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Objective: To investigate the perspectives of Australian nursing educators on the preparation of Bachelor of Nursing students for the care of older people's oral health. Background: The Australian population is ageing. Older people with poor oral health are at increased risk of worsening health and chronic disease conditions. Nurses can and need to take a leadership role in improving and maintaining older Australians' oral health in community, hospital, and residential care settings. Thus, it is important to investigate the perspectives of nursing educators on the preparation of nursing students for the care of older people's oral health. Study design and methods: Semi-structured interviews were conducted with 13 participants, including course coordinators, lecturers, directors, and researchers at 10 universities delivering accredited Bachelor of Nursing programs across seven different states in Australia. Data were analysed thematically. Results: Four themes were identified in nursing educators' perspectives: (1) the education of nursing students in providing oral healthcare is important, (2) there are notable gaps in nursing students' oral health education, (3) there are both internal and external barriers to strengthening oral health education across nursing programs, and (4) there is a need to develop and promote a shared oral health curriculum that includes interprofessional education and collaborative practice. Inherent in these themes was the need for a clear definition of the role of nurses in oral healthcare. Discussion and Conclusion: It is recommended that administrators and policymakers develop nursing accreditation standards that specify the role of nurses in oral health education, and the scope of this education including interprofessional and collaborative practice, for the oral healthcare of older people. Infusing such standards in nursing curricula will better educate and prepare nursing students for effective practice and leadership in gerontological care. What is already known about the topic? * Older people frequently have oral diseases that adversely affect chronic health conditions and increase the risk of poorer general health. * Even though oral healthcare is an essential part of nursing for older people, the provision of such care is implied rather than stated specifically in Australian Nursing and Midwifery Accreditation Council (ANMAC) standards. What this paper adds: * The education and preparation of students to provide oral healthcare appears to be expected rather than required in Australian nursing curricula. Based on the perspectives of nursing educators, this paper suggests that many nursing students may not be well prepared to provide evidence-based oral care and lead oral health initiatives. The paper identifies ways these issues can be addressed. * The paper discusses the importance of developing and promoting a clear oral health curriculum that includes interprofessional collaborative practice to strengthen nursing students' education and prepare them to provide effective oral healthcare for older people. * The paper outlines a needed definition of the role of nurses in providing oral healthcare. [ABSTRACT FROM AUTHOR]

Aims and objective: To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. Background: Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. Method: An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward‐based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. Results: Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). Conclusion: The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. Relevance to clinical practice: Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance. [ABSTRACT FROM AUTHOR]

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Aim: To explore how clinical leadership is perceived by nurses in rural and remote areas of New South Wales, Australia. Background: There are few empirical studies aimed at understanding clinical leadership from a rural and remote perspective. Methods: A qualitative approach, based on interpretive phenomenology, used thematic analysis of recorded and transcribed interviews. Ethical approval was secured, 56 interviews were undertaken, across 14 different rural and remote health facilities, with nurses across the spectrum of practice. Results: Thematic analysis led to five themes and findings that support an understanding of clinical leadership from a rural and remote context. Clinical leaders were seen to considerably impact on the initiation of change and quality of care. They also faced barriers if the health facility was poorly staffed, lacked support and if the community were strongly co‐dependent. Conclusion: In rural and remote areas, clinical leadership is evident to support change, innovation and care quality. Implications for Nursing Management: Managers should be aware that staff shortages and challenges to staff retention or the initiation of change are affected by poor clinical leadership. This paper suggests that managers who facilitate clinical leadership are better able to support professional education and greater efficiencies in the delivery of quality health care. [ABSTRACT FROM AUTHOR]

Nurses are increasingly needed in primary healthcare settings to support community-based healthcare delivery. Programs to facilitate transition of new graduate nurses are well established in acute care; however, there are few similar programs reported in settings like general practice. This paper sought to explore the experiences of new graduate registered nurses and their registered nurse mentors in a new graduate program within Australian general practice. New graduates (n = 9) and their mentors participated in interviews before, during and at the conclusion of a 12-month new graduate program. Interviews were digitally audio-recorded and professionally transcribed verbatim before being analysed using thematic analysis. Eighteen new graduate and 10 mentor interviews were conducted, revealing four themes. Preparation and Opportunities describes the influence that pre-registration education had on preparing nurses for general practice employment. Exceeding Expectations highlights the positive experiences within the program. Program Challenges draws attention to the difficulties experienced by participants, and Future Career Intentions explores future career plans. This study highlights that a general practice new graduate nurse program has the potential to build the workforce. However, strengthening undergraduate preparation of nurses around primary health care and addressing funding issues in general practice, are important to promote the success of such programs. [ABSTRACT FROM AUTHOR]

Sessional teachers are taking an increasing role in classroom teaching in Schools of Nursing. However, there is a paucity of literature reporting the experiences of, and impact on, career academics working with or alongside the burgeoning numbers of sessional teachers. Therefore, the purpose of this paper is to explore the experiences of continuing academics working with sessional teachers. This qualitative study used purposive sampling to recruit nurse academics and collect narrative data related to their experiences of working with sessional teachers. Four major themes emerged from the data, namely: They have got real credibility -- perceptions of clinical currency, We've got people who are very good clinically, but don't know how to teach - lacking skills and confidence, No allegiance to the school or the students -- perceived lack of commitment and accountability, and A terrible burden -- workload implications for continuing academics. The development and implementation of standards for the recruitment and employment of sessional teachers would benefit both continuing academics and sessional teachers, and assist in the delivery of quality teaching and learning to nursing students. [ABSTRACT FROM AUTHOR]

Aims: To (a) explore the experiences of early career registered nurses in rural hospitals in Australia and (b) identify strategies they believe would help increase job satisfaction and retention. Design: Qualitative descriptive design. Methods: Thirteen registered nurses located in outer regional, remote or very remote (herein 'rural') Australian hospitals participated in semi‐structured interviews. Participants had graduated from a Bachelor of Nursing program in 2018–2020. Data were analyzed using thematic analysis and an essentialist, bottom‐up approach. Results: Seven themes related to the experiences of rural early career nursing: (1) appreciate diverse scope of practice; (2) rewarding sense of community and opportunity to give back; (3) staff support determines the quality of experience; (4) feeling underprepared and the need for ongoing education; (5) diverse views on the optimal length of rotation and level of input into choice of clinical area; (6) difficulty maintaining work/life balance due to work hours and rostering; and (7) lack of staff and resources. Strategies to improve nurses' experiences included: (1) assistance with accommodation and transport; (2) social gatherings to enhance connection; (3) sufficient orientation and supernumerary time; (4) increased frequency of contact with clinical facilitators and multiple mentors; (5) prioritizing clinical education across diverse topics; (6) greater involvement in choice of rotations and clinical areas; and (7) desire for more flexible work hours and rostering. Conclusions: This study highlighted the experiences of rural nurses and explored their suggestions for how to overcome challenges in their roles. Greater consideration of early career registered nurses' needs and preferences is vital to improving and maintaining a satisfied, dedicated and sustainable rural nursing workforce. Impact: Many of the strategies for improving job retention identified by nurses in this study could be actioned at a local level, with little financial or time investment. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aim: To investigate the strategies used by nurse leaders to facilitate fundamental care delivery in their clinical area. Design: An interpretative qualitative design study reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods: Twenty‐four self‐identified nurse leaders from across Australia were interviewed between November 2020 and April 2021 to discuss their strategies for facilitating fundamental care. Data was analysed using inductive thematic analysis. Results: Nurse leaders' experience of facilitating fundamental care produced two major themes, delivery of fundamental care (comprising three sub‐themes: valuing fundamental care, understanding and developing staff capacity and supportive relationships), and monitoring of fundamental care (including three sub‐themes: visibility in the clinical area, embedding fundamental care in the practice setting and specific direct actions). Conclusion: Facilitating fundamental care delivery is complex. This study highlighted the importance of nurse leaders' individual characteristics, and nurse leaders' ability to establish and maintain relationships alongside the role of informal and formal monitoring of fundamental care delivery. Impact Findings from this study build on existing research into fundamental care and contribute to our understanding of the role, characteristics and actions of nurse leaders to facilitate fundamental care. The results demonstrate the complexity and intricacy of nursing leadership to facilitate fundamental care, and that a dynamic 'thinking and linking' approach is required. The results show individualized practice which may create challenges for new nurse leaders seeking guidance, and for monitoring nurse leader activity. Further research is advocated to explore insights and tools to optimize nurse leaders' endeavours in facilitating fundamental care. Patient or Public Contribution: This study was designed using insights generated from patient and public involvement in nursing leadership and fundamental care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to explore healthcare managers' perceptions about older nurses' and midwives' and their contribution to the workplace. Design: A qualitative descriptive methodology. Method: Twenty healthcare managers working in Australia participated in semi‐structured interviews. Data were collected between April 2019 and April 2021. Interviews were recorded, transcribed and then analysed using thematic analysis. Results: All healthcare managers said older nurses and midwives contributed to the workplace through their experience and knowledge. Managers viewed them as a different type of worker and while there were some positive aspects to this, it was mostly negative. Although managers identified a broad age range for the older nurses or midwives, there was a common perception that if they were no longer able to perform their duties, they should leave the workforce. Conclusion: Healthcare managers' perceptions towards older nurses and midwives are mostly negative, and their understanding of older workers' contribution is contradictory and poor. These negative views co‐exist with the lack of agreement on who is the older worker, which explain the reluctance of healthcare organizations to invest in their older workforce. Future research is needed to better understand the unique contribution of older nurses and midwives in healthcare and how they can be supported at work. Impact The global ageing population will result in a rise in complex age‐related health issues and will require an experienced and knowledgeable workforce. Given the greater experience of older nurses and midwives they are an important part of the health workforce. Yet managers' perception of the contribution by older nurses and midwives were often negative. The findings of this study highlight the need for organizational change so that the contribution of older nurses and midwives is recognized and supported by managers. [ABSTRACT FROM AUTHOR]

Aims: This study explored the acceptability of a workplace health promotion intervention embedded into a transition to practice (TTP) programme to assist new graduate nurses in establishing healthy dietary and physical activity (PA) behaviours from career commencement. Design: A sequential mixed methods design. Methods: The Start Healthy and Stay Healthy (SH&SH) intervention, informed by the Behaviour Change Wheel, was conducted in an Australian Local Health District. It included face‐to‐face education sessions, the use of a fitness tracker and twice‐weekly short answer messages. Participants completed three online surveys: at orientation, 6 weeks and 6 months. A sub‐sample participated in semi‐structured interviews to explore their experience of the intervention. Interview data were analysed thematically. Results: The intervention was delivered from February to December 2019. A total of 99 nurses completed the baseline survey, 62 at 6 weeks and 69 at 6 months. After 6 months, health knowledge increased as participants correctly identified recommended amounts of fruits, vegetables and PA. Fruit consumption increased at 6 months with little change to vegetable intake. Takeaway consumption decreased, but consumption of some discretionary foods increased. Across the three time points, there was a low engagement in PA during leisure time. The interviews identified three themes: (1) Support of Colleagues and Peers, (2) The Work Environment and (3) Engagement with SH&SH. Conclusion: Providing a targeted intervention for new graduate nurses embedded into a TTP programme improved their health knowledge, some dietary behaviours, and participation in PA by some participants. Impact: Ensuring a healthy nursing workforce is critical to retaining staff. Implementing a workplace health promotion intervention that targets new graduate nurses can help them adopt and maintain healthy lifestyle behaviours to support them in their future careers. [ABSTRACT FROM AUTHOR]

Aim: To use expert consensus to develop guidance for nurse leaders implementing e‐health tools to support nursing work in hospitals. Background: Nurse leaders are increasingly required to make decisions about the selection, development, implementation and optimisation of e‐health tools for nursing work in hospitals. Guidance in this rapidly evolving and complex space is limited. Design: A two‐phase modified Delphi study. Methods: Phase one involved in‐depth interviews with five nursing informatics experts. Analysis used the qualitative framework method, informed by the Theoretical Domains Framework (TDF), to develop statements for an anonymous online Delphi scoring survey. This was distributed using snowball sampling methods to Australian nurse informatics leaders and experts. Final analysis involved synthesis of qualitative and quantitative data. The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. Results: Ten guidance statements to support nurse leaders to implement e‐health tools in hospitals were developed from the synthesis of qualitative interview data and 29 experts' responses to the 55‐item Delphi response survey. Conclusion: Implementation of e‐health tools for nursing work is complex in health settings and requires careful examination of multiple factors and interactions between clinicians, tools, service users and the health organisation. This research proposes ten statements to support nurse leaders with decisions about implementing e‐health tools to support nursing work in hospitals. Relevance to clinical practice: The ten statements developed by this research provide a resource to assist policy and practice decisions about e‐tools to ensure they are suited to supporting nursing work. Nurse leaders can use the ten statements for guidance in the selection, development, implementation and optimisation of e‐health tools to ensure suitability and adaptation for nursing work in hospitals. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate a mentoring programme embedded in a work‐based personal resilience enhancement intervention for forensic nurses. This qualitative study formed part of a wider mixed‐methods study that aimed to implement and evaluate the intervention. Twenty‐four semistructured interviews were carried out with forensic nurse mentees and senior nurse mentors; these explored their experiences of the mentoring programme and any benefits and challenges involved in constructing and maintaining a mentor–mentee relationship. Qualitative data were analysed thematically using the Framework Method. Four key themes relating to the initiation and maintenance of mentor–mentee relationships were identified: finding time and space to arrange mentoring sessions; building rapport and developing the relationship; setting expectations of the mentoring relationship and the commitment required; and the impact of the mentoring relationship for both mentees and mentors. Study findings highlight the benefits of senior nurses mentoring junior staff and provide evidence to support the integration of mentoring programmes within wider work‐based resilience enhancement interventions. Effective mentoring can lead to the expansion of professional networks, career development opportunities, increased confidence and competence at problem‐solving, and higher levels of resilience, well‐being, and self‐confidence. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore nurses' decision‐making regarding intravenous administration set replacement for vascular access device infusions in paediatric and adult clinical settings. Background: Intravenous administration sets are routinely replaced at regular intervals in clinical practice with the goal of preventing catheter‐related bloodstream infection; however, emerging evidence is challenging traditional hang‐time durations. Nurses' perceptions and contextual factors affecting decision‐making for administration set replacement have not been assessed previously. Design: Qualitative study using focus groups with contextualism methodology and inductive analysis. Method: During November–December 2016, eight semi‐structured focus groups were conducted with 38 nurses at two metropolitan hospitals in Queensland, Australia. Interviews were audio‐recorded and transcribed. Two authors independently reviewed transcripts and extracted significant statements using Braun and Clarke's 7‐step method of thematic analysis. The COREQ checklist provided a framework to report the study methods, context, findings, analysis and interpretation. Results: Five key themes emerged from the analysis: (a) infection prevention, (b) physical safety, (c) patient preference, (d) clinical knowledge and beliefs, and (e) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts and local policies, to aid their decisions. Conclusions: Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice. Relevance to clinical practice: Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands. [ABSTRACT FROM AUTHOR]

Aim: To explore Registered Nurses' attitudes and behaviour towards patients' use of complementary therapies. Background: Despite high rates of use of complementary therapies by the general population, little is known of how nurses respond to patients' use of these therapies. Design: A two-phase sequential exploratory mixed methods design. Methods: Nineteen Registered Nurses working in Australia participated in a semi-structured interview in 2015-2016 and emerging themes informed the development of a quantitative survey instrument administered online nationwide in 2016. Findings: Emerging key themes "Promoting safe care"; "Seeking complementary therapies knowledge";" Supporting holistic health care"; and "Integrating complementary therapies in practice" were reflected in survey results. Survey responses (N = 614) revealed >90% agreement that complementary therapies align with a holistic view of health and that patients have the right to use them. Most nurses (77.5%) discussed complementary therapies with patients and 91.8% believed nurses should have some understanding of the area. One-third did not recommend complementary therapies and there was a lack of overall consensus as to whether these therapies should be integrated into nursing practice. Nurses with training in complementary therapies held more positive views than those without. Conclusion: Nurses were generally supportive of patients' interest in complementary therapies, although their primary concern was safety of the patient. Despite broad acceptance that nurses should have a basic understanding of complementary therapies, there was a lack of consensus about recommendation, integration into nursing practice and referral. Further research should explore how nurses can maintain safe, patient-centred care in the evolving pluralistic healthcare system. [ABSTRACT FROM AUTHOR]

Aims To outline the way the culture of austerity arising from the Global Financial Crisis has been used by Australian and New Zealand governments to maintain and extend healthcare budget cuts, through new public management strategies leading to missed nursing care. Background Ten years on the cost of the Global Financial Crisis continues to be borne by tax payers and those employed by the welfare state, yet analysis shows clearly that it was caused by a failure to adequately regulate markets, particularly the banks and multinational corporations. In health care, one of the impacts is increased workload for nurses leading to missed care. Design/Methods Registered Nurses and midwives ( n = 7,302) completed the MISSCARE surveys between 2012 - 2015, in four Australian states and New Zealand providing quantitative and qualitative responses. The qualitative comments were analysed using a template analysis approach based on key features of New Public Management. Findings Sixty-two qualitative responses identified measures in place directly linked to austerity and new public management strategies that impacted on the quality of patient care and nursing work, as well as contributing to missed care. Conclusion Opportunities for resistance may lie outside public and private health organizations in civil society, in the nurse union movements and other health and nursing professional associations. [ABSTRACT FROM AUTHOR]

Background: Families come in many forms and single parent women headed households are common with nurses being well positioned to provide support for these women and their children. For children growing up in lone parent households, the nature of family relationships and the availability of a social support network are important factors in reducing developmental risks. Aim: The aim of this study was to explore adult men's recollections of growing up in a fatherabsent home. Design: This study utilised a qualitative methodology. Methods: Semi-structured interviews were conducted with 21 adult men who grew up in a father-absent home due to family discord. Interview transcripts were thematically analysed using an inductive approach. Findings: Analysis of the interview transcripts revealed two themes relating to childhood father figures and family relational networks. For some men, ambivalent, violent or unavailable father figures stepped into the void created by the absent father. Others experienced positive father figures or multigenerational relationships, which provided positive relational supports and attachments. Conclusion: The findings illuminate the dynamics of family resilience and provide important insights for nurses and other family healthcare workers. [ABSTRACT FROM AUTHOR]

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after‐hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care. [ABSTRACT FROM AUTHOR]

Aims and objectives. To describe the healthcare experiences of young adults with type 1 diabetes who access diabetes services in rural areas of New South Wales, Australia. Background. The incidence of type 1 diabetes in childhood and adolescence is increasing worldwide; internationally, difficulties are encountered in supporting young people during their transition from children to adulthood. Consumers' experiences and views will be essential to inform service redesign. Design. This was a qualitative exploratory study. Methods. Semistructured telephone interviews were conducted with 26 people aged 18-28 years living rurally, recruited through staff in four regional healthcare centres in 2008. Results. Two key themes were evident: lack of access (comprised of transfer to adult services, access to health professionals and access to up-to-date information) and age-appropriate provision. The impact of place of residence and personal motivation crossed all themes. Participants contrasted unfavourably the seamless care and support received from paediatric outreach services with the shortages in specialist and general practice-based care and information and practical problems of service fragmentation and lack of coordination experienced as adults. They identified a range of issues including need for ongoing education, age-appropriate services and support networks related to developing their ability to self-manage. They valued personal service; online and electronic support was seldom volunteered as an alternative. Conclusion. This was a first view of rural young people's experiences with adult diabetes services. Reported experiences were in line with previous reports from other settings in that they did not perceive services in this rural area of Australia as meeting their needs; suggestions for service redesign differed. Relevance to clinical practice. New models of age-appropriate service provision are required, to meet their needs for personal as well as other forms of support, whilst acknowledging the very real resource limitations of these locations. [ABSTRACT FROM AUTHOR]

Aim and objectives. To explore Australian lesbian mothers' experiences of becoming parents. Background. Lesbians are becoming parents and, since legislative changes in Australia, their numbers are increasing. Prior to legislative changes, fertility and health services for women in Australia exclusively served the needs of the heterosexual community. Although lesbian experience of seeking health services has been studied in other contexts, little has been done to understand their experience of deciding, conceiving and birthing. Design. Qualitative descriptive study. Method. Seven interviews conducted with lesbian mothers in Australia. Results. The following themes were identified: 'making the decision'; 'the search'; 'perseverance'; and 'problems of isolation'. Conclusions. Although legislation now affords lesbians access to reproductive technologies throughout most of Australia, their involvement with health professionals can result in homophobic interactions. One way to address the needs of lesbian families is to provide an environment where the disclosure of sexual identity is encouraged. Further larger scale research should identify changes to service provision required to address the inequalities between heterosexual and lesbian women and ensure health services are provided that are free from discrimination. Relevance to clinical practice. Most health services have policies and procedures in place to prevent discrimination on all grounds, including sexual orientation. It is imperative that administrators and clinicians take steps to ensure that these guidelines are applied. [ABSTRACT FROM AUTHOR]