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Objective: To evaluate the impact of using an academic electronic medical record program on first-year nursing students' confidence and skill in E-documentation after their hospital clinical placement. Background: Registered nurses are the largest user group of health information technology systems such as patient electronic medical records (eMR). As such, nurse undergraduate programs need to reflect contemporary practices and respond to emerging trends including digital technology, however integration of eMR learning has not occurred in many countries. To address this gap, a fit-for-purpose academic eMR simulation program was developed by nursing academics and a university Learning Design Department member. Study Design and Methods: A quasi-experimental study design, with self-administered pre-test, post-test surveys, was used with a convenience sample of all first-year nursing students at one regional university in NSW Australia in 2019 and 2021. Results: A total of 105 students completed the surveys (9.7% pre, and 7.4% post-test survey). Only 23% of respondents received training during hospital clinical placement on eMR and electronic observation charts. There was a significant increase in participant confidence and knowledge in documenting in electronic adult observational charts and notes after using the academic eMR program and attending clinical placement. Three themes emerged from the qualitative data: preparation for practice; more exposure increases confidence; and we can't forget the patient. Conclusion: Students acknowledged the need for repeated practice using an academic eMR program in university learning environments to ensure they would be work-ready. The identified challenge was the communication barrier (computer on wheels) and the potential negative impact on person-centred care and therapeutic communication. Implications for research, policy and practice: Further research is required to determine whether repeated practice with electronic documentation is best placed within a curriculum to increase learner confidence. Simulations that incorporate workstations on wheels should be tested to determine best practice for therapeutic communication. What is already known about this topic? • Registered nurses are the largest user group of health information technology systems. • Nursing undergraduate program needs to reflect contemporary practices including digital technologies. • Integration of eMR education in undergraduate nursing programs has not occurred in many countries. What this paper adds: • Evaluation of a fit-for-purpose academic electronic medical record program integrated into an undergraduate nursing student's curriculum. • There was a significant increase in participant confidence and knowledge in documenting in electronic adult observational charts and notes after using the academic eMR program. • Digital technology education tailored for students of different age groups may be required. [ABSTRACT FROM AUTHOR]

Background: Improving health, patient and system outcomes through a practice-based research agenda requires infrastructural supports, leadership and capacity building approaches, at both the individual and organisational levels. Embedding research as normal nursing and midwifery practice requires a flexible approach that is responsive to the diverse clinical contexts within which care is delivered and the variable research skills and interest of clinicians. This paper reports the study protocol for research being undertaken in a Local Health District (LHD) in New South Wales (NSW) Australia. The study aims to evaluate existing nursing and midwifery research activity, culture, capacity and capability across the LHD. This information, in addition to input from key stakeholders will be used to develop a responsive, productive and sustainable research capacity building framework aimed at enculturating practice-based research activities within and across diverse clinical settings of the LHD. Methods: A three-phased, sequential mixed-methods action research design underpinned by Normalization Process Theory (NPT). Participants will be nursing and midwifery clinicians and managers across rural and metropolitan services. A combination of survey, focus group, individual interviews and peer supported action-learning groups will be used to gather data. Quantitative data will be analysed using descriptive statistics, correlation and regression, together with thematic analysis of qualitative data to produce an integrated report. Discussion: Understanding the current research activity and capacity of nurses and midwives, together with organisational supports and culture is essential to developing a productive and sustainable research environment. However, knowledge alone will not bring about change. This study will move beyond description of barriers to research participation for nurses and midwives and the promulgation of various capacity building frameworks to employ a theory driven action-oriented approach to normalisation of nursing and midwifery research practice. In doing so, our aim is to make possible the utilisation, generation and translation of practice based research that informs improved patient and service delivery outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare staff are on the frontline during disasters despite any personal adversity and vicarious trauma they may be experiencing. Wellness Warrior training is a post-disaster intervention developed in response to the 2019-2020 Australian bushfires to support staff in a rural hospital located on the South Coast of New South Wales, Australia. Method: This study explored the experiences and perspectives of 18 healthcare staff who were trained to provide emotional and peer support to their colleagues in the aftermath of a crisis. All the Wellness Warriors participated in semi-structured interviews between March and April 2020. Data were analysed using the reflexive thematic approach. Results: Healthcare staff reported developing interpersonal skills around deep listening and connecting with others which allowed for hearing the core of their colleagues' concerns. The training also helped staff to feel differently about work and restored their faith in healthcare leadership. Conclusion: Wellness Warrior training provided staff with knowledge and skills to support their colleagues in the aftermath of a natural disaster and later during the COVID-19 pandemic. As such, these findings suggest that peer support programs such as Wellness Warriors could be one way healthcare organisations can attempt to alleviate the psychological impact of natural disasters. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is a global health concern. Early intervention to help parents adopt best practice for infant feeding and physical activity is critical for maintaining healthy weight. Australian governments provide universal free primary healthcare from child and family health nurses (CFHNs) to support families with children aged up to five years and to provide evidence-based advice to parents. This paper aims to examine factors influencing the child obesity prevention practices of CFHNs and to identify opportunities to support them in promoting healthy infant growth. Methods: This mixed methods study used a survey (n = 90) and semi-structured interviews (n = 20) with CFHNs working in two local health districts in Sydney, Australia. Survey data were analysed descriptively; interview transcripts were coded and analysed iteratively. Survey and interview questions examined how CFHNs addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behaviour during routine consultations; factors influencing such practices; and how CFHNs could be best supported. Results: CFHNs frequently advised parents on breastfeeding, introducing solid foods, and techniques for settling infants. They spent less time providing advice on evidence-based formula feeding practices or encouraging physical activity in young children. Although nurses frequently weighed and measured children, they did not always use growth charts to identify those at risk of becoming overweight or obese. Nurses identified several barriers to promoting healthy weight gain in infants and young children, including limited parental recognition of overweight in their children or motivation to change diet or lifestyle; socioeconomic factors (such as the cost of healthy food); and beliefs and attitudes about infant weight and the importance of breastfeeding and physical activity amongst parents and family members. Conclusions: CFHNs require further education and support for their role in promoting optimal child growth and development, especially training in behaviour change techniques to increase parents' understanding of healthy infant weight gain. Parent information resources should be accessible and address cultural diversity. Resources should highlight the health effects of childhood overweight and obesity and emphasise the benefits of breastfeeding, appropriate formula feeding, suitable first foods, responsiveness to infant feeding cues, active play and limiting screen time. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare (PHC) services are crucial in supporting people who use substances. The aims of this study were to explore the experiences of Aboriginal males in NSW in treatment for substance use about speaking about their substance use with PHC staff, and their preferences for accessing PHC about their substance use. Methods: Semi-structured interviews with residential drug and alcohol rehabilitation treatment service clients. Thematic analysis was used to develop themes inductively and deductively. Two interviews were independently double coded by an Aboriginal researcher and the project was supported by an Aboriginal Advisory Group. Results: Twenty male adults who self-identified as Aboriginal participated (mean age 27 years). Half reported visiting PHC and talking about their substance use before their residential service stay. Two major themes developed: (1) speaking up about substance use or mental health problems linked with substance use, (2) ways to improve access to PHC about substance use. Although some males were offered treatment, some were not, and others had concerns about the treatments offered. Conclusion: This research highlights opportunities to improve access and to better support Aboriginal males who use substances in PHC. Focus on culturally appropriate PHC and providing staff with training around substance use and treatment options may improve access. It is important to foster culturally appropriate services, develop PHC staff knowledge around substance use, focus on therapeutic relationships and have a range of treatment options available that can be tailored to individual circumstances. [ABSTRACT FROM AUTHOR]

Purpose: As the cost of healthcare continues to rise, healthcare organizations internationally are seeking long-term solutions to eradicate inefficiency, achieve value-based healthcare, and minimize hospital inpatient services. This requires transformational change in healthcare organizations, and associated change management and leadership capability at multiple levels. Despite the critical need for effective change leadership and management in healthcare, limited evidence exists that this currently occurs in addition to the capability and capacity for managing change in health systems. Methods: Semi-structured interviews were undertaken with 16 healthcare managers and leaders at a range of levels in nine healthcare organizations across the public health system of one Australian state (New South Wales), including metropolitan, regional and rural geographical areas. Thematic content analysis was undertaken with the emergent data. Results: Four key themes emerged from the data: 1) lack of adoption of frameworks and methods for change management for any scope or scale of change, 2) inadequate resources for delivering, managing and leading change, 3) insufficient leadership, capacity and capability in managing change, and 4) the need for support and culture that supports change at all levels of the system. Conclusion: Ensuring dedicated resources for change and sufficient capacity and capability amongst health professionals and managers at every level in a health system are required for effective management of change. An enabling culture for change, supported by adequate education and training in change leadership and management are critical in order for the benefits of health service and system changes to be realised. [ABSTRACT FROM AUTHOR]

Background: This research examined whether young adults with Type 1 diabetes engage with the multidisciplinary consultation process and if not, then why. Methods: We designed a web‐based self‐reported survey, available online from February to May 2011, for Australian adults 18–35 years with Type 1 diabetes. Respondents were asked about which clinicians they consulted to assist with self‐management. To expand on the results of the survey, we interviewed 33 respondents. Results: Survey: Respondents (n = 150) consulted with the following clinicians: endocrinologist and diabetes educators: 23.3%; endocrinologist only: 18.0%; endocrinologist, diabetes educators and dieticians: 14.6%; endocrinologist, diabetes educators, dietician and general practitioners (GP): 11.3%; endocrinologist and GP: 10.6%; GP only: 4.6%; all clinicians recommended to assist with self‐management: 1.3%; 2.7% did not consult any clinician. Interview: Participants (n = 33) reported eight key disincentives to consultation with multidisciplinary clinicians. These were time constraints; provision of conflicting advice; inaccessibility of health services; variation in service standards; cost constraints; failure of clinicians to refer to other clinicians; lack of opportunity to build a therapeutic relationship; and failure of clinicians to engage in shared decision making. Conclusion: Our results indicate that high attrition rates of young adults with Type 1 diabetes from recommended diabetes health services is linked to the failure of those services to meet the needs and preferences of their patients. The identified needs and preferences included joint consultation with multi‐disciplinary team clinicians; flexible access to advice by email or telephone consultation; and shared decision making. Patient engagement in health‐service re‐design has implications for improved health‐service delivery and enhanced treatment outcomes. [ABSTRACT FROM AUTHOR]

Aim To identify characteristics of enabling and disabling research cultures. Background 'Research culture' is a term that is taken for granted and seldom defined. However, the need for an enabling and sustaining culture for conducting research is emphasised in nursing and other disciplines. The characteristics of this culture have been suggested but no empirical research has apparently been conducted. Data sources Experienced interdisciplinary researchers (n=72) responded to a qualitative questionnaire to determine the key characteristics of a positive and enabling research culture. Data collection A descriptive survey was used. It consisted of four questions asking participants to define research culture and name three characteristics of a 'good' research culture and describe situations of good and bad research cultures in their workplace. Discussion Analysis revealed 'environment' to be the key construct associated with an enabling research culture. Conclusion An enabling research culture is an environment characterised by: research productivity, positive collegial relationships, inclusivity, non-competitiveness, and effective research processes and training. The authors' findings resonate with and provide empirical support for previous literature highlighting the importance of community and collegial relationships to research productivity. Implications for research/practice Nurses, whether researchers, administrators, teachers or clinicians, should work together to foster collegial relationships and partnerships to assist in the creation of positive and enabling research cultures in all settings. [ABSTRACT FROM AUTHOR]