Developing people
  • Developing the organisation
  • Teaching & learning

Educational models to guide development of nurse educators.


Gurr, D., & Drysdale, L. (2012). Tensions and dilemmas in leading Australia’s schools. School Leadership & Management32(5), 403-420.

Gurr, D. (2014). Successful school leadership across contexts and culturesLeading and Managing20(2), 75.





NNEC2018 Notes & Thoughts (Day 2)

Session: Changing World, Change in Clinical Practice

Focus: Overcoming the theory-practice gap

Research translation: slow process of change, translation of evidence

Deimplementation of Practice

The transition from hospital nurse education to Tertiary (university) sector.

Nurse researching and impact by Florence

Difficulty staying up to date through impact of information overload: volume of research, guidelines.

Value of systematic review- to make research manageable. Resources such as:


Donaldson, M. S., Corrigan, J. M., & Kohn, L. T. (Eds.). (2000). To err is human: building a safer health system (Vol. 6). National Academies Press.

Greenhalgh, T. (2014). How to read a paper: The basics of evidence-based medicine. John Wiley & Sons.

Greenhalgh, T., Howick, J., & Maskrey, N. (2014). Evidence based medicine: a movement in crisis?Bmj348, g3725.

Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients’ careThe lancet362(9391), 1225-1230.

McGlynn, E. A., Asch, S. M., & Kerr, E. A. (2003). Quality of health care delivered to adults in the United States-Reply. New England Journal of Medicine349(19), 1867-1868.

Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015). Towards understanding the de-adoption of low-value clinical practices: a scoping reviewBMC medicine13(1), 255.


Session: Educating With The Brain in Mind

Sustainable transformational processes: thinking, practice and culture.

Neuroscience & collaboration (Rock & Cox, 2012): The SCARF® model stands for

  • Status,
  • Certainty,
  • Autonomy,
  • Relatedness and
  • Fairness

Challenge/support framework (Mariani, 1997).

The way the brain forms thoughts by Kahneman: System 1 and 2 (Thinking, fast and slow)


Kahneman, D. (2011). Thinking, fast and slow. Macmillan.

Mariani, L. (1997). Teacher support and teacher challenge in promoting learner autonomyPerspectives: A Journal of TESOL Italy, XXIII (2). 

Rock, D. (2010). The neuroscience of leadership (Doctoral dissertation, Middlesex University).

Rock, David, and Christine Cox. “SCARF in 2012: Updating the social neuroscience of collaborating with others.” NeuroLeadership Journal 4, no. 4 (2012): 1-16.

Session: Technology and online learning

  • CPD,
  • readiness to learn
  • core competencies
  • alignment between objectives and content (standardisation)


Blended Learning

Blended Synchronous Learning

Bower, M., Kenney, J., Dalgarno, B., Lee, M. J., Kennedy, G. E., Carter, H., … & Hedberg, J. (2013). Blended synchronous learning: Patterns and principles for simultaneously engaging co-located and distributed learnersElectric Dreams. Proceedings ascilite.

Prensky, M. (2001). Digital natives, digital immigrants part 1On the horizon9(5), 1-6.

Session:  Undergrad Systematic Review on Appraisal 

4 Themes of the review:

Systems Approach


Session: Preparing for Practice

  • Self efficacy

Babenko-Mould, Y., Andrusyszyn, M. A., & Goldenberg, D. (2004). Effects of computer-based clinical conferencing on nursing students’ self-efficacy. Journal of Nursing Education43(4), 149-155.

  • Preference for online learning & Task value

Artino Jr, A. R., & Stephens, J. M. (2009). Academic motivation and self-regulation: A comparative analysis of undergraduate and graduate students learning onlineThe Internet and Higher Education12(3-4), 146-151.

Some data analysis statistics: Cronbach’s alpha

Session: The Future of Nursing

Changing world of practice and graduate capabilities.

Missen, K., McKenna, L., & Beauchamp, A. (2014). Graduate nurse program coordinators’ perceptions of role adaptation experienced by new nursing graduates: A descriptive qualitative approachJournal of Nursing Education and Practice4(12), 134.

Missen, K., McKenna, L., & Beauchamp, A. (2016). Graduate nurse program coordinators’ perspectives on graduate nurse programs in Victoria, Australia: A descriptive qualitative approachCollegian23(2), 201-208.

Missen, K., McKenna, L., Beauchamp, A., & Larkins, J. A. (2016). Qualified nurses’ rate new nursing graduates as lacking skills in key clinical areas. Journal of clinical nursing25(15-16), 2134-2143.

End of day thought

Social Media: Low #SoMe engagement use across the conference, organisors and attendees included. Set up Symplur conference hashtag



NNEC2018 Notes & Thoughts (Day 1)

Session: Safer Care Victoria

Importance and power of storytelling and the narrative for learning in nursing.
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Aims and approaches for safer care:

  1. Targeting zero avoidable harm,
  2. Sharing excellence,
  3. Collecting and sharing data to improve patient care.


Session: Assessment & Learner Engagement

Impact of assessment- impact on learning, the need to make a positive impact.

Consider how can we use assessment for learning and for competency (rather than something that is merely done to us).

That assessment can influence the teaching focus and student behaviour just by the choice of assessment.

What assessment needs to do:

  1. Certify learners performance (summative assessment)
  2. Provide learners with info to aid learning (formative)
  3. Build students capacity judge their own learning (sustaniable assessment)

Build capacity to judge good work, and need to look at optomising the timing of assessments in courses (look at student workload), and to encourage good habits not rote learning.

Distractions can occur through a focus on marks or grades instead of focusing on achievements and the quality of work. Intended learning outcomes and the difficulty measuring by grades, instead mark by outcomes not numbers (what is the expectation for the minimum standard).

Feedback: What does or doesn’t the student do to meet the learning outcomes. Provide more descriptive assessment terms, not classified/standarsied rubric terms (such as good/satisfactory/excellent).

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Opportunities for feedback – be selective in what we do and when we do it.

Empower student to be more assertive and to seek feedback. Students to think about what they think is good criteria, think about how they did or did not meet the criteria.


Assessment Design Decisions

Assuring Learning

Boud, D., & Molloy, E. (2013). Rethinking models of feedback for learning: the challenge of designAssessment & Evaluation in Higher Education38(6), 698-712.

Boud, D., & Molloy, E. (Eds.). (2013). Feedback in higher and professional education: understanding it and doing it well. Routledge. [link to Ch. 13]

Cradle: Centre for Research in Assessment and Digital Learning

Feedback for Closing The Assesment Loop

Other Educational Ideas

  • Blended On-line and Digital (BOLD) Learning 

Develop curriculum and build critical thinking when using a blended online approach. Reduced face to face teacher time (online theory, but miss the applying critical thinking, apply theory into practice). Solution – innovative online lesson “apply your knowledge”, linked to learning content, relevant to the theory, instant feedback from case based scenarios.

Resource: Blended On-line and Digital (BOLD) Learning 

  • Steps towards Innovation 

    • Be courageous and embrace vulnerability. authenticity.
    • Be realistic.
    • focus on your goal.
    • think outside the triangle (content, educator, participant)
    • implement, assess, adapt – new ideas, feedback and evaluate

Resource: Brené Brown: The Power of Vulnerability

  • TRACS Video Resource Project 

Process in resource, planning and colaboration for a video resource.

  • key stakeholders,
  • logistical planning, learning objectives, cost, time frames,
  • real clinicians and patients (consent) in a real clinical setting (capture the experience of the patient journey),
  • story boarding key messages,
  • use of multi-media resources for video production,
  • ongoing project management, supporting facilitator guides,
  • Learning resources to go along with the video resources.

Resource: TRACS (TRAining Centre in Subacute care) videos

  • Teaching for 2020 and Beyond. 

Wicked health problems and how nursing education can influence and impact society.

  1. Inequality: rising social injustice.
  2. Empathy deficit: empathy in nursing (learning others experience, cultural skills)
  3. Robotic Nurses: healthcare technology
  4. Battling ourselves: workforce culture, budget, targets

The pedagogy (transformative learning)

  • students to become agents of change,
  • awakening empathy

Nurses as co-creators of healthcare environments. Nursing focus historical on health and well-being. Solution focused nursing being at the forefront of advancing health care with technology and the adaption of technology.

  • AI- clinical decision making
  • Telehealth
  • Digital capacity and technology.

Robo-nurse (Dystopian view of the future)


The Answer: Develop optimistic actions, change agents. Modelling of ethical, courageous, and admirable problem solving.

  • Open the VALT (Visually authentic learning tools) 

Simulation on a small budget and small space, following principles of:

  • authentic learning environments
  • immersion
  • sim on a budget,
  • hands on,
  • case scenario,
  • sim on the go,
  • transportable
  • Cost effective
  • Recyclable materials


Open the VALT

Tilbrook, V. A. (2017). Open the VALT™(Visually authentic learning tools): Using play to facilitate knowledge and collaborative practice. Women and Birth30, 39-40.