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To develop and psychometrically test a comprehensive Cancer Nurse Self-Assessment Tool (CaN-SAT).
Modified Delphi to assess content validity and cross-sectional survey to assess reliability and validity.
Phase 1: An expert group developed the tool structure and item content. Phase 2: Through a modified Delphi, cancer nursing experts rated the importance of each element of practice and assessed the relevance and clarity of each item. Content Validation Indexes (CVI) were calculated, and a CVI of ≥ 0.78 was required for items to be included. Phase 3: Cancer nurses participated in a survey to test internal consistency (using Cronbach's alpha coefficients) and known-group validity (through Mann–Whitney U tests). This study was reported using the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) checklist.
The CaN-SAT underwent two rounds of Delphi with 24 then 15 cancer nursing experts. All elements of practice were rated as important. Only three items achieved a CVI < 0.78 after round one; however, based on open-ended comments, 26 items were revised and one new item added. After round two, all items received a CVI above 0.78. The final tool consisted of 93 items across 15 elements of practice. Cronbach's alpha coefficients were between 0.92 and 0.98 indicating good reliability. Mann–Whitney U tests demonstrated significant differences between clinical nurses and advanced practice nurses across 13 out of 15 elements of practice.
The CaN-SAT is a comprehensive, valid and reliable tool that can be used for cancer nurses to self-assess current skill levels, identify their learning needs and inform decisions about educational opportunities to optimise cancer care provision.
The research team included three patient advocates from Cancer Voices NSW, who were actively involved in all aspects of the study and are listed as authors.
Over one billion adults attend emergency departments (EDs) internationally every year, including 6.6 million in Australia. Up to half of these patients have a peripheral intravenous catheter (PIVC) inserted. Although healthcare workers believe that placing a cannula is helpful (‘just in case’), PIVCs often remain idle. PIVC insertion is painful for patients, takes clinicians’ attention away from other care, has adverse outcomes and causes major economic and environmental burden. Our aim is to codesign an implementation toolkit to reduce unnecessary PIVC insertions and improve other national quality indicators using an implementation science framework.
A stepped-wedge cluster-controlled trial will be conducted in nine ED sites (clusters) across Australia. The interventions will be codesigned with and adapted to sites based on local context. The interventions are evidence-based multimodal intervention (MMI) and aligned to the 2021 Australian Commission for Safety and Quality in Health Care National PIVC Clinical Care Standard. The Consolidated Framework for Implementation Research and Learning Health System will be used to guide implementation. Interventions will be phased across three steps (three sites per step), and each site will collect control and postintervention data using mainly routinely collected clinical data. Each site will be allocated to receive the intervention at one of three study steps. Implementation strategies will tailor broad clinician and consumer engagement, policy changes, education, audit and feedback and clinical champions, along with environment and equipment changes, to each site. The primary objective is to reduce the proportion of adult patients who have a PIVC inserted by 10%. We will evaluate the clinical, implementation and cost-effectiveness of the intervention.
Study findings will be used to conduct a health economic analysis, develop an implementation toolkit and inform a sustainable roadmap for national roll-out. This will meet the needs of a diverse range of EDs nationally and internationally.
The protocol was approved by the Monash Health Human Research Ethics Committee (HREC Reference Number: HREC/100808/MonH-2023-390692(v3)). The outcomes of this trial will be disseminated through peer-reviewed publications, conference presentations and communication with study partners and stakeholders including professional colleges and the Australian Commission for Safety and Quality in Health Care.
Australian New Zealand Clinical Trials Registry registration number: ACTRN12623001248651. Date of registration: 1 December 2023. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386256&showOriginal=true&isReview=true
To develop and psychometrically test two newly developed Cancer Nurse Self-Assessment Tools for early and metastatic breast cancer (CaN-SAT-eBC and CAN-SAT-mBC).
Instrument development and psychometric testing of content validity, reliability and construct validity.
A three-phase procedure was conducted. Phase 1: An expert working group was formed to design and develop each tool using Benner's Model of Clinical Competence. Phase 2: The Content Validation Index (CVI) was used to assess the relevance and clarity of each item on the tools with breast cancer nurse experts and nursing educators. A CVI ≥ 0.78 was required for an item to be included in each tool. Phase 3: The tools were tested for internal consistency using Cronbach's alpha and construct validity using principal component analysis (PCA). The Guidelines for Reporting Reliability and Agreement Studies were followed in reporting this study.
Each tool underwent two rounds of content validation. Ten experts were involved in the content validation for the CaN-SAT-eBC and 12 experts involved for CaN-SAT-mBC. The final versions comprised 18 (CAN-SAT-eBC) and 22 elements (CaN-SAT-mBC). All items obtained a satisfactory CVI of 0.83–1.0. Data from 159 and 126 nurses were analysed to evaluate reliability for CaN-SAT-eBC and CaN-SAT-mBC, respectively. The Cronbach's alpha coefficients for all elements were between 0.83 and 0.98. The PCA supported that each element was unidimensional and composed of internally correlated items, with the exception of the ‘Diagnostics’ element of practice which has a two-component structure measuring basic and advanced diagnostic tasks.
The two CaN-SATs are comprehensive, valid and reliable. They can be used for self-assessment by nurses in relation to breast cancer care and for identifying learning needs for long-term professional development. The self-assessment tools can also be used to develop education initiatives for specialised breast cancer nurses.
No patient or public contribution.
To survey registered nurses' familiarity with delegation standards and confidence to delegate to unlicenced workers within their practice.
Cross-sectional exploratory survey design.
The survey focused on Australian registered nurses (n = 420). Initial descriptive analysis was undertaken. Additionally, inferential analysis was undertaken between two independent variables focused on familiarity of delegation policy, and confidence to delegate, and several demographic and workplace variables. Stepwise linear regression was undertaken to determine predictors of the two delegation variables. The cross-sectional study was undertaken according to the STROBE reporting checklist.
The majority of respondents were somewhat familiar, or not familiar at all with delegation standards. This pattern was followed for results relevant to confidence delegating to unlicenced workers. Nurses working in adult acute, intensive care and emergency department reported the lowest levels of familiarity with delegation. Additionally, intensive care nurses were significantly less likely to feel very confident delegating to unlicenced support workers. Stepwise regression revealed identifying as male, and working in the public sector were less likely to be confident delegating. Nurses working in the acute setting and public sector were less familiar with delegation standards.
The findings of this study highlight the nuanced nature of delegation to unlicenced workers in Australian nursing settings, with nurses from certain contexts being far less likely to be familiar with or confident undertaking the practice.
The findings of this study have significant implications to increase understanding of nurses diverse contexts of practice and how delegation standards might not be implemented in practice in a confident manner.
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